Changes in peripheral arterial blood pressure after resuscitative endovascular balloon occlusion of the aorta (REBOA) in non-traumatic cardiac arrest patients

Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be an adjunct treatment to cardiopulmonary resuscitation (CPR). Aortic occlusion may increase aortic pressure and increase the coronary perfusion pressure and the cerebral blood flow. Peripheral arterial blood pressure is often measured during or after CPR, however, changes in peripheral blood pressure after aortic occlusion is insufficiently described. This study aimed to assess changes in peripheral arterial blood pressure after REBOA in patients with out of hospital cardiac arrest. Methods A prospective observational study performed at the helicopter emergency medical service in Trondheim (Norway). Eligible patients received REBOA as adjunct treatment to advanced cardiac life support. Peripheral invasive arterial blood pressure and end-tidal CO2 (EtCO2) was measured before and after aortic occlusion. Differences in arterial blood pressures and EtCO2 before and after occlusion was analysed with Wilcoxon Signed Rank test. Results Five patients were included to the study. The median REBOA procedural time was 11 min and median time from dispatch to aortic occlusion was 50 min. Two patients achieved return of spontaneous circulation. EtCO2 increased significantly 60 s after occlusion, by a mean of 1.16 kPa (p = 0.043). Before occlusion the arterial pressure in the compression phase were 43.2 (range 12–112) mmHg, the mean pressure 18.6 (range 4–27) mmHg and pressure in the relaxation phase 7.8 (range − 7 – 22) mmHg. After aortic occlusion the corresponding pressures were 114.8 (range 23–241) mmHg, 44.6 (range 15–87) mmHg and 14.8 (range 0–29) mmHg. The arterial pressures were significant different in the compression phase and as mean pressure (p = 0.043 and p = 0.043, respectively) and not significant in the relaxation phase (p = 0.223). Conclusion This study is, to our knowledge, the first to assess the peripheral invasive arterial blood pressure response to aortic occlusion during CPR in the pre-hospital setting. REBOA application during CPR is associated with a significantly increase in peripheral artery pressures. This likely indicates improved central aortic blood pressure and warrants studies with simultaneous peripheral and central blood pressure measurement during aortic occlusion. Trial registration The study is registered in ClinicalTrials.gov (NCT03534011).

Numerical procedure to effectively assess sequestration capacity of geological structures

The paper presents a numerical procedure of estimating the sequestration capacity of an underground geological structure as a potential sequestration site. The procedure adopts a reservoir simulation model of the structure and performs multiple simulation runs of the sequestration process on the model according to a pre-defined optimization scheme. It aims at finding the optimum injection schedule for existing and/or planned injection wells. Constraints to be met for identifying the sequestration capacity of the structure include a no-leakage operation for an elongated period of the sequestration performance that contains a relaxation phase in addition to the injection one. The leakage risk analysis includes three basic leakage pathways: leakage to the overburden of a storage formation, leakage beyond the structural trap boundary, leakage via induced fractures. The procedure is implemented as a dedicated script of the broadly used Petrel package and tested on an example of a synthetic geologic structure. The script performs all the tasks of the procedure flowchart including: input data definitions, simulation model initialization, iteration loops control, simulation launching, simulation results processing and analysis. Results of the procedure are discussed in detail with focus put on various leakage mechanisms and their handling in the adopted scheme. The overall results of the proposed procedure seem to confirm its usefulness and effectiveness as a numerical tool to facilitate estimation of the sequestration capacity of an underground geological structure. In addition, by studying details of the procedure runs and its intermediate results, it may be also very useful for the estimation of various leakage risks.

Efeitos e Aplicações do Campo Eletromagnético de Alta Intensidade (PEMF) em saúde e estética: perspectivas e evidências clínicas

The increased interest and concern with physical fitness, not only from an athletic point of view, but also from an aesthetic point of view, has driven the search for new methods and technologies capable of helping to gain mass and muscle tone. Recent studies show that 81% percent of respondents reported dissatisfaction with their body image, even with 56% having a normal body mass index. Pulsed electromagnetic field (PEMF) muscle stimulation technology uses alternating magnetic fields based on the law of electromagnetic induction to promote supramaximal muscle contractions. PEMF generates impulses that are independent of brain function, and with such a fast frequency that it does not allow the muscle relaxation phase, characterizing tetanic contractions. Electric currents and electromagnetism have been used in physical therapy and rehabilitation, especially for muscle strengthening. However, the PEMF technology has emerged as a more efficient and comfortable alternative for the patient, with the primary objective of toning and strengthening muscle groups. In this work, we performed a literature review of all scientific articles available and indexed in Pubmed and Web of Science about this technology in the last 20 years and its effects on skeletal muscles. We discuss the scientific evidence available from clinical studies and discuss effects and possible mechanisms of action on muscle contraction.

Effect of Virtual Reality on Stress Reduction and Change of Physiological Parameters Including Heart Rate Variability in People With High Stress: An Open Randomized Crossover Trial

Introduction: Although, attempts to apply virtual reality (VR) in mental healthcare are rapidly increasing, it is still unclear whether VR relaxation can reduce stress more than conventional biofeedback.Methods: Participants consisted of 83 healthy adult volunteers with high stress, which was defined as a score of 20 or more on the Perceived Stress Scale-10 (PSS-10). This study used an open, randomized, crossover design with baseline, stress, and relaxation phases. During the stress phase, participants experienced an intentionally generated shaking VR and serial-7 subtraction. For the relaxation phase, participants underwent a randomly assigned relaxation session on day 1 among VR relaxation and biofeedack, and the other type of relaxation session was applied on day 2. We compared the State-Trait Anxiety Inventory-X1 (STAI-X1), STAI-X2, the Numeric Rating Scale (NRS), and physiological parameters including heart rate variability (HRV) indexes in the stress and relaxation phases.Results: A total of 74 participants were included in the analyses. The median age of participants was 39 years, STAI-X1 was 47.27 (SD = 9.92), and NRS was 55.51 (SD = 24.48) at baseline. VR and biofeedback significantly decreased STAI-X1 and NRS from the stress phase to the relaxation phase, while the difference of effect between VR and biofeedback was not significant. However, there was a significant difference in electromyography, LF/HF ratio, LF total, and NN50 between VR relaxation and biofeedback.Conclusion: VR relaxation was effective in reducing subjectively reported stress in individuals with high stress.

Changes in Peripheral Arterial Blood Pressure After Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Non-traumatic Cardiac Arrest Patients

Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be an adjunct treatment to cardiopulmonary resuscitation (CPR). Aortic occlusion may increase aortic pressure and increase the coronary perfusion pressure and the cerebral blood flow. Peripheral arterial blood pressure is often measured during or after CPR, however, changes in peripheral blood pressure after aortic occlusion is insufficiently described. This study aimed to assess changes in peripheral arterial blood pressure after REBOA in patients with out of hospital cardiac arrest.Methods An observational study performed at the helicopter emergency medical service in Trondheim (Norway). Eligible patients received REBOA as adjunct treatment to advanced cardiac life support. Peripheral invasive arterial blood pressure and end-tidal CO2 (EtCO2) was measured before and after aortic occlusion. Differences in arterial blood pressures and EtCO2 before and after occlusion was analysed with Wilcoxon Signed Rank test.Results Five patients were included to the study. The median REBOA procedural time was 11 minutes and median time from dispatch to aortic occlusion was 50 minutes. Two patients achieved return of spontaneous circulation. EtCO2 increased significantly 60 seconds after occlusion, by a mean of 1.16 kPa (p = 0.043). Before occlusion the arterial pressure in compression phase were 43.2 (12 – 112) mmHg, the mean pressure 18.6 (4 – 27) mmHg and pressure in the relaxation phase 7.8 (-7 – 22) mmHg. Two minutes after aortic occlusion the corresponding pressures were 114.8 (23 – 241) mmHg, 44.6 (15 – 87) mmHg and 14.8 (0 – 29) mmHg. The arterial pressures were significant different in the compression phase and as mean pressure (p = 0.043 and p = 0.043, respectively) and not significant in the relaxation phase (p = 0.223).Conclusion This study is, to our knowledge, the first to assess the peripheral invasive arterial blood pressure response to aortic occlusion during CPR in the pre-hospital setting. REBOA application during CPR significantly increase the peripheral artery pressures. This likely indicates improved central aortic blood pressure and warrants studies with simultaneous peripheral and central blood pressure measurement during aortic occlusion.Trial registration The study is registered in ClinicalTrials.gov (NCT03534011).

Cyclic stretching-induced epithelial cell reorientation is driven by microtubule-modulated transverse extension during the relaxation phase

Many types of adherent cells are known to reorient upon uniaxial cyclic stretching perpendicularly to the direction of stretching to facilitate such important events as wound healing, angiogenesis, and morphogenesis. While this phenomenon has been documented for decades, the underlying mechanism remains poorly understood. Using an on-stage stretching device that allowed programmable stretching with synchronized imaging, we found that the reorientation of NRK epithelial cells took place primarily during the relaxation phase when cells underwent rapid global retraction followed by extension transverse to the direction of stretching. Inhibition of myosin II caused cells to orient along the direction of stretching, whereas disassembly of microtubules enhanced transverse reorientation. Our results indicate distinct roles of stretching and relaxation in cell reorientation and implicate a role of myosin II-dependent contraction via a microtubule-modulated mechanism. The importance of relaxation phase also explains the difference between the responses to cyclic and static stretching.

Gravitational tests of electroweak relaxation

We consider a scenario in which the electroweak scale is stabilized via the relaxion mechanism during inflation, focussing on the case in which the back-reaction potential is generated by the confinement of new strongly interacting vector-like fermions. If the reheating temperature is sufficiently high to cause the deconfinement of the new strong interactions, the back-reaction barrier then disappears and the Universe undergoes a second relaxation phase. This phase stops when the temperature drops sufficiently for the back-reaction to form again. We identify the regions of parameter space in which the second relaxation phase does not spoil the successful stabilization of the electroweak scale. In addition, the generation of the back-reaction potential that ends the second relaxation phase can be associated to a strong first order phase transition. We then study when such transition can generate a gravitational wave signal in the range of detectability of future interferometer experiments.

A temporal Ca2+-desensitization of myosin light chain kinase in phasic smooth muscles induced by CaMKKß/PP2A pathways.

Cell signaling pathways regulating myosin regulatory light chain (LC20) phosphorylation contribute to determining contractile responses in smooth muscles. Following excitation and contraction, phasic smooth muscles, such as digestive tract and urinary bladder, undergo a relaxation due to a decline of cellular [Ca2+] and a decreased Ca2+ sensitivity of LC20 phosphorylation, named Ca2+ desensitization. Here, we determined mechanisms underlying the temporal Ca2+ desensitization of LC20 phosphorylation in phasic smooth muscles using permeabilized strips of mouse ileum and urinary bladder. Upon the stimulation with pCa6.0 at 20°C, the contraction and the LC20 phosphorylation peaked within 30 sec and then declined to about 50% of the peak force at 2 min after stimulation. During the relaxation phase after the contraction, the LC20 kinase (MLCK) was inactivated, but no fluctuation in the LC20 phosphatase activity occurred, suggesting that the MLCK inactivation is a cause of the Ca2+-induced Ca2+-desensitization of LC20 phosphorylation. The MLCK inactivation was associated with phosphorylation at the calmodulin binding domain of the kinase. Treatment with antagonists for CaMKKß (STO-609 and TIM-063) attenuated both the phasic response of the contraction and MLCK phosphorylation, whereas neither CaMKII, AMPK nor PAK induced the MLCK inactivation in phasic smooth muscles. Conversely, PP2A inhibition amplified the phasic response. Signaling pathways through CaMKKß and PP2A may contribute to regulating the Ca2+ sensitivity of MLCK and the contractile response of phasic smooth muscles.

Salivary Proteome Changes in Response to Acute Psychological Stress Due to an Oral Exam Simulation in University Students: Effect of an Olfactory Stimulus

The autonomic nervous system (ANS) plays a crucial role both in acute and chronic psychological stress eliciting changes in many local and systemic physiological and biochemical processes. Salivary secretion is also regulated by ANS. In this study, we explored salivary proteome changes produced in thirty-eight University students by a test stress, which simulated an oral exam. Students underwent a relaxation phase followed by the stress test during which an electrocardiogram was recorded. To evaluate the effect of an olfactory stimulus, half of the students were exposed to a pleasant odor diffused in the room throughout the whole session. Saliva samples were collected after the relaxation phase (T0) and the stress test (T1). State anxiety was also evaluated at T0 and T1. Salivary proteins were separated by two-dimensional electrophoresis, and patterns at different times were compared. Spots differentially expressed were trypsin digested and identified by mass spectrometry. Western blot analysis was used to validate proteomic results. Anxiety scores and heart rate changes indicated that the fake exam induced anxiety. Significant changes of α-amylase, polymeric immunoglobulin receptor (PIGR), and immunoglobulin α chain (IGHA) secretion were observed after the stress test was performed in the two conditions. Moreover, the presence of pleasant odor reduced the acute social stress affecting salivary proteome changes. Therefore, saliva proteomic analysis was a useful approach to evaluate the rapid responses associated to an acute stress test also highlighting known biomarkers.

How Epithelial Cells Reorient in Response to Cyclic Stretching

Many types of adherent cells are known to reorient upon uniaxial cyclic stretching perpendicularly to the direction of stretching to facilitate such important events as wound healing, angiogenesis, and morphogenesis. While this phenomenon has been documented for decades, the underlying mechanism remains poorly understood. Using an on-stage stretching device that allowed programmable stretching with synchronized imaging, we found that the reorientation of NRK epithelial cells took place primarily during the relaxation phase when cells underwent rapid global retraction followed by extension transverse to the direction of stretching. Inhibition of myosin II caused cells to orient along the direction of stretching, whereas disassembly of microtubules enhanced transverse reorientation. Our results indicate distinct roles of stretching and relaxation in cell reorientation and implicate a role of myosin II-dependent contraction via a microtubule-modulated mechanism. The importance of relaxation phase also explains the difference between the responses to cyclic and static stretching.