Search

Background: Heatstroke is a life-threatening condition characterized by severe hyperthermia and multiple organ dysfunction. Both normal saline (NS) and lactated Ringer's solution (LR) are commonly used for cooling and volume resuscitation in heatstroke patients; however, their specific impacts on patient outcomes during heatstroke management are poorly understood. Given that the systemic inflammatory response and multiple-organ damage caused by heat toxicity are the main pathophysiological features of heatstroke, the aim of this study was to evaluate the effects of NS and LR on the production of inflammatory cytokines and the functional and structural integrity of renal and cardiac tissues in a rat model of heatstroke. Methods: Fifty-five male Sprague‒Dawley rats were randomly divided into four groups: cold NS or LR infusion postheatstroke (4 ℃, 4 ml/100 g, over 10 min) and NS or LR infusion without heatstroke induction (control groups). Vital signs, arterial blood gases, inflammatory cytokines, and renal and cardiac function indicators, such as serum creatinine and cTnI, were monitored after treatment. Tissue samples were analysed via HE staining, electron microscopy, and fluorescence staining for apoptosis markers, and protein lysates were used for Western blotting of pyroptosis-related proteins. Results: Compared with LR-treated heatstroke rats, NS-treated heatstroke rats presented lower mean arterial pressures, worsened metabolic acidosis, and higher levels of IL-6 and TNF-α in both the serum and tissue. These rats also presented increased serum creatinine, troponin, catecholamines, and NGAL and reduced renal clearance. Histological and ultrastructural analyses revealed more severe tissue damage in NS-treated rats, with increased apoptosis and increased expression of NLRP3/caspase-1/GSDMD signalling molecules. Similar differences were not observed between the control groups receiving either NS or LR infusion. One NS-treated heatstroke rat died within 24 h, whereas all the LR-treated and control rats survived. Conclusions: NS resuscitation in heat-exposed rats significantly promotes metabolic acidosis and the inflammatory response, leading to greater functional and structural organ damage than does LR. These findings underscore the necessity of selecting appropriate resuscitation fluids for heatstroke management to minimize organ damage and improve outcomes. [ABSTRACT FROM AUTHOR]

Background Objectives Animals Methods Results Conclusions and Clinical Importance Noninvasive ventilation (NIV) provides effective respiratory support in foals, but face masks are poorly tolerated and associated with hypercapnia. Bi‐nasal prongs might be a more effective device interface in foals.To compare bi‐nasal prongs and masks for NIV in foals with pharmacologically induced respiratory insufficiency.Six healthy foals.In a randomized cross‐over study, sedated foals received NIV delivered by mask or bi‐nasal prongs, with the treatment repeated using the alternative device interface after a 3‐day rest period. After periods of spontaneous ventilation through the allocated interface, with and without supplementary O2 (T2‐T3), foals were subject to 10‐minute treatment periods of NIV at different pressure support (5 or 10 cmH2O) and end‐expiratory pressure settings (5 or 10 cmH2O), with and without supplementary O2 (T4‐T7). Vital signs, arterial blood gases, spirometry, and gas exchange data were measured in the final 2 minutes of each treatment window.Bi‐nasal prongs were well tolerated and required less manual positioning or monitoring compared to the mask. Partial pressure of carbon dioxide did not increase during NIV with bi‐nasal prongs and was lower than observed with masks (mean difference, 8.2 mmHg [95% confidence interval, 4.1‐12.2 mmHg] at T6). Oxygenation and respiratory mechanics were improved in all foals and not different between device interfaces.Nasal prongs were well tolerated, had similar effects on respiratory function, and appeared to ameliorate hypercapnia observed previously during NIV in foals. [ABSTRACT FROM AUTHOR]

Background: Eosinophilic airway inflammation has been detected in up to 40% of chronic obstructive pulmonary disease (COPD) patients during stable periods of the disease, and increased sputum eosinophil count was associated with better lung function, more future exacerbations, and symptoms that responded better to treatment with inhaled and oral corticosteroids. The aim of this work was to investigate the relationship of blood eosinophils and plasma periostin with lung function changes related to ICS and long-acting beta2-agonist combination treatment in stable COPD patients for 3 months. Methods: This prospective experimental study was carried out on 50 COPD patients with post-bronchodilator FEV1/FVC ratio < 70%. Patients collected from outpatient clinics of Chest Department Tanta University Hospitals, Tanta Chest Hospital, and Mansoura Chest Hospital from February 2020 to February 2022. Patients were subjected to complete history taking, and clinical examinations including general and local examinations and laboratory investigations (complete blood count to assess eosinophilic count, arterial blood gases, and plasma periostin) and spirometry were done for all patients pre- and post-treatment. All patients received 3 months of treatment with a fixed dose of combined inhalers of ICS and LABA, and then they were classified into FEV1 responder and FEV1 non-responder according to improvement in FEV1 at least 12% and 200 mL from baseline of 3 months of combined treatment with ICS/LABA. Results: Blood eosinophil count had a significant positive correlation with smoking index (pack/year), negative correlations with FEV1% of predicted, FEV1 actual value (L), and FEV1/FVC ratio. Plasma periostin concentration had significant positive correlation with blood eosinophil count, COPD grade, and FVC actual value (L) and significant negative correlations with FEV1% of predicted, FEV1 actual value (L), and FEV1/FVC. Cutoff values of blood eosinophil count > 265 cell/µL, plasma periostin concentration > 15.747 ng/mL, and FEV1% < 40.5% were associated with posttreatment FEV1 response. Conclusions: COPD patients with poor lung functions regarding FEV1/FVC ratio, FEV1 actual value (L), and FEV1% of predicted as well as high blood eosinophil count and high plasma periostin concentration are predicted to have FEV1 response with fixed-dose ICS/LABA combination treatment. [ABSTRACT FROM AUTHOR]

Background and Aims: Because bronchoscopy is an invasive procedure, sedatives and analgesics are commonly administered, which may suppress the patient's spontaneous breathing and can lead to hypoventilation and hypoxemia. Few reports exist on the dynamic monitoring of oxygenation and ventilation during bronchoscopy. This study aimed to prospectively monitor and evaluate oxygenation and ventilation during bronchoscopy using transcutaneous arterial blood oxygen saturation and carbon dioxide. Methods: We included patients who required pathological diagnosis using fluoroscopic bronchoscopy at our hospital between March 2021 and April 2022. Midazolam was intravenously administered to all patients as a sedative during bronchoscopy, and fentanyl was administered in addition to midazolam when necessary. A transcutaneous blood gas monitor was used to measure dynamic changes, including arterial blood partial pressure of carbon dioxide (tcPCO2), transcutaneous arterial blood oxygen saturation (SpO2), pulse rate, and perfusion index during bronchoscopy. Quantitative data of tcPCO2 and SpO2 were presented as mean ± standard deviation (SD) (min–max), while the quantitative data of midazolam plus fentanyl and midazolam alone were compared. Similarly, data on sex, smoking history, and body mass index were compared. Subgroup comparisons of the difference (Δ value) between baseline tcPCO2 at the beginning of bronchoscopy and the maximum value of tcPCO2 during the examination were performed. Results: Of the 117 included cases, consecutive measurements were performed in 113 cases, with a success rate of 96.6%. Transbronchial lung biopsy was performed in 100 cases, whereas transbronchial lung cryobiopsy was performed in 17 cases. Midazolam and fentanyl were used as anesthetics during bronchoscopy in 46 cases, whereas midazolam alone was used in 67 cases. The median Δ value in the midazolam plus fentanyl and midazolam alone groups was 8.10 and 4.00 mmHg, respectively, indicating a significant difference of p < 0.005. The mean ± standard deviation of tcPCO2 in the midazolam plus fentanyl and midazolam alone groups was 44.8 ± 7.83 and 40.6 ± 4.10 mmHg, respectively. The SpO2 in the midazolam plus fentanyl and midazolam alone groups was 94.4 ± 3.37 and 96.2 ± 2.61%, respectively, with a larger SD and greater variability in the midazolam plus fentanyl group. Conclusion: A transcutaneous blood gas monitor is non-invasive and can easily measure the dynamic transition of CO2. Furthermore, tcPCO2 can be used to evaluate the ventilatory status during bronchoscopy easily. A transcutaneous blood gas monitor may be useful to observe regarding respiratory depression during bronchoscopy, particularly when analgesics are used. [ABSTRACT FROM AUTHOR]

Background Aims Methods Results Conclusions Peripherally measured oxygen saturation (SpO2) may often differ from arterial oxygen saturation (SaO2), measured by co‐oximetry, especially within the lower range of oxygen saturations. This can potentially impact clinical decisions and therapy in children with congenital heart disease, as critical hypoxemia might remain unnoticed.Our aim was to investigate the accuracy of two different pulse oximeters compared to SaO2 in infants with congenital heart diseases.Simultaneous recordings of SpO2, measured by two different pulse oximeters (Philips IntelliVue X3 Monitor and Nellcor™ OxiMax™), were compared to SaO2 obtained by arterial blood gas analysis.A total of 153 measurements were performed in 44 infants with arterial oxygen saturation between 70 and 100%. We divided the measurements into 3 subgroups: group 1—SaO2 70.0%–85.0%, group 2—SaO2 85.1%–94.0%, group 3—SaO2 >94.1%. For Philipps, the median bias was 5.3 (IQR: 2.6–8.7) %, 2.3 (IQR: 0.9–6.0) % and 1.1 (IQR: −0.8–2.4) % in group 1, 2 and 3, respectively. For OxiMax™, the median bias was 2.7 (IQR: 0.5–5.1) %, 0.2 (IQR: −0.9–2.6) % and −0.5 (IQR: −1.3–0.6) % in group 1, 2 and 3, respectively. Regarding the accuracy of these oximeters, as evaluated with the Accuracy root mean squared index (Arms), it was 9.8 versus 4.5% in group 1, 4.5 versus 2.9% in group 2 and 2.4 versus 1.9% in group 3 for Philipps and OxiMax™, respectively.In lower range saturations between 70% and 85% the accuracy of both pulse oximeters exceeded the threshold of ≤3% recommended by the Food and Drug Administration (FDA). Therefore, peripheral pulse oximetry within the lower range of oxygen saturations should be interpreted with caution in infants with congenital heart diseases, taking into consideration its limitations. Direct co‐oximetry should be the preferred method to support clinical decisions in children with cyanotic congenital heart diseases. [ABSTRACT FROM AUTHOR]

Purpose: To report the efficiency of OT utilisation and perioperative outcomes with a dedicated spine team approach in AIS patients who underwent posterior spinal fusion (PSF) surgeries in a consecutive case operation list. Methods: Three AIS patients operated in a day (8:00 AM–8:00 PM) by a dedicated spine team were recruited between 2021 and 2022. The dedicated team comprised of three senior spine consultants who operated using a dual attending surgeon strategy, an anaesthetic consultant, dedicated surgical scrub nurses, anaesthesiology nurses, radiographers, and neuromonitoring technicians. Patients were categorised according to the sequence of operation list of the day (Case 1, Case 2, and Case 3). OT efficiency was represented by OT time in five stages (preoperative time, operative time, postoperative time, total OT time, and turnover time). OT time and perioperative outcomes were compared. Results: 102 cases were analysed. On average, Case 1 began at 8:38 AM whereas Case 3 ended by 5:54 PM. OT efficiency was consistent throughout the day of operation with comparable OT time in all five stages between groups (p > 0.05). The mean turnover time was 15.1 ± 13.5 min and the mean operative time was 123.0 ± 28.1 min. Intraoperative arterial blood gas (ABG) parameters were maintained in an optimal range. The complication rate was 2.0% (N = 2/102). Conclusion: Consistent OT efficiency was demonstrated with a dedicated spine team approach. Despite performing three AIS cases in a consecutive case operation list, patients' safety was not compromised as perioperative outcomes between groups were comparable. [ABSTRACT FROM AUTHOR]

Background: Inhaled nitric oxide (iNO) can improve oxygenation in acute respiratory syndrome (ARDS), has anti-inflammatory and antithrombotic effects, and can inhibit coronavirus- replication. The study aim was to investigate the impact of iNO in COVID-19 associated ARDS (CARDS) on oxygenation, the length of mechanical ventilation (MV), the level of inflammatory markers and the rate of thrombotic events during ICU stay. Methods: This was a retrospective, observational, monocentric study analyzing the effect of INO (15 parts per million) vs. non-iNO in adult ventilated CARDS patients on oxygenation, the level of inflammatory markers, and the rate of thrombotic events during ICU stay. Within the iNO group, the impact on gas exchange was assessed by comparing arterial blood gas results obtained at different time points. Results: Overall, 19/56 patients were treated with iNO, with no difference regarding sex, age, body mass index, and SOFA-/APACHE II- score between the iNO and non-iNO groups. iNO improved oxygenation in iNO-responders (7/19) and had no impact on inflammatory markers or the rate of thrombotic events but was associated with an increased MV length. Conclusions: iNO was able to improve oxygenation in CARDS in iNO-responders but did not show an impact on inflammatory markers or the rate of thrombotic events, while it was associated with an increased MV length. [ABSTRACT FROM AUTHOR]

Background: Septic shock is now the leading cause of mortality in intensive care units (ICUs). Refractory septic shock requires high doses of vasopressors. Some previous studies have revealed that methylene blue could improve hypotension status and help reduce the dosage of catecholamines. This study aims to investigate the clinical effect of methylene blue in septic shock and explore whether it can increase arterial pressure and reduce the usage of vasopressors. Methods: This study is a multicenter, randomized, placebo-controlled trial planning to include 100 refractory septic shock patients. The protocol is to administer a bolus of 2 mg/kg methylene blue intravenously followed by a continuous infusion of 0.5 mg/kg/h for 48 h. The primary outcome is the total dose of vasopressor required in refractory septic shock in the first 48 h. Secondary outcomes include other hemodynamic parameters, oxygen metabolism indexes, tissue perfusion indexes, major organ function indexes, and certain plasma cytokines and other factors. Discussion: This protocol aims to evaluate the safety and efficacy of methylene blue as adjuvant therapy for refractory septic shock. The main outcome measure will be vasopressor requirements and hemodynamic parameters. Additionally, bedside ultrasonography, blood gases, and cytokines will be assessed to evaluate perfusion, respiratory, and metabolic effects. The results are intended to provide evidence on the safety and efficacy of methylene blue in refractory septic shock, guiding clinical decision-making. Trial registration: This clinical trial has been registered at ChiCTR (https://www.chictr.org.cn/) on March 16, 2023. ChiCTR registration number: ChiCTR2300069430. [ABSTRACT FROM AUTHOR]

Background: Exposure to a hypobaric hypoxic environment at high altitudes can lead to lung injury. In this study, we aimed to determine whether curcumin (Cur) could improve lung barrier function and protect against high-altitude-associated acute lung injury. Methods: Two hundred healthy rats were randomly divided into standard control, high-altitude control (HC), salidroside (40 mg/kg, positive control), and Cur (200 mg/kg) groups. Each group was further divided into five subgroups. Basic vital signs, lung injury histopathology, routine blood parameters, plasma lactate level, and arterial blood gas indicators were evaluated. Protein and inflammatory factor (tumor necrosis factor α (TNF-α), interleukin [IL]-1β, IL-6, and IL-10) concentrations in bronchoalveolar lavage fluid (BALF) were determined using the bicinchoninic acid method and enzyme-linked immunosorbent assay, respectively. Inflammation-related and lung barrier function-related proteins were analyzed using immunoblotting. Results: Cur improved blood routine indicators such as hemoglobin and hematocrit and reduced the BALF protein content and TNF-α, IL-1β, and IL-6 levels compared with those in the HC group. It increased IL-10 levels and reduced pulmonary capillary congestion, alveolar hemorrhage, and the degree of pulmonary interstitial edema. It increased oxygen partial pressure, oxygen saturation, carbonic acid hydrogen radical, and base excess levels, and the expression of zonula occludens 1, occludin, claudin-4, and reduced carbon dioxide partial pressure, plasma lactic acid, and the expression of phospho-nuclear factor kappa. Conclusions: Exposure to a high-altitude environment for 48 h resulted in severe lung injury in rats. Cur improved lung barrier function and alleviated acute lung injury in rats at high altitudes. Highlights: • Curcumin (Cur) improves lung barrier function under high-altitude stress in rats • Cur mitigated acute lung injury under high-altitude stress • Cur improved hemoglobin and hematocrit levels under high-altitude stress • Cur reduced bronchoalveolar lavage fluid protein content under high-altitude stress • Cur reduced inflammatory factor TNF-α, IL-α, IL-6 levels under high-altitude stress [ABSTRACT FROM AUTHOR]

Key points It remains unclear whether feedback from group III/IV muscle afferents is of continuous significance for regulating the pulmonary response during prolonged (>5 min), steady‐state exercise. To elucidate the influence of these sensory neurons on hyperpnoea, gas exchange efficiency, arterial oxygenation and acid–base balance during prolonged locomotor exercise, 13 healthy participants (4 females; 21 (3) years, V̇O2max${{\dot{V}}_{{{{\mathrm{O}}}_{\mathrm{2}}}{\mathrm{max}}}}$: 46 (8) ml/kg/min) performed consecutive constant‐load cycling bouts at ∼50% (20 min), ∼75% (20 min) and ∼100% (5 min) of V̇O2max${{\dot{V}}_{{{{\mathrm{O}}}_{\mathrm{2}}}{\mathrm{max}}}}$ with intact (CTRL) and pharmacologically attenuated (lumbar intrathecal fentanyl; FENT) group III/IV muscle afferent feedback from the legs. Pulmonary responses were continuously recorded and arterial blood (radial catheter) periodically collected throughout the exercise. Pulmonary gas exchange efficiency was evaluated using the alveolar‐arterial PO2${{P}_{{{{\mathrm{O}}}_{\mathrm{2}}}}}$ difference (A−aDO2${\mathrm{A - a}}{{D}_{{{{\mathrm{O}}}_{\mathrm{2}}}}}$). There were no differences in any of the variables of interest between conditions before the start of the exercise. Pulmonary ventilation was up to 20% lower across all intensities during FENT compared to CTRL exercise (P < 0.001) and this hypoventilation was accompanied by an up to 10% lower arterial PO2${{P}_{{{{\mathrm{O}}}_{\mathrm{2}}}}}$ and a 2–4 mmHg higher PCO2${{P}_{{\mathrm{C}}{{{\mathrm{O}}}_{\mathrm{2}}}}}$ (both P < 0.001). The exercise‐induced widening of A−aDO2${\mathrm{A - a}}{{D}_{{{{\mathrm{O}}}_{\mathrm{2}}}}}$ was up to 25% larger during FENT compared to CTRL (P < 0.001). Importantly, the differences developed within the first minute of each stage and persisted, or further increased, throughout the remainder of each bout. These findings reflect a critical and time‐independent significance of feedback from group III/IV leg muscle afferents for continuously regulating the ventilatory response, gas exchange efficiency, arterial oxygenation and acid–base balance during human locomotion. Feedback from group III/IV leg muscle afferents reflexly contributes to hyperpnoea during short duration (i.e. <5 min) locomotor exercise. Whether continuous feedback from these sensory neurons is obligatory to ensure adequate pulmonary responses during steady‐state exercise of longer duration remains unknown. Lumbar intrathecal fentanyl was used to attenuate the central projection of group III/IV leg muscle afferents during prolonged locomotor exercise (i.e. 45 min) at intensities ranging from 50% to 100% of V̇O2max${{\dot{V}}_{{{{\mathrm{O}}}_{\mathrm{2}}}{\mathrm{max}}}}$. Without affecting the metabolic rate, afferent blockade compromised pulmonary ventilation and gas exchange efficiency, consistently impairing arterial oxygenation and facilitating respiratory acidosis throughout exercise. These findings reflect the time‐independent significance of feedback from group III/IV muscle afferents for regulating exercise hyperpnoea and gas exchange efficiency, and thus for optimizing arterial oxygenation and acid–base balance, during prolonged human locomotion. [ABSTRACT FROM AUTHOR]

The ability to cost-effectively produce large surface area microfluidic devices would bring many smallscale technologies such as microfluidic artificial lungs (μALs) from the realm of research to clinical and commercial applications. However, efforts to scale up these devices, such as by stacking multiple flat μALs have been labor intensive and resulted in bulky devices. Here, we report an automated manufacturing system, and a series of cylindrical multi-layer lungs manufactured with the system and tested for fluidic fidelity and function. A roll-to-roll (R2R) system to engrave multiple-layer devices was assembled. Unlike typical applications of R2R, the rolling process is synchronized to achieve consistent radial positioning. This allows the fluidics in the final device to be accessed without being unwrapped. To demonstrate the capabilities of the R2R manufacturing system, this method was used to manufacture multi-layer μALs. Gas and blood are engraved in alternating layers and routed orthogonally to each other. The proximity of gas and blood separated by gas permeable PDMS permits CO2 and O2 exchange via diffusion. After manufacturing, they were evaluated using water for pressure drop and CO2 gas exchange. The best performing device was tested with fresh whole bovine blood for O2 exchange. Three μALs were successfully manufactured and passed leak testing. The top performing device had 15 alternating blood and gas layers. It oxygenated blood from 70% saturation to 95% saturation at a blood flow of 3 mL min−1 and blood side pressure drop of 234 mmHg. This new roll-to-roll manufacturing system is suitable for the automated construction of multi-layer microfluidic devices that are difficult to manufacture by conventional means. With some upgrades and improvements, this technology should allow for the automatic creation of large surface area microfluidic devices that can be employed for various applications including large-scale membrane gas exchange such as clinical-scale microfluidic artificial lungs. [ABSTRACT FROM AUTHOR]

Background: There is a growing concern that opioids and benzodiazepines can depress the respiratory drive and could contribute to worsening respiratory failure and higher exacerbation frequency in COPD. However, the relationship between the exacerbation rate and medication taken is poorly understood in patients with chronic respiratory failure due to COPD. Methods: As part of a service evaluation project, we analysed 339 patients with COPD who were established on long-term non-invasive ventilation (LT-NIV) at our tertiary centre. We investigated the relationship between benzodiazepine and opioid prescription and clinical outcomes as well as their impact on the exacerbation rate and overall survival following setup. Results: Before LT-NIV setup, 40 patients took benzodiazepines and 99 patients took opioids. Neither benzodiazepine nor opioid use was associated with changes in daytime blood gases, overnight hypoxia or annual exacerbations before NIV setup, but patients taking opioids were more breathless as assessed by modified Medical Research Council scores (3.91 ± 0.38 vs. 3.65 ± 0.73, p < 0.01). Long-term NIV significantly reduced the number of yearly exacerbations (from 3.0/2.0–5.0/ to 2.8/0.71–4.57/, p < 0.01) in the whole cohort, but the effect was limited in those who took benzodiazepines (from 3.0/2.0–7.0/ to 3.5/1.2–5.5/) or opioids (3.0/2.0–6.0/ to 3.0/0.8–5.5/). Benzodiazepine use was associated with reduced exacerbation-free survival and overall survival (both p < 0.05). However, after adjustment with relevant covariates, the relationship with exacerbation-free survival became insignificant (p = 0.12). Opioids were not associated with adverse outcomes. Conclusions: Benzodiazepines and opiates are commonly taken in this cohort. Whilst they do not seem to contribute to impaired gas exchange pre-setup, they, especially benzodiazepines, may limit the benefits of LT-NIV. [ABSTRACT FROM AUTHOR]

Simple Summary: Common blue-tongued skinks (Tiliqua scincoides) are popular pets due to their docile temper. Because of their popularity, they are routinely presented to veterinarians for examinations or procedures; however, to date, there has been limited research evaluating sedation protocols for this species. This study aimed to test different sedation combinations in these skinks: alfaxalone alone, alfaxalone with midazolam, dexmedetomidine with midazolam, and a combination of alfaxalone, dexmedetomidine, and midazolam. All four combinations provided safe sedation, but there were different physiologic responses noted. According to our trials, the combinations of all three drugs or alfaxalone with midazolam are recommended for minor procedures. Common blue-tongued skinks (Tiliqua scincoides) are popular pet reptiles; however, there has been limited research to investigate sedatives for this species. The purpose of this study was to measure the physiologic effects of four combinations of alfaxalone, dexmedetomidine, and midazolam for minor procedures such as intubation and blood collection. Eleven common blue-tongued skinks (Tiliqua scincoides) were used for this prospective, randomized cross-over study. The subcutaneous combinations were used as follows: 20 mg/kg alfaxalone (A); 10 mg/kg alfaxalone and 1 mg/kg midazolam (AM); 0.1 mg/kg dexmedetomidine and 1 mg/kg midazolam (DM); and 5 mg/kg alfaxalone, 0.05 mg/kg dexmedetomidine, and 0.5 mg/kg midazolam (ADM). Heart rate, respiratory rate, palpebral reflex, righting reflex, escape reflex, toe pinch withdrawal reflex, tongue flicking, and the possibility of intubation were recorded at baseline and every 5 min for 60 min. Venous blood gases were measured at baseline, full sedation, and recovery. Heart and respiratory rates decreased significantly in all groups, but the reductions were most prominent in DM and ADM. Analgesic effects, as measured by the toe pinch withdrawal reflex, were only observed in DM and ADM. Intubation was possible in all four protocols; however, it was not possible in two DM skinks. Based on these trials, ADM and AM are recommended for minor procedures in blue-tongue skinks. [ABSTRACT FROM AUTHOR]

Background: Hypoxic pulmonary vasoconstriction is the most important regulatory mechanism by which right-to-left shunts decrease during one-lung ventilation (OLV), but the effects of pulmonary microarterial thrombosis and impaired HPV after SARS-CoV-2 infection on intrapulmonary shunt during OLV remain unknown. The aim of this study was to observe the changes of intrapulmonary shunt in patients undergoing thoracoscopic partial pneumonectomy at different periods after SARS-CoV-2 infection compared with patients without SARS-CoV-2 infection history. Methods: A total of 80 patients who underwent elective thoracoscopic partial lung resection and were classified as American Society of Anaesthesiologists (ASA) grades I-II were selected and divided into 4 groups (n = 20 in each group): patients not infected with SARS-CoV-2 (Group A), patients infected with SARS-CoV-2 for 5–8 weeks (Group B), patients infected with SARS-CoV-2 for 9–12 weeks (Group C), and patients infected with SARS-CoV-2 for 13–16 weeks (Group D). For all patients, the same anaesthesia method was adopted, and anaesthesia was maintained with propofol, remifentanil, and cisatracurium. Radial artery and mixed venous blood gases were measured at 10 min of two-lung ventilation (TLV), 15 min of one-lung ventilation (OLV15), and 30 min of OLV (OLV30) in the lateral recumbent position to calculate the intrapulmonary shunt. Multiple linear regression analysis was employed to investigate the association between intrapulmonary shunt and SARS-CoV-2 infection. Results: Qs/Qt at TLV was significantly higher in Groups B and C than in Group A (P < 0.05), and PaO2 at TLV was significantly lower in Groups B and C than in Group A (P < 0.05). Qs/Qt values at OLV15 and OLV30 were significantly higher in Group B, C or D than in Group A (P < 0.05), and PaO2 values at OLV15 and OLV30 were significantly lower in Groups B, C or D than in Group A (P < 0.05). Multiple linear regression analysis revealed that SARS-CoV-2 infection (95%CI -4.245 to -0.679, P = 0.007) was an independent risk factor for increased intrapulmonary shunt during TLV, while SARS-CoV-2 infection (95%CI 0.124 to 3.661, P = 0.036), exacerbation of COVID-19 clinical classification (95%CI -5.203 to -1.139, P = 0.003), and persistent symptoms (95%CI -12.122 to -5.522, P < 0.001) were independent risk factors for increased intrapulmonary shunt during OLV after SARS-CoV-2 infection. Conclusion: SARS-CoV-2 infection increased intrapulmonary shunt and reduced oxygenation. Although oxygenation improved at TLV after 13–16 weeks of infection, intrapulmonary shunt and oxygenation under OLV took longer to recover. Trial registration: Chinese Clinical Trial Registry, Retrospectively registered, Full date of first registration: 17/05/2023, Registration number: ChiCTR2300071539. [ABSTRACT FROM AUTHOR]

An interoceptive homeostatic reflex monitors levels of CO2/H+ to maintain blood gas homeostasis and rapidly regulate tissue acid–base balance by driving lung ventilation and CO2 excretion—this CO2-evoked increase in respiration is the hypercapnic ventilatory reflex (HCVR). Retrotrapezoid nucleus (RTN) neurons provide crucial excitatory drive to downstream respiratory rhythm/pattern-generating circuits, and their activity is directly modulated by changes in CO2/H+ . RTN neurons express GPR4 and TASK-2, global deletion of which abrogates CO2/H+ activation of RTN neurons and the HCVR. It has not been determined if the intrinsic pH sensitivity of these proton detectors is required for these effects. We used CRISPR/Cas9 genome editing to generate mice with mutations in either of two pH-sensing histidine residues in GPR4 to determine effects on RTN neuronal CO2/H+ sensitivity and the HCVR. In global GPR4(H81F) and GPR4(H167F) mice, CO2-stimulated breathing and CO2-induced RTN neuronal activation were strongly blunted, with no effect on hypoxia-stimulated breathing. In brainstem slices from GPR4(H81F) mice, peak firing of RTN neurons during bath acidification was significantly reduced compared with GPR4 wild-type mice, and a subpopulation of RTN neurons was rendered pH-insensitive, phenocopying previous results from GPR4-deleted mice. These effects were independent of changes in RTN number/distribution, neuronal excitability or transcript levels for GPR4 and TASK-2. CO2-stimulated breathing was reduced to a similar extent in GPR4(H81F) and TASK-2-deleted mice, with combined mutation yielding no additional deficit in the HCVR. Together, these data demonstrate that the intrinsic pH sensitivity of GPR4 is necessary for full elaboration of the HCVR. [ABSTRACT FROM AUTHOR]

Aim: Neonatal encephalopathy remains one of the most significant causes of neonatal morbidity and mortality. The present study compared the risk factors, demographic data, laboratory and imaging findings, and short-term outcomes of two groups of patients. Materials and Methods: A retrospective analysis was conducted on 45 patients who had undergone therapeutic hypothermia (TH) between January 1st, 2021, and August 31st, 2023. According to blood gas parameters; Group 1 (32 patients) met the criteria (pH ≤7.0 and/or base excess BE ≤-16) for TH, while Group 2 (13 patients) did not (pH >7.0, BE >-16, and with an absence of clinical findings). Results: A comparison of the demographic data revealed higher incidences of birth trauma (p=0.046) and neonatal risk (p=0.026) in Group 1 than in Group 2, with no other significant differences. Severe amplitude electroencephalogram (aEEG) abnormalities were more common in Group 1 but one patient of Group 2 displayed moderate abnormality during follow-up. A comparison of all imaging findings [aEEG, transfontanelle ultrasonography (USG), abdominal USG, cranial magnetic resonance imaging, echocardiography] revealed no significant differences (p=0.45). At the end of the follow-up period, 35 patients (77.7%) were discharged, while two (4.4%) patients did not survive (both in Group 1). Upon discharge, all patients in Group 2 exhibited normal neurological examination findings. Conclusion: Re-evaluating the existing criteria for the identification of those infants who may benefit from TH, but who are often deemed ineligible due to incomplete adherence to the treatment criteria, could significantly reduce the mortality and morbidity associated with birth asphyxia. [ABSTRACT FROM AUTHOR]

Aim: This study aims to investigate the early effects of the mode of delivery on the newborn in cases of non-complicated primiparous and multiparous vaginal deliveries who were admitted to the clinic in active labor, and elective cesarean section by analyzing fetal umbilical cord blood gas. Materials and Methods: In this retrospective study, 120 cases were enrolled in the study, including 40 primiparous cases, 40 multiparous cases, and 40 elective cesarean section cases. Age, pregnancy history, medical history, age of gestation at birth, delivery type, fetalWeight, APGAR score, baby gender and fetal blood gas values were statistically analyzed. Results: Statistically significant differences were found between the primiparous vaginal delivery group and the cesarean section and multiparous vaginal delivery groups in the parameters of age, gravidity, parity, and fetal Weight, with primiparous vaginal delivery showing significantly lower parameters. When compared with multiparous and primiparous vaginal delivery, a statistically significant difference was observed in APGAR 1 score, with C/S births having lower scores. In primiparous vaginal delivery, it was found that pH, pH(T), Base(Ecf)c, cHCO3(P)c, cHCO3(p,st)c, cBase(B,ox)c, and cBase(Ecf,ox)c were significantly lower compared to other groups, while only higher levels of pCO2 and mOsmc were observed. In the cesarean section group, lower levels of ctHb, Hctc, cCa, cGlu, and cLac parameters were observed compared to other groups, while the cNa level was significantly higher. Significant differences were found only between primiparous vaginal delivery and cesarean section groups in the parameter cK, with a significantly lower cK value in the C/S group. Conclusion: Primiparous pregnant women exhibited lower birth weight, lower pH in umbilical cord blood, and higher levels of pCO2, while in the cesarean group, lower APGAR score at 1 minute, lower levels of hemoglobin, calcium, glucose, lactate, and potassium were observed. [ABSTRACT FROM AUTHOR]

A LOx-based electrochemical biosensor for high-level lactate determination was developed. For the construction of the biosensor, chitosan and Nafion layers were integrated by using a spin coating procedure, leading to less porous surfaces in comparison with those recorded after a drop casting procedure. The analytical performance of the resulting biosensor for lactate determination was evaluated in batch and flow regime, displaying satisfactory results in both modes ranging from 0.5 to 20 mM concentration range for assessing the lactic acidosis. Finally, the lactate levels in raw serum samples were estimated using the biosensor developed and verified with a blood gas analyzer. Based on these results, the biosensor developed is promising for its use in healthcare environment, after its proper miniaturization. A pH probe based on common polyaniline-based electrochemical sensor was also developed to assist the biosensor for the lactic acidosis monitoring, leading to excellent results in stock solutions ranging from 6.0 to 8.0 mM and raw plasma samples. The results were confirmed by using two different approaches, blood gas analyzer and pH-meter. Consequently, the lactic acidosis monitoring could be achieved in continuous flow regime using both (bio)sensors. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a major global health concern, characterized by persistent respiratory symptoms and airflow limitation. Acute exacerbations of COPD can significantly impact disease progression and patient outcomes. Magnesium, an essential mineral, has been implicated in various respiratory conditions, but its role in COPD exacerbations remains underexplored. Aims and Objectives: This study aims to assess serum magnesium levels in patients with acute exacerbations of COPD compared to those with stable COPD. Objectives include evaluating correlations between magnesium levels and clinical parameters such as age, sex, smoking habits, number of days of hospital stay, and arterial blood gas (ABG) analysis. Methodology: A cross-sectional study was conducted involving 90 COPD patients, with 45 experiencing acute exacerbations and 45 stable. Serum magnesium levels, demographics, smoking history, hospital stay duration and ABG parameters were recorded. Data were analyzed to compare magnesium levels and correlate findings with clinical parameters. Results: Serum magnesium levels were significantly lower in the acute exacerbation group compared to the stable group. Correlation analyses showed that lower magnesium levels were associated with longer hospital stays and worse ABG parameters. Conclusion: This study suggests that lower serum magnesium levels are associated with acute exacerbations of COPD. Monitoring magnesium levels could be beneficial in managing exacerbations and improving patient outcomes. [ABSTRACT FROM AUTHOR]

The serum calcium plays a role as a cofactor in critical steps such as cardiac contractility, vascular tone, and the coagulation cascade. This study aimed to determine if the level of ionized calcium can predict outcomes in patients with spontaneous subarachnoid hemorrhage (SAH) in the emergency department. The study was a retrospective cross-sectional case series. Patients aged 18 and over diagnosed with spontaneous SAH in the emergency department were included in the study. Patients' demographic characteristics, comorbidities, vital signs, laboratory parameters, World Federation of Neurosurgical Societies score, SAH grading according to the Fisher scale, needs of mechanical ventilation and inotropic treatment, administered treatments, complications, Rankin scores at discharge, and outcome were recorded in a standard data form. A total of 267 patients were studied, with a mean age of 55.5 ± 13.4 years, and 53.9% (n = 144) were female. Hydrocephalus was present in 16.5% of patients. The average hospital stay was 20.4 ± 19.8 days. Mortality rate was 34.8% (n = 93). Mortality was significantly higher in patients with low calcium levels upon admission (P = 0.024). Ionized calcium levels during complication development independently predicted mortality (OR: 0.945, 95% CI: 0.898–0.996, P = 0.034). Patients with poor neurologic outcomes (Rankin: 3–6) had significantly lower initial ionized calcium levels (P = 0.002). The ionized calcium level is a readily accessible blood gas parameter that assists clinicians in predicting functional independence and mortality at discharge in patients presenting to the emergency department with spontaneous SAH. [ABSTRACT FROM AUTHOR]

This Thoracic Society of Australia and New Zealand Guideline on the provision of home oxygen therapy in adults updates a previous Guideline from 2015. The Guideline is based upon a systematic review and meta‐analysis of literature to September 2022 and the strength of recommendations is based on GRADE methodology. Long‐term oxygen therapy (LTOT) is recommended for its mortality benefit for patients with COPD and other chronic respiratory diseases who have consistent evidence of significant hypoxaemia at rest (PaO2 ≤ 55 mm Hg or PaO2 ≤59 mm Hg in the presence of hypoxaemic sequalae) while in a stable state. Evidence does not support the use of LTOT for patients with COPD who have moderate hypoxaemia or isolated nocturnal hypoxaemia. In the absence of hypoxaemia, there is no evidence that oxygen provides greater palliation of breathlessness than air. Evidence does not support the use of supplemental oxygen therapy during pulmonary rehabilitation in those with COPD and exertional desaturation but normal resting arterial blood gases. Both positive and negative effects of LTOT have been described, including on quality of life. Education about how and when to use oxygen therapy in order to maximize its benefits, including the use of different delivery devices, expectations and limitations of therapy and information about hazards and risks associated with its use are key when embarking upon this treatment. See relatededitorial [ABSTRACT FROM AUTHOR]

To compare the effects of propofol, ketamine–propofol and isoflurane, at similar anesthetic depth, on cardiopulmonary variables in unpremedictated chickens. Prospective, randomized, crossover experimental trial. A total of 10 male Leghorn domestic chickens, aged 3 months and body mass 1.4–2.0 kg. Birds were randomly assigned to each of three anesthetic protocols, 7 days apart: intravenous propofol, intravenous ketamine–propofol or isoflurane. Anesthesia was induced (indicated by loss of righting reflex and tracheal intubation) and maintained with propofol (10 mg kg–1 minute–1, then 1.1 mg kg–1 minute–1), ketamine–propofol (5 mg mL–1 ketamine and 5 mg mL–1 propofol combined; 10 mg kg–1 minute–1, then 1.1 mg kg–1 minute–1) or isoflurane [5% vaporizer setting initially, then end-tidal concentration (F e ′Iso) of 2%] for 65 minutes. Anesthesia was maintained at a similar anesthetic depth based upon positive or negative responses to toe pinch. Heart rate (HR), respiratory rate (f R), noninvasive arterial blood pressure and arterial blood gases were measured during anesthesia. Propofol or ketamine–propofol infusion rates and F e′ Iso required to prevent movement in response to a noxious stimulus and recovery times were recorded. Anesthesia induction dose was 9.0 ± 0.8 (mean ± SD) and 12.2 ± 0.3 mg kg–1 for propofol and ketamine–propofol, respectively. Propofol and ketamine–propofol infusion rates and F e′ Iso required to prevent movement in response to the noxious stimulus were 0.88 ± 0.14 mg kg–1 minute–1, 0.92 ± 0.14 mg kg–1 minute–1 and 1.45 ± 0.28%, respectively. Cardiopulmonary variables remained clinically acceptable, but ketamine–propofol was associated with a significantly higher HR (p = 0.0001) and lower f R (p = 0.0001). Time to extubation did not differ among treatments. Cardiovascular and respiratory variables were maintained within normal ranges in all treatments. Coadministration of ketamine with propofol significantly reduced the induction and maintenance dose of propofol. [ABSTRACT FROM AUTHOR]

No study has determined the minimal effective dose of trazodone required to induce behavioral changes and its safety profile in rabbits. Therefore, this study aimed to determine the minimal effective dose of trazodone to improve compliance to handling, and to evaluate associated changes in motor activity, physiological and arterial blood gas parameters. Eight intact female New Zealand White rabbits (2-month-old; 1.66 ± 0.12 kg) were included in this prospective, blinded, randomized cross-over study. After a 10-day acclimation, rabbits randomly received placebo or trazodone 10, 20 or 30 mg/kg orally (PLAC, TRAZ10, TRAZ20, TRAZ30) with a 1-week wash-out period. Compliance scoring (dynamic interactive visual analog scale; DIVAS), activity levels measured with accelerometry (T0-T600), physiological parameters (temperature, heart, and respiratory rates), and arterial blood gas parameters (up to T240) were evaluated. Compliance scores, accelerometry, physiological and arterial blood gas parameters and hypoxemia prevalence (PaO2 <60 mmHg) were analyzed using linear mixed models and Chi-squared tests, respectively (P<0.05). When compared with PLAC, DIVAS scores were significantly higher at T80-120, T40-120 and T120-200 in TRAZ10, TRAZ20 and TRAZ30 post-administration, respectively. When compared with baseline, DIVAS scores were significantly higher from T80-160, T40-240 and T80-200 in TRAZ10, TRAZ20 and TRAZ30, respectively. All other parameters were not significantly different. In TRAZ30, hypoxemia was observed in 2/8 rabbits (P=0.104). In conclusion, oral trazodone improved rabbit compliance at all studied dosages, especially 20 mg/kg improved rabbit compliance without decreasing motor activity or causing hypoxemia. [ABSTRACT FROM AUTHOR]

This article presents a case study of a 57-year-old man with hypertension and COVID-19 who experienced severe metabolic imbalances, including low sodium levels. The study explores the potential connection between COVID-19 infection or treatment and hyponatremia. The patient's use of a specific medication and excessive water intake likely contributed to his condition. The article emphasizes the importance of monitoring and correcting hyponatremia to prevent complications, and notes that severe cases may not always present noticeable symptoms. [Extracted from the article]

Trail runners (TRs) must carry an extra load of equipment, food (bars and gels) and liquids, to delay the anticipation of fatigue and dehydration during their competitions. Therefore, we aimed to evaluate how an extra load can influence the metabolic level. Thirteen well-trained trail runners performed a randomized crossover study (total n = 39), completing three treadmill running sessions with a weighted vest of 0%, 5% and 10% of their body mass during a combined test (rectangular test + ramp test). In addition, biomarkers of oxygen metabolism, acid–base and electrolyte status pre-, during and post-test, as well as the rectangular from capillary blood of the finger and time to exhaustion, were analyzed. Repeated-measures ANOVA showed no significant difference between conditions for any of the analyzed biomarkers of blood gas. However, one-way ANOVA showed a significant difference in trial duration between conditions (p ≤ 0.001). Tukey's post hoc analysis observed a significant decrease in time to exhaustion in the weighted vest of 10% compared to 0% (p ≤ 0.001) and 5% (p ≤ 0.01) and 5% compared to 0% (p = 0.030). In addition, repeated-measures ANOVA detected a significant difference in pH in the group x time interaction (p = 0.035). Our results show that increasing the weighted vest (5% and 10%) anticipates fatigue in runners trained in TR. In addition, increasing the load decreased pH by a smaller magnitude at 10% compared to 0% and 5% at the end of the exercise protocol. [ABSTRACT FROM AUTHOR]

A 3‐year‐old male neutered domestic shorthair cat presented with lethargy, hyporexia, and pyrexia of unknown origin. Biochemical analysis using a Beckman Coulter AU480 demonstrated marked increases in creatine kinase and aspartate aminotransferase, indicative of severe muscle injury, with concurrent presumptive myoglobinuria on urinalysis. A marked, non‐physiologic increase in measured bicarbonate and resultant negative anion gap was documented; however, calculated bicarbonate obtained via a point‐of‐care blood gas analyzer was within normal limits. Laboratory error due to interference by lactate dehydrogenase was suspected and supported by the results of subsequent biochemical testing. Artifactual increases in bicarbonate have been documented in cases of rhabdomyolysis in horses, cows, and a bird. However, to the best of the authors' knowledge, this is the first report to demonstrate this spurious change in a cat. [ABSTRACT FROM AUTHOR]

Simple Summary: The brown pelican (Pelecanus occidentalis) is frequently impacted by both human activity and natural disasters, such as hurricanes, and is treated by rehabilitation centers. We have established normal values for juvenile brown pelicans at the end of rehabilitation to aid veterinarians and rehabilitation staff in determining if birds are healthy enough for release using analyzers readily available to these groups. We also attempted to validate a test for fibrinogen (Abaxis VSPro equine fibrinogen cartridge) in this species. Fibrinogen is a protein that can be used to measure inflammation. We found that that particular fibrinogen test is not a good way to measure fibrinogen in brown pelicans. The brown pelican (Pelecanus occidentalis) is a species often affected by natural and man-made disasters such as hurricanes and oil spills, as well as general human activities; that subsequently receives medical care and rehabilitation. During rehabilitation, blood may be collected for various tests to help with diagnosis, treatment, and monitoring. Reference intervals for this species are limited, dated, and typically from small sample sizes. Seventy-one presumed healthy brown pelicans were sampled as part of their pre-release examination from rehabilitation at the Wildlife Center of Texas after a large volume stranding from December 2014 to January 2015, and various venous analytes were measured to establish updated reference intervals for brown pelicans. Fibrinogen was measured via heat precipitation and the Abaxis VSPro equine fibrinogen cartridge to determine reference intervals and in an attempt to validate the VSPro for use in avian species. Abaxis VS2 Avian/Reptile Chemistry panel, iSTAT CG4+, and iSTAT Chem8+ results, in addition to body condition score, spun PCV, cloacal temperature, and fibrinogen were measured. Proposed reference intervals for brown pelicans are presented. Fibrinogen results were not comparable between the gold standard method and the VSPro, indicating that the VSPro is not appropriate for use in brown pelicans. [ABSTRACT FROM AUTHOR]

Objective:To explore the application effect of closed thoracic drainage tube combined with high-frequency oscillatory ventilation on neonatal meconium aspiration syndrome with respiratory failure. Methods:Sixty newborns with meconium aspiration syndrome and respiratory failure admitted to our hospital from January 2018 to January 2024 were selected. They were divided into an observation group and a matched group, with 30 cases. Children in the matched group adopted conventional mechanical ventilation and chest closed drainage, and children in the children in the observation group adopted chest closed drainage tube combined with high-frequency oscillatory ventilation to compare relevant indicators. Results:The total response rate in the observation group was high compared with the matched group (P＜0. 05); Before treatment, there was no significant difference in the pH value, PaCO2, SaO2, and PaO2 levels between the two groups of children (P＞0. 05). Post-treatment, PaCO2 decreased, and pH, SaO2 and PaO2 increased in the two groups, with the same trend compared with the control group (P＜0. 05); There was no difference in MAP and HR between the two groups of children before and Post-treatment (P＞0. 05); There was no difference in the incidence of complications between the two groups of children (P＞0. 05); Before treatment, there was no difference in MAP and HR between the two groups of children (P＞0. 05). Post-treatment, the MAP of the two groups of children increased, and the observation group was higher than the matched group, while HR decreased. The observation group was higher than the matched group (P＜0. 05); There was no difference in the incidence of complications between the two groups of children (P＞0. 05). Conclusion: For newborns with meconium aspiration syndrome combined with respiratory failure and pneumothorax, the use of closed thoracic drainage combined with high-frequency oscillatory ventilation can improve clinical efficacy, improve blood gas indicators, stabilize vital signs, and have high safety. [ABSTRACT FROM AUTHOR]

Objective: To explore the efficacy of intestinal probiotics combined with health Qigong in patients with chronic obstructive lung (disease) and its effect on nuclear factor κB receptor activation factor ligand (RANKL) and blood gas index. Methods:88 stable patients with COPD from January 2018 to December 2023 were selected. They were divided into an observation group and a matched group, with 44 cases in each group. The matched group patients were treated with conventional Western medicine, while the observation group was treated with intestinal probiotics combined with fitness Qigong Eight Section Brocade in addition to the matched group. Pulmonary function, 6-minute walking test (6MWT), and Chronic Obstructive Pulmonary Disease Assessment Scale (CAT) were used to evaluate the therapeutic effect of the two groups of patients. Inflammatory response indicators and RANKL levels were compared before and Post-treatment, and blood gas indicators and quality of life were compared between the two groups of patients. Results: FEV1,FVC, FEV1/FVC, and 6 MWT were increased in both groups post-treatment, A ed CAT score. The same trend was observed between the observation group and the matched group (P＜0.05); Post-treatment, IL-17, TNF-α, and RANKL levels were reduced in both groups,The observation group was lower than the matched group (P＜0.05); Lower PaCO2levels Post-treatment, Increased levels of SaO2and PaO2, The observation group followed the matched group (P＜0.05); GQOLI-74 related dimension scores were elevated in both groups Post-treatment. Different compared from the matched group (P＜0.05). Conclusion: The combination of intestinal probiotics and fitness qigong Baduanjin has a significant therapeutic effect on stable patients with chronic obstructive pulmonary disease in addition to conventional treatment. It can improve lung function, exercise endurance, alleviate disease severity, reduce inflammatory factors and RANKL levels, improve blood gas indicators, and enhance patient quality of life. [ABSTRACT FROM AUTHOR]

Context: Most deaths of lambs in the first days of life are due to failure to adapt to extrauterine life. Aims: This study aimed to test the hypothesis that adding magnesium sulfate (MgSO4) to the diet of twin-bearing ewes in the last week of gestation improves the adaptation to the extrauterine life of the lambs. Methods: Eighty-three multiparous Finnish × Polwarth ewes carrying twins in the last week of gestation were MgSO4 supplemented (n = 40) or allocated to control (n = 43). We recorded the durations of gestation, expulsion and lambing, interlambing interval, and birthweights, meconium score, lamb rectal temperature (at birth and 3 h after birth), whether assistance was needed (yes or no) and time from lamb expulsion to stand and to suck (n = 148). A jugular blood sample of the lambs was analysed for acidity, partial pressures of CO2 and oxygen; active and standard HCO3, blood base excess (BE b) and extracellular fluid base excess (BE ecf), saturated oxygen, and total CO2 concentration. Glucose was analysed with a portable device. Key results: Gestation was longer in supplemented ewes (147.7 ± 2.0 vs control: 146.7 ± 1.7 days, P < 0.05). Birthweight and litter birthweight of lambs were higher when ewes were supplemented (3.74 ± 0.6 and 7.47 ± 0.9 kg vs control: 3.51 ± 0.5 and 7.02 ± 0.9 kg, P < 0.05). The need for assistance, meconium score, durations of expulsion and lambing, and time to stand and to suck were not different between treatments (P > 0.05). The interlambing interval was shorter in the supplemented ewes (6.7 ± 2.7 m vs control: 10.4 ± 2.6, P < 0.05). Lamb rectal temperature was not different between treatments 3 h after birth, but at birth was lower in lambs of supplemented ewes (P < 0.05). Treatments did not differ in blood acidity, CO2 partial pressure and total concentration, active and standard HCO3, both measures of base excess, nor blood glucose. Lambs of supplemented ewes had higher oxygen saturation and partial pressure (P < 0.05). Conclusions: The MgSO4 supplementation improves the adaptation to extrauterine life in pen conditions. Implications: It should be tested whether maternal supplementation with MgSO4 reduces the mortality of twin lambs. Perinatal mortality in the first week of life is one of the most significant productive and animal welfare losses in sheep production countries; most of these deaths are due to a lack of adaptation to extrauterine life. In this work, we demonstrated that magnesium sulfate supplementation of adult ewes carrying twin lambs extended the gestation duration and improved the lambs' birthweight. This supplementation improves the lambs' adaptation to extrauterine life. [ABSTRACT FROM AUTHOR]

This study aims to investigate how inert gas affects the partial pressure of alveolar and venous blood using a fast and accurate operator splitting method (OSM). Unlike previous complex methods, such as the finite element method (FEM), OSM effectively separates governing equations into smaller sub‐problems, facilitating a better understanding of inert gas transport and exchange between blood capillaries and surrounding tissue. The governing equations were discretized with a fully implicit finite difference method (FDM), which enables the use of larger time steps. The model employed partial differential equations, considering convection‐diffusion in blood and only diffusion in tissue. The study explores the impact of initial arterial pressure, breathing frequency, blood flow velocity, solubility, and diffusivity on the partial pressure of inert gas in blood and tissue. Additionally, the effects of anesthetic inert gas and oxygen on venous blood partial pressure were analyzed. Simulation results demonstrate that the high solubility and diffusivity of anesthetic inert gas lead to its prolonged presence in blood and tissue, resulting in lower partial pressure in venous blood. These findings enhance our understanding of inert gas interaction with alveolar/venous blood, with potential implications for medical diagnostics and therapies. [ABSTRACT FROM AUTHOR]

Background: This study aimed to address the increasing prevalence of cesarean section and the importance of evaluating newborn health through arterial blood gas analysis. Its primary objective was to compare the umbilical cord blood gas levels in newborns delivered through different delivery methods. Method: This retrospective descriptive cross-sectional study included singleton pregnancies with a gestational age between 37 and 42 weeks and infants weighing between 2500 and 4000 g. Newborns with an Apgar score of 7 or higher at 1 and 5 min were included. Umbilical cord blood samples were collected from each newborn for blood gas analysis within 60 min after birth. Result: The study included 340 neonates, with 170 born via caesarean section and 170 born through vaginal delivery. No significant differences were observed in Apgar scores between two groups. ABG analysis showed that vaginally born neonates had lower pH (7.24 ± 0.08 vs. 7.27 ± 0.07, P < 0.001), PCO2 (P = 0.015), and HCO3 (P < 0.001). Cesarean section neonates had higher oxygen saturation (P = 0.007) and pressure of oxygen (P < 0.001), and less negative base excess (P < 0.001). In the subgroup analysis, neonates whose mothers received epidural anesthesia had lower pH (7.23 ± 0.07 vs. 7.25 ± 0.08, P = 0.021) and more negative base excess (P = 0.026). Other parameters of ABG did not differ significantly between the groups (P > 0.05). Conclusion: It has been proven that the mode of delivery, whether it is vaginal or cesarean, as well as the administration of epidural anesthesia during vaginal delivery, have a significant impact on newborns at birth. Newborns delivered vaginally exhibit metabolic acidosis compared to those delivered via cesarean section. Although these differences are statistically significant, they do not have a notable clinical significance, as the average values of the evaluated parameters in both groups fall within the normal range. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the current workflow of blood gas ordering and testing in a cardiothoracic operating room to identify opportunities to streamline the process, using performance improvement methodologies. Methods Issues with specimen relabeling were identified that lead to delayed results and potential patient safety concerns. Blood gas specimen relabeling was evaluated for operating room cases from August 2018 to December 2022. An OpTime Epic Sidebar button for arterial blood gas and venous blood gas orders was created in January 2019 to streamline the ordering process so that laboratory barcode labels were then printed in the operating room and attached to the specimen, eliminating the need for relabeling by the technologists. Results This Epic Sidebar intervention led to a drastic improvement of appropriate labeling, which has been sustained. From March 2019 to January 2023, with our new workflow, over 95% of blood gas specimens arrived barcode labeled compared to less than 1% in the preintervention era. Conclusions A multidisciplinary team with key stakeholders is important to address complex care issues. Performance improvement methodology is critical to develop interventions that hardwire the process. This intervention led to a sustained reduction in secondary relabeling of patient samples and improved timeliness of reporting of blood gas results. [ABSTRACT FROM AUTHOR]

Summary: Background: Impaired oxygenation during anaesthesia can be detrimental. Bodyweight and body shape influence arterial oxygen tension (PaO2) but the effect of body condition score (BCS) has not been investigated. Objectives: To examine the effect of BCS on respiratory indices. Study design: Retrospective. Methods: In total, 524 anaesthetic records were reviewed. Records from healthy adult horses under isoflurane anaesthesia in dorsal recumbency, receiving controlled mechanical ventilation, with complete ventilation and arterial blood gas data and BCS assessment by one person (KL) were included in data analysis. Data were analysed using student's t‐test, Mann–Whitney U test, chi‐squared analysis and logistic regression. Results: In total, 135 records for 85 horses with BCS <6/9 (Group N) and 50 horses with BCS ≥6/9 (Group O) met the inclusion criteria. Overall, there was a strong negative correlation between BCS and PaO2 (Spearman's r = 0.72, p < 0.001). Group O had significantly lower PaO2 (112 [50–546 mmHg]) compared to Group N (380 [65–658 mmHg], p < 0.001) which remained when horses were further categorised by bodyweight >500 kg (118 mmHg vs. 390 mmHg, p < 0.001) and <500 kg (160 mmHg vs. 451 mmHg, p < 0.04). Group O were 34 times more likely to be hypoxaemic (PaO2 < 100 mmHg) compared to Group N (χ2 = 34.39, p = 0.03). Alveolar dead space fraction was greater in Group O (0.27 [0.10–0.41]) versus Group N (0.24 [0.12–0.35]), p < 0.001. Multivariate logistic regression analysis identified a significant association between PaO2 and bodyweight (p = 0.01), alveolar dead space fraction (p = 0.005) and BCS (p < 0.001). Main limitations: Retrospective design. Conclusions: Body condition score ≥6/9 has a detrimental effect on PaO2, alveolar dead space fraction and is a risk factor for hypoxaemia in healthy anaesthetised horses in dorsal recumbency. [ABSTRACT FROM AUTHOR]

Introduction: There is an increasing use of point-of-care testing (POCT) devices for patients. These portable devices are preferred by healthcare personnel because they are quick and easy to use. The aim of this study was to investigate whether POCT devices can provide rapid and reliable blood gas measurements. Methods: Blood gas measurements were performed for 30 pediatric patients at the University of Health Sciences Turkey, Bakırköy Dr. Sadi Konuk Training and Research Hospital using a POCT device and a fully automatic blood gas analyzer. Eleven parameters (pH, pCO2, pO2, sodium, potassium, calcium, glucose, lactate, hematocrit, cHCO3, and cSO2) were compared. The statistical analyses were performed using the NCSS software. To determine the correlation between the two methods, the intraclass correlation coefficient (ICC) was calculated, and Bland-Altman graphs were used. Results: The ICC demonstrated an almost strong correlation with pH (ICC=0.889), pCO2 (ICC=0.968), pO2 (ICC=0.981), sodium (ICC=0.799), potassium (ICC=0.968), calcium (ICC=0.909), glucose (ICC=0.967), cHCO3 (ICC=0.919) and cSO2(ICC=0.988) and moderate correlation with lactate (ICC=0.626) and hematocrit (ICC=0.491). All p-values were all <0.001 for all analytes. Conclusion: The POCT device was compared with a fully automatic blood gas analyzer. Unjustified postponement of analysis in patients with respiratory failure, shock, or electrolyte disorders can delay the application of appropriate treatment. Not only the benefits of an accurate POCT measurement but also the benefits of clinical practice and process changes should be taken into consideration. [ABSTRACT FROM AUTHOR]

High-altitude acclimatization refers to the physiological adjustments and adaptation processes by which the human body gradually adapts to the hypoxic conditions of high altitudes after entering such environments. This study analyzed three mRNA expression profile datasets from the GEO database, focusing on 93 healthy residents from low altitudes (≤1400 m). Peripheral blood samples were collected for analysis on the third day after these individuals rapidly ascended to higher altitudes (3000–5300 m). The analysis identified significant differential expression in 382 genes, with 361 genes upregulated and 21 downregulated. Further, gene ontology (GO) annotation analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis indicated that the top-ranked enriched pathways are upregulated, involving blood gas transport, erythrocyte development and differentiation, and heme biosynthetic process. Network analysis highlighted ten key genes, namely, SLC4A1, FECH, EPB42, SNCA, GATA1, KLF1, GYPB, ALAS2, DMTN, and GYPA. Analysis revealed that two of these key genes, FECH and ALAS2, play a critical role in the heme biosynthetic process, which is pivotal in the development and maturation of red blood cells. These findings provide new insights into the key gene mechanisms of high-altitude acclimatization and identify potential biomarkers and targets for personalized acclimatization strategies. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Clinical & Cardiovascular Perfusion / Türk Klinik ve Kardiyovasküler Perfüzyon Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Clinical & Cardiovascular Perfusion / Türk Klinik ve Kardiyovasküler Perfüzyon Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This case study investigated the impact of SCS on alterations in blood pressure during constant‐load exercise in a female patient with heart failure. Three different SCS frequencies [No SCS (~0 Hz), Low SCS (~100 Hz), and High SCS (~1000 Hz)] with and without ischaemic stimulation of the legs (cuffs) were randomly applied during constant‐load exercise. To determine cardiovascular and ventilatory responses to exercise following SCS frequencies, BP, heart rate (HR), and respiratory gas exchange were measured. This experiment was duplicated in visit 1 and visit 2 with a random application of SCS frequency order and the data were averaged. There were no significant differences among three frequencies with no leg ischaemia. However, High SCS demonstrated lower BP, HR, and respiratory gas exchange relative to No SCS and Low SCS. SCS may be effective in improving cardiovascular and ventilatory responses in HF and high‐frequency stimulation provides more clinical benefit; however, further studies are needed. [ABSTRACT FROM AUTHOR]

Hemorheological factors may show arterio-venous differences. Alterations in acid-base and metabolic parameters may also influence these factors. However, little is known about changes in micro-rheological parameters during abdominal surgery, influencing splanchnic circulation. In anesthetized pigs, the external jugular vein, femoral artery and vein were cannulated unilaterally, and paramedian laparotomy was performed. In the anastomosis group, after resecting a bowel segment, end-to-end jejuno-jejunostomy was completed. Blood samples (from cannulas and by puncturing the portal vein) were taken before and after the intervention. Hematological, acid-base and blood gas parameters, metabolites, red blood cell (RBC) deformability and aggregation were determined. The highest hematocrit was found in portal blood, increasing further by the end of operation. A significant pH decrease was seen, and portal blood showed the highest lactate and creatinine concentration. The highest RBC aggregation values were found in arterial, the lowest in renal venous blood. The RBC aggregation increased with higher lactate concentration and lower pH. Osmotic gradient deformability declined, with the lowest values in portal and renal venous samples. In conclusion, micro-rheological parameters showed arterio-venous and porto-renal venous differences, influenced by oxygenation level, pH and lactate concentration. The intestinal anastomosis operation caused an immediate micro-rheological deterioration with portal venous dominancy in this experiment. [ABSTRACT FROM AUTHOR]

Aim: Neonatal encephalopathy remains one of the most significant causes of neonatal morbidity and mortality. The present study compared the risk factors, demographic data, laboratory and imaging findings, and short-term outcomes of two groups of patients. Materials and Methods: A retrospective analysis was conducted on 45 patients who had undergone therapeutic hypothermia (TH) between January 1st, 2021, and August 31st, 2023. According to blood gas parameters; Group 1 (32 patients) met the criteria (pH ≤7.0 and/or base excess BE ≤-16) for TH, while Group 2 (13 patients) did not (pH >7.0, BE >-16, and with an absence of clinical findings). Results: A comparison of the demographic data revealed higher incidences of birth trauma (p=0.046) and neonatal risk (p=0.026) in Group 1 than in Group 2, with no other significant differences. Severe amplitude electroencephalogram (aEEG) abnormalities were more common in Group 1 but one patient of Group 2 displayed moderate abnormality during follow-up. A comparison of all imaging findings [aEEG, transfontanelle ultrasonography (USG), abdominal USG, cranial magnetic resonance imaging, echocardiography] revealed no significant differences (p=0.45). At the end of the follow-up period, 35 patients (77.7%) were discharged, while two (4.4%) patients did not survive (both in Group 1). Upon discharge, all patients in Group 2 exhibited normal neurological examination findings. Conclusion: Re-evaluating the existing criteria for the identification of those infants who may benefit from TH, but who are often deemed ineligible due to incomplete adherence to the treatment criteria, could significantly reduce the mortality and morbidity associated with birth asphyxia.

Good management practices are essential to ensure a sustainable aquaculture promoting fish health and environmental protection. Among these practices, the acclimation procedure is important to mitigate post-transport stress allowing the fish to adapt to new rearing environment; however, it is often neglected. This study evaluated acclimation procedures for fish tambaqui Colossoma macropomum. The fish were transported for 400 km and then submitted at different acclimation procedures (NOAC—no acclimation, AC30—fish acclimated in 30 min, and AC60—fish acclimated in 60 min) and pathogens (Aeromonas hydrophila and Saprolegnia parasitica). Blood analysis was performed before the fish transportation (baseline values) and at 01, 24, 48, 72, and 96 h after acclimation procedures, determining the biochemical parameters, erythrogram, leukogram, ions, gasses, and hematimetric indices. As expected, the transport was a stressor for fish, increasing 700% glucose and 300% cortisol compared to the baseline values. In addition, fish after transport, submitted to acclimation procedure for 60min and exposed to pathogens presented 15% mortality. However, fish that underwent the acclimation procedure for 30 min showed early return of glucose, total plasmatic protein, hemoglobin, hematocrit, erythrocyte, MCV, MCH, MCHC, Na, K, and pH to the baseline, mitigating the post-transport stress. Contrary, the acclimation procedure for 60 min was not adequate for tambaqui causing more stress, not returning blood parameters to baseline, and mortalities. The fish not acclimated showed similar results to AC30; however, blood parameters remain altered through 96 h compared to AC30. The AC30 was the best management practice to mitigate the post-transport stress in tambaqui promoting early return to homeostasis and prevent mortality. [ABSTRACT FROM AUTHOR]

[Display omitted] • Biomimetic decorated nanoporous membrane is developed for blood oxygenation. • Intrinsic porous property and asymmetric structure facilitate gas permeation. • Fe-tannic acid network boosts hemocompatibility and antiaging property. • More preferential adsorption to water than protein is critical to hemocompatibility. • Membrane shows fast exchange rates and no detectable thrombus and plasma leakage. Membrane technology holds great potential for separation applications and also finds critical needs in biomedical fields, such as blood oxygenation. However, the bottlenecks in gas permeation, plasma leakage, and especially hemocompatibility hamper the development of membrane oxygenation. It remains extremely challenging to design efficient membranes and elucidate underlying principles. In this study, we report biomimetic decoration of asymmetric nanoporous membranes by ultrathin FeIII-tannic acid metal–ligand networks to realize fast gas exchange with on plasma leakage and substantially enhance hemocompatibility. Because the intrinsic nanopores facilitate gas permeability and the FeIII-catechol layers enable superior hydrophilicity and electronegativity to original surfaces, the modified membranes exhibit high transport properties for gases and great resistances to protein adsorption, platelet activation, coagulation, thrombosis, and hemolysis. Molecular docking and density functional theory simulations indicate that more preferential adsorption of metal–ligand networks with water molecules than proteins is critical to anticoagulation. Moreover, benefiting from the better antiaging property gave by biomimetic decoration, the membranes after four-month aging present gas permeances similar to or even larger than those of pristine ones, despite the initial permeation decline. Importantly, for blood oxygenation, the designed membranes after aging show fast O 2 and CO 2 exchange processes with rates up to 28–17 and 97–47 mL m−2 min−1, respectively, accompanied with no detectable thrombus and plasma leakage. We envisage that the biomimetic decoration of nanoporous membranes provide a feasible route to achieve great biocompatibility and transport capability for various applications. [ABSTRACT FROM AUTHOR]

Background: The effects of obesity on pulmonary gas and blood distribution in patients with acute respiratory failure remain unknown. Dual-energy computed tomography (DECT) is a X-ray-based method used to study regional distribution of gas and blood within the lung. We hypothesized that 1) regional gas/blood mismatch can be quantified by DECT; 2) obesity influences the global and regional distribution of pulmonary gas and blood; 3) regardless of ventilation modality (invasive vs. non-invasive ventilation), patients' body mass index (BMI) has an impact on pulmonary gas/blood mismatch. Methods: This single-centre prospective observational study enrolled 118 hypoxic COVID-19 patients (92 male) in need of respiratory support and intensive care who underwent DECT. The cohort was divided into three groups according to BMI: 1. BMI<25 kg/m2 (non-obese), 2. BMI = 25-40 kg/m2 (overweight to obese), and 3. BMI>40 kg/m2 (morbidly obese). Gravitational analysis of Hounsfield unit distribution of gas and blood was derived from DECT and used to calculate regional gas/blood mismatch. A sensitivity analysis was performed to investigate the influence of the chosen ventilatory modality and BMI on gas/blood mismatch and adjust for other possible confounders (i.e., age and sex). Results: 1) Regional pulmonary distribution of gas and blood and their mismatch were quantified using DECT imaging. 2) The BMI>40 kg/m2 group had less hyperinflation in the non-dependent regions and more lung collapse in the dependent regions compared to the other BMI groups. In morbidly obese patients, gas and blood were more evenly distributed; therefore, the mismatch was lower than in other patients (30% vs. 36%, p < 0.05). 3) An increase in BMI of 5 kg/m2 was associated with a decrease in mismatch of 3.3% (CI: 3.67% to -2.93%, p < 0.05). Neither the ventilatory modality nor age and sex affected the gas/blood mismatch (p > 0.05). Conclusion: 1) In a hypoxic COVID-19 population needing intensive care, pulmonary gas/blood mismatch can be quantified at a global and regional level using DECT. 2) Obesity influences the global and regional distribution of gas and blood within the lung, and BMI>40 kg/m2 improves pulmonary gas/blood mismatch. 3) This is true regardless of the ventilatory mode and other possible confounders, i.e., age and sex. [ABSTRACT FROM AUTHOR]

The article delves into historical and modern efforts to develop blood substitutes, highlighting the shift from early experiments with milk transfusions in the 19th century to contemporary research on hemoglobin-based oxygen carriers (HBOCs) like ErythroMer. These synthetic alternatives aim to address critical shortages and logistical challenges associated with conventional blood transfusions, potentially offering a stable, universal solution for emergency settings and beyond.

It aimed to compare the trans anesthetic clinical and perioperative analgesic effects by prolonged continuous infusion of fentanyl (GF, bolus of 5 µg/kg and continuous infusion (CI) of 15 µg/kg/h) or remifentanil (GR, CI of 18 µg/kg/h) in dogs undergoing to elective ovariohysterectomy. Twenty female healthy dogs were premedicated with acepromazine, inducted to unconsciousness with propofol and kept under anesthesia with isoflurane. The M0 (baseline) was recorded and animals were randomly allocated in GF (n = 10) or GR (n = 10), recording clinical and blood gas parameters every 15 minutes (M15...M120) for two hours and, after, during surgery, adjusting the opioid rate according to surgical requirement. The isoflurane vaporization reduced by up to 47% and 42% in GF and GR, respectively, when compared to M0. During the first two hours of CI, six animals of each group required atropine intervention and three animals of GF required ephedrine. The number of rate adjustments during intraoperative was significant higher in GR when compared to GF (P = 0.0248). By the Log-rank test, there was a higher possibility of not receiving analgesic rescue in the first 30 minutes of postoperative in GF when compared to GR (P < 0.0001) and all animals required analgesic rescue during the firsts 3 and 6 hours in GR and GF, respectively. It is concluded that, when the proposal continuous infusions were compared, fentanyl required fewer analgesic rescues during perioperative, nonetheless, it is recommended rate adjustment during intraoperative and additional analgesia for postoperative for both treatments. [ABSTRACT FROM AUTHOR]

Studies investigating physiological deviations from normality in newborn calves derived from in vitro fertilization procedures remain important for the understanding of factors that reduce calf survival after birth. The aim of this study was to investigate parameters affecting health and welfare of newborn Flemish calves derived from in vitro embryo production (IVP) in the first hours of life in comparison to in vivo‐derived calves. Physical traits of newborn calves and fetal membranes (FM) were recorded soon after birth. Newborn venous blood samples were collected at several time points within the first 24 h of life for analyses of energy substrates, electrolytes, blood gases, acid–base balance, blood chemistry, and haematology. A liver biopsy was taken within the first hour after birth for analysis of gene expression of key enzymes of the fructolytic and glycolytic pathways. Newborn IVP calves were heavier and larger at birth, which was associated with heavier FM. At several time points during the first 24 h of life, IVP‐derived calves had altered rectal temperature, blood gases, electrolyte concentrations, blood parameters for liver, kidney and muscle function, and acid–base balance, plasma lipid metabolism, and hemogram parameters. The relative mRNA abundances for triokinase and lactate dehydrogenase‐B were greater in IVP calves. In summary, IVP‐derived newborn calves were at higher risk of clinical problems after birth, which was markedly greater in heavier and larger calves. Such animals take longer to adapt to extrauterine life and should receive a special attention during the immediate neonatal period. [ABSTRACT FROM AUTHOR]

Copyright of MN Cardiology / MN Kardiyoloji is the property of Medical Network and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: One of the most frequently used scoring systems routinely to determine whether pneumonia patients need inpatient treatment is the CURB-65 score. Recently, studies conducted with simple, cheap, and rapid blood tests such as hemogram and biochemistry parameters, which every clinician can easily interpret, have gained popularity. This study examined the relationship between blood tests requested in the emergency department (ED) and pneumonia severity and prognosis. Methods: The study examined the files of patients who came to the ED with complaints of fever, cough, phlegm and fatigue between January 1 and December 31, 2017. Pneumonia severity according to thorax tomography and CURB-65 score at admission were evaluated. The patient's vital signs, hemogram, biochemistry and blood gas parameters were examined. It was compared with the ward they were admitted to and their 30-day prognosis. Results: The files of 117 patients were examined. The age of the patients was significantly higher in the group with severe pneumonia than mild and moderate pneumonia groups. In the group with moderate and severe pneumonia, comorbidities were significantly higher than the mild pneumonia group. The rate of intensive care admission and ex in the group with severe pneumonia was significantly higher than in mild and moderate pneumonia groups. In the ex-group, the CURB-65 score, neutrophil-lymphocyte ratio (NLR), C-Reactive Protein (CRP)/Albumin and pneumonia severity were significantly higher than the other group. Conclusion: NLR and CRP/Albumin ratios may be as effective as CURB-65 scoring in predicting 30-day mortality, and ED burden can be reduced with simple blood tests. [ABSTRACT FROM AUTHOR]

Aim: our study aimed to characterize the lung ultrasound (LUS) patterns noted immediately after delivery in term and near-term neonates, and to investigate whether the LUS scores or patterns observed at that point could anticipate the need for respiratory support in the sample of patients studied. Materials and methods: We performed two ultrasound examinations: one in the delivery room and the second at one hour of age. The anterior and lateral regions of both lungs were examined. We assessed the correlation between the LUS scores or patterns and the gestational age, umbilical arterial blood gases, the need for respiratory support (CPAP or mechanical ventilation), the presence of respiratory distress, and the need for the administration of oxygen. Results: LUS scores were significantly higher in the delivery room examination (8.05 ± 1.95) than at 1 h of age (6.4 ± 1.75) (p < 0.001). There were also statistically significant differences between the LUS patterns observed in different lung regions between the delivery room exam and the exam performed at 1 h of age (p values between 0.001 and 0.017). There were also differences noted regarding the LUS patterns between different lung regions at the exam in the delivery room (the right anterior region LUS patterns were significantly worse than the right lateral LUS patterns (p < 0.004), left anterior LUS patterns (p < 0.001), and left lateral LUS patterns (p < 0.001)). A statistically significant correlation was found between LUS scores and the gestational age of the patients (r = 0.568, p < 0.001—delivery room; r = 4.0443, p < 0.001—one hour of age). There were statistically significant associations between LUS scores, patterns at delivery (p < 0.001) and 1 h of age (p < 0.001), and the need for respiratory support (CPAP or mechanical ventilation). Conclusions: LUS in the delivery room offers important information regarding lung fluid elimination and aeration of the lungs, and early LUS features are significantly associated with the risk of respiratory distress and the need for respiratory support. [ABSTRACT FROM AUTHOR]