Discover and read the best of Twitter Threads about #physiology

Most recents (24)

Read our latest analysis from the #ADVOR trial @JACCJournals. Deeper dive into the relationship of #natriuresis with decongestion & clinical outcomes after diuretic therapy in acute #heartfailure! Tweetorial below...…

@PieterMartensMD @WilfriedMullens
First, look at detailed #ADVOR protocol below:…

We did 2 consecutive urine collections:
1. Randomization => First morning (<24 h)
2. First morning => Second morning (=24 h)

If in those 2 collections, cumulative urine output <3.5 L ➡️ Failed decongestion! Image
Allocation to #acetazolamide clearly increased:
✅total urine output (+12.6%)
✅total natriuresis (+26.9%)

In relative terms: effect on natriuresis > urine output, UO🚫significant after 1st diuretic dose, natriuresis remained high!

*Normalized UO to 24 h for collection 1. Image
Read 20 tweets
Here’s a critical care puzzle & illustrates some important cardiopulmonary physiology:

These two pictures were taken just an hour apart. What intervention was done in between that changed the respiratory pattern? (Red box)

Multiple choice & answers in the 🧵.

1/ ImageImage
The intervention was:

This is Cheyne-Stokes Respirations (CSR) in a person with heart failure.

The intervention was dobutamine (an inotrope).

Cheyne-Stokes is a characteristically regular crescendo-descresendo respiratory pattern with interspersed periods of apnea.
3/ ImageImageImage
Read 25 tweets
Our new case study highlights why it's important for physicians to better understand the body's response to #exercise #training. 🧵1/5

🔓… #medicine #liver #physiology @theliverdr
In Oct 2021, I had a routine blood test that revealed elevated liver enzymes. A later blood test with a different doctor showed the liver panel was "elevated and worsening", more than double the normal range for some variables. 2/5
A series of additional tests, including abdominal ultrasound, were negative. Physician referred me to a gastroenterologist who suggested (an invasive) liver biopsy. However, before the next blood test, I stopped exercising for 7 days. 3/5
Read 5 tweets
What is the best physiology book for 1st year?

It this one in my humble opinion.

Crisp, sufficiently detailed with good diagrams and explanations for various phenomena --> this is my Grade A recommendation. Image
I have gone through Ganong, Guyton, Taylor and Boron & Boulpaep ---> those are NOT for beginners.

The Indian textbooks are okayish but the diagrams are pretty terrible.

That is where Lippincott wins hands down.
Read 4 tweets
1/ Out now on @ScienceAdvances!

#StemCells are a wonderful tool to create atrial cardiomyocytes that spontaneously and continuosly beat in a dish… but what happens if we transfect them with the highly potassium selective channelrhodopsin WiChR? #Thread…
2/ WiChR is a channel that comes from the marine species Wobblia Lunata.

Differently from previosly described K+-conducting channels such as HcKcR1, this channel is characterized by small photocurrent inactivation and improved light sensitivity. #Thread #Physiology #Optogenetics
3/ During my secondment and thanks to the collaboration with @JoH_VieR and other labs, we successfully transfected my hiPSC-derived atrial cardiomyocytes with WiChR.
This beating cluster in the video is one of those that I indented to get sharp electrode recording! #StemCell
Read 7 tweets
Though not its intention, this study from #OW2022 illustrated the concepts of satiation vs satiety very well

Colloquially we use these terms interchangeable

But they are technically different

#obesity #science #research #physiology #pathophysiology

1/ Image
Satiation is the feeling of fullness WITHIN a meal while satiety is the feeling of fullness IN BETWEEN meals

Even though current meds like GLP1s seem to affect both, it’s an impt distinction especially when some peptides (eg, amylin)
may only effect satiation (⬇️meal size) and not satiety (change meal frequency)

[btw This study was an intracerebral injection of calcitonin into male rats and calcitonin is an agonist at the amylin receptor in the ventral tegmental area]
Read 4 tweets
More fun pulmonary physiology:

🤿A person takes a deep breath of ambient air & free dives (e.g. holds her breath without a SCUBA tank) in the ocean. At a depth of 40m an arterial blood gas is drawn.

Compared to an ABG drawn at the surface, the divers PaO2 at 40m is:
The answer is INCREASED.

We know because people have free-dived with an arterial line: mean PaO2 at 40m was 197 mmHg (after 45s of breath holding!)…

But why? Understanding requires a deep dive into the alveolar gas equation. A 🫁 pulm #physiology🧵.
2/ ImageImageImage
Before getting to the fun stuff, we should acknowledge that it’s *weird* for your PaO2 to increase while breath holding.

For comparison look how PaO2 DECREASES if you hold your breath on land: it plummets from 110 to 60 mmHg in just 35 seconds!

What makes diving different?
3/ Image
Read 20 tweets
🚀 We are live! Here is the correct streaming link for all of today's discussions and performances, starting with a panel on complex time with David Krakauer, James Gleick, Ted Chiang, and David Wolpert in a few moments (measured linearly...):

"One of the ideas we had with #InterPlanetary was, 'What would it take to make science hedonistic? And instead of telling people to do it, you'd have to tell people to STOP doing it?"

- SFI President David Krakauer sets the tone for this weekend's celebrations
#IPFest Image
David Krakauer: "Do you have a favorite model or metaphor for #time?"

@JamesGleick: "You've already mentioned a river; that's everybody's favorite. Borges said time is a tiger. People talk about it as a thread. We ONLY talk about time in metaphors." Image
Read 141 tweets
Dreadnoughtus!!! 🦕

I like sauropods (long-necked dinosaurs) in general, as these Mesozoic puzzles 🧩 pushed evolutionary innovation to the extreme, & even the simplest aspects of their biology are confounding, oft-debated subjects. A thread 🧵 highlighting few of those.

Dreadnoughtus schrani was discovered (2014) in southern Patagonia, Argentina 🇦🇷 and is thought to be the largest 🏆 terrestrial animal to have ever walked the planet (i.e., it possesses the greatest mass of any land animal that can be calculated 🧮 with...

...reasonable certainty). This colossal sauropod flourished during the Late Cretaceous Epoch (100.5 million to 66 million years ago). It was about 26 m (85 feet) long 📏 and may have weighed about 59 metric tons ⚖️ (image source: Wikimedia Commons) -...

Read 42 tweets
For those who can't get enough from #ADVOR, below the promised Tweetorial!

Acetazolamide in acute #HeartFailure w volume overload on background high-dose loop diuretics:
👍Increases diuresis & natriuresis
👍More euvolemia after 3 days & discharge
#ESCCongress #Cardiology
First, the unsung hero's of this trial, done with a little bit over 2 million €, bargain for largest diuretic #RCT ever!
@KatrienTartagl2 & her team, with only 3FTE, they ran the most successful trial in #AHF
@PieterMartensMD & @JeroenDauw who did most fieldwork
How did we come up with the idea? Actually, cause we all love #physiology. Credits go to Prof. Em. Paul Steels who teached us all how kidneys work.

65% of sodium is reabsorbed in the proximal tubules, can be up to 85% in #HeartFailure
Read 12 tweets
"We evolved to be physically active. But most of us avoid physical activity."

The Active Grandparents Hypothesis

Daniel Lieberman, @Harvard

SFI Colloquium, streaming now:
"We evolved from #apes and apes are couch potatoes."

Daniel Lieberman, @Harvard

SFI Colloquium, streaming now:

#evolution #hominin #anthropology #physiology
"Your average hunter-gatherer walks from New York to LA every year."

Daniel Lieberman, @Harvard

SFI Colloquium, streaming now:
Read 24 tweets
At long last, here is part 5️⃣ in my animal #physiology in the ICU series #FOAMed

Case 1: You are called about a very high blood glucose (BG) value: 738 mg/dL (41 mM)!

The RN asks if you want to start an insulin drip. You say no, it’s totally normal because the patient is a:
Answer: Hummingbird

Part of it's adaptation to energy intensive activities (flying, hovering) the Hummingbird maintains a very high blood glucose:
Fasting: >300 mg/dL
Fed: >700 mg/dL

That's right - a fasting hummingbird has a higher blood glucose than almost any fed mammal!
The wrong answers: 🐑
A sheep’s normal blood glucose is 25-50 mg/dL! (among the lowest of all mammals!)

A sheep with a fasting blood glucose of 90 mg/dl would likely be diabetic!
Read 21 tweets
A follow up to yesterday's tweet on how we can use nose-breathing to identify the right intensity...

Where most athletes get it wrong...

A brief #physiology thread
As we continue to increase the intensity of exercise after moving from nose breathing to quiet mouth breathing, eventually we encounter a second breakpoint in ventilation - the transition from quiet mouth breathing to loud mouth breathing...
At this point, metabolic acidosis is starting to increase and the body's response to it is to "blow off" the increasing carbonic acid in the form of additional CO2...
Read 7 tweets
Why quiet breathing through the nose for the bulk of your training is the key to knowing that you're at the right training intensity:

A brief #physiology thread... 👇
The #AerobicThreshold or first rise in the lactate curve is a key training intensity.

Primarily because it usually coincides with the highest rates of #FatBurning coupled with relatively low CHO oxidation, so the athlete can accrue a lot of work with minimal metabolic fatigue
My buddy @feelthebyrn1 always said that he could feel the AeT as:

"the first deepening of the breath"

In my experience, most athletes don't do a very good job of identifying this point & mistake their AeT for a point further up the curve. So, what should you be feeling?
Read 11 tweets
OK. I'll say it. What are we to conclude from the all male @NobelPrize awards in #STEM these past two weeks?
1st. I'm sure the winners were all deserving. There's nothing to take away from them, and that is not my intention.
2nd. But there are so many deserving #WomenInSTEM, not the least of whom is Katalin Karikó @kkariko.
Imagine your research lays the groundwork for a novel #vaccine that is leading the world out of a once-per-century global pandemic. Surely that is worth at least one if not two @NobelPrize awards?
Read 12 tweets
The last few weeks have been tough. For those in need of a light hearted thread, here’s a brand new 3rd #tweetorial in my extremes of #physiology series. What can the animal kingdom teach us about our physiology?

Buckle up for some fun animal pulmonary facts 🫁!
You are performing a bronchoscopy. Upon reaching the main carina instead of the usual TWO airways (right & left mainstem bronchi) you see THREE.

Your assistant says “Whoa! That’s weird”

You say no it’s totally normal because the patient is a:
Answer: 🐖
In pigs, the RUL lobe bronchus originates from the supra-carinal trachea (e.g. before the R & L mainstream branches). The view from the trachea looks like this (see the tracheal bronchus on the right).

image source:…
Read 26 tweets
Buckle up! This 🧵 is a deep dive into the #physiology of defecation, the mechanics of pooping! 🧰 🚽 💩…

#medicine #MedEd #science #GITwitter #GI #gut #motility #constipation #IBS
Defecation requires
1. intact #GI tract
2. coordination of many systems: neural (enteric nervous system, modulated by the peripheral somatic, autonomic and the CNS); muscular (smooth and striated); hormonal (endocrine and paracrine); and cognitive (behavioural and psychosocial)
#Constipation is the3⃣rd most common #GI symptom

💰 Annual cost of fecal incontinence and constipation: $1,594 - $7,522
Read 31 tweets
Don’t miss the latest research from #FacesOfCell Zuri Sullivan (@zurisullivan), “Food allergy as a biological food quality control system”… "I’m passionate about ...
Dr. Sullivan is a HHMI Hanna H. Gray fellow at Harvard University (@Harvard) where she is researching how the #ImmuneSystem influences #physiology and behavior to help animals adapt to different environments. @DulacLab
@zurisullivan’s research interests are in #MucosalImmunology, #SocialBehavior, and #neuroscience.
Read 5 tweets
This gentle man is Sir William Osler.. He has frequently been described as the “Father of Modern Medicine” and one of the "greatest diagnosticians ever to wield a stethoscope". What did he hv to say about #India ? @sanjeevsanyal @vipintukur @naveenthacker @EricTopol @mvankerkhove Image
His fascination for #India, The land of #Vishnu had no bounds..!! At each & every intellectual commentary he mentions about his interest in the values #India was known for @ProfSomashekhar @iapindia @IndianMedicalAs @MoHFW_INDIA @VirusesImmunity Image
In one of his essays; “Of India, of "Vishnu-land," what can one say in a few minutes? To the Hindoos we owe a debt which we can at any rate acknowledge; and even in medicine, many of our traditions and practices may be traced to them”. @drharshvardhan @PMOIndia @BharadwajSpeaks Image
Read 11 tweets
Acute Kidney Failure

OR 🤔

Acute Kidney Success?

…bare with me while I explain 🧵

#NephTwitter #MedTwitter #Physiology #askrenal #tweetorial #aki #MedStudentTwitter #meded #FOAMed
We make 1-2 L of urine per day to eliminate

❎excess solutes


✅maintain homeostasis.

This process is accurate to the T.
To achieve this accuracy, plasma is continuously filtered and reprocessed by the kidneys. ♻️

How much plasma is filtered per day, you ask? 😳

Roughly 200 LITRES! 🌊
Read 15 tweets
Here’s a #tweetorial about extremes of #physiology that are very much "compatible with life".

Case #1. You are called about a critical drop in platelets.
Platelet Count (x10^3/uL)
Previous 475
Current 45

It’s nothing to worry about. This sample came from a ___.
Answer 🐿
To avoid VTE while hibernating, squirrels drop their Plt counts 10x! They also ⬇️vWF & Factors VIII/IX

Red tailed 🦌 have Plt counts ~750 as fawns that drop to ~250 as adults (over yrs)

Stepping on a Lonomia🐛is a medical emergency. It *CAUSES* thrombocytopenia/DIC! Source: https://pubmed.ncbi...Source: https://www.researc...Source:
Case #2: You get a call from bedside nurse about an abnormal blood pressure:
BP 330/240

You reassure him, that's a totally OK blood pressure because it was measured in a ___.
Read 15 tweets
Suchitra Ranjit discusses multimodal monitoring during #sepsis to help decode the physiological diagnosis and personalise therapy

Opening message is that cardiac output is difficult to assess at the bedside

MAP is often used as a proxy of CO - is this reasonable?

There is not a strong relationship between them in post-cardiac surgical children

#PedsICU #WFPICCS20 Image
What happens when fluid is given in #sepsis?

Again: v weak correlation between CI & MAP

Interestingly almost 50% of patients did not respond to fluid & significant % of patients had a fall in BO/CI!

48% of children needed more inotrope after the fluid

#PedsICU #WFPICCS20 ImageImageImageImage
Read 5 tweets
Prof. Bettina Vom Dessauer now talks about the #burns patient as a critically ill patient with systemic problems.

Outcomes in #burns patient associated with:
- early admission to hospital
- care in a specialised burns unit
- control of infections
- early nutrition

These children are often healthy before the injury and this results in the whole homeostasis being altered

The pathophysiology of #burns patients is multi systemic and occur at a cellular level

What we see clinically is distributive shock.

#PedsICU #WFPICCS20 #physiology
Read 7 tweets
Allan Doctor discusses the functional assessment of haemostasis and anticoagulation therapy during critical illness

let’s look at normal #coagulation system #physiology...

New ways of thinking at a cellular level moves from the classic intrinsic and extrinsic a pathway to a cell based process consisting of:
- Initiation
- amplification phase
- propagation phase

And fibrinolysis is an important part of #coagulation #physiology to prevent excess clot growth and clot break down after healing...

It is this process we accelerate with thrombolysis

Read 5 tweets

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