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Lipid peroxidation: detection in vivo and in vitro through the formation of saturated hydrocarbon gases.

Saturated, short-chain hydrocarbon gases (ethane, propane, etc.--but not methane) are evolved during the spontaneous lipid peroxidation of mouse tissue slices or homogenates. A relatively-selective increase in either ethane or pentane was observed when either linolenic acid or linoleic acid, respectively, was added to tissue homogenates. When mice were challenged by injection of carbon tetrachloride or cumene hydroperoxide (two agents that induce a lipid peroxidative attack on liver), they exhaled ethane. The gas chromatographic detection and monitoring of hydrocarbon gases can serve as an index of lipid peroxidation in vivo.

Animals

Histamine metabolism in cluster headache and migraine. Catabolism of 14C histamine.

Various parameters of histamine metabolism were studied in patients with migraine, cluster headache and chronic paroxysmal hemicrania. These included urinary excretion of radioactivity and of 14C histamine and its metabolites, exhaled 14CO2 and fecal radioactivity after oral as well as subcutaneous administration of radioactive histamine. No marked deviation from the normal was found except in one patient with the cluster headache variant, chronic paroxysmal hemicrania, in whom an aberration in 14C histamine degradation seemed to be present. Only minute quantities of the 14C histamine metabolite C14 imidazoleacetic acid riboside seemed to be formed during a period with severe paroxysms. During a symptom-free period no deviation from normal was observed. The most likely explanation for this finding seems to be a defect in the conversion of imidazoleacetic acid to its riboside. This defect may possibly explain the increased urinary excretion of histamine in this particular patient. The relationship of this metabolic aberration to the production of headache still remains dubious for various reasons.

Biotransformation

New parachute cuff and positive end-expiratory pressure to minimize tracheal injury and prevent aspiration.

A new parachute cuff has been tested in combination with a positive end-expiratory pressure (PEEP) on mongrel dogs. During positive-pressure ventilation the intracuff and intratracheal pressures showed synchronous, identical pressure variations, and therefore theoretically with this type of cuff the pressure against the tracheal wall would be minimal. The cuff provided a seal against gas leakage from the lungs throughout the entire test period, i.e., for up to 7 h. To avoid aspiration of mouth contents during the passive exhalation phase, different amounts of PEEP were tested. A PEEP of 4.0--8.0 cm H2O always produced a seal against a column of fluid in the mouth exerting a hydrostatic pressure of 5.4--8.8 cm H2O against the cuff. This seal was maintained during the whole test period. No difference in sealing capacity was found when the cuff was used with a normal respiratory frequency (20/min) and with high-frequency positive-pressure ventilation (60/min). When the PEEP is eliminated, e.g., when the respirator is disconnected for suction of the endotracheal tube, the sealing effect will be abolished. As the cuff extends up into the larynx there will be no pooling of fluid above the cuff. The risk of aspiration can therefore be diminished by suction of oral cavity before disconnecting the respirator. With the use of the pneumatic valve principle together with high-frequency positive-pressure ventilation, an open respirator system can produce a continuous PEEP, thereby preventing aspiration even during suctioning of the tracheal tube.

Animals

Rate of drug metabolism in man measured by 14CO2-breath analysis.

Exhalation of 14CO2 in breath has been used to assess the rate of hepatic demethylation of (14C-dimethyl)aminopyrine, but due to the complexity of aminopyrine metabolism the pharmacokinetics of the procedure are insufficiently understood. Therefore, studies were performed in five individuals after oral administration of (14C-methoxy)glycodiazine, a model substance with relatively simple kinetic properties. Plasma concentrations of the drug and urinary output of its metabolites measured by high pressure liquid chromatography were analysed by a two-compartment open model. The terminal disappearance of 14CO2 from breath was practically identical with the terminal disappearance of glycodiazine from plasma, which could be correlated with the plasma clearance of free glycodiazine. The mean transit time of 14C-atoms from plasma to breath was 3 h. These results contribute to the pharmacokinetic basis for use of 14C-demethylation breath tests. In particular, they are consistent with the hypothesis that 14CO2-breath analysis may be used to assess certain pharmacokinetic parameters of appropriately labelled test compounds. These parameters may not necessarily be a direct reflection of the rate of demethylation.

Adult

[Increased demethylation of aminopyrine under long-term treatment with anticonvulsive drugs (author's transl)].

Demethylation of aminopyrine was measured in 25 healthy controls and 19 epileptics on long-term treatment with anticonvulsants by the 14C-aminopyrine breath test. Compared to controls epileptics exhibited increased cumulative 14CO2-exhalation rates (88.7% at 30 min, 62.6% at 2 h and 24.8% at 8h) following ingestion of 2 mu Ci 14C-aminopyrine. The results suggest that long-term treatment with antiepileptic drugs results in increased demethylating function of the liver which can be easily detected by a simple breath analysis technique like decreased demethylation in chronic liver disease.

Aminopyrine

A proximal system for positive end-expiratory pressure (PEEP) and continuous positive airway pressure (CPAP).

A proximal positive end-expiratory pressure (PEEP) and continuous positive airway pressure (CPAP) system was constructed by the simple addition of a venturi T-piece proximal to the exhalation limb of a breathing circuit. The level of PEEP or CPAP was determined by the amount of flow powering the venturi. This system can provide positive pressure in excess of 40 cm H2O without the need for check valves, dump valves or additional nebuliers and flowmeters.

Humans

The "D circle": closed-circuit operation of the Bain circuit.

A method of converting a Mapleson D (Bain) circuit to closed-circuit operation is presented, utilizing a laboratory air pump and a Waters carbon dioxide absorber canister to recirculate exhaled gas. The elimination of carbon dioxide from the circuit was studied and found to be adequate. The circuit would allow the use of low fresh gas flows for the maintenance of anaesthesia without the danger of carbon dioxide rebreathing. We suggest that such a circuit could provide appropriate conditions of gas humidity and temperature for endotracheal anaesthesia, while realizing the advantage of a circulator in mask anaesthesia is possible. Further design considerations for a "D circle" breathing system for clinical use are discussed.

Anesthesiology

Modeling airborne transmission of viral genome using computational fluid dynamics simulation: A case study for SARS-CoV-2 virus.

Predicting indoor air quality during infectious disease conditions relies on models simulating particle materials (PM)/bioaerosols distribution. Understanding the thermo-fluid properties of exhaled air is crucial for comprehending disease transmission dynamics. This study employs a computational fluid dynamics (CFD) model to simulate cough-induced particle dispersion in a closed space. Furthermore, the number of released particles and the presence of SARS-CoV-2 viral genomes by a cough were assessed (in eight COVID-19 patients). According to the CFD model, in the first 30 s of cough, the vertical height and lateral breadth of the particles' dispersion were up to 138cm and 92cm, respectively. As the distance from the patient's respiratory zone increased, the lateral distribution width of particles expanded, reaching 1.3 m at 2.4 m away. Larger droplets (> 62.5µ) were deposited at shorter distances, while smaller particles remained airborne longer. The comparison of experimental and simulated results focused on particle dispersion at specific distances from the patient, particularly in the 2.5µ range. The distribution pattern of PM2.5 and PM10 at a distance of 1 and 2 m for women, not men, is similar to the distribution pattern of PM in CFD modeling. Viral genome detection was more prevalent in particles near the left side of the body, especially within the first 20 min post-cough, exhibiting a correlation with CFD predictions.

Airborne transmission

Nasal secretion from normal subjects.

A new method of collection of nasal secretion, by dilution with condensed mositure of the exhaled air, is described. This method may be defined as a sefl-administered nasal lavage. The method permits quantitative determination of pH, relative viscosity, and electrolyte and protein composition. Concentrations of sodium, potassium, calcium, total protein, IgA, IgG, IgM, secretory compoenent and polysaccharide are reported for normal subjects. Significant correlations were noted between the relative viscosity and variables: dry weight, total protein and calcium.

Calcium

Clinical insights into catathrenia: A real-world analysis from a tertiary sleep center.

INTRODUCTION: Catathrenia is a rare sleep-related breathing disorder marked by groaning during prolonged expiration, often underrecognized or misdiagnosed as obstructive or central sleep apnoea (OSA or CSA) or parasomnia. Understanding its clinical and polysomnographic features is essential for accurate diagnosis and management. MATERIALS AND METHODS: We performed a retrospective observational study of adult patients diagnosed with catathrenia at Serviço de Medicina do Sono de Coimbra. Diagnosis was established by attended overnight polysomnography (PSG) with synchronised audio-video recording. Demographic data, symptoms, comorbidities, PSG variables, treatment modalities, and outcomes were reviewed. Catathrenia events were defined as deep inhalation followed by prolonged exhalation with monotonous groaning. RESULTS: Ten patients were included. Median age was 46 years (range 27-78), mostly female (70%). Common comorbidities included obesity (n = 4), depression (n = 2), Parkinson's disease (n = 1), and restless legs syndrome (n = 1). Six patients (60%) had concomitant obstructive sleep apnoea (OSA). Seven patients had excessive daytime sleepiness (Epworth Sleepiness Scale > 10). All catathrenia episodes occurred exclusively during REM sleep. Continuous positive airway pressure (CPAP) therapy was the most frequently used treatment and was associated with objective or subjective improvement in most patients. Two patients experienced spontaneous remission. CONCLUSION: Catathrenia remains underdiagnosed and can mimic other sleep disorders. Recognition of its REM-sleep predominance and PSG pattern is essential. Individualised treatment, often involving PAP therapy, may improve symptoms and patient outcomes.

Humans

Comparison of assisted and controlled mechanical ventilation in anesthetized swine.

We compared assisted mechanical ventilation with controlled mechanical ventilation with and without PEEP in 10 anesthetized swine. Catheters were placed to measure airway, intrapleural, and blood pressure; PaO2 and PaCO2; arterial pH; total minute ventilation; and mixed exhaled oxygen and carbon dioxide tensions. We calculated the ratio of physiological dead space to tidal volume, alveolar minute ventilation, CO2 production, VO2, and RQ. We found no clinically or statistically significant difference between assisted and controlled ventilation.

Anesthesia

Bile acid metabolism in ileostomy patients.

In ten ileostomy patients, a 14C-cholylglycine breath test was performed. The 14CO2 in the exhaled air and the 14C bile acid quantity and composition and fat content in the subsequent 24 h ileostomy effluent were determined and compared to the values in twenty healthy controls. The results show that in ileostomy patients only minor bile acid-deconjugation occurs in vivo. Deconjugation in the ileostomy bags was found to be mainly responsible for the absence of conjugated bile acids in many of the ileostomy effluent samples. Secondary bile acids were not present in these patients, as determined by TLC. The fecal fat and bile acid excretion was found to be in the normal range in ileostomy patients provided no concomitant ileum resection was present.

Bile Acids and Salts

A simple method of monitoring carbon dioxide output in anaesthetized patients.

The mean CO2 output during anaesthesia in paralyzed patients can be monitored by continuous capnographic analysis of the total exhaled gases, the latter being mechanically integrated by pumice canisters. The gas is evacuated from the Hafnia A circuit via an ejector flowmeter. The results are not influenced by the flow rates employed.

Anesthesia

Tobacco smoking habits and attitudes of Australians with oral mucous membrane keratoses.

The purpose of this study was to ascertain whether or not a relationship existed between the presence of oral mucous membrane keratoses and tobacco smoking habits. Two groups of tobacco smokers, one group exhibiting oral mucous membrane keratoses, and the other no such changes, were chosen for their similar smoking habits. Detailed tobacco smoking histories of each group were ascertained. Similar results for both groups, in terms of the number of years of smoking, quantity of tobacco consumed dialy, type of tobacco smoked and the method of inhalation and exhalation were found. Eighty per cent of patients wanted to stop smoking with the fear of cancer being the major reason in the subjects with oral keratoses and the continued cost of smoking the major reason in the control subjects. In the affected patients the prevalence of white patches was not related to the quantity of tobacco consumed but rather to the number of years the subject had smoked.

Attitude

Respiratory abnormalities among grain handlers: a clinical, physiologic, and immunologic study.

A survey of 300 grain elevator workers revealed that 77 per cent complained of eye symptoms; 64 per cent, of nasal symptoms; and 88 per cent, of one or more respiratory symptoms on exposure to airborne grain dust. Symptoms on exposure were independent of age and length of employment. Cough and wheezing on exposure were more common among smokers than nonsmokers (P less than 0.025). Nineteen per cent of the workers had had episodes of grain fever. The prevalence of chronic bronchitis was 37 per cent (42 per cent of smokers and 30 per cent of nonsmokers). Wheezes on auscultation were found in 23 per cent. Measurements of lung ventilatory function, as well as diffusing capacity, correlated significantly with age and smoking habits, but not with length of employment. Thirty-seven per cent of the workers had an abnormal mean forced expiratory flow during the middle half of the forced vital capacity (47 per cent of smokers and 13 per cent of nonsmokers), and 34 per cent had an abnormal maximal expiratory flow after exhalation of 50 per cent of the forced vital capacity (40 per cent of smokers and 13 per cent of nonsmokers), whereas only 13 per cent had an abnormal ratio of 1-sec forced expiratory volume to forced vital capacity. There was no correlation between precipitins to fungi, bacteria, grain, or grain dust antigens and acute or chronic respiratory symptoms, lung function, or grain fever. There was, however, a significant correlation between cutaneous reactivity to grain dust and wheezing on exposure (P less than 0.02). Abnormal flows at low lung volumes were more common among cutaneous reactors to common allergens. We concluded that exposure to airborne grain dust can cause acute inflammatory reaction to the exposed mucosa, and it is highly probable that grain dust contributes and, in some cases, causes chronic airway disease.

Adult

Thermal stimulation of the oral mucosa and nasal airway resistance.

A procedure for measuring nasal airway resistance using posterior rhinorheometry is described. Baseline nasal airway resistances +/- 1 S.D. at an airflow of 0.5 L/sec were found to be 1.077 +/- 0.683 cm H2O for inhalation and 1.359 +/- 0.792 cm H2O for exhalation. Application of either cold water (4 to 6 C) or warm water (44 to 52 C) to the oral mucosa significantly increased nasal airway resistance. Application of tepid water (26 to 28 C) did not alter nasal airway resistance significantly.

Airway Resistance

The bird respirator modified for PEEP, CPAP and IMV.

A Bird Mk. 8 respirator has been modified to permit the use of PEEP, CPAP and IMV. Gas supply is from an oxygen blender to allow easy adjustment of the inhaled oxygen concentration. A special fitting was made to mount a flow meter which supplies the IMV reservoir. PEEP is generated by the Mk. 8 negative pressure generator mounted in opposition to exhalation and its magnitude can be adjusted by the negative pressure control of the respirator. This modified machine is simple, reliable and relatively inexpensive.

Humans