'We Remember Night' to honor fire, EMS personnel who died by suicide

SCOTTSDALE, Ariz. — The Firefighter Behavioral Health Alliance will be honoring and recognizing those in the fire and EMS service who died by suicide on Friday, May 20.

At 9 p.m., in recognition of Mental Health Awareness month, the FBHA is asking fire and EMS crews to participate in 'We Remember Night' by placing a rig in their driveway and turn on their emergency lights for one minute to show support for the families that have suffered a loss. 

Community members are welcome to join at their local participating location or stand in their own driveway and light a candle to remember a loved one.

The FBHA is hosting their second annual weekend retreat, Those Left Behind, in Scottsdale, Ariz. May 18-22. The event is for families of firefighters and EMS personnel that died by suicide.

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Burst-suppression is reactive to photic stimulation in comatose children with acquired brain injury

Burst-suppression is an electroencephalographic pattern observed during coma. In individuals without known brain pathologies undergoing deep general anesthesia, somatosensory stimulation transiently increases the occurrence of bursts. We investigated the reactivity of burst-suppression in children with acquired brain injury.

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Dispatcher assisted CPR saves lives

Dispatcher assisted CPR can save lives. This step-by-step video explains the process.

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FDNY join the Running Man Challenge

FDNY EMTs join in on the Running Man Challenge.

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Dispatcher assisted CPR saves lives

Dispatcher assisted CPR can save lives. This step-by-step video explains the process.

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FDNY join the Running Man Challenge

FDNY EMTs join in on the Running Man Challenge.

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Dispatcher assisted CPR saves lives

Dispatcher assisted CPR can save lives. This step-by-step video explains the process.

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FDNY join the Running Man Challenge

FDNY EMTs join in on the Running Man Challenge.

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Efficacy of double-coated probiotics for irritable bowel syndrome: a randomized double-blind controlled trial

Abstract

Background

The purpose of this study was to elucidate the effects of a dual-coated probiotic supplement (Duolac Care) on symptoms of diarrhea-predominant irritable bowel syndrome in a randomized double-blind clinical trial.

Methods

Fifty subjects with diarrhea-predominant irritable bowel syndrome were randomly assigned to either the non-coating group or the dual-coating group in order to receive two capsules per day of multi-species probiotics containing 5 billion bacteria per capsule for 4 weeks. Data from an adequate relief questionnaire were used in assessment of primary outcome. Daily records of stool frequencies and the Bristol stool scale, a weekly symptom diary using 100-mm visual analog scale, and Beck depression inventories were collected. Blood tests including blood cell counts, interleukin-10, tumor necrosis factor-alpha and inducible nitric oxide synthase, and regulatory T cells—CD4 + CD25^high T cells, CD4 + LAP + T cells and CD25^high + LAP + T cells—were analyzed before and after the study. The shift of gut microbiota was investigated using a quantitative real-time polymerase chain reaction assay.

Results

Responses to the adequate relief questionnaire indicated significant improvement in overall discomfort in the dual-coating group and the ratio of normal stools to hard or watery stools had a better effect from dual-coated probiotics compared to non-coated probiotics. This may be due to a shift of intestinal microbiota, as our correlation analysis showed significant negative correlation between Bifidobacterium and urgency of defecation.

Conclusions

Our result implies that dual-coating layers of probiotic supplement can be a candidate for treatment of diarrhea-predominant irritable bowel syndrome.

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Sojourner in a foreign land

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Response to: Papetti et al., “The crucial role of FBXO28 in the pathogenesis of the 1q41q42 microdeletion syndrome”

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Alone against the group: A unanimously disagreeing group leads to conformity, but cardiovascular threat depends on one's goals

Abstract

A long history of research in psychology has studied the consequences of when individuals face a group that unanimously disagrees with them. However, relatively little research has attempted to understand individuals' internal reactions to such disagreement while it is experienced. Psychophysiological measures are particularly well suited for this purpose. We used the perspective of the biopsychosocial model of challenge/threat to test whether and under what circumstances expressing one's political opinion to a disagreeing group led to a cardiovascular threat response (high total peripheral resistance, low cardiac output). We hypothesized that, when participants were provided with a goal to fit in with the group, a disagreeing group would elicit cardiovascular responses consistent with greater threat than an agreeing group, but that this effect would disappear if not reverse when participants were provided with a goal to express their individuality. Results supported hypotheses and further revealed a divergence between cardiovascular responses and conformity behavior, such that a disagreeing group fostered conformity regardless of goal condition. These findings suggest that (a) facing the prospect of a disagreeing group need not necessarily result in the negative experience of threat (reflecting evaluating low resources/high demands), and (b) conformity behavior can mask a range of internal states.

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The pupil's response to affective pictures: Role of image duration, habituation, and viewing mode

Abstract

The pupil has been shown to be sensitive to the emotional content of stimuli. We examined this phenomenon by comparing fearful and neutral images carefully matched in the domains of luminance, image contrast, image color, and complexity of content. The pupil was more dilated after viewing affective pictures, and this effect was (a) shown to be independent of the presentation time of the images (from 100–3,000 ms), (b) not diminished by repeated presentations of the images, and (c) not affected by actively naming the emotion of the stimuli in comparison to passive viewing. Our results show that the emotional modulation of the pupil is present over a range of variables that typically vary from study to study (image duration, number of trials, free viewing vs. task), and encourages the use of pupillometry as a measure of emotional processing in populations where alternative techniques may not be appropriate.

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Editorial Board

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Editorial Board

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Basal cell carcinoma in oculo-cutaneous albinism

2016-05-13T04-35-17Z
Source: International Journal of Research in Medical Sciences
Ajay Kumar, Ashish Chauhan, Subhash Kashyap.
The basal cell carcinoma is the most common skin tumour especially affecting the white individuals worldwide. The exact incidence of basal cell carcinoma is not known from India but non melanoma skin cancers comprises about 1-2% of cutaneous tumour in India. The most common skin tumour is squamous cell carcinoma in albinism and the incidence of basal cell carcinoma is less. Hereby, we report a peculiar case of basal cell carcinoma in albinism to highlights the importance of early recognition and diagnosis of suspected lesions by performing histopathological examination in unusual circumstances.


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Huriez syndrome: a rare palmoplantar keratoderma

2016-05-13T04-35-17Z
Source: International Journal of Research in Medical Sciences
Ajay Kumar, Geeta Ram Tegta, Ghanshyam Kumar Verma.
The Huriez syndrome is a rare autosomal dominant transgradient palmoplantar keratoderma which is characterized by scleroatrophy of the fingers, nail changes and squamous cell carcinomas in affected skin. Herein, we present a non-familial case of very rare plamoplantar keratoderma with scleroatrophy - the Huriez syndrome in a 45 year old female patient.


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Antioxidant enzyme status on rat after date seeds (Phoenix dactylifera) steeping treatment

2016-05-13T04-35-17Z
Source: International Journal of Research in Medical Sciences
Saryono, Eni Rahmawati, Heryanto, Eti Dwi Hapsari, Arif Imam Hidayat.
Background: Free radicals can damage normal cells thereby accelerating aging. Endogen antioxidant enzymes play an important role in inhibiting the oxidation rate of free radicals. This study aimed to assess the effect of date seed steeping on the indigenous antioxidant enzymes status in rats induced by alloxan. Methods: This research used pre and post-test with control group design. A total of 30 rats were randomized to six groups. There were the treatment groups with different dosage of date seeds steeping (0.25; 0.5; 0.75; 1) g/kg, positive control group with vitamin C 1 g/kg per day and negative control group. Deglet Noor date seeds variant were cleaned and dried and was roasted and mashed. Examination of the glutathione peroxidase (GPx) and superoxide dismutase (SOD) activity were conducted in accordance of the research of Castenmiller et al., (1999). Data were analyzed by Anova and continued by post-hoc test. Results: The results showed that GPx and SOD levels increased significantly. There were differences in SOD and GPx activity between the groups after treatment of date seed steeping. Increasing of SOD activity in the group that was given date seed steeping dose of 0.75 g/kg and vitamin C as a positive control group was comparable. The GPx activity between treatment group of date seed steeping a dose of 1 g/kg is not significantly different from positive control group. Conclusions: Date Seeds (Phoenix dactylifera) steeping have potential to increase antioxidant enzyme states.


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NSD1 duplication in Silver-Russell syndrome (SRS): Molecular karyotyping in patients with SRS features

Abstract

Silver-Russell syndrome (SRS) is a growth retardation syndrome characterized by intrauterine and postnatal growth retardation, relative macrocephaly and protruding forehead, body asymmetry and feeding difficulties. Nearly 50% of cases show a hypomethylation in 11p15.5, in 10% maternal uniparental disomy of chromosome 7 is present. A significant number of patients with SRS features also exhibit chromosomal aberrations. We analysed 43 individuals referred for SRS genetic testing by molecular karyotyping. Pathogenic variants could be detected in five of them, including a NSD1 duplication in 5q35 and a 14q32 microdeletion. NSD1 deletions are detectable in overgrowth disorders (Sotos, Beckwith-Wiedemann syndrome), whereas NSD1 duplications are associated with growth retardation. The 14q32 deletion is typically associated with Temple syndrome (TS14), but the identification of a patient in our cohort reflects the clinical overlap between TS14 and SRS. As determination of molecular subtypes is the basis for a directed counselling and therapy, the identification of pathogenic variants in >10% of the total cohort of patients referred for SRS testing and in >16% of characteristic individuals with the characteristic SRS phenotype confirms the need to apply molecular karyotyping in this cohort.

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mRNA-based Detection of Rare CFTR Mutations Improves Genetic Diagnosis of Cystic Fibrosis in Populations with High Genetic Heterogeneity

Abstract

Even with advent of Next Generation Sequencing complete sequencing of large disease-associated genes and intronic regions is economically not feasible. This is the case of CFTR, the gene responsible for Cystic Fibrosis (CF). Yet, to confirm a CF diagnosis, proof of CFTR dysfunction needs to be obtained, namely by identification of two disease-causing mutations. Moreover, with the advent of mutation-based therapies, genotyping is an essential tool for CF disease management. There is however, still an unmet need to genotype CF patients by fast, comprehensive and cost-effective approaches, especially in populations with high genetic heterogeneity (and low p.F508del incidence), where CF is now emerging with new diagnosis dilemmas (Brazil, Asia, etc).

Herein, we report an innovative mRNA-based approach to identify CFTR mutations in the complete coding and intronic regions. We applied this protocol to genotype individuals with a suspicion of CF and only 1/no CFTR mutations identified by routine methods. It successfully detected multiple intronic mutations unlikely to be detected by CFTR exon sequencing.

We conclude that this is a rapid, robust and inexpensive method to detect any CFTR coding/ intronic mutation (including rare ones) that can be easily used either as primary approach or after routine DNA analysis.

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Does 'altitude training' increase exercise performance in elite athletes?

Athletes may use one of the various altitude training strategies to improve exercise performance. The scientific support for such strategies is however not as sound as one would perhaps imagine. The question addressed in this review is whether altitude training should be recommended to elite athletes or not.

This article is protected by copyright. All rights reserved

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DEVELOPMENT AND EVALUATION OF GASTRORETENTIVE DELIVERY SYSTEM OF LOSARTAN POTASSIUM

2016-05-13T03-38-16Z
Source: Indo American Journal of Pharmaceutical Research
Shaikh Siraj*, Molvi Khurshid .I.
The objective of the study was to design and develop Gastroretentive dosage form for Losartan potassium using floating bioadhesive tablet approach with Polyox Wsr 1105 & HPMC K 4M polymers & sodium bicarbonate & citric acid as gas generating agents to reduce floating lag time. Optimization study was carried out by using 32 factorial design to prepare formulations. Vit E is added as a antioxidant for development of this gastroretentive dosage form of Losartan potassium by using Polyox to avoid stability risk associated with Polyox .The concentration of polymers was considered as independent variables whereas Swelling index, bioadhesive strength, % drug release at 10 hrs, of the tablets were utilized as dependent variables .Tablets were prepared by direct compression method. The prepared tablets were thoroughly evaluated for physical properties, floating, swelling, bioadhesive and in vitro release behaviors .The optimized F4 gastroretentive batch, gave floating lag time of 21±2 sec and with in vitro dissolution of 98.71 % in 12 hrs with appropriate bioadhesive property. After stability studies, no significant change was observed in floating lag time, bioadhesive strength, total floating duration and drug release rates. These results suggest that this floating bioadhesive gastroretentive dosage form is a promising approach for the oral delivery of Losarten potassium by improving its Gastric residence time for better management of hypertension.


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Impact of polymorphisms in microRNA biogenesis genes on colon cancer risk and microRNA expression levels: A population-based, case-control study

BMC Genomics

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Relationship between articular and nonarticular manifestations in inflammatory bowel diseases

Journal of Research in Medical Sciences

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Transjugular intrahepatic porto-systemic shunt in patients with liver cirrhosis and model for end-stage liver disease ≥15

Digestive Diseases and Sciences

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The impact of abuse and mood on bowel symptoms and health-related quality of life in irritable bowel syndrome (IBS)

Neurogastroenterology & Motility

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Time sequence evaluation of biliary stent occlusion by dissection analysis of retrieved stents

Digestive Diseases and Sciences

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Calcium supplementation for the prevention of colorectal adenomas: a systematic review and meta-analysis of randomized controlled trials

World Journal of Gastroenterology

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Oral and parenteral versus parenteral antibiotic prophylaxis in elective laparoscopic colorectal surgery (jmto prev 07–01): a phase 3, multicenter, open-label, randomized trial

Annals of Surgery

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Gluten free diet and nutrient deficiencies: a review

Clinical Nutrition

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Choledochoscopic high-frequency needle-knife electrotomy for treatment of anastomotic strictures after Roux-en-Y hepaticojejunostomy

BMC Gastroenterology

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Correlation between Helicobacter pylori-associated gastric diseases and colorectal neoplasia

World Journal of Gastroenterology

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MicroRNA-544a regulates migration and invasion in colorectal cancer cells via regulation of Homeobox A10

Digestive Diseases and Sciences

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Low energy intake plus low energy expenditure (low energy flux), not energy surfeit, predicts future body fat gain

American Journal of Clinical Nutrition

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Radiological response is associated with better long-term outcomes and is a potential treatment target in patients with small bowel Crohn's disease

The American Journal of Gastroenterology

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Does neighborhood fast-food outlet exposure amplify inequalities in diet and obesity? A cross-sectional study

American Journal of Clinical Nutrition

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The use of capsule endoscopy in the emergency department as a triage of patients with GI bleeding

Gastrointestinal Endoscopy

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Association between severity of obstructive sleep apnea and blood markers of liver injury

Clinical Gastroenterology and Hepatology

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Correlation of nucleated red blood cells with severity of birth asphyxia and its immediate outcome in term newborns

2016-05-13T02-55-22Z
Source: International Journal of Contemporary Pediatrics
Pradeep Meena, Maheshwar Gunawat, Rameshwar L. Suman.
Background: The severity of birth asphyxia can be predicted by APGAR score and umbilical cord blood pH. The Nucleated Red Blood Cells (NRBCs) in the cord blood at birth emerged as a newer predictor of birth asphyxia. This study was conducted to find the correlation of cord blood Nucleated Red Blood Cell (NRBC) count with the severity of birth asphyxia and its immediate outcome in term newborns. Methods: An observational hospital based prospective case control study was conducted at inborn NICU, Bal Chikitsalya, RNT Medical College, Udaipur (Raj.) INDIA from March 2015 to September 2015. Total 100 term newborns including 50 as cases (with birth asphyxia) and 50 as controls (normal babies) were enrolled for the study. The cord blood was collected immediately after birth for the measurement of NRBC/100 WBC count and pH value. All the enrolled cases were admitted in NICU and observed for the immediate neurological outcome. The correlation of cord blood NRBC count with APGAR scores, cord blood pH and outcome was analysed statistically. Results: The mean NRBC (NRBC/100 WBC) count was 17.82±19.55 (range from 0-102) in case group and 1.42±3.26 (range from 0 to 18) in control group (p

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Dysphagia in patients with acute ischemic stroke: early dysphagia screening may reduce stroke-related pneumonia and improve stroke outcomes

Cerebrovascular Diseases

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The inter-rater reliability of the International Classification of Functioning, Disability and Health set for spinal cord injury nursing.

The International Classification of Functioning, Disability and Health (ICF) has potential to be used as a clinical assessment instrument directly. However, difficulty in operationalizing the ICF qualifiers has led to unsatisfactory inter-rater reliability of ICF instruments in previous studies. The ICF set for spinal cord injury (SCI) nursing contains a group of categories that can reflect the functioning of SCI patients from the perspective of nurses. The aim of this study was to explore the inter-rater reliability of the ICF set for SCI nursing. Detailed measuring guidelines were prepared for each category of the ICF set. Two trained nurses then used the ICF set to independently rate 40 SCI patients within the first 3 days after their admission. The results showed that the percentage of the observed agreement between the nurses ranged from 42.5 to 100% (median 75%, interquartile range 62.5-87.5%). The weighted [kappa] ranged from -0.03 to 1.00 (median 0.68, interquartile range 0.45-0.84). A total of 50 categories (79.4%) showed weighted [kappa] greater than 0.4 and 39 categories (61.9%) had weighted [kappa] greater than 0.6. The medians of the weighted [kappa] for the body functions, body structures, activity and participation and environmental factors components were 0.6, 0.64, 0.84, and 0.11, respectively. This study indicated that the inter-rater reliability of the ICF set for SCI nursing was acceptable. Establishment of detailed measuring guidelines could help reduce the differences between raters. Simpler and clearer measuring guidelines are recommended and the definitions of some categories need to be clarified in future studies. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Myocardial performance index in severe acute malnutrition children aged 6 month to 5 years

2016-05-13T02-55-22Z
Source: International Journal of Contemporary Pediatrics
Reeta Meena, Rameshwar Lal Suman, Pradeep Meena, Shiv Lal Meena.
Background: Severe Acute Malnutrition (SAM) is one of the most common health problem. Children suffering from SAM frequently exhibit cardiovascular abnormalities leading to morbidity and mortality. We evaluated myocardial performance index (MPI) to measure both systolic and diastolic functions of the heart. Methods: Hospital based prospective study in which we enrolled 100 children with SAM aged 6 months to 5 years admitted in malnutrition treatment centre (MTC), Bal Chikitaslya, Udaipur, Rajasthan, India. All the children underwent a detailed clinical and echocardiographic evaluation. The different echocardiographic variables along with MPI were calculated. Results: Out of 100 children majority of study population was in


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Applicability of hepatitis C virus RNA viral load thresholds for 8-week treatments in patients with chronic hepatitis C virus genotype 1 infection

Clinical Infectious Diseases

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Cognitive reserve and preinjury educational attainment: effects on outcome of community-based rehabilitation for longer-term individuals with acquired brain injury.

The cognitive reserve hypothesis has been proposed to account for the mismatch between brain pathology and its clinical expression. The aim of the current research was to explore, in a longitudinal data set, the effects of level of educational attainment before brain injury (cognitive reserve) and clinical factors on the level of rehabilitation-induced changes in disability and community integration. Participants in receipt of postacute rehabilitation were assessed at induction to the service and again at between 14 and 18 months of follow-up while still in service on changes in aspects of their abilities, adjustment and participation (Mayo Portland Adaptability Indices) and community integration (Community Integration Questionnaire). Controlling for type and severity of injury, age at onset of injury and duration of time since injury, participants with higher previous educational attainment showed significantly greater changes over the course of rehabilitation on adjustment to their injury and participation, but not on abilities, or community integration following postacute rehabilitation. Level of education would appear to be an important element of cognitive reserve in brain injury that serves to aid responses to postacute rehabilitation in terms of an individual's adjustment to disability and participation. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Management and outcomes of leaks after oesophagectomy

British Journal of Surgery

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Prevalence of overweight and obesity among children and adolescents with intellectual disabilities: a systematic review and meta-analysis

Obesity Reviews

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The relationship between static posturography measures and specific cognitive domains in individuals with multiple sclerosis.

There are still limitations as to the understanding of the cognitive-postural control relationship in people with multiple sclerosis (PwMS). The aim of the current study' was to examine the relationship between cognition with measures of posturography in PwMS. The study was cross-sectional comprising 253 PwMS (162 women) with a mean age of 42.0 (SD=14.0). All participants completed a computerized cognitive test battery designed to evaluate multiple cognitive domains (Mindstreams; NeuroTrax) and static posturography tests (Zebris Medical GmbH). PwMS were divided into four levels of disability on the basis of their Expanded Disability Status Scale (EDSS) score: very mild (EDSS: 0-2.0), mild (EDSS: 2.5-3.5), moderate (EDSS: 4.0-5.5), and severe (EDSS: 6.0-6.5; using a walking aid). Significant correlations were observed between cognitive domains and posturography measures. However, the correlations were different between the disability subgroups. For the mild group, significant correlation scores were observed between the balance measures to the executive function and motor skills cognitive domains (Pearson's [rho]=~0.3 and ~0.4, respectively). As for the moderate group, significant correlation scores were observed in memory and verbal function (Pearson's [rho]=~0.4 and ~0.4, respectively). Attention was the only cognitive domain correlated significantly with posturography measures in the severe group (Pearson's [rho]=~0.55). Our study found that posturography measures are related to cognition in PwMS. However, the associations vary in terms of cognitive domains and disability levels. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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The Risks to Patient Privacy from Publishing Data from Clinical Anesthesia Studies.

In this article, we consider the privacy implications of posting data from small, randomized trials, observational studies, or case series in anesthesia from a few (e.g., 1-3) hospitals. Prior to publishing such data as supplemental digital content, the authors remove attributes that could be used to re-identify individuals, a process known as "anonymization." Posting health information that has been properly "de-identified" is assumed to pose no risks to patient privacy. Yet, computer scientists have demonstrated that this assumption is flawed. We consider various realistic scenarios of how the publication of such data could lead to breaches of patient privacy. Several examples of successful privacy attacks are reviewed, as well as the methods used. We survey the latest models and methods from computer science for protecting health information and their application to posting data from small anesthesia studies. To illustrate the vulnerability of such published data, we calculate the "population uniqueness" for patients undergoing one or more surgical procedures using data from the State of Texas. For a patient selected uniformly at random, the probability that an adversary could match this patient's record to a unique record in the state external database was 42.8% (SE

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Issue Information

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Butterflies and the brain

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Developmental functions of electrical synapses

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Big brain, small body: towards a better understanding of cerebrovascular physiology in children

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Simultaneous recordings of voltage and current waveforms from dendrites

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Neither load nor systemic hormones determine resistance training-mediated hypertrophy or strength gains in resistance-trained young men

We reported, using a unilateral resistance training (RT) model, that training with high or low loads (mass per repetition) resulted in similar muscle hypertrophy and strength improvements in RT-naïve subjects. Here we aimed to determine whether the same was true in men with previous RT experience using a whole-body RT program and whether post-exercise systemic hormone concentrations were related to changes in hypertrophy and strength. Forty-nine resistance-trained men (mean ± SEM, 23 ± 1 y) performed 12 wk of whole-body RT. Subjects were randomly allocated into a higher-repetition (HR) group who lifted loads of ~30-50% of their maximal strength (1RM) for 20-25 repetitions/set (n=24) or a lower-repetition (LR) group (~75-90% 1RM, 8-12 repetitions/set, n=25), with all sets being performed to volitional failure. Skeletal muscle biopsies, strength testing, DXA scans, and acute changes in systemic hormone concentrations were examined pre- and post-training. In response to RT, 1RM strength increased for all exercises in both groups (p < 0.01), with only the change in bench press being significantly different between groups (HR: 9 ± 1 vs. LR: 14 ±1 kg, p = 0.012). Fat- and bone-free (lean) body mass, type I and type II muscle fibre cross sectional area increased following training (p < 0.01) with no significant differences between groups. No significant correlations between the acute post-exercise rise in any purported anabolic hormone and the change in strength or hypertrophy were found. In congruence with our previous work, acute post-exercise systemic hormonal rises are not related to or in any way indicative of RT-mediated gains in muscle mass or strength. Our data show that in resistance-trained individuals load, when exercises are performed to volitional failure, does not dictate hypertrophy or, for the most part, strength gains.

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Free-living gait characteristics in ageing and Parkinson’s disease: impact of environment and ambulatory bout length

Gait is emerging as a powerful diagnostic and prognostic tool, and as a surrogate marker of disease progression for Parkinson's disease (PD). Accelerometer-based body worn monitors (BWMs) facilitate the measur...

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A validated 3D microstructure-based constitutive model of coronary artery adventitia

A structure-based model that accurately predicts micro- or macro-mechanical behavior of blood vessels is necessary to understand vascular physiology. Based on recently measured microstructural data, we propose a 3-D microstructural model of coronary adventitia that incorporates the elastin and collagen distributions throughout the wall. The role of ground substance was found to be negligible under physiological axial stretch _z=1.3, based on enzyme degradation of glycosaminoglycans in swine coronary adventitia (n=5). The thick collagen bundles of outer adventitia (n=4) were found to be undulated and unengaged at physiological loads, while the inner adventitia consisting of multiple sublayers of entangled fibers that bear the majority of load at higher pressures. The microstructural model was validated against biaxial (inflation and extension) experiments of coronary adventitia (n=5). The model accurately predicted the nonlinear responses of the adventitia, even at high axial force (axial stretch ratio _z=1.5). The model also enabled a reliable estimation of material parameters of individual fibers that were physically reasonable. A sensitivity analysis was performed to assess the effect of using mean values of the distributions for fiber orientation and waviness as opposed to the full distributions. The simplified mean analysis affects the fiber stress-strain relation, resulting in incorrect estimation of mechanical parameters, which underscores the need for measurements of fiber distribution for a rigorous analysis of fiber mechanics. The validated structure-based model of coronary adventitia provides a deeper understanding of vascular mechanics in health and can be extended to disease conditions.

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Morphometric Differences Between Central vs. Surface Acini in A/J Mice Using High-Resolution Micro Computed Tomography.

Through interior tomography, high-resolution micro computed tomography (μCT) systems provide the ability to nondestructively assess the pulmonary acinus at micron and sub-micron resolutions. With the application of Systematic Uniform Random Sampling (SURS) principles applied to in-situ fixed, intact, ex-vivo lungs we have sought to characterize morphometric differences in central vs. surface acini to better understand how well surface acini reflect global acinar geometry. Lungs from six mice (A/J strain, 15-20 weeks of age) were perfusion fixed in-situ, and imaged using a multi-resolution μCT system (Micro XCT 400, Zeiss Inc.). Using lower resolution whole lung images, SURS methods were used for identification of central and surface foci for high-resolution imaging. Acinar morphometric metrics included diameters, lengths and branching angles for each alveolar duct and total path lengths from entrance of the acinus to the terminal alveolar sacs. In addition acinar volume, alveolar surface area and surface area/volume ratios were assessed. A generation-based analysis demonstrated that central acini have significantly smaller branch diameters at each generation with no significant increase in branch lengths. In addition to larger diameter alveolar ducts, surface acini had significantly increased numbers of branches and terminal alveolar sacs. The total path lengths from the acinar entrance to the terminal nodes were found to be higher in the case of surface acini. Volumes and surface areas of surface acini are greater than central acini but there were no differences in surface/volume ratios. In conclusion, there are significant structural differences between surface and central acini in the A/J mouse.

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Predicting Ventilator-Induced Lung Injury Using a Lung Injury Cost Function

Managing patients with acute respiratory distress syndrome (ARDS) requires mechanical ventilation that balances the competing goals of sustaining life whilst avoiding ventilator-induced lung injury (VILI). In particular, it is reasonable to suppose that, for any given ARDS patient, there must exist an optimum pair of values for tidal volume (V_T) and positive end-expiratory pressure (PEEP) that together minimize the risk for VILI. In order to find these optimum values, and thus develop a personalized approach to mechanical ventilation in ARDS, we need to be able to predict how injurious a given ventilation regimen will be in any given patient so that the minimally injurious regimen for that patient can be determined. Our goal in the present study was therefore to develop a simple computational model of the mechanical behavior of the injured lung in order to calculate potential injury cost functions to serve as predictors of VILI. We set the model parameters to represent normal, mildly injured, and severely injured lungs and estimated the amount of volutrauma and atelectrauma caused by ventilating these lungs with a range of V_T and PEEP. We estimated total VILI in two ways: 1) as the sum of the contributions from volutrauma and atelectrauma and 2) as the product of their contributions. We found the product provided estimates of VILI that are more in line with our previous experimental findings. This model may thus serve as the basis for the objective choice of mechanical ventilation parameters for the injured lung.

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