Teriparatide improves microarchitectural characteristics of peri-implant bone in orchiectomized rats.

This study evaluated the peri-implant bone repair in orchiectomized rats receiving intermittently PTH 1-34. The treatment returned the bone quality and quantity of the animals to normal in the computerized microtomography, laser confocal microscopy, and histological analysis. The PTH 1-34 promoted marked bone formation with increased volume, improved quality, and greater bone turnover. INTRODUCTION: Osteoporosis can be a problem in implant osseointegration. So this study aimed to evaluate the quantity and quality of peri-implant bone repair in orchiectomized Wistar rats receiving intermittently administered PTH 1-34. METHODS: Animals (n = 24) were divided into 3 groups: healthy control (SHAM), orchiectomized (ORQ), and orchiectomized and treated with 0.5 µg/kg/day PTH 1-34 (TERI), and each received an implant in the right and left tibial metaphysis, which was allowed to repair for 60 days. The resultant bone formation was evaluated through computerized microtomography (micro-CT) to compare the percent bone volume (BV/TV), trabecular thickness (Tb.Th), trabecular number and separation (Tb.N, Tb.Sp), and bone implant contact (BIC) through the intersection surface (i.S) between groups. Laser confocal microscopy was used to evaluate fluorochrome areas for mineral apposition rate (MAR) and neoformed bone area (NBA). In addition, histological evaluation of calcified tissues with Stevenel blue and alizarin red staining was performed. RESULTS: Treatment with PTH 1-34 returned the bone quality and quantity of the osteoporotic animal to normal, as the TERI group presented statistically significant higher values for BV/TV, Tb.Th, and BIC parameters compared with ORQ (p < 0.05), but when compared with SHAM (p > 0.05), no statistical difference was noted. In addition, in the bone turnover analysis (MAR, NBA) for TERI, the highest results are presented, followed by SHAM, and then ORQ (TERI × ORQ: p < 0.05). CONCLUSIONS: Intermittent treatment with PTH 1-34 on orchiectomized animals promoted marked bone formation with increased volume, improved quality, and greater bone turnover in the peri-implant space, returning the bone quality and quantity to the present standard in healthy animals.

IFPA meeting 2015 workshop report II: mechanistic role of the placenta in fetal programming; biomarkers of placental function and complications of pregnancy.

Workshops are an integral component of the annual International Federation of Placenta Association (IFPA) meeting, allowing for networking and focused discussion related to specialized topics on the placenta. At the 2015 IFPA meeting (Brisbane, Australia) twelve themed workshops were held, three of which are summarized in this report. These workshops focused on various aspects of placental function, particularly in cases of placenta-mediated disease. Collectively, these inter-connected workshops highlighted the role of the placenta in fetal programming, the use of various biomarkers to monitor placental function across pregnancy, and the clinical impact of novel diagnostic and surveillance modalities in instances of late onset fetal growth restriction (FGR).

Prolonged weaning: from the intensive care unit to home.

Weaning is the process of withdrawing mechanical ventilation which starts with the first spontaneous breathing trial (SBT). Based on the degree of difficulty and duration, weaning is classified as simple, difficult and prolonged. Prolonged weaning, which includes patients who fail 3 SBTs or are still on mechanical ventilation 7 days after the first SBT, affects a relatively small fraction of mechanically ventilated ICU patients but these, however, requires disproportionate resources. There are several potential causes which can lead to prolonged weaning. It is nonetheless important to understand the problem from the point of view of each individual patient in order to adopt appropriate treatment and define precise prognosis. An otherwise stable patient who remains on mechanical ventilation will be considered for transfer to a specialized weaning unit (SWU). Though there is not a precise definition, SWU can be considered as highly specialized and protected environments for patients requiring mechanical ventilation despite resolution of the acute disorder. Proper staffing, well defined short-term and long-term goals, attention to psychological and social problems represent key determinants of SWU success. Some patients cannot be weaned, either partly or entirely, and may require long-term home mechanical ventilation. In these cases the logistics relating to caregivers and the equipment must be carefully considered and addressed.

Physiologic evaluation of 4 weeks of nocturnal nasal positive pressure ventilation in stable hypercapnic patients with chronic obstructive pulmonary disease.

BACKGROUND: The long-term daily use of noninvasive mechanical ventilation (NIMV) to treat chronic respiratory failure in chronic obstructive pulmonary disease (COPD) patients is not widely recommended, partly because of a lack of clear clinical results and partly because the physiological mechanisms by which the daily application of NIMV would be helpful in these patients have not yet been clarified. OBJECTIVES: We designed a physiological study in order to assess the effects of supervised long-term NIMV on gas exchange, respiratory muscle function, pulmonary mechanics and to ascertain the possible effect of the treatment in responders and nonresponders. METHODS: Fourteen consecutive inpatients with stable hypercapnic COPD (pH = 7.37 +/- 0.01; PaCO(2) = 56.73 +/- 6.48 mm Hg) underwent 4 weeks of nocturnal NIMV delivered with a bilevel ventilator 'physiologically' set to reduce tidal transdiaphragmatic pressure (Pdi) by at least 50% and the amount of dynamic intrinsic positive end-expiratory pressure by 70%. Various measurements were compared with those obtained in a control group of consecutive patients with comparable baseline characteristics who refused NIMV and underwent breathing exercises for the same period of time. RESULTS: By the end of the 4 weeks NIMV had induced a slight but significant (p < 0.01) reduction in resting PaCO(2) (53.78 +/- 5.64 mm Hg) associated with a decrease in the pressure time product of the diaphragm per minute (from 172 +/- 60 to 136 +/- 61 cm H(2)O/l/s; p < 0.05). This latter value was primarily due to a significant shortening of the inspiratory duty cycle, while Pdi and lung mechanics were not modified. Eight of the 13 NIMV-treated patients (1 dropped out for nonmedical reasons) had a clear reduction in PaCO(2) (>3 mm Hg or >5% from enrollment) and were classified as responders. The acute reduction in PaCO(2) during the first trial with NIMV resulted to be a strong index of the final response. The subgroup of responders had a significantly increased maximal Pdi (from 41 +/- 19 to 49 +/- 23 cm H(2)O, p < 0.05) and an enhanced ability of the ventilatory pump to clear CO(2) (9.7 +/- 3.4 vs. 7.2 +/- 2.9 cm H(2)O x s/min; p < 0.01). No significant changes were observed in the control group. CONCLUSIONS: These results suggest that in a remarkable and identifyable proportion of patients with stable hypercapnic COPD, nocturnal NIMV may decrease resting PaCO(2), reraising the role of chronically supporting the respiratory pump.

Physiologic evaluation of noninvasive mechanical ventilation delivered with three types of masks in patients with chronic hypercapnic respiratory failure.

OBJECTIVE: The efficacy of noninvasive mechanical ventilation (NIMV) in improving breathing pattern and arterial blood gases (ABG) in hypercapnic patients has been well documented; however, little attention has been given to the choice of the interface and the ventilatory mode. We evaluated the effects of three types of masks and two modes of ventilation on patients' ABG, breathing pattern, and tolerance to ventilation. DESIGN: Prospective randomized study. SETTING: Two respiratory weaning centers. PATIENTS: A total of 26 stable hypercapnic patients (pH, 7.38 +/- 0.04; PaCO2, 59.2. +/- 10.9 torr) had not received NIMV and were affected by restrictive thoracic disease or obstructive pulmonary disease. INTERVENTIONS: Three 30-min runs of NIMV, delivered using volume-assisted (n = 13) or pressure-assisted modes of partial mechanical support (n = 13), were performed in random order with a full-face mask, a nasal mask, and nasal plugs. MEASUREMENTS: ABG, breathing pattern, and patients' tolerance to ventilation. MAIN RESULTS: Compared with spontaneous breathing, the application of NIMV significantly improved ABG and minute ventilation, irrespective of the ventilatory mode, the underlying pathology or the type of mask. Overall, a nasal mask was better tolerated than the other two interfaces (p < .005 vs. nasal plugs and full-face mask). PaCO2 was significantly lower (p < .01) with a full-face mask or nasal plugs than with a nasal mask (49.5 +/- 9.4 torr, 49.7 +/- 8 torr, and 52.4 +/- 11 torr, respectively). Minute ventilation was significantly higher with a full-face mask than with a nasal mask because of an increase in tidal volume. No differences were observed in tolerance to ventilation, ABG, or breathing pattern, using assist control or pressure-assisted modes. CONCLUSIONS: In this physiologic study, we have shown that in patients with hypercapnic respiratory failure, irrespective of the underlying pathology, the type of interface affects the NIMV outcome more than the ventilatory mode.