[Extracorporeal CO2 removal as life support system for a severe organizing pneumonia]

INTRODUCTION

Acute lung injuries are usually found in intensive care unit. The diffuse alveolar damage (DAD) is the associated histological pattern and the most severe end-stage of the disease. Organizing pneumonia (OP), for which corticosteroids are the reference therapy, can mimic DAD. While postponing the response to treatment, to limit mechanical ventilation side effects, extracorporeal membrane oxygene can be proposed. We present a case of a severe OP for which extracorporeal CO₂ removal (ECCO₂R) is used as a bridge to recovery under corticosteroid therapy.

CASE REPORT

In the context of a flu-like syndrome, the non-recovery of a lung impairment is reported to a severe OP. ECCO₂R is applied when using an ultraprotective ventilation and while waiting for lung healing under corticosteroid. This strategy allowed successful recovery, early physical therapy and active mobilization.

CONCLUSION

This observation presents the diagnostic and therapeutic difficulties of the lung parenchymental disease in intensive care. OP must be recognized. ECCO₂R can be used in severe OP as a bridge to recovery while waiting for the corticosteroid efficacy.

Simultaneous multi-slice (SMS) acquisition enhances the sensitivity of hemodynamic mapping using gas challenges

Hemodynamic mapping using gas inhalation has received increasing interest in recent years. Cerebrovascular reactivity (CVR), which reflects the ability of the brain vasculature to dilate in response to a vasoactive stimulus, can be measured by CO₂ inhalation with continuous acquisition of blood oxygen level-dependent (BOLD) magnetic resonance images. Cerebral blood volume (CBV) can be measured by O₂ inhalation. These hemodynamic mapping methods are appealing because of their absence of gadolinium contrast agent, their ability to assess both baseline perfusion and vascular reserve, and their utility in calibrating the functional magnetic resonance imaging (fMRI) signal. However, like other functional and physiological indices, a major drawback of these measurements is their poor sensitivity and reliability. Simultaneous multi-slice echo planar imaging (SMS EPI) is a fast imaging technology that allows the excitation and acquisition of multiple two-dimensional slices simultaneously, and has been shown to enhance the sensitivity of several MRI applications. To our knowledge, the benefit of SMS in gas inhalation imaging has not been investigated. In this work, we compared the sensitivity of CO₂ and O₂ inhalation data collected using SMS factor 2 (SMS2) and SMS factor 3 (SMS3) with those collected using conventional EPI (SMS1). We showed that the sensitivity of SMS scans was significantly (p = 0.01) higher than that of conventional EPI, although no difference was found between SMS2 and SMS3 (p = 0.3). On a voxel-wise level, approximately 20-30% of voxels in the brain showed a significant enhancement in sensitivity when using SMS compared with conventional EPI, with other voxels showing an increase, but not reaching statistical significance. When using SMS, the scan duration can be reduced by half, whilst maintaining the sensitivity of conventional EPI. The availability of a sensitive acquisition technique can further enhance the potential of gas inhalation MRI in clinical applications.

Evaluation of renal oxygenation change under the influence of carbogen breathing using a dynamic R2 , R2 ' and R2 * quantification approach

The purpose of this study is to demonstrate the feasibility of dynamic renal R₂ /R₂ '/R₂ * measurements based on a method, denoted psMASE-ME, in which a periodic 180° pulse-shifting multi-echo asymmetric spin echo (psMASE) sequence, combined with a moving estimation (ME) strategy, is adopted. Following approval by the institutional animal care and use committee, a block design of respiratory challenge with interleaved air and carbogen (97% O₂ , 3% CO₂ ) breathing was employed in nine rabbits. Parametrical R₂ /R₂ '/R₂ * maps were computed and average R₂ /R₂ '/R₂ * values were measured in regions of interest in the renal medulla and cortex. Bland-Altman plots showed good agreement between the proposed method and reference standards of multi-echo spin echo and multi-echo gradient echo sequences. Renal R₂ , R₂ ' and R₂ * decreased significantly from 16.2 ± 4.4 s^-1 , 9.8 ± 5.2 s^-1 and 25.9 ± 5.0 s^-1 to 14.9 ± 4.4 s^-1 (p < 0.05), 8.5 ± 4.1 s^-1 (p < 0.05) and 23.4 ± 4.8 s^-1 (p < 0.05) in the cortex when switching the gas mixture from room air to carbogen. In the renal medulla, R₂ , R₂ ' and R₂ * also decreased significantly from 12.9 ± 4.7 s^-1 , 15.1 ± 5.8 s^-1 and 27.9 ± 5.3 s^-1 to 11.8 ± 4.5 s^-1 (p < 0.05), 14.2 ± 4.2 s^-1 (p < 0.05) and 25.8 ± 5.1 s^-1 (p < 0.05). No statistically significant differences in relative R₂ , R₂ ' and R₂ * changes were observed between the cortex and medulla (p = 0.72 for R₂ , p = 0.39 for R₂ ' and p = 0.61 for R₂ *). The psMASE-ME method for dynamic renal R₂ /R₂ '/R₂ * measurements, together with the respiratory challenge, has potential use in the evaluation of renal oxygenation in many renal diseases.

Dynamic oxygen challenge evaluated by NMR T1 and T2*--insights into tumor oxygenation

There is intense interest in developing non-invasive prognostic biomarkers of tumor response to therapy, particularly with regard to hypoxia. It has been suggested that oxygen sensitive MRI, notably blood oxygen level-dependent (BOLD) and tissue oxygen level-dependent (TOLD) contrast, may provide relevant measurements. This study examined the feasibility of interleaved T2*- and T1-weighted oxygen sensitive MRI, as well as R2* and R1 maps, of rat tumors to assess the relative sensitivity to changes in oxygenation. Investigations used cohorts of Dunning prostate R3327-AT1 and R3327-HI tumors, which are reported to exhibit distinct size-dependent levels of hypoxia and response to hyperoxic gas breathing. Proton MRI R1 and R2* maps were obtained for tumors of anesthetized rats (isoflurane/air) at 4.7 T. Then, interleaved gradient echo T2*- and T1-weighted images were acquired during air breathing and a 10 min challenge with carbogen (95% O2 -5% CO2). Signals were stable during air breathing, and each type of tumor showed a distinct signal response to carbogen. T2* (BOLD) response preceded T1 (TOLD) responses, as expected. Smaller HI tumors (reported to be well oxygenated) showed the largest BOLD and TOLD responses. Larger AT1 tumors (reported to be hypoxic and resist modulation by gas breathing) showed the smallest response. There was a strong correlation between BOLD and TOLD signal responses, but ΔR2* and ΔR1 were only correlated for the HI tumors. The magnitude of BOLD and TOLD signal responses to carbogen breathing reflected expected hypoxic fractions and oxygen dynamics, suggesting potential value of this test as a prognostic biomarker of tumor hypoxia.

[Reduction of omalgia in laparoscopic cholecystectomy: clinical randomized trial ketorolac vs ketorolac and acetazolamide]

BACKGROUND

Laparoscopy cholecystectomy for the surgical treatment of cholelithiasis has been considered the gold standard. The referred pain to the shoulder (omalgia) may be present to 63% of the patients and limits outpatient management.

OBJECTIVE

The study was to evaluate the usefulness of acetazolamide associated with ketorolac for reduction of the omalgia to minimally invasive treatment.

METHODS

We performed a clinical trial, randomized, double blind in patients undergoing laparoscopic cholecystectomy to assess the reduction of post-operative omalgia comparing ketorolac and ketorolaco+acetazolamida. 31 patients in each group were studied. The study group: 250 mg of acetazolamide before anesthetic induction and 30 mg of ketorolac in the immediate postoperative period.

CONTROL GROUP

one tablet of placebo prior to the anesthetic induction and 30 mg of ketorolac in the immediate postoperative. The presence of omalgia was assessed using the analog visual scale. The variables recorded included: age, sex, flow of carbon dioxide intra-abdominal pressure, surgical time, urgent or elective surgery, omalgia, severity of pain evaluated by analog visual scale, addition analgesia.

RESULTS

Both groups were homogeneous and statistical analysis showed no differences in the variables studied. The omalgia in the study group was presented at 9.67% and in the group control was the 58.06% (p < 0.001).

CONCLUSION

250 mg oral acetazolamide associated 30 mg of ketorolac reduces significantly the development of omalgia in patients undergoing laparoscopic cholecystectomy.

Changes in end-tidal carbon dioxide due to gastric perforation during pneumoperitoneum in the rat

BACKGROUND

Carbon dioxide is the most widely used gas to establish pneumoperitoneum during laparoscopic surgery. Gastrointestinal trauma may occur during the peritoneal insufflation or during the operative phase itself. Early diagnosis of these injuries is critical.

OBJECTIVES

To assess changes in end-tidal carbon dioxide (ETCO2) following gastric perforation during pneumoperitoneum in the rat.

METHODS

Wistar rats were anesthetized, tracheotomized and mechanically ventilated with fixed minute volume. Each animal underwent a 1 cm abdominal longitudinal incision. A 0.3 x 0.3 cm cross-incision of the stomach was performed in the perforation group but not in the controls (n = 10/group) and the abdomen was closed in both groups. After stabilization, CO2-induced pneumoperitoneum was established at 0, 5, 8 and 12 mmHg for 20 min periods consecutively, each followed by complete pressure relief for 5 min.

RESULTS

Ventilatory pressure increased in both groups when pneumoperitoneal pressure 5 mmHg was applied, but more so in the perforated stomach group (P = 0.003). ETCO2 increased in both groups during the experiment, but less so in the perforated group (P = 0.04). It then returned to near baseline values during pressure annulation in all perforated animals but only following the 0 and 5 mmHg periods in the controls.

CONCLUSIONS

When subjected to pneumoperitoneum, ETCO2 was lower in rats with a perforated stomach than in those with an intact stomach. An abrupt decrease in ETCO2 during laparoscopy may signal gastric perforation.

Influence of carbon dioxide insufflation of the neck on intraocular pressure during robot-assisted endoscopic thyroidectomy: a comparison with open thyroidectomy

BACKGROUND

Increased intraocular pressure (IOP) during surgery can result in serious ophthalmic complications. We hypothesized that carbon dioxide (CO₂) insufflation of the neck during endoscopic thyroidectomy would constrict the jugular veins mechanically, causing elevated venous pressure and thus elevated IOP. We compared IOP changes at each step of open thyroidectomy (OT) versus robot-assisted endoscopic thyroidectomy (RET) METHODS: Perioperatively, IOP was measured at six time points in patients undergoing OT (n = 18) or RET with CO₂ insufflation (n = 19). Anesthesia, ventilatory strategy, intravenous infusions, and surgical positioning were standardized

RESULTS

In both groups, induction of anesthesia reduced IOP, but surgical positioning with the neck in extension had no effect on IOP. In the OT group, IOP remained unchanged during anesthesia. In the RET group, CO₂ insufflation significantly increased IOP to an average of 3.6 ± 3.0 mmHg higher than the previous measurement (P < 0.001), and this IOP increase persisted immediately before gas deflation. These elevated IOP values during CO₂ insufflation in the RET group were significantly higher than those at corresponding time points in the OT group. However, these elevated IOP values were similar to the pre-anesthetic baseline IOP CONCLUSION: CO₂ insufflation of the neck at pressure of 6 mmHg increased the IOP significantly compared with open thyroidectomy. However, this increase in IOP could be balanced by an anesthetic-induced IOP-lowering effect, thereby having no clinical significance in patients with normal IOP undergoing robot-assisted endoscopic thyroidectomy.

Air-water fluxes of N₂O and CH₄ during microalgae (Staurosira sp.) cultivation in an open raceway pond

The industrial-scale production of biofuels from cultivated microalgae has gained considerable interest in the last several decades. While the climate benefits of microalgae cultivation that result from the capture of atmospheric CO(2) are known, the counteracting effect from the potential emission of other greenhouse gases has not been well quantified. Here, we report the results of a study conducted at an industrial pilot facility in Hawaii to determine the air-water fluxes of N(2)O and CH(4) from open raceway ponds used to grow the marine diatom Staurosira sp. as a feedstock for biofuel. Dissolved O(2), CH(4), and N(2)O concentrations were measured over a 24 h cycle. During this time, four SF(6) tracer release experiments were conducted to quantify gas transfer velocities in the ponds, and these were then used to calculate air-water fluxes. Our results show that pond waters were consistently supersaturated with CH(4) (up to 725%) resulting in an average emission of 19.9 ± 5.6 μmol CH(4) m(-2) d(-1). Upon NO(3)(-) depletion, the pond shifted from being a source to being a sink of N(2)O, with an overall net uptake during the experimental period of 3.4 ± 3.5 μmol N(2)O m(-2) d(-1). The air-water fluxes of N(2)O and CH(4) expressed as CO(2) equivalents of global warming potential were 2 orders of magnitude smaller than the overall CO(2) uptake by the microalgae.

Liver function assessment with three (13)C breath tests by two-point measurements

In this study, we performed three breath tests - l-[1-(13)C ]phenylalanine breath test (PBT), l-[1-(13)C ] methionine breath test, and [(13)C]methacetin breath test (MethaBT) - in patients with chronic liver disease to determine the optimal timing of expired air collection for diagnosing chronic liver disease and evaluating the grade of fibrosis. The subjects were 61 adults with normal livers, 98 chronic hepatitis patients, and 91 liver cirrhosis patients. We investigated the relationships of breath test results with routine biochemical tests and the Child-Pugh score, as well as the diagnostic capacities of the breath tests for liver dysfunction/cirrhosis and grade of liver fibrosis. For the diagnosis of liver cirrhosis and correlations with liver fibrosis, the accuracy of the PBT at 30 min (PBT30) was similar to that of the MethaBT at 15 min (Metha15). For liver function assessment by two-point measurement with (13)C breath tests, we recommend the PBT30 and the Metha15.

A novel system for transcutaneous application of carbon dioxide causing an "artificial Bohr effect" in the human body

Background

Carbon dioxide (CO₂) therapy refers to the transcutaneous administration of CO₂ for therapeutic purposes. This effect has been explained by an increase in the pressure of O₂ in tissues known as the Bohr effect. However, there have been no reports investigating the oxygen dissociation of haemoglobin (Hb) during transcutaneous application of CO₂in vivo. In this study, we investigate whether the Bohr effect is caused by transcutaneous application of CO2 in human living body.

Methods

We used a novel system for transcutaneous application of CO₂ using pure CO₂ gas, hydrogel, and a plastic adaptor. The validity of the CO₂ hydrogel was confirmed in vitro using a measuring device for transcutaneous CO₂ absorption using rat skin. Next, we measured the pH change in the human triceps surae muscle during transcutaneous application of CO₂ using phosphorus-31 magnetic resonance spectroscopy (³¹P-MRS) in vivo. In addition, oxy- and deoxy-Hb concentrations were measured with near-infrared spectroscopy in the human arm with occulted blood flow to investigate O2 dissociation from Hb caused by transcutaneous application of CO₂.

Results

The rat skin experiment showed that CO₂ hydrogel enhanced CO₂ gas permeation through the rat skin. The intracellular pH of the triceps surae muscle decreased significantly 10 min. after transcutaneous application of CO₂. The NIRS data show the oxy-Hb concentration decreased significantly 4 min. after CO₂ application, and deoxy-Hb concentration increased significantly 2 min. after CO₂ application in the CO₂-applied group compared to the control group. Oxy-Hb concentration significantly decreased while deoxy-Hb concentration significantly increased after transcutaneous CO₂ application.

Conclusions

Our novel transcutaneous CO₂ application facilitated an O₂ dissociation from Hb in the human body, thus providing evidence of the Bohr effect in vivo.

[Uptake 14CO2 from air and accumulation of 14C in hornwort]

Uptake 14CO2 from air and accumulation of 14C in the hornwort were studied by using the isotope-tracer techniques in order to get a better understanding of the environmental behavior of 14CO2. And the possibility of hornwort used as the indicator plant in the supervisor of 14CO2 air pollution was discussed. The results show that the hornwort could uptake 14CO2 from the air by some way and formed an accumulating trend. The main way was that the hornwort absorbed free 14CO2 and H 14CO3- from the water through photosynthesis. During the introducing 14CO2, the increasing rate of 14C specific activity in dry hornwort and fresh hornwort were between 91.9-95.6 Bq/(g x d) and 6.1-6.3 Bq/(g x d), respectively, which was roughly equal to the increasing rate in the wheat. The results indicate that the hornwort had strong ability of absorbing 14CO2 indirectly through water. The hornwort has an certain concentration of 14CO2. And the concentration factor (CF) values rise with the introduction of 14CO2 and decline slowly after it reached the maximum value. Owing to its accumulation of 14CO2, hornwort can be used as the indicator plant in the supervisor of 14CO2 air pollution.

[Carbon dioxide baths: state of the art]

Modern concepts of the mechanism of therapeutic action of carbon dioxide are reviewed with special reference to its effects on the patients with different pathologies undergoing treatment with the use of carbon dioxide baths. Further prospects for practical application of this method are discussed.

Pitfalls and Related Improvements of In Vivo Gas Uptake Pharmacokinetic Experimental Systems

Gas uptake chamber studies have been widely used to study inhalation pharmacokinetics (PKs) in rodents, often for the ultimate purpose of developing physiologically-based pharmacokinetic (PBPK) models that can be used to describe human PKs and to support risk assessment for the chemical. In the course of our studies of gasoline PKs, we revisited several important issues heretofore not thoroughly addressed. Here, we report several refinements which will significantly improve future studies with this type of system, relating to the understanding of loss rates, the importance of carbon dioxide removal, and sampling of blood and chamber air at the same time. Losses of chemicals in gas uptake systems consist of leakage, adsorption to system components, and adsorption to the hair and skin (fur) of experimental animals. The loss rates were experimentally determined for a series of chemicals and mixtures including n-hexane, benzene, toluene, ethylbenzene, o-xylene, gasoline, and other gasoline components. The rate of loss to the animals' fur was similar to loss rates to system components and involved absorption to both hair and skin. Most of the absorption to fur was reversible when the chamber concentration was low enough. The amount of chemical that desorbed from the animal after an experiment was significant when compared to the amount of chemical in the chamber at the end of a gas uptake experiment, indicating that the rate of decline in concentrations can be influenced by a decrease in the fur absorption rate or desorption of chemicals. A modified gas uptake system design is described in which a steel ring improved the connections to an autosampler and allowed insertion of probes to monitor gases, such as carbon dioxide (CO2), in the chamber. When CO2 absorbent efficiency was inadequate, CO2 concentrations rose to levels that significantly affected the animals' ventilation rate. Using a real-time CO2 probe, an absorbent system was developed that adequately controlled CO2 levels in the chamber. Attention to details of absorptive loss and CO2 scrubbing can improve the reliability of kinetic constants inferred from closed chamber studies. We then describe a method for extending gas uptake experiments by simultaneously collecting blood to be analyzed for chemicals and/or metabolites.

Subcutaneous carbon dioxide emphysema following laparoscopic salpingo-oophorectomy: a case report

Multiple patient and economic benefits have contributed to the widespread popularity of laparoscopic surgery. Although the laparoscopic approach is safe, it is not without potential complications. The following case study describes a patient undergoing a laparoscopic salpingo-oophorectomy who had a sudden rise in end-tidal carbon dioxide to 65 mm Hg and was found to have developed subcutaneous emphysema. Hyperventilation, close monitoring, and mechanical ventilation for 4 hours postoperatively resulted in a positive patient outcome. The mechanisms of carbon dioxide absorption, as well as risk factors, complications, treatment, and prevention of subcutaneous emphysema will be described.

Factors affecting 13C-natural abundance measurement of breath carbon dioxide during surgery: absorption of carbon dioxide during endoscopic procedures

The aim of this paper is to review the factors which may affect breath (13)CO(2)/(12)CO(2) natural abundance in patients undergoing surgery or intensive care. Intravenous glucose administration is a major determinant of the (13)CO(2)/(12)CO(2) of breath as intravenous glucose preparations are almost all derived from cornstarch. In addition, the oxidation of endogenous substrates can affect the (13)CO(2)/(12)CO(2) ratio. During many endoscopic procedures, such as laparoscopic surgery, carbon dioxide insufflation is used to provide a working space. As medical CO(2) is relatively depleted in (13)CO(2) compared with endogenous and exogenous metabolic CO(2) sources, breath (13)CO(2)/(12)CO(2) measurements can be used to estimate CO(2) absorption during these procedures. However, all these factors may also be affected by the bicarbonate pool, making a definitive attribution of changes in breath (13)CO(2)/(12)CO(2) to a single factor problematic.

CFTR inhibition augments NHE3 activity during luminal high CO2 exposure in rat duodenal mucosa

We hypothesized that the function of duodenocyte apical membrane acid-base transporters are essential for H(+) absorption from the lumen. We thus examined the effect of inhibition of Na(+)/H(+) exchanger-3 (NHE3), cystic fibrosis transmembrane regulator (CFTR), or apical anion exchangers on transmucosal CO(2) diffusion and HCO(3)(-) secretion in rat duodenum. Duodena were perfused with a pH 6.4 high CO(2) solution or pH 2.2 low CO(2) solution with the NHE3 inhibitor, S3226, the anion transport inhibitor, DIDS, or pretreatment with the potent CFTR inhibitor, CFTR(inh)-172, with simultaneous measurements of luminal and portal venous (PV) pH and carbon dioxide concentration ([CO(2)]). Luminal high CO(2) solution increased CO(2) absorption and HCO(3)(-) secretion, accompanied by PV acidification and PV Pco(2) increase. During CO(2) challenge, CFTR(inh)-172 induced HCO(3)(-) absorption, while inhibiting PV acidification. S3226 reversed CFTR(inh)-associated HCO(3)(-) absorption. Luminal pH 2.2 challenge increased H(+) and CO(2) absorption and acidified the PV, inhibited by CFTR(inh)-172 and DIDS, but not by S3226. CFTR inhibition and DIDS reversed HCO(3)(-) secretion to absorption and inhibited PV acidification during CO(2) challenge, suggesting that HCO(3)(-) secretion helps facilitate CO(2)/H(+) absorption. Furthermore, CFTR inhibition prevented CO(2)-induced cellular acidification reversed by S3226. Reversal of increased HCO(3)(-) loss by NHE3 inhibition and reduced intracellular acidification during CFTR inhibition is consistent with activation or unmasking of NHE3 activity by CFTR inhibition, increasing cell surface H(+) available to neutralize luminal HCO(3)(-) with consequent CO(2) absorption. NHE3, by secreting H(+) into the luminal microclimate, facilitates net transmucosal HCO(3)(-) absorption with a mechanism similar to proximal tubular HCO(3)(-) absorption.

Determination of growth rate and yield of nitrifying bacteria by measuring carbon dioxide uptake rate

Nitrifier growth parameters--the maximum growth rate (microAmax) and yield (YA)--were estimated by measuring the rate of carbon dioxide uptake and additional rates of oxygen uptake and ammonia (or nitrite) use. Batch tests in a combined titrimetric and offgas analyzer with enriched Nitrobacter and Nitrosomonas cultures and an activated sludge sample were performed. The measured microAmax values for the Nitrobacter and Nitrosomonas cultures were 0.67 +/- 0.03 day(-1) and 0.54 +/- 0.09 day(-1), while the YA values were 0.072 +/- 0.01 g volatile suspended solids (VSS) x g nitrogen (N)(-1) and 0.14 +/- 0.02 gVSS x gN(-1), respectively. For the activated sludge sample, microAmax was observed to increase with pH (microAmax = 0.72 x 3.3(pH-7.1)) over the range 6.8 to 7.1. All microAmax and YA values determined by this method were similar to those previously reported. Compared with other microAmax and YA estimation methods, this method allows for unique microAmax and YA estimations for given conditions from a single experiment.

Enhancement of dissolution amount and in vivo bioavailability of itraconazole by complexation with β-cyclodextrin using supercritical carbon dioxide

The main objective of this study was to improve the inclusion formation between itraconazole and beta-cyclodextrin and thus enhance dissolution amount and bioavailability characteristics of itraconazole. Inclusion complexes between itraconazole and beta-cyclodextrin were prepared using simple physical mixing, conventional coprecipitation method, and supercritical carbon dioxide (SC CO(2)). Effects of process variables (temperature, pressure) and drug:cyclodextrin ratio on inclusion yield and thermal behavior of the solid complexes prepared by SC CO(2) were studied and compared to those obtained by physical mixing and coprecipitation methods. In addition, dissolution amounts of the products obtained by different methods were measured in gastric fluid. Finally, pharmacokinetic studies of the inclusion complexes were conducted in male Wistar rats to assess the bioavailability of the prepared complexes. Results showed that temperature, pressure and itraconazole:beta-cyclodextrin ratio had significant effects on the inclusion yield of the complex prepared by SC CO(2) method. Higher inclusion yields were obtained in the SC CO(2) method as compared to physical mixing and coprecipitation methods. In vivo drug pharmacokinetic studies showed that the itraconazole-beta-cyclodextrin product prepared using SC CO(2) gave higher bioavailability of itraconazole (in blood, liver and kidney of male Wistar rats) as compared to the products obtained by physical mixing or coprecipitation methods.

The plasma membrane of erythrocytes plays a fundamental role in the transport of oxygen, carbon dioxide and nitric oxide and in the maintenance of the reduced state of the heme iron

Here we review new insights into the role of the erythrocyte membrane and the implications of its architecture on the several functions accomplished by the red blood cells. The picture which emerges highlights the capability of Hb and band 3 to modulate erythrocyte metabolism and to meet the needs of the cell.

Carbon dioxide clearance in rabbits during expiratory phase intratracheal pulmonary ventilation

The purpose of this study was to compare the efficacy of CO2 removal during conventional mechanical ventilation (CMV) with and without expiratory phase intratracheal pulmonary ventilation (expiratory ITPV or Exp-ITPV); and to compare CO2 clearance during Exp-ITPV, in pressure-controlled ventilation (PCV) and in volume-controlled ventilation (VCV) modes. Seven anesthetized rabbits were tracheotomized and intubated using a 4 mm endotracheal tube. Venous and arterial lines were established. The rabbits were paralyzed, mechanically ventilated, and ventilation parameters were adjusted to achieve baseline arterial hypercapnia. Animals were then ventilated during 30-minute trials of CMV and Exp-ITPV, in both PCV and VCV modes. A custom-built, microprocessor-controlled solenoid valve was used to limit ITPV gas flow to the expiratory phase. Proximal and carinal airway pressures and hemodynamic variables were continuously recorded, and arterial blood gases were analyzed at the end of each trial. Exp-ITPV, as compared with CMV, reduced arterial PCO2 by 12% and 21% in PCV and VCV modes, respectively (p < 0.02 and p < 0.001; one-sided paired t test), without significant changes in other cardiorespiratory variables. In conclusion, Exp-ITPV is more effective than CMV in clearing CO2 through a small endotracheal tube. Exp-ITPV is also more effective in VCV mode than PCV mode.

Absorption of carbon dioxide during laparoscopy in children measured using a novel mass spectrometric technique

BACKGROUND

Carbon dioxide (CO(2)) is absorbed during pneumoperitoneum and may cause adverse haemodynamic effects. The aim of this study was to measure the elimination of exogenous CO(2) during laparoscopy in children.

METHODS

Ten children [27.6 (56.5) months; mean (SD)] undergoing laparoscopic and nine [24.5 (17.3) months] undergoing open surgery were studied. Breath samples were collected at the line for end-tidal CO(2) and analysed for (13)CO(2)/(12)CO(2) ratio expressed as deltaPDB (difference from standard), by isotope-ratio mass spectrometry. The proportion of absorbed CO(2) was calculated comparing exhaled (13)CO(2)/(12)CO(2) before and during CO(2) pneumoperitoneum.

RESULTS

(13)CO(2)/(12)CO(2) in medical CO(2) was -32.7 (2.1) deltaPDB. (13)CO(2)/(12)CO(2) in breath of patients undergoing open procedures was -24.3 (2.4) deltaPDB at the start of operation and did not change during the operation (P > 0.2). (13)CO(2)/(12)CO(2) in breath of patients undergoing laparoscopy was -21.5 (5.4) deltaPDB at the start of insufflation, and decreased during pneumoperitoneum by 2.5 (1.6) deltaPDB, indicating absorption of exogenous CO(2). The percentage of expired CO(2) absorbed rose to 15.5 (7.7)% after 30 min of pneumoperitoneum and decreased rapidly after desufflation.

CONCLUSION

After 10 min of laparoscopy 10-20% of expired CO(2) derives from the exogenous CO(2). CO(2) absorption can be measured using a simple mass spectrometric technique.

13C-NMR Study of the Ruthenium(II)-Catalyzed Degradation of Labeled G-Factor Endoperoxides: Proposal of a Likely Biogenetic Pathway and Evidence for CO2 Release

G-factor endoperoxides are natural products acting as phytohormones and contribute to root inhibition and frost resistance in Eucalyptus grandis and other Myrtaceae. Several (Z)- and (E)-configured cyclopentane-1,3-dione metabolites of G-factors have been found in some Eucalyptus extracts. Interestingly, these probable metabolites are identical to the products obtained by Ru(II)-catalyzed reduction of G-factors. In the present work, we, thus, studied the mechanism involved in the formation of these compounds by means of in-depth NMR distribution analysis of two differently 13C-labeled G3-factors. The observed CO2 release is underlined, and a comparison with the corresponding Fe(II)-induced degradation of G-factor endoperoxides is made. Also, the type of electron transfer proposed in the two processes is discussed and, tentatively, connected to the role of endoperoxides in plants.

Evaluation of drug delivery characteristics of microspheres of PMMA-PCL-cholesterol obtained by supercritical-CO2 impregnation and by dissolution-evaporation techniques

Poly(methyl methacrylate), PMMA, and of PMMA/Poly(epsilon-caprolactone), PCL, microspheres were loaded with different amounts of cholesterol by using a supercritical carbon dioxide (SC-CO2) impregnation process in order to use a clean technique with the absence of organic solvents, and to provide information for the infusion of additives into nonporous polymeric substrates. A conventional dissolution-evaporation method was also used to obtain PMMA and PMMA-PCL microparticles loaded with cholesterol. The obtained microspheres were characterized by environmental scanning electronic microscope, ESEM, nuclear magnetic resonance spectroscopy, NMR, and differential scanning calorimetry, DSC, thermal analysis. A comparison of drug release from particles obtained using both methods, the supercritical and the conventional, is presented.

Usefulness of selective contrast echocardiography and selective scintigraphy for the evaluation of pulmonary arteriovenous fistula in a patient with systemic arterial supply to a normal lung

To determine a surgical procedure for the correction of a systemic arterial supply to a normal lung, it is important to evaluate whether the patient has a pulmonary arteriovenous fistula. In this article, the authors report for the first time a patient in which selective contrast echocardiography and selective perfusion scintigraphy from an abnormal artery clearly demonstrated and quantified the pulmonary arteriovenous fistula. The authors believe that these methods are useful in determining the appropriate operative procedure for this condition.

Carbon dioxide elimination and gas displacement vary with piston position during high-frequency oscillatory ventilation

INTRODUCTION

Alterations in gas displacement in pediatric patients ventilated with the SensorMedics 3100A high-frequency oscillator are most commonly manipulated by adjusting the amplitude, frequency, and percent inspiratory time. The piston-position-and-displacement indicator is commonly centered and subsequently not adjusted. That practice may limit the clinician's ability to optimize carbon dioxide elimination. We hypothesized that varying the piston position would alter gas displacement and carbon dioxide elimination.

METHODS

We conducted an observational study in a tertiary pediatric intensive care unit and a correlated bench study. In the clinical study, 24 patients were ventilated with a SensorMedics 3100A high-frequency oscillator. Transcutaneously measured carbon dioxide ((tCO(2))) values were documented with the piston-position-and-displacement indicator in left, center, and right positions. In the bench study the oscillator was set and maintained at: mean airway pressure 15 cm H(2)O, inspiratory time 33% of respiratory-cycle time, bias flow 20 L/min. A pneumotachometer attached to a respiratory mechanics monitor was placed between the ventilator circuit and a test lung. Data were collected with the piston-position-and-displacement indicator at the left, center, and right positions with frequencies of 4-14 Hz and amplitudes of 25-55 cm H(2)O. Data were collected over a 3-minute time period for each combination of frequency, amplitude, and piston-position-and-displacement-indicator position. We compared the data with repeated-measures analysis of variance. Pairwise comparisons were performed with a 2-tailed Student's test with Bonferroni correction.

RESULTS

Among the 24 patients (tCO(2)) was significantly associated with the position of the piston (p < 0.007). In the bench study, gas displacement was higher when the piston-position-and-displacement indicator was positioned to the left (than when at the center position) 91.7% of the time (p < 0.0001). When the piston-position-and-displacement indicator was positioned to the right (as compared to the center position), gas displacement was lower 75% of the time (p < 0.0001).

CONCLUSION

Adjusting the oscillator piston alters the volume of gas displaced and provides an additional means for titrating carbon dioxide elimination. .

Amsorb Plus and Drägersorb Free, two new-generation carbon dioxide absorbents that produce a low compound A concentration while providing sufficient CO2 absorption capacity in simulated sevoflurane anesthesia

PURPOSE

The properties of two new-generation CO(2) absorbents, Amsorb Plus (Armstrong Medical, Coleraine, UK) and Drägersorb Free (Drager, Lubeck, Germany), were compared with those of Amsorb (Armstrong Medical) and Sodasorb II (W.R. Grace, Lexington, MA, USA).

METHODS

The concentration of compound A produced by each absorbent was determined in a low-flow circuit containing sevoflurane, and the CO(2) absorption capacity of the absorbent was measured. The circuit contained 1000 g of each absorbent and had a fresh gas (O(2)) flow rate of 1 l.min(-1) containing 2% sevoflurane. CO(2) was delivered to the circuit at a flow rate of 200 ml.min(-1).

RESULTS

The maximum concentrations of compound A were 2.2 +/- 0.0, 2.3 +/- 0.3, 2.2 +/- 0.2, and 23.5 +/- 1.5 ppm (mean +/- SD) for Amsorb Plus, Drägersorb Free, Amsorb, and Sodasorb II, respectively. The maximum concentration of compound A for Sodasorb II was significantly higher than those for the other absorbents (P < 0.01). The CO(2) absorption capacities (time taken to reach an inspiratory CO(2) level of 2 mmHg) were 1023 +/- 48, 1074 +/- 36, 767 +/- 41, and 1084 +/- 54 min, respectively, and the capacity of Amsorb was significantly lower than that of the other absorbents (P < 0.01).

CONCLUSION

The new-generation carbon dioxide absorbents, Amsorb Plus and Drägersorb Free, produce a low concentration of compound A in the circuit while showing sufficient CO(2) absorption capacity.

Effective protein release from PEG/PLA nano-particles produced by compressed gas anti-solvent precipitation techniques

Homogeneous PLA/insulin solutions containing different amounts of 350, 750 or 1900 Da PEG (0-75 wt.% PEG) were processed by semi-continuous compressed CO2 anti-solvent precipitation to fabricate protein-loaded polymeric nano-particles. Proper operative conditions (temperature, pressure, CO2 flow rate and washing time) yielded more than 70% product recovery. Scanning electron microscopy, transmission electron microscopy and light scattering demonstrated that spherical, smooth surfaced particles with size below 1 microm could be obtained. X-ray diffraction analysis showed that the gas anti-solvent process modifies the polylactide crystalline state. PEG concentration and molecular weight were found to affect both optimal operative conditions and morphological and biopharmaceutical properties of the final product. Insulin loading yield dropped from 95% to 65% by increasing the 1900 Da PEG content from 0 to 75 wt.% or the PEG molecular weight from 350 to 1900 Da. The release rate increased significantly as the PEG content in the formulation increases. After 3-month incubation the drug released raised from 10% to 100% by increasing the 1900 Da PEG content from 23 to 7 wt.%. Formulations containing the same 350, 750 or 1900 Da PEG amount (67 wt.% PEG) displayed similar release profiles. Insulin release was found to take place by diffusion mechanism, despite the observation of matrix degradation.

Hydrolysis of Lactose in Whey Permeate for Subsequent Fermentation to Ethanol

Fermentation of lactose in whey permeate directly into ethanol has had only limited commercial success, as the yields and alcohol tolerances of the organisms capable of directly fermenting lactose are low. This study proposes an alternative strategy: treat the permeate with acid to liberate monomeric sugars that are readily fermented into ethanol. We identified optimum hydrolysis conditions that yield mostly monomeric sugars and limit formation of fermentation inhibitors such as hydroxymethyl furfural by caramelization reactions. Both lactose solutions and commercial whey permeates were hydrolyzed using inorganic acids and carbonic acid. In all cases, more glucose was consumed by secondary reactions than galactose. Galactose was recovered in approximately stoichiometric proportions. Whey permeate has substantial buffering capacity-even at high partial pressures (>5500 kPa[g]), carbon dioxide had little effect on the pH in whey permeate solutions. The elevated temperatures required for hydrolysis with CO2-generated inhibitory compounds through caramelization reactions. For these reasons, carbon dioxide was not a feasible acidulant. With mineral acids reversion reactions dominated, resulting in a stable amount of glucose released. However, the Maillard browning reactions also appeared to be involved. By applying Hammet's acidity function, kinetic data from all experiments were described by a single line. With concentrated inorganic acids, low reaction temperatures allowed lactose hydrolysis with minimal by-product formation and generated a hexose-rich solution amenable to fermentation.

Itraconazole Formation Using Supercritical Carbon Dioxide

A new method of preparing Itraconazole (C35H38Cl2N8O4), a synthetic triazole antifungal agent, was developed using supercritical carbon dioxide (SC CO2) while eliminating the use of toxic solvents. Dissolution amounts of the product were measured in gastric fluid and compared to those of conventional drug formulations. Different operating conditions (five levels of treatment temperature ranging between 110-140 degrees C, four levels of treatment pressure ranging between 30-400 atm, and four different treatment times ranging from 10-60 minutes) were tested in order to produce a desired Itraconazole product, which does not degrade during the product formation and has the highest extent of dissolution in gastric fluid after one hour. Itraconazole dissolution of 100% at one-hour was achieved for the drug produced at the optimum treatment condition: 135 degrees C, 300 atm, and 30 minutes. Extent of dissolution obtained from this solvent and detergent-free process is 10% higher than that of the conventional method involving toxic organic solvents. Itraconazole produced using SC CO2 should provide minimal side effects in human body.

A biokinetic model for carbon dioxide and bicarbonate

A systemic biokinetic model is presented for radiocarbon taken into the body as carbon dioxide or bicarbonate. Parameter values describing retention and excretion of carbon during the first few weeks after administration are based on studies of the fate of radiocarbon in human subjects after injection of labelled bicarbonate or inhalation of carbon dioxide. Data on laboratory animals administered labelled bicarbonate, carbonate or carbon dioxide provide information on the tissue distribution and long-term retention of carbon. Model predictions of the time-dependent distribution and retention of carbon differ considerably from those of models recommended by the International Commission on Radiological Protection.

Influence of the stimulation of central chemoreceptors on the gastric mucosal blood flow in artificially ventilated and spontaneously breathing rats

Respiratory failure coincides frequently with the occurrence of gastric ulceration. In advanced respiratory insufficiency hypoxemia is often accompanied by hypercapnia, which is the stimulus for central chemoreceptors as well as for carotid body chemoreceptors. The purpose of the work was to investigate the reflex effect of stimulation of central chemoreceptors on gastric mucosal blood flow (GMBF) in the rat. Central chemoreceptors were stimulated by a gas mixture composed of 10% carbon dioxide, 50% oxide and 40% nitrogen. In artificially ventilated and spontaneously breathing animals, the stimulation of central chemoreceptors caused a significant increase in gastric mucosal vascular resistance, accompanied by a marked decline in blood flow. We hypothesize that in patients with respiratory insufficiency accompanied by hypercapnia, the reflex impairment of GMBF may contribute to gastric ulceration.

Increased carbon dioxide absorption during retroperitoneal laparoscopy

BACKGROUND

Retroperitoneoscopy for renal surgery is now a common procedure. We compared carbon dioxide absorption in patients undergoing retroperitoneoscopy for adrenal or renal surgery with that of patients undergoing laparoscopic cholecystectomy.

METHODS

We measured carbon dioxide elimination with a metabolic monitor in 30 anaesthetized patients with controlled ventilation, undergoing retroperitoneoscopy (n=10), laparoscopy (n=10) or orthopaedic surgery (n=10).

RESULTS

Carbon dioxide production increased by 38, 46 and 63% at 30, 60 and 90 min after insufflation (P<0.01) in patients having retroperitoneoscopy. Carbon dioxide production (mean (SD)) increased from 92 (21) to 150 (43) ml x min(-1) m(-2) 60-90 min after insufflation and remained increased after the end of insufflation. During laparoscopy, V(.)(CO(2)) increased less (by 15%) (P<0.05 compared with retroperitoneoscopy) and remained steady throughout the procedure.

CONCLUSION

Retroperitoneal carbon dioxide insufflation causes more carbon dioxide absorption than intraperitoneal insufflation, and controlled ventilation should be increased if hypercapnia should be avoided.

Reduction of correlation dimension in human respiration by inhaling a mixture gas of 5% carbon dioxide and 95% oxygen

In order to investigate the effect of the respiratory control system on deterministic behavior in respiration, we used nonlinear analysis in subjects breathing a mixture gas of 5% carbon dioxide (CO2) and 95% oxygen (O2) (CO2-mixed gas). The respiratory movements during breathing air or CO2-mixed gas in eight healthy volunteers were measured. We estimated the values of the correlation dimension (D2) in respiratory movement using Grassberger-Procaccia algorithm. The respiratory movements during inhaling either air or CO2-mixed gas showed a nonlinear behavior using surrogate data method. The values of D2 in respiratory movement during inhaling CO2-mixed gas (1.77 +/- 0.17) were significantly smaller than those during inhaling air (2.52 +/- 0.60) (P < 0.05). This might be related to a prompt change in the nonlinear signal from the central respiratory chemical system.

Temporal variation in delta(13)C of ecosystem respiration in the Pacific Northwest: links to moisture stress

We measured seasonal and interannual variations in delta(13)C values within the carbon reservoirs (leaves and soil) and CO(2) fluxes (soil and ecosystem respired CO(2)) of an old growth coniferous forest in the Pacific Northwest USA with relation to local meteorological conditions. There were significant intra-annual and interannual differences in the carbon isotope ratios of CO(2) respired at both the ecosystem (delta(13)C(R)) and the soil levels (delta(13)C(R-soil)), but only limited variations in the carbon isotope ratios of carbon stocks. The delta(13)C(R) values varied by as much as 4.4 per thousand over a growing season, while delta(13)C(R-soil )values changed as much as 6.2 per thousand. The delta(13)C of soil organic carbon (delta(13)C(SOC)) and needle organic carbon (delta(13)C(P)) exhibited little or no significant changes over the course of this study. Carbon isotope discrimination within leaves (Delta(p)) showed systematic decreases with increased canopy height, but remained fairly constant throughout the year (Delta(p)=17.9 per thousand -19.2 per thousand at the top of the canopy, Delta(p)=19.6 per thousand -20.9 per thousand at mid-canopy, Delta(p)=23.3 per thousand -25.1 per thousand at the canopy base). The temporal variation in the delta(13)C of soil and ecosystem respired CO(2) was correlated ( r=0.93, P<0.001) with soil moisture levels, with dry summer months having the most (13)C-enriched values. The dynamic seasonal changes in delta(13)C of respired CO(2) are hypothesized to be the result of fast cycling of recently fixed carbon back to the atmosphere. One scaling consequence of the seasonal and interannual variations in delta(13)C(R) is that inversion-based carbon-cycle models dependent on observed atmospheric CO(2) concentration and isotope values may be improved by incorporating dynamic delta(13)C(R) values to interpret regional carbon sink strength.

Uptake of atmospheric carbon dioxide into silk fiber by silkworms

The relation between the uptake of atmospheric CO(2) and insect's production of silk fiber has not yet been reported. Here, we provide the first quantitative demonstrations that four species of silkworms (Bombyx mori, Samia cynthia ricini, Antheraea pernyi, and Antheraea yamamai) and a silk-producing spider (Nephila clavata) incorporate atmospheric CO(2) into their silk fibers. The abundance of (13)C incorporated from the environment was determined by mass spectrometry and (13)C NMR measurements. Atmospheric CO(2) was incorporated into the silk fibers in the carbonyl groups of alanine, aspartic acid, serine, and glycine and the C(gamma) of aspartic acid. We show a simple model for the uptake of atmospheric CO(2) by silkworms. These results will demonstrate that silkworm has incorporated atmospheric CO(2) into silk fiber via the TCA cycle; however, the magnitude of uptake into the silk fibers is smaller than that consumed by the photosynthesis in trees and coral reefs.

Non-steady state monitoring by respiratory gas exchange

Traditionally, the study of CO2 and O2 kinetics in the body has been mostly confined to equilibrium conditions. However, the peri-anesthesia period and the critical care arena often involve conditions of non-steady state. The detection and explanation of CO2 kinetics during non-steady state pathophysiology have required the development of new methodologies, including the CO2 expirogram, average alveolar expired PCO2, and CO2 volume exhaled per breath. Several clinically relevant examples of non-steady state CO2 kinetics perturbations are examined, including abrupt decrease in cardiac output, application of positive end-expiratory pressure during mechanical ventilation, and occurrence of pulmonary embolism. The lesser known area of non-steady state O2 kinetics is introduced, including the measurement of pulmonary O2 uptake per breath. Future directions include the study of the respiratory quotient per breath, where the anaerobic threshold during anesthesia is identified by increasing respiratory quotient.

Carbon dioxide elimination during laparoscopy in children is age dependent

The absorption of carbon dioxide (CO2) used for positive pressure pneumoperitoneum may lead to an increased CO2 load. CO2 elimination during laparoscopy has not been investigated previously in paediatrics. The aim of this study was to characterise the pattern of CO2 elimination during laparoscopic surgery in infants and children.

METHODS

Twenty children undergoing laparoscopy and 19 children undergoing laparotomy for elective abdominal operations were studied. Pneumoperitoneum was achieved using insufflation of unheated CO2. CO2 elimination (metabolically produced + absorbed; milliliters per kilogram per minute) was measured minute by minute during the operation by indirect calorimetry. End-tidal CO2 (kPa) was recorded every 10 minutes. The above variables were assessed before CO2 insufflation, during pneumoperitoneum, and after desufflation.

RESULTS

Before insufflation, CO2 elimination was 4.6 +/- 0.3 ml/kg/min and increased after 15 minutes of pneumoperitoneum to 5.2 +/- 0.3 (P <.001). Post desufflation, CO2 elimination decreased toward preinsufflation values, but did not return to baseline by the end of operation (5.8 +/- 0.3; P <.001). End-tidal CO2 was 4.7 +/- 0.2 preinsufflation, peaked at 1 hour (5.3 +/- 0.2; P <.001) and subsequently decreased in response to ventilatory adjustments. The total amount of CO2 insufflated was positively correlated with patient age (r2 = 0.27; P <.01). CO2 elimination was age related, as indicated by multilevel model analysis and by negative correlations between maximum increase in CO2 elimination and both age (r2 = 0.27; P <.01) and weight (r2 = 0.29; P <.01). These data suggest that the younger or smaller the child, the larger the increase in CO2 elimination. Seven patients (35%) responded to desufflation with a sharp transient increase in CO2 elimination, which did not appear to be related to patient age, length of pneumoperitoneum, abdominal pressure, or type of operation.

CONCLUSIONS

During pneumoperitoneum, younger children absorb proportionately more CO2 than older individuals. The short-lived increase in CO2 elimination postdesufflation may be related to an increase in venous return from the lower limbs after release of the abdominal pressure. These findings suggest that small children warrant close monitoring during laparoscopy and during the immediate postoperative period.

Supercritical fluid extraction of a lignocellulosic hydrolysate of spruce for detoxification and to facilitate analysis of inhibitors

This work describes a novel approach to detoxify lignocellulosic hydrolysates and facilitate the analysis of inhibitory compounds, namely supercritical fluid extraction (SFE). The efficiency of the fermentation of lignocellulosic dilute-acid hydrolysates depends upon the composition of the hydrolysate and the organism used. Furthermore, it has been shown that inhibitors in the hydrolysate reduce the fermentation yield. This knowledge has given rise to the need to identify and remove the inhibiting compounds. Sample clean-up or work-up steps, to provide a clean and concentrated sample for the analytical system, facilitate the characterization of inhibitors, or indeed any compound in the hydrolysates. Removal of inhibitors was performed with countercurrent flow supercritical fluid extraction of liquid hydrolysates. Three different groups of inhibitors (furan derivatives, phenolic compounds, and aliphatic acids) and sugars were subsequently analyzed in the hydrolysate, extracted hydrolysate, and extract. The effect of the SFE treatment was examined with respect to fermentability with Saccharomyces cerevisiae. Not only did the extraction provide a clean and concentrated sample (extract) for analysis, but also a hydrolysate with increased fermentability as well as lower concentrations of inhibitors such as phenolics and furan derivatives.

Sensing and transfer of respiratory gases at the fish gill

The gill is both a site of gas transfer and an important location of chemoreception or gas sensing in fish. While often considered separately, these two processes are clearly intricately related because the gases that are transferred between the ventilatory water and blood at the gill are simultaneously sensed by chemoreceptors on, and within, the gill. Modulation of chemoreceptor discharge in response to changes in O(2) and CO(2) levels, in turn, is believed to initiate a series of coordinated cardiorespiratory reflexes aimed at optimising branchial gas transfer. The past decade has yielded numerous advances in terms of our understanding of gas transfer and gas sensing at the fish gill, particularly concerning the transfer and sensing of carbon dioxide. In addition, recent research has moved from striving to construct a single model that covers all fish species, to recognition of the considerable inter-specific variation that exists with respect to the mechanics of gas transfer and the cardiorespiratory responses of fish to changes in O(2) and CO(2) levels. The following review attempts to integrate gas transfer and gas sensing at the fish gill by exploring recent advances in these areas.

Disappearance of intraperitoneal gas following gynaecological laparoscopy

We investigated 25 day case gynaecological laparoscopy patients to determine the duration of the pneumoperitoneum, the rate at which residual gas disappeared and the relative contribution of this gas to pain in the early postoperative period. The volume of gas was calculated from measurements of the subdiaphragmatic gas bubble obtained from an erect chest X-ray. Each patient was X-rayed twice, either immediately prior to discharge and at 24 h post laparoscopy, or at 24 h and 48 h post surgery. Patients were contacted by telephone at 24 and 48 h to confirm fitness to return for the X-ray and at the same time verbal pain and activity scores were recorded. We found that residual gas was almost entirely gone by 48 h following surgery and that it appeared to reduce in an exponential manner. The contribution of this gas to postoperative pain was significant in the first 24 h, but by 48 h it was considerably reduced. We conclude that in day case gynaecological laparoscopy patients, postoperative pneumoperitoneum is short-lived, and that by 48 h its volume and contribution to postoperative pain should be minimal.

Measurement of oxygen consumption on-kinetics during exercise: implications for patients with heart failure

Oxygen consumption (VO(2)) on-kinetics describes the rate change in oxygen uptake at the initiation of exercise. Several mathematical and graphical methods are used to assess VO(2) on-kinetics during constant-load or progressive exercise. VO(2) on-kinetics is prolonged in patients with heart failure (HF) compared with individuals who have normal cardiopulmonary function. Cardiac function has been implicated as one of the controlling mechanism for this observation. The contribution that pulmonary, vascular, and skeletal muscle function makes to delayed VO(2) on-kinetics in HF has yet to be determined. VO(2) on-kinetics also appears to have clinical value in HF, although evidence supporting this claim is limited. Questions about the controlling mechanism(s) and practical application of VO(2) on-kinetics in HF therefore remain unanswered. This report provides an overview of VO(2) on-kinetics assessment techniques, reviews research pertaining to the HF population, and provides direction for future investigations.

Distinct constitutive and low-CO2-induced CO2 uptake systems in cyanobacteria: genes involved and their phylogenetic relationship with homologous genes in other organisms

Cyanobacteria possess a CO(2)-concentrating mechanism that involves active CO(2) uptake and HCO(3)(-) transport. For CO(2) uptake, we have identified two systems in the cyanobacterium Synechocystis sp. strain PCC 6803, one induced at low CO(2) and one constitutive. The low CO(2)-induced system showed higher maximal activity and higher affinity for CO(2) than the constitutive system. On the basis of speculation that separate NAD(P)H dehydrogenase complexes were essential for each of these systems, we reasoned that inactivation of one system would allow selection of mutants defective in the other. Thus, mutants unable to grow at pH 7.0 in air were recovered after transformation of a DeltandhD3 mutant with a transposon-bearing library. Four of them had tags within slr1302 (designated cupB), a homologue of sll1734 (cupA), which is cotranscribed with ndhF3 and ndhD3. The DeltacupB, DeltandhD4, and DeltandhF4 mutants showed CO(2)-uptake characteristics of the low CO(2)induced system observed in wild type. In contrast, mutants DeltacupA, DeltandhD3, and DeltandhF3 showed characteristics of the constitutive CO(2)-uptake system. Double mutants impaired in one component of each of the systems were unable to take up CO(2) and required high CO(2) for growth. Phylogenetic analysis indicated that the ndhD3/ndhD4-, ndhF3/ndhF4-, and cupA/cupB-type genes are present only in cyanobacteria. Most of the cyanobacterial strains studied possess the ndhD3/ndhD4-, ndhF3/ndhF4-, and cupA/cupB-type genes in pairs. Thus, the two types of NAD(P)H dehydrogenase complexes essential for low CO(2)-induced and constitutive CO(2)-uptake systems associated with the NdhD3/NdhF3/CupA-homologues and NdhD4/NdhF4/CupB-homologues, respectively, appear to be present in these cyanobacterial strains but not in other organisms.

Preliminary development and evaluation of an algae-based air regeneration system

The potential of air regeneration system based on the growth of microalgae on the surface of porous ceramic tubes is evaluated. The algae have been maintained in the system for extended periods, up to 360 days. Preliminary measurements of the photosynthetic capacity have been made for Chlorella vulgaris (UTEX 259), Neospongiococcum punctatum (UTEX 786), Stichococcus sp., and Gloeocapsa sp. Under standard test conditions (photosynthetic photon flux approximately 66 micromoles m-2 s-1, initial CO2 concentration approximately 450 micromoles mol-1), mature tubes remove up to 0.2 micromoles of CO2 per tube per minute. The rate of removal increases with photon flux up to at least 225 micromoles m-2 s-1 (PPF); peak rates of 0.35 micromoles of CO2 per tube per minute have been achieved with Chlorella vulgaris. These rates correspond to between 120 and 210 micromoles of CO2 removed per square meter of projected area per minute.

Effects of CO2 pneumoperitoneum on the basilar artery

BACKGROUND

Laparoscopic surgery provides many benefits to the patients. The purpose of this study was to evaluate cerebral blood flow changes and the possibility of ischemia-reperfusion injury occurring during carbon dioxide (CO(2)) pneumoperitoneum.

METHODS

Forty-eight New Zealand white rabbits were divided into four experimental and two control groups. Rabbits were subjected to CO(2) pneumoperitoneum with an intraabdominal pressure of 8 and 15 mmHg for 60 or 180 min as designed for experimental groups. We then assessed the changes in physiological and transcranial Doppler ultrasonographic parameters, as well as brain malondialdehyde levels.

RESULTS

Transcranial Doppler sonography of the basilar artery revealed elevated mean velocity and decreased resistance index and pulsatility index values with the longer-duration and higher-pressure CO(2) pneumoperitoneum. However, there were no statistically significant difference in m alondialdehyde values.

CONCLUSION

Elevated intraabdominal pressure by CO(2)-pneumoperitoneum, which does not lead to ischemia-reperfusion injury of the brain tissue, results in increased cerebral blood flow and reduced cerebrovascular resistance as an autoregulatory cerebral answer for CO(2).

Recovery of (13)CO(2) from infused [1-(13)C]leucine and [1,2-(13)C(2)]leucine in healthy humans

Carbon (C) in the 1-position of leucine is released as CO(2) with the decarboxylation of alpha-ketoisocaproate (KIC). Carbon in the 2-position of leucine undergoes several additional metabolic steps before entering the tricarboxylic acid (TCA) cycle in the 1-position of acetyl-CoA, where it can be released as CO(2) or be incorporated into other compounds. This study examined the metabolic fate of C in the 2-position of leucine. We infused 11 healthy subjects with [1-(13)C]leucine and [1,2-(13)C(2)]leucine for 3.5--4 h to measure leucine kinetics and the oxidation of the tracers from enrichments of (13)C in blood and expired CO(2). The fraction of leucine infused that was oxidized (f(ox)) was used to define the degree of recovery of the (13)C label(s) for each tracer. As expected, leucine appearance (means +/- SE) did not differ between tracers ((13)C(1): 92.1 +/- 3.1 vs. (13)C(2): 89.2 +/- 3.2 micromol x kg(-1) x h(-1)) when calculated using plasma leucine enrichments as an index of intracellular enrichment. A small (3%) but significant (P = 0.048) difference between tracers was found when KIC was used to calculate leucine appearance ((13)C(1): 118.0 +/- 4.1 vs. (13)C(2): 114.4 +/- 4.5 micromol x kg(-1) x h(-1)). The value of f(ox) was 14 +/- 1% for [1,2-(13)C(2)]leucine and was lower than the f(ox) for [1-(13)C]leucine (19 +/- 1%). From the f(ox) data, we calculated that the recovery of the 2-(13)C label in breath CO(2) was 58 +/- 6% relative to the 1-(13)C label. These findings show that, although a majority of the 2-(13)C label of leucine is recovered in breath CO(2), a significant percentage (approximately 42%) is retained in the body, presumably by transfer to other compounds, via TCA exchange reactions.

Repeated hypoxic exposures change respiratory chemoreflex control in humans

1. A group of seven volunteers (5 male, 2 female) were exposed to 20 min isocapnic (eucapnic) hypoxia once daily for 14 consecutive days. Their chemoreflexes were measured before and after each exposure. The same volunteers repeated the exposures with air substituted for the hypoxic gas mixture in a pseudorandom crossover design. 2. On day 1 an initial ventilatory response to hypoxia and subsequent decline was discernible in two volunteers, but the mean response for all volunteers at this stage was not significant. However, the response gradually increased, and by day 14 was discernible in six volunteers making the mean response for all volunteers significant. No change was observed over the 14 days of air exposure. 3. Only the chemoreflex threshold measured in iso-oxic (hypoxic) modified rebreathing tests changed significantly, and only for the series of exposures to hypoxia. 4. Over 14 days, the mean +/- S.E.M. threshold for all volunteers fell proportionately, from 42 +/- 1.1 mmHg on day 1 to 39 +/- 1.0 mmHg on day 14. By contrast, the mean +/- S.E.M. threshold, for all volunteers and all days, rose from 40 +/- 0.4 mmHg before to 42 +/- 0.5 mmHg after the hypoxic exposures. 5. We conclude that the enhancement of the initial ventilatory response to hypoxia induced by repeated hypoxic exposure is produced by a decrease in chemoreflex threshold. However, the decline in the ventilatory response during a single exposure is produced by an increase in the chemoreflex threshold. Since threshold changes were only found for hypoxic (iso-oxic) modified rebreathing tests, we conclude that only the peripheral chemoreflex changed.

Absorption of intraperitoneal CO2 after laparoscopy in piglets: an experimental study

PURPOSE

The aim of this study was to study the absorption time of CO(2) after laparoscopy in piglets.

METHODS

Laparoscopies were performed on 14 6-week-old piglets. The animals' abdomens were x-rayed immediately after closure 1, 1.5, and 2 hours postoperatively, and thereafter daily.

RESULTS

All CO(2) was absorbed completely within 1 day.

CONCLUSION

CO(2) absorption may follow a similar time course in small children. J Pediatr Surg 36:913-916.

Improved respiratory delivery of the anticancer drugs, camptothecin and paclitaxel, with 5% CO2-enriched air: pharmacokinetic studies

PURPOSE

To increase pulmonary deposition of anticancer liposome aerosols in mice by modulation of respiratory physiology through the addition of 5% CO2 to the air source used to generate the aerosols. Breathing CO2-enriched aerosol increases pulmonary ventilation with concurrent increased deposition of inhaled particles.

METHODS

Dilauroylphosphatidylcholine liposome formulations of two anticancer drugs, paclitaxel (PTX) and camptothecin (CPT), were investigated. The aerosol droplet size was measured using an Andersen cascade impactor. Drug concentrations in aerosol droplet fractions and tissues were determined by HPLC analysis. ICR mice were exposed to each liposome aerosol for 30 min. For each drug, one group of mice inhaled the drug-liposome aerosol generated with a mixture of 5% CO2 in air and another group inhaled the drug-liposome aerosols produced with normal air. Tissue distribution and pharmacokinetics were determined for both drug delivery systems.

RESULTS

Significantly higher concentrations of PTX and CPT were found in organs of mice exposed to 5% CO2-air aerosols compared to organs of mice exposed to normal air aerosols. The highest concentrations of drug were detected in the lungs and were two- to fourfold higher with 5% CO2-air aerosols than with aerosols generated with normal air. Higher concentrations were also detected in liver, spleen, kidneys, blood, and brain.

CONCLUSION

5% CO2 enrichment of air increased respiratory tract deposition of inhaled aerosol particles containing PTX and CPT.