Reverse triggering ? a novel or previously missed phenomenon?

BACKGROUND: Reverse triggering (RT) was described in 2013 as a form of patient-ventilator asynchrony, where patient's respiratory effort follows mechanical insufflation. Diagnosis requires esophageal pressure (Pes) or diaphragmatic electrical activity (EAdi), but RT can also be diagnosed using standard ventilator waveforms. HYPOTHESIS: We wondered (1) how frequently RT would be present but undetected in the figures from literature, especially before 2013; (2) whether it would be more prevalent in the era of small tidal volumes after 2000. METHODS: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, from 1950 to 2017, with key words related to asynchrony to identify papers with figures including ventilator waveforms expected to display RT if present. Experts labelled waveforms. 'Definite' RT was identified when Pes or EAdi were in the tracing, and 'possible' RT when only flow and pressure waveforms were present. Expert assessment was compared to the author's descriptions of waveforms. RESULTS: We found 65 appropriate papers published from 1977 to now, containing 181 ventilator waveforms. 21 cases of 'possible' RT and 25 cases of 'definite' RT were identified by the experts. 18.8% of waveforms prior to 2013 had evidence of RT. Most cases were published after 2000 (1 before vs. 45 after, p = 0.03). 54% of RT cases were attributed to different phenomena. A few cases of identified RT were already described prior to 2013 using different terminology (earliest in 1997). While RT cases attributed to different phenomena decreased after 2013, 60% of 'possible' RT remained missed. CONCLUSION: RT has been present in the literature as early as 1997, but most cases were found after the introduction of low tidal volume ventilation in 2000. Following 2013, the number of undetected cases decreased, but RT are still commonly missed. Reverse Triggering, A Missed Phenomenon in the Literature. Critical Care Canada Forum 2019 Abstracts. Can J Anesth/J Can Anesth 67 (Suppl 1), 1-162 (2020). https://doi-org.myaccess.library.utoronto.ca/ https://doi.org/10.1007/s12630-019-01552-z .

Oxidants Regulated Diaphragm Proteolysis during Mechanical Ventilation in Rats.

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Diaphragm dysfunction and atrophy develop during controlled mechanical ventilation. Although oxidative stress injures muscle during controlled mechanical ventilation, it is unclear whether it causes autophagy or fiber atrophy. WHAT THIS ARTICLE TELLS US THAT IS NEW: Pretreatment of rats undergoing 24 h of mechanical ventilation with N-acetylcysteine prevents decreases in diaphragm contractility, inhibits the autophagy and proteasome pathways, but has no influence on the development of diaphragm fiber atrophy. BACKGROUND: Diaphragm dysfunction and atrophy develop during prolonged controlled mechanical ventilation. Fiber atrophy has been attributed to activation of the proteasome and autophagy proteolytic pathways. Oxidative stress activates the proteasome during controlled mechanical ventilation, but it is unclear whether it also activates autophagy. This study investigated whether pretreatment with the antioxidant N-acetylcysteine affects controlled mechanical ventilation-induced diaphragm contractile dysfunction, fiber atrophy, and proteasomal and autophagic pathway activation. The study also explored whether proteolytic pathway activity during controlled mechanical ventilation is mediated by microRNAs that negatively regulate ubiquitin E3 ligases and autophagy-related genes. METHODS: Three groups of adult male rats were studied (n = 10 per group). The animals in the first group were anesthetized and allowed to spontaneously breathe. Animals in the second group were pretreated with saline before undergoing controlled mechanical ventilation for 24 h. The animals in the third group were pretreated with N-acetylcysteine (150 mg/kg) before undergoing controlled mechanical ventilation for 24 h. Diaphragm contractility and activation of the proteasome and autophagy pathways were measured. Expressions of microRNAs that negatively regulate ubiquitin E3 ligases and autophagy-related genes were measured with quantitative polymerase chain reaction. RESULTS: Controlled mechanical ventilation decreased diaphragm twitch force from 428 ± 104 g/cm (mean ± SD) to 313 ± 50 g/cm and tetanic force from 2,491 ± 411 g/cm to 1,618 ± 177 g/cm. Controlled mechanical ventilation also decreased diaphragm fiber size, increased expression of several autophagy genes, and augmented Atrogin-1, MuRF1, and Nedd4 expressions by 36-, 41-, and 8-fold, respectively. Controlled mechanical ventilation decreased the expressions of six microRNAs (miR-20a, miR-106b, miR-376, miR-101a, miR-204, and miR-93) that regulate autophagy genes. Pretreatment with N-acetylcysteine prevented diaphragm contractile dysfunction, attenuated protein ubiquitination, and downregulated E3 ligase and autophagy gene expression. It also reversed controlled mechanical ventilation-induced microRNA expression decreases. N-Acetylcysteine pretreatment had no affect on fiber atrophy. CONCLUSIONS: Prolonged controlled mechanical ventilation activates the proteasome and autophagy pathways in the diaphragm through oxidative stress. Pathway activation is accomplished, in part, through inhibition of microRNAs that negatively regulate autophagy-related genes.

The impact of a research elective on a respiratory therapy student's perspective.

As the infrastructure of the healthcare landscape continues to change, Registered Respiratory Therapists (RRTs) may be required to assume nontraditional roles in health care. One such role is RRTs as researchers. However, there are few opportunities for students to explore research as a career option given current rigidly structured didactic curriculums. One possible solution to this dilemma is the addition of a summertime research elective. The following article will discuss the general importance of research, followed by an overview of RRTs involved in research. We conclude this article with a narrative recount of an RRT researcher and a respiratory therapy student's initiative to organize and execute a summertime research elective.

The impact of a research elective on a respiratory therapy student's perspective.

As the infrastructure of the healthcare landscape continues to change, Registered Respiratory Therapists (RRTs) may be required to assume nontraditional roles in health care. One such role is RRTs as researchers. However, there are few opportunities for students to explore research as a career option given current rigidly structured didactic curriculums. One possible solution to this dilemma is the addition of a summertime research elective. The following article will discuss the general importance of research, followed by an overview of RRTs involved in research. We conclude this article with a narrative recount of an RRT researcher and a respiratory therapy student's initiative to organize and execute a summertime research elective.

Regulation of ULK1 Expression and Autophagy by STAT1.

Autophagy involves the lysosomal degradation of cytoplasmic contents for regeneration of anabolic substrates during nutritional or inflammatory stress. Its initiation occurs rapidly after inactivation of the protein kinase mammalian target of rapamycin (mTOR) (or mechanistic target of rapamycin), leading to dephosphorylation of Unc-51-like kinase 1 (ULK1) and autophagosome formation. Recent studies indicate that mTOR can, in parallel, regulate the activity of stress transcription factors, including signal transducer and activator of transcription-1 (STAT1). The current study addresses the role of STAT1 as a transcriptional suppressor of autophagy genes and autophagic activity. We show that STAT1-deficient human fibrosarcoma cells exhibited enhanced autophagic flux as well as its induction by pharmacological inhibition of mTOR. Consistent with enhanced autophagy initiation, ULK1 mRNA and protein levels were increased in STAT1-deficient cells. By chromatin immunoprecipitation, STAT1 bound a putative regulatory sequence in the ULK1 5'-flanking region, the mutation of which increased ULK1 promoter activity, and rendered it unresponsive to mTOR inhibition. Consistent with an anti-apoptotic effect of autophagy, rapamycin-induced apoptosis and cytotoxicity were blocked in STAT1-deficient cells but restored in cells simultaneously exposed to the autophagy inhibitor ammonium chloride. In vivo, skeletal muscle ULK1 mRNA and protein levels as well as autophagic flux were significantly enhanced in STAT1-deficient mice. These results demonstrate a novel mechanism by which STAT1 negatively regulates ULK1 expression and autophagy.

Cation-Dependent Self-assembly of Vanadium Polyoxoniobates.

Reaction of Na7H[Nb6O19]·15H2O with NaVO3·2H2O at 220 °C in the presence of NaHCO3 gives new bicapped α-Keggin vanadododecaniobate [VNb12O40{NbO(CO3)}2]13-, isolated and structurally characterized as Na9H4[VNb12O40{NbO(CO3)}2]·37H2O (1). According to 51V NMR and ESI-MS data, this anion equilibrates in solution with [VNb12O40]15- and oligomeric species that result from dissociation of the {NbO(CO3)}+ fragments. In the presence of potassium, the same reaction gives [VxNb24O76]n- (x = 4, n = 12 (2a); x = 3, n = 17 (2b)). The anions with x = 3 and 4 cocrystallize together, but exist as separate entities both in solid and in solution according to 51V MAS NMR and ESI-MS data.

Prolonged controlled mechanical ventilation in humans triggers myofibrillar contractile dysfunction and myofilament protein loss in the diaphragm.

BACKGROUND: Prolonged controlled mechanical ventilation (CMV) in humans and experimental animals results in diaphragm fibre atrophy and injury. In animals, prolonged CMV also triggers significant declines in diaphragm myofibril contractility. In humans, the impact of prolonged CMV on myofibril contractility remains unknown. The objective of this study was to evaluate the effects of prolonged CMV on active and passive human diaphragm myofibrillar force generation and myofilament protein levels. METHODS AND RESULTS: Diaphragm biopsies were obtained from 13 subjects undergoing cardiac surgery (control group) and 12 brain-dead organ donors (CMV group). Subjects in each group had been mechanically ventilated for 2-4 and 12-74 h, respectively. Specific force generation of diaphragm myofibrils was measured with atomic force cantilevers. Rates of force development (Kact), force redevelopment after a shortening protocol (Ktr) and relaxation (Krel) in fully activated myofibrils (pCa(2+)=4.5) were calculated to assess myosin cross-bridge kinetics. Myofilament protein levels were measured with immunoblotting and specific antibodies. Prolonged CMV significantly decreased active and passive diaphragm myofibrillar force generation, Kact, Ktr and Krel. Myosin heavy chain (slow), troponin-C, troponin-I, troponin-T, tropomyosin and titin protein levels significantly decreased in response to prolonged CMV, but no effects on α-actin, α-actinin or nebulin levels were observed. CONCLUSIONS: Prolonged CMV in humans triggers significant decreases in active and passive diaphragm myofibrillar force generation. This response is mediated, in part, by impaired myosin cross-bridge kinetics and decreased myofibrillar protein levels.

Synthesis and Characterization of [(OH)TeNb5O18](6-) in Water Solution, Comparison with [Nb6O19](8-).

Reaction of [Nb6O19](8-) with H6TeO6 in water gives telluropentaniobate [(OH)TeNb5O18](6-) (1) as single product, which was isolated as Na(+) and mixed Na(+)/K(+) salts. Crystal structures were determined for Na6[(OH)TeNb5O18]·15H2O (Na6-1) and K6Na[Nb(5.5){Te(OH)}(0.5)O(18.5)]·26H2O (K6Na-1). Formation of 1 was monitored with electrospray ionization mass spectrometry (ESI-MS) and (125)Te NMR techniques. Capillary electrophoresis was used to calculate electrophoretic mobilities and radii of the anionic species in solutions of [(OH)TeNb5O18](6-) and [Nb6O19](8-) in borate buffer. No condensation or degradation products were detected. Reactions of 1 with {Cp*Rh}(2+) sources gives 1:1 and 2:1 hybrid polyoxometalate, which are present in solution as a mixture of isomers, as detected by (125)Te NMR. The isomerism is related to various possibilities of coordination of {Cp*Rh}(2+) to different {M3O3} faces, relative to the unique Te atom. According to ESI-MS experiments in water and methanol, rapid redistribution of the organometallic fragments between the 1:1 and 2:1 complexes takes place. The 1:1 complexes are more stable in water, while 2:1 complexes dominate in methanol. X-ray structural analysis of the crystals isolated from 2:1 reaction mixture allowed identification of Na3[{Cp*Rh}2TeNb5O19]·24H2O (Cp*2Rh2-1) with two {Cp*Rh}(2+) fragments capping the opposing faces of the Lindqvist anion.

High proton conductivity and spectroscopic investigations of metal-organic framework materials impregnated by strong acids.

Strong toluenesulfonic and triflic acids were incorporated into a MIL-101 chromium(III) terephthalate coordination framework, producing hybrid proton-conducting solid electrolytes. These acid@MIL hybrid materials possess stable crystalline structures that do not deteriorate during multiple measurements or prolonged heating. Particularly, the triflic-containing compound demonstrates the highest 0.08 S cm(-1) proton conductivity at 15% relative humidity and a temperature of 60 °C, exceeding any of today's commercial materials for proton-exchange membranes. The structure of the proton-conducting media, as well as the long-range proton-transfer mechanics, was unveiled, in a certain respect, by Fourier transform infrared and (1)H NMR spectroscopy investigations. The acidic media presumably constitutes large separated droplets, coexisting in the MIL nanocages. One component of proton transfer appears to be related to the facile relay (Grotthuss) mechanism through extensive hydrogen-bonding interactions within such droplets. The second component occurs during continuous reorganization of the droplets, thus ensuring long-range proton transfer along the porous structure of the material.

Cyclic tungstoselenites based on {Se2W12} units.

The reaction of Na2WO4 and SeO2 under moderately acidic conditions yielded a novel 39-tungsto-6-selenite, [(Se2W12O46(WO(H2O))3](24-) (1), isolated as Na24[H6Se6W39O144]·74H2O. The macrocyclic polyanion consists of three {Se2W12} fragments connected via three trans-{WO(H2O)}(4+) groups. The same {Se2W12} building block is present in the structure of [(Se2W12O46)2{Mn2Cl(H2O)2}{Mn(H2O)2}2(SeO)2](13-) (2), which was obtained from the same reagents in the presence of MnCl2. The compounds were characterized by single-crystal X-ray diffraction, (77)Se NMR, Fourier transform infrared, and Raman spectroscopy.

Cd2+ complexation with P(CH2OH)3, OP(CH2OH)3, and (HOCH2)2PO2(-): coordination in solution and coordination polymers.

The coordination of Cd(2+) with P(CH(2)OH)(3) (THP) in methanol was followed by (31)P and (111)Cd NMR techniques. A cadmium-to-phosphine coordination ratio of 1:3 has been established, and effective kinetic parameters have been calculated. Air oxidation of THP in the presence of CdCl(2) at room temperature produces coordination polymer (3)(∞)[Cd(3)Cl(6)(OP(CH(2)OH)(3))(2)] (1). The same oxidation reaction at 70 °C gives another coordination polymer, (∞)[CdCl(2)(OP(CH(2)OH)(3))] (2). Complexes 1 and 2 are the first structurally characterized complexes featuring OP(CH(2)OH)(3) as a ligand that acts as a linker between Cd atoms. The addition of NaBPh(4) to the reaction mixture gives coordination polymer (∞)[Na(2)CdCl(2)(O(2)P(CH(2)OH)(2))(2)(H(2)O)(3)] (3) with (HOCH(2))(2)PO(2)(-) as the ligand. Coordination polymers 1-3 have been characterized by X-ray analysis, elemental analysis, and IR spectroscopy.

Unusual H-bonding in novel cyano-cluster polymeric hydrates [(H){Ln(H2O)4}{Re6S8(CN)6}]*2H2O (Ln = Yb, Lu).

X-Ray studies and (1)H NMR measurements for novel cyano-bridged polymers [(H){Ln(H(2)O)(4)}{Re(6)S(8)(CN)(6)}]*2H(2)O (Ln = Yb, Lu) reveal temperature dependence of proton localization: acid protons are trapped between nitrogen atoms at low temperatures, but can be transferred to the water sublattice at higher temperatures; this transfer resulted in intermolecular proton exchange.