We have described a rat model that responds to repetitive episodic hypoxia (12-s infusions of nitrogen into daytime sleeping chambers every 30 s, 7 h/day for 35 days) with an increase in diurnal systemic blood pressure. We hypothesized that afferent information from the peripheral chemoreceptors may be necessary to produce diurnal blood pressure elevation in this hypoxia model. Carotid body denervation (CBD) was accomplished by severing both carotid sinus nerves in two groups of male Wistar rats (250-375 g). Group 4 CBD rats were subjected to intermittent hypoxia for 35 days (3-5% nadir ambient O2) as described above, whereas group 5 CBD rats remained unhandled in their usual cages. Additional sham-operated controls included group 2 sham-"hypoxia" rats, which were housed in chambers identical to the hypoxia rats but supplied with compressed air instead of nitrogen, group 1 (not denervated) rats, which remained unhandled in their usual cages, and group 3 sham-operated rats, which were subjected to 35 days of intermittent hypoxia identical to group 4 CBD rats. Femoral arterial baseline and end-of-study blood pressures were measured in conscious rats. The group 3 rats exposed to episodic hypoxia displayed a 13-mmHg increase in mean blood pressure, whereas the other groups showed no significant change from baseline. Left ventricular hypertrophy was evident in all rats exposed to episodic hypoxia, but right ventricular hypertrophy was evident only in the group 4 rats. All CBD rats developed increased hematocrit and hemoglobin, while the group 3 rats (non-CBD, episodic hypoxia) did not. The baroreceptor reflex at baseline was not depressed in the CBD rats.(ABSTRACT TRUNCATED AT 250 WORDS)

An association between chronic high blood pressure and obstructive sleep apnea has been described. We hypothesized that repetitive episodic hypoxia patterned after the hypoxia seen in sleep apnea could contribute to diurnal elevation of blood pressure. Using 12-second infusions of nitrogen into daytime sleeping chambers, four groups of male rats (250-375 g) were subjected to intermittent hypoxia (3-5% nadir ambient oxygen) every 30 seconds, 7 hours per day for up to 35 days. In one group, blood pressure was measured weekly by the tail-cuff method in conscious animals during 5 weeks of episodic hypoxia. In the other three groups, blood pressure was measured in conscious animals via femoral artery catheters at baseline and after 20, 30, or 35 days of exposure. Additional groups served as controls: two sham groups housed in identical "hypoxia" chambers received compressed air instead of nitrogen (35 days) while two other groups remained unhandled in their usual cages (35 days). Both groups challenged with 35 days episodic hypoxia showed significant increases in blood pressure compared with controls: the tail-cuff rats showed a 21 mm Hg increase in systolic pressure (/?<0.05) and the intra-arterially measured rats a 13.7 mm Hg increase in mean arterial pressure (p<0.05). The 30-day exposed rats also showed a 5.7 mm Hg increase in mean pressure over baseline (p<0.05). Blood pressure did not change significantly from baseline in the control groups. Left ventricle-to-body weight ratio was higher in both 35-day exposed groups than in unhandled or sham controls. This duration-of-exposure-related blood pressure response to hypoxia along with increased left ventricular size after 35 days indicates that chronic intermittent hypoxia could be a mechanism directly contributing to diurnal arterial blood pressure elevation. 1 Chronic hypertension seen in OSA patients may be reversed by treatment of the apnea.2 -4 Other reports show an increased prevalence of sleep apnea in populations of middle-aged men with primary hypertension, 5 -8 but this association has been challenged by more recent epidemiological studies.910 Possible mechanisms for the development of long-term diurnal blood pressure (BP) elevation in this setting are stress related to episodic repetitive hypoxia, disruption of sleep architecture, and modification of the cardiovascular system (including fluid balance) in response to marked fluctuations in intrathoracic pressure. There have been no studies to date examining the effect of any of these individual mechanisms on long-term diurnal BP. It would be quite difficult to prospectively examine factors effecting diurnal BP in humans since such changes may take many years to manifest in the face of progressively more severe, recurrent OSA. One approach is to develop an animal model with a sufficiently short life span in which some conditions of OSA can be duplicated. We chose the rat as a suitable animal in which to examine the effects of hypoxia on BP because of extensive knowledge about mechanisms of systemic hyperte...

These data indicate acidosis and hypothermia to be well managed. Coagulopathy was not corrected in the ICU despite adherence to pre-ICU MT and ICU protocols, likely because of inadequate pre-ICU intervention. More aggressive pre-ICU intervention to correct coagulopathy may be effective in decreasing PRBC requirement during ICU resuscitation, and, because of the association with increased mortality, could improve outcome. We have revised our pre-ICU MT protocol to emphasize early FFP in a FFP:PRBC ratio of 1:1. We think that treatment of coagulopathy can be improved with the development of standardized protocols, both empiric and data driven.

No abstract

In this initial experience, the results of TEVAR did not differ from OR. Long-term follow-up is required to determine the effectiveness of this treatment strategy. Adherence to follow-up imaging protocols is challenging in this patient population. Next generation devices will make TEVAR applicable to a wider range of patients.

Primary and secondary ACS have similar demographics, injury severity, time to decompression from hospital admit, and bad outcome. 2 degrees ACS is an earlier ICU event preceded by more crystalloid administration. With appropriate monitoring both could be accurately predicted upon ICU admission.

Influenza epidemics are associated with a rise in autopsy-confirmed coronary deaths. Influenza vaccination should be advocated for patients at high risk of developing cardiovascular events.

The growing demand for liver transplantation and the concomitant scarcity of cadaveric livers have increased the need for living donor liver transplantation (LDLT). Ensuring the safety of donors and recipients is critical. The preoperative identification of the vascular and biliary tract anatomy with 3-dimensional (3D) printing may allow better preoperative surgical planning, avert unnecessary surgery in patients with potentially unsuitable anatomy, and thereby decrease the complications of liver transplant surgery. We developed a protocol and successfully 3D-printed synthetic livers (along with their complex networks of vascular and biliary structures) replicating the native livers of 6 patients: 3 living donors and 3 respective recipients who underwent LDLT. To our knowledge, these are the first complete 3D-printed livers. Using standardized preoperative, intraoperative, and postoperative assessments, we demonstrated identical anatomical and geometrical landmarks in the 3D-printed models and native livers. Three-dimensional (3D) printing is a process for making a solid 3D object of virtually any shape from a digital model. A 3D printer works as an ordinary office printer, but instead of placing a single layer of ink on paper, the machine lays down successive thin layers of a material to form a 3D object that replicates the original one. 1 The growing demand for liver transplantation and the concomitant shortage of cadaveric livers have led to a rise in living donor liver transplantation (LDLT), in which resection of the right or left liver lobe is performed for the purpose of liver transplantation. 2 Living donors are healthy individuals, so ensuring their safety is of paramount importance. There have been a number of reported donor deaths worldwide and a substantial number of donor morbidities, so there is a need for measures to optimize donor safety. 3 Many of these morbidities are attributable to incomplete preoperative anatomical characterization of vascular and biliary structures and inaccurate estimates of the liver volume; these data are needed to determine the extent of the resection. This information provides a road map, and its accuracy has improved with the introduction of radiological software able to provide 3D visualization of liver structures. 4,5 3D imaging has the ability to better demonstrate the 3D relationships between vital vascular and biliary structures and the surrounding parenchyma in comparison with conventional computed tomography (CT) or magnetic resonance imaging (MRI). 3D imaging Additional Supporting Information may be found in the online version of this article.