Medical grade 3D printable bioabsorbable PLDL/Mg and PLDL/Zn composites for biomedical applications

Medical grade PLDL, PLDL/Mg and PLDL/Zn filaments were manufactured by a dual extrusion method and used to prepare coupons and scaffolds with controlled porosity by fused filament fabrication. The mechanical properties, degradation mechanisms and biological performance were carefully analyzed. It was found that the presence of 4 vol.% of Mg and Zn particles did not substantially modify the mechanical properties but accelerated the degradation rate of PLDL. Moreover, the acidification of the pH due to degradation of the PLDL was reduced in the presence of metallic particles. Finally, cell adhesion and proliferation were excellent in the medical grade PLDL as well as in the polymer/metal composites. These results demonstrate the potential of bioabsorbable metal/polymer composites to tailor the mechanical properties, degradation rate and biocompatibility for specific clinical applications.

Mine Water for the Generation and Storage of Renewable Energy: A Hybrid Hydro-Wind System

Mine water is normally considered as waste that has to be managed. However, new applications are increasingly being sought for the water that floods mining voids, especially in relation to its use as an energy resource. The worldwide energy market, within the current transition framework, is searching for creative approaches to produce and store clean energy. In particular, underground pumped hydroelectric energy storage systems (UPHS) constitute efficient and flexible alternatives to deal with intermittent renewable energy sources. In this work, a UPHS is designed using the mine water and the voids of a closed coal mine in Asturias (North-west Spain) as a lower reservoir. Moreover, this system is combined with a wind energy generation facility and the efficiency of the hybrid system is evaluated. With an investment cost of EUR 193 M, a 40 MW UPHES joined to a 60 MW wind farm would generate benefits of about EUR 54 M in 40 years. The reduction in CO₂ emissions (29,000 equivalent tons per year) and the social benefits in a traditional mining area are other intangible advantages of this system.

Association between progesterone concentration and endometrial gene expression in dairy cows

The objective of this study was to evaluate the association between progesterone concentration on Days 4 and 9 of the estrus cycle and endometrial transcriptome at Day 9 in lactating grazing dairy cows. Blood samples were obtained on Days 0, 4, and 9 for progesterone measurement by chemiluminescence. Cows were assigned to one of the following groups (n = 3 per group): cows with low physiological progesterone on Day 4, cows in anestrous, cows with high physiological progesterone on Day 4, and superovulated cows. Endometrial biopsy samples were obtained on Day 9 for RNA sequencing. Quality control and determination of differentially expressed genes (false discovery rate <0.05) were determined using the edgeR package for R software. We identified 3,042 differentially expressed genes among the 4 groups. Cows having high physiological progesterone and superovulated cows showed high similarities and clustered apart from those in anestrus or having low physiological progesterone. Functional analysis using Database for Annotation, Visualization, and Integrated Discovery revealed that endometrial genes upregulated by low progesterone concentration are enriched genes involved in the immune system and inflammatory response. Conversely, cows with high physiological progesterone concentration presented an endometrial transcriptome with similarities to cows with good genetic merit for fertility, showing upregulation of genes related to uterine relaxation-contraction, focal adhesion, GnRH signaling pathway, and epidermal growth factor-like related terms, suggesting a favorable embryo environment. In conclusion, our results support the concept that there is a threshold of progesterone concentration at the beginning of the luteal phase associated with endometrial expression of critical genes involved in the preparation of the uterine environment for embryo implantation.

Clinical implications of the deregulated TP73 isoforms expression in cancer

TP73 is a member of the TP53 family whose expression has been observed altered in most human cancers and associated with the prognosis. TP73 translates into a complex number of isoforms with both oncogenic and tumour-suppressor functions and presents a complex cross-talk with other members of the family (TP53 and TP63). In this revision, we focus on the evidence that may support TP73 variants as prognostic markers in cancer. Nowadays, most publications in this topic highlight the association between overexpression of the oncogenic variants and failure to respond to chemotherapy and/or shorter survival. In addition, we comment on the putative possibilities that the detection through a liquid biopsy of TP73 variants may provide, and finally, the significance of determining the value of the combined alteration of the TP53 family members in the clinical setting.

β-Cryptoxanthin modulates the response to phytosterols in post-menopausal women carrying NPC1L1 L272L and ABCG8 A632 V polymorphisms: an exploratory study

Phytosterol (PS) intake may be used for hypercholesterolaemia in some groups although the presence of non-responders is well known. Carotenoids and PS/cholesterol may compete for the same transporters during absorption. As part of a randomized, double-blind, crossover, multiple-dose supplementation study with β-cryptoxanthin (β-Cx) and PS, single and combined, polymorphisms of ABCG8 (A632V) and NCPL1 (L272L) were determined in 19 post-menopausal women. Subjects carrying CC polymorphism for NCP1L1 (L272L) showed a net increase in total cholesterol and LDL after PS intake but, interestingly, displayed a decrease in both lipid fractions after consuming PS plus β-Cx. For the ABCG8 (A632V) gene, CT/TT carriers consuming PS also displayed an increase in total cholesterol and LDL, but this increment was much lower after the intake of PS plus β-Cx. Additionally, in CC carriers for ABCG8 (A632V), a greater decrease in total cholesterol and LDL was found after the intake of PS plus β-Cx compared to that observed after PS alone. Overall, our results suggest that β-Cx improves the response to PS in individuals carrying specific genetic polymorphisms (i.e. non-responders), opening the possibility to modulate the response to PS by food technology. (ClinicalTrials.gov NCT01074723).

[Transumbilical cholecystectomy using hybrid technique: a new promising approach]

OBJECTIVES

The use of magnets in transumbilical cholecystectomy improves triangulation and achieves optimal critical view. However, the attraction between magnets can cause collisions and their management complicates the procedure, and this will become more important in children. In order to simplify the technique, we have developed a hybrid model with a single magnet.

MATERIAL AND METHODS

Retrospective review of cholecystectomies performed in our department between June 2011 and July 2012. The technique combines the use of a magnet and a curved grasper. Through transumbilical incision, a 12 mm trocar and another flexible 5 mm are placed. Laparoscope with working channel uses the 12 mm trocar. The magnet is introduced to the abdominal cavity using the working channel to provide cephalad retraction of gallbladder fundus. Curved grasper is run by the assistant to mobilize the infundibulum across flexible trocar. The surgeon operates through the working channel of the laparoscope.

RESULTS

Twenty-six patients were operated on with this technique. Mean age was 14 years (4-17) and weight 50 kg (18-90). 65% were girls. The mean operative time was 62 minutes (50-70) and the critical view of safety was achieved in all cases. Instrumental collision or hands crossing were not seen. There were no intraoperative or postoperative complications. The hospital stay was 1.4 +/- 0.6 days and the median follow-up 201 days (42-429).

CONCLUSIONS

The hybrid technique, combining magnet and a curved grasper, simplifies transumbilical surgery. It seems a feasible and safe for transumbilical cholecystectomy and potentially reproducible.

Aberrant epigenetic regulation of bromodomain BRD4 in human colon cancer

The bromodomain protein BRD4 is involved in cell proliferation and cell cycle progression, primarily through its role in acetylated chromatin-dependent regulation of transcription at targeted loci. Here, we show that BRD4 is frequently downregulated by aberrant promoter hypermethylation in human colon cancer cell lines and primary tumors. Ectopic re-expression of BRD4 in these colon cancer cell lines markedly reduced in vivo tumor growth, suggesting a role of BRD4 in human colon cancer.

Vesicle-related microRNAs in plasma of nonsmall cell lung cancer patients and correlation with survival

The identification of tumour biomarkers that detect the presence of disease using noninvasive diagnostic procedures is a key part of cancer research. We determined in plasma the vesicle-related microRNA (miRNA) expression profile of nonsmall cell lung cancer (NSCLC) and evaluate whether plasma miRNAs can be both discriminating (between patients and healthy controls) and prognostic markers. 365 human miRNAs were analysed by Taqman® low-density arrays (Applied Biosystems, Foster City, CA, USA) in the plasma from 28 NSCLC patients and 20 controls. Five selected miRNAs (let-7f, miR-20b, miR-30e-3p, miR-223 and miR-301) were validated independently by real-time PCR in plasma from 78 NSCLC and 48 controls and correlated with pathologic parameters and survival. Levels of let-7f, miR-20b and miR-30e-3p were decreased in plasma vesicles of NSCLC patients. Moreover, levels of let-7f and miR-30e-3p distinguished between two groups of patients for stage of disease and therefore possibility of surgery. Plasma levels of miR-30e-3p and let-7f were associated with short disease-free survival and overall survival, respectively. NSCLC patients and healthy controls differ in vesicle-related miRNAs in plasma. Levels of let-7f and miR-30e-3p in NSCLC patients are associated with poor outcome. Thus, plasma vesicle-related miRNAs obtained by noninvasive methods could serve as circulating tumour biomarkers of discriminating and prognostic value.

The presence of an intronic deletion in p73 and high levels of ZEB1 alter the TAp73/DeltaTAp73 ratio in colorectal carcinomas

TAp73 variants largely mimic p53 suppressor activities, while DeltaTAp73 forms act as oncogenes through the inactivation of p53 and TAp73. The present study analysed how TAp73 and DeltaTAp73 levels might be affected by the presence of a 73 bp deletion in a regulatory region of p73. The clinical relevance of this deletion was also examined. ZEB1 can bind to the region repressing p73 transcription in vitro. The relationship between ZEB1 and p73 variant expression levels was studied in the context of this deletion and the levels of the ZEB1 cofactors p300 and CtBP. Tumour and normal tissue from 81 colorectal cancer patients was analysed to evaluate firstly the levels of TAp73, DeltaTAp73 (DeltaEx2p73, DeltaEx2/3p73, and DeltaNp73), ZEB1, p300, and CtBP by quantitative real-time RT-PCR, and secondly the presence of the 73 bp deletion. Tumour characteristics were examined in each patient. Suppressor and oncogenic isoforms of p73 were co-up-regulated in tumour tissues. Overexpression of p73 variants was associated with adverse tumour features. The 73 bp deletion was present in 40% of the patients and was associated with adverse pathological parameters of the tumours and also with TAp73 down-regulation. In those cases harbouring the deletion, the levels of ZEB1 and those of DeltaEx2p73, DeltaEx2/3p73, and DeltaNp73 correlated directly. Variations in the concentration of p300 affected the observed correlations between ZEB1 and the different p73 variants. In conclusion, in colorectal cancer, the 73 bp deletion in the first intron of the p73 gene and different expression levels of ZEB1 and p300 may act in concert to affect the ratio of TAp73/DeltaTAp73 forms, favouring p73 oncogenic variants. In addition, up-regulation of p73 oncogenic isoforms predicts a poor prognosis based on its relationship with advanced tumour stage.

Maintenance of Subcutaneous Cavities With CO2

Since mechanical retractors in endoscopic plastic surgery cause certain drawbacks, we developed a model in dogs, which, by insufflating CO2 into a subcutaneous cavity, we were able to maintain. We evaluated the magnitude of subcutaneous emphysema and absorption of CO2 by insufflating different pressures and the efficacy of external pressure on the skin with the purpose of limiting the subcutaneous emphysema. Sixteen dogs were divided in 3 groups, A, B, and C. We controlled the pulmonary function by using a volume-cycle ventilator. In all groups, we maintained a subcutaneous cavity by insufflating CO2. Groups A and C were insufflated at 15 mm Hg; group B, at 8 mm Hg. We placed circumferential Esmarch bandages on the thorax of groups B and C to delimit superiorly and inferiorly the surgical area. Arterial blood gas analyses (ABGA) were taken from the femoral artery 60 minutes after intubation, 60 minutes after Esmarch bandage was placed and at the end of the CO2 insufflation. Statistically, results were analyzed by Wilcoxon test. P < 0.05 was considered statistically significant. Group A showed extensive subcutaneous emphysema. Two dogs died. The systemic increase of the CO2 showed a median of 9.6 mm Hg (P < 0.05). In Group B, Esmarch bandages caused increase in CO2, with a median of 1.65 mm Hg (P < 0.028). None of these dogs showed subcutaneous emphysema during the insufflation after CO2 insufflation pressure augmented with a median of 3.7 mm Hg (P < 0.028). In Group C, chest restriction increased CO2 median of 6.1 mm Hg (P < 0.043), and subcutaneous emphysema shown was less extensive than group A. The CO2 increased after insufflation a median of 16 mm Hg (P < 0.043).

CONCLUSIONS

Subcutaneous cavities can be maintained open with CO2 insufflation at 8 mm Hg, limiting perfectly the surgical area; as done with Esmarch bandages, it reduces CO2 absorption and makes this procedure safe.

A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome

RATIONALE

Ventilation in the prone position for about 7 h/d in patients with acute respiratory distress syndrome (ARDS), acute lung injury, or acute respiratory failure does not decrease mortality. Whether it is beneficial to administer prone ventilation early, and for longer periods of time, is unknown.

METHODS

We enrolled 136 patients within 48 h of tracheal intubation for severe ARDS, 60 randomized to supine and 76 to prone ventilation. Guidelines were established for ventilator settings and weaning. The prone group was targeted to receive continuous prone ventilation treatment for 20 h/d.

RESULTS

The intensive care unit mortality was 58% (35/60) in the patients ventilated supine and 43% (33/76) in the patients ventilated prone (p = 0.12). The latter had a higher simplified acute physiology score II at inclusion. Multivariate analysis showed that simplified acute physiology score II at inclusion (odds ratio [OR], 1.07; p < 0.001), number of days elapsed between ARDS diagnosis and inclusion (OR, 2.83; p < 0.001), and randomization to supine position (OR, 2.53; p = 0.03) were independent risk factors for mortality. A total of 718 turning procedures were done, and prone position was applied for a mean of 17 h/d for a mean of 10 d. A total of 28 complications were reported, and most were rapidly reversible.

CONCLUSION

Prone ventilation is feasible and safe, and may reduce mortality in patients with severe ARDS when it is initiated early and applied for most of the day.

North Spain (Burgos) wild mammals ectoparasites

Twenty-seven species of arthropods were collected from 105 wild mammals, six wolves Canis lupus (Linnaeus, 1758) included. A total of 87 animals (82.8%) harboured some ectoparasites. Ticks were found in 60% of the samples, fleas in 51.4%, chewing-lice in 3.8%, and others (Mesostigmata and hippoboscids) in 3.8%. Moreover, 42.5% were single infestation and 57.5% mixed. Some of the species were new records for a host in spanish country such as Trichodectes canis (De Géer, 1778), Ixodes trianguliceps (Birula, 1895), Ceratophyllus (Monopsyllus) S. sciurorum (Schrank, 1803) and Paraceras melis melis (Walker, 1856) on several mammals. Two species were new records for Spain: Chaetopsylla matina (Jordan, 1925) and Archaeopsylla erinacei erinacei (Bouché, 1835).

Role of ionic fluxes in the apoptotic cell death of cultured cerebellar granule neurons

Cultured cerebellar granule neurons (CGC) increase survival in a medium containing 25 mM KCl (K25), and they die apoptotically when cultures are treated with staurosporine (St) or are transferred to a 5-mM KCl containing medium (K5). Apoptotic CGC show nuclear condensation and caspase-3 activation. Cell death induced by these conditions was partially prevented when cultures were maintained under alkaline conditions, which also induced a marked reduction of the caspase-3 activation. The acidification of the medium further increased cell death induced by both stimuli. Cultures transferred to K5 suffered an immediate intracellular alkalinization that remained constant during the time K5 was present. In contrast, St did not modify cytosolic pH at any of the evaluated times. On the other hand, DIDS, furosemide, and bumetanide prevented CGC death induced by K5 and St. Other drugs such as amiloride, EIPA, tamoxifen, NEM, or NPPB did not modify cell death induced by these conditions. Both DIDS and bumetanide markedly inhibited the processing and activation of caspase-3, and DIDS prevented the nuclear condensation induced by K5 and St. These findings suggest that pH is a condition that could contribute to the modulation of cell death induced by some stimuli and that other ions, such as potassium, could have a role in the initial phase of apoptotic death of CGC.

Synthesis of antitumor dendritic imides

Dendritic imides were synthesized and evaluated as antitumor compounds. Compounds 8 and 11 showing a promising profile as inhibitors of lck but their antiproliferative activity against HT-29 was not so relevant.

Analysis of genetic and epigenetic processes that influence p14ARF expression in breast cancer

The INK4a/ARF locus encodes two unrelated cell cycle-regulatory proteins that both function in tumor suppression, p16INK4a and p14ARF. In human tumors including breast cancer, alterations affecting selectively p14ARF have been poorly analysed. We have performed a comprehensive analysis of the inactivation mechanisms (mutation, homozygous and hemizygous deletion, and promoter hypermethylation) in a large series of 100 primary breast carcinomas. RT-PCR showed expression variable of the p14ARF transcript, with 17% demonstrating overexpression and 26% demonstrating decreased expression. No detectable alterations were observed in the majority of cases with overexpressed p14ARF mRNA, but 77% of tumors with decreased expression presented at least one of these genetic/epigenetic alterations. Nevertheless, a statistically significant correlation was observed between decreased p14ARF expression and several poor prognostic parameters.

Different expression of P14ARF defines two groups of breast carcinomas in terms of TP73 expression and TP53 mutational status

In 95 breast carcinomas, we investigated P14ARF and TP73 mRNA expression and their relationship to TP53 mutations, determined by an immunohistochemical method, studying several clinicopathologic features of the tumors. P14ARF and TP73 mRNA levels were determined by semiquantitative reverse transcription polymerase chain reaction (RT-PCR), using beta-actin as a control. P14ARF was overexpressed in 19% of the cases and underexpressed in 24%. TP73 was overexpressed in 22% of the tumors, and normal levels were found in the remaining 78%. The analysis of TP53 showed positive immunostaining in 38% of cases. The association of P14ARF and TP73 overexpression was statistically significant, as was the association between positive TP53 staining and TP73 overexpression. P14ARF was related to TP53 only in those cases in which there was low expression of P14ARF. Concomitant overexpression of P14ARF and TP73 was statistically related to positive TP53 immunostaining. The analysis of concomitant P14ARF and TP73 overexpression and clinicopathologic parameters of the tumors showed a statistically significant difference with respect to peritumoral vessel invasion (P = 0.01), lymph node metastasis (P = 0.03), negative ERBB2 expression (P = 0.005), and more advanced pathologic stages (P = 0.03). These results suggest that overexpression of P14ARF and TP73 could be implicated in breast carcinoma tumorigenesis and, ultimately, in the phenotypic features of these lesions.

Alternatives in the induction and preparation of phenobarbital/naphthoflavone-induced S9 and their activation profiles

With the aim of optimizing the efficiency of S9 fractions used in in vitro mutagenicity assays, different schemes for the induction of liver enzymes in rats were tried and the amount of S9 fraction required was assessed. The activity of 2-anthramine (2AA), 2-acetylaminofluorene (2AAF), 3-methylcholanthrene (3MTCL) and benzo[a]pyrene in bacterial mutagenicity tests was compared with the enzymatic activity in S9 fractions obtained from rats treated with either phenobarbital (NaPB), beta-naphthoflavone (betaNF) or combinations of both. Three pool systems prepared with different amounts of NaPB-induced S9 and betaNF-induced S9 were also analyzed for their activation capacities. Profiles of standard plate incorporation assays with Salmonella typhimurium TA98 increased with the amount of S9 fraction added for all drugs tested, except for 2AA, which showed a maximun of activity at low protein concentrations. According to these profiles, an optimal S9 protein content of 700-1000 microg/plate was estimated. For 2AAF and 3MTCL an S9 fraction obtained following a simultaneous treatment with NaPB (i.p.) and betaNF (oral gavage) (NaPB + betaNF) yielded the greatest response. This preparation was the only one which produced positive activation with 3MTCL as test drug. With the other test drugs all the S9 fractions were very active, including the NAPB + betaNF-induced S9. Both Phase I and Phase II cytochrome P450 enzymatic activities were enhanced in this S9 fraction. These results suggest that the simultaneous treatment (NaPB + betaNF) would be an adequate inducer for in vitro activation when used at 700-1000 microg protein/plate.

The sulphydryl-activated cytolysin and a sphingomyelinase C are the major membrane-damaging factors involved in cooperative (CAMP-like) haemolysis of Listeria spp

The negative mutant approach was used in this study to identify listerial cytolytic factors involved in cooperative haemolysis (CAMP-like phenomenon) with Staphylococcus aureus and Rhodococcus equi. A Listeria monocytogenes non-haemolytic mutant specifically impaired in listeriolysin O (LLO) production gave no CAMP reaction with S. aureus, and was virtually CAMP-negative with R. equi, indicating that the listerial sulphydryl-activated toxin played a major role in cooperative haemolysis. This was confirmed by direct evidence using purified LLO and alveolysin (from Bacillus alvei) in diffusion CAMP assays. To our knowledge, this is the first evidence of involvement of a sulphydryl-activated toxin in cooperative lytic processes. Phosphatidylcholine- and phosphatidylinositol-specific phospholipases C from L. monocytogenes did not seem to significantly contribute to cooperative haemolysis, as the corresponding mutants displayed wild-type CAMP reactions. In contrast, the sphingomyelinase C from Listeria iva-novii was the cytolytic factor responsible for the characteristic shovel-shaped CAMP reaction shown by this listerial species with R. equi. Possible mechanisms of lytic cooperation are discussed.

Volume-controlled ventilation and pressure-controlled inverse ratio ventilation: a comparison of their effects in ARDS patients

Volume-controlled ventilation with positive end-expiratory pressure (PEEP) (CPPV) is the conventional ventilatory approach in adult respiratory distress syndrome (ARDS) patients, but some reports suggest that pressure-controlled ventilation with an inverse inspiratory to expiratory ratio (PCIRV) may improve gas exchange in these patients. We analysed the acute effects on gas exchange, lung mechanics and haemodynamics induced by CPPV and PCIRV in ARDS patients. CPPV and PCIRV were applied randomly in ARDS patients. During CPPV, external PEEP was titrated according to the initial inflection point in the static pressure-volume (P-V) curve of the respiratory system, or it was 10 cmH2O when there was no inflection. During PCIRV, external PEEP was not applied, and inspiratory to expiratory (I/E) ratio was inversed until total PEEP was equal to the inflection point in the P-V curve, or it was 10 cmH2O. Respiratory rate, fractional inspiratory oxygen (FIO2), and tidal volume (VT) were kept constant in both modes. Eight ARDS patients were studied prospectively and admitted to a general Intensive Care Unit (ICU) of a University Hospital. Haemodynamic measurements, airflow (V), airway pressure (Paw) and VT were obtained using standard methods. We did not observe any significant change between CPPV and PCIRV with respect to: arterial oxygen tension (PaO2) 117 +/- 12 vs 107 +/- 15 mmHg (16 +/- 2 vs 14 +/- 2 kPa), arterial carbon dioxide tension (PaCO2) 40 +/- 2 vs 39 +/- 2 mmHg (6 +/- 0.3 vs 5 +/- 0.3 kPa), intrapulmonary shunt function (QS/QT) 36 +/- 3 vs 38 +/- 4%, cardiac output (CO) 7.1 +/- 0.7 vs 7 +/- 0.8 l.min-1, and total PEEP 9.7 +/- 0.6 vs 9 +/- 0.3 cmH2O. Oxygen transport and total respiratory system compliance remained unchanged in both modes. Mean Paw was slightly lower during CPPV (17 +/- 1 cmH2O) than during PCIRV (19 +/- 1 cmH2O). PCIRV does not appear to have clinical advantages over CPPV in terms of gas exchange, haemodynamics, or static lung mechanics when using the same total PEEP and minute ventilation.

Relationship between oxygen consumption and oxygen delivery during anesthesia in high-risk surgical patients

OBJECTIVE

To identify critical oxygen delivery (DO2) and oxygen extraction ratio in high-risk surgical patients studied preoperatively and intraoperatively.

DESIGN

Prospective study. Consecutive series of intraoperatively monitored patients.

SETTING

The surgical ICU in a tertiary care center.

PATIENTS

High-risk surgical patients undergoing major noncardiac surgery.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Twenty high-risk patients were studied during the preoperative and intraoperative periods. All patients were monitored with triple-lumen thermodilution catheters. Hemodynamic profiles consisted of determinations of intravascular pressures, cardiac output, and arterial and venous pulmonary gases. Oxygen transport variables were calculated by standard formulas. Multiple determinations were carried out during the perioperative period in each patient. The critical levels of DO2, determined by a polynomial regression method, were 375 and 390 mL/min/m2 in the preoperative and intraoperative periods, respectively. Oxygen extraction reached at the critical level of DO2 was significantly (p < .01) lower during the intraoperative period (31 +/- 4.5% vs. 18 +/- 2.3%). Critical mixed venous oxygen tension was significantly (p < .01) higher in the intraoperative period (36 +/- 5 vs. 46 +/- 4 torr [4.8 +/- 0.7 vs. 6.1 +/- 0.5 kPa]).

CONCLUSIONS

Our data show that the intraoperative period might be associated with a reduction in tissue ability to extract oxygen. If this reduction in oxygen extraction is proportionately higher than the reduction in metabolic oxygen demand produced by anesthetic agents and hypothermia, then the critical value for DO2 may be similar to, or higher than, that value in the preoperative period. Thus, the intraoperative period represents, for this patient population, a high-risk condition for the development of a tissue oxygenation debt in the presence of a limitation in DO2. Cautious dosing of inhaled agents, maintenance of normothermia, and early optimization of the oxygen delivery/oxygen consumption relationship seem to constitute reasonable measures in the intraoperative handling of these patients in order to reduce perioperative morbidity and mortality.