Exposure to Non-Steady-State Oxygen Is Reflected in Changes to Arterial Blood Gas Values, Prefrontal Cortical Activity, and Systemic Cytokine Levels.

Onboard oxygen-generating systems (OBOGSs) provide increased inspired oxygen (FiO2) to mitigate the risk of neurologic injury in high altitude aviators. OBOGSs can deliver highly variable oxygen concentrations oscillating around a predetermined FiO2 set point, even when the aircraft cabin altitude is relatively stable. Steady-state exposure to 100% FiO2 evokes neurovascular vasoconstriction, diminished cerebral perfusion, and altered electroencephalographic activity. Whether non-steady-state FiO2 exposure leads to similar outcomes is unknown. This study characterized the physiologic responses to steady-state and non-steady-state FiO2 during normobaric and hypobaric environmental pressures emulating cockpit pressures within tactical aircraft. The participants received an indwelling radial arterial catheter while exposed to steady-state or non-steady-state FiO2 levels oscillating ± 15% of prescribed set points in a hypobaric chamber. Steady-state exposure to 21% FiO2 during normobaria produced arterial blood gas values within the anticipated ranges. Exposure to non-steady-state FiO2 led to PaO2 levels higher upon cessation of non-steady-state FiO2 than when measured during steady-state exposure. This pattern was consistent across all FiO2 ranges, at each barometric condition. Prefrontal cortical activation during cognitive testing was lower following exposure to non-steady-state FiO2 >50% and <100% during both normobaria and hypobaria of 494 mmHg. The serum analyte levels (IL-6, IP-10, MCP-1, MDC, IL-15, and VEGF-D) increased 48 h following the exposures. We found non-steady-state FiO2 levels >50% reduced prefrontal cortical brain activation during the cognitive challenge, consistent with an evoked pattern of neurovascular constriction and dilation.

Climate change and Australia's primary industries: factors hampering an effective and coordinated response.

Australia's primary production sector operates in one of the world's most variable climates with future climate change posing a challenge to its ongoing sustainability. Recognising this, Australia has invested in understanding climate change risks to primary production with a substantial amount of research produced. Recently, focus on this research space has broadened, with interests from the financial sector and expanded scopes of works from government and industry. These expanded needs require sector- and country-wide assessments to assist with the implementation of climate strategies. We considered the applicability of the current research body for these needs by reviewing 188 peer-reviewed studies that considered the quantitative impacts of climate change on Australia's primary industries. Our broad review includes cropping, livestock, horticulture, forestry and fisheries and biosecurity threats. This is the first such review for Australia, and no other similar country-wide review was found. We reviewed the studies through three lenses, industry diversity, geographic coverage and study comparability. Our results show that all three areas are lacking for sector- and country-wide assessments. Industry diversity was skewed towards cropping and biosecurity threats (64% of all studies) with wheat in particular a major focus (25% of all studies). Geographic coverage at a state level appeared to be evenly distributed across the country; however, when considered in conjunction with industry focus, gaps emerged. Study comparability was found to be very limited due to the use of different historical baseline periods and different impact models. We make several recommendations to assist with future research directions, being (1) co-development of a standard set of method guidelines for impact assessments, (2) filling industry and geographic knowledge gaps, and (3) improving transparency in study method descriptions. Uptake of these recommendations will improve study application and transparency enabling and enhancing responses to climate change in Australia's primary industries.

A case of capillary malformation-arteriovenous malformation and Ebstein's anomaly in a child with EphB4 mutation.

Capillary malformation-arteriovenous malformation (CM-AVM) is a rare condition characterized by multiple cutaneous capillary malformations with potential associated arteriovenous malformations. RAS p21 protein activator 1 (RASA1) and ephrin type-B receptor 4 (EPHB4) genes are implicated. We present a child with CM-AVM, due to EPHB4 mutation, and Ebstein's anomaly. Although EPHB4 is a known effector of vascular remodeling, its contribution to cardiogenesis is still being explored. Further research is needed to determine causality of Ebstein's anomaly in the setting of CM-AVM due to EPHB4 mutation.

Human Papillomavirus Infection of the Skin.

CONTEXT: - Human papillomavirus is implicated in the pathogenesis of benign and malignant neoplasms of the skin. OBJECTIVE: - To review the role of human papillomavirus in the development of malignancies and their precursor lesions in skin. DATA SOURCES: - The study comprised a review of the literature. CONCLUSIONS: - The use of low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion terminology brings order and simplicity to these lesions, correlates with the current understanding of the biology of human papillomavirus infections, and helps to promote accurate diagnosis of and appropriate treatment for these lesions.

Clinical Impact of Cabin Altitude Restriction Following Aeromedical Evacuation.

Combat medical care relies on aeromedical evacuation (AE). Vital to AE is the validating flight surgeon (VFS) who warrants a patient is "fit to fly." To do this, the VFS considers clinical characteristics and inflight physiological stressors, often prescribing specific interventions such as a cabin altitude restriction (CAR). Unfortunately, limited information is available regarding the clinical consequences of a CAR. Consequently, a dual case-control study (CAR patients versus non-CAR patients and non-CAR patients flown with a CAR versus non-CAR patients) was executed. Data on 1,114 patients were obtained from TRANSCOM Regulating and Command and Control Evacuation System and Landstuhl Regional Medical Center trauma database (January 2007 to February 2008). Demographic and clinical factors essentially showed no difference between groups; however, CAR patients appeared more severely injured than non-CAR patients. Despite being sicker, CAR patients had similar clinical outcomes when compared with non-CAR patients. In contrast, despite an equivocal severity picture, the non-CAR patients flown with a CAR had superior clinical outcomes when compared with non-CAR patients. It appeared that the CAR prescription normalized severely injured to moderately injured and brought moderately injured into a less morbid state. These results suggest that CAR should be seriously considered when evacuating seriously ill/injured patients.

Regulated expression of a cytokinin biosynthesis gene IPT delays leaf senescence and improves yield under rainfed and irrigated conditions in canola (Brassica napus L.).

Delay of leaf senescence through genetic modification can potentially improve crop yield, through maintenance of photosynthetically active leaves for a longer period. Plant growth hormones such as cytokinin regulate and delay leaf senescence. Here, the structural gene (IPT) encoding the cytokinin biosynthetic enzyme isopentenyltransferase was fused to a functionally active fragment of the AtMYB32 promoter and was transformed into canola plants. Expression of the AtMYB32xs::IPT gene cassette delayed the leaf senescence in transgenic plants grown under controlled environment conditions and field experiments conducted for a single season at two geographic locations. The transgenic canola plants retained higher chlorophyll levels for an extended period and produced significantly higher seed yield with similar growth and phenology compared to wild type and null control plants under rainfed and irrigated treatments. The yield increase in transgenic plants was in the range of 16% to 23% and 7% to 16% under rainfed and irrigated conditions, respectively, compared to control plants. Most of the seed quality parameters in transgenic plants were similar, and with elevated oleic acid content in all transgenic lines and higher oil content and lower glucosinolate content in one specific transgenic line as compared to control plants. The results suggest that by delaying leaf senescence using the AtMYB32xs::IPT technology, productivity in crop plants can be improved under water stress and well-watered conditions.