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2. Update of Bisphosphonate Flight Experiment

Author

LeBlanc, A, Matsumoto, T, Jones, J, Shapiro, J, Lang, T, Shackelford, L, Smith, S. M, Evans, H, Spector, E, Snyder, R. P, Sibonga, J, Keyak, J, Nakamura, T, Kohri, K, Ohshima, H, and Moralez, G

Subjects
Aerospace Medicine
Abstract

Elevated bone resorption is a hallmark of human spaceflight and bed rest indicating that elevated remodeling is a major factor in the etiology of space flight bone loss. In a collaborative effort between the NASA and JAXA space agencies, we are testing whether an antiresorptive drug would provide additional benefit to in-flight exercise to ameliorate bone loss and hypercalciuria during long-duration spaceflight. Measurements of bone loss include DXA, QCT, pQCT, urinary and blood biomarkers. We have completed analysis of R+1year data from 7 crewmembers treated with alendronate during flight, as well as immediate post flight (R+<2wks) data from 6 of 10 concurrent controls without treatment. The treated astronauts used the Advanced Resistive Exercise Device (ARED) during their missions. The purpose of this report is twofold: 1) to report the results of inflight, post flight and one year post flight bone measures compared with available controls with and without the use of ARED; and 2) to discuss preliminary data on concurrent controls. The figure below compares the BMD changes in ISS crewmembers exercising with and without the current ARED protocol and the alendronate treated crewmembers also using the ARED. This shows that the use of ARED prevents about half the bone loss seen in early ISS crewmembers and that the addition of an antiresorptive provides additional benefit. Resorption markers and urinary Ca excretion are not impacted by exercise alone but are significantly reduced with antiresorptive treatment. Bone measures for treated subjects, 1 year after return from space remain at or near baseline. DXA data for the 6 concurrent controls using the ARED device are similar to DXA data shown in the figure below. QCT data for these six indicate that the integral data are consistent with the DXA data, i.e., comparing the two control groups suggests significant but incomplete improvement in maintaining BMD using the ARED protocol. Biochemical data of the concurrent control group await sample return and analysis. The preliminary conclusion is that an antiresorptive may be an effective adjunct to exercise during long-duration spaceflight.

Published
2015

3. Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome : a Randomized Clinical Trial

Author

Cavalcanti, A. B., Suzumura, E. A., Laranjeira, L. N., De Moraes Paisani, D., Damiani, L. P., Guimaraes, H. P., Romano, E. R., De Moraes Regenga, M., Taniguchi, L. N. T., Teixeira, C., De Oliveira, R. P., Machado, F. R., Diaz-Quijano, F. A., De Alencar Filho, M. S., Maia, I. S., Caser, E. B., De Oliveira Filho, W., De Carvalho Borges, M., De Aquino Martins, P., Matsui, M., Ospina-Tascon, G. A., Giancursi, T. S., Giraldo-Ramirez, N. D., Vieira, S. R. R., De Lima Assef, M. D. G. P., Hasan, M. S., Szczeklik, W., Rios, F., Amato, M. B. P., Berwanger, O., De Carvalho, C. R. R., Tucci, M. R., Souza Dos Santos, L., Franca de Oliveira, M. C., Peres, I., Freitas, I., Reis, H., Verissimo, A., Torres, D., Barroso, A., Semboloni Bitencourt, W., Franco, M. R., Oliveira Lage, J., Aparecida Pessoa Conde, K., Charro, F. A., Naia, A., de Brito Sobrinho, E., Lameira Verissimo, A., Barros de Oliveira, M. E., Zampieri, F., Ladeira, J. P., Cordioli, R., Diogo Sala, A., Tadahiro Ikeoka, D., Baptista Filho, M. L. A., Ray, A., Guerra de Almeida, A., Nazareno Conceicao, C., Ribeiro Salgado, D., Rosso Verdeal, J. C., Martins, G. A., Junqueira Ribeiro, L., Vilela Siqueira, H., Flavio Costa Filho, F., Adler Maccagnan Pinheiro Besen, B., Vieira Do Nascimento Martins, E., Aparecida Pereira, J., Milioli Ferreira, D., Alves Ferreira Goncalves, F., de Souza Nobrega, M., Barros Duarte, I. J., Nobre, V., Miranda Barreto Mourao, L., Gomez Ravetti, C., Scalzo, A. C., Martins De Stefano, L., Gut, A. L., Nogueira Filho, W., Gatti Cirillo, C., Ishiwaki, S., Lobo, S., Elias de Oliveira, N., Fernandes Machado, L., Sisconetto, L., Rios Vieira, S. R., Fialkow, L., Fontoura Prado, K., Franke, C., Barberena Moraes, R., Christmann Wawrzeniak, I., Rech, T. H., Parolo, E., Almeida Victorino, J., Marques Barroso, C., Marcal de Vasconcelos, M. O., Souza da Silva, R., Lesti Esteves, A. R., Camassola, A. P., Antoniazzi, R., Griebler, M., Favretto, J., Romano, M., Franz da Costa, A., Werneck, V., Miura, M. C., Farran, J., Vasconcelos, R., Isola, A., Resende, E., Goulart, R., Luzzi, S., Rea-Neto, A., de Oliveira, M. C., Bruinje Cosentino, M. F., Martins Dzivielevski, B., Reese, F. B., Ferreira da Silva, S. D., Elias Aquim, E., Girotto, F., Helenditi Fernandes Camurca Martins, R., Lima de Andrade, A., Breckenfeld Heirel, D. C., Ryoji Takatani, R., Dias de Almeida, S., Medina Matos, A., Iwamoto, T., Do Val Tavares, P. E., Valiatti, J. L., de Lucca, F. C., Fornazari, J. C., Dias Brugugnolli, I., de Araujo Nazare, M., Nascimento Loureiro, N., Vasconcelos de Sousa, G., Staffa Gonzaga da Silva, L., Dos Anjos Sad, F. C., Stucchi, E. M., Melo Silva, R., Fonseca Silva, T., Mendes Filho, S. P., Borba Pereira, T., da Silva, P. N., Martines Moralez, G., Abrantes Saraiva, S., Abrunhosa, A., Chagas, C. E. R. C., Thompson, M. M., Pinto Goncalves, C. H., de Oliveira Dias, R., Schwan Filho, F., Magalhaes Carvalho Grion, C., Mezzaroba, A. L., Festti, J., Massariol, T. C., de Souza, G. F., Martins Lima Silva, M., de Souza Andrade Neto, J., Costa, G., Souza Ribeiro, M., Coelho, M., Cruz Carbonell, R. C., de Souza Trindade, R., Valente Barbas, C. S., Domingos Correa, T., Serpa Neto, A., Santucci Cesar de Assuncao, M., Vilela Costa Pinto, B., Goncalves Libanio, P., da Silva Motta, J., Santa Maria Lucin, G., Macedo Araujo, L., Anibal Leite Barros Agostinho, T., de Andrade, K. M., da Silva, M. S., Pereira da Silva, E., Mousinho Gomes, R. L., Campos, N. M. P., Fonseca de Sousa, J., Ramos Nicolau da Costa, L., de Carvalho Fonseca Assuncao, N. S., Martins de Lima, G., Pinheiro de Oliveira, R., Gasparetto Maccari, J., de Campos Balzano, P., Tagliari, L., Metran Nascente, A. P., de Carvalho, M. A., Buttignol, M., Henn Moura, R., Vinicius Pereira, M., Alberti da Silva, G., Akemi Higo, M., Morales, M., Andrade, A. H. V., de Paiva, A. P., da Silva, K. S., Andrioli de Araujo, P., Cordeiro de Abreu Filho, C. A., Abdalla, G., Loureiro Sebold, M., Moreira, R., Caldeira Filho, M., de Brito Cordeiro, R., Pfuetzenreiter, F., Costa Carvalho, L. F., da Silva Guimaraes, B. L., de Faria Cordeiro, H., Pimentel Alvim, S. H., Do Espirito Santo, J. A., Silva Maia, I., Pincelli, M., Zandonai, C. L., Burigo Grumann, A. C., Kretzer, L. P., Nedel, W., Manozzo Boniatti, M., Santos Pellegrini, J. A., da Silva Marques, L., Girardelli Baptista, W. C., da Silva Franco, R. S., Moreira de Sousa, M., de Marchi Benfica, A. F., Veiga de Oliveira, A. L., Reis, D. L., Morais, M. O., Santa Rosa Santana, H., Murilo Domingues, S., de Menezes Ferreira, C., Amado Rabelo, L., Menezes de Rezende, C., Riccio, P., Silva de Almeida, P., Rubini, P., da Graca Pasquotto de Lima Assef, M., Nardela, R., Locks Stahlhofer, L., Gatelli Noronha, C., de Azevedo Naves, S., Dias da Silva, F., Mazza, B. F., Longhi Simoes de Almeida, S., Mayumi Higa, R., Papacidero, C. H., Lima Silva, M. M., de Assuncao Melo, L., Miranda Mafra Oliveira, M., Matos Brito Coelho, C., Machado, J. A., de Souza Machado, Y. L., Vitor Fera, J., Dos Santos Ramos, N. C., Botelho Foernges, R., de Souza, R. R., Rutzen, W., Villasante Troncoso, E. M., Paiva, T. K. B., Vieira de Lacerda, N. M., Aires de Araujo Neto, J., de Oliveira Maia, M., Bastos de Moura, E., Brocco Magnan, G., Soares Nasrala, M. L., Campos Tonussi, R. L., Kohl Pinheiro, E., Simoes da Silva, F., Dal-Pizzol, F., Schmitz de Figueiredo, F., Ritter, C., de Vasconcellos Baldisserotto, S., Blattner, C., Saldanha Dos Santos, R., da Silva Bettega, F., Almeida Delfino Duarte, P., Tozo, T. C., Peliser, P., Deczka Morsch, R., Guimaraes Leal Guadalupe, E., Souza Amorim, D., Rezegue de Moraes Rego, L., Azevedo, L., Ramos, F., Pastore, L., Nery, P., Spegiorin Moreno, M., Nakad Orsatti, V., Yudi Horikawa, F., Samartino Zavanelli, G., Adrieno Westphal, G., Sperotto, G., Dadam, M., Nunes, M., Pantaleao, S. L., Camargo Narciso, R., Bernadete Caser, E., Falcao, J. G., Genelhu, G., Lessa Soares, F., Silva Sales, B., Rebello de Jesus, K., Correia Santos Bonomo, D., Martins Arruda, J., de Pinho, J. C., Belacho Azeredo Coutinho, J., Braga Hagreaves Ribeiro de Freitas, R., de Souza Oliveira Garcia, T., Frizera Vassallo, P., Buarque Souza de Lima, M. H., Eberhart Neto, E., Satoshi Inagaki, A., Oliveira de Paula, A. E., Amador Correia, T., Nomoto, S., Seiji Ueno Gil, F., Florizel Almeida de Araujo, M., Bezerra Lima, Z., Simoes Giancursi, T., Rejane de Lima, C., Costa, M., Osaku, E. F., Jorge, A. C., Rodrigues da Cruz, M., da Cunha, S., Silva Cavallaro Torres, K., Rocha Rodrigues da Silva, F., Lisboa de Souza, R., Osni Machado, F., Buss, E. K., Cattelan Bonorino, K., Germano, A., Bin da Silva, S. R., Herek, A., Tavares Gurgel, S. J., Sanches Laranjeira, A., Toshiyuki Tanita, M., Tibery Queiroz Cardoso, L., Osorio Guerreiro, M., Peres Bainy, M., de Oliveira Teixeira, L., Colozza Mecatti, G., Carolina Salomao, M., Ribeiro Moreira, A., Vantini Capasso Palamim, C., Deucher, R. A. O., Castro Escobar Furlan, F., Rodrigues Torres de Carvalho, F., Muniz, R., Penna Guimaraes, H., Conceicao Andrade, L., Abrahao Hajjar, L., Barbosa Gomes Galas, F. R., Pinheiro de Almeida, J., Marco, R., Peixoto, E., Hirata, F., Yen Ju, C., Bonaccorsi Fernandino, B., Lage de Assis Rocha, D., Azzi Barbosa, N., Dias Alves, J., Furtado Lamego, L., de Linhares, J. M., Ferreira Sousa, M., Ferreira de Souza, M. M., Guimaraes de Carvalho, F. L., Aparecida Leite, M., Torres, P., Bolognese, D., Lacerda, V., Cisari, G., Souza Marques, A., Amarante Costa, A., Bonin Campos, L., Lovato, W. J., Guimaraes Dantas, B., Ribeiro Campos, D., Pires Barrientto, L. C., Rossi Peras Americo, V., Barboza Carnevalli Bueno, T., Morales, D., Mara Gomes, T., Barbosa Cerantola, R., Hoher, J., Sa Malbouisson, L. M., Matheus Cadamuro, F., Bassi, E., Maia, R., Dias E Santos, J. A., Oliveira, C., Balzi, A. P., Tierno, P., Marques Andrade, G., Delascio Lopes, R., Ramos Mello, M., Vendrame, L. S., Ribeiro Machado, F., Baccaro Rossetti Santana, H., de Carvalho, A., Marques Ferreira Mendez, V., de Araujo Macedo Pinto, W., Dos Santos Francisco, R., Steponovicius Piedade Cruz, F., Silva de Araujo, A., Paiva de Souza, A., Teixeira Pinheiro, T., Martins Santos, T., Gontijo-Coutinho, C. M., Franci, D., de Carvalho-Filho, M. A., Ribas Rosa de Oliveira, A. M., Silva, J. M., Costa Lisboa, T., Peretti Torelly, A., Silva de Souza, A., Hadrich, M., Schwarz, P., Berto, P., Teixeira de Gois, A. F., Silva, M., Gessolo Lins, P., Cavalcante Lola Biazzoto, E. P., Dragosavac, D., Ribeiro de Carvalho, C. R., Passos Amato, M. B., Toufen, C., Ribeiro de Santis Santiago, R., Hirota, A. S., Rodrigues, M., Dias Chiavegato, L., Bastos Vieira, P. C., de Almeida, M. M. M. F., Barbosa, P. G., Pereira Santos, J. R., Nogueira de Paula, L., Piras, C., Giuberti, J., Siqueira da Silva, A., Conti Ramos, R., Plata Valdivieso, R., Gonzalez, H. H., Ortiz, M., Bautista-Rincon, D. F., Quinones, E., Calderon, L. E., Vargas, M., Pizarro, C., Orozco Levi, M., Espitia Hernandez, A. M., Cadavid Gutierrez, C., Giraldo Ramirez, N., Gallego, D. A., Naranjo Sierra, S., Ortiz, G., Esneda Rocha Gaona, M., Garay, M., Vieda, E., Bermudez, W. F., Castaneda, J. A., Cortegiani, A., Russotto, V., Raineri, S. M., Giarratano, A., Shahnaz Hasan, M., Rai Hakumat Rai, V., Fadhil Hadi Bin Jamaluddin, M., Afiq Syahmi Ramli, M., Gorka, J., Nowak, I., Seczynska, B., Sega, A., Paulino, C., Povoa, P., Belda, F. J., Ferrando, C., Carbonell, J. A., Puig, J., Soro, M., Nin, N., Hurtado, J., Gacel, A., Gaudin, A., Sande, L., Cavalcanti, A, Suzumura, E, Laranjeira, L, De Moraes Paisani, D, Damiani, L, Guimaraes, H, Romano, E, De Moraes Regenga, M, Taniguchi, L, Teixeira, C, De Oliveira, R, Machado, F, Diaz-Quijano, F, De Alencar Filho, M, Maia, I, Caser, E, De Oliveira Filho, W, De Carvalho Borges, M, De Aquino Martins, P, Matsui, M, Ospina-Tascon, G, Giancursi, T, Giraldo-Ramirez, N, Vieira, S, De Lima Assef, M, Hasan, M, Szczeklik, W, Rios, F, Amato, M, Berwanger, O, De Carvalho, C, Tucci, M, Souza Dos Santos, L, Franca de Oliveira, M, Peres, I, Freitas, I, Reis, H, Verissimo, A, Torres, D, Barroso, A, Semboloni Bitencourt, W, Franco, M, Oliveira Lage, J, Aparecida Pessoa Conde, K, Charro, F, Naia, A, de Brito Sobrinho, E, Lameira Verissimo, A, Barros de Oliveira, M, Zampieri, F, Ladeira, J, Cordioli, R, Diogo Sala, A, Tadahiro Ikeoka, D, Baptista Filho, M, Ray, A, Guerra de Almeida, A, Nazareno Conceicao, C, Ribeiro Salgado, D, Rosso Verdeal, J, Martins, G, Junqueira Ribeiro, L, Vilela Siqueira, H, Flavio Costa Filho, F, Adler Maccagnan Pinheiro Besen, B, Vieira Do Nascimento Martins, E, Aparecida Pereira, J, Milioli Ferreira, D, Alves Ferreira Goncalves, F, de Souza Nobrega, M, Barros Duarte, I, Nobre, V, Miranda Barreto Mourao, L, Gomez Ravetti, C, Scalzo, A, Martins De Stefano, L, Gut, A, Nogueira Filho, W, Gatti Cirillo, C, Ishiwaki, S, Lobo, S, Elias de Oliveira, N, Fernandes Machado, L, Sisconetto, L, Rios Vieira, S, Fialkow, L, Fontoura Prado, K, Franke, C, Barberena Moraes, R, Christmann Wawrzeniak, I, Rech, T, Parolo, E, Almeida Victorino, J, Marques Barroso, C, Marcal de Vasconcelos, M, Souza da Silva, R, Lesti Esteves, A, Camassola, A, Antoniazzi, R, Griebler, M, Favretto, J, Romano, M, Franz da Costa, A, Werneck, V, Miura, M, Farran, J, Vasconcelos, R, Isola, A, Resende, E, Goulart, R, Luzzi, S, Rea-Neto, A, de Oliveira, M, Bruinje Cosentino, M, Martins Dzivielevski, B, Reese, F, Ferreira da Silva, S, Elias Aquim, E, Girotto, F, Helenditi Fernandes Camurca Martins, R, Lima de Andrade, A, Breckenfeld Heirel, D, Ryoji Takatani, R, Dias de Almeida, S, Medina Matos, A, Iwamoto, T, Do Val Tavares, P, Valiatti, J, de Lucca, F, Fornazari, J, Dias Brugugnolli, I, de Araujo Nazare, M, Nascimento Loureiro, N, Vasconcelos de Sousa, G, Staffa Gonzaga da Silva, L, Dos Anjos Sad, F, Stucchi, E, Melo Silva, R, Fonseca Silva, T, Mendes Filho, S, Borba Pereira, T, da Silva, P, Martines Moralez, G, Abrantes Saraiva, S, Abrunhosa, A, Chagas, C, Thompson, M, Pinto Goncalves, C, de Oliveira Dias, R, Schwan Filho, F, Magalhaes Carvalho Grion, C, Mezzaroba, A, Festti, J, Massariol, T, de Souza, G, Martins Lima Silva, M, de Souza Andrade Neto, J, Costa, G, Souza Ribeiro, M, Coelho, M, Cruz Carbonell, R, de Souza Trindade, R, Valente Barbas, C, Domingos Correa, T, Serpa Neto, A, Santucci Cesar de Assuncao, M, Vilela Costa Pinto, B, Goncalves Libanio, P, da Silva Motta, J, Santa Maria Lucin, G, Macedo Araujo, L, Anibal Leite Barros Agostinho, T, de Andrade, K, da Silva, M, Pereira da Silva, E, Mousinho Gomes, R, Campos, N, Fonseca de Sousa, J, Ramos Nicolau da Costa, L, de Carvalho Fonseca Assuncao, N, Martins de Lima, G, Pinheiro de Oliveira, R, Gasparetto Maccari, J, de Campos Balzano, P, Tagliari, L, Metran Nascente, A, de Carvalho, M, Buttignol, M, Henn Moura, R, Vinicius Pereira, M, Alberti da Silva, G, Akemi Higo, M, Morales, M, Andrade, A, de Paiva, A, da Silva, K, Andrioli de Araujo, P, Cordeiro de Abreu Filho, C, Abdalla, G, Loureiro Sebold, M, Moreira, R, Caldeira Filho, M, de Brito Cordeiro, R, Pfuetzenreiter, F, Costa Carvalho, L, da Silva Guimaraes, B, de Faria Cordeiro, H, Pimentel Alvim, S, Do Espirito Santo, J, Silva Maia, I, Pincelli, M, Zandonai, C, Burigo Grumann, A, Kretzer, L, Nedel, W, Manozzo Boniatti, M, Santos Pellegrini, J, da Silva Marques, L, Girardelli Baptista, W, da Silva Franco, R, Moreira de Sousa, M, de Marchi Benfica, A, Veiga de Oliveira, A, Reis, D, Morais, M, Santa Rosa Santana, H, Murilo Domingues, S, de Menezes Ferreira, C, Amado Rabelo, L, Menezes de Rezende, C, Riccio, P, Silva de Almeida, P, Rubini, P, da Graca Pasquotto de Lima Assef, M, Nardela, R, Locks Stahlhofer, L, Gatelli Noronha, C, de Azevedo Naves, S, Dias da Silva, F, Mazza, B, Longhi Simoes de Almeida, S, Mayumi Higa, R, Papacidero, C, Lima Silva, M, de Assuncao Melo, L, Miranda Mafra Oliveira, M, Matos Brito Coelho, C, Machado, J, de Souza Machado, Y, Vitor Fera, J, Dos Santos Ramos, N, Botelho Foernges, R, de Souza, R, Rutzen, W, Villasante Troncoso, E, Paiva, T, Vieira de Lacerda, N, Aires de Araujo Neto, J, de Oliveira Maia, M, Bastos de Moura, E, Brocco Magnan, G, Soares Nasrala, M, Campos Tonussi, R, Kohl Pinheiro, E, Simoes da Silva, F, Dal-Pizzol, F, Schmitz de Figueiredo, F, Ritter, C, de Vasconcellos Baldisserotto, S, Blattner, C, Saldanha Dos Santos, R, da Silva Bettega, F, Almeida Delfino Duarte, P, Tozo, T, Peliser, P, Deczka Morsch, R, Guimaraes Leal Guadalupe, E, Souza Amorim, D, Rezegue de Moraes Rego, L, Azevedo, L, Ramos, F, Pastore, L, Nery, P, Spegiorin Moreno, M, Nakad Orsatti, V, Yudi Horikawa, F, Samartino Zavanelli, G, Adrieno Westphal, G, Sperotto, G, Dadam, M, Nunes, M, Pantaleao, S, Camargo Narciso, R, Bernadete Caser, E, Falcao, J, Genelhu, G, Lessa Soares, F, Silva Sales, B, Rebello de Jesus, K, Correia Santos Bonomo, D, Martins Arruda, J, de Pinho, J, Belacho Azeredo Coutinho, J, Braga Hagreaves Ribeiro de Freitas, R, de Souza Oliveira Garcia, T, Frizera Vassallo, P, Buarque Souza de Lima, M, Eberhart Neto, E, Satoshi Inagaki, A, Oliveira de Paula, A, Amador Correia, T, Nomoto, S, Seiji Ueno Gil, F, Florizel Almeida de Araujo, M, Bezerra Lima, Z, Simoes Giancursi, T, Rejane de Lima, C, Costa, M, Osaku, E, Jorge, A, Rodrigues da Cruz, M, da Cunha, S, Silva Cavallaro Torres, K, Rocha Rodrigues da Silva, F, Lisboa de Souza, R, Osni Machado, F, Buss, E, Cattelan Bonorino, K, Germano, A, Bin da Silva, S, Herek, A, Tavares Gurgel, S, Sanches Laranjeira, A, Toshiyuki Tanita, M, Tibery Queiroz Cardoso, L, Osorio Guerreiro, M, Peres Bainy, M, de Oliveira Teixeira, L, Colozza Mecatti, G, Carolina Salomao, M, Ribeiro Moreira, A, Vantini Capasso Palamim, C, Deucher, R, Castro Escobar Furlan, F, Rodrigues Torres de Carvalho, F, Muniz, R, Penna Guimaraes, H, Conceicao Andrade, L, Abrahao Hajjar, L, Barbosa Gomes Galas, F, Pinheiro de Almeida, J, Marco, R, Peixoto, E, Hirata, F, Yen Ju, C, Bonaccorsi Fernandino, B, Lage de Assis Rocha, D, Azzi Barbosa, N, Dias Alves, J, Furtado Lamego, L, de Linhares, J, Ferreira Sousa, M, Ferreira de Souza, M, Guimaraes de Carvalho, F, Aparecida Leite, M, Torres, P, Bolognese, D, Lacerda, V, Cisari, G, Souza Marques, A, Amarante Costa, A, Bonin Campos, L, Lovato, W, Guimaraes Dantas, B, Ribeiro Campos, D, Pires Barrientto, L, Rossi Peras Americo, V, Barboza Carnevalli Bueno, T, Morales, D, Mara Gomes, T, Barbosa Cerantola, R, Hoher, J, Sa Malbouisson, L, Matheus Cadamuro, F, Bassi, E, Maia, R, Dias E Santos, J, Oliveira, C, Balzi, A, Tierno, P, Marques Andrade, G, Delascio Lopes, R, Ramos Mello, M, Vendrame, L, Ribeiro Machado, F, Baccaro Rossetti Santana, H, de Carvalho, A, Marques Ferreira Mendez, V, de Araujo Macedo Pinto, W, Dos Santos Francisco, R, Steponovicius Piedade Cruz, F, Silva de Araujo, A, Paiva de Souza, A, Teixeira Pinheiro, T, Martins Santos, T, Gontijo-Coutinho, C, Franci, D, de Carvalho-Filho, M, Ribas Rosa de Oliveira, A, Silva, J, Costa Lisboa, T, Peretti Torelly, A, Silva de Souza, A, Hadrich, M, Schwarz, P, Berto, P, Teixeira de Gois, A, Silva, M, Gessolo Lins, P, Cavalcante Lola Biazzoto, E, Dragosavac, D, Ribeiro de Carvalho, C, Passos Amato, M, Toufen, C, Ribeiro de Santis Santiago, R, Hirota, A, Rodrigues, M, Dias Chiavegato, L, Bastos Vieira, P, de Almeida, M, Barbosa, P, Pereira Santos, J, Nogueira de Paula, L, Piras, C, Giuberti, J, Siqueira da Silva, A, Conti Ramos, R, Plata Valdivieso, R, Gonzalez, H, Ortiz, M, Bautista-Rincon, D, Quinones, E, Calderon, L, Vargas, M, Pizarro, C, Orozco Levi, M, Espitia Hernandez, A, Cadavid Gutierrez, C, Giraldo Ramirez, N, Gallego, D, Naranjo Sierra, S, Ortiz, G, Esneda Rocha Gaona, M, Garay, M, Vieda, E, Bermudez, W, Castaneda, J, Cortegiani, A, Russotto, V, Raineri, S, Giarratano, A, Shahnaz Hasan, M, Rai Hakumat Rai, V, Fadhil Hadi Bin Jamaluddin, M, Afiq Syahmi Ramli, M, Gorka, J, Nowak, I, Seczynska, B, Sega, A, Paulino, C, Povoa, P, Belda, F, Ferrando, C, Carbonell, J, Puig, J, Soro, M, Nin, N, Hurtado, J, Gacel, A, Gaudin, A, Sande, L, Cavalcanti A.B., Suzumura E.A., Laranjeira L.N., De Moraes Paisani D., Damiani L.P., Guimaraes H.P., Romano E.R., De Moraes Regenga M., Taniguchi L.N.T., Teixeira C., De Oliveira R.P., Machado F.R., Diaz-Quijano F.A., De Alencar Filho M.S., Maia I.S., Caser E.B., De Oliveira Filho W., De Carvalho Borges M., De Aquino Martins P., Matsui M., Ospina-Tascon G.A., Giancursi T.S., Giraldo-Ramirez N.D., Vieira S.R.R., De Lima Assef M.D.G.P., Hasan M.S., Szczeklik W., Rios F., Amato M.B.P., Berwanger O., De Carvalho C.R.R., Tucci M.R., Souza Dos Santos L., Franca de Oliveira M.C., Peres I., Freitas I., Reis H., Verissimo A., Torres D., Barroso A., Semboloni Bitencourt W., Franco M.R., Oliveira Lage J., Aparecida Pessoa Conde K., Charro F.A., Naia A., de Brito Sobrinho E., Lameira Verissimo A., Barros de Oliveira M.E., Zampieri F., Ladeira J.P., Cordioli R., Diogo Sala A., Tadahiro Ikeoka D., Baptista Filho M.L.A., Ray A., Guerra de Almeida A., Nazareno Conceicao C., Ribeiro Salgado D., Rosso Verdeal J.C., Martins G.A., Junqueira Ribeiro L., Vilela Siqueira H., Flavio Costa Filho F., Adler Maccagnan Pinheiro Besen B., Vieira Do Nascimento Martins E., Aparecida Pereira J., Milioli Ferreira D., Alves Ferreira Goncalves F., de Souza Nobrega M., Barros Duarte I.J., Nobre V., Miranda Barreto Mourao L., Gomez Ravetti C., Scalzo A.C., Martins De Stefano L., Gut A.L., Nogueira Filho W., Gatti Cirillo C., Ishiwaki S., Lobo S., Elias de Oliveira N., Fernandes Machado L., Sisconetto L., Rios Vieira S.R., Fialkow L., Fontoura Prado K., Franke C., Barberena Moraes R., Christmann Wawrzeniak I., Rech T.H., Parolo E., Almeida Victorino J., Marques Barroso C., Marcal de Vasconcelos M.O., Souza da Silva R., Lesti Esteves A.R., Camassola A.P., Antoniazzi R., Griebler M., Favretto J., Romano M., Franz da Costa A., Werneck V., Miura M.C., Farran J., Vasconcelos R., Isola A., Resende E., Goulart R., Luzzi S., Rea-Neto A., de Oliveira M.C., Bruinje Cosentino M.F., Martins Dzivielevski B., Reese F.B., Ferreira da Silva S.D., Elias Aquim E., Girotto F., Helenditi Fernandes Camurca Martins R., Lima de Andrade A., Breckenfeld Heirel D.C., Ryoji Takatani R., Dias de Almeida S., Medina Matos A., Iwamoto T., Do Val Tavares P.E., Valiatti J.L., de Lucca F.C., Fornazari J.C., Dias Brugugnolli I., de Araujo Nazare M., Nascimento Loureiro N., Vasconcelos de Sousa G., Staffa Gonzaga da Silva L., Dos Anjos Sad F.C., Stucchi E.M., Melo Silva R., Fonseca Silva T., Mendes Filho S.P., Borba Pereira T., da Silva P.N., Martines Moralez G., Abrantes Saraiva S., Abrunhosa A., Chagas C.E.R.C., Thompson M.M., Pinto Goncalves C.H., de Oliveira Dias R., Schwan Filho F., Magalhaes Carvalho Grion C., Mezzaroba A.L., Festti J., Massariol T.C., de Souza G.F., Martins Lima Silva M., de Souza Andrade Neto J., Costa G., Souza Ribeiro M., Coelho M., Cruz Carbonell R.C., de Souza Trindade R., Valente Barbas C.S., Domingos Correa T., Serpa Neto A., Santucci Cesar de Assuncao M., Vilela Costa Pinto B., Goncalves Libanio P., da Silva Motta J., Santa Maria Lucin G., Macedo Araujo L., Anibal Leite Barros Agostinho T., de Andrade K.M., da Silva M.S., Pereira da Silva E., Mousinho Gomes R.L., Campos N.M.P., Fonseca de Sousa J., Ramos Nicolau da Costa L., de Carvalho Fonseca Assuncao N.S., Martins de Lima G., Pinheiro de Oliveira R., Gasparetto Maccari J., de Campos Balzano P., Tagliari L., Metran Nascente A.P., de Carvalho M.A., Buttignol M., Henn Moura R., Vinicius Pereira M., Alberti da Silva G., Akemi Higo M., Morales M., Andrade A.H.V., de Paiva A.P., da Silva K.S., Andrioli de Araujo P., Cordeiro de Abreu Filho C.A., Abdalla G., Loureiro Sebold M., Moreira R., Caldeira Filho M., de Brito Cordeiro R., Pfuetzenreiter F., Costa Carvalho L.F., da Silva Guimaraes B.L., de Faria Cordeiro H., Pimentel Alvim S.H., Do Espirito Santo J.A., Silva Maia I., Pincelli M., Zandonai C.L., Burigo Grumann A.C., Kretzer L.P., Nedel W., Manozzo Boniatti M., Santos Pellegrini J.A., da Silva Marques L., Girardelli Baptista W.C., da Silva Franco R.S., Moreira de Sousa M., de Marchi Benfica A.F., Veiga de Oliveira A.L., Reis D.L., Morais M.O., Santa Rosa Santana H., Murilo Domingues S., de Menezes Ferreira C., Amado Rabelo L., Menezes de Rezende C., Riccio P., Silva de Almeida P., Rubini P., da Graca Pasquotto de Lima Assef M., Nardela R., Locks Stahlhofer L., Gatelli Noronha C., de Azevedo Naves S., Dias da Silva F., Mazza B.F., Longhi Simoes de Almeida S., Mayumi Higa R., Papacidero C.H., Lima Silva M.M., de Assuncao Melo L., Miranda Mafra Oliveira M., Matos Brito Coelho C., Machado J.A., de Souza Machado Y.L., Vitor Fera J., Dos Santos Ramos N.C., Botelho Foernges R., de Souza R.R., Rutzen W., Villasante Troncoso E.M., Paiva T.K.B., Vieira de Lacerda N.M., Aires de Araujo Neto J., de Oliveira Maia M., Bastos de Moura E., Brocco Magnan G., Soares Nasrala M.L., Campos Tonussi R.L., Kohl Pinheiro E., Simoes da Silva F., Dal-Pizzol F., Schmitz de Figueiredo F., Ritter C., de Vasconcellos Baldisserotto S., Blattner C., Saldanha Dos Santos R., da Silva Bettega F., Almeida Delfino Duarte P., Tozo T.C., Peliser P., Deczka Morsch R., Guimaraes Leal Guadalupe E., Souza Amorim D., Rezegue de Moraes Rego L., Azevedo L., Ramos F., Pastore L., Nery P., Spegiorin Moreno M., Nakad Orsatti V., Yudi Horikawa F., Samartino Zavanelli G., Adrieno Westphal G., Sperotto G., Dadam M., Nunes M., Pantaleao S.L., Camargo Narciso R., Bernadete Caser E., Falcao J.G., Genelhu G., Lessa Soares F., Silva Sales B., Rebello de Jesus K., Correia Santos Bonomo D., Martins Arruda J., de Pinho J.C., Belacho Azeredo Coutinho J., Braga Hagreaves Ribeiro de Freitas R., de Souza Oliveira Garcia T., Frizera Vassallo P., Buarque Souza de Lima M.H., Eberhart Neto E., Satoshi Inagaki A., Oliveira de Paula A.E., Amador Correia T., Nomoto S., Seiji Ueno Gil F., Florizel Almeida de Araujo M., Bezerra Lima Z., Simoes Giancursi T., Rejane de Lima C., Costa M., Osaku E.F., Jorge A.C., Rodrigues da Cruz M., da Cunha S., Silva Cavallaro Torres K., Rocha Rodrigues da Silva F., Lisboa de Souza R., Osni Machado F., Buss E.K., Cattelan Bonorino K., Germano A., Bin da Silva S.R., Herek A., Tavares Gurgel S.J., Sanches Laranjeira A., Toshiyuki Tanita M., Tibery Queiroz Cardoso L., Osorio Guerreiro M., Peres Bainy M., de Oliveira Teixeira L., Colozza Mecatti G., Carolina Salomao M., Ribeiro Moreira A., Vantini Capasso Palamim C., Deucher R.A.O., Castro Escobar Furlan F., Rodrigues Torres de Carvalho F., Muniz R., Penna Guimaraes H., Conceicao Andrade L., Abrahao Hajjar L., Barbosa Gomes Galas F.R., Pinheiro de Almeida J., Marco R., Peixoto E., Hirata F., Yen Ju C., Bonaccorsi Fernandino B., Lage de Assis Rocha D., Azzi Barbosa N., Dias Alves J., Furtado Lamego L., de Linhares J.M., Ferreira Sousa M., Ferreira de Souza M.M., Guimaraes de Carvalho F.L., Aparecida Leite M., Torres P., Bolognese D., Lacerda V., Cisari G., Souza Marques A., Amarante Costa A., Bonin Campos L., Lovato W.J., Guimaraes Dantas B., Ribeiro Campos D., Pires Barrientto L.C., Rossi Peras Americo V., Barboza Carnevalli Bueno T., Morales D., Mara Gomes T., Barbosa Cerantola R., Hoher J., Sa Malbouisson L.M., Matheus Cadamuro F., Bassi E., Maia R., Dias E Santos J.A., Oliveira C., Balzi A.P., Tierno P., Marques Andrade G., Delascio Lopes R., Ramos Mello M., Vendrame L.S., Ribeiro Machado F., Baccaro Rossetti Santana H., de Carvalho A., Marques Ferreira Mendez V., de Araujo Macedo Pinto W., Dos Santos Francisco R., Steponovicius Piedade Cruz F., Silva de Araujo A., Paiva de Souza A., Teixeira Pinheiro T., Martins Santos T., Gontijo-Coutinho C.M., Franci D., de Carvalho-Filho M.A., Ribas Rosa de Oliveira A.M., Silva J.M., Costa Lisboa T., Peretti Torelly A., Silva de Souza A., Hadrich M., Schwarz P., Berto P., Teixeira de Gois A.F., Silva M., Gessolo Lins P., Cavalcante Lola Biazzoto E.P., Dragosavac D., Ribeiro de Carvalho C.R., Passos Amato M.B., Toufen C., Ribeiro de Santis Santiago R., Hirota A.S., Rodrigues M., Dias Chiavegato L., Bastos Vieira P.C., de Almeida M.M.M.F., Barbosa P.G., Pereira Santos J.R., Nogueira de Paula L., Piras C., Giuberti J., Siqueira da Silva A., Conti Ramos R., Plata Valdivieso R., Gonzalez H.H., Ortiz M., Bautista-Rincon D.F., Quinones E., Calderon L.E., Vargas M., Pizarro C., Orozco Levi M., Espitia Hernandez A.M., Cadavid Gutierrez C., Giraldo Ramirez N., Gallego D.A., Naranjo Sierra S., Ortiz G., Esneda Rocha Gaona M., Garay M., Vieda E., Bermudez W.F., Castaneda J.A., Cortegiani A., Russotto V., Raineri S.M., Giarratano A., Shahnaz Hasan M., Rai Hakumat Rai V., Fadhil Hadi Bin Jamaluddin M., Afiq Syahmi Ramli M., Gorka J., Nowak I., Seczynska B., Sega A., Paulino C., Povoa P., Belda F.J., Ferrando C., Carbonell J.A., Puig J., Soro M., Nin N., Hurtado J., Gacel A., Gaudin A., and Sande L.

Subjects
Adult, Male, ARDS, medicine.medical_specialty, acure respitatory distress syndrome, medicine.medical_treatment, mechanical ventilation, law.invention, Positive-Pressure Respiration, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Intensive care, Tidal Volume, medicine, Humans, Treatment Failure, ARDS, ventilation, PEEP, MED/41 - ANESTESIOLOGIA, PEEP, Tidal volume, Positive end-expiratory pressure, Aged, intensive care, Mechanical ventilation, Respiratory Distress Syndrome, business.industry, Hazard ratio, Pneumothorax, 030208 emergency & critical care medicine, General Medicine, Middle Aged, medicine.disease, Surgery, Intensive Care Units, Editorial, 030228 respiratory system, Anesthesia, Female, business
Abstract

Importance The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. Objective To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. Design, Setting, and Participants Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. Interventions An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory–system compliance (n = 501; experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. Main Outcomes and Measures The primary outcome was all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stay; ventilator-free days through day 28; pneumothorax requiring drainage within 7 days; barotrauma within 7 days; and ICU, in-hospital, and 6-month mortality. Results A total of 1010 patients (37.5% female; mean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.20; 95% CI, 1.01 to 1.42; P = .041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%; HR, 1.18; 95% CI, 1.01 to 1.38; P = .04), decreased the number of mean ventilator-free days (5.3 vs 6.4; difference, −1.1; 95% CI, −2.1 to −0.1; P = .03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%; difference, 2.0%; 95% CI, 0.0% to 4.0%; P = .03), and the risk of barotrauma (5.6% vs 1.6%; difference, 4.0%; 95% CI, 1.5% to 6.5%; P = .001). There were no significant differences in the length of ICU stay, length of hospital stay, ICU mortality, and in-hospital mortality. Conclusions and Relevance In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients. Trial Registration clinicaltrials.gov Identifier:NCT01374022

Published
2017

4. Effect of lung recruitment and titrated Positive End-Expiratory Pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome - A randomized clinical trial

Author

Cavalcanti, A, Suzumura, E, Laranjeira, L, De Moraes Paisani, D, Damiani, L, Guimaraes, H, Romano, E, De Moraes Regenga, M, Taniguchi, L, Teixeira, C, De Oliveira, R, Machado, F, Diaz-Quijano, F, De Alencar Filho, M, Maia, I, Caser, E, De Oliveira Filho, W, De Carvalho Borges, M, De Aquino Martins, P, Matsui, M, Ospina-Tascon, G, Giancursi, T, Giraldo-Ramirez, N, Vieira, S, De Lima Assef, M, Hasan, M, Szczeklik, W, Rios, F, Amato, M, Berwanger, O, De Carvalho, C, Tucci, M, Souza Dos Santos, L, Franca de Oliveira, M, Peres, I, Freitas, I, Reis, H, Verissimo, A, Torres, D, Barroso, A, Semboloni Bitencourt, W, Franco, M, Oliveira Lage, J, Aparecida Pessoa Conde, K, Charro, F, Naia, A, de Brito Sobrinho, E, Lameira Verissimo, A, Barros de Oliveira, M, Zampieri, F, Ladeira, J, Cordioli, R, Diogo Sala, A, Tadahiro Ikeoka, D, Baptista Filho, M, Ray, A, Guerra de Almeida, A, Nazareno Conceicao, C, Ribeiro Salgado, D, Rosso Verdeal, J, Martins, G, Junqueira Ribeiro, L, Vilela Siqueira, H, Flavio Costa Filho, F, Adler Maccagnan Pinheiro Besen, B, Vieira Do Nascimento Martins, E, Aparecida Pereira, J, Milioli Ferreira, D, Alves Ferreira Goncalves, F, de Souza Nobrega, M, Barros Duarte, I, Nobre, V, Miranda Barreto Mourao, L, Gomez Ravetti, C, Scalzo, A, Martins De Stefano, L, Gut, A, Nogueira Filho, W, Gatti Cirillo, C, Ishiwaki, S, Lobo, S, Elias de Oliveira, N, Fernandes Machado, L, Sisconetto, L, Rios Vieira, S, Fialkow, L, Fontoura Prado, K, Franke, C, Barberena Moraes, R, Christmann Wawrzeniak, I, Rech, T, Parolo, E, Almeida Victorino, J, Marques Barroso, C, Marcal de Vasconcelos, M, Souza da Silva, R, Lesti Esteves, A, Camassola, A, Antoniazzi, R, Griebler, M, Favretto, J, Romano, M, Franz da Costa, A, Werneck, V, Miura, M, Farran, J, Vasconcelos, R, Isola, A, Resende, E, Goulart, R, Luzzi, S, Rea-Neto, A, de Oliveira, M, Bruinje Cosentino, M, Martins Dzivielevski, B, Reese, F, Ferreira da Silva, S, Elias Aquim, E, Girotto, F, Helenditi Fernandes Camurca Martins, R, Lima de Andrade, A, Breckenfeld Heirel, D, Ryoji Takatani, R, Dias de Almeida, S, Medina Matos, A, Iwamoto, T, Do Val Tavares, P, Valiatti, J, de Lucca, F, Fornazari, J, Dias Brugugnolli, I, de Araujo Nazare, M, Nascimento Loureiro, N, Vasconcelos de Sousa, G, Staffa Gonzaga da Silva, L, Dos Anjos Sad, F, Stucchi, E, Melo Silva, R, Fonseca Silva, T, Mendes Filho, S, Borba Pereira, T, da Silva, P, Martines Moralez, G, Abrantes Saraiva, S, Abrunhosa, A, Chagas, C, Thompson, M, Pinto Goncalves, C, de Oliveira Dias, R, Schwan Filho, F, Magalhaes Carvalho Grion, C, Mezzaroba, A, Festti, J, Massariol, T, de Souza, G, Martins Lima Silva, M, de Souza Andrade Neto, J, Costa, G, Souza Ribeiro, M, Coelho, M, Cruz Carbonell, R, de Souza Trindade, R, Valente Barbas, C, Domingos Correa, T, Serpa Neto, A, Santucci Cesar de Assuncao, M, Vilela Costa Pinto, B, Goncalves Libanio, P, da Silva Motta, J, Santa Maria Lucin, G, Macedo Araujo, L, Anibal Leite Barros Agostinho, T, de Andrade, K, da Silva, M, Pereira da Silva, E, Mousinho Gomes, R, Campos, N, Fonseca de Sousa, J, Ramos Nicolau da Costa, L, de Carvalho Fonseca Assuncao, N, Martins de Lima, G, Pinheiro de Oliveira, R, Gasparetto Maccari, J, de Campos Balzano, P, Tagliari, L, Metran Nascente, A, de Carvalho, M, Buttignol, M, Henn Moura, R, Vinicius Pereira, M, Alberti da Silva, G, Akemi Higo, M, Morales, M, Andrade, A, de Paiva, A, da Silva, K, Andrioli de Araujo, P, Cordeiro de Abreu Filho, C, Abdalla, G, Loureiro Sebold, M, Moreira, R, Caldeira Filho, M, de Brito Cordeiro, R, Pfuetzenreiter, F, Costa Carvalho, L, da Silva Guimaraes, B, de Faria Cordeiro, H, Pimentel Alvim, S, Do Espirito Santo, J, Silva Maia, I, Pincelli, M, Zandonai, C, Burigo Grumann, A, Kretzer, L, Nedel, W, Manozzo Boniatti, M, Santos Pellegrini, J, da Silva Marques, L, Girardelli Baptista, W, da Silva Franco, R, Moreira de Sousa, M, de Marchi Benfica, A, Veiga de Oliveira, A, Reis, D, Morais, M, Santa Rosa Santana, H, Murilo Domingues, S, de Menezes Ferreira, C, Amado Rabelo, L, Menezes de Rezende, C, Riccio, P, Silva de Almeida, P, Rubini, P, da Graca Pasquotto de Lima Assef, M, Nardela, R, Locks Stahlhofer, L, Gatelli Noronha, C, de Azevedo Naves, S, Dias da Silva, F, Mazza, B, Longhi Simoes de Almeida, S, Mayumi Higa, R, Papacidero, C, Lima Silva, M, de Assuncao Melo, L, Miranda Mafra Oliveira, M, Matos Brito Coelho, C, Machado, J, de Souza Machado, Y, Vitor Fera, J, Dos Santos Ramos, N, Botelho Foernges, R, de Souza, R, Rutzen, W, Villasante Troncoso, E, Paiva, T, Vieira de Lacerda, N, Aires de Araujo Neto, J, de Oliveira Maia, M, Bastos de Moura, E, Brocco Magnan, G, Soares Nasrala, M, Campos Tonussi, R, Kohl Pinheiro, E, Simoes da Silva, F, Dal-Pizzol, F, Schmitz de Figueiredo, F, Ritter, C, de Vasconcellos Baldisserotto, S, Blattner, C, Saldanha Dos Santos, R, da Silva Bettega, F, Almeida Delfino Duarte, P, Tozo, T, Peliser, P, Deczka Morsch, R, Guimaraes Leal Guadalupe, E, Souza Amorim, D, Rezegue de Moraes Rego, L, Azevedo, L, Ramos, F, Pastore, L, Nery, P, Spegiorin Moreno, M, Nakad Orsatti, V, Yudi Horikawa, F, Samartino Zavanelli, G, Adrieno Westphal, G, Sperotto, G, Dadam, M, Nunes, M, Pantaleao, S, Camargo Narciso, R, Bernadete Caser, E, Falcao, J, Genelhu, G, Lessa Soares, F, Silva Sales, B, Rebello de Jesus, K, Correia Santos Bonomo, D, Martins Arruda, J, de Pinho, J, Belacho Azeredo Coutinho, J, Braga Hagreaves Ribeiro de Freitas, R, de Souza Oliveira Garcia, T, Frizera Vassallo, P, Buarque Souza de Lima, M, Eberhart Neto, E, Satoshi Inagaki, A, Oliveira de Paula, A, Amador Correia, T, Nomoto, S, Seiji Ueno Gil, F, Florizel Almeida de Araujo, M, Bezerra Lima, Z, Simoes Giancursi, T, Rejane de Lima, C, Costa, M, Osaku, E, Jorge, A, Rodrigues da Cruz, M, da Cunha, S, Silva Cavallaro Torres, K, Rocha Rodrigues da Silva, F, Lisboa de Souza, R, Osni Machado, F, Buss, E, Cattelan Bonorino, K, Germano, A, Bin da Silva, S, Herek, A, Tavares Gurgel, S, Sanches Laranjeira, A, Toshiyuki Tanita, M, Tibery Queiroz Cardoso, L, Osorio Guerreiro, M, Peres Bainy, M, de Oliveira Teixeira, L, Colozza Mecatti, G, Carolina Salomao, M, Ribeiro Moreira, A, Vantini Capasso Palamim, C, Deucher, R, Castro Escobar Furlan, F, Rodrigues Torres de Carvalho, F, Muniz, R, Penna Guimaraes, H, Conceicao Andrade, L, Abrahao Hajjar, L, Barbosa Gomes Galas, F, Pinheiro de Almeida, J, Marco, R, Peixoto, E, Hirata, F, Yen Ju, C, Bonaccorsi Fernandino, B, Lage de Assis Rocha, D, Azzi Barbosa, N, Dias Alves, J, Furtado Lamego, L, de Linhares, J, Ferreira Sousa, M, Ferreira de Souza, M, Guimaraes de Carvalho, F, Aparecida Leite, M, Torres, P, Bolognese, D, Lacerda, V, Cisari, G, Souza Marques, A, Amarante Costa, A, Bonin Campos, L, Lovato, W, Guimaraes Dantas, B, Ribeiro Campos, D, Pires Barrientto, L, Rossi Peras Americo, V, Barboza Carnevalli Bueno, T, Morales, D, Mara Gomes, T, Barbosa Cerantola, R, Hoher, J, Sa Malbouisson, L, Matheus Cadamuro, F, Bassi, E, Maia, R, Dias E Santos, J, Oliveira, C, Balzi, A, Tierno, P, Marques Andrade, G, Delascio Lopes, R, Ramos Mello, M, Vendrame, L, Ribeiro Machado, F, Baccaro Rossetti Santana, H, de Carvalho, A, Marques Ferreira Mendez, V, de Araujo Macedo Pinto, W, Dos Santos Francisco, R, Steponovicius Piedade Cruz, F, Silva de Araujo, A, Paiva de Souza, A, Teixeira Pinheiro, T, Martins Santos, T, Gontijo-Coutinho, C, Franci, D, de Carvalho-Filho, M, Ribas Rosa de Oliveira, A, Silva, J, Costa Lisboa, T, Peretti Torelly, A, Silva de Souza, A, Hadrich, M, Schwarz, P, Berto, P, Teixeira de Gois, A, Silva, M, Gessolo Lins, P, Cavalcante Lola Biazzoto, E, Dragosavac, D, Ribeiro de Carvalho, C, Passos Amato, M, Toufen, C, Ribeiro de Santis Santiago, R, Hirota, A, Rodrigues, M, Dias Chiavegato, L, Bastos Vieira, P, de Almeida, M, Barbosa, P, Pereira Santos, J, Nogueira de Paula, L, Piras, C, Giuberti, J, Siqueira da Silva, A, Conti Ramos, R, Plata Valdivieso, R, Gonzalez, H, Ortiz, M, Bautista-Rincon, D, Quinones, E, Calderon, L, Vargas, M, Pizarro, C, Orozco Levi, M, Espitia Hernandez, A, Cadavid Gutierrez, C, Giraldo Ramirez, N, Gallego, D, Naranjo Sierra, S, Ortiz, G, Esneda Rocha Gaona, M, Garay, M, Vieda, E, Bermudez, W, Castaneda, J, Cortegiani, A, Russotto, V, Raineri, S, Giarratano, A, Shahnaz Hasan, M, Rai Hakumat Rai, V, Fadhil Hadi Bin Jamaluddin, M, Afiq Syahmi Ramli, M, Gorka, J, Nowak, I, Seczynska, B, Sega, A, Paulino, C, Povoa, P, Belda, F, Ferrando, C, Carbonell, J, Puig, J, Soro, M, Nin, N, Hurtado, J, Gacel, A, Gaudin, A, Sande, L, Cavalcanti A. B., Suzumura E. A., Laranjeira L. N., De Moraes Paisani D., Damiani L. P., Guimaraes H. P., Romano E. R., De Moraes Regenga M., Taniguchi L. N. T., Teixeira C., De Oliveira R. P., Machado F. R., Diaz-Quijano F. A., De Alencar Filho M. S., Maia I. S., Caser E. B., De Oliveira Filho W., De Carvalho Borges M., De Aquino Martins P., Matsui M., Ospina-Tascon G. A., Giancursi T. S., Giraldo-Ramirez N. D., Vieira S. R. R., De Lima Assef M. D. G. P., Hasan M. S., Szczeklik W., Rios F., Amato M. B. P., Berwanger O., De Carvalho C. R. R., Tucci M. R., Souza Dos Santos L., Franca de Oliveira M. C., Peres I., Freitas I., Reis H., Verissimo A., Torres D., Barroso A., Semboloni Bitencourt W., Franco M. R., Oliveira Lage J., Aparecida Pessoa Conde K., Charro F. A., Naia A., de Brito Sobrinho E., Lameira Verissimo A., Barros de Oliveira M. E., Zampieri F., Ladeira J. P., Cordioli R., Diogo Sala A., Tadahiro Ikeoka D., Baptista Filho M. L. A., Ray A., Guerra de Almeida A., Nazareno Conceicao C., Ribeiro Salgado D., Rosso Verdeal J. C., Martins G. A., Junqueira Ribeiro L., Vilela Siqueira H., Flavio Costa Filho F., Adler Maccagnan Pinheiro Besen B., Vieira Do Nascimento Martins E., Aparecida Pereira J., Milioli Ferreira D., Alves Ferreira Goncalves F., de Souza Nobrega M., Barros Duarte I. J., Nobre V., Miranda Barreto Mourao L., Gomez Ravetti C., Scalzo A. C., Martins De Stefano L., Gut A. L., Nogueira Filho W., Gatti Cirillo C., Ishiwaki S., Lobo S., Elias de Oliveira N., Fernandes Machado L., Sisconetto L., Rios Vieira S. R., Fialkow L., Fontoura Prado K., Franke C., Barberena Moraes R., Christmann Wawrzeniak I., Rech T. H., Parolo E., Almeida Victorino J., Marques Barroso C., Marcal de Vasconcelos M. O., Souza da Silva R., Lesti Esteves A. R., Camassola A. P., Antoniazzi R., Griebler M., Favretto J., Romano M., Franz da Costa A., Werneck V., Miura M. C., Farran J., Vasconcelos R., Isola A., Resende E., Goulart R., Luzzi S., Rea-Neto A., de Oliveira M. C., Bruinje Cosentino M. F., Martins Dzivielevski B., Reese F. B., Ferreira da Silva S. D., Elias Aquim E., Girotto F., Helenditi Fernandes Camurca Martins R., Lima de Andrade A., Breckenfeld Heirel D. C., Ryoji Takatani R., Dias de Almeida S., Medina Matos A., Iwamoto T., Do Val Tavares P. E., Valiatti J. L., de Lucca F. C., Fornazari J. C., Dias Brugugnolli I., de Araujo Nazare M., Nascimento Loureiro N., Vasconcelos de Sousa G., Staffa Gonzaga da Silva L., Dos Anjos Sad F. C., Stucchi E. M., Melo Silva R., Fonseca Silva T., Mendes Filho S. P., Borba Pereira T., da Silva P. N., Martines Moralez G., Abrantes Saraiva S., Abrunhosa A., Chagas C. E. R. C., Thompson M. M., Pinto Goncalves C. H., de Oliveira Dias R., Schwan Filho F., Magalhaes Carvalho Grion C., Mezzaroba A. L., Festti J., Massariol T. C., de Souza G. F., Martins Lima Silva M., de Souza Andrade Neto J., Costa G., Souza Ribeiro M., Coelho M., Cruz Carbonell R. C., de Souza Trindade R., Valente Barbas C. S., Domingos Correa T., Serpa Neto A., Santucci Cesar de Assuncao M., Vilela Costa Pinto B., Goncalves Libanio P., da Silva Motta J., Santa Maria Lucin G., Macedo Araujo L., Anibal Leite Barros Agostinho T., de Andrade K. M., da Silva M. S., Pereira da Silva E., Mousinho Gomes R. L., Campos N. M. P., Fonseca de Sousa J., Ramos Nicolau da Costa L., de Carvalho Fonseca Assuncao N. S., Martins de Lima G., Pinheiro de Oliveira R., Gasparetto Maccari J., de Campos Balzano P., Tagliari L., Metran Nascente A. P., de Carvalho M. A., Buttignol M., Henn Moura R., Vinicius Pereira M., Alberti da Silva G., Akemi Higo M., Morales M., Andrade A. H. V., de Paiva A. P., da Silva K. S., Andrioli de Araujo P., Cordeiro de Abreu Filho C. A., Abdalla G., Loureiro Sebold M., Moreira R., Caldeira Filho M., de Brito Cordeiro R., Pfuetzenreiter F., Costa Carvalho L. F., da Silva Guimaraes B. L., de Faria Cordeiro H., Pimentel Alvim S. H., Do Espirito Santo J. A., Silva Maia I., Pincelli M., Zandonai C. L., Burigo Grumann A. C., Kretzer L. P., Nedel W., Manozzo Boniatti M., Santos Pellegrini J. A., da Silva Marques L., Girardelli Baptista W. C., da Silva Franco R. S., Moreira de Sousa M., de Marchi Benfica A. F., Veiga de Oliveira A. L., Reis D. L., Morais M. O., Santa Rosa Santana H., Murilo Domingues S., de Menezes Ferreira C., Amado Rabelo L., Menezes de Rezende C., Riccio P., Silva de Almeida P., Rubini P., da Graca Pasquotto de Lima Assef M., Nardela R., Locks Stahlhofer L., Gatelli Noronha C., de Azevedo Naves S., Dias da Silva F., Mazza B. F., Longhi Simoes de Almeida S., Mayumi Higa R., Papacidero C. H., Lima Silva M. M., de Assuncao Melo L., Miranda Mafra Oliveira M., Matos Brito Coelho C., Machado J. A., de Souza Machado Y. L., Vitor Fera J., Dos Santos Ramos N. C., Botelho Foernges R., de Souza R. R., Rutzen W., Villasante Troncoso E. M., Paiva T. K. B., Vieira de Lacerda N. M., Aires de Araujo Neto J., de Oliveira Maia M., Bastos de Moura E., Brocco Magnan G., Soares Nasrala M. L., Campos Tonussi R. L., Kohl Pinheiro E., Simoes da Silva F., Dal-Pizzol F., Schmitz de Figueiredo F., Ritter C., de Vasconcellos Baldisserotto S., Blattner C., Saldanha Dos Santos R., da Silva Bettega F., Almeida Delfino Duarte P., Tozo T. C., Peliser P., Deczka Morsch R., Guimaraes Leal Guadalupe E., Souza Amorim D., Rezegue de Moraes Rego L., Azevedo L., Ramos F., Pastore L., Nery P., Spegiorin Moreno M., Nakad Orsatti V., Yudi Horikawa F., Samartino Zavanelli G., Adrieno Westphal G., Sperotto G., Dadam M., Nunes M., Pantaleao S. L., Camargo Narciso R., Bernadete Caser E., Falcao J. G., Genelhu G., Lessa Soares F., Silva Sales B., Rebello de Jesus K., Correia Santos Bonomo D., Martins Arruda J., de Pinho J. C., Belacho Azeredo Coutinho J., Braga Hagreaves Ribeiro de Freitas R., de Souza Oliveira Garcia T., Frizera Vassallo P., Buarque Souza de Lima M. H., Eberhart Neto E., Satoshi Inagaki A., Oliveira de Paula A. E., Amador Correia T., Nomoto S., Seiji Ueno Gil F., Florizel Almeida de Araujo M., Bezerra Lima Z., Simoes Giancursi T., Rejane de Lima C., Costa M., Osaku E. F., Jorge A. C., Rodrigues da Cruz M., da Cunha S., Silva Cavallaro Torres K., Rocha Rodrigues da Silva F., Lisboa de Souza R., Osni Machado F., Buss E. K., Cattelan Bonorino K., Germano A., Bin da Silva S. R., Herek A., Tavares Gurgel S. J., Sanches Laranjeira A., Toshiyuki Tanita M., Tibery Queiroz Cardoso L., Osorio Guerreiro M., Peres Bainy M., de Oliveira Teixeira L., Colozza Mecatti G., Carolina Salomao M., Ribeiro Moreira A., Vantini Capasso Palamim C., Deucher R. A. O., Castro Escobar Furlan F., Rodrigues Torres de Carvalho F., Muniz R., Penna Guimaraes H., Conceicao Andrade L., Abrahao Hajjar L., Barbosa Gomes Galas F. R., Pinheiro de Almeida J., Marco R., Peixoto E., Hirata F., Yen Ju C., Bonaccorsi Fernandino B., Lage de Assis Rocha D., Azzi Barbosa N., Dias Alves J., Furtado Lamego L., de Linhares J. M., Ferreira Sousa M., Ferreira de Souza M. M., Guimaraes de Carvalho F. L., Aparecida Leite M., Torres P., Bolognese D., Lacerda V., Cisari G., Souza Marques A., Amarante Costa A., Bonin Campos L., Lovato W. J., Guimaraes Dantas B., Ribeiro Campos D., Pires Barrientto L. C., Rossi Peras Americo V., Barboza Carnevalli Bueno T., Morales D., Mara Gomes T., Barbosa Cerantola R., Hoher J., Sa Malbouisson L. M., Matheus Cadamuro F., Bassi E., Maia R., Dias E Santos J. A., Oliveira C., Balzi A. P., Tierno P., Marques Andrade G., Delascio Lopes R., Ramos Mello M., Vendrame L. S., Ribeiro Machado F., Baccaro Rossetti Santana H., de Carvalho A., Marques Ferreira Mendez V., de Araujo Macedo Pinto W., Dos Santos Francisco R., Steponovicius Piedade Cruz F., Silva de Araujo A., Paiva de Souza A., Teixeira Pinheiro T., Martins Santos T., Gontijo-Coutinho C. M., Franci D., de Carvalho-Filho M. A., Ribas Rosa de Oliveira A. M., Silva J. M., Costa Lisboa T., Peretti Torelly A., Silva de Souza A., Hadrich M., Schwarz P., Berto P., Teixeira de Gois A. F., Silva M., Gessolo Lins P., Cavalcante Lola Biazzoto E. P., Dragosavac D., Ribeiro de Carvalho C. R., Passos Amato M. B., Toufen C., Ribeiro de Santis Santiago R., Hirota A. S., Rodrigues M., Dias Chiavegato L., Bastos Vieira P. C., de Almeida M. M. M. F., Barbosa P. G., Pereira Santos J. R., Nogueira de Paula L., Piras C., Giuberti J., Siqueira da Silva A., Conti Ramos R., Plata Valdivieso R., Gonzalez H. H., Ortiz M., Bautista-Rincon D. F., Quinones E., Calderon L. E., Vargas M., Pizarro C., Orozco Levi M., Espitia Hernandez A. M., Cadavid Gutierrez C., Giraldo Ramirez N., Gallego D. A., Naranjo Sierra S., Ortiz G., Esneda Rocha Gaona M., Garay M., Vieda E., Bermudez W. F., Castaneda J. A., Cortegiani A., Russotto V., Raineri S. M., Giarratano A., Shahnaz Hasan M., Rai Hakumat Rai V., Fadhil Hadi Bin Jamaluddin M., Afiq Syahmi Ramli M., Gorka J., Nowak I., Seczynska B., Sega A., Paulino C., Povoa P., Belda F. J., Ferrando C., Carbonell J. A., Puig J., Soro M., Nin N., Hurtado J., Gacel A., Gaudin A., Sande L., Cavalcanti, A, Suzumura, E, Laranjeira, L, De Moraes Paisani, D, Damiani, L, Guimaraes, H, Romano, E, De Moraes Regenga, M, Taniguchi, L, Teixeira, C, De Oliveira, R, Machado, F, Diaz-Quijano, F, De Alencar Filho, M, Maia, I, Caser, E, De Oliveira Filho, W, De Carvalho Borges, M, De Aquino Martins, P, Matsui, M, Ospina-Tascon, G, Giancursi, T, Giraldo-Ramirez, N, Vieira, S, De Lima Assef, M, Hasan, M, Szczeklik, W, Rios, F, Amato, M, Berwanger, O, De Carvalho, C, Tucci, M, Souza Dos Santos, L, Franca de Oliveira, M, Peres, I, Freitas, I, Reis, H, Verissimo, A, Torres, D, Barroso, A, Semboloni Bitencourt, W, Franco, M, Oliveira Lage, J, Aparecida Pessoa Conde, K, Charro, F, Naia, A, de Brito Sobrinho, E, Lameira Verissimo, A, Barros de Oliveira, M, Zampieri, F, Ladeira, J, Cordioli, R, Diogo Sala, A, Tadahiro Ikeoka, D, Baptista Filho, M, Ray, A, Guerra de Almeida, A, Nazareno Conceicao, C, Ribeiro Salgado, D, Rosso Verdeal, J, Martins, G, Junqueira Ribeiro, L, Vilela Siqueira, H, Flavio Costa Filho, F, Adler Maccagnan Pinheiro Besen, B, Vieira Do Nascimento Martins, E, Aparecida Pereira, J, Milioli Ferreira, D, Alves Ferreira Goncalves, F, de Souza Nobrega, M, Barros Duarte, I, Nobre, V, Miranda Barreto Mourao, L, Gomez Ravetti, C, Scalzo, A, Martins De Stefano, L, Gut, A, Nogueira Filho, W, Gatti Cirillo, C, Ishiwaki, S, Lobo, S, Elias de Oliveira, N, Fernandes Machado, L, Sisconetto, L, Rios Vieira, S, Fialkow, L, Fontoura Prado, K, Franke, C, Barberena Moraes, R, Christmann Wawrzeniak, I, Rech, T, Parolo, E, Almeida Victorino, J, Marques Barroso, C, Marcal de Vasconcelos, M, Souza da Silva, R, Lesti Esteves, A, Camassola, A, Antoniazzi, R, Griebler, M, Favretto, J, Romano, M, Franz da Costa, A, Werneck, V, Miura, M, Farran, J, Vasconcelos, R, Isola, A, Resende, E, Goulart, R, Luzzi, S, Rea-Neto, A, de Oliveira, M, Bruinje Cosentino, M, Martins Dzivielevski, B, Reese, F, Ferreira da Silva, S, Elias Aquim, E, Girotto, F, Helenditi Fernandes Camurca Martins, R, Lima de Andrade, A, Breckenfeld Heirel, D, Ryoji Takatani, R, Dias de Almeida, S, Medina Matos, A, Iwamoto, T, Do Val Tavares, P, Valiatti, J, de Lucca, F, Fornazari, J, Dias Brugugnolli, I, de Araujo Nazare, M, Nascimento Loureiro, N, Vasconcelos de Sousa, G, Staffa Gonzaga da Silva, L, Dos Anjos Sad, F, Stucchi, E, Melo Silva, R, Fonseca Silva, T, Mendes Filho, S, Borba Pereira, T, da Silva, P, Martines Moralez, G, Abrantes Saraiva, S, Abrunhosa, A, Chagas, C, Thompson, M, Pinto Goncalves, C, de Oliveira Dias, R, Schwan Filho, F, Magalhaes Carvalho Grion, C, Mezzaroba, A, Festti, J, Massariol, T, de Souza, G, Martins Lima Silva, M, de Souza Andrade Neto, J, Costa, G, Souza Ribeiro, M, Coelho, M, Cruz Carbonell, R, de Souza Trindade, R, Valente Barbas, C, Domingos Correa, T, Serpa Neto, A, Santucci Cesar de Assuncao, M, Vilela Costa Pinto, B, Goncalves Libanio, P, da Silva Motta, J, Santa Maria Lucin, G, Macedo Araujo, L, Anibal Leite Barros Agostinho, T, de Andrade, K, da Silva, M, Pereira da Silva, E, Mousinho Gomes, R, Campos, N, Fonseca de Sousa, J, Ramos Nicolau da Costa, L, de Carvalho Fonseca Assuncao, N, Martins de Lima, G, Pinheiro de Oliveira, R, Gasparetto Maccari, J, de Campos Balzano, P, Tagliari, L, Metran Nascente, A, de Carvalho, M, Buttignol, M, Henn Moura, R, Vinicius Pereira, M, Alberti da Silva, G, Akemi Higo, M, Morales, M, Andrade, A, de Paiva, A, da Silva, K, Andrioli de Araujo, P, Cordeiro de Abreu Filho, C, Abdalla, G, Loureiro Sebold, M, Moreira, R, Caldeira Filho, M, de Brito Cordeiro, R, Pfuetzenreiter, F, Costa Carvalho, L, da Silva Guimaraes, B, de Faria Cordeiro, H, Pimentel Alvim, S, Do Espirito Santo, J, Silva Maia, I, Pincelli, M, Zandonai, C, Burigo Grumann, A, Kretzer, L, Nedel, W, Manozzo Boniatti, M, Santos Pellegrini, J, da Silva Marques, L, Girardelli Baptista, W, da Silva Franco, R, Moreira de Sousa, M, de Marchi Benfica, A, Veiga de Oliveira, A, Reis, D, Morais, M, Santa Rosa Santana, H, Murilo Domingues, S, de Menezes Ferreira, C, Amado Rabelo, L, Menezes de Rezende, C, Riccio, P, Silva de Almeida, P, Rubini, P, da Graca Pasquotto de Lima Assef, M, Nardela, R, Locks Stahlhofer, L, Gatelli Noronha, C, de Azevedo Naves, S, Dias da Silva, F, Mazza, B, Longhi Simoes de Almeida, S, Mayumi Higa, R, Papacidero, C, Lima Silva, M, de Assuncao Melo, L, Miranda Mafra Oliveira, M, Matos Brito Coelho, C, Machado, J, de Souza Machado, Y, Vitor Fera, J, Dos Santos Ramos, N, Botelho Foernges, R, de Souza, R, Rutzen, W, Villasante Troncoso, E, Paiva, T, Vieira de Lacerda, N, Aires de Araujo Neto, J, de Oliveira Maia, M, Bastos de Moura, E, Brocco Magnan, G, Soares Nasrala, M, Campos Tonussi, R, Kohl Pinheiro, E, Simoes da Silva, F, Dal-Pizzol, F, Schmitz de Figueiredo, F, Ritter, C, de Vasconcellos Baldisserotto, S, Blattner, C, Saldanha Dos Santos, R, da Silva Bettega, F, Almeida Delfino Duarte, P, Tozo, T, Peliser, P, Deczka Morsch, R, Guimaraes Leal Guadalupe, E, Souza Amorim, D, Rezegue de Moraes Rego, L, Azevedo, L, Ramos, F, Pastore, L, Nery, P, Spegiorin Moreno, M, Nakad Orsatti, V, Yudi Horikawa, F, Samartino Zavanelli, G, Adrieno Westphal, G, Sperotto, G, Dadam, M, Nunes, M, Pantaleao, S, Camargo Narciso, R, Bernadete Caser, E, Falcao, J, Genelhu, G, Lessa Soares, F, Silva Sales, B, Rebello de Jesus, K, Correia Santos Bonomo, D, Martins Arruda, J, de Pinho, J, Belacho Azeredo Coutinho, J, Braga Hagreaves Ribeiro de Freitas, R, de Souza Oliveira Garcia, T, Frizera Vassallo, P, Buarque Souza de Lima, M, Eberhart Neto, E, Satoshi Inagaki, A, Oliveira de Paula, A, Amador Correia, T, Nomoto, S, Seiji Ueno Gil, F, Florizel Almeida de Araujo, M, Bezerra Lima, Z, Simoes Giancursi, T, Rejane de Lima, C, Costa, M, Osaku, E, Jorge, A, Rodrigues da Cruz, M, da Cunha, S, Silva Cavallaro Torres, K, Rocha Rodrigues da Silva, F, Lisboa de Souza, R, Osni Machado, F, Buss, E, Cattelan Bonorino, K, Germano, A, Bin da Silva, S, Herek, A, Tavares Gurgel, S, Sanches Laranjeira, A, Toshiyuki Tanita, M, Tibery Queiroz Cardoso, L, Osorio Guerreiro, M, Peres Bainy, M, de Oliveira Teixeira, L, Colozza Mecatti, G, Carolina Salomao, M, Ribeiro Moreira, A, Vantini Capasso Palamim, C, Deucher, R, Castro Escobar Furlan, F, Rodrigues Torres de Carvalho, F, Muniz, R, Penna Guimaraes, H, Conceicao Andrade, L, Abrahao Hajjar, L, Barbosa Gomes Galas, F, Pinheiro de Almeida, J, Marco, R, Peixoto, E, Hirata, F, Yen Ju, C, Bonaccorsi Fernandino, B, Lage de Assis Rocha, D, Azzi Barbosa, N, Dias Alves, J, Furtado Lamego, L, de Linhares, J, Ferreira Sousa, M, Ferreira de Souza, M, Guimaraes de Carvalho, F, Aparecida Leite, M, Torres, P, Bolognese, D, Lacerda, V, Cisari, G, Souza Marques, A, Amarante Costa, A, Bonin Campos, L, Lovato, W, Guimaraes Dantas, B, Ribeiro Campos, D, Pires Barrientto, L, Rossi Peras Americo, V, Barboza Carnevalli Bueno, T, Morales, D, Mara Gomes, T, Barbosa Cerantola, R, Hoher, J, Sa Malbouisson, L, Matheus Cadamuro, F, Bassi, E, Maia, R, Dias E Santos, J, Oliveira, C, Balzi, A, Tierno, P, Marques Andrade, G, Delascio Lopes, R, Ramos Mello, M, Vendrame, L, Ribeiro Machado, F, Baccaro Rossetti Santana, H, de Carvalho, A, Marques Ferreira Mendez, V, de Araujo Macedo Pinto, W, Dos Santos Francisco, R, Steponovicius Piedade Cruz, F, Silva de Araujo, A, Paiva de Souza, A, Teixeira Pinheiro, T, Martins Santos, T, Gontijo-Coutinho, C, Franci, D, de Carvalho-Filho, M, Ribas Rosa de Oliveira, A, Silva, J, Costa Lisboa, T, Peretti Torelly, A, Silva de Souza, A, Hadrich, M, Schwarz, P, Berto, P, Teixeira de Gois, A, Silva, M, Gessolo Lins, P, Cavalcante Lola Biazzoto, E, Dragosavac, D, Ribeiro de Carvalho, C, Passos Amato, M, Toufen, C, Ribeiro de Santis Santiago, R, Hirota, A, Rodrigues, M, Dias Chiavegato, L, Bastos Vieira, P, de Almeida, M, Barbosa, P, Pereira Santos, J, Nogueira de Paula, L, Piras, C, Giuberti, J, Siqueira da Silva, A, Conti Ramos, R, Plata Valdivieso, R, Gonzalez, H, Ortiz, M, Bautista-Rincon, D, Quinones, E, Calderon, L, Vargas, M, Pizarro, C, Orozco Levi, M, Espitia Hernandez, A, Cadavid Gutierrez, C, Giraldo Ramirez, N, Gallego, D, Naranjo Sierra, S, Ortiz, G, Esneda Rocha Gaona, M, Garay, M, Vieda, E, Bermudez, W, Castaneda, J, Cortegiani, A, Russotto, V, Raineri, S, Giarratano, A, Shahnaz Hasan, M, Rai Hakumat Rai, V, Fadhil Hadi Bin Jamaluddin, M, Afiq Syahmi Ramli, M, Gorka, J, Nowak, I, Seczynska, B, Sega, A, Paulino, C, Povoa, P, Belda, F, Ferrando, C, Carbonell, J, Puig, J, Soro, M, Nin, N, Hurtado, J, Gacel, A, Gaudin, A, Sande, L, Cavalcanti A. B., Suzumura E. A., Laranjeira L. N., De Moraes Paisani D., Damiani L. P., Guimaraes H. P., Romano E. R., De Moraes Regenga M., Taniguchi L. N. T., Teixeira C., De Oliveira R. P., Machado F. R., Diaz-Quijano F. A., De Alencar Filho M. S., Maia I. S., Caser E. B., De Oliveira Filho W., De Carvalho Borges M., De Aquino Martins P., Matsui M., Ospina-Tascon G. A., Giancursi T. S., Giraldo-Ramirez N. D., Vieira S. R. R., De Lima Assef M. D. G. P., Hasan M. S., Szczeklik W., Rios F., Amato M. B. P., Berwanger O., De Carvalho C. R. R., Tucci M. R., Souza Dos Santos L., Franca de Oliveira M. C., Peres I., Freitas I., Reis H., Verissimo A., Torres D., Barroso A., Semboloni Bitencourt W., Franco M. R., Oliveira Lage J., Aparecida Pessoa Conde K., Charro F. A., Naia A., de Brito Sobrinho E., Lameira Verissimo A., Barros de Oliveira M. E., Zampieri F., Ladeira J. P., Cordioli R., Diogo Sala A., Tadahiro Ikeoka D., Baptista Filho M. L. A., Ray A., Guerra de Almeida A., Nazareno Conceicao C., Ribeiro Salgado D., Rosso Verdeal J. C., Martins G. A., Junqueira Ribeiro L., Vilela Siqueira H., Flavio Costa Filho F., Adler Maccagnan Pinheiro Besen B., Vieira Do Nascimento Martins E., Aparecida Pereira J., Milioli Ferreira D., Alves Ferreira Goncalves F., de Souza Nobrega M., Barros Duarte I. J., Nobre V., Miranda Barreto Mourao L., Gomez Ravetti C., Scalzo A. C., Martins De Stefano L., Gut A. L., Nogueira Filho W., Gatti Cirillo C., Ishiwaki S., Lobo S., Elias de Oliveira N., Fernandes Machado L., Sisconetto L., Rios Vieira S. R., Fialkow L., Fontoura Prado K., Franke C., Barberena Moraes R., Christmann Wawrzeniak I., Rech T. H., Parolo E., Almeida Victorino J., Marques Barroso C., Marcal de Vasconcelos M. O., Souza da Silva R., Lesti Esteves A. R., Camassola A. P., Antoniazzi R., Griebler M., Favretto J., Romano M., Franz da Costa A., Werneck V., Miura M. C., Farran J., Vasconcelos R., Isola A., Resende E., Goulart R., Luzzi S., Rea-Neto A., de Oliveira M. C., Bruinje Cosentino M. F., Martins Dzivielevski B., Reese F. B., Ferreira da Silva S. D., Elias Aquim E., Girotto F., Helenditi Fernandes Camurca Martins R., Lima de Andrade A., Breckenfeld Heirel D. C., Ryoji Takatani R., Dias de Almeida S., Medina Matos A., Iwamoto T., Do Val Tavares P. E., Valiatti J. L., de Lucca F. C., Fornazari J. C., Dias Brugugnolli I., de Araujo Nazare M., Nascimento Loureiro N., Vasconcelos de Sousa G., Staffa Gonzaga da Silva L., Dos Anjos Sad F. C., Stucchi E. M., Melo Silva R., Fonseca Silva T., Mendes Filho S. P., Borba Pereira T., da Silva P. N., Martines Moralez G., Abrantes Saraiva S., Abrunhosa A., Chagas C. E. R. C., Thompson M. M., Pinto Goncalves C. H., de Oliveira Dias R., Schwan Filho F., Magalhaes Carvalho Grion C., Mezzaroba A. L., Festti J., Massariol T. C., de Souza G. F., Martins Lima Silva M., de Souza Andrade Neto J., Costa G., Souza Ribeiro M., Coelho M., Cruz Carbonell R. C., de Souza Trindade R., Valente Barbas C. S., Domingos Correa T., Serpa Neto A., Santucci Cesar de Assuncao M., Vilela Costa Pinto B., Goncalves Libanio P., da Silva Motta J., Santa Maria Lucin G., Macedo Araujo L., Anibal Leite Barros Agostinho T., de Andrade K. M., da Silva M. S., Pereira da Silva E., Mousinho Gomes R. L., Campos N. M. P., Fonseca de Sousa J., Ramos Nicolau da Costa L., de Carvalho Fonseca Assuncao N. S., Martins de Lima G., Pinheiro de Oliveira R., Gasparetto Maccari J., de Campos Balzano P., Tagliari L., Metran Nascente A. P., de Carvalho M. A., Buttignol M., Henn Moura R., Vinicius Pereira M., Alberti da Silva G., Akemi Higo M., Morales M., Andrade A. H. V., de Paiva A. P., da Silva K. S., Andrioli de Araujo P., Cordeiro de Abreu Filho C. A., Abdalla G., Loureiro Sebold M., Moreira R., Caldeira Filho M., de Brito Cordeiro R., Pfuetzenreiter F., Costa Carvalho L. F., da Silva Guimaraes B. L., de Faria Cordeiro H., Pimentel Alvim S. H., Do Espirito Santo J. A., Silva Maia I., Pincelli M., Zandonai C. L., Burigo Grumann A. C., Kretzer L. P., Nedel W., Manozzo Boniatti M., Santos Pellegrini J. A., da Silva Marques L., Girardelli Baptista W. C., da Silva Franco R. S., Moreira de Sousa M., de Marchi Benfica A. F., Veiga de Oliveira A. L., Reis D. L., Morais M. O., Santa Rosa Santana H., Murilo Domingues S., de Menezes Ferreira C., Amado Rabelo L., Menezes de Rezende C., Riccio P., Silva de Almeida P., Rubini P., da Graca Pasquotto de Lima Assef M., Nardela R., Locks Stahlhofer L., Gatelli Noronha C., de Azevedo Naves S., Dias da Silva F., Mazza B. F., Longhi Simoes de Almeida S., Mayumi Higa R., Papacidero C. H., Lima Silva M. M., de Assuncao Melo L., Miranda Mafra Oliveira M., Matos Brito Coelho C., Machado J. A., de Souza Machado Y. L., Vitor Fera J., Dos Santos Ramos N. C., Botelho Foernges R., de Souza R. R., Rutzen W., Villasante Troncoso E. M., Paiva T. K. B., Vieira de Lacerda N. M., Aires de Araujo Neto J., de Oliveira Maia M., Bastos de Moura E., Brocco Magnan G., Soares Nasrala M. L., Campos Tonussi R. L., Kohl Pinheiro E., Simoes da Silva F., Dal-Pizzol F., Schmitz de Figueiredo F., Ritter C., de Vasconcellos Baldisserotto S., Blattner C., Saldanha Dos Santos R., da Silva Bettega F., Almeida Delfino Duarte P., Tozo T. C., Peliser P., Deczka Morsch R., Guimaraes Leal Guadalupe E., Souza Amorim D., Rezegue de Moraes Rego L., Azevedo L., Ramos F., Pastore L., Nery P., Spegiorin Moreno M., Nakad Orsatti V., Yudi Horikawa F., Samartino Zavanelli G., Adrieno Westphal G., Sperotto G., Dadam M., Nunes M., Pantaleao S. L., Camargo Narciso R., Bernadete Caser E., Falcao J. G., Genelhu G., Lessa Soares F., Silva Sales B., Rebello de Jesus K., Correia Santos Bonomo D., Martins Arruda J., de Pinho J. C., Belacho Azeredo Coutinho J., Braga Hagreaves Ribeiro de Freitas R., de Souza Oliveira Garcia T., Frizera Vassallo P., Buarque Souza de Lima M. H., Eberhart Neto E., Satoshi Inagaki A., Oliveira de Paula A. E., Amador Correia T., Nomoto S., Seiji Ueno Gil F., Florizel Almeida de Araujo M., Bezerra Lima Z., Simoes Giancursi T., Rejane de Lima C., Costa M., Osaku E. F., Jorge A. C., Rodrigues da Cruz M., da Cunha S., Silva Cavallaro Torres K., Rocha Rodrigues da Silva F., Lisboa de Souza R., Osni Machado F., Buss E. K., Cattelan Bonorino K., Germano A., Bin da Silva S. R., Herek A., Tavares Gurgel S. J., Sanches Laranjeira A., Toshiyuki Tanita M., Tibery Queiroz Cardoso L., Osorio Guerreiro M., Peres Bainy M., de Oliveira Teixeira L., Colozza Mecatti G., Carolina Salomao M., Ribeiro Moreira A., Vantini Capasso Palamim C., Deucher R. A. O., Castro Escobar Furlan F., Rodrigues Torres de Carvalho F., Muniz R., Penna Guimaraes H., Conceicao Andrade L., Abrahao Hajjar L., Barbosa Gomes Galas F. R., Pinheiro de Almeida J., Marco R., Peixoto E., Hirata F., Yen Ju C., Bonaccorsi Fernandino B., Lage de Assis Rocha D., Azzi Barbosa N., Dias Alves J., Furtado Lamego L., de Linhares J. M., Ferreira Sousa M., Ferreira de Souza M. M., Guimaraes de Carvalho F. L., Aparecida Leite M., Torres P., Bolognese D., Lacerda V., Cisari G., Souza Marques A., Amarante Costa A., Bonin Campos L., Lovato W. J., Guimaraes Dantas B., Ribeiro Campos D., Pires Barrientto L. C., Rossi Peras Americo V., Barboza Carnevalli Bueno T., Morales D., Mara Gomes T., Barbosa Cerantola R., Hoher J., Sa Malbouisson L. M., Matheus Cadamuro F., Bassi E., Maia R., Dias E Santos J. A., Oliveira C., Balzi A. P., Tierno P., Marques Andrade G., Delascio Lopes R., Ramos Mello M., Vendrame L. S., Ribeiro Machado F., Baccaro Rossetti Santana H., de Carvalho A., Marques Ferreira Mendez V., de Araujo Macedo Pinto W., Dos Santos Francisco R., Steponovicius Piedade Cruz F., Silva de Araujo A., Paiva de Souza A., Teixeira Pinheiro T., Martins Santos T., Gontijo-Coutinho C. M., Franci D., de Carvalho-Filho M. A., Ribas Rosa de Oliveira A. M., Silva J. M., Costa Lisboa T., Peretti Torelly A., Silva de Souza A., Hadrich M., Schwarz P., Berto P., Teixeira de Gois A. F., Silva M., Gessolo Lins P., Cavalcante Lola Biazzoto E. P., Dragosavac D., Ribeiro de Carvalho C. R., Passos Amato M. B., Toufen C., Ribeiro de Santis Santiago R., Hirota A. S., Rodrigues M., Dias Chiavegato L., Bastos Vieira P. C., de Almeida M. M. M. F., Barbosa P. G., Pereira Santos J. R., Nogueira de Paula L., Piras C., Giuberti J., Siqueira da Silva A., Conti Ramos R., Plata Valdivieso R., Gonzalez H. H., Ortiz M., Bautista-Rincon D. F., Quinones E., Calderon L. E., Vargas M., Pizarro C., Orozco Levi M., Espitia Hernandez A. M., Cadavid Gutierrez C., Giraldo Ramirez N., Gallego D. A., Naranjo Sierra S., Ortiz G., Esneda Rocha Gaona M., Garay M., Vieda E., Bermudez W. F., Castaneda J. A., Cortegiani A., Russotto V., Raineri S. M., Giarratano A., Shahnaz Hasan M., Rai Hakumat Rai V., Fadhil Hadi Bin Jamaluddin M., Afiq Syahmi Ramli M., Gorka J., Nowak I., Seczynska B., Sega A., Paulino C., Povoa P., Belda F. J., Ferrando C., Carbonell J. A., Puig J., Soro M., Nin N., Hurtado J., Gacel A., Gaudin A., and Sande L.

Abstract

IMPORTANCE: The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. OBJECTIVE: To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. INTERVENTIONS: An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory-system compliance (n = 501; experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stay; ventilator-free days through day 28; pneumothorax requiring drainage within 7 days; barotrauma within 7 days; and ICU, in-hospital, and 6-month mortality. RESULTS: A total of 1010 patients (37.5% female; mean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.20; 95% CI, 1.01 to 1.42; P = .041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%; HR, 1.18; 95% CI, 1.01 to 1.38; P = .04), decreased the number of mean ventilator-free days (5.3 vs 6.4; difference, −1.1; 95% CI, −2.1 to −0.1; P = .03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%; difference, 2.0%; 95% CI, 0.0% to 4.0%; P = .03), and the risk of barotrauma (5.6% vs 1.6%; difference, 4.0%; 95% CI

Published
2017

8. 36th International Symposium on Intensive Care and Emergency Medicine

Author

Bateman, R. M., Sharpe, M. D., Jagger, J. E., Ellis, C. G., Solé-Violán, J., López-Rodríguez, M., Herrera-Ramos, E., Ruíz-Hernández, J., Borderías, L., Horcajada, J., González-Quevedo, N., Rajas, O., Briones, M., Rodríguez de Castro, F., Rodríguez Gallego, C., Esen, F., Orhun, G., Ergin Ozcan, P., Senturk, E., Ugur Yilmaz, C., Orhan, N., Arican, N., Kaya, M., Kucukerden, M., Giris, M., Akcan, U., Bilgic Gazioglu, S., Tuzun, E., Riff, R., Naamani, O., Douvdevani, A., Takegawa, R., Yoshida, H., Hirose, T., Yamamoto, N., Hagiya, H., Ojima, M., Akeda, Y., Tasaki, O., Tomono, K., Shimazu, T., Ono, S., Kubo, T., Suda, S., Ueno, T., Ikeda, T., Ogura, H., Takahashi, H., Kang, J., Nakamura, Y., Kojima, T., Izutani, Y., Taniguchi, T., O, M., Dinter, C., Lotz, J., Eilers, B., Wissmann, C., Lott, R., Meili, M. M., Schuetz, P. S., Hawa, H., Sharshir, M., Aburageila, M., Salahuddin, N., Chantziara, V., Georgiou, S., Tsimogianni, A., Alexandropoulos, P., Vassi, A., Lagiou, F., Valta, M., Micha, G., Chinou, E., Michaloudis, G., Kodaira, A., Imaizumi, H., De la Torre-Prados, M. V., Garcia-De la Torre, A., Enguix-Armada, A., Puerto-Morlan, A., Perez-Valero, V., Garcia-Alcantara, A., Bolton, N., Dudziak, J., Bonney, S., Tridente, A., Nee, P., Nicolaes, G., Wiewel, M., Schultz, M., Wildhagen, K., Horn, J., Schrijver, R., Van der Poll, T., Reutelingsperger, C., Pillai, S., Davies, G., Mills, G., Aubrey, R., Morris, K., Williams, P., Evans, P., Gayat, E. G., Struck, J., Cariou, A., Deye, N., Guidet, B., Jabert, S., Launay, J., Legrand, M., Léone, M., Resche-Rigon, M., Vicaut, E., Vieillard-Baron, A., Mebazaa, A., Arnold, R., Capan, M., Linder, A., Akesson, P., Popescu, M., Tomescu, D., Sprung, C. L., Calderon Morales, R., Munteanu, G., Orenbuch-Harroch, E., Levin, P., Kasdan, H., Reiter, A., Volker, T., Himmel, Y., Cohen, Y., Meissonnier, J., Girard, L., Rebeaud, F., Herrmann, I., Delwarde, B., Peronnet, E., Cerrato, E., Venet, F., Lepape, A., Rimmelé, T., Monneret, G., Textoris, J., Beloborodova, N., Moroz, V., Osipov, A., Bedova, A., Sarshor, Y., Pautova, A., Sergeev, A., Chernevskaya, E., Odermatt, J., Bolliger, R., Hersberger, L., Ottiger, M., Christ-Crain, M., Mueller, B., Schuetz, P., Sharma, N. K., Tashima, A. K., Brunialti, M. K., Machado, F. R., Assuncao, M., Rigato, O., Salomao, R., Cajander, S. C., Rasmussen, G., Tina, E., Söderquist, B., Källman, J., Strålin, K., Lange, A. L., Sundén-Cullberg, J. S., Magnuson, A. M., Hultgren, O. H., Van der Geest, P., Mohseni, M., Linssen, J., De Jonge, R., Duran, S., Groeneveld, J., Miller, R., Lopansri, B. K., McHugh, L. C., Seldon, A., Burke, J. P., Johnston, J., Reece-Anthony, R., Bond, A., Molokhia, A., Mcgrath, C., Nsutebu, E., Bank Pedersen, P., Pilsgaard Henriksen, D., Mikkelsen, S., Touborg Lassen, A., Tincu, R., Cobilinschi, C., Ghiorghiu, Z., Macovei, R., Wiewel, M. A., Harmon, M. B., Van Vught, L. A., Scicluna, B. P., Hoogendijk, A. J., Zwinderman, A. H., Cremer, O. L., Bonten, M. J., Schultz, M. J., Juffermans, N. P., Wiersinga, W. J., Eren, G., Tekdos, Y., Dogan, M., Acicbe, O., Kaya, E., Hergunsel, O., Alsolamy, S., Ghamdi, G., Alswaidan, L., Alharbi, S., Alenezi, F., Arabi, Y., Heaton, J., Boyce, A., Nolan, L., Dukoff-Gordon, A., Dean, A., Mann Ben Yehudah, T., Fleischmann, C., Thomas-Rueddel, D., Haas, C., Dennler, U., Reinhart, K., Suntornlohanakul, O., Khwannimit, B., Breckenridge, F., Puxty, A., Szturz, P., Folwarzcny, P., Svancara, J., Kula, R., Sevcik, P., Caneva, L., Casazza, A., Bellazzi, E., Marra, S., Pagani, L., Vetere, M., Vanzino, R., Ciprandi, D., Preda, R., Boschi, R., Carnevale, L., Lopez, V., Aguilar Arzapalo, M., Barradas, L., Escalante, A., Gongora, J., Cetina, M., Adamik, B, Jakubczyk, D, Kübler, A, Radford, A., Lee, T., Singer, J., Boyd, J., Fineberg, D., Williams, M., Russell, J., Scarlatescu, E., Droc, G., Arama, S., Müller, M., Straat, M., Zeerleder, S. S., Fuchs, C. F., Scheer, C. S., Wauschkuhn, S. W., Vollmer, M. V., Meissner, K. M., Kuhn, S. K., Hahnenkamp, K. H., Rehberg, S. R., Gründling, M. G., Hamaguchi, S., Gómez-Sánchez, E., Heredia-Rodríguez, M., Álvarez-Fuente, E., Lorenzo-López, M., Gómez-Pesquera, E., Aragón-Camino, M., Liu-Zhu, P., Sánchez-López, A., Hernández-Lozano, A., Peláez-Jareño, M. T., Tamayo, E., Thomas-Rüddel, D. O., Adora, V., Kar, A., Chakraborty, A., Roy, S., Bandyopadhyay, A., Das, M., BenYehudah, G., Salim, M., Kumar, N., Arabi, L., Burger, T., Lephart, P., Toth-martin, E., Valencia, C., Hammami, N., Blot, S., Vincent, J. L., Lambert, M. L., Brunke, J., Riemann, T., Roschke, I., Nimitvilai, S., Jintanapramote, K., Jarupongprapa, S., Adukauskiene, D., Valanciene, D., Bose, G., Lostarakos, V., Carr, B., Khedher, S., Maaoui, A., Ezzamouri, A., Salem, M., Chen, J., Cranendonk, D. R., Day, M., Penrice, G., Roy, K., Robertson, P., Godbole, G., Jones, B., Booth, M., Donaldson, L., Kawano, Y., Ishikura, H., Al-Dorzi, H., Almutairi, M., Alhamadi, B., Crizaldo Toledo, A., Khan, R., Al Raiy, B., Talaie, H., Van Oers, J. A., Harts, A., Nieuwkoop, E., Vos, P., Boussarsar, Y., Boutouta, F., Kamoun, S., Mezghani, I., Koubaji, S., Ben Souissi, A., Riahi, A., Mebazaa, M. S., Giamarellos-Bourboulis, E., Tziolos, N., Routsi, C., Katsenos, C., Tsangaris, I., Pneumatikos, I., Vlachogiannis, G., Theodorou, V., Prekates, A., Antypa, E., Koulouras, V., Kapravelos, N., Gogos, C., Antoniadou, E., Mandragos, K., Armaganidis, A., Robles Caballero, A. R., Civantos, B., Figueira, J. C., López, J., Silva-Pinto, A., Ceia, F., Sarmento, A., Santos, L., Almekhlafi, G., Sakr, Y., Baharoon, S., Aldawood, A., Matroud, A., Alchin, J., Al Johani, S., Balkhy, H., Yousif, S. Y., Alotabi, B. O., Alsaawi, A. S., Ang, J., Curran, M. D., Enoch, D., Navapurkar, V., Morris, A., Sharvill, R., Astin, J., Patel, J., Kruger, C., O’Neal, J., Rhodes, H., Jancik, J., François, B., Laterre, P. F., Eggimann, P., Torres, A., Sánchez, M., Dequin, P. F., Bassi, G. L., Chastre, J., Jafri, H. S., Ben Romdhane, M., Douira, Z., Bousselmi, M., Vakalos, A., Avramidis, V., Craven, T. H., Wojcik, G., Kefala, K., McCoubrey, J., Reilly, J., Paterson, R., Inverarity, D., Laurenson, I., Walsh, T. S., Mongodi, S., Bouhemad, B., Orlando, A., Stella, A., Via, G., Iotti, G., Braschi, A., Mojoli, F., Haliloglu, M., Bilgili, B., Kasapoglu, U., Sayan, I., Süzer Aslan, M., Yalcın, A., Cinel, I., Ellis, H. E., Bauchmuller, K., Miller, D., Temple, A., Luyt, C. E., Singer, M., Nassar, Y., Ayad, M. S., Trifi, A., Abdellatif, S., Daly, F., Nasri, R., Ben Lakhal, S., Gul, F., Kuzovlev, A., Shabanov, A., Polovnikov, S., Kadrichu, N., Dang, T., Corkery, K., Challoner, P., Bassi, G. Li, Aguilera, E., Chiurazzi, C., Travierso, C., Motos, A., Fernandez, L., Amaro, R., Senussi, T., Idone, F., Bobi, J., Rigol, M., Hodiamont, C. J., Janssen, J. M., Bouman, C. S., Mathôt, R. A., De Jong, M. D., Van Hest, R. M., Payne, L., Fraser, G. L., Tudor, B., Lahner, M., Roth, G., Krenn, C., Jault, P., Gabard, J., Leclerc, T., Jennes, S., Que, Y., Rousseau, A., Ravat, F., Eissa, A., Al-Harbi, S., Aldabbagh, T., Abdellatif., S., Paramba, F., Purayil, N., Naushad, V., Mohammad, O., Negi, V., Chandra, P., Kleinsasser, A., Witrz, M. R., Buchner-Doeven, J. F., Tuip-de Boer, A. M., Goslings, J. C., Van Hezel, M., Boing, A, Van Bruggen, R, Juffermans, N, Markopoulou, D., Venetsanou, K., Kaldis, V., Koutete, D., Chroni, D., Alamanos, I., Koch, L., Walter, E., Maekawa, K., Hayakawa, M., Kushimoto, S., Shiraishi, A., Kato, H., Sasaki, J., Matauoka, T., Uejima, T., Morimura, N., Hagiwara, A., Takeda, M., Tarabrin, O., Shcherbakow, S., Gavrychenko, D., Mazurenko, G., Ivanova, V., Chystikov, O., Plourde, C., Lessard, J., Chauny, J., Daoust, R., Kropman, L., In het Panhuis, L., Konings, J., Huskens, D., Schurgers, E., Roest, M., De Laat, B., Lance, M., Durila, M., Lukas, P., Astraverkhava, M., Jonas, J., Budnik, I., Shenkman, B., Hayami, H., Koide, Y., Goto, T., Iqbal, R., Alhamdi, Y., Venugopal, N., Abrams, S., Downey, C., Toh, C. H., Welters, I. D., Bombay, V. B., Chauny, J. M., Daoust, R. D., Lessard, J. L., Marquis, M. M., Paquet, J. P., Siemens, K., Sangaran, D., Hunt, B. J., Durward, A., Nyman, A., Murdoch, I. A., Tibby, S. M., Ampatzidou, F., Moisidou, D., Dalampini, E., Nastou, M., Vasilarou, E., Kalaizi, V., Chatzikostenoglou, H., Drossos, G., Spadaro, S., Fogagnolo, A., Fiore, T., Schiavi, A., Fontana, V., Taccone, F., Volta, C., Chochliourou, E., Volakli, E., Violaki, A., Samkinidou, E., Evlavis, G., Panagiotidou, V., Sdougka, M., Mothukuri, R., Battle, C., Guy, K., Wijesuriya, J., Keogh, S., Docherty, A., O’Donnell, R., Brunskill, S., Trivella, M., Doree, C., Holst, L., Parker, M., Gregersen, M., Almeida, J., Walsh, T., Stanworth, S., Moravcova, S., Mansell, J., Rogers, A., Smith, R. A., Hamilton-Davies, C., Omar, A., Allam, M., Bilala, O., Kindawi, A., Ewila, H., Malamas, A., Ferreira, G., Caldas, J., Fukushima, J., Osawa, E. A., Arita, E., Camara, L., Zeferino, S., Jardim, J., Gaioto, F., Dallan, L., Jatene, F. B., Kalil Filho, R., Galas, F., Hajjar, L. A., Mitaka, C., Ohnuma, T., Murayama, T., Kunimoto, F., Nagashima, M., Takei, T., Tomita, M., Mahmoud, K., Hanoura, S., Sudarsanan, S., Sivadasan, P., Othamn, H., Shouman, Y., Singh, R., Al Khulaifi, A., Mandel, I., Mikheev, S., Suhodolo, I., Kiselev, V., Svirko, Y., Podoksenov, Y., Jenkins, S. A., Griffin, R., Tovar Doncel, M. S., Lima, A., Aldecoa, C., Ince, C., Taha, A., Shafie, A., Mostafa, M., Syed, N., Hon, H., Righetti, F., Colombaroli, E., Castellano, G., Hravnak, M., Chen, L. C., Dubrawski, A. D., Clermont, G. C., Pinsky, M. R., Gonzalez, S., Macias, D., Acosta, J., Jimenez, P., Loza, A., Lesmes, A., Lucena, F., Leon, C., Bastide, M., Richecoeur, J., Frenoy, E., Lemaire, C., Sauneuf, B., Tamion, F., Nseir, S., Du Cheyron, D., Dupont, H., Maizel, J., Shaban, M., Kolko, R., AbuRageila, M., AlHussain, A., Mercado, P., Kontar, L., Titeca, D., Brazier, F., Riviere, A., Joris, M., Soupison, T., De Cagny, B., Slama, M., Wagner, J., Körner, A., Kubik, M., Kluge, S., Reuter, D., Saugel, B., Tran, T., De Bels, D., Cudia, A., Strachinaru, M., Ghottignies, P., Devriendt, J., Pierrakos, C., Martínez González, Ó., Blancas, R., Luján, J., Ballesteros, D., Martínez Díaz, C., Núñez, A., Martín Parra, C., López Matamala, B., Alonso Fernández, M., Chana, M., Huber, W., Eckmann, M., Elkmann, F., Gruber, A., Klein, I., Schmid, R. M., Lahmer, T., Moller, P. W., Sondergaard, S., Jakob, S. M., Takala, J., Berger, D., Bastoni, D., Aya, H., Toscani, L., Pigozzi, L., Rhodes, A., Cecconi, M., Ostrowska, C., Abbas, A., Mellinghoff, J., Ryan, C., Dawson, D., Cronhjort, M., Wall, O., Nyberg, E., Zeng, R., Svensen, C., Mårtensson, J., Joelsson-Alm, E., Parenti, N., Palazzi, C., Amidei, L. A., Borrelli, F. B., Campanale, S. C., Tagliazucchi, F. T., Sedoni, G. S., Lucchesi, D. L., Carella, E. C., Luciani, A. L, Mackovic, M., Maric, N., Bakula, M., Grounds, R. M., Fletcher, N., Avard, B., Zhang, P., Mezidi, M., Charbit, J., Ould-Chikh, M., Deras, P., Maury, C., Martinez, O., Capdevila, X., Hou, P., Linde-Zwirble, W. Z., Douglas, I. D., Shapiro, N. S., Ben Aicha, Y., Laribi, B., Jeribi, B., Pereira, C., Marinho, R., Antunes, R., Marinho, A., Crivits, M., Raes, M., Decruyenaere, J., Hoste, E., Bagin, V., Rudnov, V., Savitsky, A., Astafyeva, M., Korobko, I., Vein, V., Kampmeier, T., Arnemann, P., Hessler, M., Wald, A., Bockbreder, K., Morelli, A., Van Aken, H., Rehberg, S., Ertmer, C., Reddy, S., Bailey, M., Beasley, R., Bellomo, R., Mackle, D., Psirides, A., Young, P., Venkatesh, H., Ramachandran, S., Basu, A., Nair, H., Egan, S., Bates, J., Oliveira, S., Rangel Neto, N. R., Reis, F. Q., Lee, C. P., Lin, X. L., Choong, C., Eu, K. M., Sim, W. Y., Tee, K. S., Pau, J., Abisheganaden, J., Maas, K., De Geus, H., Lafuente, E., Moura, J., Doris, T. E., Monkhouse, D., Shipley, T., Kardasz, S., Gonzalez, I, Stads, S., Groeneveld, A. J., Elsayed, I., Ward, N., Raithatha, A., Steuber, A., Pelletier, C., Schroeder, S., Michael, E., Slowinski, T., Kindgen-Milles, D., Ghabina, S., Turani, F., Belli, A., Busatti, S., Barettin, G., Candidi, F., Gargano, F., Barchetta, R., Falco, M., Demirkiran, O., Kosuk, M., Bozbay, S., Weber, V., Hartmann, J., Harm, S., Linsberger, I., Eichhorn, T., Valicek, G., Miestinger, G., Hoermann, C., Faenza, S., Ricci, D., Mancini, E., Gemelli, C., Cuoghi, A., Magnani, S., Atti, M., Laddomada, T., Doronzio, A., Balicco, B., Gruda, M. C., O’Sullivan, P., Dan, V. P., Guliashvili, T., Scheirer, A., Golobish, T. D., Capponi, V. J., Chan, P. P., Kogelmann, K., Drüner, M., Jarczak, D., Belli, A. B., Martni, S. M., Cotticelli, V. C., Mounajergi, F., Morimoto, S., Hussain, I., Nadeem, A., Ghorab, K., Maghrabi, K., Kloesel, S. K., Goldfuss, C., Stieglitz, A., Stieglitz, A. S., Krstevska, L., Albuszies, G., Jimmy, G., Izawa, J., Iwami, T., Uchino, S., Takinami, M., Kitamura, T., Kawamura, T., Powell-Tuck, J. G., Crichton, S., Raimundo, M., Camporota, L., Wyncoll, D., Ostermann, M., Hana, A., De Geus, H. R., Aydogdu, M., Boyaci, N., Yuksel, S., Gursel, G., Cayci Sivri, A. B., Meza-Márquez, J., Nava-López, J., Carrillo-Esper, R., Dardashti, A., Grubb, A., Wetzstein, M., Peters, E., Njimi, H., Pickkers, P., Waraich, M., Doyle, J., Samuels, T., Forni, L., Desai, N., Baumber, R., Gunning, P., Sell, A., Lin, S., Torrence, H., O’Dwyer, M., Kirwan, C., Prowle, J., Kim, T., O’Connor, M. E., Hewson, R. W., Kirwan, C. J., Pearse, R. M., Maksoud, M., Uzundere, O., Memis, D., Ýnal, M., Gultekin, A., Turan, N., Aydin, M. A., Basar, H., Sencan, I., Kapuagasi, A., Ozturk, M., Uzundurukan, Z., Gokmen, D., Ozcan, A., Kaymak, C., Artemenko, V. A., Budnyuk, A., Pugh, R., Bhandari, S., Mauri, T., Turrini, C., Langer, T., Taccone, P., Volta, C. A., Marenghi, C., Gattinoni, L., Pesenti, A., Sweeney, L., O’Sullivan, A., Kelly, P., Mukeria, E., MacLoughlin, R., Pfeffer, M., Thomas, J. T., Bregman, G. B., Karp, G. K., Kishinevsky, E. K., Stavi, D. S., Adi, N. A., Poropat, T., Knafelj, R., Llopart, E., Batlle, M., De Haro, C., Mesquida, J., Artigas, A., Pavlovic, D., Lewerentz, L., Spassov, A., Schneider, R., De Smet, S., De Raedt, S., Derom, E., Depuydt, P, Oeyen, S., Benoit, D., Gobatto, A., Besen, B., Tierno, P., Melro, L., Mendes, P., Cadamuro, F., Park, M., Malbouisson, L. M., Civantos, B. C., Lopez, J. L., Robles, A., Figueira, J., Yus, S., Garcia, A., Oglinda, A., Ciobanu, G., Oglinda, C., Schirca, L., Sertinean, T., Lupu, V., Wolny, M., Pagano, A., Numis, F., Visone, G., Saldamarco, L., Russo, T., Porta, G., Paladino, F., Bell, C., Liu, J., Debacker, J., Lee, C., Tamberg, E., Campbell, V., Mehta, S., Kara, Ý., Yýldýrým, F., Zerman, A., Güllü, Z., Boyacý, N., Basarýk Aydogan, B., Gaygýsýz, Ü., Gönderen, K., Arýk, G., Turkoglu, M., Aygencel, G., Ülger, Z., Isýkdogan, Z., Özdedeoglu, Ö., Badoglu, M., Gaygýsýz, U., Kongpolprom, N., Sittipunt, C., Eden, A., Kokhanovsky, Y., Bursztein – De Myttenaere, S., Pizov, R., Neilans, L., MacIntyre, N., Radosevich, M., Wanta, B., Meyer, T., Smischney, N., Brown, D., Diedrich, D., Fuller, A., McLindon, P., Sim, K., Shoaeir, M., Noeam, K., Mahrous, A., Matsa, R., Ali, A., Dridi, C., Haddad, F., Pérez-Calatayud, A., Zepeda-Mendoza, A., Diaz-Carrillo, M., Arch-Tirado, E., Carbognin, S., Pelacani, L., Zannoni, F., Agnoli, A., Gagliardi, G., Cho, R., Adams, A., Lunos, S., Ambur, S., Shapiro, R., Prekker, M., Thijssen, M., Janssen, L., Foudraine, N., Voscopoulos, C. J., Freeman, J., George, E., Eversole, D., Muttini, S., Bigi, R., Villani, G., Patroniti, N., Williams, G., George, E, Waldmann, A., Böhm, S., Windisch, W., Strassmann, S., Karagiannidis, C., Karagiannidis, C. K., Waldmann, A. W., Böhm, S. B., Windisch, W. W., Persson, P., Lundin, S., Stenqvist, O., Serra, C. S., Pagano, A. P., Masarone, M. M., Rinaldi, L. R., Amelia, A. A., Fascione, M. F., Adinolfi, L. A., Ruggiero, E. R., Asota, F., O’Rourke, K., Ranjan, S., Morgan, P., DeBacker, J. W., O’Neill, L., Munshi, L., Burry, L., Fan, E., Poo, S., Mahendran, K., Fowles, J., Gerrard, C., Vuylsteke, A., Loveridge, R., Chaddock, C., Patel, S., Kakar, V., Willars, C., Hurst, T., Park, C., Best, T., Vercueil, A., Auzinger, G., Borgman, A., Proudfoot, A. G., Grins, E., Emiley, K. E., Schuitema, J., Fitch, S. J., Marco, G., Sturgill, J., Dickinson, M. G., Strueber, M., Khaghani, A., Wilton, P., Jovinge, S. M., Sampson, C., Harris-Fox, S., Cove, M. E., Vu, L. H., Sen, A., Federspiel, W. J., Kellum, J. A., Mazo Torre, C., Riera, J., Ramirez, S., Borgatta, B., Lagunes, L., Rello, J., Kuzovlev, A. K., Goloubev, A., Nenchuk, S., Karavana, V., Glynos, C., Asimakos, A., Pappas, K., Vrettou, C., Magkou, M., Ischaki, E., Stathopoulos, G., Zakynthinos, S., Kozhevnikova, I., Dalla Corte, F., Grasso, S., Casolari, P., Caramori, G., Andrianjafiarinoa, T., Randriamandrato, T., Rajaonera, T., El-Dash, S., Costa, E. L. V., Tucci, M. R., Leleu, F, Kontar, L, Bacari-Risal, G., Amato, M., El Dash, S., Remmington, Fischer, A., Squire, S., Boichat, M., Honzawa, H., Yasuda, H., Adati, T., Suzaki, S., Horibe, M., Sasaki, M., Sanui, M., Daniel, J., Miranda, H., Milinis, K., Cooper, M., Williams, G. R., McCarron, E., Simants, S., Patanwala, I., Welters, I., Su, Y., Fernández Villanueva, J., Fernández Garda, R., López Lago, A., Rodríguez Ruíz, E., Hernández Vaquero, R., Tomé Martínez de Rituerto, S., Varo Pérez, E., Lefel, N., Schaap, F., Bergmans, D., Olde Damink, S., Van de Poll, M., Tizard, K., Lister, C., Poole, L., Ringaitiene, D., Gineityte, D., Vicka, V., Norkiene, I., Sipylaite, J., O’Loughlin, A., Maraj, V., Dowling, J., Velasco, M. B., Dalcomune, D. M., Dias, E. B., Fernandes, S. L., Oshima, T., Graf, S., Heidegger, C., Genton, L., Karsegard, V., Dupertuis, Y., Pichard, C., Friedli, N., Stanga, Z., Vandersteen, L., Stessel, B., Evers, S., Van Assche, A., Jamaer, L., Dubois, J., Castro, H., Valente, J., Martins, P., Casteloes, P., Magalhaes, C., Cabral, S., Santos, M., Oliveira, B., Salgueiro, A., Duarte, S., Castro, S., Melo, M., Gray, S., Maipang, K., Bhurayanontachai, R., Grädel, L. G., Schütz, P., Langlois, P., Manzanares, W., Lemieux, M., Elke, G., Bloos, F., Heyland, D., Aramendi, I., Babo, N., Hoshino, M., Haraguchi, Y., Kajiwara, S., Mitsuhashi, T., Tsubata, T., Aida, M., Rattanapraphat, T., Kongkamol, C., Xavier, B., Koutsogiannidis, C., Moschopoulou, M., Taskin, G., Çakir, M., Güler, AK, Taskin, A., Öcal, N., Özer, S., Yamanel, L., Wong, J. M., Fitton, C., Anwar, S., Stacey, S., Aggou, M., Fyntanidou, B., Patsatzakis, S., Oloktsidou, E., Lolakos, K., Papapostolou, E., Grosomanidis, V., Gaudry, S., Desailly, V., Pasquier, P., Brun, PB, Tesnieres, AT, Ricard, JD, Dreyfuss, D., Mignon, A., White, J. C, Stilwell, A., Friedlaender, G., Peters, M., Stipulante, S., Delfosse, A., Donneau, AF, Ghuysen, A., Feldmann, C., Freitag, D., Dersch, W., Irqsusi, M., Eschbach, D., Steinfeldt, T., Wulf, H., Wiesmann, T., Cholkraisuwat, J., Beitland, S., Nakstad, E., Stær-Jensen, H., Drægni, T., Andersen, G., Jacobsen, D., Brunborg, C., Waldum-Grevbo, B., Sunde, K., Hoyland, K., Pandit, D., Hayakawa, K., Kotzampassi, K., Loukipoudi, L., Doumaki, E., Admiraal, M. M., Van Assen, M., Van Putten, M. J., Tjepkema-Cloostermans, M., Van Rootselaar, A. F., Ragusa, F., Marudi, A., Baroni, S., Gaspari, A., Bertellini, E., Abdullah, T., Abdel Monem, S., Alcorn, S., McNeill, S., Russell, S., Eertmans, W., Genbrugge, C., Meex, I., Dens, J., Jans, F., De Deyne, C., Avard, B, Burns, R, Patarchi, A., Spina, T., Tanaka, H., Otani, N., Ode, S., Ishimatsu, S., Cho, J., Moon, J. B., Park, C. W., Ohk, T. G., Shin, M. C., Won, M. H., Dakova, S., Ramsheva, Z., Ramshev, K., Marudi, A, Baroni, S, Gaspari, A, Bertellini, E, Ozcan, P. E., Sencer, S., Ulusoy, C., Fallenius, M., Skrifvars, M. B., Reinikainen, M., Bendel, S., Raj, R., Abu-Habsa, M., Hymers, C., Borowska, A., Sivadhas, H., Sahiba, S., Perkins, S., Rubio, J., Rubio, J. A., Sierra, R., English, S., Chasse, M., Turgeon, A., Lauzier, F., Griesdale, D., Garland, A., Fergusson, D., Zarychanski, R., Tinmouth, A., Van Walraven, C., Montroy, K., Ziegler, J., Dupont Chouinard, R., Carignan, R., Dhaliwal, A., Lum, C., Sinclair, J., Pagliarello, G., McIntyre, L., Groza, T., Moreau, N., Castanares-Zapatero, D., Hantson, P., Carbonara, M., Ortolano, F., Zoerle, T., Magnoni, S., Pifferi, S., Conte, V., Stocchetti, N., Carteron, L., Suys, T., Patet, C., Quintard, H., Oddo, M., Spatenkova, V., Pokorna, E., Suchomel, P., Ebert, N., Bylinski, T., Hawthorne, C., Shaw, M., Piper, I., Kinsella, J., Kink, A. K., Rätsep, I. R., Boutin, A., Moore, L., Lacroix, J., Lessard-Bonaventure, P., Turgeon, A. F., Green, R., Erdogan, M., Butler, M., Desjardins, P., Fergusson, D. A., Goncalves, B., Vidal, B., Valdez, C., Rodrigues, A. C., Miguez, L., Moralez, G., Hong, T., Kutz, A., Hausfater, P., Amin, D., Struja, T., Haubitz, S., Huber, A., Brown, T., Collinson, J., Pritchett, C., Slade, T., Le Guen, M., Hellings, S., Ramsaran, R., Alsheikhly, A., Abe, T., Kanapeckaite, L., Bahl, R., Russell, M. Q., Real, K. J., Lyon, R. M., Oveland, N. P., Penketh, J., Mcdonald, M., Kelly, F., Alfafi, M., Almutairi, W., Alotaibi, B., Van den Berg, A. E, Schriel, Y., Dawson, L., Meynaar, I. A., Silva, D., Fernandes, S., Gouveia, J., Santos Silva, J., Foley, J., Kaskovagheorgescu, A., Evoy, D., Cronin, J., Ryan, J., Huck, M., Hoffmann, C., Renner, J., Laitselart, P., Donat, N., Cirodde, A., Schaal, J. V., Masson, Y., Nau, A., Howarth, O., Davenport, K., Jeanrenaud, P., Raftery, S., MacTavish, P., Devine, H., McPeake, J., Daniel, M., Quasim, T., Alrabiee, S., Alrashid, A., Gundogan, O., Bor, C., Akýn Korhan, E., Demirag, K., Uyar, M., Frame, F., Ashton, C., Bergstrom Niska, L., Dilokpattanamongkol, P., Suansanae, T., Suthisisang, C., Morakul, S., Karnjanarachata, C., Tangsujaritvijit, V., Mahmood, S., Al Thani, H., Almenyar, A., Morton, S. E., Chiew, Y. S., Pretty, C., Chase, J. G., Shaw, G. M., Kordis, P., Grover, V., Kuchyn, I., Bielka, K., Aidoni, Z., Stavrou, G., Skourtis, C., Lee, S. D., Williams, K., Weltes, I. D., Berhane, S., Arrowsmith, C., Peters, C., Robert, S., Panerai, R. B., Robinson, T. G., Borg-Seng-Shu, E., De Lima Oliveira, M., Mian, N. C., Nogueira, R., Zeferino, S. P., Jacobsen Teixeira, M., Killeen, P., McPhail, M., Bernal, W., Maggs, J., Wendon, J., Hughes, T., Taniguchi, L. U., Siqueira, E. M., Vieira Jr, J. M., Azevedo, L. C., Ahmad, A. N., Helme, E., Hadfield, S., Shak, J., Senver, C., Howard-Griffin, R., Wacharasint, P., Fuengfoo, P., Sukcharoen, N., Rangsin, R., Sbiti-Rohr, D., Na, H., Song, S., Lee, S., Jeong, E., Lee, K., Zoumpelouli, E., Volakli, E. A, Chrysohoidou, V., Charisopoulou, K., Kotzapanagiotou, E., Manavidou, K., Stathi, Z., AlGhamdi, B., Marashly, Q., Zaza, K., Khurshid, M., Ali, Z., Malgapo, M., Jamil, M., Shafquat, A., Shoukri, M., Hijazi, M., Rocha, F. A., Ebecken, K., Rabello, L. S., Lima, M. F., Hatum, R., De Marco, F. V., Alves, A., Pinto, J. E., Godoy, M., Brasil, P. E., Bozza, F. A., Salluh, J. I., Soares, M., Krinsley, J., Kang, G., Perry, J., Hines, H., Wilkinson, K. M., Tordoff, C., Sloan, B., Bellamy, M. C., Moreira, E., Verga, F., Barbato, M., Burghi, G., Soares, M, Silva, U. V., Torelly, A. P., Kahn, J. M., Angus, D. C., Knibel, M. F., Marshall, R., Gilpin, T., Mota, D., Loureiro, B., Dias, J., Afonso, O., Coelho, F., Martins, A., Faria, F., Al Orainni, H., AlEid, F., Tlaygeh, H., Itani, A., Hejazi, A., Messika, J., Ricard, J. D., Guillo, S., Pasquet, B., Dubief, E., Tubach, F., James, K., Temblett, P., Davies, L., Lynch, C., Pereira, S., Cavaco, S., Fernandes, J., Moreira, I., Almeida, E., Seabra Pereira, F., Malheiro, M., Cardoso, F., Aragão, I., Cardoso, T., Fister, M., Muraray Govind, P., Brahmananda Reddy, N., Pratheema, R., Arul, E. D., Devachandran, J., Chin-Yee, N., D’Egidio, G., Thavorn, K., Kyeremanteng, K., Murchison, A. G., Swalwell, K., Mandeville, J., Stott, D., Guerreiro, I., Goossens, C., Marques, M. B., Derde, S., Vander Perre, S., Dufour, T., Thiessen, S. E., Güiza, F., Janssens, T., Hermans, G., Vanhorebeek, I., De Bock, K., Van den Berghe, G., Langouche, L., Miles, B., Madden, S., Weiler, M., Marques, P., Rodrigues, C., Boeira, M., Brenner, K., Leães, C., Machado, A., Townsend, R., Andrade, J., Kishore, R., Fenlon, C., Fiks, T., Ruijter, A., Te Raa, M., Spronk, P., Docherty, P., Dickson, J., Moltchanova, E., Scarrot, C., Hall, T., Ngu, W. C., Jack, J. M., Pavli, A., Gee, X., Akin Korhan, E., Shirazy, M., Fayed, A., Gupta, S., Kaushal, A., Dewan, S., Varma, A., Ghosh, E., Yang, L., Eshelman, L., Lord, B., Carlson, E., Broderick, R., Ramos, J., Forte, D., Yang, F., Feeney, J., Wilkinson, K., Shuker, K., Faulds, M., Bryden, D., England, L., Shuker, K, Tridente, A, Faulds, M, Matheson, A, Gaynor, J., Bryden, D, Peroni, B., Daglius-Dias, R., Miranda, L., Cohen, C., Carvalho, C., Velasco, I., Kelly, J. M., Neill, A., Rubenfeld, G., Masson, N., Min, A., Boezeman, E., Hofhuis, J., Hovingh, A., De Vries, R., Cabral-Campello, G., Van Mol, M., Nijkamp, M., Kompanje, E., Ostrowski, P., Kiss, K., Köves, B., Csernus, V., Molnár, Z., Hoydonckx, Y., Vanwing, S., Medo, V., Galvez, R., Miranda, J. P., Stone, C., Wigmore, T., Arunan, Y., Wheeler, A., Wong, Y., Poi, C., Gu, C., Molmy, P., Van Grunderbeeck, N., Nigeon, O., Lemyze, M., Thevenin, D., Mallat, J., Correa, M., Carvalho, R. T., Fernandez, A., McBride, C., Koonthalloor, E., Walsh, C., Webber, A., Ashe, M., Smith, K., Volakli, E. A., Dimitriadou, M., Mantzafleri, P., Vrani, O., Arbouti, A., Varsami, T., Bollen, J. A., Van Smaalen, T. C., De Jongh, W. C., Ten Hoopen, M. M., Ysebaert, D., Van Heurn, L. W., Van Mook, W. N., Roze des Ordons, A., Couillard, P., Doig, C., Van Keer, R. V., Deschepper, R. D., Francke, A. F., Huyghens, L. H., Bilsen, J. B., Nyamaizi, B., Dalrymple, C., Dobru, A., Marrinan, E., Ankuli, A., Struthers, R., Crawford, R., Mactavish, P., Morelli, P., Degiovanangelo, M., Lemos, F., MArtinez, V., Cabrera, J., Rutten, A., Van Ieperen, S., De Geer, S., Van Vugt, M., Der Kinderen, E., Giannini, A., Miccinesi, G, Marchesi, T, and Prandi, E

Subjects
Protocol (science), medicine.medical_specialty, business.industry, medicine.medical_treatment, French, 030208 emergency & critical care medicine, Compression (physics), Critical Care and Intensive Care Medicine, Meeting Abstracts, language.human_language, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Ventilation (architecture), Emergency medicine, language, Medicine, 030212 general & internal medicine, Cardiopulmonary resuscitation, business
Abstract

Table of contents P001 - Sepsis impairs the capillary response within hypoxic capillaries and decreases erythrocyte oxygen-dependent ATP efflux R. M. Bateman, M. D. Sharpe, J. E. Jagger, C. G. Ellis P002 - Lower serum immunoglobulin G2 level does not predispose to severe flu. J. Solé-Violán, M. López-Rodríguez, E. Herrera-Ramos, J. Ruíz-Hernández, L. Borderías, J. Horcajada, N. González-Quevedo, O. Rajas, M. Briones, F. Rodríguez de Castro, C. Rodríguez Gallego P003 - Brain protective effects of intravenous immunoglobulin through inhibition of complement activation and apoptosis in a rat model of sepsis F. Esen, G. Orhun, P. Ergin Ozcan, E. Senturk, C. Ugur Yilmaz, N. Orhan, N. Arican, M. Kaya, M. Kucukerden, M. Giris, U. Akcan, S. Bilgic Gazioglu, E. Tuzun P004 - Adenosine a1 receptor dysfunction is associated with leukopenia: A possible mechanism for sepsis-induced leukopenia R. Riff, O. Naamani, A. Douvdevani P005 - Analysis of neutrophil by hyper spectral imaging - A preliminary report R. Takegawa, H. Yoshida, T. Hirose, N. Yamamoto, H. Hagiya, M. Ojima, Y. Akeda, O. Tasaki, K. Tomono, T. Shimazu P006 - Chemiluminescent intensity assessed by eaa predicts the incidence of postoperative infectious complications following gastrointestinal surgery S. Ono, T. Kubo, S. Suda, T. Ueno, T. Ikeda P007 - Serial change of c1 inhibitor in patients with sepsis – A prospective observational study T. Hirose, H. Ogura, H. Takahashi, M. Ojima, J. Kang, Y. Nakamura, T. Kojima, T. Shimazu P008 - Comparison of bacteremia and sepsis on sepsis related biomarkers T. Ikeda, S. Suda, Y. Izutani, T. Ueno, S. Ono P009 - The changes of procalcitonin levels in critical patients with abdominal septic shock during blood purification T. Taniguchi, M. O P010 - Validation of a new sensitive point of care device for rapid measurement of procalcitonin C. Dinter, J. Lotz, B. Eilers, C. Wissmann, R. Lott P011 - Infection biomarkers in primary care patients with acute respiratory tract infections – Comparison of procalcitonin and C-reactive protein M. M. Meili, P. S. Schuetz P012 - Do we need a lower procalcitonin cut off? H. Hawa, M. Sharshir, M. Aburageila, N. Salahuddin P013 - The predictive role of C-reactive protein and procalcitonin biomarkers in central nervous system infections with extensively drug resistant bacteria V. Chantziara, S. Georgiou, A. Tsimogianni, P. Alexandropoulos, A. Vassi, F. Lagiou, M. Valta, G. Micha, E. Chinou, G. Michaloudis P014 - Changes in endotoxin activity assay and procalcitonin levels after direct hemoperfusion with polymyxin-b immobilized fiber A. Kodaira, T. Ikeda, S. Ono, T. Ueno, S. Suda, Y. Izutani, H. Imaizumi P015 - Diagnostic usefullness of combination biomarkers on ICU admission M. V. De la Torre-Prados, A. Garcia-De la Torre, A. Enguix-Armada, A. Puerto-Morlan, V. Perez-Valero, A. Garcia-Alcantara P016 - Platelet function analysis utilising the PFA-100 does not predict infection, bacteraemia, sepsis or outcome in critically ill patients N. Bolton, J. Dudziak, S. Bonney, A. Tridente, P. Nee P017 - Extracellular histone H3 levels are inversely correlated with antithrombin levels and platelet counts and are associated with mortality in sepsis patients G. Nicolaes, M. Wiewel, M. Schultz, K. Wildhagen, J. Horn, R. Schrijver, T. Van der Poll, C. Reutelingsperger P018 - Il-8: is this a more reliable biomarker for sepsis severity than CRP, Procalcitonin, E-selectin, IL-6 and TNF-[alpha] S. Pillai, G. Davies, G. Mills, R. Aubrey, K. Morris, P. Williams, P. Evans P019 - Relation between adrenomedullin and short-term outcome in ICU patients: Results from the frog ICU study E. G. Gayat, J. Struck, A. Cariou, N. Deye, B. Guidet, S. Jabert, J. Launay, M. Legrand, M. Léone, M. Resche-Rigon, E. Vicaut, A. Vieillard-Baron, A. Mebazaa P020 - Impact of disease severity assessment on performance of heparin-binding protein for the prediction of septic shock R. Arnold, M. Capan, A. Linder, P. Akesson P021 - Kinetics and prognostic value of presepsin (sCD14) in septic patients. A pilot study M. Popescu, D. Tomescu P022 - Comparison of CD64 levels performed by the facs and accellix systems C. L. Sprung, R. Calderon Morales, G. Munteanu, E. Orenbuch-Harroch, P. Levin, H. Kasdan, A. Reiter, T. Volker, Y. Himmel, Y. Cohen, J. Meissonnier P023 - Diagnosing sepsis in 5 minutes: Nanofluidic technology study with pancreatic-stone protein (PSP/ reg) L. Girard, F. Rebeaud P024 - How nanotechnology-based approaches could contribute to sepsis prevention, diagnosis and treatment I. Herrmann P025 - Il7r transcriptional expression analysis during septic shock B. Delwarde, E. Peronnet, E. Cerrato, F. Venet, A. Lepape, T. Rimmelé, G. Monneret, J. Textoris P026 - Disbalance of microbial metabolites of aromatic acids affects the severity in critically ill patients N. Beloborodova, V. Moroz, A. Osipov, A. Bedova, Y. Sarshor, A. Pautova, A. Sergeev, E. Chernevskaya P027 - Copeptin predicts 10-year all-cause mortality in community patients J. Odermatt, R. Bolliger, L. Hersberger, M. Ottiger, M. Christ-Crain, B. Mueller, P. Schuetz P028 - Identification of differential proteomic response in septic patients secondary to community and hospital acquired pneumonia N. K. Sharma, A. K. Tashima, M. K. Brunialti, F. R. Machado, M. Assuncao, O. Rigato, R. Salomao P029 - Monocyte HLA-DR expression in community-acquired bacteremic sepsis - dynamics associated to aetiology and prediction of secondary sepsis S. C. Cajander, G. Rasmussen, E. Tina, B. Söderquist, J. Källman, K. Strålin P030 - Soluble B- and T-lymphocyte attenuator: A possible prognostic marker in sepsis A. L. Lange, J. S. Sundén-Cullberg, A. M. Magnuson, O. H. Hultgren P031 - Fractal dimension: A new biomarker for quantifying clot microstructure in patients across the sepsis spectrum G. Davies, S. Pillai, G. Mills, R. Aubrey, K. Morris, P. Williams, P. Evans P032 - Comparison between the new biomarker for coagulation, clot microstructure (Df) with rotational thromboelastometry (ROTEM) in patients across the sepsis spectrum S. Pillai, G. Davies, G. Mills, R. Aubrey, K. Morris, P. Williams, P. Evans P033 - Changes in fibrinolysis across the sepsis spectrum: The use of rotational thromboelastometry (ROTEM) lysis index (LI60) and D-Dimer concentration S. Pillai, G. Davies, G. Mills, R. Aubrey, K. Morris, P. Williams, P. Evans P034 - The intensive care infection score – a promising marker for the prediction of infection and its severity. P. Van der Geest, M. Mohseni, J. Linssen, R. De Jonge, S. Duran, J. Groeneveld P035 - Challenges in the clinical diagnosis of sepsis R. Miller III, B. K. Lopansri, L. C. McHugh, A. Seldon, J. P. Burke P036 - Does zero heat flux thermometry more accurately identify sepsis on intensive care? J. Johnston, R. Reece-Anthony, A. Bond, A. Molokhia P037 - Advancing quality (AQ) sepsis programme: Improving early identification & treatment of sepsis in North West England. C. Mcgrath, E. Nsutebu P038 - Prehospital transport of acute septic patients P. Bank Pedersen, D. Pilsgaard Henriksen, S. Mikkelsen, A. Touborg Lassen P039 - Vasodilatory plant extracts gel as an alternative treatment for fever in critically ill patients R. Tincu, C. Cobilinschi, D. Tomescu, Z. Ghiorghiu, R. Macovei P040 - Host response and outcome of hypothermic sepsis M. A. Wiewel, M. B. Harmon, L. A. Van Vught, B. P. Scicluna, A. J. Hoogendijk, J. Horn, A. H. Zwinderman, O. L. Cremer, M. J. Bonten, M. J. Schultz, T. Van der Poll, N. P. Juffermans, W. J. Wiersinga P041 - Septic shock alert over SIRS criteria has an impact on outcome but needs to be revised G. Eren, Y Tekdos, M. Dogan, O. Acicbe, E. Kaya, O. Hergunsel P042 - Association between previous prescription of βblockers and mortality rate among septic patients: A retrospective observational study S. Alsolamy, G. Ghamdi, L. Alswaidan, S. Alharbi, F. Alenezi, Y. Arabi P043 - Recognition and treatment of sepsis on labour ward– teaching & information resources can improve knowledge J. Heaton, A. Boyce, L. Nolan, J. Johnston, A. Dukoff-Gordon, A. Dean, A. Molokhia P044 - Culture negative sepsis in the ICU – what is unique to this patient population? T. Mann Ben Yehudah P045 - Organ dysfunction in severe sepsis patients identified in administrative data in Germany, 2007-2013 C. Fleischmann, D. Thomas-Rueddel, C. Haas, U. Dennler, K. Reinhart P046 - A comparison of residents’ knowledge regarding; the Surviving Sepsis Campaign 2012 guideline O. Suntornlohanakul, B. Khwannimit P047 - Effectiveness of a septic shock bundle to improve outcomes in the ICU F. Breckenridge, A. Puxty P048 - Dose of norepinephrine in the first 24 hours as a parameter evaluating the effectiveness of treatment in patients with severe sepsis and septic shock P. Szturz, P. Folwarzcny, J. Svancara, R. Kula, P. Sevcik P049 - Norepinephrine or vasopressin + norepinephrine in septic shock. A retrospective series of 39 patients L. Caneva, A. Casazza, E. Bellazzi, S. Marra, L. Pagani, M. Vetere, R. Vanzino, D. Ciprandi, R. Preda, R. Boschi, L. Carnevale P050 - Methylene blue effectiveness as contributory treatment in patients with septic shock V. Lopez, M. Aguilar Arzapalo, L. Barradas, A. Escalante, J. Gongora, M. Cetina P051 - Coagulation disorders in patients with severe sepsis and DIC evaluated with thromboelastometry. B Adamik, D Jakubczyk, A Kübler P052 - Frequency and outcome of early sepsis-associated coagulopathy A. Radford, T. Lee, J. Singer, J. Boyd, D. Fineberg, M. Williams, J. Russell P053 - Assessment of coagulopathy in cancer patients with severe sepsis or septic shock. A case-control pilot study E. Scarlatescu, D. Tomescu, G. Droc, S. Arama P054 - Thromboelastometry in critically ill patients with disseminated intravascular coagulation M. Müller, M. Straat, S. S. Zeerleder, N. P. Juffermans P055 - Cessation of a preexisting chronic antiplatelet therapy is associated with increased mortality rates in severe sepsis and septic shock C. F. Fuchs, C. S. Scheer, S. W. Wauschkuhn, M. V. Vollmer, K. M. Meissner, S. K. Kuhn, K. H. Hahnenkamp, S. R. Rehberg, M. G. Gründling P056 - Neutrophil Extracellular Traps (NETs) production under hypoxic condition N. Yamamoto, M. Ojima, S. Hamaguchi, T. Hirose, Y. Akeda, R. Takegawa, O. Tasaki, T. Shimazu, K. Tomono P057 - Impact of ultraviolet air sterilizer in intensive care unit room, and clinical outcomes of patients E. Gómez-Sánchez, M. Heredia-Rodríguez, E. Álvarez-Fuente, M. Lorenzo-López, E. Gómez-Pesquera, M. Aragón-Camino, P. Liu-Zhu, A. Sánchez-López, A. Hernández-Lozano, M. T. Peláez-Jareño, E. Tamayo P058 - Focus of infection in severe sepsis - comparison of administrative data and prospective cohorts from Germany D. O. Thomas-Rüddel, C. Fleischmann, C. Haas, U. Dennler, K. Reinhart P059 - “Zero CLABSI” – can we get there? Obstacles on the 4 year journey and our strategies to overcome them – experience from an Indian ICU V. Adora, A. Kar, A. Chakraborty, S. Roy, A. Bandyopadhyay, M. Das P060 - Novel molecular techniques to identify central venous catheter (CVC) associated blood stream infections (BSIs) T. Mann Ben Yehudah, G. Ben Yehudah, M. Salim, N. Kumar, L. Arabi, T. Burger, P. Lephart, E. Toth-martin P061 - Zero clabsi” – can we get there? Obstacles on the 4 year journey and our strategies to overcome them – experience from an Indian ICU R. Rao, A. Kar, A. Chakraborty P062 - Prevention of central line-associated bloodstream infections in intensive care units: An international online survey C. Valencia, N. Hammami, S. Blot, J. L. Vincent, M. L. Lambert P063 - 30 days antimicrobial efficacy of non-leaching central venous catheters J. Brunke, T. Riemann, I. Roschke P064 - Efficacy of noble metal alloy-coated catheter in prevention of bacteriuria R. Tincu, C. Cobilinschi, D. Tomescu, Z. Ghiorghiu, R. Macovei P065 - Predicting bacteremic urinary tract infection in community setting: A prospective observational study S. Nimitvilai, K. Jintanapramote, S. Jarupongprapa P066 - Eight-year analysis of acinetobacter spp. monobacteremia in surgical and medical intensive care units at university hospital in Lithuania D. Adukauskiene, D. Valanciene P067 - Group A and group B streptococcal infections in intensive care unit – our experience in a tertiary centre G. Bose, V. Lostarakos, B. Carr P068 - Improved detection of spontaneous bacterial peritonitis by uritop + tm strip test and inoculation of blood culture bottles with ascitic fluid S. Khedher, A. Maaoui, A. Ezzamouri, M. Salem P069 - Increased risk of cellulitis in patients with congestive heart failure: a population based cohort study J. Chen P070 - Outcomes of severe cellulitis and necrotizing fasciitis in the critically ill D. R. Cranendonk, L. A. Van Vught, M. A. Wiewel, O. L. Cremer, J. Horn, M. J. Bonten, M. J. Schultz, T. Van der Poll, W. J. Wiersinga P071 - Botulism outbreak associated with people who inject drugs (PWIDs) in Scotland. M. Day, G. Penrice, K. Roy, P. Robertson, G. Godbole, B. Jones, M. Booth, L. Donaldson P072 - Surveillance of ESBL-producing enterobacteriaceae fecal carriers in the ICU Y. Kawano, H. Ishikura P073 - Prevalence of ESBL and carbapenemase producing uropathogens in a newly opened hospital in south India S. Sreevidya, N. Brahmananda Reddy, P. Muraray Govind, R. Pratheema, J. Devachandran Apollo Speciality Hospital - OMR, Chennai, India P074 - Prevalence, risk factors and outcomes of methicillin-resistant staphylococcus aureus nasal colonization in critically ill patients H. Al-Dorzi, M. Almutairi, B. Alhamadi, A. Crizaldo Toledo, R. Khan, B. Al Raiy, Y. Arabi P075 - Multidrug-resistant Acinetobacter baumannii infection in intensive care unit patients in a hospital with building construction: Is there an association? H. Talaie P076 - Multidrug-resistant organisms in a Dutch ICU J. A. Van Oers, A. Harts, E. Nieuwkoop, P. Vos P077 - Epidemiology and risk factors of ICU acquired infections caused by multidrug-resistant gram negative bacilli Y. Boussarsar, F. Boutouta, S. Kamoun, I. Mezghani, S. Koubaji, A. Ben Souissi, A. Riahi, M. S. Mebazaa P078 - Improving outcomes of severe infections by multidrug-resistant pathogens with polyclonal IgM-enriched immunoglobulins E. Giamarellos-Bourboulis, N. Tziolos, C. Routsi, C. Katsenos, I. Tsangaris, I. Pneumatikos, G. Vlachogiannis, V. Theodorou, A. Prekates, E. Antypa, V. Koulouras, N. Kapravelos, C. Gogos, E. Antoniadou, K. Mandragos, A. Armaganidis P079 - Must change the medical practice in ICU? A. R. Robles Caballero, B. Civantos, J. C. Figueira, J. López P080 - Mediterranean spotted fever in an infectious diseases intensive care unit A. Silva-Pinto, F. Ceia, A. Sarmento, L. Santos P081 - Clinical features and outcomes of patients with Middle East respiratory syndrome requiring admission to a saudi intensive care unit: A retrospective analysis of 31 cases G. Almekhlafi, Y. Sakr P082 - The ICU response to a hospital outbreak of Middle East respiratory syndrome coronavirus infection H. Al-Dorzi, R. Khan, S. Baharoon, A. Aldawood, A. Matroud, J. Alchin, S. Al Johani, H. Balkhy, Y. Arabi P083 - Middle East respiratory syndrome: Surveillance data analysis S. Alsolamy, S. Y. Yousif, B. O. Alotabi, A. S. Alsaawi P085 - Use of Taqman array card molecular diagnostics in severe pneumonia: A case series J. Ang, MD Curran, D. Enoch, V. Navapurkar, A. Conway Morris P086 - ‘BUNS’: An investigation protocol improves the ICU management of pneumonia R. Sharvill, J. Astin P087 - Pneumonia in patients following secondary peritonitis: epidemiological features and impact on mortality M. Heredia-Rodríguez, E. Gómez-Sánchez, M. T. Peláez-Jareño, E. Gómez-Pesquera, M. Lorenzo-López, P. Liu-Zhu, M. Aragón-Camino, A. Hernández-Lozano, A. Sánchez-López, E. Álvarez-Fuente, E. Tamayo P088 - The use of the “CURB-65 score” by emergency room clinicians in a large teaching hospital J. Patel, C. Kruger P089 - Incidence of community acquired pneumonia with viral infection in mechanically ventilated patients in the medical intensive care unit J. O’Neal, H. Rhodes, J. Jancik P090 - The SAATELLITE Study: Prevention of S aureus Nosocomial Pneumonia (NP) with MEDI4893, a Human Monoclonal Antibody (mAb) Against S aureus B. François, P. F. Laterre, P. Eggimann, A. Torres, M. Sánchez, P. F. Dequin, G. L. Bassi, J. Chastre, H. S. Jafri P091 - Risk factors and microbiological profile for nosocomial infections in trauma patients M. Ben Romdhane, Z. Douira, S. Kamoun, M. Bousselmi, A. Ben Souissi, Y. Boussarsar, A. Riahi, M.S. Mebazaa P092 - Correlation between percentages of ventilated patients developed vap and use of antimicrobial agents in ICU patients. A. Vakalos, V. Avramidis P093 - A comparison of two ventilator associated pneumonia surveillance techniques T. H. Craven, G. Wojcik, K. Kefala, J. McCoubrey, J. Reilly, R. Paterson, D. Inverarity, I. Laurenson, T. S. Walsh P094 - Lung ultrasound before and after fiberbronchoscopy - modifications may improve ventilator-associated pneumonia diagnosis S. Mongodi, B. Bouhemad, A. Orlando, A. Stella, G. Via, G. Iotti, A. Braschi, F. Mojoli P095 - Comparing the accuracy of predictors of mortality in ventilator-associated pneumonia M. Haliloglu, B. Bilgili, U. Kasapoglu, I. Sayan, M. Süzer Aslan, A. Yalcın, I. Cinel P096 - Impact of pRBCs transfusion on percentage of ventilated patients developed VAP in ICU patients A. Vakalos, V. Avramidis P097 - The impact of a series of interventions on the rate of ventilator associated pneumonia in a large teaching hospital H. E. Ellis, K. Bauchmuller, D. Miller, A Temple P098 - The EVADE study: Prevention of Nosocomial Pneumonia (NP) caused by P aeruginosa with MEDI3902, a Novel Bispecific Monoclonal Antibody, against P aeruginosa virulence factors J. Chastre, B. François, A. Torres, C. E. Luyt, M. Sánchez, M. Singer, H. S. Jafri P099 - Short-term inhaled colistin adjunctive therapy for ventilator-associated pneumonia Y. Nassar, M. S. Ayad P100 - Effect of aerosolised colistin on weaning from mechanical ventilation A. Trifi, S. Abdellatif, F. Daly, R. Nasri, S. Ben Lakhal P101 - Septic shock is an independent risk factor for colistin-induced severe acute kidney injury: a retrospective cohort study B. Bilgili, M. Haliloglu, F. Gul, I. Cinel P102 - Nosocomial pneumonia - emphasis on inhaled tobramycin A. Kuzovlev, A. Shabanov, S. Polovnikov, V. Moroz P103 - In vitro evaluation of amikacin inhale and commercial nebulizers in a mechanical ventilator N. Kadrichu, T. Dang, K. Corkery, P. Challoner P104 - The effects of nebulized amikacin/fosfomycin and systemic meropenem on severe amikacin-resistant meropenem-susceptible P.aeruginosa pneumonia G. Li Bassi, E. Aguilera, C. Chiurazzi, C. Travierso, A. Motos, L. Fernandez, R. Amaro, T. Senussi, F. Idone, J. Bobi, M. Rigol, A. Torres P105 - Optimization of gentamicin peak concentrations in critically ill patients C. J. Hodiamont, N. P. Juffermans, J. M. Janssen, C. S. Bouman, R. A. Mathôt, M. D. De Jong, R. M. Van Hest P106 - Systematic review of cefepime induced neurotoxicity L. Payne, G. L. Fraser P107 - Unasyn® causes QT prolongation during treatment of intensive care patients B. Tudor, M. Lahner, G. Roth, C. Krenn P108 - Comparative study between teicoplanin and vancomycin in methicillin-resistant staphylococcus aureus (mrsa) infectious of toxicological intensive care unit (ticu) patients – Tehran, Iran H. Talaie P109 - Phage therapy against antimicrobial resistance, design of the first clinical study phagoburn P. Jault, J. Gabard, T. Leclerc, S. Jennes, Y. Que, A. Rousseau, F. Ravat P110 - Antibiotic dosing errors in critically ill patients with severe sepsis or septic shock H. Al-Dorzi, A. Eissa, S. Al-Harbi, T. Aldabbagh, R. Khan, Y. Arabi P111 - Does empiric antifungal therapy improve survival in septic critically ill patients? (immunocompromised excluded) A. Trifi, S. Abdellatif, F. Daly, R. Nasri, S. Ben Lakhal P112 - Neurocysticercosis-Qatar experience F. Paramba, N. Purayil, V. Naushad, O. Mohammad, V. Negi, P. Chandra P113 - Early indicators in acute haemorrhagic shock A. Kleinsasser P114 - Filtering of red blood cells reduces the inflammatory response of pulmonary cells in an in vitro model of mechanical ventilation M. R. Witrz, J. F. Buchner-Doeven, A. M. Tuip-de Boer, J. C. Goslings, N. P. Juffermans P115 - Microparticles from red blood cell transfusion induce a pro-coagulant and pro-inflammatory endothelial cell response M. Van Hezel, M. Straat, A Boing, R Van Bruggen, N Juffermans P116 - The contribution of cytokines on thrombosis development during hospitalization in ICU D. Markopoulou, K. Venetsanou, V. Kaldis, D. Koutete, D. Chroni, I. Alamanos P117 - Prophylactic enoxaparin dosing and adjustment through anti-xa monitoring in an inpatient burn unit L. Koch, J. Jancik, H. Rhodes, E. Walter P118 - Determination of optimal cut-off values of haemoglobin, platelet count and fibrinogen at 24 hours after injury associated with mortality in trauma patients K. Maekawa, M. Hayakawa, S. Kushimoto, A. Shiraishi, H. Kato, J. Sasaki, H. Ogura, T. Matauoka, T. Uejima, N. Morimura, H. Ishikura, A. Hagiwara, M. Takeda P119 - Trauma-induced coagulopathy - prothrombin complex concentrate vs fresh frozen plasma O. Tarabrin, S. Shcherbakow, D. Gavrychenko, G. Mazurenko, V. Ivanova, O. Chystikov P120 - First study to prove the superiority of prothrombin complex concentrates on mortality rate over fresh frozen plasma in patients with acute bleeding C. Plourde, J. Lessard, J. Chauny, R. Daoust P121 - Prothrombin complex concentrate vs fresh frozen plasma in obstetric massive bleeding S. Shcherbakow, O. Tarabrin, D. Gavrychenko, G. Mazurenko, O. Chystikov P122 - Impact of FFP transfusion on VAP in ICU patients A. Vakalos, V. Avramidis P123 - Preoperative platelet function test and the thrombin generation assay are predictive for blood loss after cardiac surgery L. Kropman, L. In het Panhuis, J. Konings, D. Huskens, E. Schurgers, M. Roest, B. De Laat, M. Lance P124 - Rotational thromboelastometry versus standard coagulation tests before surgical interventions M. Durila, P. Lukas, M. Astraverkhava, J. Jonas P125 - Correction of impaired clot quality and stability by fibrinogen and activated prothrombin complex concentrate in a model of severe thrombocytopenia I. Budnik, B. Shenkman P126 - Assessment of point-of-care prothrombin time analyzer as a monitor after cardiopulmonary bypass H. Hayami, Y. Koide, T. Goto P127 - Disseminated intravascular coagulation (dic) is underdiagnosed in critically ill patients: do we need d-dimer measurements? R. Iqbal, Y. Alhamdi, N. Venugopal, S. Abrams, C. Downey, C. H. Toh, I. D. Welters P128 - Validity of the age-adjusted d-dimer cutoff in patients with COPD B. Bombay, J. M. Chauny, R. D. Daoust, J. L. Lessard, M. M. Marquis, J. P. Paquet P129 - A scoping review of strategies for prevention and management of bleeding following paediatric cardiopulmonary bypass surgery K. Siemens, D. Sangaran, B. J. Hunt, A. Durward, A. Nyman, I. A. Murdoch, S. M. Tibby P130 - Nadir hemoglobulin during cardiopulmonary bypass: impact on postoperative morbidity and mortality F. Ampatzidou, D. Moisidou, E. Dalampini, M. Nastou, E. Vasilarou, V. Kalaizi, H. Chatzikostenoglou, G. Drossos P131 - Red blood cell transfusion do not influence the prognostic value of RDW in critically ill patients S. Spadaro, A. Fogagnolo, T. Fiore, A. Schiavi, V. Fontana, F. Taccone, C. Volta P132 - Reasons for admission in the paediatric intensive care unit and the need for blood and blood products transfusions E. Chochliourou, E. Volakli, A. Violaki, E. Samkinidou, G. Evlavis, V. Panagiotidou, M. Sdougka P133 - The implementation of a massive haemorrhage protocol (mhp) for the management of major trauma: a ten year, single-centre study R. Mothukuri, C. Battle, K. Guy, G. Mills, P. Evans P134 - An integrated major haemorrhage protocol for pre-hospital and retrieval medical teams J. Wijesuriya, S. Keogh P135 - The impact of transfusion thresholds on mortality and cardiovascular events in patients with cardiovascular disease (non-cardiac surgery): a systematic review and meta-analysis A. Docherty, R. O’Donnell, S. Brunskill, M. Trivella, C. Doree, L. Holst, M. Parker, M. Gregersen, J. Almeida, T. Walsh, S. Stanworth P136 - The relationship between poor pre-operative immune status and outcome from cardiac surgery is specific to the peri-operative antigenic threat S. Moravcova, J. Mansell, A. Rogers, R. A. Smith, C. Hamilton-Davies P137 - Impact of simple clinical practice guidelines for reducing post-operative atrial fibrillation after cardiac surgery. A. Omar, M. Allam, O. Bilala, A. Kindawi, H. Ewila P138 - Dexamethasone administration during cardiopulmonary bypass has no beneficial effects on elective postoperative cardiac surgery patients F. Ampatzidou, D. Moisidou, M. Nastou, E. Dalampini, A. Malamas, E. Vasilarou, G. Drossos P139 - Intra-aortic balloon counterpulsation in patients undergoing cardiac surgery (IABCS): preliminary results G. Ferreira, J. Caldas, J. Fukushima, E. A. Osawa, E. Arita, L. Camara, S. Zeferino, J. Jardim, F. Gaioto, L. Dallan, F. B. Jatene, R. Kalil Filho, .F Galas, L. A. Hajjar P140 - Effects of low-dose atrial natriuretic peptide infusion on cardiac surgery-associated acute kidney injury C. Mitaka, T. Ohnuma, T. Murayama, F. Kunimoto, M. Nagashima, T. Takei, M. Tomita P141 - Acute kidney injury influence on high sensitive troponin measurements after cardiac surgery A. Omar, K. Mahmoud, S. Hanoura, S. Sudarsanan, P. Sivadasan, H. Othamn, Y. Shouman, R. Singh, A. Al Khulaifi P142 - Complex evaluation of endothelial dysfunction markers for prognosis of outcomes in patients undergoing cardiac surgery I. Mandel, S. Mikheev, I. Suhodolo, V. Kiselev, Y. Svirko, Y. Podoksenov P143 - New-onset atrial fibrillation in intensive care: incidence, management and outcome S. A. Jenkins, R. Griffin P144 - One single spot measurement of the sublingual microcirculation during acute pulmonary hypertension in a pig model of shock M. S. Tovar Doncel, A. Lima, C. Aldecoa, C. Ince P145 - Assessment of levosimendan as a therapeutic option to recruit the microcirculation in cardiogenic shock – initial experience in cardiac ICU A. Taha, A. Shafie, M. Mostafa, N. Syed, H. Hon P146 - Terlipressin vs. norepinephrine in the Potential Multiorgan Donor(PMD) F. Righetti, E. Colombaroli, G. Castellano P147 - Echocardiography in the potential heart donor exposed to substitution hormonotherapy F. Righetti, E. Colombaroli P148 - Machine learning can reduce rate of monitor alarms M. Hravnak, L. C. Chen, A. D. Dubrawski, G. C. Clermont, M. R. Pinsky P149 - Peripherally inserted central catheters placed in the ICU S. Gonzalez, D. Macias, J. Acosta, P. Jimenez, A. Loza, A. Lesmes, F. Lucena, C. Leon P150 - Recordings of abnormal central venous pressure waveform morphology during an episode of pulmonary hypertension in a porcine shock model M. S. Tovar Doncel, C. Ince, C. Aldecoa, A. Lima P151 - Ultrasound guided central venous access technique among French intensivists M. Bastide, J. Richecoeur, E. Frenoy, C. Lemaire, B. Sauneuf, F. Tamion, S. Nseir, D. Du Cheyron, H. Dupont, J. Maizel P152 - Predictive ability of the Pv-aCO2 gap in patients with shock M. Shaban, R. Kolko, N. Salahuddin, M. Sharshir, M. AbuRageila, A. AlHussain P153 - Comparison of echocardiography and pulmonary artery catheter measurements of hemodynamic parameters in critical ill patients P. Mercado, J. Maizel, L. Kontar, D. Titeca, F. Brazier, A. Riviere, M. Joris, T. Soupison, B. De Cagny, M. Slama P154 - The volume clamp method for noninvasive cardiac output measurement in postoperative cardiothoracic surgery patients: a comparison with intermittent pulmonary artery thermodilution J. Wagner, A. Körner, M. Kubik, S. Kluge, D. Reuter, B. Saugel P155 - Hemodynamic monitoring in patients with septic shock (SS) – CPCCO (continuous pulse contour cardiac output) vs. TEE (transesophageal echocardiography) E. Colombaroli, F. Righetti, G. Castellano P156 - Cardiac output measurement with transthoracic echocardiography in critically ill patients: a pragmatic clinical study T. Tran, D. De Bels, A. Cudia, M. Strachinaru, P. Ghottignies, J. Devriendt, C. Pierrakos P157 - Left ventricular outflow tract velocity time integral correlates with stroke volume index in mechanically ventilated patients Ó. Martínez González, R. Blancas, J. Luján, D. Ballesteros, C. Martínez Díaz, A. Núñez, C. Martín Parra, B. López Matamala, M. Alonso Fernández, M. Chana P158 - Transpulmonary thermodilution (TPTD) derived from femoral vs. jugular central venous catheter: validation of a previously published correction formula and a proprietary correction formula for global end-diastolic volume index (GEDVI) W. Huber, M. Eckmann, F. Elkmann, A. Gruber, I. Klein, R. M. Schmid, T. Lahmer P160 - Dynamic arterial elastance calculated with lidcoplus monitor does not predict changes in arterial pressure after a fluid challenge in postsurgical patients D. Bastoni, H. Aya, L. Toscani, L. Pigozzi, A. Rhodes, M. Cecconi P159 - Venous return driving pressure and resistance in acute blood volume changes P. W. Moller, S. Sondergaard, S. M. Jakob, J. Takala, D. Berger P160 - Dynamic arterial elastance calculated with lidcoplus monitor does not predict changes in arterial pressure after a fluid challenge in postsurgical patients D. Bastoni, H. Aya, L. Toscani, L. Pigozzi, A. Rhodes, M. Cecconi P161 - Analysis of duration of post-operative goal-directed therapy protocol C. Ostrowska, H. Aya, A. Abbas, J. Mellinghoff, C. Ryan, D. Dawson, A. Rhodes, M. Cecconi P162 - Hemodynamic optimization – back to square one? M. Cronhjort, O. Wall, E. Nyberg, R. Zeng, C. Svensen, J. Mårtensson, E. Joelsson-Alm P163 - Effectiveness of fluid thoracic content measurement by bioimpedance guiding intravascular volume optimization in patients with septic shock M. Aguilar Arzapalo, L. Barradas, V. Lopez, M. Cetina P164 - A systematic review on the role of internal jugular vein ultrasound measurements in assessment of volume status in critical shock patients N. Parenti, C. Palazzi, L. A. Amidei, F. B. Borrelli, S. C. Campanale, F. T. Tagliazucchi, G. S. Sedoni, D. L. Lucchesi, E. C. Carella, A. L Luciani P165 - Importance of recognizing dehydration in medical Intensive Care Unit M. Mackovic, N. Maric, M. Bakula P166 - Effect of volume for a fluid challenge in septic patients H. Aya, A. Rhodes, R. M. Grounds, N. Fletcher, M. Cecconi P167 - Fluid bolus practices in a large Australian intensive care unit B. Avard, P. Zhang P168 - Liberal late fluid management is associated with longer ventilation duration and worst outcome in severe trauma patients: a retrospective cohort of 294 patients M. Mezidi, J. Charbit, M. Ould-Chikh, P. Deras, C. Maury, O. Martinez, X. Capdevila P169 - Association of fluids and outcomes in emergency department patients hospitalized with community-acquired pneumonia P. Hou, W. Z. Linde-Zwirble, I. D. Douglas, N. S. Shapiro P170 - Association of positive fluid balance with poor outcome in medicosurgical ICU patients A. Ben Souissi, I. Mezghani, Y. Ben Aicha, S. Kamoun, B. Laribi, B. Jeribi, A. Riahi, M. S. Mebazaa P171 - Impact of fluid balance to organ dysfunction in critically ill patients C. Pereira, R. Marinho, R. Antunes, A. Marinho P172 - Volume bolus in ICU patients: do we need to balance our crystalloids? M. Crivits, M. Raes, J. Decruyenaere, E. Hoste P173 - The use of 6 % HES solution do not reduce total fluid requirement in the therapy of patients with burn shock V. Bagin, V. Rudnov, A. Savitsky, M. Astafyeva, I. Korobko, V. Vein P174 - Electron microscopic assessment of acute kidney injury in septic sheep resuscitated with crystalloids or different colloids T. Kampmeier , P. Arnemann, M. Hessler, A. Wald, K. Bockbreder, A. Morelli, H. Van Aken, S. Rehberg, C. Ertmer P175 - Alterations of conjunctival microcirculation in a sheep model of haemorrhagic shock and resuscitation with 0.9 % saline or balanced tetrastarch P. Arnemann, M. Hessler, T. Kampmeier, S. Rehberg, H. Van Aken, C. Ince, C. Ertmer P176 - A single centre nested pilot study investigating the effect of using 0.9 % saline or Plasma-Lyte 148 ® as crystalloid fluid therapy on gastrointestinal feeding intolerance in mechanically ventilated patients receiving nasogastric enteral nutrition S. Reddy, M. Bailey, R. Beasley, R. Bellomo, D. Mackle, A. Psirides, P. Young P177 - A single centre nested pilot study investigating the effect on post-operative bleeding of using 0.9 % saline or Plasma-Lyte® 148 as crystalloid fluid therapy in adults in ICU after heart surgery S. Reddy, M. Bailey, R. Beasley, R. Bellomo, D. Mackle, P. Young P178 - Extreme hypernatremia and sepsis in a patient with Huntington’s dementia: a conundrum in fluid management H. Venkatesh, S. Ramachandran, A. Basu, H. Nair P179 - Diagnosis and management of severe hypernatraemia in the critical care setting S. Egan, J. Bates P180 - Correlation between arterial blood gas and electrolyte disturbances during hospitalization and outcome in critically ill patients S. Oliveira, N. R. Rangel Neto, F. Q. Reis P181 - Missing the “I” in MUDPILES – a rare cause of high anion gap metabolic acidosis (HAGMA) C. P. Lee, X. L. Lin, C. Choong , K. M. Eu, W. Y. Sim , K. S. Tee, J. Pau , J. Abisheganaden P182 - Plasma NGAL and urinary output: potential parameters for early initiation of renal replacement therapy K. Maas, H. De Geus P183 - Renal replacement therapy for critically ill patients: an intermittent continuity E. Lafuente, R. Marinho, J. Moura, R. Antunes, A. Marinho P184 - A survey of practices related to renal replacement therapy in critically ill patients in the north of England. T. E. Doris, D. Monkhouse, T. Shipley, S. Kardasz, I Gonzalez P185 - High initiation creatinine associated with lower 28-day mortality in critically ill patients necessitating continuous renal replacement therapy S. Stads, A. J. Groeneveld P186 - The impact of Karnofsky performance scale on outcomes in acute kidney injury patients receiving renal replacement therapy on the intensive care unit I. Elsayed, N. Ward, A. Tridente, A. Raithatha P187 - Severe hypophosphatemia during citrate-anticoagulated CRRT A. Steuber, C. Pelletier, S. Schroeder, E. Michael, T. Slowinski, D. Kindgen-Milles P188 - Citrate regional anticoagulation for post dilution continuous renal replacement therapy S. Ghabina P189 - Citrate 18 mmol/l improves anticoagulation during RRT with adsorbing filters F. Turani, A. Belli, S. Busatti, G. Barettin, F. Candidi, F. Gargano, R. Barchetta, M. Falco P190 - Calcium gluconate instead of calcium chloride in citrate-anticoagulated CVVHD O. Demirkiran, M. Kosuk, S. Bozbay P191 - Enhanced clearance of interleukin-6 with continuous veno-venous haemodialysis (CVVHD) using Ultraflux EMiC2 vs. Ultraflux AV1000S V. Weber, J. Hartmann, S. Harm, I. Linsberger, T. Eichhorn, G. Valicek, G. Miestinger, C. Hoermann P192 - Removal of bilirubin with a new adsorbent system: in vitro kinetics S. Faenza, D. Ricci, E. Mancini, C. Gemelli, A. Cuoghi, S. Magnani, M. Atti P193 - Case series of patients with severe sepsis and septic shock treated with a new extracorporeal sorbent T. Laddomada, A. Doronzio, B. Balicco P194 - In vitro adsorption of a broad spectrum of inflammatory mediators with CytoSorb® hemoadsorbent polymer beads M. C. Gruda, P. O’Sullivan, V. P. Dan, T. Guliashvili, A. Scheirer, T. D. Golobish, V. J. Capponi, P. P. Chan P195 - Observations in early vs. late use of cytosorb therapy in critically ill patients K. Kogelmann, M. Drüner, D. Jarczak P196 - Oxiris membrane decreases endotoxin during rrt in septic patients with basal EAA > 0,6 F. Turani, A. B. Belli, S. M. Martni, V. C. Cotticelli, F. Mounajergi, R. Barchetta P197 - An observational prospective study on the onset of augmented renal clearance: the first report S. Morimoto, H. Ishikura P198 - An ultrasound- guided algorithm for the management of oliguria in severe sepsis I. Hussain, N. Salahuddin, A. Nadeem, K. Ghorab, K. Maghrabi P199 - Ultrasound in acute kidney injury (aki). First findings of farius, an education-programme in structural ultrasonography S. K. Kloesel, C. Goldfuss, A. Stieglitz, A. S. Stieglitz, L. Krstevska, G. Albuszies P200 - Effectiveness of renal angina index score predicting acute kidney injury on critically ill patients M. Aguilar Arzapalo, L. Barradas, V. Lopez, A. Escalante, G. Jimmy, M. Cetina P201 - Time length below blood pressure thresholds and progression of acute kidney injury in critically ill patients with or without sepsis: a retrospective, exploratory cohort study J. Izawa, T. Iwami, S. Uchino, M. Takinami, T. Kitamura, T. Kawamura P202 - Anaemia does not affect renal recovery in acute kidney injury J. G. Powell-Tuck, S. Crichton, M. Raimundo, L. Camporota, D. Wyncoll, M. Ostermann P203 - Estimated glomerular filtration rate based on serum creatinine: actual practice in Dutch ICU’s A. Hana, H. R. De Geus P204 - Comparison of estimated glomerular filtration rate calculated by mdrd, ckd-epi-serum-creatinine and ckd-epi-cystatin-c in adult critically ill patients H. R. De Geus, A. Hana P205 - Early diagnosis of septic acute kidney injury in medical critical care patients with a urine cell cycle arrest marker: insulin like growth factor binding protein-7 (IGFBP-7) M. Aydogdu, N. Boyaci, S. Yuksel, G. Gursel, A. B. Cayci Sivri P206 - Urinary neutrophil gelatinase-associated lipocalin as early biomarker of severe acute kidney injury in intensive care J. Meza-Márquez, J. Nava-López, R. Carrillo-Esper P207 - Shrunken pore syndrome is associated with a sharp rise in mortality in patients undergoing elective coronary artery bypass grafting A. Dardashti, A. Grubb P208 - The biomarker nephrocheck™ can discriminate the septic shock patients with an akin 1 or 2 acute renal failure who will not progress toward the akin 3 level J. Maizel, M. Wetzstein, D. Titeca, L. Kontar, F. Brazier, B. De Cagny, A. Riviere, T. Soupison, M. Joris, M. Slama P209 - A worldwide multicentre evaluation of acute kidney injury in septic and non-septic critically ill patients: the intensive care over nations (icon) audit E. Peters, H. Njimi, P. Pickkers, J. L. Vincent P210 - Does enhanced recovery after surgery reduce the incidence of acute kidney injury in those undergoing major gynae-oncological surgery? M. Waraich , J. Doyle, T. Samuels, L. Forni P211 - Identification of risk factors for the development of acute kidney injury after lower limb arthroplasty N. Desai, R. Baumber, P. Gunning, A. Sell P212 - Incidences and associations of acute kidney injury after major trauma S. Lin, H. Torrence, M. O’Dwyer, C. Kirwan, J. Prowle P213 - Acute kidney injury of major trauma patients T Kim P214 - Trajectory of serum creatinine after major surgery and the diagnosis of acute kidney injury M. E. O’Connor, R. W. Hewson, C. J. Kirwan, R. M. Pearse, J. Prowle P215 - Epidemiology of acute kidney injury after cardiac surgery. A single center retrospective study S. Hanoura , A. Omar, H. Othamn, S. Sudarsanan , M. Allam, M. Maksoud, R. Singh, A. Al Khulaifi P216 - Post-operative acute kidney injury after major non-cardiac surgery and its association with death in the following year M. E. O’Connor, R. W. Hewson, C. J. Kirwan, R. M. Pearse, J. Prowle P217 - Factors affecting acute renal failure in intensive care unit and effect of these factors on mortality O. Uzundere, D. Memis , M. Ýnal, A. , N. Turan P218 - Results of the live kidney transplantations according to national data of turkish organ and tissue information system M. A. Aydin, H. Basar, I. Sencan, A. Kapuagasi, M. Ozturk, Z. Uzundurukan, D. Gokmen, A. Ozcan, C. Kaymak P219 - Anaesthesia procedure and intensive therapy in patients with neck phlegmon V. A. Artemenko, A. Budnyuk P220 - Nasal high flow oygen for acute respiratory failure: a systematic review R. Pugh , S. Bhandari P221 - Setting optimal flow rate during high flow nasal cannula support: preliminary results T. Mauri, C. Turrini, T. Langer, P. Taccone, C. A. Volta, C. Marenghi, L. Gattinoni, A. Pesenti P222 - Dose to dose consistency across two different gas flow rates using cystic fibrosis and normal adult breathing profiles during nasal high flow oxygen therapy L. Sweeney, A . O’ Sullivan, P. Kelly, E. Mukeria, R. MacLoughlin P223 - Final results of an evaluation of airway medix closed suction system compared to a standard closed suction system M. Pfeffer, J. T. Thomas, G. B. Bregman, G. K. Karp, E. K. Kishinevsky, D. S. Stavi, N. A. Adi P224 - Different cuff materials and different leak tests - one size does not fit all T. Poropat, R. Knafelj P225 - Observational study on the value of the cuff-leak test and the onset of upper airway obstruction after extubation E. Llopart, M. Batlle, C. De Haro, J. Mesquida, A. Artigas P226 - A device for emergency transtracheal lung ventilation D. Pavlovic, L. Lewerentz, A. Spassov, R. Schneider P227 - Long-term outcome and health-related quality of life in patients discharged from the intensive care unit with a tracheostomy and with or without prolonged mechanical ventilation S. De Smet, S. De Raedt, E. Derom, P Depuydt, S. Oeyen, D. Benoit, J. Decruyenaere P228 - Ultrasound-guided percutaneous dilational tracheostomy versus bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients (trachus): a randomized clinical trial A. Gobatto, B. Bese, P. Tierno, L. Melro, P. Mendes, F. Cadamuro, M. Park, L. M. Malbouisson P229 - Is it safe to discharge patients with tracheostomy from the ICU to the ward? B. C. Civanto, J. L. Lopez, A. Robles, J. Figueira, S. Yus, A. Garcia P230 - The application of tracheostomy in children in ICU A. Oglinda, G. Ciobanu, C. Oglinda, L. Schirca, T. Sertinean, V. Lupu P231 - The impact of passive humidifiers on aerosol drug delivery during mechanical ventilation P. Kelly, A. O’Sullivan, L. Sweeney, R. MacLoughlin P232 - Evaluation of vibrating mesh and jet nebuliser performance at two different attachment setups in line with a humidifier nebuliser system A. O’Sullivan, P. Kelly, L. Sweeney, E. Mukeria, M. Wolny , R. MacLoughlin P233 - Psv-niv versus cpap in the treatment of acute cardiogenic pulmonary edema A. Pagano, F. Numis, G. Vison, L. Saldamarco, T. Russo, G. Porta, F. Paladino P234 - Noninvasive ventilation in patients with haematologic malignancy: a retrospective review C. Bell, J. Liu, J. Debacker, C. Lee, E. Tamberg, V. Campbell, S. Mehta P235 - Use of non-invasive ventilation in infectious diseases besides classical indications A. Silva-Pinto, A. Sarmento, L. Santos P236 - The impact of fragility on noninvasive mechanical ventilation application and results in the ICU Ý. Kara, F. Yýldýrým, A. Zerman, Z. Güllü, N. Boyacý, B. Basarýk Aydogan, Ü. Gaygýsýz, K. Gönderen, G. Arýk, M. Turkoglu, M. Aydogdu, G. Aygencel, Z. Ülger, G. Gursel P237 - Effects of metabolic alkalosis on noninvasive ventilation success and ICU outcome in patients with hypercapnic respiratory failure N. Boyacý, Z. Isýkdogan, Ö. Özdedeoglu, Z. Güllü, M. Badoglu, U. Gaygýsýz, M. Aydogdu, G. Gursel P238 - Asynchrony index and breathing patterns of acute exacerbation copd patients assisted with noninvasive pressure support ventilation and neurally adjusted ventilatory assist N. Kongpolprom, C. Sittipunt P239 - High frequency jet ventilation for severe acute hypoxemia A. Eden, Y. Kokhanovsky, S. Bursztein – De Myttenaere, R. Pizov P240 - HFOV revisited: a 7 year retrospective analysis of patients receiving HFOV who met oscillate trial entry criteria L. Neilans, N. MacIntyre P241 - Implementation of a goal-directed mechanical ventilation order set driven by respiratory therapists can improve compliance with best practices for mechanical ventilation M. Radosevich, B. Wanta, V. Weber, T. Meyer, N. Smischney, D. Brown, D. Diedrich P242 - A reduction in tidal volumes for ventilated patients on ICU calculated from IBW. can it minimise mortality in comparison to traditional strategies? A . Fuller, P. McLindon, K. Sim P243 - Predictive value of lung aeration scoring using lung ultrasound in weaning failure M. Shoaeir, K. Noeam, A. Mahrous, R. Matsa, A. Ali P244 - Conventional versus automated weaning from mechanical ventilation using SmartCare™ C. Dridi, S. Koubaji, S. Kamoun, F. Haddad, A. Ben Souissi, B. Laribi, A. Riahi, M. S. Mebazaa P245 - Ultrasonographic evaluation protocol for weaning from mechanichal ventilation A. Pérez-Calatayud, R. Carrillo-Esper, A. Zepeda-Mendoza, M. Diaz-Carrillo, E. Arch-Tirado P246 - Diaphragm ultrasonography: a method for weaning patients from mechanical ventilation S. Carbognin, L. Pelacani, F. Zannoni, A. Agnoli, G. Gagliardi P247 - Dorsal diaphragmatic excursion tracks transpulmonary pressure in ventilated ARDS patients: a potential non-invasive indicator of lung recruitment? R. Cho, A. Adams , S. Lunos, S. Ambur, R. Shapiro, M. Prekker P248 - Pulse oximetry in the icu patient: is the perfusion index of any value? M. Thijssen, L. Janssen, N. Foudraine P249 - Ventilation is a better assessment of respiratory status than EtCO2 C. J. Voscopoulos, J. Freeman P250 - Evaluation of the relationship between non-invasive minute ventilation and end-tidal CO2 in patients undergoing general vs spinal anesthesia C. J. Voscopoulos, J. Freeman, E. George P251 - Respiratory volume monitoring provides early warning of respiratory depression and can be used to reduce false alarms in non-intubated patients C. J. Voscopoulos, D. Eversole, J. Freeman, E. George P252 - P/i index: a predictive edi-derived weaning index during nava S. Muttini, R. Bigi, G. Villani, N. Patroniti P253 - Adequacy of ventilation in patients receiving opioids in the post anesthesia care unit: minute ventilation versus respiratory rate G. Williams, C. J. Voscopoulos, J. Freeman, E. George P254 - Comparison of regional and global expiratory time constants measured by electrical impedance tomography (EIT) A. Waldmann, S. Böhm, W. Windisch, S. Strassmann, C. Karagiannidis P255 - Electrical impedance tomography: robustness of a new pixel wise regional expiratory time constant calculation A. Waldmann, S. Böhm, W. Windisch, S. Strassmann, C. Karagiannidis P256 - Validation of regional and global expiratory time constant measurement by electrical impedance tomography in ards and obstructive pulmonary diseases C. K. Karagiannidis, A. W. Waldmann, S. B. Böhm, S. Strassmann, W. W. Windisch P257 - Transpulmonary pressure in a model with elastic recoiling lung and expanding chest wall P. Persson, S. Lundin, O. Stenqvist P258 - Lactate in pleural and abdominal effusion G. Porta, F. Numis, C. S. Serra, A. P. Pagano, M. M. Masarone, L. R. Rinaldi, A. A. Amelia, M. F. Fascione, L. A. Adinolfi, E. R. Ruggiero P259 - Outcome of patients admitted to the intensive care with pulmonary fibrosis F. Asota, K. O’Rourke, S. Ranjan, P. Morgan P260 - Sedation and analgesia practice in extra-corporeal membrane oxygenation (ECMO)-treated patients with acute respiratory distress syndrome (ARDS): a retrospective study J. W. DeBacker, E. Tamberg, L. O’Neill, L. Munshi, L. Burry, E. Fan, S. Mehta P261 - Characteristics and outcomes of patients deemed not eligible when referred for veno-venous extracorporeal membrane oxygenation (vv-ECMO) S. Poo, K. Mahendran, J. Fowles, C. Gerrard, A. Vuylsteke P262 - The SAVE SMR for veno-arterial ECMO R. Loveridge, C. Chaddock, S. Patel, V. Kakar, C. Willars, T. Hurst, C. Park, T. Best, A. Vercueil, G. Auzinger P263 - A simplified score to predict early (48 h) mortality in patients being considered for VA-ECMO A. Borgman, A. G. Proudfoot, E. Grins, K. E. Emiley, J. Schuitema, S. J. Fitch, G. Marco, J. Sturgill, M. G. Dickinson, M. Strueber, A. Khaghani, P. Wilton, S. M. Jovinge P264 - Lung function six months post extra corporeal membrane oxygenation (ECMO) for severe acute respiratory failure in adult survivors C. Sampson, S. Harris-Fox P265 - Bicarbonate dialysis removes carbon dioxide in hypoventilated rodents. M. E. Cove, L. H. Vu, A. Sen, W. J. Federspiel, J. A. Kellum P266 - Procalcitonin as predictor of primary graft dysfunction and mortality in post-lung transplantation C. Mazo Torre, J. Riera, S. Ramirez, B. Borgatta, L. Lagunes, J. Rello P267 - New molecular biomarkers of acute respiratory distress syndrome in abdominal sepsis A. K. Kuzovlev, V. Moroz, A. Goloubev, S. Polovnikov, S. Nenchuk P268 - Tight junction’s proteins claudin -5 and regulation by tnf in experimental murine lung injury model of ali/ards V. Karavana, C. Glynos, A. Asimakos, K. Pappas, C. Vrettou, M. Magkou, E. Ischaki, G. Stathopoulos, S. Zakynthinos P269 - Cell counts in endobronchial aspirate to assess airway inflammation in ARDS patients: a pilot study S. Spadaro, I. Kozhevnikova, F. Dalla Corte, S. Grasso, P. Casolari, G. Caramori, C. Volta P270 - Epidemiological and clinical profile of patients with acute respiratory distress syndrome in the surgical intensive care unit surgical, hospital JRA, Antananarivo T. Andrianjafiarinoa, T. Randriamandrato, T. Rajaonera P271 - Effect of high PEEP after recruitment maneuver on right ventricular function in ARDS. Is it good for the lung and for the heart? S. El-Dash, ELV Costa, MR Tucci, F Leleu, L Kontar, B. De Cagny, F. Brazier, D. Titeca, G. Bacari-Risal, J. Maizel, M. Amato, M. Slama P272 - Effect of recruitment maneuver on left ventricular systolic strain P. Mercado, J. Maizel, L. Kontar, D. Titeca, F. Brazier, A. Riviere, M. Joris, T. Soupison, B. De Cagny, S. El Dash, M. Slama P273 - Inhaled nitric oxide – is switching supplier cost effective? Remmington, A. Fischer, S. Squire, M. Boichat P274 - Epidemiological study of severe acute pancreatitis in Japan, comparison of the etiology and the patient outcomes on 1159 patients. H. Honzawa, H. Yasuda, T. Adati, S. Suzaki, M. Horibe, M. Sasaki, M. Sanui P275 - Extracorporeal liver support therapy. Experience in an intensive care unit R. Marinho, J. Daniel, H. Miranda, A. Marinho P276 - Accuracy of mortality prediction models in acute versus acute-on-chronic liver failure in the intensive care setting K. Milinis, M. Cooper, G. R. Williams, E. McCarron, S. Simants, I. Patanwala, I. Welters P277 - Risk of coronary artery disease in patients with chronic liver disease: a population based cohort study Y. Su P278 - 20 years of liver transplantation in Santiago de Compostela (Spain). Experience review J. Fernández Villanueva, R. Fernández Garda, A. López Lago, E. Rodríguez Ruíz, R. Hernández Vaquero, S. Tomé Martínez de Rituerto, E. Varo Pérez P279 - Diarrhea is a risk factor for liver injury and may lead to intestinal failure associated liver disease in critical illness N. Lefel, F. Schaap, D. Bergmans, S. Olde Damink, M. Van de Poll P280 - Bowel care on the intensive care unit: constipation guideline compliance and complications K. Tizard, C. Lister, L. Poole P281 - Malnutrition assessed by phase angle determines outcomes in low risk cardiac surgery patients D. Ringaitiene, D. Gineityte, V. Vicka, I. Norkiene, J. Sipylaite P282 - Preoperative fasting times in an irish hospital A. O’Loughlin, V. Maraj, J. Dowling P283 - Costs and final outcome of early x delayed feeding in a private Brazil ICU M. B. Velasco, D. M. Dalcomune, E. B. Dias, S. L. Fernandes P284 - Can ventilator derived energy expenditure measurements replace indirect calorimetry? T. Oshima, S. Graf, C. Heidegger, L. Genton, V. Karsegard, Y. Dupertuis, C. Pichard P285 - Revisiting the refeeding syndrome: results of a systematic review N. Friedli, Z. Stanga, B. Mueller, P. Schuetz P286 - Compliance with the new protocol for parenteral nutrition in our ICU L. Vandersteen, B. Stessel, S. Evers, A. Van Assche, L. Jamaer, J. Dubois P287 - Nutrition may be another treatment in the intensive care unit where less is more? R. Marinho, H. Castro, J. Moura, J. Valente, P. Martins, P. Casteloes, C. Magalhaes, S. Cabral, M. Santos, B. Oliveira, A. Salgueiro, A. Marinho P288 - Should we provide more protein to critically ill patients? R. Marinho, M. Santos, E. Lafuente, H. Castro, S. Cabral, J. Moura, P. Martins, B. Oliveira, A. Salgueiro, S. Duarte, S. Castro, M. Melo, P. Casteloes, A. Marinho P289 Protein provision in an adult intensive care unit S. Gray P290 - Prevalence and clinical outcomes of vitamin d deficiency in the medical critically ill patients in Songklanagarind hospital K. Maipang, R. Bhurayanontachai P291 - Vitamin d deficiency strongly predicts adverse medical outcome across different medical inpatient populations: results from a prospective study L. G. Grädel, P. Schütz P292 - Omega-3 fatty acids in patients undergoing cardiac surgery: a systematic review and meta-analysis P. Langlois, W. Manzanares P293 - Can 5-hydroxytriptophan prevent post-traumatic stress disorder in critically ill patients? R. Tincu, C. Cobilinschi, D. Tomescu, Z. Ghiorghiu, R. Macovei P294 - Parenteral selenium in the critically ill: an updated systematic review and meta-analysis W. Manzanares, P. Langlois, M. Lemieux, G. Elke, F. Bloos, K. Reinhart, D. Heyland P295 - Probiotics in the critically ill: an updated systematic review and meta-analysis P. Langlois, M. Lemieux, I. Aramendi, D. Heyland, W. Manzanares P296 - Diabetes with hyperglycemic crisis episodes may be associated with higher risk of pancreatic cancer: a population-based cohort study Y. Su P297 - Incidence of hypoglycemia in an intensive care unit depending on insulin protocol R. Marinho, N. Babo, A. Marinho P298 - Severity of the diseases is two-dimensionally correlated to blood glucose, including blood glucose variability, especially in moderately to severely ill patients with glucose intolerance. M. Hoshino, Y. Haraguchi, S. Kajiwara, T. Mitsuhashi, T. Tsubata, M. Aida P299 - A study of glycemic control by subcutaneous glargine injection transition from continuous regular insulin infusion in critically ill patients T. Rattanapraphat, R. Bhurayanontachai, C. Kongkamol, B. Khwannimit P300 - Glycemic control in Portuguese intensive care unit R. Marinho, M. Santos, H. Castro, E. Lafuente, A. Salgueiro, S. Cabral, P. Martins, J. Moura, B. Oliveira, M. Melo, B. Xavier, J. Valente, C. Magalhaes, P. Casteloes, A. Marinho P301 - Impact of hyperglycemia duration on the day of operation on short-term outcome of cardiac surgery patients D. Moisidou, F. Ampatzidou, C. Koutsogiannidis, M. Moschopoulou, G. Drossos P302 - Lactate levels in diabetic ketoacidosis patients at ICU admissions G. Taskin, M. Çakir, AK Güler, A. Taskin, N. Öcal, S. Özer, L. Yamanel P303 - Intensive care implications of merging heart attack centre units in London J. M. Wong, C. Fitton, S. Anwar, S. Stacey P304 - Special characteristics of in-hospital cardiac arrests M. Aggou, B. Fyntanidou, S. Patsatzakis, E. Oloktsidou, K. Lolakos, E. Papapostolou, V. Grosomanidis P305 - Clinical evaluation of ICU-admitted patients who were resuscitated in the general medicine ward S. Suda , T. Ikeda, S. Ono, T. Ueno, Y. Izutani P306 - Serious game evaluation of a one-hour training basic life support session for secondary school students: new tools for future bystanders S. Gaudry, V. Desailly, P. Pasquier, PB Brun, AT Tesnieres, JD Ricard, D. Dreyfuss, A. Mignon P307 - Public and clinical staff perceptions and knowledge of CPR compared to local and national data J. C White, A. Molokhia, A. Dean, A. Stilwell, G. Friedlaender P308 Dispatcher-assisted telephone cardiopulmonary resuscitation using a French-language compression-ventilation pediatric protocol M. Peters, S. Stipulante, A. Delfosse, AF Donneau, A. Ghuysen P309 Dantrolene versus amiodarone for resuscitation – an experimental study C. Feldmann, D. Freitag, W. Dersch, M. Irqsusi, D. Eschbach, T. Steinfeldt, H. Wulf, T. Wiesmann P310 Long term survival and functional neurological outcome in comatose survivors undergoing therapeutic hypothermia N. Kongpolprom, J. Cholkraisuwat P311 Impact of kidney disease on mortality and neurological outcome in out-of-hospital cardiac arrest: a prospective observational study S. Beitland , E. Nakstad, H. Stær-Jensen , T. Drægni , G. Andersen , D. Jacobsen , C. Brunborg, B. Waldum-Grevbo , K. Sunde P312 ICU dependency of patients admitted after primary percutaneous coronary intervention (PPCI) following out of the hospital cardiac arrest K. Hoyland, D. Pandit P313 Prognostic indicators and outcome prediction model for patients with return of spontaneous circulation from cardiopulmonary arrest: comprehensive registry of in-hospital intensive care on OHCA survival (critical) study in Osaka, Japan K. Hayakawa P314 Cerebral oxygen saturation during resuscitation in a porcine model of cardiac arrest E. Oloktsidou, K. Kotzampassi, B. Fyntanidou, S. Patsatzakis, L. Loukipoudi, E. Doumaki, V. Grosomanidis P315 Presumption of cardiopulmonary resuscitation for sustaining cerebral oxidation using regional cerebral saturation of oxygen: observational cohort study (press study) H. Yasuda P316 EEG reactivity in patients after cardiac arrest: a close look at stimuli MM Admiraal, M. Van Assen, MJ Van Putten, M. Tjepkema-Cloostermans, AF Van Rootselaar, J. Horn P317 Prognostic value of neuron-specific enolase after cardiac arrest F. Ragusa, A. Marudi , S. Baroni, A. Gaspari, E. Bertellini P318 Correlation between electroencephalographic findings and serum neuron specific enolase with outcome of post cardiac arrest patients A. Taha, T. Abdullah, S. Abdel Monem P319 Introduction of a targeted temperature management strategy following cardiac arrest in a district general hospital intensive care unit. S. Alcorn, S. McNeill, S. Russell P320 The evolution of cerebral oxygen saturation in post-cardiac arrest patients treated with therapeutic hypothermia W. Eertmans, C. Genbrugge, I. Meex, J. Dens, F. Jans, C. De Deyne P321 Prognostic factors and neurological outcomes of therapeutic hypothermia in comatose survivors from cardiac arrest: 8-year single center experience J. Cholkraisuwat, N. Kongpolprom P322 Adherence to targeted temperature management after out of hospital cardiac arrest B. Avard, R. Burns P323 Implementation of a therapeutic hypothermia protocol for comatose survivors of out-of-hospital cardiac arrest. A. Patarchi, T. Spina P324 Factors associated with ventilator weaning after targeted temperature management for cardiac arrest patients in japan H. Tanaka, N. Otani, S. Ode, S. Ishimatsu P325 Differential activation of c-fos in paraventricular nuclei of the hypothalamus and thalamus of the rat following myocardial infarction J. Cho, J. B. Moon, C. W. Park, T. G. Ohk, M. C. Shin, M. H. Won P326 Monitoring of cTroponin I in patients with acute ischemic stroke - predictor of inhospital mortality S. Dakova, Z. Ramsheva, K. Ramshev P327 Hyperthermic preconditioning severely accelerates neuronal damage in the gerbil ischemic hippocampal dentate gyrus via decreasing sods expressions J. Cho, J. B. Moon, C. W. Park, T. G. Ohk, M. C. Shin P328 Failure in neuroprotection of remote limb ischemic post conditioning in the hippocampus of a gerbil model of transient cerebral ischemia J. Cho, J. B. Moon, C. W. Park, T. G. Ohk, M. C. Shin P329 Brain death and admission diagnosis in neurologic intensive care unit, a correlation? A Marudi, S Baroni, A Gaspari, E Bertellini P330 Brain magnetic resonance imaging findings in patients with septic shock G. Orhun, E. Senturk, P. E. Ozcan, S. Sencer, C. Ulusoy, E. Tuzun, F . Esen P331 Benefits of L-carnitine in valproic acid induced encephalopathy R. Tincu, C. Cobilinschi, D. Tomescu, Z. Ghiorghiu, R. Macovei P332Automatic analysis of EEG reactivity in comatose patients M. Van Assen, M. M. Admiraal, M. J. Van Putten, M. Tjepkema-Cloostermans, A. F. Van Rootselaar, J. Horn P333 Usefulness of common ICU severity scoring systems in predicting outcome after spontaneous intracerebral hemorrhage M. Fallenius, M. B. Skrifvars, M. Reinikainen, S. Bendel, R. Raj P334 Evalution of patients with suspected subarachnoid haemorrhage and negative ct imaging M. Abu-Habsa, C. Hymers, A. Borowska, H. Sivadhas, S. Sahiba, S. Perkins P335 Timing of endovascular and surgical treatment for aneurysmal subarachnoid haemorrhage: early but not so fast. J. Rubio, J. A. Rubio, R. Sierra P336 Red blood cell transfusion in aneurysmal subarachnoid hemorrhage – the Sahara cohort study S. English, M. Chasse, A. Turgeon, F. Lauzier, D. Griesdale, A. Garland, D. Fergusson, R. Zarychanski, A. Tinmouth, C. Van Walraven, K. Montroy, J. Ziegler, R. Dupont Chouinard, R. Carignan, A. Dhaliwal, C. Lum, J. Sinclair, G. Pagliarello, L. McIntyre P337 - Aneurysmal subarachnoid hemorrhage and anemia: a canadian multi-centre retrospective cohort study S. English, M. Chasse, A. Turgeon, F. Lauzier, D. Griesdale, A. Garland, D. Fergusson, R. Zarychanski, A. Tinmouth, C. Van Walraven, K. Montroy, J. Ziegler, R. Dupont Chouinard, R. Carignan, A. Dhaliwal, C. Lum, J. Sinclair, G. Pagliarello, L. McIntyre P338 - Does the neutrophil-to-lymphocyte (NLR) ratio predict symptomatic vasospasm or delayed cerebral ischemia (DCI) after aneurysmal subarachnoid haemorrhage (SAH)? T. Groza, N. Moreau, D. Castanares-Zapatero, P. Hantson P339 - ICU-acquired infections in aneurysmal subarachnoid hemorrhage patients: impact on ICU and hospital length of stay M. Carbonara , F. Ortolano, T. Zoerle, S. Magnoni, S. Pifferi, V. Conte, N. Stocchetti P340 - Cerebral metabolic effects of normobaric hyperoxia during the acute phase of aneurysmal subarachnoid hemorrhage L. Carteron, T. Suys, C. Patet, H. Quintard, M. Oddo P341 - Postoperative care for elective craniotomy: where is best done? J. A. Rubio, J. Rubio, R. Sierra P342 - 5-year follow-up of patients after transplantation of organs from donors from neurocritical care V. Spatenkova, E. Pokorna, P. Suchomel P343 - Evaluation of levetiracetam pharmacokinetics after severe traumatic brain injury in neurocritical care patients at a level one trauma center N. Ebert, J. Jancik, H. Rhodes P344 - Model based time series cluster analysis to determine unique patient states in traumatic brain injury T. Bylinski, C. Hawthorne, M. Shaw, I. Piper, J. Kinsella P345 - Brain compartment monitoring capabilities from ICP to BI (bioimpedance) during HS (hypertonic saline) administration. State of art simulation outcome depending on brain swelling type A. K. Kink , I. R. Rätsep P346 - Transfusion of red blood cells in patients with traumatic brain injury admitted to Canadian trauma health centers: a multicenter cohort study A. Boutin, L. Moore, M. Chasse, R. Zarychanski, F. Lauzier, S. English, L. McIntyre, J. Lacroix, D. Griesdale, P. Lessard-Bonaventure, A. F. Turgeon P347 - Hemoglobin thresholds and red blood cell transfusions in adult patients with moderate or severe traumatic brain injury: a retrospective cohort study A. Boutin, L. Moore, R. Green, P. Lessard-Bonaventure, M. Erdogan, M. Butler, F. Lauzier, M. Chasse, S. English, L. McIntyre, R. Zarychanski, J. Lacroix, D. Griesdale, P. Desjardins, D. A. Fergusson, A. F. Turgeon P348 - Characteristics of patients with gunshot wounds to the head - an observational Brazilian study B. Goncalves, B. Vidal, C. Valdez, A. C. Rodrigues, L. Miguez, G. Moralez P349 - Base excess as predictor for ICU admission and the injury severity in blunt trauma patients T. Hong P350 - Enhancement of usual emergency department care with proadrenomedullin to improve outcome prediction - Results from the multi-national, prospective, observational TRIAGE study A. Kutz, P. Hausfater, D. Amin, T. Struja, S. Haubitz, A. Huber, B. Mueller, P. Schuetz P351 - Developing an innovative emergency medicine point-of-care simulation programme T. Brown, J. Collinson, C. Pritchett, T. Slade P352 - The InSim program: an in situ simulation program for junior trainees in intensive care M. Le Guen, S. Hellings, R. Ramsaran P353 - Impact of excessive and inappropriate troponin testing in the emergency setting how good are we A. Alsheikhly P354 - The development of time tracking monitor at emergency department T. Abe P355 - Role of focussed echocardiography in emergency assessment of syncope L. Kanapeckaite, M. Abu-Habsa, R. Bahl P356 - Insertion of an open-ended 14-gauge catheter through the chest wall causes a significant pneumothorax in a self-ventilating swine model M. Q Russell, K. J. Real, M. Abu-Habsa , R. M. Lyon, N. P. Oveland P357 - Ez-io® intraosseous access teaching in the workplace using a mobile ‘tea trolley’ training method J. Penketh, M. Mcdonald, F. Kelly P358 - Black widow envenomation in Saudi Arabia: a prospective observational case series M. Alfafi, S. Alsolamy, W. Almutairi, B. Alotaibi P359 - Mechanical ventilation in patients with overdose not yet intubated on icu admission A. E. Van den Berg, Y. Schriel, L. Dawson, I. A. Meynaar P360 - Central nervous system depressants poisoning and ventilator associated pneumonia: an underrated risk factor in toxicological intensive care unit H. Talaie P361 - Acute barium intoxication treated with hemodiafiltration D. Silva, S. Fernandes, J. Gouveia, J. Santos Silva P362 - Major trauma presenting to the emergency department. the spectrum of cycling injuries in Ireland J. Foley, A. Kaskovagheorgescu, D. Evoy, J. Cronin, J. Ryan P363 - Burns from French military operations: a 14-year retrospective observational analysis. M. Huck, C. Hoffmann, J. Renner, P. Laitselart, N. Donat, A. Cirodde, J. V. Schaal, Y. Masson, A. Nau, T. Leclerc P364 - A comparison of mortality scores in burns patients on the intensive care unit. O. Howarth, K. Davenport, P. Jeanrenaud, S. Raftery P365 - Clasification of pain and its treatment and an intensive care rehabiliation clinic P. MacTavish, H. Devine, J. McPeake, M. Daniel, J. Kinsella, T. Quasim P366 - Pain management adequacy in critical care areas ,the process and the barriers perceived by critical care nurses S. Alrabiee, A. Alrashid , S. Alsolamy P367 - Pain assessment in critically ill adult patients: validation of the Turkish version of the critical-care pain observation tool O. Gundogan, C. Bor, E. Akýn Korhan, K. Demirag , M. Uyar P368 - An audit of pain and sedation assessments in the intensive care unit: recommendations for clinical practice F. Frame, C. Ashton, L. Bergstrom Niska P369 - Impact of pharmaceutical care on treatment of pain and agitation in medical intensive care unit P. Dilokpattanamongkol, T. Suansanae, C. Suthisisang, S. Morakul, C. Karnjanarachata, V. Tangsujaritvijit P370 - Agitation in trauma ICU, prevention and outcome S. Mahmood, H. Al Thani, A. Almenyar P371 Correlation between percentages of ventilated patients developed vap and use of sedative agents in icu patients. A. Vakalos , V. Avramidis P372 - Improving recording of sedation events in the Emergency Department: The implementation of the SIVA International Taskforce adverse event reporting tool for procedural sedation R. Sharvill, J. Penketh P373 - Impact of sedative drug use on the length of mechanical ventilation S. E. Morton, Y. S. Chiew, C. Pretty, J. G. Chase, G. M. Shaw P374 - Co-administration of nitric oxide and sevoflurane using anaconda R. Knafelj, P. Kordis P375 - A retrospective study of the use of Dexmedetomidine in an oncological critical care setting S. Patel, V. Grover P376 - Dexmedetomidine and posttraumatic stress disorder incidence in alcohol withdrawal icu patients I. Kuchyn, K. Bielka P377 - Hemodynamic effects of dexmedetomidine in a porcine model of septic shock Z. Aidoni, V. Grosomanidis, K. Kotzampassi, G. Stavrou, B. Fyntanidou, S. Patsatzakis, C. Skourtis P378 - Ketamine for analgosedation in severe hypoxic respiratory failure S. D. Lee, K. Williams, I. D. Weltes P379 - Madness from the moon? lunar cycle and the incidence of delirium on the intensive care unit S. Berhane, C. Arrowsmith, C. Peters, S. Robert P380 - Impaired dynamic cerebral autoregulation after coronary artery bypass grafting and association with postoperative delirium J. Caldas, R. B. Panerai, T. G. Robinson, L. Camara, G. Ferreira, E. Borg-Seng-Shu, M. De Lima Oliveira, N. C. Mian, L. Santos, R. Nogueira, S. P. Zeferino, M. Jacobsen Teixeira, F. Galas, L. A. Hajjar P381 - Risk factors predicting prolonged intensive care unit length of stay after major elective surgery. P. Killeen, M. McPhail, W. Bernal, J. Maggs, J. Wendon, T. Hughes P382 - Systemic inflammatory response syndrome criteria and hospital mortality prediction in a brazilian cohort of critically ill patients L. U. Taniguchi, E. M. Siqueira, J. M. Vieira Jr, L. C. Azevedo P383 - Evaluating the efficacy of a risk predictor panel in identifying patients at elevated risk of morbidity following emergency admission A. N. Ahmad, M. Abu-Habsa, R. Bahl, E. Helme, S. Hadfield, R. Loveridge P384 - A retrospective comparison of outcomes for elective surgical patients admitted post-operatively to the critical care unit or general ward J. Shak, C. Senver, R. Howard-Griffin P385 - Effect of obesity on mortality in surgical critically ill patients. P. Wacharasint, P. Fuengfoo, N. Sukcharoen, R. Rangsin P386 - The national early warning score (news) reliably improves adverse clinical outcome prediction in community-acquired pneumonia - results from a 6 year follow-up D. Sbiti-Rohr, P. Schuetz P387 - Clinical usefulness of the charlson¡¯s weighted index of comorbidities _as prognostic factor in patients with prolonged acute mechanical ventilation H. Na, S. Song, S. Lee, E. Jeong, K. Lee P388 - Comparison of mortality prediction scoring systems in patients with cirrhosis admitted to general intensive care unit M. Cooper, K. Milinis, G. Williams, E. McCarron, S. Simants, I. Patanwala, I. D. Welters P389 - Impact of admission source and time of admission on outcome of pediatric intensive care patients: retrospective 15 years study E. Zoumpelouli, EA Volakli, V. Chrysohoidou, S. Georgiou, K. Charisopoulou, E. Kotzapanagiotou, V. Panagiotidou, K. Manavidou, Z. Stathi, M. Sdougka P390 - Heart rate variability and outcomes prediction in critical illness N. Salahuddin, B. AlGhamdi, Q. Marashly, K. Zaza, M. Sharshir, M. Khurshid, Z. Ali, M. Malgapo, M. Jamil, A. Shafquat, M. Shoukri, M. Hijazi P391 - The incidence and outcome of hyperlactatemia in the post anaesthesia care unit T. Abe, S. Uchino, M. Takinami P392 - Correlation between arterial blood gas disturbances and arterial lactate levels during hospitalization and outcome in critically septic patients N. R. Rangel Neto, S. Oliveira, F. Q. Reis, F. A. Rocha P393 - External validation of saps 3 and mpm iii scores in 48,816 patients from 72 brazilian icus G. Moralez, K. Ebecken, L. S. Rabello, M. F. Lima, R. Hatum, F. V. De Marco, A. Alves, J. E. Pinto, M. Godoy, P. E. Brasil, F. A. Bozza, J. I. Salluh, M. Soares P394 - The frailty penalty: pre-admission functional status confounds mortality prediction models in critically ill patients J. Krinsley, G. Kang P395 - ‘sooner rather than later”: how delayed discharge from critical care leads to increased out of hours discharges and subsequent increase in in-hospital mortality. J. Perry, H. Hines P396 - Identifying poor outcome patient groups in a resource-constrained critical care unit K. M. Wilkinson, C. Tordoff, B. Sloan, M. C. Bellamy P397 - Effects of icu weekend admission and discharge on mortality. E. Moreira, F. Verga, M. Barbato, G. Burghi P398 - Organizational factors, outcomes and resource use in 9,946 cancer patients admitted to 70 ICUs M Soares, U. V. Silva, L. C. Azevedo, A. P. Torelly, J. M. Kahn, D. C. Angus, M. F. Knibel, P. E. Brasil, F. A. Bozza, J. I. Salluh P399 - Evaluation of oncological critically ill patients, severity score and outcome compared to not oncological in a particular hospital cti. M. B. Velasco, D. M. Dalcomune P400 - Outcomes of patients admitted to a large uk critical care department with palliative oncological diagnoses R. Marshall, T. Gilpin, A. Tridente, A. Raithatha P401 - Predictors of mortality in febrile neutropenic patients with haematological malignancies admitted to an intensive care unit of a cancer center D. Mota, B. Loureiro, J. Dias, O. Afonso, F. Coelho, A. Martins, F. Faria P402 - Patients with hematologic malignancies requiring invasive mechanical ventilation: characteristics and predictors of mortality H. Al-Dorzi, H. Al Orainni , F. AlEid, H. Tlaygeh, A. Itani, A. Hejazi, Y. Arabi P403 - Patient-important outcomes in randomized controlled trials in critically ill patients: a systematic review S. Gaudry, J. Messika, J. D. Ricard, S. Guillo, B. Pasquet, E. Dubief, D. Dreyfuss, F. Tubach P404 - Alopecia in survivors of critical illness: a qualitative study C . Battle, K. James, P. Temblett P405 - The impact of mental health on icu admission L. Davies, C. Battle, C. Lynch P406 - Cognitive impairment 5 years after ICU discharge S. Pereira, S. Cavaco, J. Fernandes, I. Moreira, E. Almeida, F. Seabra Pereira, M. Malheiro, F. Cardoso, I. Aragão, T. Cardoso P407 - Apache ii versus apache iv for octagenerians in medical icu M. Fister, R. Knafelj P408 - Outcomes of octagenarians in an indian icu P. Muraray Govind, N. Brahmananda Reddy, R. Pratheema, E. D. Arul, J. Devachandran P409 - Mortality and outcomes in elderly patients 80 years of age or older admitted to the icu M. B. Velasco , D. M. Dalcomune P410 - Octagenerians in medical icu - adding days to life or life to days? R. Knafelj, M. Fister P411 - The very elderly admitted to intensive care unit: outcomes and economic evaluation N. Chin-Yee, G. D’Egidio, K. Thavorn, D. Heyland, K. Kyeremanteng P412 - The very elderly in intensive care: relationship between acuity of illness and long-term mortality A. G. Murchison, K. Swalwell, J. Mandeville, D. Stott P413 - Acquired weakness in an oncological intensive care unit I. Guerreiro P414 - Musculoskeletal problems in intensive care unit (ICU) patients post-discharge H. Devine, P. MacTavish, J. McPeake, T. Quasim, J. Kinsella, M. Daniel P415 - Premorbid obesity, but not nutrition, prevents critical illness-induced muscle wasting and weakness C. Goossens M. B. Marques, S. Derde, S. Vander Perre, T. Dufour, S. E. Thiessen, F. Güiza, T. Janssens, G. Hermans, I. Vanhorebeek, K. De Bock, G. Van den Berghe, L. Langouche P416 - Physical outcome measures for critical care patients following intensive care unit (icu) discharge H. Devine, P. MacTavish, T. Quasim, J. Kinsella, M. Daniel, J. McPeake P417 - Improving active mobilisation in a general intensive care unit B. Miles , S. Madden, H. Devine P418 - Mobilization in patients on vasoactive drugs use – a pilot study. M. Weiler, P. Marques, C. Rodrigues, M. Boeira, K. Brenner, C. Leães, A. Machado, R. Townsend, J. Andrade P419 - Pharmacy intervention at an intensive care rehabilitation clinic P. MacTavish, J. McPeake, H. Devine, J. Kinsella, M. Daniel, R. Kishore, C. Fenlon, T. Quasim P420 - Interactive gaming is feasible and potentially increases icu patients’ motivation to be engaged in rehabilitation programs T. Fiks, A. Ruijter, M. Te Raa, P. Spronk P421 - Simulation-based design of a robust stopping rule to ensure patient safety Y. S. Chiew, P. Docherty, J. Dickson, E. Moltchanova, C. Scarrot, C. Pretty, G. M. Shaw, J. G. Chase P422 - Are daily blood tests on the intensive care unit necessary? T. Hall, W. C. Ngu, J. M. Jack, P. Morgan P423 - Measuring urine output in ward patients: is it helpful? B. Avard, A. Pavli, X. Gee P424 - The incidence of pressure ulcers in an adult mixed intensive care unit in turkey C . Bor, E. Akin Korhan, K. Demirag, M. Uyar P425 - Intensivist/patient ratios in closed ICUs in Alexandria, Egypt; an overview M. Shirazy, A. Fayed P426 - Eicu (electronic intensive care unit): impact on ALOS (average length of stay) in a developing country like India S. Gupta, A. Kaushal, S. Dewan, A. Varma P427 - Predicting deterioration in general ward using early deterioration indicator E. Ghosh, L. Yang, L. Eshelman, B. Lord, E. Carlson P428 - High impact enhanced critical care outreach - the imobile service: making a difference E. Helme, R. Broderick, S. Hadfield, R. Loveridge P429 - Impact of bed availability and cognitive load on intensive care unit (ICU) bed allocation: a vignette-based trial J. Ramos, D. Forte P430 - Characteristics of critically ill patients admitted through the emergency department F. Yang, P. Hou P431 - Admission to critical care: the quantification of functional reserve J. Dudziak, J. Feeney, K. Wilkinson, K. Bauchmuller, K. Shuker, M. Faulds, A. Raithatha, D. Bryden, L. England, N. Bolton, A. Tridente P432 - Admission to critical care: the importance of frailty K. Bauchmuller, K Shuker, A Tridente, M Faulds, A Matheson, J. Gaynor, D Bryden, S South Yorkshire Hospitals Research Collaboration P433 - Development of an instrument to aid triage decisions for intensive care unit admission J. Ramos, B. Peroni, R. Daglius-Dias, L. Miranda, C. Cohen, C. Carvalho, I . Velasco, D. Forte P434 - Using selective serotonin re-uptake inhibitors and serotonin-norepinephrine re-uptake inhibitors in critical care: a systematic review of the evidence for benefit or harm J. M. Kelly, A. Neill, G. Rubenfeld, N. Masson, A. Min P435 - Measuring adaptive coping of hospitalized patients with a severe medical condition:the sickness insight in coping questionnaire (sicq) E. Boezeman, J. Hofhuis , A. Hovingh, R. De Vries, P. Spronk P436 - Results of a national survey regarding intensive care medicine training G. Cabral-Campello, I. Aragão, T. Cardoso P437 - Work engagement among healthcare professionals in the intensive care unit M. Van Mol, M. Nijkamp, E . Kompanje P438 - Empowering the intensive care practitioners. is it a burnout ameliorating intervention? P. Ostrowski, A. Omar P439 - Icu patients suffer from circadian rhythm desynchronisation K. Kiss , B. Köves, V. Csernus, Z. Molnár P440 - Noise reduction in the ICU: feasible ? Y. Hoydonckx, S. Vanwing, B. Stessel, A. Van Assche, L. Jamaer, J. Dubois P441 - Accidental removal of invasive devices in the critical patient into the bed-washing. does the presence of professional nurse modify his incidence? V. Medo, R. Galvez, J. P. Miranda P442 - Deprivation of liberty safeguards (dols): audit of compliance in a of a 16-bed specialist cancer critical care unit. C. Stone, T. Wigmore P443 - Use of a modified cristal score to predict futility of critical care in the elderly Y. Arunan, A. Wheeler, K. Bauchmuller, D. Bryden P444 - Improvement of Referral Rate to Palliative Care for Patients with Poor Prognosis in Neurosurgical Intensive Care Unit Y. Wong, C. Poi, C. Gu P445 - Factors associated with limitation of life supporting care (lsc) in a medico-surgical intermediate care unit, and outcome of patients with lsc limitation: a monocentric, six-month study. P. Molmy, N. Van Grunderbeeck, O. Nigeon, M. Lemyze, D. Thevenin, J. Mallat P446 - Palliative care consultation and intensive care unit admission request: a cohort study J. Ramos, M. Correa, R. T. Carvalho, D. Forte P447 - Nursing and medicine together in postsurgical intensive care unit: situations of prognostic conflict at the end of life. our critical care nurses suffer with our medical activism? A. Fernandez, C. McBride P448 - End of life who may decide E. Koonthalloor, C. Walsh P449 - Correctly diagnosing death A. Webber, M. Ashe, K. Smith, P. Jeanrenaud P450 - Skin procurement performed by intensive care physicians: yes, we can. A. Marudi , S. Baroni, F. Ragusa, E. Bertellini P451 - Death analysis in pediatric intensive care patients E. A. Volakli , E. Chochliourou, M. Dimitriadou, A. Violaki, P. Mantzafleri, E. Samkinidou, O. Vrani, A. Arbouti, T. Varsami, M. Sdougka P452 - The potential impact of euthanasia on organ donation: analysis of data from belgium J. A. Bollen, T. C. Van Smaalen, W. C. De Jongh, M. M. Ten Hoopen, D. Ysebaert, L. W. Van Heurn, W. N. Van Mook P453 - Communication within an intensive care setting K. Sim, A. Fuller P454 - Development and implementation of a longitudinal communication curriculum for critical care medicine fellows A. Roze des Ordons, P. Couillard, C. Doig P455 - Staff-family conflict in a multi-ethnic intensive care unit R. V. Van Keer, R. D. Deschepper, A. F. Francke, L. H. Huyghens, J. B. Bilsen P456 - Does the source of admission to critical care affect family satisfaction? B. Nyamaizi, C. Dalrymple, A. Molokhia, A. Dobru P457 - A simple alternative to the family satisfaction survey (fs-icu) E. Marrinan, A. Ankuli, A. Molokhia P458 - A study to explore the experiences of patient and family volunteers in a critical care environment: a phenomenological analysis J. McPeake, R. Struthers, R. Crawford , H. Devine , P. Mactavish , T. Quasim P459 - Prevalence and risk factors of anxiety and depression in relatives of burn patients. P. Morelli, M. Degiovanangelo, F. Lemos, V. MArtinez, F. Verga, J. Cabrera, G. Burghi P460 - Guidance of visiting children at an adult intensive care unit (icu) A. Rutten , S. Van Ieperen, S. De Geer, M. Van Vugt, E. Der Kinderen P461 - Visiting policies in Italian pediatric ICUs: an update A. Giannini, G Miccinesi, T Marchesi, E Prandi

Published
2016

9. INCA-GYN001: Erlotinib added to cisplatin and definitive radiotherapy in untreated patients with locally advanced squamous cell cervical carcinoma — A phase II trial and correlative tumor molecular profiling

Author

Rodrigues, A., primary, Alves, F., additional, Carmo, C., additional, Erlich, F., additional, Ferreira, C., additional, Graziotin, R., additional, Mamede, M., additional, Moralez, G., additional, Small, I., additional, and Triginelli, S., additional

Published
2012
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10. INCA-GYN001: Erlotinib added to cisplatin and definitive radiotherapy in untreated patients with locally advanced squamous cell cervical carcinoma—Final report of a phase II trial.

Author

Rodrigues, A. N., primary, Small, I. A., additional, Carmo, C. C., additional, Moralez, G. M., additional, Erlich, F., additional, Grazziotin, R., additional, Lewer, M. H., additional, Camisao, C. c., additional, Alves, F. V., additional, and Ferreira, C. G. M., additional

Published
2011
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11. Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

Author

Author et al, Bateman, R. M., Sharpe, M. D., Jagger, J. E., Ellis, C. G., Solé-Violán, J., López-Rodríguez, M., Herrera-Ramos, E., Ruíz-Hernández, J., Borderías, L., Horcajada, J., González-Quevedo, N., Rajas, O., Briones, M., Rodríguez de Castro, F., Rodríguez Gallego, C., Esen, F., Orhun, G., Ergin Ozcan, P., Senturk, E., Ugur Yilmaz, C., Orhan, N., Arican, N., Kaya, M., Kucukerden, M., Giris, M., Akcan, U., Bilgic Gazioglu, S., Tuzun, E., Riff, R., Naamani, O., Douvdevani, A., Takegawa, R., Yoshida, H., Hirose, T., Yamamoto, N., Hagiya, H., Ojima, M., Akeda, Y., Tasaki, O., Tomono, K., Shimazu, T., Ono, S., Kubo, T., Suda, S., Ueno, T., Ikeda, T., Ogura, H., Takahashi, H., Kang, J., Nakamura, Y., Kojima, T., Izutani, Y., Taniguchi, T., O, M., Dinter, C., Lotz, J., Eilers, B., Wissmann, C., Lott, R., Meili, M. M., Schuetz, P. S., Hawa, H., Sharshir, M., Aburageila, M., Salahuddin, N., Chantziara, V., Georgiou, S., Tsimogianni, A., Alexandropoulos, P., Vassi, A., Lagiou, F., Valta, M., Micha, G., Chinou, E., Michaloudis, G., Kodaira, A., Imaizumi, H., De la Torre-Prados, M. V., Garcia-De la Torre, A., Enguix-Armada, A., Puerto-Morlan, A., Perez-Valero, V., Garcia-Alcantara, A., Bolton, N., Dudziak, J., Bonney, S., Tridente, A., Nee, P., Nicolaes, G., Wiewel, M., Schultz, M., Wildhagen, K., Horn, J., Schrijver, R., Van der Poll, T., Reutelingsperger, C., Pillai, S., Davies, G., Mills, G., Aubrey, R., Morris, K., Williams, P., Evans, P., Gayat, E. G., Struck, J., Cariou, A., Deye, N., Guidet, B., Jabert, S., Launay, J., Legrand, M., Léone, M., Resche-Rigon, M., Vicaut, E., Vieillard-Baron, A., Mebazaa, A., Arnold, R., Capan, M., Linder, A., Akesson, P., Popescu, M., Tomescu, D., Sprung, C. L., Calderon Morales, R., Munteanu, G., Orenbuch-Harroch, E., Levin, P., Kasdan, H., Reiter, A., Volker, T., Himmel, Y., Cohen, Y., Meissonnier, J., Girard, L., Rebeaud, F., Herrmann, I., Delwarde, B., Peronnet, E., Cerrato, E., Venet, F., Lepape, A., Rimmelé, T., Monneret, G., Textoris, J., Beloborodova, N., Moroz, V., Osipov, A., Bedova, A., Sarshor, Y., Pautova, A., Sergeev, A., Chernevskaya, E., Odermatt, J., Bolliger, R., Hersberger, L., Ottiger, M., Christ-Crain, M., Mueller, B., Schuetz, P., Sharma, N. K., Tashima, A. K., Brunialti, M. K., Machado, F. R., Assuncao, M., Rigato, O., Salomao, R., Cajander, S. C., Rasmussen, G., Tina, E., Söderquist, B., Källman, J., Strålin, K., Lange, A. L., Sundén-Cullberg, J. S., Magnuson, A. M., Hultgren, O. H., Van der Geest, P., Mohseni, M., Linssen, J., De Jonge, R., Duran, S., Groeneveld, J., Miller, R., Lopansri, B. K., McHugh, L. C., Seldon, A., Burke, J. P., Johnston, J., Reece-Anthony, R., Bond, A., Molokhia, A., Mcgrath, C., Nsutebu, E., Bank Pedersen, P., Pilsgaard Henriksen, D., Mikkelsen, S., Touborg Lassen, A., Tincu, R., Cobilinschi, C., Ghiorghiu, Z., Macovei, R., Wiewel, M. A., Harmon, M. B., Van Vught, L. A., Scicluna, B. P., Hoogendijk, A. J., Zwinderman, A. H., Cremer, O. L., Bonten, M. J., Schultz, M. J., Juffermans, N. P., Wiersinga, W. J., Eren, G., Tekdos, Y., Dogan, M., Acicbe, O., Kaya, E., Hergunsel, O., Alsolamy, S., Ghamdi, G., Alswaidan, L., Alharbi, S., Alenezi, F., Arabi, Y., Heaton, J., Boyce, A., Nolan, L., Dukoff-Gordon, A., Dean, A., Mann Ben Yehudah, T., Fleischmann, C., Thomas-Rueddel, D., Haas, C., Dennler, U., Reinhart, K., Suntornlohanakul, O., Khwannimit, B., Breckenridge, F., Puxty, A., Szturz, P., Folwarzcny, P., Svancara, J., Kula, R., Sevcik, P., Caneva, L., Casazza, A., Bellazzi, E., Marra, S., Pagani, L., Vetere, M., Vanzino, R., Ciprandi, D., Preda, R., Boschi, R., Carnevale, L., Lopez, V., Aguilar Arzapalo, M., Barradas, L., Escalante, A., Gongora, J., Cetina, M., Adamik, B, Jakubczyk, D, Kübler, A, Radford, A., Lee, T., Singer, J., Boyd, J., Fineberg, D., Williams, M., Russell, J., Scarlatescu, E., Droc, G., Arama, S., Müller, M., Straat, M., Zeerleder, S. S., Fuchs, C. F., Scheer, C. S., Wauschkuhn, S. W., Vollmer, M. V., Meissner, K. M., Kuhn, S. K., Hahnenkamp, K. H., Rehberg, S. R., Gründling, M. G., Hamaguchi, S., Gómez-Sánchez, E., Heredia-Rodríguez, M., Álvarez-Fuente, E., Lorenzo-López, M., Gómez-Pesquera, E., Aragón-Camino, M., Liu-Zhu, P., Sánchez-López, A., Hernández-Lozano, A., Peláez-Jareño, M. T., Tamayo, E., Thomas-Rüddel, D. O., Adora, V., Kar, A., Chakraborty, A., Roy, S., Bandyopadhyay, A., Das, M., BenYehudah, G., Salim, M., Kumar, N., Arabi, L., Burger, T., Lephart, P., Toth-martin, E., Valencia, C., Hammami, N., Blot, S., Vincent, J. L., Lambert, M. L., Brunke, J., Riemann, T., Roschke, I., Nimitvilai, S., Jintanapramote, K., Jarupongprapa, S., Adukauskiene, D., Valanciene, D., Bose, G., Lostarakos, V., Carr, B., Khedher, S., Maaoui, A., Ezzamouri, A., Salem, M., Chen, J., Cranendonk, D. R., Day, M., Penrice, G., Roy, K., Robertson, P., Godbole, G., Jones, B., Booth, M., Donaldson, L., Kawano, Y., Ishikura, H., Al-Dorzi, H., Almutairi, M., Alhamadi, B., Crizaldo Toledo, A., Khan, R., Al Raiy, B., Talaie, H., Van Oers, J. A., Harts, A., Nieuwkoop, E., Vos, P., Boussarsar, Y., Boutouta, F., Kamoun, S., Mezghani, I., Koubaji, S., Ben Souissi, A., Riahi, A., Mebazaa, M. S., Giamarellos-Bourboulis, E., Tziolos, N., Routsi, C., Katsenos, C., Tsangaris, I., Pneumatikos, I., Vlachogiannis, G., Theodorou, V., Prekates, A., Antypa, E., Koulouras, V., Kapravelos, N., Gogos, C., Antoniadou, E., Mandragos, K., Armaganidis, A., Robles Caballero, A. R., Civantos, B., Figueira, J. C., López, J., Silva-Pinto, A., Ceia, F., Sarmento, A., Santos, L., Almekhlafi, G., Sakr, Y., Baharoon, S., Aldawood, A., Matroud, A., Alchin, J., Al Johani, S., Balkhy, H., Yousif, S. Y., Alotabi, B. O., Alsaawi, A. S., Ang, J., Curran, M. D., Enoch, D., Navapurkar, V., Morris, A., Sharvill, R., Astin, J., Patel, J., Kruger, C., O’Neal, J., Rhodes, H., Jancik, J., François, B., Laterre, P. F., Eggimann, P., Torres, A., Sánchez, M., Dequin, P. F., Bassi, G. L., Chastre, J., Jafri, H. S., Ben Romdhane, M., Douira, Z., Bousselmi, M., Vakalos, A., Avramidis, V., Craven, T. H., Wojcik, G., Kefala, K., McCoubrey, J., Reilly, J., Paterson, R., Inverarity, D., Laurenson, I., Walsh, T. S., Mongodi, S., Bouhemad, B., Orlando, A., Stella, A., Via, G., Iotti, G., Braschi, A., Mojoli, F., Haliloglu, M., Bilgili, B., Kasapoglu, U., Sayan, I., Süzer Aslan, M., Yalcin, A., Cinel, I., Ellis, H. E., Bauchmuller, K., Miller, D., Temple, A., Luyt, C. E., Singer, M., Nassar, Y., Ayad, M. S., Trifi, A., Abdellatif, S., Daly, F., Nasri, R., Ben Lakhal, S., Gul, F., Kuzovlev, A., Shabanov, A., Polovnikov, S., Kadrichu, N., Dang, T., Corkery, K., Challoner, P., Bassi, G. Li, Aguilera, E., Chiurazzi, C., Travierso, C., Motos, A., Fernandez, L., Amaro, R., Senussi, T., Idone, F., Bobi, J., Rigol, M., Hodiamont, C. J., Janssen, J. M., Bouman, C. S., Mathôt, R. A., De Jong, M. D., Van Hest, R. M., Payne, L., Fraser, G. L., Tudor, B., Lahner, M., Roth, G., Krenn, C., Jault, P., Gabard, J., Leclerc, T., Jennes, S., Que, Y., Rousseau, A., Ravat, F., Eissa, A., Al-Harbi, S., Aldabbagh, T., Abdellatif., S., Paramba, F., Purayil, N., Naushad, V., Mohammad, O., Negi, V., Chandra, P., Kleinsasser, A., Witrz, M. R., Buchner-Doeven, J. F., Tuip-de Boer, A. M., Goslings, J. C., Van Hezel, M., Boing, A, Van Bruggen, R, Juffermans, N, Markopoulou, D., Venetsanou, K., Kaldis, V., Koutete, D., Chroni, D., Alamanos, I., Koch, L., Walter, E., Maekawa, K., Hayakawa, M., Kushimoto, S., Shiraishi, A., Kato, H., Sasaki, J., Matauoka, T., Uejima, T., Morimura, N., Hagiwara, A., Takeda, M., Tarabrin, O., Shcherbakow, S., Gavrychenko, D., Mazurenko, G., Ivanova, V., Chystikov, O., Plourde, C., Lessard, J., Chauny, J., Daoust, R., Kropman, L., In het Panhuis, L., Konings, J., Huskens, D., Schurgers, E., Roest, M., De Laat, B., Lance, M., Durila, M., Lukas, P., Astraverkhava, M., Jonas, J., Budnik, I., Shenkman, B., Hayami, H., Koide, Y., Goto, T., Iqbal, R., Alhamdi, Y., Venugopal, N., Abrams, S., Downey, C., Toh, C. H., Welters, I. D., Bombay, V. B., Chauny, J. M., Daoust, R. D., Lessard, J. L., Marquis, M. M., Paquet, J. P., Siemens, K., Sangaran, D., Hunt, B. J., Durward, A., Nyman, A., Murdoch, I. A., Tibby, S. M., Ampatzidou, F., Moisidou, D., Dalampini, E., Nastou, M., Vasilarou, E., Kalaizi, V., Chatzikostenoglou, H., Drossos, G., Spadaro, S., Fogagnolo, A., Fiore, T., Schiavi, A., Fontana, V., Taccone, F., Volta, C., Chochliourou, E., Volakli, E., Violaki, A., Samkinidou, E., Evlavis, G., Panagiotidou, V., Sdougka, M., Mothukuri, R., Battle, C., Guy, K., Wijesuriya, J., Keogh, S., Docherty, A., O’Donnell, R., Brunskill, S., Trivella, M., Doree, C., Holst, L., Parker, M., Gregersen, M., Almeida, J., Walsh, T., Stanworth, S., Moravcova, S., Mansell, J., Rogers, A., Smith, R. A., Hamilton-Davies, C., Omar, A., Allam, M., Bilala, O., Kindawi, A., Ewila, H., Malamas, A., Ferreira, G., Caldas, J., Fukushima, J., Osawa, E. A., Arita, E., Camara, L., Zeferino, S., Jardim, J., Gaioto, F., Dallan, L., Jatene, F. B., Kalil Filho, R., Galas, F., Hajjar, L. A., Mitaka, C., Ohnuma, T., Murayama, T., Kunimoto, F., Nagashima, M., Takei, T., Tomita, M., Mahmoud, K., Hanoura, S., Sudarsanan, S., Sivadasan, P., Othamn, H., Shouman, Y., Singh, R., Al Khulaifi, A., Mandel, I., Mikheev, S., Suhodolo, I., Kiselev, V., Svirko, Y., Podoksenov, Y., Jenkins, S. A., Griffin, R., Tovar Doncel, M. S., Lima, A., Aldecoa, C., Ince, C., Taha, A., Shafie, A., Mostafa, M., Syed, N., Hon, H., Righetti, F., Colombaroli, E., Castellano, G., Hravnak, M., Chen, L. C., Dubrawski, A. D., Clermont, G. C., Pinsky, M. R., Gonzalez, S., Macias, D., Acosta, J., Jimenez, P., Loza, A., Lesmes, A., Lucena, F., Leon, C., Bastide, M., Richecoeur, J., Frenoy, E., Lemaire, C., Sauneuf, B., Tamion, F., Nseir, S., Du Cheyron, D., Dupont, H., Maizel, J., Shaban, M., Kolko, R., AbuRageila, M., AlHussain, A., Mercado, P., Kontar, L., Titeca, D., Brazier, F., Riviere, A., Joris, M., Soupison, T., De Cagny, B., Slama, M., Wagner, J., Körner, A., Kubik, M., Kluge, S., Reuter, D., Saugel, B., Tran, T., De Bels, D., Cudia, A., Strachinaru, M., Ghottignies, P., Devriendt, J., Pierrakos, C., Martínez González, Ó., Blancas, R., Luján, J., Ballesteros, D., Martínez Díaz, C., Núñez, A., Martín Parra, C., López Matamala, B., Alonso Fernández, M., Chana, M., Huber, W., Eckmann, M., Elkmann, F., Gruber, A., Klein, I., Schmid, R. M., Lahmer, T., Moller, P. W., Sondergaard, S., Jakob, S. M., Takala, J., Berger, D., Bastoni, D., Aya, H., Toscani, L., Pigozzi, L., Rhodes, A., Cecconi, M., Ostrowska, C., Abbas, A., Mellinghoff, J., Ryan, C., Dawson, D., Cronhjort, M., Wall, O., Nyberg, E., Zeng, R., Svensen, C., Mårtensson, J., Joelsson-Alm, E., Parenti, N., Palazzi, C., Amidei, L. A., Borrelli, F. B., Campanale, S. C., Tagliazucchi, F. T., Sedoni, G. S., Lucchesi, D. L., Carella, E. C., Luciani, A. L, Mackovic, M., Maric, N., Bakula, M., Grounds, R. M., Fletcher, N., Avard, B., Zhang, P., Mezidi, M., Charbit, J., Ould-Chikh, M., Deras, P., Maury, C., Martinez, O., Capdevila, X., Hou, P., Linde-Zwirble, W. Z., Douglas, I. D., Shapiro, N. S., Ben Aicha, Y., Laribi, B., Jeribi, B., Pereira, C., Marinho, R., Antunes, R., Marinho, A., Crivits, M., Raes, M., Decruyenaere, J., Hoste, E., Bagin, V., Rudnov, V., Savitsky, A., Astafyeva, M., Korobko, I., Vein, V., Kampmeier, T., Arnemann, P., Hessler, M., Wald, A., Bockbreder, K., Morelli, A., Van Aken, H., Rehberg, S., Ertmer, C., Reddy, S., Bailey, M., Beasley, R., Bellomo, R., Mackle, D., Psirides, A., Young, P., Venkatesh, H., Ramachandran, S., Basu, A., Nair, H., Egan, S., Bates, J., Oliveira, S., Rangel Neto, N. R., Reis, F. Q., Lee, C. P., Lin, X. L., Choong, C., Eu, K. M., Sim, W. Y., Tee, K. S., Pau, J., Abisheganaden, J., Maas, K., De Geus, H., Lafuente, E., Moura, J., Doris, T. E., Monkhouse, D., Shipley, T., Kardasz, S., Gonzalez, I, Stads, S., Groeneveld, A. J., Elsayed, I., Ward, N., Raithatha, A., Steuber, A., Pelletier, C., Schroeder, S., Michael, E., Slowinski, T., Kindgen-Milles, D., Ghabina, S., Turani, F., Belli, A., Busatti, S., Barettin, G., Candidi, F., Gargano, F., Barchetta, R., Falco, M., Demirkiran, O., Kosuk, M., Bozbay, S., Weber, V., Hartmann, J., Harm, S., Linsberger, I., Eichhorn, T., Valicek, G., Miestinger, G., Hoermann, C., Faenza, S., Ricci, D., Mancini, E., Gemelli, C., Cuoghi, A., Magnani, S., Atti, M., Laddomada, T., Doronzio, A., Balicco, B., Gruda, M. C., O’Sullivan, P., Dan, V. P., Guliashvili, T., Scheirer, A., Golobish, T. D., Capponi, V. J., Chan, P. P., Kogelmann, K., Drüner, M., Jarczak, D., Belli, A. B., Martni, S. M., Cotticelli, V. C., Mounajergi, F., Morimoto, S., Hussain, I., Nadeem, A., Ghorab, K., Maghrabi, K., Kloesel, S. K., Goldfuss, C., Stieglitz, A., Stieglitz, A. S., Krstevska, L., Albuszies, G., Jimmy, G., Izawa, J., Iwami, T., Uchino, S., Takinami, M., Kitamura, T., Kawamura, T., Powell-Tuck, J. G., Crichton, S., Raimundo, M., Camporota, L., Wyncoll, D., Ostermann, M., Hana, A., De Geus, H. R., Aydogdu, M., Boyaci, N., Yuksel, S., Gursel, G., Cayci Sivri, A. B., Meza-Márquez, J., Nava-López, J., Carrillo-Esper, R., Dardashti, A., Grubb, A., Wetzstein, M., Peters, E., Njimi, H., Pickkers, P., Waraich, M., Doyle, J., Samuels, T., Forni, L., Desai, N., Baumber, R., Gunning, P., Sell, A., Lin, S., Torrence, H., O’Dwyer, M., Kirwan, C., Prowle, J., Kim, T., O’Connor, M. E., Hewson, R. W., Kirwan, C. J., Pearse, R. M., Maksoud, M., Uzundere, O., Memis, D., Ýnal, M., Gultekin, A., Turan, N., Aydin, M. A., Basar, H., Sencan, I., Kapuagasi, A., Ozturk, M., Uzundurukan, Z., Gokmen, D., Ozcan, A., Kaymak, C., Artemenko, V. A., Budnyuk, A., Pugh, R., Bhandari, S., Mauri, T., Turrini, C., Langer, T., Taccone, P., Volta, C. A., Marenghi, C., Gattinoni, L., Pesenti, A., Sweeney, L., O’Sullivan, A., Kelly, P., Mukeria, E., MacLoughlin, R., Pfeffer, M., Thomas, J. T., Bregman, G. B., Karp, G. K., Kishinevsky, E. K., Stavi, D. S., Adi, N. A., Poropat, T., Knafelj, R., Llopart, E., Batlle, M., De Haro, C., Mesquida, J., Artigas, A., Pavlovic, D., Lewerentz, L., Spassov, A., Schneider, R., De Smet, S., De Raedt, S., Derom, E., Depuydt, P, Oeyen, S., Benoit, D., Gobatto, A., Besen, B., Tierno, P., Melro, L., Mendes, P., Cadamuro, F., Park, M., Malbouisson, L. M., Civantos, B. C., Lopez, J. L., Robles, A., Figueira, J., Yus, S., Garcia, A., Oglinda, A., Ciobanu, G., Oglinda, C., Schirca, L., Sertinean, T., Lupu, V., Wolny, M., Pagano, A., Numis, F., Visone, G., Saldamarco, L., Russo, T., Porta, G., Paladino, F., Bell, C., Liu, J., Debacker, J., Lee, C., Tamberg, E., Campbell, V., Mehta, S., Kara, Ý., Yýldýrým, F., Zerman, A., Güllü, Z., Boyacý, N., Basarýk Aydogan, B., Gaygýsýz, Ü., Gönderen, K., Arýk, G., Turkoglu, M., Aygencel, G., Ülger, Z., Isýkdogan, Z., Özdedeoglu, Ö., Badoglu, M., Gaygýsýz, U., Kongpolprom, N., Sittipunt, C., Eden, A., Kokhanovsky, Y., Bursztein – De Myttenaere, S., Pizov, R., Neilans, L., MacIntyre, N., Radosevich, M., Wanta, B., Meyer, T., Smischney, N., Brown, D., Diedrich, D., Fuller, A., McLindon, P., Sim, K., Shoaeir, M., Noeam, K., Mahrous, A., Matsa, R., Ali, A., Dridi, C., Haddad, F., Pérez-Calatayud, A., Zepeda-Mendoza, A., Diaz-Carrillo, M., Arch-Tirado, E., Carbognin, S., Pelacani, L., Zannoni, F., Agnoli, A., Gagliardi, G., Cho, R., Adams, A., Lunos, S., Ambur, S., Shapiro, R., Prekker, M., Thijssen, M., Janssen, L., Foudraine, N., Voscopoulos, C. J., Freeman, J., George, E., Eversole, D., Muttini, S., Bigi, R., Villani, G., Patroniti, N., Williams, G., George, E, Waldmann, A., Böhm, S., Windisch, W., Strassmann, S., Karagiannidis, C., Karagiannidis, C. K., Waldmann, A. W., Böhm, S. B., Windisch, W. W., Persson, P., Lundin, S., Stenqvist, O., Serra, C. S., Pagano, A. P., Masarone, M. M., Rinaldi, L. R., Amelia, A. A., Fascione, M. F., Adinolfi, L. A., Ruggiero, E. R., Asota, F., O’Rourke, K., Ranjan, S., Morgan, P., DeBacker, J. W., O’Neill, L., Munshi, L., Burry, L., Fan, E., Poo, S., Mahendran, K., Fowles, J., Gerrard, C., Vuylsteke, A., Loveridge, R., Chaddock, C., Patel, S., Kakar, V., Willars, C., Hurst, T., Park, C., Best, T., Vercueil, A., Auzinger, G., Borgman, A., Proudfoot, A. G., Grins, E., Emiley, K. E., Schuitema, J., Fitch, S. J., Marco, G., Sturgill, J., Dickinson, M. G., Strueber, M., Khaghani, A., Wilton, P., Jovinge, S. M., Sampson, C., Harris-Fox, S., Cove, M. E., Vu, L. H., Sen, A., Federspiel, W. J., Kellum, J. A., Mazo Torre, C., Riera, J., Ramirez, S., Borgatta, B., Lagunes, L., Rello, J., Kuzovlev, A. K., Goloubev, A., Nenchuk, S., Karavana, V., Glynos, C., Asimakos, A., Pappas, K., Vrettou, C., Magkou, M., Ischaki, E., Stathopoulos, G., Zakynthinos, S., Kozhevnikova, I., Dalla Corte, F., Grasso, S., Casolari, P., Caramori, G., Andrianjafiarinoa, T., Randriamandrato, T., Rajaonera, T., El-Dash, S., Costa, E. L. V., Tucci, M. R., Leleu, F, Kontar, L, Bacari-Risal, G., Amato, M., El Dash, S., Remmington, Fischer, A., Squire, S., Boichat, M., Honzawa, H., Yasuda, H., Adati, T., Suzaki, S., Horibe, M., Sasaki, M., Sanui, M., Daniel, J., Miranda, H., Milinis, K., Cooper, M., Williams, G. R., McCarron, E., Simants, S., Patanwala, I., Welters, I., Su, Y., Fernández Villanueva, J., Fernández Garda, R., López Lago, A., Rodríguez Ruíz, E., Hernández Vaquero, R., Tomé Martínez de Rituerto, S., Varo Pérez, E., Lefel, N., Schaap, F., Bergmans, D., Olde Damink, S., Van de Poll, M., Tizard, K., Lister, C., Poole, L., Ringaitiene, D., Gineityte, D., Vicka, V., Norkiene, I., Sipylaite, J., O’Loughlin, A., Maraj, V., Dowling, J., Velasco, M. B., Dalcomune, D. M., Dias, E. B., Fernandes, S. L., Oshima, T., Graf, S., Heidegger, C., Genton, L., Karsegard, V., Dupertuis, Y., Pichard, C., Friedli, N., Stanga, Z., Vandersteen, L., Stessel, B., Evers, S., Van Assche, A., Jamaer, L., Dubois, J., Castro, H., Valente, J., Martins, P., Casteloes, P., Magalhaes, C., Cabral, S., Santos, M., Oliveira, B., Salgueiro, A., Duarte, S., Castro, S., Melo, M., Gray, S., Maipang, K., Bhurayanontachai, R., Grädel, L. G., Schütz, P., Langlois, P., Manzanares, W., Lemieux, M., Elke, G., Bloos, F., Heyland, D., Aramendi, I., Babo, N., Hoshino, M., Haraguchi, Y., Kajiwara, S., Mitsuhashi, T., Tsubata, T., Aida, M., Rattanapraphat, T., Kongkamol, C., Xavier, B., Koutsogiannidis, C., Moschopoulou, M., Taskin, G., Çakir, M., Güler, AK, Taskin, A., Öcal, N., Özer, S., Yamanel, L., Wong, J. M., Fitton, C., Anwar, S., Stacey, S., Aggou, M., Fyntanidou, B., Patsatzakis, S., Oloktsidou, E., Lolakos, K., Papapostolou, E., Grosomanidis, V., Gaudry, S., Desailly, V., Pasquier, P., Brun, PB, Tesnieres, AT, Ricard, JD, Dreyfuss, D., Mignon, A., White, J. C, Stilwell, A., Friedlaender, G., Peters, M., Stipulante, S., Delfosse, A., Donneau, AF, Ghuysen, A., Feldmann, C., Freitag, D., Dersch, W., Irqsusi, M., Eschbach, D., Steinfeldt, T., Wulf, H., Wiesmann, T., Cholkraisuwat, J., Beitland, S., Nakstad, E., Stær-Jensen, H., Drægni, T., Andersen, G., Jacobsen, D., Brunborg, C., Waldum-Grevbo, B., Sunde, K., Hoyland, K., Pandit, D., Hayakawa, K., Kotzampassi, K., Loukipoudi, L., Doumaki, E., Admiraal, M. M., Van Assen, M., Van Putten, M. J., Tjepkema-Cloostermans, M., Van Rootselaar, A. F., Ragusa, F., Marudi, A., Baroni, S., Gaspari, A., Bertellini, E., Abdullah, T., Abdel Monem, S., Alcorn, S., McNeill, S., Russell, S., Eertmans, W., Genbrugge, C., Meex, I., Dens, J., Jans, F., De Deyne, C., Avard, B, Burns, R, Patarchi, A., Spina, T., Tanaka, H., Otani, N., Ode, S., Ishimatsu, S., Cho, J., Moon, J. B., Park, C. W., Ohk, T. G., Shin, M. C., Won, M. H., Dakova, S., Ramsheva, Z., Ramshev, K., Marudi, A, Baroni, S, Gaspari, A, Bertellini, E, Ozcan, P. E., Sencer, S., Ulusoy, C., Fallenius, M., Skrifvars, M. B., Reinikainen, M., Bendel, S., Raj, R., Abu-Habsa, M., Hymers, C., Borowska, A., Sivadhas, H., Sahiba, S., Perkins, S., Rubio, J., Rubio, J. A., Sierra, R., English, S., Chasse, M., Turgeon, A., Lauzier, F., Griesdale, D., Garland, A., Fergusson, D., Zarychanski, R., Tinmouth, A., Van Walraven, C., Montroy, K., Ziegler, J., Dupont Chouinard, R., Carignan, R., Dhaliwal, A., Lum, C., Sinclair, J., Pagliarello, G., McIntyre, L., Groza, T., Moreau, N., Castanares-Zapatero, D., Hantson, P., Carbonara, M., Ortolano, F., Zoerle, T., Magnoni, S., Pifferi, S., Conte, V., Stocchetti, N., Carteron, L., Suys, T., Patet, C., Quintard, H., Oddo, M., Spatenkova, V., Pokorna, E., Suchomel, P., Ebert, N., Bylinski, T., Hawthorne, C., Shaw, M., Piper, I., Kinsella, J., Kink, A. K., Rätsep, I. R., Boutin, A., Moore, L., Lacroix, J., Lessard-Bonaventure, P., Turgeon, A. F., Green, R., Erdogan, M., Butler, M., Desjardins, P., Fergusson, D. A., Goncalves, B., Vidal, B., Valdez, C., Rodrigues, A. C., Miguez, L., Moralez, G., Hong, T., Kutz, A., Hausfater, P., Amin, D., Struja, T., Haubitz, S., Huber, A., Brown, T., Collinson, J., Pritchett, C., Slade, T., Le Guen, M., Hellings, S., Ramsaran, R., Alsheikhly, A., Abe, T., Kanapeckaite, L., Bahl, R., Russell, M. Q., Real, K. J., Lyon, R. M., Oveland, N. P., Penketh, J., Mcdonald, M., Kelly, F., Alfafi, M., Almutairi, W., Alotaibi, B., Van den Berg, A. E, Schriel, Y., Dawson, L., Meynaar, I. A., Silva, D., Fernandes, S., Gouveia, J., Santos Silva, J., Foley, J., Kaskovagheorgescu, A., Evoy, D., Cronin, J., Ryan, J., Huck, M., Hoffmann, C., Renner, J., Laitselart, P., Donat, N., Cirodde, A., Schaal, J. V., Masson, Y., Nau, A., Howarth, O., Davenport, K., Jeanrenaud, P., Raftery, S., MacTavish, P., Devine, H., McPeake, J., Daniel, M., Quasim, T., Alrabiee, S., Alrashid, A., Gundogan, O., Bor, C., Akýn Korhan, E., Demirag, K., Uyar, M., Frame, F., Ashton, C., Bergstrom Niska, L., Dilokpattanamongkol, P., Suansanae, T., Suthisisang, C., Morakul, S., Karnjanarachata, C., Tangsujaritvijit, V., Mahmood, S., Al Thani, H., Almenyar, A., Morton, S. E., Chiew, Y. S., Pretty, C., Chase, J. G., Shaw, G. M., Kordis, P., Grover, V., Kuchyn, I., Bielka, K., Aidoni, Z., Stavrou, G., Skourtis, C., Lee, S. D., Williams, K., Weltes, I. D., Berhane, S., Arrowsmith, C., Peters, C., Robert, S., Panerai, R. B., Robinson, T. G., Borg-Seng-Shu, E., De Lima Oliveira, M., Mian, N. C., Nogueira, R., Zeferino, S. P., Jacobsen Teixeira, M., Killeen, P., McPhail, M., Bernal, W., Maggs, J., Wendon, J., Hughes, T., Taniguchi, L. U., Siqueira, E. M., Vieira Jr, J. M., Azevedo, L. C., Ahmad, A. N., Helme, E., Hadfield, S., Shak, J., Senver, C., Howard-Griffin, R., Wacharasint, P., Fuengfoo, P., Sukcharoen, N., Rangsin, R., Sbiti-Rohr, D., Na, H., Song, S., Lee, S., Jeong, E., Lee, K., Zoumpelouli, E., Volakli, E. A, Chrysohoidou, V., Charisopoulou, K., Kotzapanagiotou, E., Manavidou, K., Stathi, Z., AlGhamdi, B., Marashly, Q., Zaza, K., Khurshid, M., Ali, Z., Malgapo, M., Jamil, M., Shafquat, A., Shoukri, M., Hijazi, M., Rocha, F. A., Ebecken, K., Rabello, L. S., Lima, M. F., Hatum, R., De Marco, F. V., Alves, A., Pinto, J. E., Godoy, M., Brasil, P. E., Bozza, F. A., Salluh, J. I., Soares, M., Krinsley, J., Kang, G., Perry, J., Hines, H., Wilkinson, K. M., Tordoff, C., Sloan, B., Bellamy, M. C., Moreira, E., Verga, F., Barbato, M., Burghi, G., Soares, M, Silva, U. V., Torelly, A. P., Kahn, J. M., Angus, D. C., Knibel, M. F., Marshall, R., Gilpin, T., Mota, D., Loureiro, B., Dias, J., Afonso, O., Coelho, F., Martins, A., Faria, F., Al Orainni, H., AlEid, F., Tlaygeh, H., Itani, A., Hejazi, A., Messika, J., Ricard, J. D., Guillo, S., Pasquet, B., Dubief, E., Tubach, F., James, K., Temblett, P., Davies, L., Lynch, C., Pereira, S., Cavaco, S., Fernandes, J., Moreira, I., Almeida, E., Seabra Pereira, F., Malheiro, M., Cardoso, F., Aragão, I., Cardoso, T., Fister, M., Muraray Govind, P., Brahmananda Reddy, N., Pratheema, R., Arul, E. D., Devachandran, J., Chin-Yee, N., D’Egidio, G., Thavorn, K., Kyeremanteng, K., Murchison, A. G., Swalwell, K., Mandeville, J., Stott, D., Guerreiro, I., Goossens, C., Marques, M. B., Derde, S., Vander Perre, S., Dufour, T., Thiessen, S. E., Güiza, F., Janssens, T., Hermans, G., Vanhorebeek, I., De Bock, K., Van den Berghe, G., Langouche, L., Miles, B., Madden, S., Weiler, M., Marques, P., Rodrigues, C., Boeira, M., Brenner, K., Leães, C., Machado, A., Townsend, R., Andrade, J., Kishore, R., Fenlon, C., Fiks, T., Ruijter, A., Te Raa, M., Spronk, P., Docherty, P., Dickson, J., Moltchanova, E., Scarrot, C., Hall, T., Ngu, W. C., Jack, J. M., Pavli, A., Gee, X., Akin Korhan, E., Shirazy, M., Fayed, A., Gupta, S., Kaushal, A., Dewan, S., Varma, A., Ghosh, E., Yang, L., Eshelman, L., Lord, B., Carlson, E., Broderick, R., Ramos, J., Forte, D., Yang, F., Feeney, J., Wilkinson, K., Shuker, K., Faulds, M., Bryden, D., England, L., Shuker, K, Tridente, A, Faulds, M, Matheson, A, Gaynor, J., Bryden, D, ᅟ, S South Yorkshire Hospitals Research Collaboration, Peroni, B., Daglius-Dias, R., Miranda, L., Cohen, C., Carvalho, C., Velasco, I., Kelly, J. M., Neill, A., Rubenfeld, G., Masson, N., Min, A., Boezeman, E., Hofhuis, J., Hovingh, A., De Vries, R., Cabral-Campello, G., Van Mol, M., Nijkamp, M., Kompanje, E., Ostrowski, P., Kiss, K., Köves, B., Csernus, V., Molnár, Z., Hoydonckx, Y., Vanwing, S., Medo, V., Galvez, R., Miranda, J. P., Stone, C., Wigmore, T., Arunan, Y., Wheeler, A., Wong, Y., Poi, C., Gu, C., Molmy, P., Van Grunderbeeck, N., Nigeon, O., Lemyze, M., Thevenin, D., Mallat, J., Correa, M., Carvalho, R. T., Fernandez, A., McBride, C., Koonthalloor, E., Walsh, C., Webber, A., Ashe, M., Smith, K., Volakli, E. A., Dimitriadou, M., Mantzafleri, P., Vrani, O., Arbouti, A., Varsami, T., Bollen, J. A., Van Smaalen, T. C., De Jongh, W. C., Ten Hoopen, M. M., Ysebaert, D., Van Heurn, L. W., Van Mook, W. N., Roze des Ordons, A., Couillard, P., Doig, C., Van Keer, R. V., Deschepper, R. D., Francke, A. F., Huyghens, L. H., Bilsen, J. B., Nyamaizi, B., Dalrymple, C., Dobru, A., Marrinan, E., Ankuli, A., Struthers, R., Crawford, R., Mactavish, P., Morelli, P., Degiovanangelo, M., Lemos, F., MArtinez, V., Cabrera, J., Rutten, A., Van Ieperen, S., De Geer, S., Van Vugt, M., Der Kinderen, E., Giannini, A., Miccinesi, G, Marchesi, T, and Prandi, E

Subjects
health care facilities, manpower, and services, education, Erratum, Critical Care and Intensive Care Medicine, reproductive and urinary physiology, humanities, health care economics and organizations
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12. Heart rate variability (HRV) after traumatic brain injury (TBI): a scoping review.

Author

Pinto SM, Wright B, Annaswamy S, Nwana O, Nguyen M, Wilmoth K, and Moralez G

Subjects
Humans, Brain Injuries, Traumatic physiopathology, Heart Rate physiology, Autonomic Nervous System physiopathology
Abstract

Background: Heart rate variability (HRV), defined as the variability between successive heart beats, is a noninvasive measure of autonomic nervous system (ANS) function, which may be altered following traumatic brain injury (TBI). This scoping review summarizes the existing literature regarding changes in HRV after TBI as well as the association between measures of HRV and outcomes following TBI., Methods: A literature search for articles assessing 'heart rate variability' and 'brain injury' or 'concussion' was completed. Articles were included if HRV was measured in human subjects with TBI or concussion. Review articles, protocol papers, and studies including non-traumatic injuries were excluded., Results: Sixty-three articles were included in this review. Varied methods were used to measure HRV in the different studies. Forty articles included information about differences in HRV measures after TBI and/or longitudinal changes after TBI. Fifteen studies assessed HRV and symptoms following TBI, and 15 studies assessed HRV and either functional or cognitive outcomes after TBI., Conclusions: HRV has been studied in the context of mortality, clinical symptoms, and medical, functional, or cognitive outcomes following TBI. Methods used to measure HRV have varied amongst the different studies, which may impact findings, standardized protocols are needed for future research.

Published
2024
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13. Prevalence of Cardiovascular Conditions After Traumatic Brain Injury: A Comparison Between the Traumatic Brain Injury Model Systems and the National Health and Nutrition Examination Survey.

Author

Pinto SM, Thakur B, Kumar RG, Rabinowitz A, Zafonte R, Walker WC, Ding K, Driver S, Venkatesan UM, Moralez G, and Bell KR

Subjects
Humans, Female, Male, Middle Aged, Prevalence, Cross-Sectional Studies, United States epidemiology, Adult, Cardiovascular Diseases epidemiology, Aged, Myocardial Infarction epidemiology, Risk Factors, Self Report, Hypertension epidemiology, Brain Injuries, Traumatic epidemiology, Brain Injuries, Traumatic diagnosis, Brain Injuries, Traumatic mortality, Nutrition Surveys
Abstract

Background: The purpose of this study is to compare the prevalence of self-reported cardiovascular conditions among individuals with moderate to severe traumatic brain injury (TBI) to a propensity-matched control cohort., Methods and Results: A cross-sectional study described self-reported cardiovascular conditions (hypertension, congestive heart failure [CHF], myocardial infarction [MI], and stroke) from participants who completed interviews between January 2015 and March 2020 in 2 harmonized large cohort studies, the TBI Model Systems and the National Health and Nutrition Examination Survey. Mixed-effect logistic regression models were used to compare the prevalence of cardiovascular conditions after 1:1 propensity-score matching based on age, sex, race, ethnicity, body mass index, education level, and smoking status. The final sample was 4690 matched pairs. Individuals with TBI were more likely to report hypertension (odds ratio [OR], 1.18 [95% CI, 1.08-1.28]) and stroke (OR, 1.70 [95% CI, 1.56-1.98]) but less likely to report CHF (OR, 0.81 [95% CI, 0.67-0.99]) or MI (OR, 0.66 [95% CI, 0.55-0.79]). There was no difference in rate of CHF or MI for those ≤50 years old; however, rates of CHF and MI were lower in the TBI group for individuals >50 years old. Over 65% of individuals who died before the first follow-up interview at 1 year post-TBI were >50 years old, and those >50 years old were more likely to die of heart disease than those ≤50 years old (17.6% versus 8.6%)., Conclusions: Individuals with moderate to severe TBI had an increased rate of self-reported hypertension and stroke but lower rate of MI and CHF than uninjured adults, which may be due to survival bias.

Published
2024
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14. Burn size and environmental conditions modify thermoregulatory responses to exercise in burn survivors.

Author

Belval LN, Cramer MN, Moralez G, Huang Dpt M, Watso JC, Fischer M, and Crandall CG

Subjects
Humans, Body Temperature Regulation physiology, Exercise, Body Temperature physiology, Fever, Hyperthermia, Hot Temperature, Burns therapy
Abstract

This project tested the hypothesis that burn survivors can perform mild/moderate-intensity exercise in temperate and hot environments without excessive elevations in core body temperature. Burn survivors with low (23 ± 5%TBSA; N = 11), moderate (40 ± 5%TBSA; N = 9), and high (60 ± 8%TBSA; N = 9) burn injuries performed 60 minutes of cycle ergometry exercise (72 ± 15 watts) in a 25°C and 23% relative humidity environment (ie, temperate) and in a 40°C and 21% relative humidity environment (ie, hot). Absolute gastrointestinal temperatures (TGI) and changes in TGI (ΔTGI) were obtained. Participants with an absolute TGI of >38.5°C and/or a ΔTGI of >1.5°C were categorized as being at risk for hyperthermia. For the temperate environment, exercise increased ΔTGI in all groups (low: 0.72 ± 0.21°C, moderate: 0.42 ± 0.22°C, and high: 0.77 ± 0.25°C; all P < .01 from pre-exercise baselines), resulting in similar absolute end-exercise TGI values (P = .19). Importantly, no participant was categorized as being at risk for hyperthermia, based upon the aforementioned criteria. For the hot environment, ΔTGI at the end of the exercise bout was greater for the high group when compared to the low group (P = .049). Notably, 33% of the moderate cohort and 56% of the high cohort reached or exceeded a core temperature of 38.5°C, while none in the low cohort exceeded this threshold. These data suggest that individuals with a substantial %TBSA burned can perform mild/moderate intensity exercise for 60 minutes in temperate environmental conditions without risk of excessive elevations in TGI. Conversely, the risk of excessive elevations in TGI during mild/moderate intensity exercise in a hot environment increases with the %TBSA burned., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Published
2024
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15. Attrition of Well-Healed Burn Survivors to a 6-Month Community-Based Exercise Program: A Retrospective Evaluation.

Author

Atkins WC, Romero SA, Moralez G, Huang M, Cramer MN, Foster J, McKenna ZJ, and Crandall CG

Subjects
Humans, Retrospective Studies, Exercise, Survivors, Burns
Abstract

The purpose of this study was to evaluate whether burn survivors have lower adherence compared to non-burned control individuals during a 6-month community-based exercise program. In burn survivors, we sought to answer if there was a relation between the size of the burn injury and dropout frequency. Fifty-two burn survivors and 15 non-burned controls (n = 67) were recruited for a 6-month community-based (ie, non-supervised), progressive, exercise training program. During the exercise program, 27% (ie, 4 of the 15 enrolled) of the non-burned individuals dropped out of the study, while 37% (ie, 19 of the 52) of the burn survivors dropped out from the study. There was no difference in the percentage of individuals who dropped out between groups (P = .552). There was no difference in size of the burn injury, expressed as percent body surface area burned (%BSA) between the burn survivors that dropped out versus those who completed the exercise regimen (P = .951). We did not observe a relation between %BSA burned and dropouts (log odds = -0.15-0.01(%BSA), B = -0.01, SE = 0.015, P = .541). There was no effect of %BSA burned on the probability of dropout [Exp (B) = 0.991, 95% CI (0.961, 1.020)] and there were no differences in the percentage of individuals who dropped out of the study based on %BSA burned (χ2(1) = 0.44, P = .51). These data demonstrate that burn survivors have similar exercise adherence relative to a non-burned group and the extent of a burn injury does not affect exercise program adherence., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Published
2023
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16. Six Months of Exercise Training Improves Ventilatory Responses during Exercise in Adults with Well-Healed Burn Injuries.

Author

Watso JC, Romero SA, Moralez G, Huang MU, Cramer MN, Jaffery MF, Balmain BN, Wilhite DP, Babb TG, and Crandall CG

Subjects
Humans, Adult, Respiratory Physiological Phenomena, Lung, Respiratory Function Tests, Exercise Tolerance, Exercise Test, Pulmonary Ventilation physiology, Oxygen Consumption physiology, Exercise physiology
Abstract

Introduction: Pulmonary function is lower after a severe burn injury, which could influence ventilatory responses during exercise. It is unclear whether exercise training improves pulmonary function or ventilatory responses during exercise in adults with well-healed burn injuries. Therefore, we tested the hypothesis that exercise training improves pulmonary function and ventilatory responses during exercise in adults with well-healed burn injuries., Methods: Thirty-nine adults (28 with well-healed burn injuries and 11 non-burn-injured controls) completed 6 months of unsupervised, progressive exercise training including endurance, resistance, and high-intensity interval components. Before and after exercise training, we performed comprehensive pulmonary function testing and measured ventilatory responses during cycling exercise. We compared variables using two-way ANOVA (group-time; i.e., preexercise/postexercise training (repeated factor))., Results: Exercise training did not increase percent predicted spirometry, lung diffusing capacity, or airway resistance measures (time: P ≥ 0.14 for all variables). However, exercise training reduced minute ventilation ( V̇E ; time: P ≤ 0.05 for 50 and 75 W) and the ventilatory equivalent for oxygen ( V̇E /V̇O 2 ; time: P < 0.001 for 75 W) during fixed-load exercise for both groups. The ventilatory equivalent for carbon dioxide ( V̇E /V̇CO 2 ) during exercise at 75 W was reduced after exercise training (time: P = 0.04). The percentage of age-predicted maximum heart rate at the ventilatory threshold was lower in adults with well-healed burn injuries before ( P = 0.002), but not after ( P = 0.22), exercise training. Lastly, exercise training increased V̇E and reduced V̇E /V̇O 2 during maximal exercise (time: P = 0.005 for both variables)., Conclusions: These novel findings demonstrate that exercise training can improve ventilatory responses during exercise in adults with well-healed burn injuries., (Copyright © 2022 by the American College of Sports Medicine.)

Published
2023
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17. Adrenergic control of skeletal muscle blood flow during chronic hypoxia in healthy males.

Author

Simpson LL, Hansen AB, Moralez G, Amin SB, Hofstaetter F, Gasho C, Stembridge M, Dawkins TG, Tymko MM, Ainslie PN, Lawley JS, and Hearon CM Jr

Subjects
Male, Humans, Vasoconstrictor Agents pharmacology, Phenylephrine pharmacology, Regional Blood Flow, Muscle, Skeletal physiology, Hypoxia, Adrenergic Agents pharmacology, Vasoconstriction
Abstract

Sympathetic transduction is reduced following chronic high-altitude (HA) exposure; however, vascular α-adrenergic signaling, the primary mechanism mediating sympathetic vasoconstriction at sea level (SL), has not been examined at HA. In nine male lowlanders, we measured forearm blood flow (Doppler ultrasound) and calculated changes in vascular conductance (ΔFVC) during 1 ) incremental intra-arterial infusion of phenylephrine to assess α 1 -adrenergic receptor responsiveness and 2 ) combined intra-arterial infusion of β-adrenergic and α-adrenergic antagonists propranolol and phentolamine (α-β-blockade) to assess adrenergic vascular restraint at rest and during exercise-induced sympathoexcitation (cycling; 60% peak power). Experiments were performed near SL (344 m) and after 3 wk at HA (4,383 m). HA abolished the vasoconstrictor response to low-dose phenylephrine (ΔFVC: SL: -34 ± 15%, vs. HA; + 3 ± 18%; P < 0.0001) and markedly attenuated the response to medium (ΔFVC: SL: -45 ± 18% vs. HA: -28 ± 11%; P = 0.009) and high (ΔFVC: SL: -47 ± 20%, vs. HA: -35 ± 20%; P = 0.041) doses. Blockade of β-adrenergic receptors alone had no effect on resting FVC ( P = 0.500) and combined α-β-blockade induced a similar vasodilatory response at SL and HA ( P = 0.580). Forearm vasoconstriction during cycling was not different at SL and HA ( P = 0.999). Interestingly, cycling-induced forearm vasoconstriction was attenuated by α-β-blockade at SL (ΔFVC: Control: -27 ± 128 vs. α-β-blockade: +19 ± 23%; P = 0.0004), but unaffected at HA (ΔFVC: Control: -20 ± 22 vs. α-β-blockade: -23 ± 11%; P = 0.999). Our results indicate that in healthy males, altitude acclimatization attenuates α 1 -adrenergic receptor responsiveness; however, resting α-adrenergic restraint remains intact, due to concurrent resting sympathoexcitation. Furthermore, forearm vasoconstrictor responses to cycling are preserved, although the contribution of adrenergic receptors is diminished, indicating a reliance on alternative vasoconstrictor mechanisms.

Published
2023
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18. Cardiac remodeling in well-healed burn survivors after 6 months of unsupervised progressive exercise training.

Author

McKenna ZJ, Moralez G, Romero SA, Hieda M, Huang M, Cramer MN, Sarma S, MacNamara JP, Jaffery MF, Atkins WC, Foster J, and Crandall CG

Subjects
Adult, Humans, Exercise, Stroke Volume, Survivors, Ventricular Function, Left physiology, Exercise Therapy, Ventricular Remodeling physiology, Burns
Abstract

Aerobic exercise is important in the rehabilitation of individuals with prior burn injuries, but no studies have examined whether adult burn survivors demonstrate cardiac remodeling to long-term aerobic exercise training. In this study, we tested the hypothesis that 6 months of progressive exercise training improves cardiac magnetic resonance imaging-based measures of cardiac structure and function in well-healed burn survivors. Secondary analyses explored relations between burn surface area and changes in cardiac structure in the cohort of burn survivors. V̇o 2peak assessments and cardiac magnetic resonance imaging were performed at baseline and following 6 months of progressive exercise training from 19 well-healed burn survivors and 10 nonburned control participants. V̇o 2peak increased following 6 months of training in both groups (Control: Δ5.5 ± 5.8 mL/kg/min; Burn Survivors: Δ3.2 ± 3.6 mL/kg/min, main effect of training, P < 0.001). Left ventricle (LV) mass (Control: Δ1.7 ± 3.1 g/m 2 ; Burn survivors: Δ1.8 ± 2.7 g/m 2 ), stroke volume (Control: Δ5.8 ± 5.2 mL/m 2 ; Burn Survivors: Δ2.8 ± 4.2 mL/m 2 ), and ejection fraction (Control: Δ2.4 ± 4.0%; Burn Survivors: Δ2.2 ± 4.3%) similarly increased following 6 months of exercise training in both cohorts (main effect of training P < 0.05 for all indexes). LV end-diastolic volume increased in the control group (Δ6.5 ± 4.5 mL/m 2 ) but not in the cohort of burn survivors (Δ1.9 ± 2.7 mL/m 2 , interaction, P = 0.040). Multiple linear regression analyses revealed that burn surface area had little to no effect on changes in ventricular mass or end-diastolic volumes in response to exercise training. Our findings provide initial evidence of physiological cardiac remodeling, which is not impacted by burn size, in response to exercise training in individuals with well-healed burn injuries. NEW & NOTEWORTHY Aerobic exercise is important in the rehabilitation of individuals with prior burn injuries, but no studies have examined whether adult burn survivors demonstrate cardiac remodeling to long-term aerobic exercise training. In this study, we tested the hypothesis that 6 months of progressive exercise training would improve cardiac magnetic resonance imaging-based measures of cardiac structure and function in well-healed burn survivors. Our findings highlight the ability of exercise training to modify cardiac structure and function in well-healed burn survivors and nonburned sedentary controls alike.

Published
2023
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19. Comparing the Effects of Low-Dose Ketamine, Fentanyl, and Morphine on Hemorrhagic Tolerance and Analgesia in Humans.

Author

Watso JC, Huang M, Hendrix JM, Belval LN, Moralez G, Cramer MN, Foster J, Hinojosa-Laborde C, and Crandall CG

Subjects
Adult, Humans, Analgesics, Analgesics, Opioid, Fentanyl, Hemorrhage drug therapy, Morphine therapeutic use, Pain drug therapy, Pain Management, Cross-Over Studies, Analgesia methods, Emergency Medical Services, Ketamine therapeutic use
Abstract

Hemorrhage is a leading cause of preventable battlefield and civilian trauma deaths. Ketamine, fentanyl, and morphine are recommended analgesics for use in the prehospital (i.e., field) setting to reduce pain. However, it is unknown whether any of these analgesics reduce hemorrhagic tolerance in humans. We tested the hypothesis that fentanyl (75 µg) and morphine (5 mg), but not ketamine (20 mg), would reduce tolerance to simulated hemorrhage in conscious humans. Each of the three analgesics was evaluated independently among different cohorts of healthy adults in a randomized, crossover (within drug/placebo comparison), placebo-controlled fashion using doses derived from the Tactical Combat Casualty Care Guidelines for Medical Personnel. One minute after an intravenous infusion of the analgesic or placebo (saline), we employed a pre-syncopal limited progressive lower-body negative pressure (LBNP) protocol to determine hemorrhagic tolerance. Hemorrhagic tolerance was quantified as a cumulative stress index (CSI), which is the sum of products of the LBNP and the duration (e.g., [40 mmHg x 3 min] + [50 mmHg x 3 min] …). Compared with ketamine ( p  = 0.002 post hoc result) and fentanyl ( p  = 0.02 post hoc result), morphine reduced the CSI (ketamine (n = 30): 99 [73-139], fentanyl (n = 28): 95 [68-130], morphine (n = 30): 62 [35-85]; values expressed as a % of the respective placebo trial's CSI; median [IQR]; Kruskal-Wallis test p  = 0.002). Morphine-induced reductions in tolerance to central hypovolemia were not well explained by a prediction model including biological sex, body mass, and age (R 2 =0.05, p  = 0.74). These experimental data demonstrate that morphine reduces tolerance to simulated hemorrhage while fentanyl and ketamine do not affect tolerance. Thus, these laboratory-based data, captured via simulated hemorrhage, suggest that morphine should not be used for a hemorrhaging individual in the prehospital setting.

Published
2023
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20. Altered cardiac β1 responsiveness in hyperthermic older adults.

Author

Fischer M, Moralez G, Sarma S, MacNamara JP, Cramer MN, Huang M, Romero SA, Hieda M, Shibasaki M, Ogoh S, and Crandall CG

Subjects
Adrenergic Agents pharmacology, Aged, Cardiac Output, Heart Rate physiology, Humans, Stroke Volume physiology, Ventricular Function, Left physiology, Dobutamine pharmacology, Hyperthermia, Induced
Abstract

Compared with younger adults, passive heating induced increases in cardiac output are attenuated by ∼50% in older adults. This attenuated response may be associated with older individuals' inability to maintain stroke volume through ionotropic mechanisms and/or through altered chronotropic mechanisms. The purpose of this study was to identify the interactive effect of age and hyperthermia on cardiac responsiveness to dobutamine-induced cardiac stimulation. Eleven young (26 ± 4 yr) and 8 older (68 ± 5 yr) participants underwent a normothermic and a hyperthermic (baseline core temperature +1.2°C) trial on the same day. In both thermal conditions, after baseline measurements, intravenous dobutamine was administered for 12 min at 5 µg/kg/min, followed by 12 min at 15 µg/kg/min. Primary measurements included echocardiography-based assessments of cardiac function, gastrointestinal and skin temperatures, heart rate, and mean arterial pressure. Heart rate responses to dobutamine were similar between groups in both thermal conditions ( P > 0.05). The peak systolic mitral annular velocity (S'), i.e., an index of left ventricular longitudinal systolic function, was similar between groups for both thermal conditions at baseline. While normothermic, the increase in S' between groups was similar with dobutamine administration. However, while hyperthermic, the increase in S' was attenuated in the older participants with dobutamine ( P < 0.001). Healthy, older individuals show attenuated inotropic, but maintained chronotropic responsiveness to dobutamine administration during hyperthermia. These data suggest that older individuals have a reduced capacity to increase cardiomyocyte contractility, estimated by changes in S', via β1-adrenergic mechanisms while hyperthermic.

Published
2022
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21. Six months of unsupervised exercise training lowers blood pressure during moderate, but not vigorous, aerobic exercise in adults with well-healed burn injuries.

Author

Watso JC, Romero SA, Moralez G, Huang M, Cramer MN, Johnson E, and Crandall CG

Subjects
Adult, Blood Pressure, Exercise physiology, Exercise Therapy, Humans, Burns, Cardiovascular Diseases, Hypertension, Hypotension
Abstract

Exercise training reduces cardiovascular disease risk, partly due to arterial blood pressure (BP) lowering at rest and during fixed-load exercise. However, it is unclear whether exercise training can reduce BP at rest and during exercise in adults with well-healed burn injuries. Therefore, the purpose of this investigation was to test the hypothesis that 6 mo of unsupervised exercise training reduces BP at rest and during lower-body cycle ergometry in adults with well-healed burn injuries. Thirty-nine adults (28 with well-healed burn injuries and 11 controls) completed 6 mo of unsupervised, progressive exercise training including endurance, resistance, and high-intensity interval components. Before and after exercise training, we measured BP at rest, during fixed-load submaximal exercise (50 and 75 W), during fixed-intensity submaximal exercise (40% and 70% of V̇o 2peak ), and during maximal exercise on a lower-body cycle ergometer. We compared cardiovascular variables using two-way ANOVA (group × pre/postexercise training [repeated factor]). Adults with well-healed burn injuries had higher diastolic BP at rest ( P = 0.04), which was unchanged by exercise training ( P = 0.26). Exercise training reduced systolic, mean, and diastolic BP during fixed-load cycling exercise at 75 W in adults with well-healed burn injuries ( P ≤ 0.03 for all), but not controls ( P ≥ 0.67 for all). Exercise training also reduced mean and diastolic BP during exercise at 40% ( P ≤ 0.02 for both), but not at 70% ( P ≥ 0.18 for both), of V̇o 2peak . These data suggest that a 6-mo unsupervised exercise training program lowers BP during moderate, but not vigorous, aerobic exercise in adults with well-healed burn injuries. NEW & NOTEWORTHY Adults with well-healed burn injuries have greater cardiovascular disease morbidity and all-cause mortality compared with nonburn-injured adults. We found that exercise training reduced blood pressure (BP) during fixed-load cycling at 75 W and during moderate, but not vigorous, intensity cycling exercise in adults with well-healed burn injuries. These data suggest that 6 mo of unsupervised exercise training provides some degree of cardioprotection by reducing BP responses during submaximal exercise in well-healed burn-injured adults.

Published
2022
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22. Adults with well-healed burn injuries have lower pulmonary function values decades after injury.

Author

Watso JC, Romero SA, Moralez G, Huang M, Cramer MN, Jaffery MF, Balmain BN, Wilhite DP, Babb TG, and Crandall CG

Subjects
Adult, Cohort Studies, Humans, Respiratory Function Tests, Burns complications
Abstract

Sub-acute (e.g., inhalation injury) and/or acute insults sustained during a severe burn injury impairs pulmonary function. However, previous work has not fully characterized pulmonary function in adults with well-healed burn injuries decades after an injury. Therefore, we tested the hypothesis that adults with well-healed burn injuries have lower pulmonary function years after recovery. Our cohort of adults with well-healed burn-injuries (n = 41) had a lower forced expiratory volume in one second (Burn: 93 ± 16 vs. Control: 103 ± 10%predicted, mean ± SD; d = 0.60, p = 0.04), lower maximal voluntary ventilation (Burn: 84 [71-97] vs. Control: 105 [94-122] %predicted, median [IQR]; d = 0.84, p < 0.01), and a higher specific airway resistance (Burn: 235 ± 80 vs. Control: 179 ± 40%predicted, mean ± SD; d = 0.66, p = 0.02) than non-burned control participants (n = 12). No variables were meaningfully influenced by having a previous inhalation injury (d ≤ 0.44, p ≥ 0.19; 13 of 41 had an inhalation injury), the size of the body surface area burned (R 2  ≤ 0.06, p ≥ 0.15; range of 15%-88% body surface area burned), or the time since the burn injury (R 2  ≤ 0.04, p ≥ 0.22; range of 2-50 years post-injury). These data suggest that adults with well-healed burn injuries have lower pulmonary function decades after injury. Therefore, future research should examine rehabilitation strategies that could improve pulmonary function among adults with well-healed burn injuries., (© 2022 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)

Published
2022
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23. Global Reach 2018: sympathetic neural and hemodynamic responses to submaximal exercise in Andeans with and without chronic mountain sickness.

Author

Hansen AB, Amin SB, Hofstätter F, Mugele H, Simpson LL, Gasho C, Dawkins TG, Tymko MM, Ainslie PN, Villafuerte FC, Hearon CM Jr, Lawley JS, and Moralez G

Subjects
Blood Pressure physiology, Chronic Disease, Hemodynamics physiology, Humans, Muscle, Skeletal innervation, Oxygen, Sympathetic Nervous System, Altitude Sickness, Polycythemia
Abstract

Andeans with chronic mountain sickness (CMS) and polycythemia have similar maximal oxygen uptakes to healthy Andeans. Therefore, this study aimed to explore potential adaptations in convective oxygen transport, with a specific focus on sympathetically mediated vasoconstriction of nonactive skeletal muscle. In Andeans with (CMS + , n = 7) and without (CMS - , n = 9) CMS, we measured components of convective oxygen delivery, hemodynamic (arterial blood pressure via intra-arterial catheter), and autonomic responses [muscle sympathetic nerve activity (MSNA)] at rest and during steady-state submaximal cycling exercise [30% and 60% peak power output (PPO) for 5 min each]. Cycling caused similar increases in heart rate, cardiac output, and oxygen delivery at both workloads between both Andean groups. However, at 60% PPO, CMS + had a blunted reduction in Δtotal peripheral resistance (CMS - , -10.7 ± 3.8 vs. CMS + , -4.9 ± 4.1 mmHg·L -1 ·min -1 ; P = 0.012; d = 1.5) that coincided with a greater Δforearm vasoconstriction (CMS - , -0.2 ± 0.6 vs. CMS + , 1.5 ± 1.3 mmHg·mL -1 ·min -1 ; P = 0.008; d = 1.7) and a rise in Δdiastolic blood pressure (CMS - , 14.2 ± 7.2 vs. CMS + , 21.6 ± 4.2 mmHg; P = 0.023; d = 1.2) compared with CMS - . Interestingly, although MSNA burst frequency did not change at 30% or 60% of PPO in either group, at 60% Δburst incidence was attenuated in CMS + ( P = 0.028; d = 1.4). These findings indicate that in Andeans with polycythemia, light intensity exercise elicited similar cardiovascular and autonomic responses compared with CMS - . Furthermore, convective oxygen delivery is maintained during moderate-intensity exercise despite higher peripheral resistance. In addition, the elevated peripheral resistance during exercise was not mediated by greater sympathetic neural outflow, thus other neural and/or nonneural factors are perhaps involved. NEW & NOTEWORTHY During submaximal exercise, convective oxygen transport is maintained in Andeans suffering from polycythemia. Light intensity exercise elicited similar cardiovascular and autonomic responses compared with healthy Andeans. However, during moderate-intensity exercise, we observed a blunted reduction in total peripheral resistance, which cannot be ascribed to an exaggerated increase in muscle sympathetic nerve activity, indicating possible contributions from other neural and/or nonneural mechanisms.

Published
2022
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24. Thermoregulatory Responses with Size-matched Simulated Torso or Limb Skin Grafts.

Author

Cramer MN, Huang MU, Fischer M, Moralez G, and Crandall CG

Subjects
Exercise physiology, Female, Heart Rate physiology, Humans, Male, Perception physiology, Physical Exertion physiology, Postoperative Complications physiopathology, Thermosensing physiology, Arm physiopathology, Body Temperature Regulation, Burns physiopathology, Burns surgery, Leg physiopathology, Skin Transplantation adverse effects, Torso physiopathology
Abstract

Purpose: This study aimed to test the hypothesis that a simulated burn injury on the torso will be no more or less detrimental to core temperature control than on the limbs during uncompensable exercise-heat stress., Methods: Nine nonburned individuals (7 men, 2 women) completed the protocol. On separate occasions, burn injuries of identical surface area (0.45 ± 0.08 m2 or 24.4% ± 4.4% of total body surface area) were simulated on the torso or the arms/legs using an absorbent, vapor-impermeable material that impedes sweat evaporation in those regions. Participants performed 60 min of treadmill walking at 5.3 km·h-1 and a 4.1% ± 0.8% grade, targeting 6 W·kg-1 of metabolic heat production in 40.1°C ± 0.2°C and 19.6% ± 0.6% relative humidity conditions. Rectal temperature, heart rate, and perceptual responses were measured., Results: Rectal temperature increased to a similar extent with simulated injuries on the torso and limbs (condition-by-time interaction, P = 0.86), with a final rectal temperature 0.9°C ± 0.3°C above baseline in both conditions. No differences in heart rate, perceived exertion, or thermal sensation were observed between conditions (condition-by-time interactions, P ≥ 0.50)., Conclusions: During uncompensable exercise-heat stress, sized-matched simulated burn injuries on the torso or limbs evoke comparable core temperature, heart rate, and perceptual responses, suggesting that the risk of exertional heat illness in such environmental conditions is independent of injury location., (Copyright © 2021 by the American College of Sports Medicine.)

Published
2021
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25. Global REACH 2018: the adaptive phenotype to life with chronic mountain sickness and polycythaemia.

Author

Hansen AB, Moralez G, Amin SB, Simspon LL, Hofstaetter F, Anholm JD, Gasho C, Stembridge M, Dawkins TG, Tymko MM, Ainslie PN, Villafuerte F, Romero SA, Hearon CM Jr, and Lawley JS

Subjects
Acclimatization, Altitude, Animals, Humans, Phenotype, Altitude Sickness, Polycythemia
Abstract

Key Points: Humans suffering from polycythaemia undergo multiple circulatory adaptations including changes in blood rheology and structural and functional vascular adaptations to maintain normal blood pressure and vascular shear stresses, despite high blood viscosity. During exercise, several circulatory adaptations are observed, especially involving adrenergic and non-adrenergic mechanisms within non-active and active skeletal muscle to maintain exercise capacity, which is not observed in animal models. Despite profound circulatory stress, i.e. polycythaemia, several adaptations can occur to maintain exercise capacity, therefore making early identification of the disease difficult without overt symptomology. Pharmacological treatment of the background heightened sympathetic activity may impair the adaptive sympathetic response needed to match local oxygen delivery to active skeletal muscle oxygen demand and therefore inadvertently impair exercise capacity., Abstract: Excessive haematocrit and blood viscosity can increase blood pressure, cardiac work and reduce aerobic capacity. However, past clinical investigations have demonstrated that certain human high-altitude populations suffering from excessive erythrocytosis, Andeans with chronic mountain sickness, appear to have phenotypically adapted to life with polycythaemia, as their exercise capacity is comparable to healthy Andeans and even with sea-level inhabitants residing at high altitude. By studying this unique population, which has adapted through natural selection, this study aimed to describe how humans can adapt to life with polycythaemia. Experimental studies included Andeans with (n = 19) and without (n = 17) chronic mountain sickness, documenting exercise capacity and characterizing the transport of oxygen through blood rheology, including haemoglobin mass, blood and plasma volume and blood viscosity, cardiac output, blood pressure and changes in total and local vascular resistances through pharmacological dissection of α-adrenergic signalling pathways within non-active and active skeletal muscle. At rest, Andeans with chronic mountain sickness had a substantial plasma volume contraction, which alongside a higher red blood cell volume, caused an increase in blood viscosity yet similar total blood volume. Moreover, both morphological and functional alterations in the periphery normalized vascular shear stress and blood pressure despite high sympathetic nerve activity. During exercise, blood pressure, cardiac work and global oxygen delivery increased similar to healthy Andeans but were sustained by modifications in both non-active and active skeletal muscle vascular function. These findings highlight widespread physiological adaptations that can occur in response to polycythaemia, which allow the maintenance of exercise capacity., (© 2021 The Authors. The Journal of Physiology © 2021 The Physiological Society.)

Published
2021
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26. Interaction of Exercise Intensity and Simulated Burn Injury Size on Thermoregulation.

Author

Belval LN, Cramer MN, Moralez G, Huang MU, Cimino FA 3rd, Watso JC, and Crandall CG

Subjects
Adult, Body Surface Area, Burns pathology, Cross-Over Studies, Female, Heart Rate, Humans, Male, Young Adult, Body Temperature Regulation, Burns physiopathology, Exercise physiology, Hot Temperature
Abstract

Purpose: This study aimed to test the hypothesis that the elevation in internal body temperature during exercise in a hot environment is influenced by the combination of exercise intensity and BSA burned., Methods: Ten healthy participants (8 males, 2 females; 32 ± 9 yr; 75.3 ± 11.7 kg) completed eight exercise trials on a cycle ergometer, each with different combinations of metabolic heat productions (low, 4 W·kg-1; moderate, 6 W·kg-1) and simulated BSA burn in a hot environmental chamber (39.9°C ± 0.3°C, 20.1% ± 1.5% RH). Burns were simulated by covering 0%, 20%, 40%, or 60% of participants' BSA with a highly absorbent, vapor-impermeable material. Gastrointestinal temperature (TGI) was recorded, with the primary analysis being the increase in TGI after 60 min of exercise., Results: We identified an interaction effect for the increase in TGI (P < 0.01), suggesting TGI was influenced by both intensity and simulated burn BSA. Regardless of the percentage BSA burn simulated, the increase in TGI was similar across low-intensity trials (0.70°C ± 0.26°C, P > 0.11 for all). However, during moderate-intensity exercise, the increase in TGI was greater for the 60% (1.78°C ± 0.38°C, P < 0.01) and 40% BSA coverage trials (1.33°C ± 0.44°C, P = 0.04), relative to 0% (0.82°C ± 0.36°C). There were no differences in TGI responses between 0% and 20% trials., Conclusion: These data suggest that exercise intensity influences the relationship between burn injury size and thermoregulatory responses in a hot environment., (Copyright © 2020 by the American College of Sports Medicine.)

Published
2021
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27. Low dose ketamine reduces pain perception and blood pressure, but not muscle sympathetic nerve activity, responses during a cold pressor test.

Author

Watso JC, Huang M, Moralez G, Cramer MN, Hendrix JM, Cimino FA 3rd, Belval LN, Hinojosa-Laborde C, and Crandall CG

Subjects
Adult, Blood Pressure, Cold Temperature, Heart Rate, Humans, Muscle, Skeletal, Muscles, Pain Perception, Sympathetic Nervous System, Ketamine pharmacology
Abstract

Key Points: Low dose ketamine is a leading medication used to provide analgesia in pre-hospital and hospital settings. Low dose ketamine is increasingly used off-label to treat conditions such as depression. In animals, ketamine stimulates the sympathetic nervous system and increases blood pressure, but these physiological consequences have not been studied in conscious humans. Our data suggest that low dose ketamine administration blunts pain perception and reduces blood pressure, but not muscle sympathetic nerve activity burst frequency, responses during a cold pressor test in healthy humans. These mechanistic, physiological results inform risk-benefit analysis for clinicians administering low dose ketamine in humans., Abstract: Low dose ketamine is an effective analgesic medication. However, our knowledge of the effects of ketamine on autonomic cardiovascular regulation is primarily limited to animal experiments. Notably, it is unknown if low dose ketamine influences autonomic cardiovascular responses during painful stimuli in humans. We tested the hypothesis that low dose ketamine blunts perceived pain, and blunts subsequent sympathetic and cardiovascular responses during an experimental noxious stimulus. Twenty-two adults (10F/12M; 27 ± 6 years; 26 ± 3 kg m -2 , mean ± SD) completed this randomized, crossover, placebo-controlled trial during two laboratory visits. During each visit, participants completed cold pressor tests (CPT; hand in ∼0.4°C ice bath for 2 min) pre- and 5 min post-drug administration (20 mg ketamine or saline). We compared pain perception (100 mm visual analogue scale), muscle sympathetic nerve activity (MSNA; microneurography, 12 paired recordings), and beat-to-beat blood pressure (BP; photoplethysmography) during the pre- and post-drug CPTs separately using paired, two-tailed t tests. For the pre-drug CPT, perceived pain (P = 0.4378), MSNA burst frequency responses (P = 0.7375), and mean BP responses (P = 0.6457) were not different between trials. For the post-drug CPT, ketamine compared to placebo administration attenuated perceived pain (P < 0.0001) and mean BP responses (P = 0.0047), but did not attenuate MSNA burst frequency responses (P = 0.3662). Finally, during the post-drug CPT, there was a moderate relation between cardiac output and BP responses after placebo administration (r = 0.53, P = 0.0121), but this relation was effectively absent after ketamine administration (r = -0.12, P = 0.5885). These data suggest that low dose ketamine administration attenuates perceived pain and pressor, but not MSNA burst frequency, responses during a CPT., (© 2020 The Authors. The Journal of Physiology © 2020 The Physiological Society.)

Published
2021
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28. Global REACH 2018: Andean highlanders, chronic mountain sickness and the integrative regulation of resting blood pressure.

Author

Simpson LL, Meah VL, Steele AR, Gasho C, Howe CA, Dawkins TG, Busch SA, Oliver SJ, Moralez G, Lawley JS, Tymko MM, Vizcardo-Galindo GA, Figueroa-Mujíca RJ, Villafuerte FC, Ainslie PN, Stembridge M, Steinback CD, and Moore JP

Subjects
Adult, Baroreflex physiology, Chronic Disease, Hemodynamics physiology, Humans, Hypoxia physiopathology, Male, Middle Aged, Muscle, Skeletal physiology, Musculoskeletal Physiological Phenomena, Young Adult, Altitude Sickness physiopathology, Arterial Pressure physiology, Blood Pressure physiology, Blood Volume physiology, Sympathetic Nervous System physiopathology
Abstract

New Findings: What is the central question of this study? Does chronic mountain sickness (CMS) alter sympathetic neural control and arterial baroreflex regulation of blood pressure in Andean (Quechua) highlanders? What is the main finding and its importance? Compared to healthy Andean highlanders, basal sympathetic vasomotor outflow is lower, baroreflex control of muscle sympathetic nerve activity is similar, supine heart rate is lower and cardiovagal baroreflex gain is greater in mild CMS. Taken together, these findings reflect flexibility in integrative regulation of blood pressure that may be important when blood viscosity and blood volume are elevated in CMS., Abstract: The high-altitude maladaptation syndrome chronic mountain sickness (CMS) is characterized by excessive erythrocytosis and frequently accompanied by accentuated arterial hypoxaemia. Whether altered autonomic cardiovascular regulation is apparent in CMS is unclear. Therefore, during the 2018 Global REACH expedition to Cerro de Pasco, Peru (4383 m), we assessed integrative control of blood pressure (BP) and determined basal sympathetic vasomotor outflow and arterial baroreflex function in eight Andean natives with CMS ([Hb] 22.6 ± 0.9 g·dL -1 ) and seven healthy highlanders ([Hb] 19.3 ± 0.8 g·dL -1 ). R-R interval (RRI, electrocardiogram), beat-by-beat BP (photoplethysmography) and muscle sympathetic nerve activity (MSNA; microneurography) were recorded at rest and during pharmacologically induced changes in BP (modified Oxford test). Although [Hb] and blood viscosity (7.8 ± 0.7 vs. 6.6 ± 0.7 cP; d = 1.7, P = 0.01) were elevated in CMS compared to healthy highlanders, cardiac output, total peripheral resistance and mean BP were similar between groups. The vascular sympathetic baroreflex MSNA set-point (i.e. MSNA burst incidence) and reflex gain (i.e. responsiveness) were also similar between groups (MSNA set-point, d = 0.75, P = 0.16; gain, d = 0.2, P = 0.69). In contrast, in CMS the cardiovagal baroreflex operated around a longer RRI (960 ± 159 vs. 817 ± 50 ms; d = 1.4, P = 0.04) with a greater reflex gain (17.2 ± 6.8 vs. 8.8 ± 2.6 ms·mmHg -1 ; d = 1.8, P = 0.01) versus healthy highlanders. Basal sympathetic vasomotor activity was also lower compared to healthy highlanders (33 ± 11 vs. 45 ± 13 bursts·min -1 ; d = 1.0, P = 0.08). In conclusion, our findings indicate adaptive differences in basal sympathetic vasomotor activity and heart rate compensate for the haemodynamic consequences of excessive erythrocyte volume and contribute to integrative blood pressure regulation in Andean highlanders with mild CMS., (© 2020 The Authors. Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.)

Published
2021
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29. Low-dose ketamine affects blood pressure, but not muscle sympathetic nerve activity, during progressive central hypovolemia without altering tolerance.

Author

Huang M, Watso JC, Moralez G, Cramer MN, Hendrix JM, Yoo JK, Badrov MB, Fu Q, Hinojosa-Laborde C, and Crandall CG

Subjects
Blood Pressure, Female, Heart Rate, Humans, Lower Body Negative Pressure, Male, Muscles, Sympathetic Nervous System, Hypovolemia, Ketamine
Abstract

Key Points: Haemorrhage is the leading cause of battlefield and civilian trauma deaths. Given that a haemorrhagic injury on the battlefield is almost always associated with pain, it is paramount that the administered pain medication does not disrupt the physiological mechanisms that are beneficial in defending against the haemorrhagic insult. Current guidelines from the US Army's Committee on Tactical Combat Casualty Care (CoTCCC) for the selection of pain medications administered to a haemorrhaging soldier are based upon limited scientific evidence, with the clear majority of supporting studies being conducted on anaesthetized animals. Specifically, the influence of low-dose ketamine, one of three analgesics employed in the pre-hospital setting by the US Army, on haemorrhagic tolerance in humans is unknown. For the first time in conscious males and females, the findings of the present study demonstrate that the administration of an analgesic dose of ketamine does not compromise tolerance to a simulated haemorrhagic insult. Increases in muscle sympathetic nerve activity during progressive lower-body negative pressure were not different between trials. Despite the lack of differences for muscle sympathetic nerve activity responses, mean blood pressure and heart rate were higher during moderate hypovolemia after ketamine vs. placebo administration., Abstract: Haemorrhage is the leading cause of battlefield and civilian trauma deaths. For a haemorrhaging soldier, there are several pain medications (e.g. ketamine) recommended for use in the prehospital, field setting. However, the data to support these recommendations are primarily limited to studies in animals. Therefore, it is unknown whether ketamine adversely affects physiological mechanisms responsible for maintenance of arterial blood pressure (BP) during haemorrhage in humans. In humans, ketamine has been demonstrated to raise resting BP, although it has not been studied with the concomitant central hypovolemia that occurs during haemorrhage. Thus, the present study aimed to test the hypothesis that ketamine does not impair haemorrhagic tolerance in humans. Thirty volunteers (15 females) participated in this double-blinded, randomized, placebo-controlled trial. A pre-syncopal limited progressive lower-body negative pressure (LBNP; a validated model for simulating haemorrhage) test was conducted following the administration of ketamine (20 mg) or placebo (saline). Tolerance was quantified as a cumulative stress index and compared between trials using a paired, two-tailed t test. We compared muscle sympathetic nerve activity (MSNA; microneurography), beat-to-beat BP (photoplethysmography) and heart rate (electrocardiogram) responses during the LBNP test using a mixed effects model (time [LBNP stage] × drug). Tolerance to the LBNP test was not different between trials (Ketamine: 635 ± 391 vs. Placebo: 652 ± 360 mmHg‧min, p = 0.77). Increases in MSNA burst frequency (time: P < 0.01, trial: p = 0.27, interaction: p = 0.39) during LBNP stages were no different between trials. Despite the lack of differences for MSNA responses, mean BP (time: P < 0.01, trial: P < 0.01, interaction: p = 0.01) and heart rate (time: P < 0.01, trial: P < 0.01, interaction: P < 0.01) were higher during moderate hypovolemia after ketamine vs. placebo administration (P < 0.05 for all, post hoc), but not at the end of LBNP. These data, which are the first to be obtained in conscious humans, demonstrate that the administration of low-dose ketamine does not impair tolerance to simulated haemorrhage or mechanisms responsible for maintenance of BP., (© 2020 The Authors. The Journal of Physiology © 2020 The Physiological Society.)

Published
2020
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30. Exercise Training Improves Microvascular Function in Burn Injury Survivors.

Author

Romero SA, Moralez G, Jaffery MF, Huang MU, Engelland RE, Cramer MN, and Crandall CG

Subjects
Adult, Brachial Artery physiology, Female, Forearm blood supply, Hand Strength physiology, Humans, Hyperemia physiopathology, Male, Blood Flow Velocity physiology, Burns physiopathology, Burns rehabilitation, Exercise physiology, Microcirculation physiology, Vasodilation physiology
Abstract

Introduction: Vasodilator function is impaired in individuals with well-healed burn injuries; however, therapeutic interventions that lessen or reverse this maladaptation are lacking. The purpose of this study was to test the hypothesis that a 6-month community-based exercise training program would increase microvascular dilator function in individuals with well-healed burn injuries, irrespective of the magnitude of the injured body surface area. Further, we hypothesize that macrovascular dilator function would remain unchanged posttraining., Methods: Microvascular function (forearm reactive hyperemia), macrovascular function (brachial artery flow-mediated dilation), and the maximal vasodilatory response after ischemic handgrip exercise (an estimate of microvascular remodeling) were assessed before and after exercise training in nonburned control subjects (n = 11) and individuals with burn injuries covering a moderate body surface area (26% ± 7%; n = 13) and a high body surface area (59% ± 15%; n = 19)., Results: Peak vascular conductance and area under the curve during postocclusive reactive hyperemia increased from pretraining to posttraining in control and burn injury groups (both P < 0.05), the magnitude of which did not differ between groups (both P = 0.6). Likewise, the maximal vasodilatory response after ischemic handgrip exercise increased in all groups after exercise training (P < 0.05). Macrovascular dilator function did not differ across time or between groups (P = 0.8)., Conclusions: These data suggest that a community-based exercise training program improves microvascular function in individuals with well-healed burn injuries, which may be due in part to vascular remodeling.

Published
2020
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31. Dietary nitrate supplementation does not influence thermoregulatory or cardiovascular strain in older individuals during severe ambient heat stress.

Author

Cramer MN, Hieda M, Huang M, Moralez G, and Crandall CG

Subjects
Aged, Aged, 80 and over, Arterial Pressure drug effects, Beta vulgaris chemistry, Dietary Supplements, Female, Fruit and Vegetable Juices, Heart Rate drug effects, Heat Stress Disorders drug therapy, Humans, Male, Middle Aged, Regional Blood Flow drug effects, Skin drug effects, Skin Temperature drug effects, Sweating drug effects, Vasodilation drug effects, Aging drug effects, Body Temperature Regulation drug effects, Cardiovascular System drug effects, Heat-Shock Response drug effects, Nitrates administration & dosage
Abstract

New Findings: What is the central question of this study? Does dietary nitrate supplementation with beetroot juice attenuate thermoregulatory and cardiovascular strain in older adults during severe heat stress? What is the main finding and its importance? A 7-day nitrate supplementation regimen lowered resting mean arterial pressure in thermoneutral conditions. During heat stress, core and mean skin temperatures, vasodilatory responses, sweat loss, heart rate and left ventricular function were unchanged, and mean arterial pressure was only transiently reduced, post-supplementation. These data suggest nitrate supplementation with beetroot juice does not mitigate thermoregulatory or cardiovascular strain in heat-stressed older individuals., Abstract: This study tested the hypothesis that dietary nitrate supplementation with concentrated beetroot juice attenuates thermoregulatory and cardiovascular strain in older individuals during environmental heat stress. Nine healthy older individuals (six females, three males; aged 67 ± 5 years) were exposed to 42.5 ± 0.1°C and 34.0 ± 0.5% relative humidity conditions for 120 min before (CON) and after 7 days of dietary nitrate supplementation with concentrated beetroot juice (BRJ; 280 ml, ∼16.8 mmol of nitrate daily). Core and skin temperatures, body mass changes (indicative of whole-body sweat loss), skin blood flow and cutaneous vascular conductance, forearm blood flow and vascular conductance, heart rate, arterial blood pressures and indices of cardiac function were measured. The 7-day beetroot juice regimen increased plasma nitrate/nitrite levels from 27.4 ± 15.2 to 477.0 ± 102.5 μmol l -1 (P < 0.01) and lowered resting mean arterial pressure from 90 ± 7 to 83 ± 10 mmHg at baseline under thermoneutral conditions (P = 0.02). However, during subsequent heat stress, no differences in core and skin temperatures, skin blood flow and vascular conductance, forearm blood flow and vascular conductance, whole-body sweat loss, heart rate, and echocardiographic indices of systolic function and diastolic filling were evident following nitrate supplementation (all P > 0.05). Mean arterial pressure was lower in BRJ vs. CON during heat stress (treatment-by-time interaction: P = 0.02). Overall, these findings suggest that dietary nitrate supplementation with concentrated beetroot juice does not attenuate thermoregulatory or cardiovascular strain in older individuals exposed to severe ambient heat stress., (© 2020 The Authors. Experimental Physiology © 2020 The Physiological Society.)

Published
2020
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32. The benefits of an unsupervised exercise program in persons with well-healed burn injuries within the International Classification of Functioning, Disability and Health (ICF).

Author

Huang M, Moralez G, Romero SA, Jaffery MF, Cramer MN, Petric JK, Nabasny AD, and Crandall CG

Subjects
Adult, Burns physiopathology, Female, Humans, International Classification of Functioning, Disability and Health, Male, Middle Aged, Trauma Severity Indices, Young Adult, Activities of Daily Living, Burns rehabilitation, Exercise Therapy methods, Mobility Limitation, Muscle Strength, Quality of Life
Abstract

Vast improvements in the survival rates following burn injuries has led to a greater number of patients living with a wide range of long-term impairments, activity limitations, and participation constraints. Therefore, long-term care is critical in this clinical population and necessitates appropriate rehabilitation strategies to maximize an individual's overall health. The purpose of this study was to test the hypothesis that the extent to which outcomes within the International Classification of Functioning, Disability, and Health (ICF) framework are improved following 6 months of unsupervised exercise training is influenced by the severity of a burn injury (i.e., percent body surface area injured). Outcome variables representing the dimensions of the ICF, body functions & structure, activity, and participation, were collected pre- and post- 6 months of exercise training in three groups of participants: non-injured control subjects (N = 11), subjects with moderate-level well-healed burn injuries (N = 13, 26 ± 6% body surface area burned), and subjects with high-level well-healed burn injuries (N = 20, 58 ± 15% body surface area burned). Exercise training improved lower extremity strength (changes in peak torque/kg body mass at 90 degrees/sec flexion: 30 ± 5% and extension: 36 ± 4%, p < 0.05) and functional activities (changes in sit to stand: -9 ± 4% and ascend stairs: -4 ± 1%; p < 0.05) in all groups. For outcome variables representing ICF levels of body functions & structure and activity, there were no differences at baseline or improvements made between the groups after training. That said, with the exception of the domain of functional activity (reported 17 ± 34% improvement in the high-level burn cohort, p < 0.05), no changes were revealed in the participation level of ICF indexed by health-related quality of life questionnaires. These findings support the utilization of a 6-month unsupervised exercise training program in the long-term rehabilitation of individuals with burn injuries; that is, improvements in body functions & structure and activity can be achieved with an exercise regimen regardless of the severity of burn injury., (Copyright © 2020 Elsevier Ltd and ISBI. All rights reserved.)

Published
2020
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33. Global Reach 2018 Heightened α-Adrenergic Signaling Impairs Endothelial Function During Chronic Exposure to Hypobaric Hypoxia.

Author

Tymko MM, Lawley JS, Ainslie PN, Hansen AB, Hofstaetter F, Rainer S, Amin S, Moralez G, Gasho C, Vizcardo-Galindo G, Bermudez D, Villafuerte FC, and Hearon CM Jr

Subjects
Acetylcholine metabolism, Acetylcholine pharmacology, Adrenergic Agents pharmacology, Adult, Altitude, Altitude Sickness blood, Altitude Sickness physiopathology, Blood Pressure, Blood Vessels drug effects, Blood Vessels metabolism, Blood Vessels physiopathology, Heart Rate, Humans, Male, Nitroprusside pharmacology, Phentolamine pharmacology, Polycythemia etiology, Polycythemia physiopathology, Propranolol pharmacology, Signal Transduction, Sympathetic Nervous System drug effects, Sympathetic Nervous System metabolism, Sympathetic Nervous System physiopathology, Vasodilator Agents pharmacology, Adaptation, Physiological, Altitude Sickness metabolism, Polycythemia metabolism, Receptors, Adrenergic metabolism, Vasodilation
Abstract

Rationale: Chronic exposure to hypoxia is associated with elevated sympathetic nervous activity and reduced vascular function in lowlanders, and Andean highlanders suffering from excessive erythrocytosis (EE); however, the mechanistic link between chronically elevated sympathetic nervous activity and hypoxia-induced vascular dysfunction has not been determined., Objective: To determine the impact of heightened sympathetic nervous activity on resistance artery endothelial-dependent dilation (EDD), and endothelial-independent dilation, in lowlanders and Andean highlanders with and without EE., Methods and Results: We tested healthy lowlanders (n=9) at sea level (344 m) and following 14 to 21 days at high altitude (4300 m), and permanent Andean highlanders with (n=6) and without (n=9) EE at high altitude. Vascular function was assessed using intraarterial infusions (3 progressive doses) of acetylcholine (ACh; EDD) and sodium nitroprusside (endothelial-independent dilation) before and after local α+β adrenergic receptor blockade (phentolamine and propranolol). Intraarterial blood pressure, heart rate, and simultaneous brachial artery diameter and blood velocity were recorded at rest and during drug infusion. Changes in forearm vascular conductance were calculated. The main findings were (1) chronic hypoxia reduced EDD in lowlanders (changes in forearm vascular conductance from sea level: ACh1: -52.7±19.6%, ACh2: -25.4±38.7%, ACh3: -35.1±34.7%, all P ≤0.02); and in Andeans with EE compared with non-EE (changes in forearm vascular conductance at ACh3: -36.4%, P =0.007). Adrenergic blockade fully restored EDD in lowlanders at high altitude, and normalized EDD between EE and non-EE Andeans. (2) Chronic hypoxia had no effect on endothelial-independent dilation in lowlanders, and no differences were detected between EE and non-EE Andeans; however, EID was increased in the non-EE Andeans after adrenergic blockade ( P =0.012), but this effect was not observed in the EE Andeans., Conclusions: These data indicate that chronic hypoxia reduces EDD via heightened α-adrenergic signaling in lowlanders and in Andeans with EE. These vascular mechanisms have important implications for understanding the physiological consequences of acute and chronic high altitude adaptation.

Published
2020
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34. Mechanisms of sympathetic restraint in human skeletal muscle during exercise: role of α-adrenergic and nonadrenergic mechanisms.

Author

Hansen AB, Moralez G, Romero SA, Gasho C, Tymko MM, Ainslie PN, Hofstätter F, Rainer SL, Lawley JS, and Hearon CM Jr

Subjects
Adult, Blood Pressure, Humans, Male, Muscle Contraction, Muscle, Skeletal drug effects, Muscle, Skeletal innervation, Phentolamine pharmacology, Propranolol pharmacology, Regional Blood Flow, Sympathetic Nervous System drug effects, Vasoconstriction, Vasodilation, Adrenergic alpha-Antagonists pharmacology, Adrenergic beta-Antagonists pharmacology, Exercise, Muscle, Skeletal physiology, Sympathetic Nervous System physiology
Abstract

Sympathetic vasoconstriction is mediated by α-adrenergic receptors under resting conditions. During exercise, increased sympathetic nerve activity (SNA) is directed to inactive and active skeletal muscle; however, it is unclear what mechanism(s) are responsible for vasoconstriction during large muscle mass exercise in humans. The aim of this study was to determine the contribution of α-adrenergic receptors to sympathetic restraint of inactive skeletal muscle and active skeletal muscle during cycle exercise in healthy humans. In ten male participants (18-35 yr), mean arterial pressure (intra-arterial catheter) and forearm vascular resistance (FVR) and conductance (FVC) were assessed during cycle exercise (60% total peak workload) alone and during combined cycle exercise + handgrip exercise (HGE) before and after intra-arterial blockade of α- and β-adrenoreceptors via phentolamine and propranolol, respectively. Cycle exercise caused vasoconstriction in the inactive forearm that was attenuated ~80% with adrenoreceptor blockade (%ΔFVR, +81.7 ± 84.6 vs. +9.7 ± 30.7%; P = 0.05). When HGE was performed during cycle exercise, the vasodilatory response to HGE was restrained by ~40% (ΔFVC HGE, +139.3 ± 67.0 vs. cycle exercise: +81.9 ± 66.3 ml·min -1 ·100 mmHg -1 ; P = 0.03); however, the restraint of active skeletal muscle blood flow was not due to α-adrenergic signaling. These findings highlight that α-adrenergic receptors are the primary, but not the exclusive mechanism by which sympathetic vasoconstriction occurs in inactive and active skeletal muscle during exercise. Metabolic activity or higher sympathetic firing frequencies may alter the contribution of α-adrenergic receptors to sympathetic vasoconstriction. Finally, nonadrenergic vasoconstrictor mechanisms may be important for understanding the regulation of blood flow during exercise. NEW & NOTEWORTHY Sympathetic restraint of vascular conductance to inactive skeletal muscle is critical to maintain blood pressure during moderate- to high-intensity whole body exercise. This investigation shows that cycle exercise-induced restraint of inactive skeletal muscle vascular conductance occurs primarily because of activation of α-adrenergic receptors. Furthermore, exercise-induced vasoconstriction restrains the subsequent vasodilatory response to hand-grip exercise; however, the restraint of active skeletal muscle vasodilation was in part due to nonadrenergic mechanisms. We conclude that α-adrenergic receptors are the primary but not exclusive mechanism by which sympathetic vasoconstriction restrains blood flow in humans during whole body exercise and that metabolic activity modulates the contribution of α-adrenergic receptors.

Published
2020
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35. Exercise Core Temperature Response with a Simulated Burn Injury: Effect of Body Size.

Author

Cramer MN, Moralez G, Huang MU, Kouda K, Poh PYS, and Crandall CG

Subjects
Body Surface Area, Humans, Military Personnel, Thermogenesis physiology, Body Size physiology, Body Temperature Regulation physiology, Burns physiopathology, Exercise physiology
Abstract

Although the severity of a burn injury is often associated with the percentage of total body surface area burned (%TBSA), the thermoregulatory consequences of a given %TBSA injury do not account for the interactive effects of body morphology and metabolic heat production (Hprod)., Purpose: Using a simulated burn injury model to mimic the detrimental effect of a 40% TBSA injury on whole-body evaporative heat dissipation, core temperature response to exercise in physiologically uncompensable conditions between morphologically disparate groups were examined at (i) an absolute Hprod (W), and (ii) a mass-specific Hprod (W·kg)., Methods: Healthy, young, nonburned individuals of small (SM, n = 11) or large (LG, n = 11) body size cycled for 60 min at 500 W or 5.3 W·kg of Hprod in 39°C and 20% relative humidity conditions. A 40% burn injury was simulated by affixing a highly absorbent, vapor-impermeable material across the torso (20% TBSA), arms (10% TBSA), and legs (10% TBSA) to impede evaporative heat loss in those regions., Results: Although the elevation in core temperature was greater in SM compared with LG at an Hprod of 500 W (SM, 1.69°C ± 0.26°C; LG, 1.05°C ± 0.26°C; P < 0.01), elevations in core temperature were not different at an Hprod of 5.3 W·kg between groups (SM, 0.99°C ± 0.32°C; LG, 1.05°C ± 0.26°C; P = 0.66)., Conclusions: These data suggest that among individuals with a 40% TBSA burn injury, a smaller body size leads to exacerbated elevations in core temperature during physical activities eliciting the same absolute Hprod (non-weight-bearing tasks) but not activities eliciting the same mass-specific Hprod (weight-bearing tasks).

Published
2020
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36. Exercise Thermoregulation with a Simulated Burn Injury: Impact of Air Temperature.

Author

Cramer MN, Moralez G, Huang MU, Kouda K, Poh PYS, and Crandall CG

Subjects
Adult, Body Surface Area, Heart Rate physiology, Humans, Male, Military Personnel, Young Adult, Air, Body Temperature Regulation physiology, Burns physiopathology, Exercise physiology, Temperature
Abstract

The U.S. Army's Standards of Medical Fitness (AR 40-501) states: "Prior burn injury (to include donor sites) involving a total body surface area of 40% or more does not meet the standard." However, the standard does not account for the interactive effect of burn injury size and air temperature on exercise thermoregulation., Purpose: To evaluate whether the detrimental effect of a simulated burn injury on exercise thermoregulation is dependent on air temperature., Methods: On eight occasions, nine males cycled for 60 min at a fixed metabolic heat production (6 W·kg) in air temperatures of 40°C or 25°C with simulated burn injuries of 0% (Control), 20%, 40%, or 60% of total body surface area (TBSA). Burn injuries were simulated by covering the skin with an absorbent, vapor-impermeable material to impede evaporation from the covered areas. Core temperature was measured in the gastrointestinal tract via telemetric pill., Results: In 40°C conditions, greater elevations in core temperature were observed with 40% and 60% TBSA simulated burn injuries versus Control (P < 0.01). However, at 25°C, core temperature responses were not different versus Control with 20%, 40%, and 60% TBSA simulated injuries (P = 0.97). The elevation in core temperature at the end of exercise was greater in the 40°C environment with 20%, 40%, and 60% TBSA simulated burn injuries (P ≤ 0.04)., Conclusions: Simulated burn injuries ≥20% TBSA exacerbate core temperature responses in hot, but not temperate, air temperatures. These findings suggest that the U.S. Army's standard for inclusion of burned soldiers is appropriate for hot conditions, but could lead to the needless discharge of soldiers who could safely perform their duties in cooler training/operational settings.

Published
2020
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37. Keeping older individuals cool in hot and moderately humid conditions: wetted clothing with and without an electric fan.

Author

Cramer MN, Huang M, Moralez G, and Crandall CG

Subjects
Aged, Body Temperature, Humans, Humidity, Skin Temperature, Sweating, Body Temperature Regulation, Hot Temperature
Abstract

The present study evaluated whether wearing a water-soaked t-shirt, with or without electric fan use, mitigates thermal and cardiovascular strain in older individuals exposed to hot and moderately humid conditions. Nine healthy older individuals (68 ± 4 yr; five women) completed three 120-min heat exposures (42.4 ± 0.2°C, 34.2 ± 0.9% relative humidity) on separate days while wearing a dry t-shirt (CON), a t-shirt soaked with 500 ml of tap water (WET), or a t-shirt soaked with 500 ml of tap water while facing an electric fan (2.4 ± 0.4 m/s; WET+FAN). Measurements included core and skin temperatures, evaporative mass losses, heart rate, and blood pressure. In the WET condition, elevations in core temperature were attenuated compared with DRY from 30 to 120 min and compared with WET+FAN from 30 to 90 min ( P < 0.05). Evaporative mass losses (inclusive of sweat and water losses from the shirt) were greatest in WET+FAN, followed by WET, and then DRY ( P < 0.01). Sweat losses were lowest in WET, followed by DRY, and then WET+FAN ( P < 0.01). Heart rate was lower only at 60 min in WET versus DRY ( P = 0.01). No differences in mean arterial pressure were observed ( P = 0.51). In conclusion, wearing a water-soaked t-shirt without, but not with, electric fan use is an effective heat management strategy to mitigate thermal strain and lower sweat losses in older individuals exposed to hot and moderately humid conditions. NEW & NOTEWORTHY In older individuals exposed to hot and moderately humid environments, electric fan use coupled with a water-soaked t-shirt exacerbates sweat losses without mitigating heat strain compared with a dry t-shirt. However, wearing a water-soaked t-shirt without fan use reduces sweat losses and attenuates heat strain compared with a dry t-shirt and a fan/water-soaked t-shirt combination. These findings suggest wearing a water-soaked t-shirt is an effective heat-management strategy for older individuals during heat waves when air conditioning is inaccessible.

Published
2020
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38. Progressive exercise training improves maximal aerobic capacity in individuals with well-healed burn injuries.

Author

Romero SA, Moralez G, Jaffery MF, Huang M, Cramer MN, Romain N, Kouda K, Haller RG, and Crandall CG

Subjects
Adult, Exercise Tolerance, Female, Humans, Male, Burns, Exercise, Exercise Therapy, Oxygen Consumption physiology
Abstract

Long-term rehabilitative strategies are important for individuals with well-healed burn injuries. Such information is particularly critical because patients are routinely surviving severe burn injuries given medical advances in the acute care setting. The purpose of this study was to test the hypothesis that a 6-mo community-based exercise training program will increase maximal aerobic capacity (V̇o 2max ) in subjects with prior burn injuries, with the extent of that increase influenced by the severity of the burn injury (i.e., percent body surface area burned). Maximal aerobic capacity (indirect calorimetry) and skeletal muscle oxidative enzyme activity (biopsy of the vastus lateralis muscle) were measured pre- and postexercise training in noninjured control subjects ( n = 11) and in individuals with well-healed burn injuries ( n = 13, moderate body surface area burned; n = 20, high body surface area burned). Exercise training increased V̇o 2max in all groups (control: 15 ± 5%; moderate body surface area: 11 ± 3%; high body surface area: 11 ± 2%; P < 0.05), though the magnitude of this improvement did not differ between groups ( P = 0.7). Exercise training also increased the activity of the skeletal muscle oxidative enzymes citrate synthase ( P < 0.05) and cytochrome c oxidase ( P < 0.05), an effect that did not differ between groups ( P = 0.2). These data suggest that 6 mo of progressive exercise training improves V̇o 2max in individuals with burn injuries and that the magnitude of body surface area burned does not lessen this adaptive response.

Published
2019
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39. No Thermoregulatory Impairment in Skin Graft Donor Sites during Exercise-Heat Stress.

Author

Cramer MN, Moralez G, Huang MU, and Crandall CG

Subjects
Adult, Burns surgery, Female, Humans, Male, Middle Aged, Physical Fitness, Skin blood supply, Sweating, Young Adult, Body Temperature Regulation, Exercise, Hot Temperature, Skin Temperature, Skin Transplantation
Abstract

The US Army's Standards of Medical Fitness, AR 40-501, state that "Prior burn injury (to include donor sites) involving a total body surface area of 40% or more does not meet the standard." Inclusion of donor sites (sites harvested for skin grafts) in this standard implies that thermoregulatory function is impaired within donor sites during exercise-heat stress; however, supporting evidence is currently lacking., Purpose: To test the hypothesis that well-healed donor and noninjured sites demonstrate similar elevations in skin blood flow and sweating during exercise-induced hyperthermia., Methods: Twenty burn survivors (>1 yr postinjury; four females) cycled for 60 min in a 39.7°C ± 0.3°C and 21.1% ± 3.3% relative humidity environment at approximately 50% of maximal aerobic capacity. Core and mean skin temperatures were recorded throughout exercise. Skin blood flow (laser-Doppler imaging) was measured at baseline and after exercise within donor (LDFDON) and adjacent noninjured control (LDFCON) sites. At 45 min of exercise, local sweat rates (Technical Absorbents) were measured within the same donor (LSRDON) and noninjured (LSRCON) areas., Results: After 60 min of exercise, core and skin temperatures reached 38.2°C ± 0.4°C and 35.5°C ± 1.2°C, respectively. The increase in skin blood flow from baseline to end-exercise (LDFDON, 91.6 ± 44.5 AU; LDFCON, 106.0 ± 61.6 AU; P = 0.17) and local sweat rates (LSRDON, 0.46 ± 0.26 mg·cm·min; LSRCON, 0.53 ± 0.25 mg·cm·min; P = 0.14) were not different between donor and noninjured control sites., Conclusions: Well-healed donor sites retain the ability to increase skin blood flow and sweating during exercise heat stress, providing evidence against the inclusion of donor sites when determining whether a burn injury meets the Army's Standards of Medical Fitness.

Published
2019
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40. Cardiac Structure and Function in Well-Healed Burn Survivors.

Author

Samuel TJ, Nelson MD, Nasirian A, Jaffery M, Moralez G, Romero SA, Cramer MN, Huang M, Kouda K, Hieda M, Sarma S, and Crandall CG

Subjects
Adult, Body Mass Index, Cardiovascular Diseases diagnostic imaging, Case-Control Studies, Echocardiography, Exercise Test, Female, Humans, Magnetic Resonance Imaging, Male, Survivors, Texas, Burns physiopathology, Cardiovascular Diseases physiopathology
Abstract

Long-term burn survivors have reduced aerobic capacity, placing them at increased risk for cardiovascular disease, morbidity, and mortality. However, the exact mechanism contributing to a reduced aerobic capacity remains incompletely understood, but may be related to adverse cardiovascular remodeling. Therefore, it was hypothesized that well-healed burn survivors would exhibit adverse left ventricular (LV) remodeling and impaired LV function. To test this hypothesis, 22 well-healed moderately burned individuals (age: 41 ± 14 years; BMI: 27.7 ± 5.4 kg/m2; male/female: 12/10; extent of burn: 37 ± 12 %BSA), 11 well-healed severely burned individuals (age: 43 ± 12 years; BMI: 29.5 ± 5.8 kg/m2; male/female: 8/3; extent of burn: 73 ± 11 %BSA), and 12 healthy, age-matched controls (age: 34 ± 9 years; BMI: 28.6 ± 5.2 kg/m2; male/female: 5/7) were enrolled in the study. All subjects were sedentary, performing less than 30 minutes of aerobic exercise per day, 3 days per week. LV morphology and function were assessed via cardiac magnetic resonance imaging. In contrast to the hypothesis, neither the presence nor severity of burn injury adversely affected LV morphology or function, when compared with equally sedentary nonburned controls. However, of note, LV mass of all three groups was in the lowest 5th percentile compared with normative values. Finally, group differences in LV morphology were largely explained by differences in aerobic capacity. Taken together, these data suggest a prior burn injury itself does not result in pathological remodeling of the LV and support a role for aerobic exercise training to improve cardiac function., (© American Burn Association 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Published
2019
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41. Reduced Resting and Increased Elevation of Heart Rate Variability With Cognitive Task Performance in Concussed Athletes.

Author

Huang M, Frantz J, Moralez G, Sabo T, Davis PF, Davis SL, Bell KR, and Purkayastha S

Subjects
Athletes, Athletic Injuries physiopathology, Attention physiology, Case-Control Studies, Electrocardiography, Executive Function physiology, Female, Humans, Male, Prefrontal Cortex physiopathology, Young Adult, Brain Concussion physiopathology, Heart Rate physiology, Neuropsychological Tests
Abstract

Objective: To examine heart rate variability (HRV) at rest and with a 2-Back cognitive task involving executive function and sustained attention in athletes during the acute phase following concussion and compare them with the controls., Participants: Twenty-three male and female collegiate athletes (20 ± 1 years) following (4 ± 1 days) a sports-related concussion and 23 sports- and sex-matched noninjured controls., Procedure: Continuous R-R interval was acquired using 3-lead electrocardiogram for 3 minutes each at rest and during the 2-Back task. HRV was quantified as percent high-frequency (HF) power., Results: At rest, lower percent HF power was observed in the concussed athletes (23 ± 11) compared with the controls (38 ± 14; P = .0027). However, with the 2-Back task, an increase in HF power was observed in the concussed group (39 ± 12; P = .0008) from rest and was comparable with the controls (36 ± 15). No difference in HF power between rest and 2-Back task was observed in the controls., Conclusion: Lower HRV was observed at rest following concussion. An increase in HRV, suggestive of enhanced prefrontal cortex (PFC) functioning, was observed during a cognitive task in the concussed athletes. Therefore, cognitive tasks as early as 4 days after injury may increase PFC functioning from rest and expedite return to learn in collegiate athletes.

Published
2019
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42. Vasodilator function is impaired in burn injury survivors.

Author

Romero SA, Moralez G, Jaffery MF, Huang M, and Crandall CG

Subjects
Adult, Blood Flow Velocity drug effects, Brachial Artery injuries, Burns physiopathology, Endothelium, Vascular drug effects, Endothelium, Vascular physiopathology, Female, Humans, Hyperemia physiopathology, Male, Middle Aged, Regional Blood Flow drug effects, Survivors, Vascular Stiffness drug effects, Brachial Artery drug effects, Burns drug therapy, Hyperemia drug therapy, Vasodilator Agents pharmacology
Abstract

The effect of severe burn injury on vascular health is unknown. We tested the hypothesis that, compared with nonburn control subjects, vasodilator function would be reduced and that pulse-wave velocity (a measure of arterial stiffness) would be increased in individuals with prior burn injuries, the extent of which would be associated with the magnitude of body surface area having sustained a severe burn. Pulse-wave velocity and macrovascular (flow-mediated dilation) and microvascular (reactive hyperemia) dilator functions were assessed in 14 nonburned control subjects and 32 age-matched subjects with well-healed burn injuries. Fifteen subjects with burn injuries covering 17-40% of body surface area were assigned to a moderate burn injury group, and 17 subjects with burn injuries covering >40% of body surface area were assigned to a high burn injury group. Pulse-wave velocity [ P = 0.3 (central) and P = 0.3 (peripheral)] did not differ between the three groups. Macrovascular dilator function was reduced in the moderate ( P = 0.07) and high ( P < 0.05) burn injury groups compared with the control group. Likewise, peak vascular conductance during postocclusive reactive hyperemia differed from the moderate burn injury group ( P = 0.08 vs. control) and the high burn injury group ( P < 0.05 vs. control). These data suggest that vasodilator function is impaired in well-healed burn injury survivors, with the extent of impairment not dependent on the magnitude of body surface area having sustained a severe burn injury.

Published
2018
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43. Tolerance to a haemorrhagic challenge during heat stress is improved with inspiratory resistance breathing.

Author

Huang M, Brothers RM, Ganio MS, Lucas RAI, Cramer MN, Moralez G, Convertino VA, and Crandall CG

Subjects
Adult, Airway Resistance, Blood Pressure, Body Temperature, Cerebrovascular Circulation, Female, Fever physiopathology, Fever therapy, Heat Stress Disorders complications, Heat Stress Disorders physiopathology, Hemodynamics, Hemorrhage complications, Hemorrhage physiopathology, Humans, Lower Body Negative Pressure, Male, Respiratory Rate, Syncope etiology, Syncope physiopathology, Heat Stress Disorders therapy, Hemorrhage therapy, Intermittent Positive-Pressure Breathing methods
Abstract

New Findings: What is the central question of this study? Does inspiratory resistance breathing improve tolerance to simulated haemorrhage in individuals with elevated internal temperatures? What is the main finding and its importance? The main finding of this study is that inspiratory resistance breathing modestly improves tolerance to a simulated progressive haemorrhagic challenge during heat stress. These findings demonstrate a scenario in which exploitation of the respiratory pump can ameliorate serious conditions related to systemic hypotension., Abstract: Heat exposure impairs human blood pressure control and markedly reduces tolerance to a simulated haemorrhagic challenge. Inspiratory resistance breathing enhances blood pressure control and improves tolerance during simulated haemorrhage in normothermic individuals. However, it is unknown whether similar improvements occur with this manoeuvre in heat stress conditions. In this study, we tested the hypothesis that inspiratory resistance breathing improves tolerance to simulated haemorrhage in individuals with elevated internal temperatures. On two separate days, eight subjects performed a simulated haemorrhage challenge [lower-body negative pressure (LBNP)] to presyncope after an increase in internal temperature of 1.3 ± 0.1°C. During one trial, subjects breathed through an inspiratory impedance device set at 0 cmH 2 O of resistance (Sham), whereas on a subsequent day the device was set at -7 cmH 2 O of resistance (ITD). Tolerance was quantified as the cumulative stress index. Subjects were more tolerant to the LBNP challenge during the ITD protocol, as indicated by a > 30% larger cumulative stress index (Sham, 520 ± 306 mmHg min; ITD, 682 ± 324 mmHg min; P < 0.01). These data indicate that inspiratory resistance breathing modestly improves tolerance to a simulated progressive haemorrhagic challenge during heat stress., (© 2018 The Authors. Experimental Physiology © 2018 The Physiological Society.)

Published
2018
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44. Effect of centrally acting angiotensin converting enzyme inhibitor on the exercise-induced increases in muscle sympathetic nerve activity.

Author

Moralez G, Jouett NP, Tian J, Zimmerman MC, Bhella P, and Raven PB

Subjects
Adult, Arterial Pressure drug effects, Baroreflex drug effects, Female, Humans, Male, Muscle, Skeletal drug effects, Sympathetic Nervous System drug effects, Young Adult, Angiotensin II metabolism, Angiotensin-Converting Enzyme Inhibitors pharmacology, Arterial Pressure physiology, Baroreflex physiology, Exercise, Muscle, Skeletal physiology, Sympathetic Nervous System physiology
Abstract

Key Points: The arterial baroreflex's operating point pressure is reset upwards and rightwards from rest in direct relation to the increases in dynamic exercise intensity. The intraneural pathways and signalling mechanisms that lead to upwards and rightwards resetting of the operating point pressure, and hence the increases in central sympathetic outflow during exercise, remain to be identified. We tested the hypothesis that the central production of angiotensin II during dynamic exercise mediates the increases in sympathetic outflow and, therefore, the arterial baroreflex operating point pressure resetting during acute and prolonged dynamic exercise. The results identify that perindopril, a centrally acting angiotensin converting enzyme inhibitor, markedly attenuates the central sympathetic outflow during acute and prolonged dynamic exercise., Abstract: We tested the hypothesis that the signalling mechanisms associated with the dynamic exercise intensity related increases in muscle sympathetic nerve activity (MSNA) and arterial baroreflex resetting during exercise are located within the central nervous system. Participants performed three randomly ordered trials of 70° upright back-supported dynamic leg cycling after ingestion of placebo and two different lipid soluble angiotensin converting enzyme inhibitors (ACEi): perindopril (high lipid solubility), captopril (low lipid solubility). Repeated measurements of whole venous blood (n = 8), MSNA (n = 7) and arterial blood pressures (n = 14) were obtained at rest and during an acute (SS1) and prolonged (SS2) bout of steady state dynamic exercise. Arterial baroreflex function curves were modelled at rest and during exercise. Peripheral venous superoxide concentrations measured by electron spin resonance spectroscopy were elevated during exercise and were not altered by ACEi at rest (P ≥ 0.4) or during exercise (P ≥ 0.3). Baseline MSNA and mean arterial pressure were unchanged at rest (P ≥ 0.1; P ≥ 0.8, respectively). However, during both SS1 and SS2, the centrally acting ACEi perindopril attenuated MSNA compared to captopril and the placebo (P < 0.05). Arterial pressures at the operating point and threshold pressures were decreased with perindopril from baseline to SS1 with no further changes in the operating point pressure during SS2 under all three conditions. These data suggest that centrally acting ACEi is significantly more effective at attenuating the increase in the acute and prolonged exercise-induced increases in MSNA., (© 2018 The Authors. The Journal of Physiology © 2018 The Physiological Society.)

Published
2018
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45. Effect of increases in cardiac contractility on cerebral blood flow in humans.

Author

Ogoh S, Moralez G, Washio T, Sarma S, Hieda M, Romero SA, Cramer MN, Shibasaki M, and Crandall CG

Subjects
Adult, Arterial Pressure drug effects, Blood Flow Velocity, Cardiac Output drug effects, Carotid Artery, External physiology, Carotid Artery, Internal physiology, Dose-Response Relationship, Drug, Echocardiography, Doppler, Female, Healthy Volunteers, Heart Rate drug effects, Humans, Infusions, Intravenous, Male, Time Factors, Young Adult, Cardiotonic Agents administration & dosage, Carotid Artery, External drug effects, Carotid Artery, Internal drug effects, Cerebrovascular Circulation drug effects, Dobutamine administration & dosage, Myocardial Contraction drug effects
Abstract

The effect of acute increases in cardiac contractility on cerebral blood flow (CBF) remains unknown. We hypothesized that the external carotid artery (ECA) downstream vasculature modifies the direct influence of acute increases in heart rate and cardiac function on CBF regulation. Twelve healthy subjects received two infusions of dobutamine [first a low dose (5 μg·kg -1 ·min -1 ) and then a high dose (15 μg·kg -1 ·min -1 )] for 12 min each. Cardiac output, blood flow through the internal carotid artery (ICA) and ECA, and echocardiographic measurements were performed during dobutamine infusions. Despite increases in cardiac contractility, cardiac output, and arterial pressure with dobutamine, ICA blood flow and conductance slightly decreased from resting baseline during both low- and high-dose infusions. In contrast, ECA blood flow and conductance increased appreciably during both low- and high-dose infusions. Greater ECA vascular conductance and corresponding increases in blood flow may protect overperfusion of intracranial cerebral arteries during enhanced cardiac contractility and associated increases in cardiac output and perfusion pressure. Importantly, these findings suggest that the acute increase of blood perfusion attributable to dobutamine administration does not cause cerebral overperfusion or an associated risk of cerebral vascular damage. NEW & NOTEWORTHY A dobutamine-induced increase in cardiac contractility did not increase internal carotid artery blood flow despite an increase in cardiac output and arterial blood pressure. In contrast, external carotid artery blood flow and conductance increased. This external cerebral blood flow response may assist with protecting from overperfusion of intracranial blood flow., (Copyright © 2017 the American Physiological Society.)

Published
2017
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46. Radiotherapy modulates expression of EGFR, ERCC1 and p53 in cervical cancer.

Author

de Almeida VH, de Melo AC, Meira DD, Pires AC, Nogueira-Rodrigues A, Pimenta-Inada HK, Alves FG, Moralez G, Thiago LS, Ferreira CG, and Sternberg C

Subjects
Adult, Aged, Blotting, Western, Carcinoma, Squamous Cell genetics, Carcinoma, Squamous Cell pathology, Cell Line, Tumor, Cell Proliferation radiation effects, DNA Repair radiation effects, DNA-Binding Proteins metabolism, Dose-Response Relationship, Radiation, Endonucleases metabolism, ErbB Receptors metabolism, Female, Gene Expression, Humans, Immunohistochemistry, Middle Aged, Mutation, Prospective Studies, Real-Time Polymerase Chain Reaction, Reproducibility of Results, Treatment Outcome, Tumor Stem Cell Assay, Tumor Suppressor Protein p53 metabolism, Uterine Cervical Neoplasms genetics, Uterine Cervical Neoplasms pathology, Carcinoma, Squamous Cell radiotherapy, DNA-Binding Proteins radiation effects, Endonucleases radiation effects, Genes, erbB-1 radiation effects, Genes, p53 radiation effects, Uterine Cervical Neoplasms radiotherapy
Abstract

Cervical cancer is a public health problem and the molecular mechanisms underlying radioresistance are still poorly understood. Here, we evaluated the modulation of key molecules involved in cell proliferation, cell cycle and DNA repair in cervical cancer cell lines (CASKI and C33A) and in malignant tissues biopsied from 10 patients before and after radiotherapy. The expression patterns of epidermal growth factor receptor (EGFR), excision repair cross-complementation group 1 (ERCC1) and p53 were evaluated in cancer cell lines by quantitative PCR and western blotting, and in human malignant tissues by immunohistochemistry. The mutation status of TP53 gene was evaluated by direct sequencing. Among cell lines, absent or weak modulations of EGFR, ERCC1 and p53 were observed after exposure to 1.8 Gy. Conversely, increased expressions of p53 (5/10 patients; P=0.0239), ERCC1 (5/10 patients; P=0.0294) and EGFR (4/10 patients; P=0.1773) were observed in malignant tissues after radiotherapy with the same radiation dose. TP53 mutations were found only in one patient. Here we show that a single dose of radiotherapy induced EGFR, ERCC1 and p53 expression in malignant tissues from cervical cancer patients but not in cancer cell lines, highlighting the gap between in vitro and in vivo experimental models. Studies on larger patient cohorts are needed to allow an interpretation that an upregulation of p53, EGFR and ERCC1 may be part of a radioresistance mechanism.

Published
2017
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47. Folic acid ingestion improves skeletal muscle blood flow during graded handgrip and plantar flexion exercise in aged humans.

Author

Romero SA, Gagnon D, Adams AN, Moralez G, Kouda K, Jaffery MF, Cramer MN, and Crandall CG

Subjects
Age Factors, Aged, Blood Flow Velocity, Brachial Artery diagnostic imaging, Female, Femoral Artery diagnostic imaging, Humans, Lower Extremity, Male, Middle Aged, Regional Blood Flow, Ultrasonography, Doppler, Duplex, Upper Extremity, Aging, Brachial Artery drug effects, Femoral Artery drug effects, Folic Acid administration & dosage, Hand Strength, Muscle Contraction, Muscle, Skeletal blood supply, Vasodilation drug effects, Vasodilator Agents administration & dosage
Abstract

Skeletal muscle blood flow is attenuated in aged humans performing dynamic exercise, which is due, in part, to impaired local vasodilatory mechanisms. Recent evidence suggests that folic acid improves cutaneous vasodilation during localized and whole body heating through nitric oxide-dependent mechanisms. However, it is unclear whether folic acid improves vasodilation in other vascular beds during conditions of increased metabolism (i.e., exercise). The purpose of this study was to test the hypothesis that folic acid ingestion improves skeletal muscle blood flow in aged adults performing graded handgrip and plantar flexion exercise via increased vascular conductance. Nine healthy, aged adults (two men and seven women; age: 68 ± 5 yr) performed graded handgrip and plantar flexion exercise before (control), 2 h after (acute, 5 mg), and after 6 wk (chronic, 5 mg/day) folic acid ingestion. Forearm (brachial artery) and leg (superficial femoral artery) blood velocity and diameter were measured via Duplex ultrasonography and used to calculate blood flow. Acute and chronic folic acid ingestion increased serum folate (both P < 0.05 vs. control). During handgrip exercise, acute and chronic folic acid ingestion increased forearm blood flow (both conditions P < 0.05 vs. control) and vascular conductance (both P < 0.05 vs. control). During plantar flexion exercise, acute and chronic folic acid ingestion increased leg blood flow (both P < 0.05 vs. control), but only acute folic acid ingestion increased vascular conductance ( P < 0.05 vs. control). Taken together, folic acid ingestion increases blood flow to active skeletal muscle primarily via improved local vasodilation in aged adults. NEW & NOTEWORTHY Our findings demonstrate that folic acid ingestion improves blood flow via enhanced vascular conductance in the exercising skeletal muscle of aged humans. These findings provide evidence for the therapeutic use of folic acid to improve skeletal muscle blood flow, and perhaps exercise and functional capacity, in human primary aging.Listen to this article's corresponding podcast at http://ajpheart.podbean.com/e/folic-acid-and-exercise-hyperemia-in-aging/., (Copyright © 2017 the American Physiological Society.)

Published
2017
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48. Losartan reduces the immediate and sustained increases in muscle sympathetic nerve activity after hyperacute intermittent hypoxia.

Author

Jouett NP, Moralez G, Raven PB, and Smith ML

Subjects
Adult, Arterial Pressure drug effects, Female, Humans, Hypertension drug therapy, Hypertension metabolism, Hypertension physiopathology, Hypoxia metabolism, Male, Muscles innervation, Muscles metabolism, Musculoskeletal Physiological Phenomena drug effects, Receptor, Angiotensin, Type 1 metabolism, Respiration drug effects, Sleep Apnea, Obstructive metabolism, Sleep Apnea, Obstructive physiopathology, Sympathetic Nervous System metabolism, Young Adult, Angiotensin Receptor Antagonists therapeutic use, Hypoxia drug therapy, Losartan therapeutic use, Muscles drug effects, Sympathetic Nervous System drug effects
Abstract

Obstructive sleep apnea (OSA) is characterized by intermittent hypoxemia, which produces elevations in sympathetic nerve activity (SNA) and associated hypertension in experimental models that persist beyond the initial exposure. We tested the hypotheses that angiotensin receptor blockade in humans using losartan attenuates the immediate and immediately persistent increases in 1 ) SNA discharge and 2 ) mean arterial pressure (MAP) after hyperacute intermittent hypoxia training (IHT) using a randomized, placebo-controlled, repeated-measures experimental design. We measured ECG and photoplethysmographic arterial pressure in nine healthy human subjects, while muscle SNA (MSNA) was recorded in seven subjects using microneurography. Subjects were exposed to a series of hypoxic apneas in which they inhaled two to three breaths of nitrogen, followed by a 20-s apnea and 40 s of room air breathing every minute for 20 min. Hyperacute IHT produced substantial and persistent elevations in MSNA burst frequency (baseline: 15.3 ± 1.8, IHT: 24 ± 1.5, post-IHT 20.0 ± 1.3 bursts/min, all P < 0.01) and MAP (baseline: 89.2 ± 3.3, IHT: 92.62 ± 3.1, post-IHT: 93.83 ± 3.1 mmHg, all P < 0.02). Losartan attenuated the immediate and sustained increases in MSNA (baseline: 17.3 ± 2.5, IHT: 18.6 ± 2.2, post-IHT 20.0 ± 1.3 bursts/min, all P < 0.001) and MAP (baseline: 81.9 ± 2.6, IHT: 81.1 ± 2.8, post-IHT: 81.3 ± 3.0 mmHg, all P > 0.70). This investigation confirms the role of angiotensin II type 1a receptors in the immediate and persistent sympathoexcitatory and pressor responses to IHT. NEW & NOTEWORTHY This study demonstrates for the first time in humans that losartan, an angiotensin receptor blocker (ARB), abrogates the acute and immediately persistent increases in muscle sympathetic nerve activity and arterial pressure in response to acute intermittent hypoxia. This investigation, along with others, provides important beginning translational evidence for using ARBs in treatment of the intermittent hypoxia observed in obstructive sleep apnea patients., (Copyright © 2017 the American Physiological Society.)

Published
2017
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49. A phase I study of mTOR inhibitor everolimus in association with cisplatin and radiotherapy for the treatment of locally advanced cervix cancer: PHOENIX I.

Author

de Melo AC, Grazziotin-Reisner R, Erlich F, Fontes Dias MS, Moralez G, Carneiro M, Ingles Garces ÁH, Guerra Alves FV, Novaes Neto B, Fuchshuber-Moraes M, Morando J, Suarez-Kurtz G, and Ferreira CG

Subjects
Adult, Antineoplastic Combined Chemotherapy Protocols adverse effects, Antineoplastic Combined Chemotherapy Protocols pharmacokinetics, Area Under Curve, Cisplatin administration & dosage, Disease Progression, Dose-Response Relationship, Drug, Everolimus adverse effects, Everolimus pharmacokinetics, Female, Follow-Up Studies, Humans, Maximum Tolerated Dose, Middle Aged, Neoplasm Staging, Uterine Cervical Neoplasms pathology, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Brachytherapy methods, Everolimus administration & dosage, Uterine Cervical Neoplasms therapy
Abstract

Background: Cervix cancer (CC) represents the fourth most common cancer in women. Treatment involving cisplatin and radiotherapy has been the standard for locally advanced disease. Everolimus inhibits the aberrant activity of mTOR that is part of carcinogenesis in CC. Further everolimus inactivates the HPV E7 oncoprotein and inhibits its proliferation. Preclinical models have suggested that everolimus sensitizes tumoral cells and vasculature to cisplatin and radiotherapy., Methods: In a 3 + 3 design, the trial aimed to treat three dose levels of at least three patients with daily doses of everolimus (2.5, 5 and 10 mg/day), cisplatin and radiotherapy delivered in a 9-week interval in CC patients, stage IIB, IIIA or IIIB. Patients received everolimus from day -7 up to the last day of brachytherapy. Primary objective was to evaluate safety, toxicity and the maximum-tolerated dose (MTD) of everolimus in association with cisplatin and radiotherapy. Pharmacokinetic (PK) parameters and response rates were analyzed as secondary objectives., Results: Thirteen patients were enrolled, 6 at 2.5 mg, 3 at 5 mg and 4 at 10 mg. Four patients did not complete the planned schedule, 1 at 2.5 mg presented grade 4 acute renal failure interpreted as dose-limiting toxicity (DLT) and 3 at 10 mg: 1 with disease progression, and 2 with DLTs-1 grade 3 rash and 1 grade 4 neutropenia. PK results were characterized by dose-dependent increases in AUC and C max., Conclusions: The MTD of everolimus in combination with cisplatin and radiotherapy has been defined as 5 mg/day. The data regarding safety and response rates support further studies.

Published
2016
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50. N-Acetylcysteine reduces hyperacute intermittent hypoxia-induced sympathoexcitation in human subjects.

Author

Jouett NP, Moralez G, White DW, Eubank WL, Chen S, Tian J, Smith ML, Zimmerman MC, and Raven PB

Subjects
Adult, Blood Pressure drug effects, Female, Humans, Male, Muscles drug effects, Muscles metabolism, Reactive Oxygen Species metabolism, Respiration drug effects, Sleep Apnea, Obstructive drug therapy, Sleep Apnea, Obstructive metabolism, Superoxides metabolism, Sympathetic Nervous System metabolism, Sympathetic Nervous System physiopathology, Acetylcysteine therapeutic use, Hypoxia physiopathology, Sympathetic Nervous System drug effects
Abstract

New Findings: What is the central question of this study? This study evaluated the following central question: does N-acetylcysteine (N-AC), an antioxidant that readily penetrates the blood-brain barrier, have the capability to reduce the increase in sympathetic nerve activity observed during hyperacute intermittent hypoxia? What is the main finding and its importance? We demonstrate that N-AC decreases muscle sympathetic nerve activity in response to hyperacute intermittent hypoxia versus placebo control. This finding suggests that antioxidants, such as N-AC, have therapeutic potential in obstructive sleep apnoea. This investigation tested the following hypotheses: that (i) N-acetylcysteine (N-AC) attenuates hyperacute intermittent hypoxia-induced sympathoexcitation, (ii) without elevating superoxide measured in peripheral venous blood. Twenty-eight healthy human subjects were recruited to the study. One hour before experimentation, each subject randomly ingested either 70 mg kg(-1) of N-AC (n = 16) or vehicle placebo (n = 12). Three-lead ECG and arterial blood pressure, muscle sympathetic nerve activity (n = 17) and whole-blood superoxide concentration (using electron paramagnetic resonance spectroscopy; n = 12) were measured. Subjects underwent a 20 min hyperacute intermittent hypoxia training (hAIHT) protocol that consisted of cyclical end-expiratory apnoeas with 100% nitrogen. N-AC decreased muscle sympathetic nerve activity after hAIHT compared with placebo (P < 0.02). However, N-AC did not alter superoxide concentrations in venous blood compared with placebo (P > 0.05). Moreover, hAIHT did not increase superoxide concentrations in the peripheral circulation as measured by electron paramagnetic resonance (P > 0.05). Based on these findings, we contend that (i) hAIHT and (ii) the actions of N-AC in hAIHT are primarily mediated centrally rather than peripherally, although central measurements of reactive oxygen species are difficult to obtain in human subjects, thus making this assertion difficult to verify. This investigation suggests the possibility of developing a pharmaceutical therapy to inhibit the sympathoexcitation associated with obstructive sleep apnoea., (© 2016 The Authors. Experimental Physiology © 2016 The Physiological Society.)

Published
2016
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