Pharmacodynamics of ceftazidime/avibactam against extracellular and intracellular forms of Pseudomonas aeruginosa

Objectives

When tested in broth, avibactam reverses ceftazidime resistance in many Pseudomonas aeruginosa that express ESBLs. We examined whether similar reversal is observed against intracellular forms of P. aeruginosa .

Methods

Strains: reference strains; two engineered strains with basal non-inducible expression of AmpC and their isogenic mutants with stably derepressed AmpC; and clinical isolates with complete, partial or no resistance to reversion with avibactam. Pharmacodynamic model: 24 h concentration-response to ceftazidime [0.01-200 mg/L alone or with avibactam (4 mg/L)] of bacteria in broth or bacteria phagocytosed by THP-1 monocytes, with calculation of ceftazidime relative potency ( C s : concentration yielding a static effect) and maximal relative effect [ E max : cfu decrease at infinitely large antibiotic concentrations (efficacy in the model)] using the Hill equation. Cellular content of avibactam: quantification by LC-MS/MS.

Results

For both extracellular and intracellular bacteria, ceftazidime C s was always close to its MIC. For ceftazidime-resistant strains, avibactam addition shifted ceftazidime C s to values close to the MIC of the combination in broth. E max was systematically below the detection limit (-5 log 10 ) for extracellular bacteria, but limited to -1.3 log 10 for intracellular bacteria (except for two isolates) with no effect of avibactam. The cellular concentration of avibactam reflected extracellular concentration and was not influenced by ceftazidime (0-160 mg/L).

Conclusions

The potential for avibactam to inhibit β-lactamases does not differ for extracellular and intracellular forms of P. aeruginosa , denoting an unhindered access to its target in both situations. The loss of maximal relative efficacy of ceftazidime against intracellular P. aeruginosa was unrelated to resistance via avibactam-inhibitable β-lactamases.

The postantibiotic effect and post-β-lactamase-inhibitor effect of ceftazidime, ceftaroline and aztreonam in combination with avibactam against target Gram-negative bacteria

The magnitudes of the postantibiotic effect (PAE) and post-β-lactamase-inhibitory effect (PLIE) of ceftazidime-avibactam, ceftaroline-avibactam, and aztreonam-avibactam were determined against isolates of Enterobacteriaceae and Pseudomonas aeruginosa that either harboured genes encoding serine and/or metallo-β-lactamases, or did not harbour bla genes. The bla genes included ones that encoded extended spectrum β-lactamases, AmpC and KPC β-lactamases, and one metallo-β-lactamase, NDM-1. No substantial PAE was observed for any combination against any isolate. One substantial PLIE was found: a value of 1·9 h for ceftazidime-avibactam against Klebsiella pneumoniae (blaKPC-2 ). From comparison with results in the literature, we propose that the existence of a substantial PLIE depends on the bacterial isolate and on the specific β-lactamase inhibitor and β-lactam combination.

SIGNIFICANCE AND IMPACT OF THE STUDY

A wave of new β-lactamase inhibitors is entering either therapeutic use or clinical trials. The present work characterizes the postantibiotic effect (PAE) and post-β-lactamase-inhibitory effect (PLIE) of the clinically most advanced of these compounds, avibactam. We show that the existence of a measurable PLIE is strain- (and possibly compound-) dependent, and cannot be relied upon as a standard component of the primary pharmacology of a new β-lactamase inhibitor. This variability was not reported in earlier studies of clavulanic acid or sulbactam.

Beef heifer growth and reproductive performance following two levels of pasture allowance during the fall grazing period

The objective of this study was to compare heifer growth and reproductive performance following 2 levels of stockpiled fall forage allowance of orchardgrass (30.5%) and tall fescue (14.1%). Spring-born heifers (n = 203 and BW = 246 ± 28.9 kg) of primarily Angus background were allocated to 2 grazing treatments during the fall period (November 12 to December 17 in yr 1, November 7 to January 4 in yr 2, and November 7 to January 14 in yr 3) each replicated 3 times per year for 3 yr. Treatments consisted of daily pasture DM allowance of 3.5% of BW (LO) or daily pasture DM allowance of 7.0% of BW (HI) under strip-grazing management. Throughout the winter feeding period, mixed grass-legume haylage and soybean hulls were fed. Heifers were grazed as 1 group under continuous stocking after the winter period. Heifers in the LO group gained less than heifers in the HI group during the fall grazing period (0.12 vs. 0.40 kg/d; P < 0.0001). For each 1 10 g increase in NDF/kg fall pasture (DM basis), fall ADG decreased 0.14 kg (P = 0.01). During winter feeding, ADG was 0.30 and 0.39 kg/d for LO vs. HI heifers, respectively (P = 0.0008). During the spring grazing period (April 16 to May 24 in yr 1, April 22 to May 26 in yr 2, and April 5 to May 16 in yr 3), LO heifers had numerically greater ADG than HI heifers (1.38 vs. 1.30 kg/d; P = 0.64). Hip height (122.7 vs. 121.4 cm; P = 0.0055), BCS (5.8 vs. 5.6; P = 0.0057), and BW (356 vs. 335 kg; P < 0.0001) at the end of spring grazing was greater for HI than LO heifers. Heifers in the LO group compensated with greater summer ADG than heifers in the HI group (0.74 vs. 0.66 kg/d; P = 0.03). Total ADG from treatment initiation (November) through pregnancy diagnosis (August) was greater for HI than LO heifers (0.61 vs. 0.55 kg/d; P < 0.001) as was BW at pregnancy diagnosis (415 vs. 402 kg; P = 0.0055). Percentage of heifers reaching puberty by the time of AI was 34% for both groups (P = 0.93). Percentage of heifers becoming pregnant to AI tended (P = 0.13) to be greater for HI (44%) than for LO heifers (32%). Fall ADG across treatment groups affected the probability of a heifer becoming pregnant by AI (P = 0.01). Percentage pregnant by natural service (61% for LO vs. 59% for HI; P = 0.80) and final pregnancy rate (74% for LO vs. 77% for HI; P = 0.61) was not different for the 2 groups. These results indicate that altering fall forage allowance may delay the majority of BW gain until late in heifer development without negatively affecting overall pregnancy rates.

Ultrathin-layer chromatography nanostructures modified by atomic layer deposition

Stationary phase morphology and surface chemistry dictate the properties of ultrathin-layer chromatography (UTLC) media and interactions with analytes in sample mixtures. In this paper, we combined two powerful thin film deposition techniques to create composite chromatography nanomaterials. Glancing angle deposition (GLAD) produces high surface area columnar microstructures with aligned macropores well-suited for UTLC. Atomic layer deposition (ALD) enables precise fabrication of conformal, nanometer-scale coatings that can tune surfaces of these UTLC films. We coated ∼5μm thick GLAD SiO2 UTLC media with <10nm thick ALD metal oxides (Al2O3, ZrO2, and ZnO) to decouple surface chemistry from the underlying GLAD scaffold microstructure. The effects of ALD coatings on GLAD UTLC media were investigated using transmission electron microscopy (TEM), gas adsorption porosimetry, and lipophilic dye separations. The results collectively show that the most significant changes occur over the first few nanometers of ALD coating. They further demonstrate independent control of film microstructure and surface characteristics. ALD coatings can enhance complex GLAD microstructures to engineer new composite nanomaterials potentially useful in analytical chromatography.

Effects of essential oils on rumen fermentation, milk production, and feeding behavior in lactating dairy cows

Seven ruminally cannulated lactating Holstein dairy cows were used in an incomplete Latin rectangle design to assess the effects of 2 commercial essential oil (EO) products on rumen fermentation, milk production, and feeding behavior. Cows were fed a total mixed ration with a 42:58 forage:concentrate ratio (DM basis). Treatments included addition of 0.5 g/d of CE Lo (85 mg of cinnamaldehyde and 140 mg of eugenol), 10 g/d of CE Hi (1,700 mg of cinnamaldehyde and 2,800 mg of eugenol), 0.25 g/d of CAP (50mg of capsicum), or no oil (CON). Cows were fed ad libitum twice daily for 21 d per period. Dry matter intake, number of meals/d, h eating/d, mean meal length, rumination events/d, h ruminating/d, and mean rumination length were not affected by EO. However, length of the first meal after feeding decreased with addition of CE Hi (47.2 min) and CAP (49.4 min) compared with CON (65.4 min). Total volatile fatty acids, individual volatile fatty acids, acetate:propionate ratio, and ammonia concentration were not affected by EO. Mean rumen pH as well as bouts, total h, mean bout length, total area, and mean bout area under pH 5.6 did not differ among treatments. Total tract digestibility of organic matter, dry matter, neutral detergent fiber, acid detergent fiber, crude protein, and starch were not affected by EO. Milk yield and composition did not change with EO. In situ dry matter disappearance of ground soybean hulls was not affected by EO. However, organic matter disappearance of soybean hulls with CE Hi tended to decrease compared with CON. Compared with CON, neutral detergent fiber disappearance (41.5 vs. 37.6%) and acid detergent fiber disappearance (44.5 vs. 38.8%) decreased with addition of CE Hi. The CE Lo had no effect on rumen fermentation, milk production, or feeding behavior but CAP shortened the length of the first meal without changing rumen fermentation or production, making it a possible additive for altering feeding behavior. The CE Hi negatively affected rumen fermentation and shortened the length of the first meal, suggesting that a dose of 10 g/d is not beneficial to lactating dairy cows.

Effects of cinnamaldehyde, eugenol, and capsicum on fermentation of a corn-based dairy ration in continuous culture

A 12-unit continuous culture system was used in a complete randomized design to study the effects of no oil (CON), cinnamaldehyde oil (CIN), eugenol oil (EUG), and capsicum oil (CAP) (500 mg L-1 d -1) with a 45:55 forage:concentrate ratio (dry matter basis) ration on rumen fermentation. Dry matter digestibility did not differ among treatments. Organic matter digestibility tended to decrease with CIN. Digestibility of neutral detergent and acid detergent fiber tended to be highest with CAP. Crude protein digestibility and bacterial nitrogen flow was depressed with CIN and EUG. CIN tended to decrease microbial protein synthesis and increase effluent ammonia nitrogen. Total volatile fatty acid production did not differ among treatments; however, isovalerate production tended to be highest with CAP. CIN and EUG had higher mean pH, spent fewer hours per day and had smaller area under the curve at pH < 5.6 and 5.8. CAP had smaller area under the curve at pH < 5.6. Supplementation with these oils at the current dose had limited effects on rumen fermentation, with the majority of effects observed being mainly attributable to the very high dosage of oil used. Key words: Dairy cow, essential oil, continuous culture, rumen fermentation, rumen pH

Diet-induced alterations in hepatic progesterone (P4) catabolic enzyme activity and P4 clearance rate in lactating dairy cows

Elevated rates of steroid clearance may lead to lower reproductive success in several mammalian species. Cytochrome P450 (EC 1.14.14.1) and aldo-keto reductases (AKR; EC 1.1.1.145-151) are involved in the first phase of steroid inactivation, before second phase conjugation and excretion of the steroid metabolite. The current objectives were to determine liver blood flow (LBF), hepatic enzyme activity, and metabolic clearance rate (MCR) of progesterone (P(4)) in dairy cows consuming isoenergetic and isonitrogenous diets formulated to cause divergent insulin secretion. Insulin concentrations increased by 22% in cows fed the high cornstarch diet, and both cytochrome P450 2C and cytochrome P450 3A activities were decreased (P<0.05) by approximately 50%, while AKR1C tended (P<0.10) to be lower in cows fed the high cornstarch diet. LBF was similar between the two diets (1891+/-91 l/h). MCR of P(4) tended (P<0.10) to be lower in cows fed the high cornstarch diet (25+/-5 l/hxBW(0.75)) versus the high fiber diet (40+/-6 l/hxBW(0.75)). The half-life of P(4) was increased (P<0.05) in cows fed the high cornstarch diet (73+/-10 min) versus the high fiber diet (24+/-10 min). In summary, cows with elevated insulin concentrations and lower enzyme activity showed a decrease in P(4) clearance without any changes in LBF. This dietary relationship with hepatic enzyme activity may explain some of the observed alterations in steroid profiles during the estrous cycle or gestation of the high producing dairy cow.

Inducing subacute ruminal acidosis in lactating dairy cows

Data from experiments in which subacute ruminal acidosis (SARA) was induced in lactating dairy cows (days in milk = 154 +/- 118) were evaluated to investigate the effectiveness of the induction protocol and its effect on production outcomes. For 13 cows in 3 trials, ruminal pH was measured continuously and recorded each minute; dry matter intake and milk yield were recorded daily. Milk composition data were obtained from 9 cows in 2 of these trials. The SARA induction protocol included 4 separate periods: 4 d of baseline [normal total mixed ration (TMR)], 1 d of 50% restricted feeding, 1 or 2 d of challenge feeding [addition of 3.5 or 4.6 kg of wheat-barley pellet (dry matter basis) to normal TMR], and 2 d of recovery measurements when feeding normal TMR. The SARA induction protocol lowered mean ruminal pH from 6.31 during the baseline period to 5.85 during the challenge period; pH remained below baseline level during the recovery period (6.16). Mean ruminal pH was highest (6.59) during the day of restricted feeding. Nadir ruminal pH decreased from baseline to challenge period (5.76 vs. 5.13). Hours below pH 5.6 increased from 1.10 to 8.26/d from baseline to challenge period and area below 5.6 (pH x min/d) increased from 15.0 to 190.3. Dry matter intake was not affected by SARA induction. Milk yield dropped from 35.2 kg/d during baseline to 31.7 k/d during the challenge period and did not return to baseline level during the recovery period (31.3 kg/d). No depression in milk fat percentage was observed when SARA was induced. Yield of fat was highest during the restricted feeding period (1.47 kg/d) and was lower during the recovery period than during the baseline period (1.12 vs. 1.31 kg/d). The protocol successfully induced SARA (low ruminal pH without signs of acute ruminal acidosis) on the challenge day. Milk yield was substantially reduced and did not recover within 2 d after the challenge.

Effects of forage particle size, forage source, and grain fermentability on performance and ruminal pH in midlactation cows

Our study investigated the effects of, and interactions between, forage particle size, level of dietary ruminally fermentable carbohydrate (RFC), and level of dietary starch on performance, chewing activity, and ruminal pH for dairy cows fed one level of dietary NDF. Twelve cows (48 DIM) were assigned to six treatments in a replicated 6 x 6 Latin square. Treatments were arranged in an incomplete 2 x 2 x 2 factorial design. Factors were: dry cracked shelled corn (DC, low RFC) or ground high-moisture corn (HMC; high RFC), finely chopped or coarse silage, and alfalfa silage as the only forage or a 50:50 ratio (DM basis) of alfalfa and corn silage. Diets combining HMC with only alfalfa silage were not included in the experiment. Diets were fed for ad libitum intake as a TMR with a concentrate:forage ratio of 61:39. Diets based on only alfalfa silage and diets based on a mix of alfalfa and corn silage averaged 18.6 and 15.8% CP, 25.8 and 24.7% NDF, 17.7 and 14.8% ADF, and 29.1 and 37.3% starch, respectively. Mean particle sizes were 5.3, 2.7, 5.6, and 2.8 mm for coarse alfalfa, fine alfalfa, coarse corn silage, and fine corn silage, respectively. Decreasing forage particle size decreased DMI (23.3 vs. 21.6 kg) and organic matter intake (22.0 vs. 20.2 kg). Increasing RFC decreased DMI (22.8 vs. 21.0 kg) and organic matter intake (21.5 vs. 20.0 kg). Decreasing forage particle size increased energy-corrected milk for alfalfa based diets (34.9 vs. 37.4 kg). Percentage of milk fat decreased with decreasing forage particle size (3.07 vs. 2.90%) and increased level of RFC (3.04 vs. 2.57%). Percentage of protein increased when corn silage partially replaced alfalfa silage (2.84 vs. 2.90%) but decreased when HMC replaced DC (2.90 vs. 2.84%). Apparent total tract digestibility of DM (66.7 vs. 68.5%), OM (65.9 vs. 70.7%), and starch (88.9 vs. 93.4%) increased when level of RFC was increased. Increasing level of RFC decreased mean ruminal pH from 5.82 to 5.67 and decreased minimum pH. Hours per day at which pH was <5.8, and area <5.8, increased when corn silage partially replaced alfalfa silage (2.6 vs. 4.4 h and 8.9 h x pH vs. 11.4 h x pH) and decreased further when level of RFC was increased (4.4 vs. 6.4 h and 11.4 h x pH vs. 14.3 h x pH). Decreasing forage particle size in HMC diets increased hours and area <5.8, but for DC diets, the effect of forage particle size depended on forage source. Interactions were found between level of physically effective fiber, forage source, and level of RFC on production and pH, complicating the inclusion of these effects in dairy ration formulation and evaluation.

Effects of increasing levels of refined cornstarch in the diet of lactating dairy cows on performance and ruminal pH

Our study investigated the effect of a linear increase in level of ruminally fermentable carbohydrate, at a constant level of dietary starch and fiber, on performance, microbial N yield, chewing activity, and ruminal pH of midlactation dairy cows. Eight cows (53 DIM) were assigned to four treatments in a double 4 x 4 Latin square. Diets consisted of increasing levels of refined cornstarch (0, 5.9, 11.9, and 17.9% of diet dry matter) replacing dry cracked, shelled corn so that increasing amounts of dietary starch originated from refined cornstarch. Corn gluten feed was used to balance diets for similar NDF content. The four diets averaged 17.9% CP, 27.2% NDF, 18.7% ADF, and 31.1% starch (dry matter basis). Diets were fed for ad libitum intake and had a forage to concentrate ratio of 40:60. Forage was coarsely chopped (13.7 mm mean particle size) alfalfa silage. Daily dry matter intake averaged 26.0 kg and tended (P = 0.08) to increase quadratically with increasing level of refined cornstarch. Milk production averaged 38.9 kg/d and milk fat percentage tended (P = 0.08) to decrease linearly, whereas percentage of protein increased quadratically, with increasing level of refined cornstarch. Yield of components and energy corrected milk was similar across diets. Total tract digestibility of starch increased linearly from 85.1% to 92.4% with increasing level of refined cornstarch. Microbial yield was unaffected by diet and averaged 371.1 g N/d. Time spent eating decreased linearly from 329 to 308 min/d when level of refined cornstarch was increased, but rumination time was unaffected. Ruminal concentration and proportion of acetate decreased linearly while concentration and proportion of propionate increased linearly with increasing level of refined cornstarch. Mean ruminal pH, time spent below pH 5.8 (h), and area below pH 5.8 (h x pH units/d) were unaffected by level of refined cornstarch and averaged 5.97, 8.4, and 2.9, respectively. Increasing the level of carbohydrates fermented in the rumen by replacing dry cracked corn with refined cornstarch (up to 57% of dietary starch) did not compromise rumen fermentation or affect performance of midlactation dairy cows.

Effects of forage particle size and grain fermentability in midlactation cows. I. Milk production and diet digestibility

Our study investigated the effects of, and interactions between, level of dietary ruminally fermentable carbohydrate (RFC) and forage particle size on milk production, nutrient digestibility, and microbial protein yield for dairy cows fed one level of dietary NDF. Eight cows (61 days in milk) were assigned to four treatments in a double 4 x 4 Latin square. Treatments were arranged in a 2 x 2 factorial design; finely chopped alfalfa silage (FS) and coarse alfalfa silage (CS) were combined with concentrates based on either dry cracked shelled corn (DC; low RFC) or ground high-moisture corn (HMC; high RFC). Diets were fed ad libitum as a total mixed rations with a concentrate to forage ratio of 61:39. Diets based on DC had a predicted NEL content of 1.73 Mcallkg dry matter (DM), while HMC diets contained 1.80 Mcal/kg DM. Diets averaged 18.7% CP, 24.0% NDF, 18.3% ADF, and 27.4% starch on a DM basis. Mean particle size of the four diets was 6.3, 2.8, 6.0, and 3.0 mm for DCCS, DCFS, HMCCS, and HMCFS, respectively. Increasing level of RFC decreased dry matter intake (DMI) from 25.0 to 23.8 kg/ d and organic matter intake from 22.3 to 21.1 kg/d, but intake was not affected by particle size. Milk production averaged 44.0 and 26.8 kg/d solids corrected milk (SCM) and was not affected by diet, but increasing level of RFC tended to increase milk yield. Efficiency of milk production, expressed as SCM/DMI, increased from 1.06 to 1.14 when level of RFC was increased. Milk composition or yield of milk components was not affected by diet, and averaged 3.53% fat, 3.11% protein, 1.55 kg/d fat, and 1.36 kg/d protein. Total tract digestibility of DM and OM increased from 71.4 to 73.0% and 72.4 to 76.1% for DM and OM, respectively, when level of RFC was increased. Total tract digestibility of fiber was unaffected by diet, but total tract starch digestibility increased from 93.1 to 97.4% when HMC replaced DC. Total urinary excretion of the purine derivatives uric acid and allantoin increased from 415 to 472 mmol/d when level of RFC was increased, and calculated microbial N supply increased from 315 to 365 g/d. When expressed as per kilogram of digestible OMI, increasing level of RFC tended to increase microbial N supply (20.4 vs. 22.2 g/kg). Cow productivity was not affected by forage particle size and ruminally fermentable carbohydrates in this study.

Effects of forage particle size and grain fermentability in midlactation cows. II. Ruminal pH and chewing activity

Our study investigated the effects of, and interactions between, level of dietary ruminally fermentable carbohydrate (RFC) and forage particle size on rumen pH and chewing activity for dairy cows fed one level of dietary NDF. Also, correlations between intake, production, chewing, and ruminal pH parameters were investigated. Eight cows (61 days in milk) were assigned to four treatments in a double 4 x 4 Latin square. Treatments were arranged in a 2 x 2 factorial design; finely chopped alfalfa silage (FS) and coarse alfalfa silage (CS) were combined with concentrates based on either dry, cracked-shelled corn (DC; low RFC) or ground, high-moisture corn (HMC; high RFC). Diets were fed ad libitum as a total mixed rations with a concentrate:forage ratio of 60:40. Diets averaged 18.7% crude protein, 24.0% neutral detergent fiber, 18.3% , acid detergent fiber and 27.4% starch on a DM basis. Mean particle size of the four diets were 6.3, 2.8, 6.0, and 3.0 mm for DCCS, DCFS, HMCCS, and HMCFS, respectively. Decreasing forage particle size decreased ruminal pH from 6.02 to 5.81, and increasing level of RFC decreased pH from 5.99 to 5.85. Minimum daily ruminal pH decreased from 5.66 to 5.47 when level of RFC was increased, and decreased from 5.65 to 5.48 when forage particle size decreased. Time below pH 5.8 per day increased from 7.4 h to 10.8 h when level of RFC increased, and increased from 6.4 h to 11.8 h when forage particle size was decreased. Area below 5.8 showed the same relationship with RFC and forage particle size. Also, forage particle size affected the postprandial pH pattern. Cows spent more time eating when fed CS compared with FS (274 vs. 237 min/d), and time spent eating decreased when level of RFC was increased (271 vs. 241 min/d). Decreasing forage particle size decreased time spent ruminating (485 vs. 320 min/d), rumination periods (15.3 vs. 11.7), and duration of rumination periods (29 vs. 26 min). Increasing level of RFC increased time spent ruminating per kg NDF intake (68.5 vs. 79.5 min/kg). Milk fat percentage was correlated to mean ruminal pH (r = 0.41), time spent below pH 5.8 (r = -0.55), and area below 5.8 (r = -0.57), but not to intake or chewing variables. DMI of particles retained on a screen equivalent in size to the top screen of the Penn State particle separator was the intake parameter explaining most of the variation in mean ruminal pH (r = 0.27) and was correlated to time spent ruminating (r = 0.61) and chewing (r = 0.61).

The effect of exposure to 35,000 ft on incidence of altitude decompression sickness

INTRODUCTION

Exposure to 35,000 ft without preoxygenation (breathing 100% oxygen prior to decompression) can result in severe decompression sickness (DCS). Exercise while decompressed increases the incidence and severity of symptoms. Clarification of the level of activity vs. time to symptom onset is needed to refine recommendations for current operations requiring 35,000-ft exposures. Currently, the U.S. Air Force limits these operations to 30 min following 75 min of preoxygenation. The objective of this study was to determine the effect of exercise intensity on DCS incidence and severity at 35,000 ft.

METHODS

Following 75 or 90 min of ground-level preoxygenation, 54 male and 38 female subjects were exposed to 35,000 ft for 3 h while performing strenuous exercise, mild exercise, or seated rest. The subjects were monitored for venous gas emboli (VGE) with an echo-imaging system and observed for signs and symptoms of DCS.

RESULTS

Exposures involving strenuous and mild exercise resulted in higher incidence (p < 0.05) and earlier onset of symptoms (p < 0.05) of DCS than exposure at rest. Mild and strenuous exercise during exposure did not differ in incidence or rate of onset. Incidence at 30 min of exposure was 8% at rest and 23% while exercising.

CONCLUSION

The results showed that current guidelines for 35,000-ft exposures keep DCS risk below 10% at rest. Exercise, even at mild levels, greatly increases the incidence and rate of onset of DCS.

The effectiveness of ground level oxygen treatment for altitude decompression sickness in human research subjects

BACKGROUND

Current therapy for altitude decompression sickness (DCS) includes hyperbaric oxygen therapy and ground-level oxygen (GLO). The purpose of this paper is to describe the Air Force Research Laboratory experience in the extensive use of GLO for the treatment of altitude DCS in research subjects.

METHODS

Data were collected from 2001 altitude chamber subject-exposures. These data, describing DCS symptoms, circulating intracardiac venous gas emboli, and treatment procedures used were collected for each subject exposure and stored in an altitude DCS database.

RESULTS

In the database of 2001 subject exposures, 801 subjects (40.0%) were diagnosed with altitude DCS. Subjects reporting DCS symptoms were immediately recompressed to ground level. Of the 749 subjects who received 2 h GLO, 739 (98.7%) resolved completely and required no further treatment.

CONCLUSIONS

Although not an operational study, these data provide indirect support for the current USAF guidelines for the treatment of altitude DCS with GLO.

Regeneration of phasic motor axons on a crayfish tonic muscle: neuron specifies synapses

Motor neurons are matched to their target muscles, often forming separate phasic and tonic systems as in the abdomen of crayfish where they are used for rapid escape and slow postural movements, respectively. To assess the role of motor neuron and muscle fiber in forming synapses we attempted a mismatch experiment by allotransplanting a phasic nerve attached to its ganglion to a denervated tonic muscle. Regenerating motor axons sprouted 10-30 branches (typical of phasic motor neurons, as tonic ones sprout far fewer branches) to reinnervate muscle fibers and form synapses that produced large excitatory postsynaptic potentials (typical of phasic motor neurons, as tonic synapses give small potentials). Therefore motor neurons, not muscle fibers, appear to specify one of the major properties of regenerating neuromuscular synapses.

Peritonitis causes diaphragm weakness in rats

Respiratory failure is a common and often lethal complication of severe peritonitis. Because this inflammatory process develops in the abdomen, adjacent to the diaphragm, we hypothesized that peritonitis might directly compromise diaphragm function. We tested this hypothesis using male Sprague-Dawley rats. We injected oyster glycogen into the rats' peritoneum, and 16 h later the peritoneum was lavaged for leukocyte analysis and muscle samples were excised. Contractile properties of diaphragm fiber bundles were measured in vitro. We found that neutrophils and macrophages were concentrated in peritoneal lavage fluid of experimental animals (p < 0.01) and were adherent to the abdominal surface of the diaphragm. Immunohistochemistry showed increases in inducible nitric oxide synthase in microvessels of the diaphragm and limb skeletal muscles but not in heart or spleen. Peritonitis decreased maximal force production by the diaphragm (23.6+/-0.6 versus 21.2+/-0.6 N/cm2; p < 0.05) and decreased the absolute forces developed at physiologic stimulus frequencies (> 30 Hz; p < 0.01), depressing the overall force-frequency relationship (p < 0.001). Peritonitis had little effect on acute muscular fatigue. These data demonstrate that peritonitis weakens the diaphragm in rats and suggest that humans with peritonitis may be predisposed to respiratory muscle dysfunction.

Muscle fibers in regenerating crayfish motor nerves

Single discrete muscle fibers were found in regenerating motor nerves in adult crayfish. The regenerating nerves were from native or transplanted ganglia in the third abdominal segments and consisted of several motor axons. The proximal end of these motor axons showed numerous sprouts. Muscle fibers in these regenerating nerves appeared newly developed and were innervated by excitatory nerve terminals. A likely source of these novel muscle fibers may be blood cells in the nerve or satellite cells from neighboring muscle. Contacts made by axon sprouts with other axon sprouts, glia, and muscle fiber, in the form of a dense bar with clustered clear vesicles, characterized the regenerating nerve. These contacts may provide a possible signaling pathway for axon regeneration and myogenesis.

Structure of allotransplanted ganglia and regenerated neuromuscular connections in crayfish

In adult crayfish, Procambarus clarkii, motoneurons to a denervated abdominal superficial flexor muscle regenerate long-lasting and highly specific synaptic connections as seen from recordings of excitatory postsynaptic potentials, even when they arise from the ganglion of another crayfish. To confirm the morphological origins of these physiological connections we examined the fine structure of the allotransplanted tissue that consisted of the third abdominal ganglion and the nerve to the superficial flexor muscle (the fourth ganglion and the connecting ventral nerve cord were also included). Although there is considerable degeneration, the allotransplanted ganglia display intact areas of axon tracts, neuropil, and somata. Thus in both short (6-8 weeks) and long (24-30 weeks) term transplants approximately 20 healthy somata are present and this is more than the five axons regenerated to the host muscle. The principal neurite and dendrites of these somata receive both excitatory and inhibitory synaptic inputs, and these types of synaptic contacts also occur among the dendritic profiles of the neuropil. Axon tracts in the allotransplanted ganglia and ventral nerve cord consist largely of small diameter axons; most of the large axons including the medial and lateral giant axons are lost. The transplanted ganglia have many blood vessels and blood lacunae ensuring long-term survival. The transplanted superficial flexor nerve regenerates from the ventral to the dorsal surface of the muscle where it has five axons, each consisting of many profiles rather than a single profile. This indicates sprouting of the individual axons and accounts for the enlarged size of the regenerated nerve. The regenerated axons give rise to normal-looking synaptic terminals with well-defined synaptic contacts and presynaptic dense bars or active zones. Some of these synaptic terminals lie in close proximity to degenerating terminals, suggesting that they may inhabit old sites and in this way ensure target specificity. The presence of intact somata, neuropil, and axon tracts are factors that would contribute to the spontaneous firing of the transplanted motoneurons.

Regeneration of neuromuscular connections in crayfish allotransplanted neurons

Transplantation of whole ganglia was used to study the regeneration of four of the neurons that innervate the superficial flexor muscles of the crayfish Procambarus clarkii. The isolated ganglia containing the somas of these neurons were successfully transplanted from one crayfish to another. Reinnervation proceeded across the muscle surface and by 8 to 10 weeks connections were detected across the entire target field. At different time periods after the transplant, junction potentials (JPs) produced in phase with spontaneous neuronal spikes were recorded. The distribution of JP sizes and their decay times were examined. JPs from transplanted preparations were smaller than JPs from control or normal regeneration animals. These JPs also failed to facilitate when stimulated at 1 and 10 Hz. These are normal characteristics of immature terminals, but in the transplant preparations, once established, they remained stable for the duration of the study. Thus, synaptogenesis appears to be arrested at a stage before synaptic efficacy is established in the allotransplants. In addition, connectivity maps were plotted for each axon over the muscle surface. Some muscle fibers did not receive any contacts, and overall innervation leveled off at around 60% of the muscle fibers, remaining stable for the duration of this study. Despite the incomplete physiological innervation, however, three of the four neurons showed the same medial/lateral preferences observed in control animals, regenerating their original patterns of connectivity across the muscle surface.

Relationship of oxygen consumption and cardiac output to work of breathing

This study examined the relationship between work of breathing and estimated blood flow to and oxygen consumption by the respiratory muscles. Five subjects performed inspiratory loaded breathing and voluntary hyperpnea while ventilatory work, cardiac output, and oxygen consumption were measured. Blood flow to and oxygen consumption by the respiratory muscles were estimated by subtracting the resting from the working values of cardiac output the oxygen consumption, respectively. Loaded breathing increased cardiac output, but there was no significant correlation with work of breathing, while oxygen consumption was significantly correlated with work of breathing. During hyperpnea both cardiac output and oxygen consumption were correlated with work of breathing. Our results indicate that blood flow and oxygen consumption are increased in a regular pattern with increases in work of breathing. These results may be significant in estimating the demand of the respiratory muscles in disease and exercise.

Ventilatory work and oxygen consumption during exercise and hyperventilation

The work of breathing (WB), and thus the energy requirement of the respiratory muscles, is increased any time minute ventilation (VE) is elevated, by either exercise or voluntary hyperventilation. Respiratory muscle O2 consumption (VRMO2) in humans has generally been estimated by having subjects breathe at a level comparable to that during exercise while the change in O2 consumption (VO2) is measured. The difference between VO2 at rest and during hyperventilation is attributed to the respiratory muscles and is assumed to be similar to VRMO2 during exercise at the same VE. However, it has been suggested that WB differs between exercise and hyperventilation and that WB during exercise is lower than during hyperventilation at the same VE. In this study we measured WB during exercise and hyperventilation and from these measurements estimated VRMO2. WB, VE, and VO2 were measured in five male subjects during rest and during exercise or hyperventilation at levels of VE ranging from 30 to 130 l/min. VE/WB relationship was determined for both hyperventilation and exercise. Multiple regression analysis showed that the shape of the two curves was different (P < 0.0001), with WB at high levels of VE being < or = 25% higher in hyperventilation than in exercise. In a second study in which frequency, tidal volume, and duty cycle were controlled as well as VE, there was no difference in WB between exercise and hyperventilation. VO2 was significantly correlated with WB, and the estimated VRMO2 did not increase as a fraction of total VO2 as exercise intensity rose.(ABSTRACT TRUNCATED AT 250 WORDS)

Ratings of perceived exertion in individuals with varying fitness levels during walking and running

It was the purpose of this investigation to: 1) compare the ratings of perceived exertion (RPEs) in high and low fit individuals when walking and running at comparable exercise intensities and 2) to determine if ventilation (VE) provides a central signal for RPEs. Nine high fit and nine low fit male subjects completed two exercise bouts on a treadmill, one uphill walking and the other level running. Workloads for each bout were set at 90% of each subject's ventilatory threshold (VT) as determined from a graded exercise test. Oxygen consumption (Vo2), heart rate (HR), and VE were all similar between the walk and run trials for the low fit subjects (P greater than 0.05). HR were found to be significantly greater during the walk trial vs. the run trial (P less than 0.05) for the high fit subjects, whereas, VE was significantly greater during the run trial. Oxygen consumption was similar for the high fit subjects during both trials (P greater than 0.05). During the walk and run trials, central (12.1 +/- 1.6 vs. 11.4 +/- 1.5), local (14.0 +/- 1.3 vs. 13.9 +/- 1.1) and overall (12.8 +/- 1.2 vs. 12.4 +/- 1.4) RPEs were not found to be significantly different for the low fit group (P greater than 0.05). In contrast, during the walk vs. the run trial there was a significant increase in central (10.7 +/- 2.0 vs. 9.2 +/- 1.9), local (11.5 +/- 2.0 vs. 9.8 +/- 1.8) and overall (11.2 +/- 2.4 vs. 9.6 +/- 2.3) RPEs for the high fit group (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)