Mechanisms of Mechanical Force Induced Pulmonary Vascular Endothelial Hyperpermeability

Mechanical ventilation is a supportive therapy for patients with acute respiratory distress syndrome (ARDS). However, it also inevitably produces or aggravates the original lung injury with pathophysiological changes of pulmonary edema caused by increased permeability of alveolar capillaries which composed of microvascular endothelium, alveolar epithelium, and basement membrane. Vascular endothelium forms a semi-selective barrier to regulate body fluid balance. Mechanical ventilation in critically ill patients produces a mechanical force on lung vascular endothelium when the endothelial barrier was destructed. This review aims to provide a comprehensive overview of molecular and signaling mechanisms underlying the endothelial barrier permeability in ventilator-induced lung jury (VILI).

Efektivitas Relaksasi Benson Terhadap Kecemasan Pasien Yang Menjalani Hemodialisa

Pendahuluan: Penyakit gagal ginjal merupakan gangguan fungsi ginjal yang terjadi saat tubuh tidak bisa mempertahankan metabolisme, keseimbangan cairan serta elektrolit sehingga menyebabkan terjadinya retensi urea dan sampah nitrogen dalam darah. Hemodialisa menjadi pilihan terapi untuk mengatasi gagal ginjal kronik. Hemodialisa dilakukan dengan alat khusus untuk mempertahankan fungsi ginjal dengan menyeimbangkan kadar elektrolit dan keseimbangan cairan tubuh. Hemodialisa yang dilakukan dalam waktu lama dapat menyebabkan gangguan pada aspek biologis maupun aspek psikologis bagi pasien hemodialisa. Sebanyak 48,6 % pasien hemodialisa mengalami gangguan kecemasan. Salah satu non-farmakologi terapi untuk mengurangi kecemasan yaitu relaksasi benson yang dilakukan selama 15-20 menit setiap pagi dan sore hari. Tujuan dari penelitian untuk mengetahui efektivitas relaksasi benson terhadap kecemasan pada pasien yang menjalani hemodialisa. Metode yang digunakan untuk penelitian ini adalah studi literature review dengan membandingkan beberapa literature dari penelusuran situs jurnal seperti Sciendirect, PubMed, Elsevier dan Google Schoolar Hasil Penelitian menunjukkan relaksasi benson yang dilakukan sehari 2 kali selama 15-20 menit efektif untuk mengatasi masalah kecemasan pada pasien yang melakukan hemodialiasa. Kesimpulan: relakasi benson efektif dan bekerja dengan baik dalam menurunkan kadar kecemasan pada pasien hemodialisa Kata Kunci : gagal ginjal kronik, Hemodialisa, Cemas, Relaksasi Benson. Abstract: Introduction: Kidney failure is a disorder of kidney function that occurs when the body cannot maintain metabolism, fluid and electrolyte balance, causing retention of urea and nitrogen waste in the blood. Hemodialysis is a therapeutic option for treating chronic renal failure. Hemodialysis is performed with special tools to maintain kidney function by balancing electrolyte levels and body fluid balance. Hemodialysis that is carried out for a long time can cause disturbances in biological and psychological aspects for hemodialysis patients. As many as 48.6% of hemodialysis patients experienced anxiety disorders. One of the non-pharmacological therapies to reduce anxiety is benson relaxation which is done for 15-20 minutes every morning and evening. The aim of this study was to determine the effectiveness of Benson relaxation on anxiety in patients undergoing hemodialysis. The method used for this research is a literature review study by comparing some literature from searching journal sites such as Sciendirect, PubMed, Elsevier and Google Schoolar. The results showed that Benson relaxation which is carried out twice a day for 15-20 minutes is effective in overcoming anxiety problems in patients with do regular hemodialysis. Conclusion: Benson Relaxation is effective and works well in reducing anxiety levels in hemodialysis patients Keywords: chronic renal failure, hemodialysis, anxiety, Benson Relaxation

Non-Reproductive Effects of Estradiol: Hydromineral Homeostasis Control

The hydromineral homeostasis is fundamental to survival due to maintenance constant the osmotic properties of the plasma and proper tissue perfusion pressure, being maintained primarily through the regulation of the ingestion and urinary excretion of water and electrolytes, mainly sodium. The Renin-Angiotensin System (RAS) plays an essential role in the maintenance of hydromineral homeostasis by eliciting sodium and water intake and by inducing sodium urinary retention through aldosterone release and hemodynamic effect via angiotensin II a key component of the RAS. The hypothalamus-pituitary system also plays a fundamental role in the maintenance of body fluid homeostasis by secreting vasopressin (AVP) and oxytocin (OT) in response to osmotic and non-osmotic, and volemic stimuli. Furthermore, some studies report that besides reproductive function and sexual behavior, ovarian gonadal hormones, mainly 17β-estradiol (E2), modulate other non-reproductive functions such as cardiovascular system, body fluid balance, mood, mental state, memory, and cognition. Estradiol is known to mediate hydromineral homeostasis and blood pressure mainly by attenuating RAS actions. On the other hand, estradiol modulates neurohypophysial hormones secretion in many different ways. In this chapter, we will discuss the main non-reproductive effects of E2 on the control of hydromineral homeostasis, focusing on ingestive behavior and neurohypophyseal hormonal release.

Thirst

Thirst is a specific and compelling sensation, often arising from internal signals of dehydration but modulated by many environmental variables. There are several historical landmarks in the study of thirst and drinking behavior. The basic physiology of body fluid balance is important, in particular the mechanisms that conserve fluid loss. The transduction of fluid deficits can be discussed in relation to osmotic pressure (osmoreceptors) and volume (baroreceptors). Other relevant issues include the neurobiological mechanisms by which these signals are transformed to intracellular and extracellular dehydration thirsts, respectively, including the prominent role of structures along the lamina terminalis. Other considerations are the integration of signals from natural dehydration conditions, including water deprivation, thermoregulatory fluid loss, and thirst associated with eating dry food. These mechanisms should also be considered within a broader theoretical framework of organization of motivated behavior based on incentive salience.

P1195ASSESSMENT OF BODY FLUID VOLUME USING THE BIOIMPEDANCE METHOD IN PERITONEAL DIALYSIS PATIENTS

Background and Aims ppropriate maintenance of body fluid balance in peritoneal dialysis (PD) patients is important for the amelioration of cardiovascular complications and prognosis. In recent years, the usefulness of body fluid measurement with the bioimpedance method in PD patients has been reported. Meanwhile, peritoneal permeability plays an important role in maintaining body fluid balance in PD patients. In the present study, we examined the correlation between peritoneal permeability and body fluid volume in PD patients. Method A total of 58 patients who were undergoing PD at our hospital (42 men and 16 women; mean age, 68 ± 16.2 years; mean dialysis history, 63.5 ± 144.9 months; 25 DM and 35 non-DM patients). Overhydration (OH), total body water (TBW) volume, extracellular water (ECW) volume, and lean tissue mass (LTM) were measured using a body composition analyzer (BCM Fresenius Medical Care Japan). At the same time, peritoneal permeability was measured with fast peritoneal equilibration test to determine the dialysate-to-plasma ratio for creatinine (D/P-Cr), and its correlations with sex, age, age at the time of introduction of dialysis, dialysis history, diabetes history, brain natriuretic peptide (BNP) level, high-sensitivity troponin I (hsTnI) level, blood pressure, body weight, residual kidney function, and ultrafiltration were examined. Results The mean OH was 2.53 ± 2.44 L, and 8 patients (13.8%) had an OH of ≤1.1 L. The results of the multivariate analysis revealed that OH positively correlated with the presence or absence of diabetes, ultrafiltration, D/P-Cr, BNP level, hsTnI level, TBW, and ECW, but showed no correlation with sex, dialysis history, age, age at the time of introduction of dialysis, residual renal function, or LTM. Furthermore, the subjects were assigned to D/P-Cr ≥ 0.65 and ≤0.65 groups. In the former, OH correlated with diabetes and male sex by being negatively correlated with age and age at the time of introduction of dialysis and positively correlated with BNP level, hsTnI level, TBW, and ECW. However, in the D/P-Cr ≤ 0.65 group, OH positively correlated with BNP level and ECW. Conclusion Our results suggest that youth, complications of DM, and men are at risk for fluid overload in PD patients with increased peritoneal permeability.

THE USE OF DIETARY SUPPLEMENTS IN SPORTS NUTRITION AND VIEW OF THEIR EFFECT ON PERFORMANCE

Aim: This study was prepared to investigate the effect of nutritional ergogenic supplements used by people who do sports on their body development in various sports branches. Methods: This review was prepared by compiling the studies on sports nutrition and supplementary foods used in sports nutrition in the last 15 years.Results: Genetic structure, appropriate training and nutrition are the primary factors affect the performance of athletes. The energy needs of athletes differ according to their age, gender, physical activity level and amount of the energy spent. The main factors should be considered in the nutritıon of each athlete must be ensuring the continuity of health and performance, consuming energy and nutrients adeqately, choosing the right food before and after the exercises, establishing continuity in body fat and leaning mass percentage according to the kind of sport performed and ensuring recovery and body fluid balance after training. In recent years, nutritional ergogenic aid has become widespread among athletes at different levels in order to increase the performance and achieve success more easily besides nutrition. As a result of reserarches and clinical trials, espicially glutamine, caffeine, creatine, vitamin and mineral supplements are allowed to be used in correct amounts and proporstions. Conclusion: Studies on Sports Nutrition and their scope are developing day by day. After the foundation of healthy nutrition is established, the sports process is supported with nutritional supplements, provided that the latest literature studies on this subject are followed.

Segmental intracellular, interstitial, and intravascular volume changes during simulated hemorrhage and resuscitation: A case study

This paper describes a new combined impedance plethysmographic (IPG) and electrical bioimpedance spectroscopic (BIS) instrument and software that will allow noninvasive real-time measurement of segmental blood flow, intracellular, interstitial, and intravascular volume changes during various fluid management procedures. The impedance device can be operated either as a fixed frequency IPG for the quantification of segmental blood flow and hemodynamics or as a multi-frequency BIS for the recording of intracellular and extracellular resistances at 40 discrete input frequencies. The extracellular volume is then deconvoluted to obtain its intravascular and interstitial component volumes as functions of elapsed time. The purpose of this paper is to describe this instrumentation and to demonstrate the information that can be obtained by using it to monitor segmental compartment volume responses of a pig model during simulated hemorrhage and resuscitation. Such information may prove valuable in the diagnosis and management of rapid changes in the body fluid balance and various clinical treatments.

A system to monitor segmental intracellular, interstitial, and intravascular volume and circulatory changes during acute hemodialysis

This paper describes a new combined impedance plethysmographic (IPG) and electrical bioimpedance spectroscopic (BIS) instrument and software that allows noninvasive real-time measurement of segmental blood flow and changes in intracellular, interstitial, and intravascular volumes during various fluid management procedures. The impedance device can be operated either as a fixed frequency IPG for the quantification of segmental blood flow and hemodynamics or as a multi-frequency BIS for the recording of intracellular and extracellular resistances at 40 discrete input frequencies. The extracellular volume is then deconvoluted to obtain its intra-vascular and interstitial component volumes as functions of elapsed time. The purpose of this paper is to describe this instrumentation and to demonstrate the information that can be obtained by using it to monitor segmental compartment volumes and circulatory responses of end stage renal disease patients during acute hemodialysis. Such information may prove valuable in the diagnosis and management of rapid changes in the body fluid balance and various clinical treatments.