Hybrid Analytical Platform Based on Field-Asymmetric Ion Mobility Spectrometry, Infrared Sensing, and Luminescence-Based Oxygen Sensing for Exhaled Breath Analysis

The reliable online analysis of volatile compounds in exhaled breath remains a challenge, as a plethora of molecules occur in different concentration ranges (i.e., ppt to %) and need to be detected against an extremely complex background matrix. Although this complexity is commonly addressed by hyphenating a specific analytical technique with appropriate preconcentration and/or preseparation strategies prior to detection, we herein propose the combination of three different detector types based on truly orthogonal measurement principles as an alternative solution: Field-asymmetric ion mobility spectrometry (FAIMS), Fourier-transform infrared (FTIR) spectroscopy-based sensors utilizing substrate-integrated hollow waveguides (iHWG), and luminescence sensing (LS). By carefully aligning the experimental needs and measurement protocols of all three methods, they were successfully integrated into a single compact analytical platform suitable for online measurements. The analytical performance of this prototype system was tested via artificial breath samples containing nitrogen (N₂), oxygen (O₂), carbon dioxide (CO₂), and acetone as a model volatile organic compound (VOC) commonly present in breath. All three target analytes could be detected within their respectively breath-relevant concentration range, i.e., CO₂ and O₂ at 3-5 % and at ~19.6 %, respectively, while acetone could be detected with LOQs as low as 165-405 ppt. Orthogonality of the three methods operating in concert was clearly proven, which is essential to cover a possibly wide range of detectable analytes. Finally, the remaining challenges toward the implementation of the developed hybrid FAIMS-FTIR-LS system for exhaled breath analysis for metabolic studies in small animal intensive care units are discussed.

A Cobalt-Free Li(Li0.17 Ni0.17 Fe0.17 Mn0.49 )O2 Cathode with More Oxygen-Involving Charge Compensation for Lithium-Ion Batteries

High-energy-density and low-cost lithium-ion batteries are sought to meet increasing demand for portable electronics. In this study, a cobalt-free Li(Li_0.17 Ni_0.17 Fe_0.17 Mn_0.49 )O₂ (LNFMO) cathode material is chosen, owing to the reversible anionic redox couple O^2- /O^- . The aim is to elucidate the Fe-substitution function and oxygen redox mechanism of experimentally synthesized Li(Li_0.16 Ni_0.19 Fe_0.18 Mn_0.46 )O₂ by DFT. The redox processes of cobalt-containing Li(Li_0.17 Ni_0.17 Co_0.17 Mn_0.49 )O₂ (LNCMO) are compared with those of LNFMO. Redox couples including Ni²⁺ /Ni³⁺ /Ni⁴⁺ , Fe³⁺ /Fe⁴⁺ or Co³⁺ /Co⁴⁺ , and O^2- /O^- are found, confirmed by a X-ray photoelectron spectroscopy, and explained by redox competition between O and transition metals. In LNFMO and LNCMO, O ions with an Li-O-Li configuration readily participate in oxidation, and the most active O ions are coordinated to Mn⁴⁺ and Li⁺ . Oxidation of O in LNCMO is triggered earlier, along with that of Co. Fe substitution activates O ions, contributes additional oxygen redox charge compensation of 0.44 e per formula unit, avoids concentrated accumulation of oxygen oxidation, and improves structural stability. This work provides new scope for designing cobalt-free, low-cost, and higher-energy-density cathode materials for Li-ion batteries.

Impaired Retinal Vascular Reactivity in Diabetic Retinopathy as Assessed by Optical Coherence Tomography Angiography

Purpose

To assess retinal vascular reactivity in healthy controls and subjects with diabetic retinopathy (DR).

Methods

A total of 22 healthy control eyes and 16 eyes with DR were enrolled. Images were acquired using a commercially available swept-source optical coherence tomography angiography (SS-OCTA) system. Three conditions were tested for each patient (hyperoxia, hypercapnia, and room-air) by employing a non-rebreathing apparatus that delivered appropriate gas mixtures (100% O2, 5% CO2, room air). Vessel skeleton density (VSD) and vessel diameter index (VDI) were compared between the conditions using mixed-model ANOVA adjusting for age and hypertension. Significant gas or interaction effects were followed by a Bonferroni adjusted pairwise post hoc analysis. Statistical significance was defined at P < 0.05.

Results

The mixed-model ANOVA of the VSD found a significant intraindividual gas effect (F[2, 70] = 20.3, P < 0.001) and intergroup effect (F[1, 35] = 6.9, P = 0.001), and interaction effects (F[2, 70] = 4.6, P = 0.03). The post hoc pairwise comparison found significant differences among all three gas conditions in the healthy controls. In the subjects with DR, there were significant differences in VSD between hyperoxic and room air, and between hyperoxic and hypercapnic conditions, but not between hypercapnic and room-air conditions. Similar results were found for VDI.

Conclusions

The retinal capillaries, assessed with SS-OCTA, in subjects with DR preferentially reacted to hyperoxia but not hypercapnia, while the healthy controls reacted to both. The difference in the vascular reactivity may be indicative of the underlying pathophysiology of DR.

Online measurement of oxygen enables continuous noninvasive evaluation of human-induced pluripotent stem cell (hiPSC) culture in a perfused 3D hollow-fiber bioreactor

For clinical and/or pharmaceutical use of human-induced pluripotent stem cells (hiPSCs), large cell quantities of high quality are demanded. Therefore, we combined the expansion of hiPSCs in closed, perfusion-based 3D bioreactors with noninvasive online monitoring of oxygen as culture control mechanism. Bioreactors with a cell compartment volume of 3 or 17 ml were inoculated with either 10 × 10⁶ or 50 × 10⁶ cells, and cells were expanded over 15 days with online oxygen and offline glucose and lactate measurements being performed. The CellTiter-Blue® Assay was performed at the end of the bioreactor experiments for indirect cell quantification. Model simulations enabled an estimation of cell numbers based on kinetic equations and experimental data during the 15-day bioreactor cultures. Calculated oxygen uptake rates (OUR), glucose consumption rates (GCR), and lactate production rates (LPR) revealed a highly significant correlation (p < 0.0001). Oxygen consumption, which was measured at the beginning and the end of the experiment, showed a strong culture growth in line with the OUR and GCR data. Furthermore, the yield coefficient of lactate from glucose and the OUR to GCR ratio revealed a shift from nonoxidative to oxidative metabolism. The presented results indicate that oxygen is equally as applicable as parameter for hiPSC expansion as glucose while providing an accurate real-time impression of hiPSC culture development. Additionally, oxygen measurements inform about the metabolic state of the cells. Thus, the use of oxygen online monitoring for culture control facilitates the translation of hiPSC use to the clinical setting.

Practice patterns and perceptions of Australian and New Zealand anaesthetists towards perioperative oxygen therapy

We conducted a survey of Australian and New Zealand anaesthetists to determine self-reported practice of perioperative oxygen administration and to quantify perceptions regarding the perceived benefits and risks resulting from liberal oxygen therapy delivered in a manner consistent with the current World Health Organization guidelines. In addition, we sought feedback on the acceptability of several proposed clinical trial designs aiming to assess the overall effect of liberal and restricted perioperative oxygen regimens on patient outcomes. We developed a 23-question electronic survey that was emailed to 972 randomly selected Australian and New Zealand College of Anaesthetists (ANZCA) Fellows. We received responses from 282 of 972 invitees (response rate 29%). The majority of survey participants indicated that they routinely titrate inspired oxygen to a level they feel is safe (164/282, 58%) or minimise oxygen administration (82/282, 29%), while 5% of respondents indicated that they aim to maximise oxygen administration. The mean value for targeted intraoperative fraction inspired oxygen (FiO2) was 0.41 (standard deviation 0.12). Of the survey respondents, 2/282 (0.7%) indicated they believe that routine intra- and postoperative administration of ≥80% oxygen reduces the risk of surgical site infection. Well-designed and conducted randomised trials on this topic may help to better direct clinicians' choices. A high level of willingness to participate (80% of responses) in a study designed to investigate the impact of differing approaches to perioperative oxygen administration suggests that recruitment is likely to be feasible in a future study.

Valence-to-Core X-ray Emission Spectroscopy as a Probe of O-O Bond Activation in Cu2 O2 Complexes

Valence-to-Core (VtC) X-ray emission spectroscopy (XES) was used to directly detect the presence of an O-O bond in a complex comprising the [Cu^II ₂ (μ-η² :η² -O₂ )]²⁺ core relative to its isomer with a cleaved O-O bond having a [Cu^III ₂ (μ-O)₂ ]²⁺ unit. The experimental studies are complemented by DFT calculations, which show that the unique VtC XES feature of the [Cu^II ₂ (μ-η² :η² -O₂ )]²⁺ core corresponds to the copper stabilized in-plane 2p π peroxo molecular orbital. These calculations illustrate the sensitivity of VtC XES for probing the extent of O-O bond activation in μ-η² :η² -O₂ species and highlight the potential of this method for time-resolved studies of reaction mechanisms.

Substrate Bias Voltage Tailoring the Interfacial Chemistry of a-SiC x:H: A Surprising Improvement in Adhesion of a-C:H Thin Films Deposited on Ferrous Alloys Controlled by Oxygen

Hydrogenated amorphous carbon thin films (a-C:H) have attracted much attention because of their surprising properties, including ultralow friction coefficients in specific conditions. Adhesion of a-C:H films on ferrous alloys is poor due to chemical and physical aspects, avoiding a widespread application of such a film. One possibility to overcome this drawback is depositing an interlayer-an intermediate thin film-between the carbon-based coating and the substrate to improve chemical interaction and adhesion. Based on this, interlayers play a key role on a-C:H thin-film adhesion through a better chemical network structure at the outermost layer of the a-SiC _x:H interlayer, i.e., the a-C:H/a-SiC _x:H interface. However, despite the latest important advances on the subject, the coating adhesion continues being a cumbersome problem since it depends on multifactorial causes. Thus, the purpose of this paper is to report a standard protocol leading to surprising good results based on the control of the interfacial chemical bonding by properly biasing the substrate (between 500 and 800 V) during the a-SiC _x:H interlayer deposition at an appropriate low temperature, by using hexamethyldisiloxane as precursor. The interlayers and the outermost interfaces were analyzed by a comprehensive set of techniques, including X-ray photoelectron spectroscopy, glow discharge optical emission spectroscopy, and Fourier transform infrared spectroscopy. Nanoscratch tests, complemented by scanning electron microscopy and energy-dispersive X-ray spectroscopy, were used to evaluate the critical load for delamination to certify and quantify the adhesion improvement. This study was important to identify the chemical local bonding of the elements at the interface and its local environment, including the in-depth chemical composition profile of the coating. An important effect is that the oxygen content decreases on increasing substrate bias voltage, improving the adhesion of the film. This is due to the fact that energetic ion hitting the growing interlayer breaks Si-O and C-O bonds, augmenting the content of Si-C and C-C bonds at the outermost interface of the a-SiC _x:H interlayer and enhancing the a-C:H coating adhesion. Moreover, the combination of high bias voltage (800 V) and low temperature (150 °C) during the a-SiC _x:H interlayer deposition allows good adhesion of a-C:H thin films due to sputtering of light elements like oxygen. Therefore, an appropriated bias and temperature combination can open new pathways in a-C:H thin-film deposition at low temperatures. These results are particularly interesting for temperature-sensible metal alloys, where well-adhered a-C:H thin films are mandatory for tribological applications.

Oxygen therapy in suspected acute myocardial infarction and concurrent normoxemic chronic obstructive pulmonary disease: a prespecified subgroup analysis from the DETO2X-AMI trial

BACKGROUND

The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial did not find any benefit of oxygen therapy compared to ambient air in normoxemic patients with suspected acute myocardial infarction. Patients with chronic obstructive pulmonary disease may both benefit and be harmed by supplemental oxygen. Thus we evaluated the effect of routine oxygen therapy compared to ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction.

METHODS AND RESULTS

A total of 6629 patients with suspected acute myocardial infarction were randomly assigned in the DETO2X-AMI trial to oxygen or ambient air. In the oxygen group (n=3311) and the ambient air group (n=3318), 155 and 141 patients, respectively, had chronic obstructive pulmonary disease (prevalence of 4.5%). Patients with chronic obstructive pulmonary disease were older, had more comorbid conditions and experienced a twofold higher risk of death at one year (chronic obstructive pulmonary disease: 32/296 (10.8%) vs. non-chronic obstructive pulmonary disease: 302/6333 (4.8%)). Oxygen therapy compared to ambient air was not associated with improved outcomes at 365 days (chronic obstructive pulmonary disease: all-cause mortality hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.50-1.99, P_interaction=0.96); cardiovascular death HR 0.80, 95% CI 0.32-2.04, P_interaction=0.59); rehospitalisation with acute myocardial infarction or death HR 1.27, 95% CI 0.71-2.28, P_interaction=0.46); hospitalisation for heart failure or death HR 1.08, 95% CI 0.61-1.91, P_interaction=0.77]); there were no significant treatment-by-chronic obstructive pulmonary disease interactions.

CONCLUSIONS

Although chronic obstructive pulmonary disease patients had twice the mortality rate compared to non-chronic obstructive pulmonary disease patients, this prespecified subgroup analysis from the DETO2X-AMI trial on oxygen therapy versus ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction revealed no evidence for benefit of routine oxygen therapy consistent with the main trial's findings.

CLINICAL TRIALS REGISTRATION

NCT02290080.

The Initial Stage in Oxidation of ZrNiSn (Half Heusler) Alloy by Oxygen

The MNiSn (M = Ti; Zr; Hf); half-Heusler semiconducting alloys have a high potential for use as n-type thermoelectric materials at elevated temperatures (~1000 K). The alloys' durability is crucial for their commercial handling and use, and therefore it is required to characterize their surface oxidation behavior and stability at the working temperature. X-ray photoelectron spectroscopy was utilized to study the surface composition and oxidation of the ZrNiSn alloy at room and elevated temperatures. It was found that during heating in a vacuum, Sn segregates to the surface in order to reduce the surface energy. Exposing the alloy to oxygen resulted mainly in the oxidation of the zirconium to ZrO₂, as well as some minor oxidation of Sn. At room temperature, the oxidation to ZrO₂ was accompanied by the formation of a thin ZrO layer at the metal-oxide interface. In contrast to TiNiSn, where most of the oxide was formed on the surface due to oxygen-enhanced segregation of Ti, and in the case of ZrNiSn, the formed oxide layer was thinner. Part of the oxide is formed due to Zr segregation to the surface, and in part due to oxygen dissolved into the alloy.

Shear stress and oxygen availability drive differential changes in opossum kidney proximal tubule cell metabolism and endocytosis

Kidney proximal tubule (PT) cells have high-metabolic demands to drive the extraordinary ion and solute transport, water reabsorption, and endocytic uptake that occur in this nephron segment. Increases in renal blood flow alter glomerular filtration rate and lead to rapid mechanosensitive adaptations in PT transport, impacting metabolic demand. Although the PT reabsorbs essentially all of the filtered glucose, PT cells rely primarily on oxidative metabolism rather than glycolysis to meet their energy demands. We lack an understanding of how PT functions are impacted by changes in O₂ availability via cortical capillaries and mechanosensitive signaling in response to alterations in luminal flow. Previously, we found that opossum kidney (OK) cells recapitulate key features of PT cells in vivo, including enhanced endocytic uptake and ion transport, when exposed to mechanical stimulation by culture on an orbital shaker. We hypothesized that increased oxygenation resulting from orbital shaking also contributes to this more physiologic phenotype. RNA seq of OK cells maintained under static conditions or exposed to orbital shaking for up to 96 hours showed significant time- and culture-dependent changes in gene expression. Transcriptional and metabolomics data were consistent with a decrease in glycolytic flux and with an increased utilization of aerobic metabolic pathways in cells exposed to orbital shaking. Moreover, we found spatial differences in the pattern of mitogenesis vs development of ion transport and endocytic capacities in our culture system that highlight the complexity of O₂ -dependent and mechanosensitive crosstalk to regulate PT cell function.

Oxygen and Carbon Dioxide Rhythms Are Circadian Clock Controlled and Differentially Directed by Behavioral Signals

Daily rhythms in animal physiology are driven by endogenous circadian clocks in part through rest-activity and feeding-fasting cycles. Here, we examined principles that govern daily respiration. We monitored oxygen consumption and carbon dioxide release, as well as tissue oxygenation in freely moving animals to specifically dissect the role of circadian clocks and feeding time on daily respiration. We found that daily rhythms in oxygen and carbon dioxide are clock controlled and that time-restricted feeding restores their rhythmicity in clock-deficient mice. Remarkably, day-time feeding dissociated oxygen rhythms from carbon dioxide oscillations, whereby oxygen followed activity, and carbon dioxide was shifted and aligned with food intake. In addition, changes in carbon dioxide levels altered clock gene expression and phase shifted the clock. Collectively, our findings indicate that oxygen and carbon dioxide rhythms are clock controlled and feeding regulated and support a potential role for carbon dioxide in phase resetting peripheral clocks upon feeding.

Morphological Plasticity in a Sulfur-Oxidizing Marine Bacterium from the SUP05 Clade Enhances Dark Carbon Fixation

Identifying shifts in microbial metabolism across redox gradients will improve efforts to model marine oxygen minimum zone (OMZ) ecosystems. Here, we show that aerobic morphology and metabolism increase cell size, sulfur storage capacity, and carbon fixation rates in “Ca. Thioglobus autotrophicus,” a chemosynthetic bacterium from the SUP05 clade that crosses oxic-anoxic boundaries.

Sulfur-oxidizing bacteria from the SUP05 clade are abundant in anoxic and oxygenated marine waters that appear to lack reduced sources of sulfur for cell growth. This raises questions about how these chemosynthetic bacteria survive across oxygen and sulfur gradients and how their mode of survival impacts the environment. Here, we use growth experiments, proteomics, and cryo-electron tomography to show that a SUP05 isolate, “Candidatus Thioglobus autotrophicus,” is amorphous in shape and several times larger and stores considerably more intracellular sulfur when it respires oxygen. We also show that these cells can use diverse sources of reduced organic and inorganic sulfur at submicromolar concentrations. Enhanced cell size, carbon content, and metabolic activity of the aerobic phenotype are likely facilitated by a stabilizing surface-layer (S-layer) and an uncharacterized form of FtsZ-less cell division that supports morphological plasticity. The additional sulfur storage provides an energy source that allows cells to continue metabolic activity when exogenous sulfur sources are not available. This metabolic flexibility leads to the production of more organic carbon in the ocean than is estimated based solely on their anaerobic phenotype.

Paleoenvironmental proxies and what the Xiamaling Formation tells us about the mid-Proterozoic ocean

The Mesoproterozoic Era (1,600-1,000 million years ago, Ma) geochemical record is sparse, but, nevertheless, critical in untangling relationships between the evolution of eukaryotic ecosystems and the evolution of Earth-surface chemistry. The ca. 1,400 Ma Xiamaling Formation has experienced only very low-grade thermal maturity and has emerged as a promising geochemical archive informing on the interplay between climate, ecosystem organization, and the chemistry of the atmosphere and oceans. Indeed, the geochemical record of portions of the Xiamaling Formation has been used to place minimum constraints on concentrations of atmospheric oxygen as well as possible influences of climate and climate change on water chemistry and sedimentation dynamics. A recent study has argued, however, that some portions of the Xiamaling Formation deposited in a highly restricted environment with only limited value as a geochemical archive. In this contribution, we fully explore these arguments as well as the underlying assumptions surrounding the use of many proxies used for paleo-environmental reconstructions. In doing so, we pay particular attention to deep-water oxygen-minimum zone environments and show that these generate unique geochemical signals that have been underappreciated. These signals, however, are compatible with the geochemical record of those parts of the Xiamaling Formation interpreted as most restricted. Overall, we conclude that the Xiamaling Formation was most likely open to the global ocean throughout its depositional history. More broadly, we show that proper paleo-environmental reconstructions require an understanding of the biogeochemical signals generated in all relevant modern analogue depositional environments. We also evaluate new data on the δ⁹⁸ Mo of Xiamaling Formation shales, revealing possible unknown pathways of molybdenum sequestration into sediments and concluding, finally, that seawater at that time likely had a δ⁹⁸ Mo value of about 1.1‰.

Responsive Porous Microcarriers With Controllable Oxygen Delivery for Wound Healing

Microcarriers with oxygen-delivering capacity have attracted increasing interest in the field of tissue regeneration. Here, a kind of molybdenum disulfide quantum dots (MoS₂ QDs) integrated responsive porous microcarriers with controllable oxygen-delivering ability for wound healing is presented. The specific gelatin methacryloyl (GelMa) porous microcarriers are derived from inverse opal microparticles which can be decorated with the oxygen-carrying protein hemoglobin. Because of their characteristic porous structure, interconnected nanochannels, and excellent biocompatibility, the resultant microcarriers could carry oxygen extensively and provide support for tissue repair physically and biologically. Besides, since the typical photothermal effect of 2D materials and their derived 2D QDs, the inverse opal particles integrated with MoS₂ QDs are imparted with photo-responsive capacity, which makes them able to release oxygen photo-controllably. It is demonstrated that the designed microcarriers can promote the repair of abdominal wall defects effectively with their multifunctional features. These remarkable properties point to the potential value of the microcarriers in wound healing and tissue engineering.

Pulsed Dose Oxygen Delivery During Mechanical Ventilation: Impact on Oxygenation

INTRODUCTION

Adequate oxygenation is one of the primary goals of mechanical ventilation. Maintenance of adequate oxygenation and prevention of hypoxemia are the primary goals for the battlefield casualty, but military operations have unique concerns. In military operations, oxygen is a limited resource. A portable oxygen concentrator has the advantage of operating solely from electrical power and theoretically is a never-exhausting supply of oxygen. Our previous bench work demonstrated that the pulsed dose setting of the concentrator can be used in concert with the ventilator to maximize oxygen delivery. We evaluated this ventilator/concentrator system with closed loop control of oxygen output in a porcine model.

MATERIALS AND METHODS

The Zoll 731 portable ventilator and Sequal Saros portable oxygen concentrator were used for this study. The ventilator and concentrator were connected via a USB cable to allow communication. The ventilator was modified to allow closed loop control of oxygen based on the oxygen saturation (SpO2) via the integral pulse oximetry sensor. The ventilator communicates with the concentrator to increase or decrease oxygen bolus size to maintain a target SpO2 of 94%. Three separate experiments were conducted in this study. Experiments 1 and 2 used oxygen bolus sizes 16-96 mL in 16-mL increments and experiment 3 used 1 mL increments. The oxygen bolus was delivered from the concentrator and injected into the ventilator circuit at the patient connector. Six pigs were used for each experiment. Experiment 1, done without lung injury, was completed to determine the optimum timing during the respiratory cycle for injecting the oxygen bolus. Lung injury for experiments 2 and 3 was induced in the animals by warmed saline lavage via the endotracheal tube until PaO2/FIO2 decreased to <100. The pigs were then placed on the ventilator/concentrator system and allowed to adjust the oxygen autonomously to determine if the target SpO2 could be maintained. PEEP was manually adjusted. Arterial blood gases were drawn to verify the PaO2 and the SpO2/SaO2 correlation.

RESULTS

Experiment 1 showed that the O2 bolus injected into the ventilator circuit 300 ms before breath delivery produced the highest PaO2. Mean PaO2/FIO2 was 500 ± 33 for experiments 2 and 3 before lung lavage and 72 ± 11 after lung lavage (p < 0.001), representing severe acute respiratory distress syndrome. Thirty minutes after placing the animals on the ventilator/concentrator system, the bolus size range was 64-96 mL and 16-96 mL after 2 hours (p < 0.05). The SpO2 range was 81-95% after 30 minutes and 94-98% after 2 hours (p < 0.05). PEEP range was 5-14 cm H2O. The SpO2 to SaO2 difference was ≤4% throughout the evaluation.

CONCLUSIONS

The ventilator/concentrator system was able to manage oxygenation of severely injured lungs in a porcine model by injecting oxygen boluses at the front end of the ventilator breath, and appropriate use of PEEP to maximize oxygen delivery at the alveolar level. This proof of concept ventilator system may prove to be of use in situations where high-pressure oxygen is unavailable but electricity is accessible.

Measuring Flap Oxygen Using Electron Paramagnetic Resonance Oximetry

OBJECTIVES/HYPOTHESIS

To determine if electron paramagnetic resonance (EPR) oximetry is a viable technology to aid in flap monitoring.

STUDY DESIGN

Prospective cohort.

METHODS

This was a cohort study assessing accuracy and speed of EPR oximetry in detecting ischemia of a saphenous artery-based flap in a rat model, using transcutaneous oximetry as a control. Measurements were obtained under both resting and ischemic conditions for nine Sprague Dawley rats (18 flaps), for 3 postoperative days following flap elevation.

RESULTS

The mean partial pressure of oxygen prior to tourniquet application was 66.9 ± 8.9 mm Hg with EPR oximetry and 64.7 ± 5.2 mm Hg with transcutaneous oximetry (P = .45). Mean partial pressures of oxygen during tourniquet application were 8.9 ± 3.2 mm Hg and 8.5 ± 2.9 mm Hg for EPR oximetry and transcutaneous oximetry, respectively (P = .48), and 67.2 ± 6.9 mm Hg and 65.3 ± 6.1 mm Hg after tourniquet release for EPR oximetry and transcutaneous oximetry, respectively (P = .44). The mean ischemia detection time of EPR oximetry was 49 ± 21 seconds.

CONCLUSIONS

Offering timely, accurate, and noninvasive tissue oxygen measurements, EPR oximetry is a promising adjunct in flap monitoring.

LEVEL OF EVIDENCE

NA Laryngoscope, 129:E415-E419, 2019.

Apneas of Heart Failure and Phenotype-Guided Treatments: Part One: OSA

Sleep-disordered breathing (SDB), including OSA and central sleep apnea, is highly prevalent in patients with heart failure (HF). Multiple studies have reported this high prevalence in asymptomatic as well as symptomatic patients with reduced left ventricular ejection fraction (HFrEF), as well as in those with HF with preserved ejection fraction. The acute pathobiologic consequences of OSA, including exaggerated sympathetic activity, oxidative stress, and inflammation, eventually could lead to progressive left ventricular dysfunction, repeated hospitalization, and excessive mortality. Large numbers of observational studies and a few small randomized controlled trials have shown improvement in various cardiovascular consequences of SDB with treatment. There are no long-term randomized controlled trials to show improved survival of patients with HF and treatment of OSA. One trial of positive airway pressure treatment of OSA included patients with HF and showed no improvement in clinical outcomes. However, any conclusions derived from this trial must take into account several important pitfalls that have been extensively discussed in the literature. With the role of positive airway pressure as the sole therapy for SDB in HF increasingly questioned, a critical examination of long-accepted concepts in this field is needed. The objective of this review was to incorporate recent advances in the field into a phenotype-based approach to the management of OSA in HF.

The Long-Term Oxygen Treatment Trial for Chronic Obstructive Pulmonary Disease: Rationale, Design, and Lessons Learned

The Long-Term Oxygen Treatment Trial demonstrated that long-term supplemental oxygen did not reduce time to hospital admission or death for patients who have stable chronic obstructive pulmonary disease and resting and/or exercise-induced moderate oxyhemoglobin desaturation, nor did it provide benefit for any other outcome measured in the trial. Nine months after initiation of patient screening, after randomization of 34 patients to treatment, a trial design amendment broadened the eligible population, expanded the primary outcome, and reduced the goal sample size. Within a few years, the protocol underwent minor modifications, and a second trial design amendment lowered the required sample size because of lower than expected treatment group crossover rates. After 5.5 years of recruitment, the trial met its amended sample size goal, and 1 year later, it achieved its follow-up goal. The process of publishing the trial results brought renewed scrutiny of the study design and the amendments. This article expands on the previously published design and methods information, provides the rationale for the amendments, and gives insight into the investigators' decisions about trial conduct. The story of the Long-Term Oxygen Treatment Trial may assist investigators in future trials, especially those that seek to assess the efficacy and safety of long-term oxygen therapy. Clinical trial registered with clinicaltrials.gov (NCT00692198).

The Effects of Intraoperative Inspired Oxygen Fraction on Postoperative Pulmonary Parameters in Patients with General Anesthesia: A Systemic Review and Meta-Analysis

High intraoperative inspired oxygen concentration is applied to prevent desaturation during induction and recovery of anesthesia. However, high oxygen concentration may lead to postoperative pulmonary complications. The purpose of this study is to compare the postoperative pulmonary parameters according to intraoperative inspired oxygen fraction in patients undergoing general anesthesia. We identified all randomized controlled trials investigating postoperative differences in arterial gas exchange according to intraoperative fraction of inspired oxygen (FiO₂). A total of 10 randomized controlled trials were included, and 787 patients were analyzed. Postoperative PaO₂ was lower in the high FiO₂ group compared with the low FiO₂ group (mean difference (MD) −4.97 mmHg, 95% CI −8.21 to −1.72, p = 0.003). Postoperative alveolar-arterial oxygen gradient (AaDO₂) was higher (MD 3.42 mmHg, 95% CI 0.95 to 5.89, p = 0.007) and the extent of atelectasis was more severe (MD 2.04%, 95% CI 0.14 to 3.94, p = 0.04) in high intraoperative FiO₂ group compared with low FiO₂ group. However, postoperative SpO₂ was comparable between the two groups. The results of this meta-analysis suggest that high inspired oxygen fraction during anesthesia may impair postoperative pulmonary parameters. Cautious approach in intraoperative inspired oxygen fraction is required for patients susceptible to postoperative pulmonary complications.

[Effects of aerobic glycolysis on pathogenesis and drug resistance of non-Hodgkin lymphoma]

It has been shown that aerobic glycolysis (AG) plays an important role in the pathogenesis and resistance mechanism of non-Hodgkin lymphoma (NHL) in recent years. Signaling pathway related to abnormal activation of AG can increase the level of AG in lymphatic and hematopoietic cells, while the enzymes related to the activity of AG are involved in the pathogenesis and prognosis of NHL. Drugs that inhibit AG can also inhibit NHL cells in vitro. Drugs inhibiting AG may increase the sensitivity of chemotherapeutic agents and prevent drug resistance. In this article, the role of signaling pathway proteins and regulatory genes related to AG in the pathogenesis and drug resistance of NHL are reviewed, and the AG as a target in the clinical diagnosis and treatment of NHL is discussed.

Use of Gases to Treat Cochlear Conditions

Although the cochlear vascular supply (stria vascularis) is designed to block to certain compounds and molecules, it must enable gas exchange to survive. The inner ear capillaries must deliver oxygen and remove carbon dioxide for the cochlea to function. These gases diffuse through tissues across a concentration gradient to reach the desired target. Tight junctions or the endothelial basement membrane do not impede them. Therefore, gases that can diffuse into the inner ear are attractive as therapeutic agents. The two gases most often used in this way are oxygen and hydrogen, although carbon dioxide, ozone, and argon have also been investigated. Typically, oxygen is delivered as hyperbaric oxygen (HBO) (oxygen at pressure higher than atmospheric) to provide increased oxygen levels to the inner ear. This not only relieves hypoxia, but also has anti-inflammatory and other biochemical effects. HBO is used clinically to treat idiopathic sudden sensorineural hearing loss, and both animal and human studies suggest it may also assist recovery after acute acoustic trauma. Laboratory studies suggest hydrogen works as a free radical scavenger and reduces the strong oxidants hydroxyl radicals and peroxynitrite. It also has anti-apoptotic effects. Because of its anti-oxidant and anti-inflammatory effects, it has been studied as a treatment for ototoxicity and shows benefit in an animal model of cisplatinum toxicity. Gas diffusion offers an effective way to provide therapy to the inner ear, particularly since some gases (oxygen, hydrogen, carbon dioxide, ozone, argon) have important therapeutic effects for minimizing cochlear damage.

Individual and Combined Impact of Oxygen and Oxygen Transporter Supplementation during Kidney Machine Preservation in a Porcine Preclinical Kidney Transplantation Model

Marginal kidney graft preservation in machine perfusion (MP) is well-established. However, this method requires improvement in order to mitigate oxidative stress during ischemia-reperfusion, by using oxygenation or an O2 carrier with anti-oxidant capacities (hemoglobin of the marine worm; M101). In our preclinical porcine (pig related) model, kidneys were submitted to 1h-warm ischemia, followed by 23 h hypothermic preservation in Waves® MP before auto-transplantation. Four groups were studied: W (MP without 100%-O2), W-O2 (MP with 100%-O2; also called hyperoxia), W-M101 (MP without 100%-O2 + M101 2 g/L), W-O2 + M101 (MP with 100%-O2 + M101 2 g/L) (n = 6/group). Results: Kidneys preserved in the W-M101 group showed lower resistance, compared to our W group. During the first week post-transplantation, W-O2 and W-M101 groups showed a lower blood creatinine and better glomerular filtration rate. KIM-1 and IL-18 blood levels were lower in the W-M101 group, while blood levels of AST and NGAL were lower in groups with 100% O2. Three months after transplantation, fractional excretion of sodium and the proteinuria/creatinuria ratio remained higher in the W group, creatininemia was lower in the W-M101 group, and kidney fibrosis was lower in M101 groups. We concluded that supplementation with M101 associated with or without 100% O2 improved the Waves® MP effect upon kidney recovery and late graft outcome.

Biological Benefits of Ultra-high Dose Rate FLASH Radiotherapy: Sleeping Beauty Awoken

FLASH radiotherapy (FLASH-RT) is a technology that could modify the way radiotherapy is delivered in the future. This technique involves the ultra-fast delivery of radiotherapy at dose rates several orders of magnitude higher than those currently used in routine clinical practice. This very short time of exposure leads to the striking observation of relative protection of normal tissues that are exposed to FLASH-RT as compared with conventional dose rate radiotherapy. Here we summarise the current knowledge about the FLASH effect and provide a synthesis of the observations that have been reported on various experimental animal models (mice, zebrafish, pig, cats), various organs (lung, gut, brain, skin) and by various groups across 40 years of research. We also propose possible mechanisms for the FLASH effect, as well as possible paths for clinical application.

Cardiovascular Parameters in a Swine Model of Normobaric Hypoxia Treated With 5-Hydroxymethyl-2-Furfural (5-HMF)

Introduction:

The consequences of low partial pressure of O₂ include low arterial O₂ saturations (SaO₂), low blood O₂ content (CaO₂), elevated mean pulmonary artery pressure (PAP), and decreased O₂ consumption VO₂. 5-hydroxymethyl-2-furfural (5-HMF) binds to the N-terminal valine of hemoglobin (HgB) and increases its affinity to O₂. We used an instrumented, sedated swine model to study the effect of 5-HMF on cardiovascular parameters during exposure to acute normobaric hypoxia (NH).

Methods

Twenty-three sedated and instrumented swine were randomly assigned to one of three treatment groups and received equal volume of normal saline (VEH), 20 mg/kg 5-HMF (5-HMF-20) or 40 mg/kg 5-HMF (5-HMF-40). Animals then breathed 10% FiO₂ for 120 min. Parameters recorded were Cardiac Output (CO), Mean Arterial Blood Pressure (MAP), Heart Rate (HR), Mean Pulmonary Artery Pressure (PAP), SaO₂ and saturation of mixed venous blood (SvO₂). The P₅₀ was measured at fixed time intervals prior to and during NH.

Results

5-HMF decreased P₅₀. In the first 30 min of NH, treatment with 5-HMF-20 and 5-HMF-40 resulted in a (1) significantly smaller decrement in SaO₂ and SvO₂, (2) significantly lower HR and CO, and (3) smaller increase in PAP compared to VEH. In the 120 min of NH there was a trend toward improved mortality with 5-HMF treatment.

Conclusion

5-HMF treatment decreased P₅₀, improved SaO₂, and mitigated increases in PAP in this swine model of NH.