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Sample records for respiratory failure caused

  1. What Causes Respiratory Failure?

    MedlinePLUS

    ... easily move oxygen into your blood and remove carbon dioxide from your blood (gas exchange). This can cause a low oxygen level or high carbon dioxide level, or both, in your blood. Respiratory failure ...

  2. Respiratory Failure

    MedlinePLUS

    ... ribs around the lungs. An injury to the chest can cause this damage. Drug or alcohol overdose Injuries from inhaling smoke or harmful fumes Treatment for respiratory failure depends on whether the condition is acute (short-term) or chronic (ongoing) and how severe ...

  3. Respiratory Failure

    MedlinePLUS

    ... What Is Respiratory Failure? Respiratory (RES-pih-rah-tor-e) failure is a condition in which not ... the help of a ventilator (VEN-til-a-tor). A ventilator is a machine that supports breathing. ...

  4. An unusual cause of type 2 respiratory failure

    PubMed Central

    Rajagopala, Srinivas; Nathan, Balamurugan; Pillai, Vivekanandan

    2015-01-01

    We present a female patient who was referred for management of respiratory failure. She was being evaluated and managed as worsening chronic inflammatory demyelinating polyneuropathy with type 2 respiratory failure. Initial examination showed hypertrichosis, clubbing and papilledema along with severe distal and proximal motor-predominant weakness with impending respiratory failure. She was managed with noninvasive ventilation (NIV) and plasmapheresis awaiting diagnostic investigations. Immunofixation showed an “M band” and free lambda chain levels were elevated. Radiographs showed the classic osteosclerotic lesions of POEMS (polyradiculoneuropathy, organomegaly, endocrinopathy, M-protein and Skin abnormalities) syndrome. Six weeks after commencing radiotherapy to the osteosclerotic lesions, the patient responded favorably and remains off nocturnal NIV support. PMID:25722557

  5. An unusual cause of type 2 respiratory failure.

    PubMed

    Rajagopala, Srinivas; Nathan, Balamurugan; Pillai, Vivekanandan

    2015-02-01

    We present a female patient who was referred for management of respiratory failure. She was being evaluated and managed as worsening chronic inflammatory demyelinating polyneuropathy with type 2 respiratory failure. Initial examination showed hypertrichosis, clubbing and papilledema along with severe distal and proximal motor-predominant weakness with impending respiratory failure. She was managed with noninvasive ventilation (NIV) and plasmapheresis awaiting diagnostic investigations. Immunofixation showed an "M band" and free lambda chain levels were elevated. Radiographs showed the classic osteosclerotic lesions of POEMS (polyradiculoneuropathy, organomegaly, endocrinopathy, M-protein and Skin abnormalities) syndrome. Six weeks after commencing radiotherapy to the osteosclerotic lesions, the patient responded favorably and remains off nocturnal NIV support. PMID:25722557

  6. Extracorporeal Membrane Oxygenation for the Management of Respiratory Failure Caused by Diffuse Alveolar Hemorrhage

    PubMed Central

    Guo, Zhen; Li, Xin; Jiang, Li-yan; Xu, Ling-feng

    2009-01-01

    Abstract: Extracorporeal membrane oxygenation (ECMO) was developed as a supportive therapy to treat severe respiratory failure. When conventional mechanical ventilation has failed or when there is not enough time to treat the pathology, ECMO has the potential to sustain life. In this report, successful use of ECMO to support an adult patient with antineutrophil cytoplasmic antibody (ANCA)-associated systemic vasculitides complicated by severe respiratory failure caused by diffuse alveolar hemorrhage will be discussed. PMID:19361031

  7. Respiratory failure in diabetic ketoacidosis

    PubMed Central

    Konstantinov, Nikifor K; Rohrscheib, Mark; Agaba, Emmanuel I; Dorin, Richard I; Murata, Glen H; Tzamaloukas, Antonios H

    2015-01-01

    Respiratory failure complicating the course of diabetic ketoacidosis (DKA) is a source of increased morbidity and mortality. Detection of respiratory failure in DKA requires focused clinical monitoring, careful interpretation of arterial blood gases, and investigation for conditions that can affect adversely the respiration. Conditions that compromise respiratory function caused by DKA can be detected at presentation but are usually more prevalent during treatment. These conditions include deficits of potassium, magnesium and phosphate and hydrostatic or non-hydrostatic pulmonary edema. Conditions not caused by DKA that can worsen respiratory function under the added stress of DKA include infections of the respiratory system, pre-existing respiratory or neuromuscular disease and miscellaneous other conditions. Prompt recognition and management of the conditions that can lead to respiratory failure in DKA may prevent respiratory failure and improve mortality from DKA. PMID:26240698

  8. Respiratory failure in diabetic ketoacidosis.

    PubMed

    Konstantinov, Nikifor K; Rohrscheib, Mark; Agaba, Emmanuel I; Dorin, Richard I; Murata, Glen H; Tzamaloukas, Antonios H

    2015-07-25

    Respiratory failure complicating the course of diabetic ketoacidosis (DKA) is a source of increased morbidity and mortality. Detection of respiratory failure in DKA requires focused clinical monitoring, careful interpretation of arterial blood gases, and investigation for conditions that can affect adversely the respiration. Conditions that compromise respiratory function caused by DKA can be detected at presentation but are usually more prevalent during treatment. These conditions include deficits of potassium, magnesium and phosphate and hydrostatic or non-hydrostatic pulmonary edema. Conditions not caused by DKA that can worsen respiratory function under the added stress of DKA include infections of the respiratory system, pre-existing respiratory or neuromuscular disease and miscellaneous other conditions. Prompt recognition and management of the conditions that can lead to respiratory failure in DKA may prevent respiratory failure and improve mortality from DKA. PMID:26240698

  9. Diaphragmatic Amyloidosis Causing Respiratory Failure: A Case Report and Review of Literature.

    PubMed

    Novikov, Aleksey; Holzer, Horatio; DeSimone, Robert A; Abu-Zeinah, Ghaith; Pisapia, David J; Mark, Tomer M; Pastore, Raymond D

    2015-01-01

    Neuromuscular respiratory failure is a rare complication of systemic immunoglobulin light chain amyloidosis. We describe a case of a 70-year-old Caucasian man with multiple myeloma who presented with worsening dyspnea. The patient was diagnosed with and treated for congestive heart failure but continued to suffer from hypercapnic respiratory insufficiency. He had restrictive physiology on pulmonary function tests and abnormal phrenic nerve conduction studies, consistent with neuromuscular respiratory failure. The diagnosis of systemic immunoglobulin light chain amyloidosis was made based on the clinical context and a cardiac biopsy. Despite treatment attempts, the patient passed away in the intensive care unit from hypercapnic respiratory failure. Autopsy revealed dense diaphragmatic amyloid deposits without phrenic nerve infiltration or demyelination or lung parenchymal involvement. Only 5 cases of neuromuscular respiratory failure due to amyloid infiltration of the diaphragm have been described. All cases, including this, were characterized by rapid progression and high mortality. Therefore, diaphragmatic amyloidosis should be on the differential for progressive neuromuscular respiratory failure in patients with multiple myeloma or any other monoclonal gammopathy. Given its poor prognosis, early recognition of this condition is essential in order to address goals of care and encourage pursuit of palliative measures. PMID:26587302

  10. Diaphragmatic Amyloidosis Causing Respiratory Failure: A Case Report and Review of Literature

    PubMed Central

    Novikov, Aleksey; Holzer, Horatio; DeSimone, Robert A.; Abu-Zeinah, Ghaith; Pisapia, David J.; Mark, Tomer M.; Pastore, Raymond D.

    2015-01-01

    Neuromuscular respiratory failure is a rare complication of systemic immunoglobulin light chain amyloidosis. We describe a case of a 70-year-old Caucasian man with multiple myeloma who presented with worsening dyspnea. The patient was diagnosed with and treated for congestive heart failure but continued to suffer from hypercapnic respiratory insufficiency. He had restrictive physiology on pulmonary function tests and abnormal phrenic nerve conduction studies, consistent with neuromuscular respiratory failure. The diagnosis of systemic immunoglobulin light chain amyloidosis was made based on the clinical context and a cardiac biopsy. Despite treatment attempts, the patient passed away in the intensive care unit from hypercapnic respiratory failure. Autopsy revealed dense diaphragmatic amyloid deposits without phrenic nerve infiltration or demyelination or lung parenchymal involvement. Only 5 cases of neuromuscular respiratory failure due to amyloid infiltration of the diaphragm have been described. All cases, including this, were characterized by rapid progression and high mortality. Therefore, diaphragmatic amyloidosis should be on the differential for progressive neuromuscular respiratory failure in patients with multiple myeloma or any other monoclonal gammopathy. Given its poor prognosis, early recognition of this condition is essential in order to address goals of care and encourage pursuit of palliative measures. PMID:26587302

  11. An unusual cause of respiratory failure in a colon cancer patient

    PubMed Central

    SERENO, MARÍA; MONTORO, FRANCISCO JAVIER; CASANOVA, CARLOS; GUTIÉRREZ-GUTIÉRREZ, GERARDO; OJEDA, JOAQUÍN; CASADO, ENRIQUE SÁENZ

    2015-01-01

    Permanent central venous catheters (CVC), such as Port-a-Cath®, Hickmann® or PICC®, are widely used in oncology patients for cancer treatment. Thrombosis is a frequent complication that should be ruled out, as it is associated with potentially severe infection and hemodynamic consequences. This is the case report of a male patient who was undergoing chemotherapy for colon cancer. The patient presented with an atrial mass secondary to a CVC-related organized thrombus located inside the atrial cavity. The mass was inducing a massive right-to-left intracardial shunt due to a persistent foramen ovale and signs of respiratory failure that required surgical intervention to remove the intracardial mass.

  12. The role of respiratory failure caused by congenital central nervous system abnormalities and the effect of ?-casomorphins in sudden infant death syndrome pathogenesis.

    PubMed

    Sumi?ska-Ziemann, B; Gos, T; Jankowski, Z

    2015-01-01

    The aim of the paper is to discuss the role of respiratory failure caused by endogenous (both structural and functional) abnormalities in the central nervous system and exogenous food-derived opioid-like peptides in the pathogenesis of sudden infant death syndrome (SIDS). By stimulating ?-opioid receptors, opioid-like peptides may suppress the tonic activity of the respiratory centre in the brain stem. PMID:26284968

  13. Adiaspiromycosis Causing Respiratory Failure and a Review of Human Infections Due to Emmonsia and Chrysosporium spp.

    PubMed Central

    Sutton, Deanna A.; Graybill, John R.

    2012-01-01

    We report a case of a 27-year-old male who presented with respiratory distress that required mechanical ventilation. Transbronchial biopsy revealed adiaspores of the fungus Emmonsia crescens within granulomata, a condition known as adiaspiromycosis. The patient received amphotericin products and corticosteroids, followed by itraconazole, and made a full recovery. Emmonsia crescens is a saprobe with a wide distribution that is primarily a rodent pathogen. The clinical characteristics of the 20 cases of human pulmonary adiaspiromycosis reported since the last comprehensive case review in 1993 are described here, as well as other infections recently reported for the genus Emmonsia. Pulmonary adiaspiromycosis has been reported primarily in persons without underlying host factors and has a mild to severe course. It remains uncertain if the optimal management of severe pulmonary adiaspiromycosis is supportive or if should consist of antifungal treatment, corticosteroids, or a combination of the latter two. The classification of fungi currently in the genus Emmonsia has undergone considerable revision since their original description, including being grouped with the genus Chrysosporium at one time. Molecular genetics has clearly differentiated the genus Emmonsia from the Chrysosporium species. Nevertheless, there has been a persistent confusion in the literature regarding the clinical presentation of infection with fungi of these two genera; to clarify this matter, the reported cases of invasive Chrysosporium infections were reviewed. Invasive Chrysosporium infections typically occur in impaired hosts and can have a fatal course. Based on limited in vitro susceptibility data for Chrysosporium zonatum, amphotericin B is the most active drug, itraconazole susceptibility is strain-dependent, and fluconazole and 5-fluorocytosine are not active. PMID:22259200

  14. Successful treatment of neonatal respiratory failure caused by a novel surfactant protein C p.Cys121Gly mutation with hydroxychloroquine.

    PubMed

    Hepping, N; Griese, M; Lohse, P; Garbe, W; Lange, L

    2013-06-01

    SFTPC (surfactant protein C) mutations resulting in SP-C deficiency causing ongoing respiratory failure in the neonatal period represent a rare entity. We report a full-term female infant who developed respiratory distress and respiratory failure shortly after birth. From the first day of life the infant was mechanically ventilated. Application of exogenous surfactant or cortisone did not lead to any clinical improvement. Genetic analysis identified a novel SFTPC mutation as the cause of her lung disease. The patient was diagnosed as heterozygous for a p.Cys121Gly/C121G substitution encoded by exon 4, which could not be detected in both parents. Experimental therapy with hydroxychloroquine resulted in a significant clinical improvement within 2 weeks time. Mechanical ventilation was no longer needed, and the patient was discharged without additional oxygen demand. The patient remained well under therapy till the age of 6 months. After that time, the therapy was successfully discontinued. PMID:23719253

  15. Respiratory failure in elderly patients.

    PubMed

    Sevransky, Jonathan E; Haponik, Edward F

    2003-02-01

    Elderly individuals comprise an increasing proportion of the population and represent a progressively expanding number of patients admitted to the ICU. Because of underlying pulmonary disease, loss of muscle mass, and other comorbid conditions, older persons are at increased risk of developing respiratory failure. Recognition of this vulnerability and the adoption of proactive measures to prevent decompensation requiring intrusive support are major priorities together with clear delineation of patients' wishes regarding the extent of support desired should clinical deterioration occur. Further, the development of coordinated approaches to identify patients at risk for respiratory failure and strategies to prevent the need for intubation, such as the use of NIV in appropriate patients, are crucial. As soon as endotracheal intubation and mechanical ventilation are implemented strategies that facilitate the liberation of elderly patients from the ventilator are especially important. The emphasis on a team approach, which characterizes geriatric medicine, is essential in coordinating the skills of multiple health care professionals in this setting. Respiratory failure can neither be effectively diagnosed nor managed in isolation. Integration with all other aspects of care is essential. Patient vulnerability to nosocomial complications and the "cascade effect" of these problems such as the effects of medications and invasive supportive procedures all impact on respiratory care of elderly patients. For example, prolonged mechanical ventilation may be required long after resolution of the underlying cause of respiratory failure because of unrecognized and untreated delirium or residual effects of small doses of sedative and/or analgesic agents or other medications in elderly patients with altered drug metabolism. The deleterious impact of the foreign and sometimes threatening ICU environment and/or sleep deprivation on the patient's course are too often overlooked because the physician focuses management on physiologic measurements, mechanical ventilator settings, and other technologic nuances of care [40]. Review of the literature suggests that the development of respiratory failure in patients with certain disease processes such as COPD, IPF, and ARDS in elderly patients may lead to worsened outcome but it appears that the disease process itself, rather than the age of the patient, is the major determinant of outcome. Additional studies suggest that other comorbid factors may be more important than age. Only when comorbid processes are taken into account should decisions be made about the efficacy of instituting mechanical ventilation. In addition, because outcome prediction appears to be more accurate for groups of patients rather than for individual patients a well-structured therapeutic trial of instituting mechanical ventilation, even if comorbidities are present, may be indicated in certain patients if appropriately informed patients wish to pursue this course. This approach requires careful and realistic definition of potential outcomes, focus on optimizing treatment of the reversible components of the illness, and continuous communication with the patient and family. Although many clinicians share a nihilistic view regarding the potential usefulness of mechanical ventilation in elderly patients few data warrant this negative prognostication and more outcome studies are needed to delineate the optimum application of this element of supportive care. As with other interventions individualization of the decision must take into account the patient's premorbid status, concomitant conditions, the nature of the precipitating illness and its prospects for improvement, and most important, patient preferences. In this determination pursuing the course most consistent with the patient's wishes is essential and it must be appreciated that caregivers' impressions regarding the vigor of support desired by the patient are often erroneous. The SUPPORT investigators observed that clinicians often underestimated the degree of i

  16. Neuromuscular disease, respiratory failure and cor pulmonale.

    PubMed Central

    White, J.; Bullock, R. E.; Hudgson, P.; Gibson, G. J.

    1992-01-01

    Respiratory muscle weakness is an uncommon cause of chronic respiratory failure and a rare cause of cor pulmonale. The problem may not be apparent unless specific physical signs are sought or appropriate investigations performed. We present three patients who presented diagnostic difficulty for prolonged periods until the presence of respiratory muscle weakness was considered. Once the diagnosis was established treatment with nocturnal nasal intermittent positive pressure ventilation produced a dramatic improvement in symptoms and allowed a return to a near normal lifestyle. PMID:1461855

  17. Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in Spain

    PubMed Central

    2009-01-01

    Introduction Patients with influenza A (H1N1)v infection have developed rapidly progressive lower respiratory tract disease resulting in respiratory failure. We describe the clinical and epidemiologic characteristics of the first 32 persons reported to be admitted to the intensive care unit (ICU) due to influenza A (H1N1)v infection in Spain. Methods We used medical chart reviews to collect data on ICU adult patients reported in a standardized form. Influenza A (H1N1)v infection was confirmed in specimens using real-time reverse transcriptase-polymerase-chain-reaction (RT PCR) assay. Results Illness onset of the 32 patients occurred between 23 June and 31 July, 2009. The median age was 36 years (IQR = 31 - 52). Ten (31.2%) were obese, 2 (6.3%) pregnant and 16 (50%) had pre-existing medical complications. Twenty-nine (90.6%) had primary viral pneumonitis, 2 (6.3%) exacerbation of structural respiratory disease and 1 (3.1%) secondary bacterial pneumonia. Twenty-four patients (75.0%) developed multiorgan dysfunction, 7 (21.9%) received renal replacement techniques and 24 (75.0%) required mechanical ventilation. Six patients died within 28 days, with two additional late deaths. Oseltamivir administration delay ranged from 2 to 8 days after illness onset, 31.2% received high-dose (300 mg/day), and treatment duration ranged from 5 to 10 days (mean 8.0 ± 3.3). Conclusions Over a 5-week period, influenza A (H1N1)v infection led to ICU admission in 32 adult patients, with frequently observed severe hypoxemia and a relatively high case-fatality rate. Clinicians should be aware of pulmonary complications of influenza A (H1N1)v infection, particularly in pregnant and young obese but previously healthy persons. PMID:19747383

  18. Trichomonas empyema with respiratory failure.

    PubMed

    Wang, Hua-Kung; Jerng, Jih Shuin; Su, Kua-Eyre; Chang, Shan-Chwen; Yang, Pan-Chyr

    2006-12-01

    Pulmonary trichomoniasis is rare, and few cases of trichomonas empyema have been reported in the literature. We describe a rare case of a non-immunocompromised 55-year-old man with Trichomonas empyema presenting with bilateral pleural effusion leading to respiratory failure. Examination of the pleural effusion showed numerous motile organisms by fresh wet preparation that were identified as Trichomonas species by Liu stain. The patient was successfully treated with metronidazole, ampicillin/clavunalate, fibrinolytic therapy, and thoracotomy decortication. PMID:17172399

  19. Acute respiratory failure secondary to esophageal dilation from undiagnosed achalasia.

    PubMed

    Layton, James; Ward, Paul W; Miller, David W; Roan, Ronald M

    2014-09-01

    Achalasia is an idiopathic motility disorder causing progressive dysphagia and dilation of the esophagus. Rarely this esophageal dilation can cause acute respiratory insufficiency and/or failure. We describe a 63-year-old woman presenting for total knee arthroplasty in whom induction of anesthesia was complicated by pulmonary aspiration requiring postoperative ventilation, hypotension requiring vasopressor therapy, and postextubation, recurrent, acute respiratory failure. Computed tomography of the chest performed for suspected pneumothorax revealed severe esophageal dilation with a mass effect. As this case describes, achalasia may present with the life-threatening complication of respiratory failure and requires a high index of suspicion for timely diagnosis and appropriate interventions. PMID:25611356

  20. Common Cause Failure Modeling

    NASA Technical Reports Server (NTRS)

    Hark, Frank; Britton, Paul; Ring, Rob; Novack, Steven D.

    2015-01-01

    Common Cause Failures (CCFs) are a known and documented phenomenon that defeats system redundancy. CCFS are a set of dependent type of failures that can be caused by: system environments; manufacturing; transportation; storage; maintenance; and assembly, as examples. Since there are many factors that contribute to CCFs, the effects can be reduced, but they are difficult to eliminate entirely. Furthermore, failure databases sometimes fail to differentiate between independent and CCF (dependent) failure and data is limited, especially for launch vehicles. The Probabilistic Risk Assessment (PRA) of NASA's Safety and Mission Assurance Directorate at Marshall Space Flight Center (MFSC) is using generic data from the Nuclear Regulatory Commission's database of common cause failures at nuclear power plants to estimate CCF due to the lack of a more appropriate data source. There remains uncertainty in the actual magnitude of the common cause risk estimates for different systems at this stage of the design. Given the limited data about launch vehicle CCF and that launch vehicles are a highly redundant system by design, it is important to make design decisions to account for a range of values for independent and CCFs. When investigating the design of the one-out-of-two component redundant system for launch vehicles, a response surface was constructed to represent the impact of the independent failure rate versus a common cause beta factor effect on a system's failure probability. This presentation will define a CCF and review estimation calculations. It gives a summary of reduction methodologies and a review of examples of historical CCFs. Finally, it presents the response surface and discusses the results of the different CCFs on the reliability of a one-out-of-two system.

  1. Common Cause Failure Modes

    NASA Technical Reports Server (NTRS)

    Wetherholt, Jon; Heimann, Timothy J.; Anderson, Brenda

    2011-01-01

    High technology industries with high failure costs commonly use redundancy as a means to reduce risk. Redundant systems, whether similar or dissimilar, are susceptible to Common Cause Failures (CCF). CCF is not always considered in the design effort and, therefore, can be a major threat to success. There are several aspects to CCF which must be understood to perform an analysis which will find hidden issues that may negate redundancy. This paper will provide definition, types, a list of possible causes and some examples of CCF. Requirements and designs from NASA projects will be used in the paper as examples.

  2. Acute respiratory failure mimicking acute respiratory distress syndrome due to parenchymal infiltration by metastatic melanoma

    PubMed Central

    2013-01-01

    Abstract Malignant melanoma is the most aggressive form of skin cancer and carries a predisposition for metastasis to many different organs. Pulmonary dissemination is common, most often presenting as multiple discrete pulmonary nodules. While a variety of other intrathoracic patterns can occur, diffuse parenchymal infiltration causing acute respiratory failure is an extremely rare manifestation of metastatic disease. We present a case of an otherwise healthy man who developed rapidly progressive respiratory failure mimicking acute respiratory distress syndrome due to melanomatous infiltration of the lung parenchyma and airways. PMID:25006412

  3. Airway Management of Respiratory Failure.

    PubMed

    Overbeck, Michael C

    2016-02-01

    Patients in respiratory distress often require airway management, including endotracheal intubation. It takes a methodical approach to transition from an unstable patient in distress with an unsecured airway, to a stable, sedated patient with a definitive airway. Through a deliberate course of advanced preparation, the emergency physician can tailor the approach to the individual clinical situation and optimize the chance of first-pass success. Sedation of the intubated patient confers physiologic benefits and should be included in the plan for airway control. PMID:26614244

  4. Respiratory sleep disorders in patients with congestive heart failure

    PubMed Central

    2015-01-01

    Respiratory sleep disorders (RSD) occur in about 40-50% of patients with symptomatic congestive heart failure (CHF). Obstructive sleep apnea (OSA) is considered a cause of CHF, whereas central sleep apnea (CSA) is considered a response to heart failure, perhaps even compensatory. In the setting of heart failure, continuous positive airway pressure (CPAP) has a definite role in treating OSA with improvements in cardiac parameters expected. However in CSA, CPAP is an adjunctive therapy to other standard therapies directed towards the heart failure (pharmacological, device and surgical options). Whether adaptive servo controlled ventilatory support, a variant of CPAP, is beneficial is yet to be proven. Supplemental oxygen therapy should be used with caution in heart failure, in particular, by avoiding hyperoxia as indicated by SpO2 values >95%. PMID:26380758

  5. Noninvasive ventilation in acute respiratory failure

    PubMed Central

    Mas, Arantxa; Masip, Josep

    2014-01-01

    After the institution of positive-pressure ventilation, the use of noninvasive ventilation (NIV) through an interface substantially increased. The first technique was continuous positive airway pressure; but, after the introduction of pressure support ventilation at the end of the 20th century, this became the main modality. Both techniques, and some others that have been recently introduced and which integrate some technological innovations, have extensively demonstrated a faster improvement of acute respiratory failure in different patient populations, avoiding endotracheal intubation and facilitating the release of conventional invasive mechanical ventilation. In acute settings, NIV is currently the first-line treatment for moderate-to-severe chronic obstructive pulmonary disease exacerbation as well as for acute cardiogenic pulmonary edema and should be considered in immunocompromised patients with acute respiratory insufficiency, in difficult weaning, and in the prevention of postextubation failure. Alternatively, it can also be used in the postoperative period and in cases of pneumonia and asthma or as a palliative treatment. NIV is currently used in a wide range of acute settings, such as critical care and emergency departments, hospital wards, palliative or pediatric units, and in pre-hospital care. It is also used as a home care therapy in patients with chronic pulmonary or sleep disorders. The appropriate selection of patients and the adaptation to the technique are the keys to success. This review essentially analyzes the evidence of benefits of NIV in different populations with acute respiratory failure and describes the main modalities, new devices, and some practical aspects of the use of this technique. PMID:25143721

  6. Motor neuron disease presenting as acute respiratory failure: a clinical and pathological study.

    PubMed Central

    Chen, R; Grand'Maison, F; Strong, M J; Ramsay, D A; Bolton, C F

    1996-01-01

    Respiratory failure is rarely a presenting symptom of motor neuron disease. Seven patients with motor neuron disease who presented with acute respiratory failure of unknown cause and required mechanical ventilation were studied. They all had symptoms and signs suggestive of diaphragmatic weakness. Respiratory involvement seemed disproportionately severe, as six were ambulatory and only three noted limb weakness. Only one had tongue weakness and none had swallowing difficulty. Electrophysiological studies showed widespread denervation and, in particular, diaphragmatic involvement to explain the severe respiratory failure. Weaning from the ventilator was unsuccessful in all cases. The four patients examined at necropsy showed severe loss of anterior horns cells in the cervical cord, with only minimal upper motor neuron involvement. Motor neuron disease should be recognised as a cause of acute respiratory failure, secondary to diaphragmatic paralysis from involvement of phrenic motor neurons. Images PMID:8774419

  7. Severe respiratory failure following ventriculopleural shunt

    PubMed Central

    Alam, Shahzad; Manjunath, Nagaraju M.

    2015-01-01

    Cerebrospinal fluid (CSF) diversion procedure has been used for long to treat hydrocephalus in children. The principle of shunting is to establish a communication between the CSF and a drainage cavity (peritoneum, right atrium, and pleura). Ventriculoperitoneal shunt is used most commonly, followed secondly by ventriculopleural shunt (VPLS). Hydrothorax due to excessive CSF accumulation is a rare complication following both the type of shunts and is more frequently seen with VPLS. We report a case of a 6-year-old female child presenting with massive CSF hydrothorax with respiratory failure following VPLS. The aim of the article is to highlight early recognition of this rare and life-threatening condition, which could easily be missed if proper history is not available.

  8. Respiratory Failure and Mechanical Ventilation in the Pregnant Patient.

    PubMed

    Schwaiberger, David; Karcz, Marcin; Menk, Mario; Papadakos, Peter J; Dantoni, Susan E

    2016-01-01

    Fewer than 2% of all peripartal patients need intensive care unit admission. But due to some anatomic and physiologic changes in pregnancy, respiratory failure can be promoted. This article reviews several obstetric and nonobstetric diseases that lead to respiratory failure and the treatment of these. Furthermore, invasive and noninvasive ventilation in pregnancy is discussed and suggestions of medication during ventilation are given. PMID:26600446

  9. Intercostal and forearm muscle deoxygenation during respiratory fatigue in patients with heart failure: potential role of a respiratory muscle metaboreflex.

    PubMed

    Moreno, A M; Castro, R R T; Silva, B M; Villacorta, H; Sant'Anna Junior, M; Nóbrega, A C L

    2014-11-01

    The purpose of this study was to determine the effect of respiratory muscle fatigue on intercostal and forearm muscle perfusion and oxygenation in patients with heart failure. Five clinically stable heart failure patients with respiratory muscle weakness (age, 66 ± 12 years; left ventricle ejection fraction, 34 ± 3%) and nine matched healthy controls underwent a respiratory muscle fatigue protocol, breathing against a fixed resistance at 60% of their maximal inspiratory pressure for as long as they could sustain the predetermined inspiratory pressure. Intercostal and forearm muscle blood volume and oxygenation were continuously monitored by near-infrared spectroscopy with transducers placed on the seventh left intercostal space and the left forearm. Data were compared by two-way ANOVA and Bonferroni correction. Respiratory fatigue occurred at 5.1 ± 1.3 min in heart failure patients and at 9.3 ± 1.4 min in controls (P<0.05), but perceived effort, changes in heart rate, and in systolic blood pressure were similar between groups (P>0.05). Respiratory fatigue in heart failure reduced intercostal and forearm muscle blood volume (P<0.05) along with decreased tissue oxygenation both in intercostal (heart failure, -2.6 ± 1.6%; controls, +1.6 ± 0.5%; P<0.05) and in forearm muscles (heart failure, -4.5 ± 0.5%; controls, +0.5 ± 0.8%; P<0.05). These results suggest that respiratory fatigue in patients with heart failure causes an oxygen demand/delivery mismatch in respiratory muscles, probably leading to a reflex reduction in peripheral limb muscle perfusion, featuring a respiratory metaboreflex. PMID:25296359

  10. Intercostal and forearm muscle deoxygenation during respiratory fatigue in patients with heart failure: potential role of a respiratory muscle metaboreflex.

    PubMed

    Moreno, A M; Castro, R R T; Silva, B M; Villacorta, H; Junior, M Sant'Anna; Nóbrega, A C L

    2014-08-29

    The purpose of this study was to determine the effect of respiratory muscle fatigue on intercostal and forearm muscle perfusion and oxygenation in patients with heart failure. Five clinically stable heart failure patients with respiratory muscle weakness (age, 66±12 years; left ventricle ejection fraction, 34±3%) and nine matched healthy controls underwent a respiratory muscle fatigue protocol, breathing against a fixed resistance at 60% of their maximal inspiratory pressure for as long as they could sustain the predetermined inspiratory pressure. Intercostal and forearm muscle blood volume and oxygenation were continuously monitored by near-infrared spectroscopy with transducers placed on the seventh left intercostal space and the left forearm. Data were compared by two-way ANOVA and Bonferroni correction. Respiratory fatigue occurred at 5.1±1.3 min in heart failure patients and at 9.3±1.4 min in controls (P<0.05), but perceived effort, changes in heart rate, and in systolic blood pressure were similar between groups (P>0.05). Respiratory fatigue in heart failure reduced intercostal and forearm muscle blood volume (P<0.05) along with decreased tissue oxygenation both in intercostal (heart failure, -2.6±1.6%; controls, +1.6±0.5%; P<0.05) and in forearm muscles (heart failure, -4.5±0.5%; controls, +0.5±0.8%; P<0.05). These results suggest that respiratory fatigue in patients with heart failure causes an oxygen demand/delivery mismatch in respiratory muscles, probably leading to a reflex reduction in peripheral limb muscle perfusion, featuring a respiratory metaboreflex. PMID:25184381

  11. Neglected Respiratory Toxicity Caused by Cancer Therapy

    PubMed Central

    Domingo, Christian; Roig, Jorge

    2007-01-01

    When a patient with lung cancer presents non-specific respiratory symptoms there are many diagnostic options. Chemotherapy is the cornerstone of treatment in many stages of lung cancer and its toxicity is well known. The main priority is to prevent life-threatening diseases such as lung infection, which can be treated successfully if a prompt, accurate diagnosis is given. Drug-induced pulmonary disease must be avoided at all costs but it is also important to avoid side-effects of drugs which do not directly interfere with respiratory physiology but may impair gas exchange. This review highlights the risks and characteristics of non-cytostatic-induced lung toxicity caused by agents that have been commonly used to treat cancer in recent decades. Physicians should be alert to the possibility of this neglected non-chemotherapy-induced lung toxicity in cancer patients, since early withdrawal of the offending drug is mandatory. PMID:19340316

  12. Induced hypothermia in critical respiratory failure after lung transplantation.

    PubMed

    Eriksson, L T; Steen, S

    1998-03-01

    Primary graft failure after lung transplantation is a serious complication with high mortality. We present 2 cases of critical respiratory failure after lung transplantation treated with surface cooling to 32 degrees and 35 degrees C, respectively, as an adjunct to conventional intensive care. Both patients were discharged from the hospital in good clinical condition. Surface cooling may be an effective mode of treatment in patients with critical respiratory failure after lung transplantation and should be considered before extracorporeal membrane oxygenation treatment is initiated. PMID:9527224

  13. Facioscapulohumeral muscular dystrophy and respiratory failure; what about the diaphragm?

    PubMed Central

    Hazenberg, A.; van Alfen, N.; Voet, N.B.M.; Kerstjens, H.A.M.; Wijkstra, P.J.

    2014-01-01

    Introduction We present a case of facioscapulohumeral muscular dystrophy (FSHD) with a diaphragm paralysis as the primary cause of ventilatory failure. FSHD is an autosomal dominant inherited disorder with a restricted pattern of weakness. Although respiratory weakness is a relatively unknown in FSHD, it is not uncommon. Methods We report on the clinical findings of a 68-year old male who presented with severe dyspnea while supine. Results Supplementing our clinical findings with laboratory, electrophysiological and radiological performances led to the diagnosis of diaphragm paralysis. Arterial blood gas in sitting position without supplemental oxygen showed a mild hypercapnia. His sleep improved after starting non-invasive ventilation and his daytime sleepiness disappeared. Discussion We conclude that in patients with FSHD who have symptoms of nocturnal hypoventilation, an adequate assessment of the diaphragm is recommended. This is of great importance as we know that nocturnal hypoventilation can be treated effectively by non-invasive ventilation. PMID:26029575

  14. Sterilization failures and their causes.

    PubMed

    Soderstrom, R M

    1985-06-15

    To say that a sterilization failure rate is expected does not answer why. Forty-seven cases of repeat sterilization have undergone such surgical and pathologic scrutiny. Resection methods failed most frequently because of spontaneous reanastomosis or fistula formation. Fimbriectomy was particularly vulnerable to reanastomosis because the fimbria ovarica was not removed. Mechanical devices failed when the device was defective, placed improperly, or placed in an improper location. Tissue damage was evident but incomplete when the bipolar electrocoagulation method failures were reviewed, and the endosalpinx remained viable. Unipolar method injuries, in contrast, were complete; they failed by fistula formation. Thus bipolar method failures may occur because of the limited range of electrical power available when using bipolar generators. Some sterilization failures are preventable, but many are not. When medicolegal questions arise, these findings may help answer the question, Why? PMID:4014332

  15. Respiratory Diseases Caused by Coal Mine Dust

    PubMed Central

    Laney, A. Scott; Weissman, David N.

    2015-01-01

    Objective To provide an update on respiratory diseases caused by coal mine dust. Methods This article presents the results of a literature review initially performed for an International Conference on Occupational and Environmental Lung Disease held in summer 2013. Results Coal mine dust causes a spectrum of lung diseases collectively termed coal mine dust lung disease (CMDLD). These include Coal Workers’ Pneumoconiosis, silicosis, mixed dust pneumoconiosis, dust-related diffuse fibrosis (which can be mistaken for idiopathic pulmonary fibrosis), and chronic obstructive pulmonary disease. CMDLD continues to be a problem in the United States, particularly in the central Appalachian region. Treatment of CMDLD is symptomatic. Those with end-stage disease are candidates for lung transplantation. Because CMDLD cannot be cured, prevention is critical. Conclusions Coal mine dust remains a relevant occupational hazard and miners remain at risk for CMDLD. PMID:25285970

  16. Extracorporeal support for severe acute respiratory failure.

    PubMed

    Fanelli, V; Costamagna, A; Ranieri, V Marco

    2014-08-01

    Extracorporeal membrane oxygenation (ECMO) and extracorporeal CO(2) removal (ECCO(2)R) techniques have increasingly been applied in patients with severe acute lung injury refractory to conventional mechanical ventilatory support. The objectives of this article are to review current concepts of extracorporeal life support techniques (ECMO and ECCO(2)R systems) and provide the rationale for their application in patients with acute respiratory distress syndrome, chronic obstruction pulmonary disease, and as adjunctive therapy for bridging patients to lung transplantation. PMID:25111648

  17. Common Cause Failure Modeling: Aerospace Versus Nuclear

    NASA Technical Reports Server (NTRS)

    Stott, James E.; Britton, Paul; Ring, Robert W.; Hark, Frank; Hatfield, G. Spencer

    2010-01-01

    Aggregate nuclear plant failure data is used to produce generic common-cause factors that are specifically for use in the common-cause failure models of NUREG/CR-5485. Furthermore, the models presented in NUREG/CR-5485 are specifically designed to incorporate two significantly distinct assumptions about the methods of surveillance testing from whence this aggregate failure data came. What are the implications of using these NUREG generic factors to model the common-cause failures of aerospace systems? Herein, the implications of using the NUREG generic factors in the modeling of aerospace systems are investigated in detail and strong recommendations for modeling the common-cause failures of aerospace systems are given.

  18. Esophageal and transpulmonary pressures in acute respiratory failure*

    PubMed Central

    Talmor, Daniel; Sarge, Todd; O’Donnell, Carl R.; Ritz, Ray; Malhotra, Atul; Lisbon, Alan; Loring, Stephen H.

    2008-01-01

    Objective Pressure inflating the lung during mechanical ventilation is the difference between pressure applied at the airway opening (Pao) and pleural pressure (Ppl). Depending on the chest wall’s contribution to respiratory mechanics, a given positive end-expiratory and/or end-inspiratory plateau pressure may be appropriate for one patient but inadequate or potentially injurious for another. Thus, failure to account for chest wall mechanics may affect results in clinical trials of mechanical ventilation strategies in acute respiratory distress syndrome. By measuring esophageal pressure (Pes), we sought to characterize influence of the chest wall on Ppl and transpulmonary pressure (PL) in patients with acute respiratory failure. Design Prospective observational study. Setting Medical and surgical intensive care units at Beth Israel Deaconess Medical Center. Patients Seventy patients with acute respiratory failure. Interventions: Placement of esophageal balloon-catheters. Measurements and Main Results Airway, esophageal, and gastric pressures recorded at end-exhalation and end-inflation Pes averaged 17.5 ± 5.7 cm H2O at end-expiration and 21.2 ± 7.7 cm H2O at end-inflation and were not significantly correlated with body mass index or chest wall elastance. Estimated PL was 1.5 ± 6.3 cm H2O at end-expiration, 21.4 ± 9.3 cm H2O at end-inflation, and 18.4 ± 10.2 cm H2O (n = 40) during an end-inspiratory hold (plateau). Although PL at end-expiration was significantly correlated with positive end-expiratory pressure (p < .0001), only 24% of the variance in PL was explained by Pao (R2 = .243), and 52% was due to variation in Pes. Conclusions In patients in acute respiratory failure, elevated esophageal pressures suggest that chest wall mechanical properties often contribute substantially and unpredictably to total respiratory impedance, and therefore Pao may not adequately predict PL or lung distention. Systematic use of esophageal manometry has the potential to improve ventilator management in acute respiratory failure by providing more direct assessment of lung distending pressure. PMID:16540960

  19. Always Consider the Possibility of Opioid Induced Respiratory Depression in Patients Presenting with Hypercapnic Respiratory Failure Who Fail to Improve as Expected with Appropriate Therapy

    PubMed Central

    Steynor, Martin; MacDuff, Andrew

    2015-01-01

    Hypercapnic respiratory failure is a frequently encountered medical emergency. Two common causes are acute exacerbations of chronic obstructive pulmonary disease (COPD) and as a side effect of opioids. The two causes may coexist leading to diagnostic confusion and consequent delay in optimal management. We report a case of what was initially thought to be an exacerbation of COPD. The patient failed to improve with treatment as expected which led to the empirical administration of naloxone resulting in a dramatic reversal of her respiratory failure. The patient was subsequently discovered to be taking regular dihydrocodeine for chronic back pain. PMID:25893118

  20. Acute respiratory distress caused by Neosartorya udagawae

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We describe the first reported case of acute respiratory distress syndrome (ARDS) attributed to Neosartorya infection. The mold grew rapidly in culture of both sputum and bronchoalveolar lavage (BAL) fluid from a previously healthy 43-year-old woman with ARDS, which developed as the culmination of a...

  1. Heliox reduces respiratory system resistance in respiratory syncytial virus induced respiratory failure

    PubMed Central

    Kneyber, Martin CJ; van Heerde, Marc; Twisk, Jos WR; Plötz, Frans B; Markhors, Dick G

    2009-01-01

    Introduction Respiratory syncytial virus (RSV) lower respiratory tract disease is characterised by narrowing of the airways resulting in increased airway resistance, air-trapping and respiratory acidosis. These problems might be overcome using helium-oxygen gas mixture. However, the effect of mechanical ventilation with heliox in these patients is unclear. The objective of this prospective cross-over study was to determine the effects of mechanical ventilation with heliox 60/40 versus conventional gas on respiratory system resistance, air-trapping and CO2 removal. Methods Mechanically ventilated, sedated and paralyzed infants with proven RSV were enrolled within 24 hours after paediatric intensive care unit (PICU)admission. At T = 0, respiratory system mechanics including respiratory system compliance and resistance, and peak expiratory flow rate were measured with the AVEA ventilator. The measurements were repeated at each interval (after 30 minutes of ventilation with heliox, after 30 minutes of ventilation with nitrox and again after 30 minutes of ventilation with heliox). Indices of gas exchange (ventilation and oxygenation index) were calculated at each interval. Air-trapping (defined by relative change in end-expiratory lung volume) was determined by electrical impedance tomography (EIT) at each interval. Results Thirteen infants were enrolled. In nine, EIT measurements were performed. Mechanical ventilation with heliox significantly decreased respiratory system resistance. This was not accompanied by an improved CO2 elimination, decreased peak expiratory flow rate or decreased end-expiratory lung volume. Importantly, oxygenation remained unaltered throughout the experimental protocol. Conclusions Respiratory system resistance is significantly decreased by mechanical ventilation with heliox (ISCRTN98152468). PMID:19450268

  2. Causes of catastrophic failure in complex systems

    NASA Astrophysics Data System (ADS)

    Thomas, David A.

    2010-08-01

    Root causes of mission critical failures and major cost and schedule overruns in complex systems and programs are studied through the post-mortem analyses compiled for several examples, including the Hubble Space Telescope, the Challenger and Columbia Shuttle accidents, and the Three Mile Island nuclear power plant accident. The roles of organizational complexity, cognitive biases in decision making, the display of quantitative data, and cost and schedule pressure are all considered. Recommendations for mitigating the risk of similar failures in future programs are also provided.

  3. Implantable stimulator failures: causes, outcomes, and solutions.

    PubMed

    Liu, Xiao; Demosthenous, Andreas; Donaldson, Nick

    2007-01-01

    Current designs of implantable stimulators for neuroprostheses exploit trade-offs in power consumption, functionality, volume, selectivity and ease of use. However, no stimulator design should compromise reliability or safety. In this paper, we consider the common failures in implantable stimulators, their causes, outcomes and solutions. A new coding scheme, Manchester non-return-to-zero code, is proposed to format the cable signal in order to avoid prolonged DC current between cable exposures. Thus, in the event of cable failure, the bidirectional charge-balanced current between cable exposures maintains the nearby tissue in safe condition. PMID:18003328

  4. Respiratory syncytial virus (RSV) and its propensity for causing bronchiolitis.

    PubMed

    Pickles, Raymond J; DeVincenzo, John P

    2015-01-01

    Infants and young children with acute onset of wheezing and reduced respiratory airflows are often diagnosed with obstruction and inflammation of the small bronchiolar airways, ie bronchiolitis. The most common aetological agents causing bronchiolitis in young children are the respiratory viruses, and of the commonly encountered respiratory viruses, respiratory syncytial virus (RSV) has a propensity for causing bronchiolitis. Indeed, RSV bronchiolitis remains the major reason why previously healthy infants are admitted to hospital. Why RSV infection is such a predominant cause of bronchiolitis is the subject of this review. By reviewing the available histopathology of RSV bronchiolitis, both in humans and relevant animal models, we identify hallmark features of RSV infection of the distal airways and focus attention on the consequences of columnar cell cytopathology occurring in the bronchioles, which directly impacts the development of bronchiolar obstruction, inflammation and disease. PMID:25302625

  5. Pyrotechnic system failures: Causes and prevention

    NASA Technical Reports Server (NTRS)

    Bement, Laurence J.

    1988-01-01

    Although pyrotechnics have successfully accomplished many critical mechanical spacecraft functions, such as ignition, severance, jettisoning and valving (excluding propulsion), failures continue to occur. Provided is a listing of 84 failures of pyrotechnic hardware with completed design over a 23-year period, compiled informally by experts from every NASA Center, as well as the Air Force Space Division and the Naval Surface Warfare Center. Analyses are presented as to when and where these failures occurred, their technical source or cause, followed by the reasons why and how these kinds of failures persist. The major contributor is a fundamental lack of understanding of the functional mechanisms of pyrotechnic devices and systems, followed by not recognizing pyrotechnics as an engineering technology, insufficient manpower with hands-on experience, too few test facilities, and inadequate guidelines and specifications for design, development, qualification and acceptance. Recommendations are made on both a managerial and technical basis to prevent failures, increase reliability, improve existing and future designs, and develop the technology to meet future requirements.

  6. Causes of hatching failure in endangered birds

    PubMed Central

    Hemmings, N.; West, M.; Birkhead, T. R.

    2012-01-01

    About 10 per cent of birds' eggs fail to hatch, but the incidence of failure can be much higher in endangered species. Most studies fail to distinguish between infertility (due to a lack of sperm) and embryo mortality as the cause of hatching failure, yet doing so is crucial in order to understand the underlying problem. Using newly validated techniques to visualize sperm and embryonic tissue, we assessed the fertility status of unhatched eggs of five endangered species, including both wild and captive birds. All eggs were classified as ‘infertile’ when collected, but most were actually fertile with numerous sperm on the ovum. Eggs of captive birds had fewer sperm and were more likely to be infertile than those of wild birds. Our findings raise important questions regarding the management of captive breeding programmes. PMID:22977070

  7. Respiratory High-Dependency Care Units for the burden of acute respiratory failure.

    PubMed

    Scala, Raffaele

    2012-06-01

    The burden of acute respiratory failure (ARF) has become one of the greatest epidemiological challenges for the modern health systems. Consistently, the imbalance between the increasing prevalence of acutely de-compensated respiratory diseases and the shortage of high-daily cost ICU beds has stimulated new health cost-effective solutions. Respiratory High-Dependency Care Units (RHDCU) provide a specialised environment for patients who require an "intermediate" level of care between the ICU and the ward, where non-invasive monitoring and assisted ventilation techniques are preferentially applied. Since they are dedicated to the management of "mono-organ" decompensations, treatment of ARF patients in RHDCU avoids the dangerous "under-assistance" in the ward and unnecessary "over-assistance" in ICU. RHDCUs provide a specialised quality of care for ARF with health resources optimisation and their spread throughout health systems has been driven by their high-level of expertise in non-invasive ventilation (NIV), weaning from invasive ventilation, tracheostomy care, and discharging planning for ventilator-dependent patients. PMID:22560375

  8. Ventilator weaning outcomes in chronic respiratory failure in children.

    PubMed

    O'Brien, Jane E; Dumas, Helene M; Haley, Stephen M; Ladenheim, Barbara; Mast, Joelle; Burke, Sharon A; Birnkrant, David J; Whitford, Kathleen; Palazzo, Regina; Neufeld, Jacob A; Kharasch, Virginia S

    2007-06-01

    The purpose of this study was to describe mechanical ventilation weaning outcomes for children with chronic respiratory failure discharged from one of six post-acute rehabilitation facilities. Demographic, clinical and outcome data were collected from the medical record. Forty-four children were included in this prospective series; 20 (45%) were weaned off the ventilator at discharge. Children required significantly lower levels of ventilatory support at discharge than admission. Hourly use on the ventilator decreased from admission to discharge for the full cohort and for the subgroup who required a ventilator at discharge. Seventy-five percent of the children discharged with a ventilator had a portable unit. We conclude that nearly half of the children using mechanical ventilation achieve weaning during a postacute rehabilitation admission, whereas others have positive outcomes in severity, hours off the ventilator or portability of equipment. PMID:17473631

  9. Radiation necrosis causing failure of automatic ventilation during sleep with central sleep apnea

    SciTech Connect

    Udwadia, Z.F.; Athale, S.; Misra, V.P.; Wadia, N.H.

    1987-09-01

    A patient operated upon for a midline cerebellar hemangioblastoma developed failure of automatic respiration during sleep, together with central sleep apnea syndrome, approximately two years after receiving radiation therapy to the brain. Clinical and CT scan findings were compatible with a diagnosis of radiation necrosis as the cause of his abnormal respiratory control.

  10. Clinical review: Respiratory failure in HIV-infected patients - a changing picture

    PubMed Central

    2013-01-01

    Respiratory failure in HIV-infected patients is a relatively common presentation to ICU. The debate on ICU treatment of HIV-infected patients goes on despite an overall decline in mortality amongst these patients since the AIDS epidemic. Many intensive care physicians feel that ICU treatment of critically ill HIV patients is likely to be futile. This is mainly due to the unfavourable outcome of HIV patients with Pneumocystis jirovecii pneumonia who need mechanical ventilation. However, the changing spectrum of respiratory illness in HIV-infected patients and improved outcome from critical illness remain under-recognised. Also, the awareness of certain factors that can affect their outcome remains low. As there are important ethical and practical implications for intensive care clinicians while making decisions to provide ICU support to HIV-infected patients, a review of literature was undertaken. It is notable that the respiratory illnesses that are not directly related to underlying HIV disease are now commonly encountered in the highly active antiretroviral therapy (HAART) era. The overall incidence of P. jirovecii as a cause of respiratory failure has declined since the AIDS epidemic and sepsis including bacterial pneumonia has emerged as a frequent cause of hospital and ICU admission amongst HIV patients. The improved overall outcome of HIV patients needing ICU admission is related to advancement in general ICU care, including adoption of improved ventilation strategies. An awareness of respiratory illnesses in HIV-infected patients along with an appropriate diagnostic and treatment strategy may obviate the need for invasive ventilation and improve outcome further. HIV-infected patients presenting with respiratory failure will benefit from early admission to critical care for treatment and support. There is evidence to suggest that continuing or starting HAART in critically ill HIV patients is beneficial and hence should be considered after multidisciplinary discussion. As a very high percentage (up to 40%) of HIV patients are not known to be HIV infected at the time of ICU admission, the clinicians should keep a low threshold for requesting HIV testing for patients with recurrent pneumonia. PMID:23806117

  11. [Respiratory infections and bacteremia caused by Neisseria meningitidis serogroup W].

    PubMed

    Rosas, Reinaldo; Solar, Sebastián; Durán, Luisa; Porte, Lorena; Noriega, Luis Miguel; Thompson, Luis; Marcotti, Alejandra; Pérez, Jorge; Weitzel, Thomas

    2015-04-01

    N. meningitidis serogroup W has recently been introduced into Chile. This serogroup has been associated with hypervirulent strains capable of causing outbreaks. Furthermore, there is data suggesting that the spectrum of clinical manifestations varies among different serogroups. Here we describe three cases of community acquired respiratory infections caused by N. meningitidis W, which were diagnosed by blood culture during 2013 in our hospital. PMID:26065462

  12. A case of thyrotoxic periodic paralysis with respiratory failure in an African American woman.

    PubMed

    Shields, Denise L

    2015-05-01

    Thyrotoxic periodic paralysis is an acute endocrine emergency characterized by hyperthyroidism, profound muscle weakness and/or paralysis, and hypokalemia that is not due to potassium deficiency. Typically described in young males of Asian descent, it is becoming increasingly recognized outside of this demographic group and is believed to be an underrecognized cause of symptomatic hypokalemia. Thyrotoxic periodic paralysis usually manifests as acute onset of symmetrical distal extremity weakness and is treated with careful potassium replacement and nonselective ?-blockers. In this case, a 43-year-old African American woman with thyrotoxic periodic paralysis had recurrent lower extremity myopathy and acute respiratory failure precipitated by noncompliance with treatment for Graves disease. PMID:25934725

  13. A case of obesity hypoventilation syndrome with respiratory failure that improved with abdominoplasty.

    PubMed

    Kuwahara, Hiroaki; Kubo, Kazuhito; Akiyama, Goh; Takayama, Yasuhiro; Tosa, Ryouichi; Hyakusoku, Hiko

    2015-01-01

    We report on a 70-year-old man with severe respiratory failure caused by obesity hypoventilation syndrome due to abdominal adiposis. Obesity hypoventilation syndrome is a severe condition that is diagnosed when all of the following criteria are satisfied: body-mass index >30 kg/m(2); apnea hypopnea index >30; PaCO2 >45 mm Hg (in the daytime); and marked daytime somnolence. Abdominoplasty, which is generally used for abdominal laxness, striae, and rectus muscle diastases and for women in the postpartum period, was performed for this patient to facilitate ventilator weaning and produced a satisfactory result. PMID:25797874

  14. Excessive Dynamic Airway Collapse: An Unexpected Contributor to Respiratory Failure in a Surgical Patient

    PubMed Central

    Lyaker, Michael R.; Davila, Victor R.; Papadimos, Thomas J.

    2015-01-01

    Central airway collapse plays a significant, underrecognized role in respiratory failure after extubation of critically ill patients. Historically, airway collapse has been attributed to tracheomalacia (TM), softening of the cartilage in the trachea and other large airways. More recently, excessive dynamic airway collapse (EDAC) has been described as a distinct process unrelated to a loss of cartilaginous airway support. EDAC is caused by the posterior wall of the trachea bulging forward and causing airway obstruction during exhalation. This process is exaggerated when intrathoracic pressure is increased and results in a clinical picture of coughing, difficulty clearing secretions, dyspnea, and stridor. The increased use of computerized tomography and fiberoptic bronchoscopy has identified varying degrees of EDAC and TM in both symptomatic and asymptomatic individuals. This has led to renewed consideration of airway collapse and the different processes that contribute to it. Here we describe a 43-year-old morbidly obese patient who failed repeated attempts at extubation after elective hysterectomy. We will discuss the processes of EDAC and TM, describe how this condition contributed to this patient's respiratory failure, and review diagnosis and management options. PMID:26167306

  15. Dacryocystocele: a rare cause of neonatal respiratory distress.

    PubMed

    Moreno-Calero, Clara; Benítez-Segura, Ignacio; Ramis, Laia Ferrés; Ferré, Consuelo Galiana; Busto, Jordi Roldan; Balliu-Badia, Pere Ramon

    2014-05-01

    Dacryocystocele consist in congenital dilatation of the tear duct. It is a benign anomaly with a good prognosis that is caused by blockage of the nasolacrimal drainage system. Classically it appears as a bluish mass in the region of the inner edge of the eye and, less frequently, as respiratory distress in the neonatal period. We report a case of a newborn with episodic cyanosis and difficult feeding secondary to dacryocystocele. PMID:23841793

  16. Relevance of Lung Ultrasound in the Diagnosis of Acute Respiratory Failure*

    PubMed Central

    Mezière, Gilbert A.

    2008-01-01

    Background: This study assesses the potential of lung ultrasonography to diagnose acute respiratory failure. Methods: This observational study was conducted in university-affiliated teaching-hospital ICUs. We performed ultrasonography on consecutive patients admitted to the ICU with acute respiratory failure, comparing lung ultrasonography results on initial presentation with the final diagnosis by the ICU team. Uncertain diagnoses and rare causes (frequency < 2%) were excluded.Weincluded 260 dyspneic patients with a definite diagnosis. Three items were assessed: artifacts (horizontal A lines or vertical B lines indicating interstitial syndrome), lung sliding, and alveolar consolidation and/or pleural effusion. Combined with venous analysis, these items were grouped to assess ultrasound profiles. Results: Predominant A lines plus lung sliding indicated asthma (n = 34) or COPD (n = 49) with 89% sensitivity and 97% specificity. Multiple anterior diffuse B lines with lung sliding indicated pulmonary edema (n = 64) with 97% sensitivity and 95% specificity. A normal anterior profile plus deep venous thrombosis indicated pulmonary embolism (n = 21) with 81% sensitivity and 99% specificity. Anterior absent lung sliding plus A lines plus lung point indicated pneumothorax (n = 9) with 81% sensitivity and 100% specificity. Anterior alveolar consolidations, anterior diffuse B lines with abolished lung sliding, anterior asymmetric interstitial patterns, posterior consolidations or effusions without anterior diffuse B lines indicated pneumonia (n = 83) with 89% sensitivity and 94% specificity. The use of these profiles would have provided correct diagnoses in 90.5% of cases. Conclusions: Lung ultrasound can help the clinician make a rapid diagnosis in patients with acute respiratory failure, thus meeting the priority objective of saving time. PMID:18403664

  17. Efficacy of noninvasive volume targeted ventilation in patients with chronic respiratory failure due to kyphoscoliosis.

    PubMed

    Piesiak, P; Brzecka, A; Kosacka, M; Jankowska, R

    2015-01-01

    Severe kyphoscoliosis can cause chronic respiratory failure. Noninvasive mechanical ventilation (NIMV) is a new optional treatment for such patients. The aim of this study was to evaluate the effectiveness of average volume-assured pressure support (AVAPS) NIMV in patients with kyphoscoliotic chronic respiratory failure. The study was performed in 12 patients (mean age 49±11 years and body mass index 27.5±7.9 kg/m2) with advanced kyphoscoliosis complicated by severe respiratory failure (PaO2 6.68±0.34 kPa, SaO2 81.7±3.1%, PaCO2 9.51±1.08 kPa) treated by the NIMV. The short-term, after 5 days, and long-term, after 1 year of home treatment, efficacy of NIMV was evaluated. We found a significant improvement of diurnal PaO2 and PaCO2 on the 5th day of NIMV (an increase of 1.4±0.3 kPa and a decrease of 1.8±0.8 kPa, respectively; p<0.05) and after one year NIMV (an increase of 2.07±0.46 kPa and a decrease of 2.68±0.85 kPa, respectively; p<0.05). There was a significant increase of mean blood oxygen saturation during sleep on the 5th day (86.2±3.2%) and after 1 year of treatment (89.4±2.1%) compared with the baseline level (83.2±3.2%). The forced vital capacity also increased after 1 year (1,024±258 ml vs. the baseline 908±267 ml; p<0.05). The NIMV was well tolerated and no patient discontinued the treatment during the observation period. We conclude that AVAPS NIMV is an effective treatment option in kyphoscoliotic patients with chronic respiratory failure, resulting in a prompt and long-term improvement of daytime and nocturnal blood gas exchange. PMID:25315620

  18. Amyotrophic Lateral Sclerosis Presenting Respiratory Failure as the Sole Initial Manifestation

    PubMed Central

    Tateno, Fuyuki; Sakakibara, Ryuji; Kawashima, Kengo; Kishi, Masahiko; Tsuyusaki, Yohei; Aiba, Yosuke; Ogata, Tsuyoshi

    2014-01-01

    It is rare that amyotrophic lateral sclerosis (ALS) presents with respiratory failure as the sole initial manifestation. A 72-year-old man with mild chronic obstructive pulmonary disease developed exertional dyspnea for 13 months. He then progressed to limb weakness that led to the diagnosis of ALS. Although rare, ALS can present with respiratory failure as the sole initial manifestation more than 1 year prior to limb weakness. PMID:25232334

  19. Respiratory Failure in Children With Hemato-oncological Diseases Admitted to the PICU: A Single-center Experience.

    PubMed

    García-Salido, Alberto; Mastro-Martínez, Ignacio; Cabeza-Martín, Beatriz; Oñoro, Gonzalo; Nieto-Moro, Montserrat; Iglesias-Bouzas, María I; Serrano-González, Ana; Casado-Flores, Juan

    2015-08-01

    Respiratory failure (RF) is a main cause of pediatric intensive care unit (PICU) admission in children with hemato-oncological diseases. We present a retrospective chart review of children admitted to our PICU because of RF (January 2006 to December 2010). The aims of this study are the following: (1) to describe the demographical and clinical characteristics and respiratory management of these children; and (2) to identify the factors associated with mechanical ventilation (MV) and mortality. A total of 69 patients, encompassing 88 episodes, were included (55/88 cases were hypoxemic RF). The first respiratory support at PICU admission was, in decreasing order of frequency, high-flow oxygen nasal cannula (HFNC; 50/88), noninvasive ventilation (NIV; 13/88), and oxygen nasal cannula (16/88). MV was necessary in 47/88 episodes, 38/47 after another respiratory support. In 18/28 children with initial NIV, MV was required later. MV was associated with O-PRISM score, NIV requirement, suspected respiratory infection, and days of PICU treatment. Patients without MV showed an increased survival rate (P=0.001). In summary, the hypoxemic RF was the main cause of PICU admission, and HFNC or NIV was almost always the first respiratory support. The use of MV was associated with a higher mortality rate. The utility of precocious HFNC or NIV should be investigated in larger clinical studies. PMID:26056792

  20. Respiratory muscle function and exercise intolerance in heart failure.

    PubMed

    Ribeiro, Jorge P; Chiappa, Gaspar R; Neder, J Alberto; Frankenstein, Lutz

    2009-06-01

    Inspiratory muscle weakness (IMW) is prevalent in patients with chronic heart failure (CHF) caused by left ventricular systolic dysfunction, which contributes to reduced exercise capacity and the presence of dyspnea during daily activities. Inspiratory muscle strength (estimated by maximal inspiratory pressure) has independent prognostic value in CHF. Overall, the results of trials with inspiratory muscle training (IMT) indicate that this intervention improves exercise capacity and quality of life, particularly in patients with CHF and IMW. Some benefit from IMT may be accounted for by the attenuation of the inspiratory muscle metaboreflex. Moreover, IMT results in improved cardiovascular responses to exercise and to those obtained with standard aerobic training. These findings suggest that routine screening for IMW is advisable in patients with CHF, and specific IMT and/or aerobic training are of practical value in the management of these patients. PMID:19486593

  1. Lower respiratory tract infection caused by respiratory syncytial virus: current management and new therapeutics.

    PubMed

    Mazur, Natalie I; Martinón-Torres, Federico; Baraldi, Eugenio; Fauroux, Brigitte; Greenough, Anne; Heikkinen, Terho; Manzoni, Paolo; Mejias, Asuncion; Nair, Harish; Papadopoulos, Nikolaos G; Polack, Fernando P; Ramilo, Octavio; Sharland, Mike; Stein, Renato; Madhi, Shabir A; Bont, Louis

    2015-11-01

    Respiratory syncytial virus (RSV) is a major worldwide cause of morbidity and mortality in children under five years of age. Evidence-based management guidelines suggest that there is no effective treatment for RSV lower respiratory tract infection (LRTI) and that supportive care, ie, hydration and oxygenation, remains the cornerstone of clinical management. However, RSV treatments in development in the past decade include 10 vaccines and 11 therapeutic agents in active clinical trials. Maternal vaccination is particularly relevant because the most severe disease occurs within the first 6 months of life, when children are unlikely to benefit from active immunisation. We must optimise the implementation of novel RSV therapeutics by understanding the target populations, showing safety, and striving for acceptable pricing in the context of this worldwide health problem. In this Review, we outline the limitations of RSV LRTI management, the drugs in development, and the remaining challenges related to study design, regulatory approval, and implementation. PMID:26411809

  2. Lung postmortem autopsy revealing extramedullary involvement in multiple myeloma causing acute respiratory distress syndrome.

    PubMed

    Ravinet, Aurélie; Perbet, Sébastien; Guièze, Romain; Lemal, Richard; Guérin, Renaud; Gayraud, Guillaume; Aliane, Jugurtha; Tremblay, Aymeric; Pascal, Julien; Ledoux, Albane; Chaleteix, Carine; Dechelotte, Pierre; Bay, Jacques-Olivier; Bazin, Jean-Etienne; Constantin, Jean-Michel

    2014-01-01

    Pulmonary involvement with multiple myeloma is rare. We report the case of a 61-year-old man with past medical history of chronic respiratory failure with emphysema, and a known multiple myeloma (Durie and Salmon stage III B and t(4;14) translocation). Six months after diagnosis and first line of treatment, he presented acute dyspnea with interstitial lung disease. Computed tomography showed severe bullous emphysema and diffuse, patchy, multifocal infiltrations bilaterally with nodular character, small bilateral pleural effusions, mediastinal lymphadenopathy, and a known lytic lesion of the 12th vertebra. He was treated with piperacillin-tazobactam, amikacin, oseltamivir, and methylprednisolone. Finally, outcome was unfavourable. Postmortem analysis revealed diffuse and nodular infracentimetric infiltration of the lung parenchyma by neoplastic plasma cells. Physicians should be aware that acute respiratory distress syndrome not responding to treatment of common causes could be a manifestation of the disease, even with negative BAL or biopsy and could be promptly treated with salvage therapy. PMID:25165587

  3. Lung Postmortem Autopsy Revealing Extramedullary Involvement in Multiple Myeloma Causing Acute Respiratory Distress Syndrome

    PubMed Central

    Ravinet, Aurélie; Perbet, Sébastien; Guièze, Romain; Guérin, Renaud; Gayraud, Guillaume; Aliane, Jugurtha; Tremblay, Aymeric; Pascal, Julien; Ledoux, Albane; Chaleteix, Carine; Dechelotte, Pierre; Bay, Jacques-Olivier; Bazin, Jean-Etienne; Constantin, Jean-Michel

    2014-01-01

    Pulmonary involvement with multiple myeloma is rare. We report the case of a 61-year-old man with past medical history of chronic respiratory failure with emphysema, and a known multiple myeloma (Durie and Salmon stage III B and t(4;14) translocation). Six months after diagnosis and first line of treatment, he presented acute dyspnea with interstitial lung disease. Computed tomography showed severe bullous emphysema and diffuse, patchy, multifocal infiltrations bilaterally with nodular character, small bilateral pleural effusions, mediastinal lymphadenopathy, and a known lytic lesion of the 12th vertebra. He was treated with piperacillin-tazobactam, amikacin, oseltamivir, and methylprednisolone. Finally, outcome was unfavourable. Postmortem analysis revealed diffuse and nodular infracentimetric infiltration of the lung parenchyma by neoplastic plasma cells. Physicians should be aware that acute respiratory distress syndrome not responding to treatment of common causes could be a manifestation of the disease, even with negative BAL or biopsy and could be promptly treated with salvage therapy. PMID:25165587

  4. Intravenous colistin-induced acute respiratory failure: A case report and a review of literature

    PubMed Central

    Shrestha, Amardeep; Soriano, Sheryll Mae; Song, Mingchen; Chihara, Shingo

    2014-01-01

    The emergence of multi-drug-resistant gram negative bacillary infections has regained popularity of ancient drugs such as polymyxins. We report a case of acute respiratory failure induced by use of intravenous colistimethate, which is one of the forms of polymyxin. The patient is a 31 year old female with paraplegia due to spina bifida who underwent excisional debridement of large lumbosacral decubitus ulcer with osteomyelitis infected with pan-resistant Pseudomonas aeruginosa and MRSA. Six days after initiation of intravenous colistimethate and vancomycin, she developed acute respiratory failure requiring mechanical ventilation. Pan-culture was negative including a chest radiograph. V/Q scan showed low probability for pulmonary embolism. Echocardiogram showed normal right ventricle with no strain or pulmonary hypertension. Colistimethate was discontinued. Within 24 hours, she was extubated. In the early years after introduction of polymyxin, there were several reports of acute respiratory paralysis. The mechanism is thought to be noncompetitive myoneuronal presynaptic blockade of acetylcholine release. Though a direct causal relationship for respiratory failure is often difficult to establish in current era with multiple co morbidities, the timeframe of apnea, acuity of onset as well as rapid recovery in our case clearly point out the causal relationship. In addition, our patient also developed acute renal failure, presumably due to colistimethate induced nephrotoxicity, a possible contributing factor for her acute respiratory failure. In summary, colistimethate can induce acute neurotoxicity including respiratory muscular weakness and acute respiratory failure. Clinicians should consider its toxicity in the differential diagnosis of acute respiratory failure especially in critically ill patients. PMID:25337492

  5. Genetics Home Reference: Hereditary myopathy with early respiratory failure

    MedlinePLUS

    ... skeletal muscles) and in heart (cardiac) muscle. Within muscle cells, titin is an essential component of structures called ... autosomal dominant ; cardiac ; cell ; contraction ; gene ; hereditary ; inherited ; muscle cells ; mutation ; protein ; proximal ; respiratory You may find definitions ...

  6. Relapsing polychondritis with initial presentations of recurrent negative-pressure pulmonary edema and acute respiratory failure.

    PubMed

    Wu, Meng-Fang; Li, Yi-Shan; Hung, Chen-Yiu; Chao, Wei-Chieh; Fu, Zhey-Ying; Kao, Kuo-Chin; Huang, Chung-Chi; Tsai, Ying-Huang; Hsieh, Meng-Jer

    2015-05-01

    Relapsing polychondritis is a rare autoimmune disease causing inflammation in cartilaginous structures and other tissues throughout the body. Negative-pressure pulmonary edema (NPPE) due to laryngeal swelling from relapsing polychondritis is rare and has not been reported. Here, we report a case of relapsing polychondritis in an 18-y-old female who presented with recurrent NPPE and acute respiratory failure, which was diagnosed initially as ARDS during the influenza season. She underwent an emergent tracheotomy to relieve the upper airway obstruction resulting from severe laryngeal edema. A chest radiograph showed diffuse infiltrations, pneumothorax, and pneumomediastinum. The pulmonary infiltrations resolved rapidly in 2 d, and NPPE was diagnosed. Left ear swelling with erythematous change and saddle nose developed during the course of hospitalization, and an ear biopsy demonstrated severe cartilage necrosis. Relapsing polychondritis was diagnosed based on clinical images and pathological findings. PMID:25550527

  7. Corrosion causes most pipeline failures in Gulf of Mexico

    SciTech Connect

    Mandke, J.S. )

    1990-10-29

    Corrosion is the leading cause of failures of subsea pipelines in the U.S. Gulf of Mexico. Third-party incidents, storms, and mud slides are additional principal causes of offshore pipeline failures. For small size lines, additionally, failures due to external corrosion were more frequent during the period studied than internal corrosion. In medium and large-size lines, failures due to internal corrosion were more frequent than those due to external corrosion. The study results presented provide an improved basis for assessment of safety of pipelines and for further improvements to current pipeline design, inspection, maintenance, and construction procedures.

  8. Coexistence of Obstructive Sleep Apnea and Superior Vena Cava Syndromes Due to Substernal Goitre in a Patient With Respiratory Failure: A Case Report

    PubMed Central

    Tunc, Mehtap; Sazak, Hilal; Karlilar, Bulent; Ulus, Fatma; Tastepe, Irfan

    2015-01-01

    Introduction: Substernal goiter may rarely cause superior vena cava syndrome (SVCS) owing to venous compression, and cause acute respiratory failure due to tracheal compression. Obstructive sleep apnea syndrome (OSAS) may rarely occur when there is a narrowing of upper airway by edema and vascular congestion resulting from SVCS. Case Presentation: We presented the clinical course and treatment of acute respiratory failure (ARF) developed in a patient with SVCS and OSAS due to substernal goiter. After treatment of ARF with invasive mechanical ventilation, weaning and total thyroidectomy were successfully performed through collar incision and median sternotomy without complications. Conclusions: Our case showed that if the respiratory failure occurred due to substernal goiter and SVCS, we would need to investigate the coexistence of OSAS and SVCS. PMID:26082848

  9. High-Output Heart Failure Caused by Thyrotoxicosis and Beriberi.

    PubMed

    McCulloch, Brenda

    2015-12-01

    High-output heart failure is not seen as commonly as low-output heart failure and some of the typical guideline recommendations may not benefit patients with high-output failure. High-output failure is caused by several diseases, including thyrotoxicosis and beriberi, highlighted in this article. Thyrotoxicosis, caused by excessive thyroid hormone production, has profound hemodynamic effects. Wet beriberi, affecting predominately the cardiovascular system, is caused by severe thiamine deficiency, most commonly seen in patients with chronic alcoholism or poor nutrition from other causes. Prompt recognition of these infrequently seen syndromes is essential. This article outlines the medical treatment and nursing care needed to return these patients to a normal state. PMID:26567494

  10. Telomere dysfunction causes alveolar stem cell failure

    PubMed Central

    Alder, Jonathan K.; Barkauskas, Christina E.; Limjunyawong, Nathachit; Stanley, Susan E.; Kembou, Frant; Tuder, Rubin M.; Hogan, Brigid L. M.; Mitzner, Wayne; Armanios, Mary

    2015-01-01

    Telomere syndromes have their most common manifestation in lung disease that is recognized as idiopathic pulmonary fibrosis and emphysema. In both conditions, there is loss of alveolar integrity, but the underlying mechanisms are not known. We tested the capacity of alveolar epithelial and stromal cells from mice with short telomeres to support alveolar organoid colony formation and found that type 2 alveolar epithelial cells (AEC2s), the stem cell-containing population, were limiting. When telomere dysfunction was induced in adult AEC2s by conditional deletion of the shelterin component telomeric repeat-binding factor 2, cells survived but remained dormant and showed all the hallmarks of cellular senescence. Telomere dysfunction in AEC2s triggered an immune response, and this was associated with AEC2-derived up-regulation of cytokine signaling pathways that are known to provoke inflammation in the lung. Mice uniformly died after challenge with bleomycin, underscoring an essential role for telomere function in AEC2s for alveolar repair. Our data show that alveoloar progenitor senescence is sufficient to recapitulate the regenerative defects, inflammatory responses, and susceptibility to injury that are characteristic of telomere-mediated lung disease. They suggest alveolar stem cell failure is a driver of telomere-mediated lung disease and that efforts to reverse it may be clinically beneficial. PMID:25840590

  11. Telomere dysfunction causes alveolar stem cell failure.

    PubMed

    Alder, Jonathan K; Barkauskas, Christina E; Limjunyawong, Nathachit; Stanley, Susan E; Kembou, Frant; Tuder, Rubin M; Hogan, Brigid L M; Mitzner, Wayne; Armanios, Mary

    2015-04-21

    Telomere syndromes have their most common manifestation in lung disease that is recognized as idiopathic pulmonary fibrosis and emphysema. In both conditions, there is loss of alveolar integrity, but the underlying mechanisms are not known. We tested the capacity of alveolar epithelial and stromal cells from mice with short telomeres to support alveolar organoid colony formation and found that type 2 alveolar epithelial cells (AEC2s), the stem cell-containing population, were limiting. When telomere dysfunction was induced in adult AEC2s by conditional deletion of the shelterin component telomeric repeat-binding factor 2, cells survived but remained dormant and showed all the hallmarks of cellular senescence. Telomere dysfunction in AEC2s triggered an immune response, and this was associated with AEC2-derived up-regulation of cytokine signaling pathways that are known to provoke inflammation in the lung. Mice uniformly died after challenge with bleomycin, underscoring an essential role for telomere function in AEC2s for alveolar repair. Our data show that alveoloar progenitor senescence is sufficient to recapitulate the regenerative defects, inflammatory responses, and susceptibility to injury that are characteristic of telomere-mediated lung disease. They suggest alveolar stem cell failure is a driver of telomere-mediated lung disease and that efforts to reverse it may be clinically beneficial. PMID:25840590

  12. Lung ultrasound imaging in avian influenza A (H7N9) respiratory failure

    PubMed Central

    2014-01-01

    Background Lung ultrasound has been shown to identify in real-time, various pathologies of the lung such as pneumonia, viral pneumonia, and acute respiratory distress syndrome (ARDS). Lung ultrasound maybe a first-line alternative to chest X-ray and CT scan in critically ill patients with respiratory failure. We describe the use of lung ultrasound imaging and findings in two cases of severe respiratory failure from avian influenza A (H7N9) infection. Methods Serial lung ultrasound images and video from two cases of H7N9 respiratory failure requiring mechanical ventilation and extracorporeal membrane oxygenation in a tertiary care intensive care unit were analyzed for characteristic lung ultrasound findings described previously for respiratory failure and infection. These findings were followed serially, correlated with clinical course and chest X-ray. Results In both patients, characteristic lung ultrasound findings have been observed as previously described in viral pulmonary infections: subpleural consolidations associated or not with local pleural effusion. In addition, numerous, confluent, or coalescing B-lines leading to ‘white lung’ with corresponding pleural line thickening are associated with ARDS. Extension or reduction of lesions observed with ultrasound was also correlated respectively with clinical worsening or improvement. Coexisting consolidated pneumonia with sonographic air bronchograms was noted in one patient who did not survive. Conclusions Clinicians with access to point-of-care ultrasonography may use these findings as an alternative to chest X-ray or CT scan. Lung ultrasound imaging may assist in the efficient allocation of intensive care for patients with respiratory failure from viral pulmonary infections, especially in resource scarce settings or situations such as future respiratory virus outbreaks or pandemics. PMID:24949191

  13. Respiratory failure from corn starch aspiration: a hazard of diaper changing.

    PubMed

    Silver, P; Sagy, M; Rubin, L

    1996-04-01

    Corn starch powder is widely used for routine infant skin care as a substitute for talcum powder, as it is believed to have fewer respiratory hazards. We describe a one-month-old infant who presented to an emergency department with respiratory failure and a severe pneumonitis from aspiration of corn starch powder. The patient recovered after five days of mechanical ventilatory support. We conclude that careless use of corn starch for infant skin care can lead to accidental aspiration of this substance and severe respiratory disease. PMID:8859920

  14. Respiratory failure after superior-based pharyngeal flap for velopharyngeal insufficiency: A rare complication.

    PubMed

    Lawlor, Claire M; Riley, Charles A; Hildrew, Douglas M; Guarisco, J Lindhe

    2015-07-01

    Velopharyngeal insufficiency (VPI) is an uncommon pediatric disorder often associated with congenital syndromes. After speech therapy, surgery is the standard management. Many surgical approaches to VPI repair have been reported and the complications of these procedures are well documented. To date, there have been no published cases of respiratory failure secondary to pneumomediastinum, pneumopericardium, and bilateral pneumothoraces with associated subcutaneous emphysema after superior-based pharyngeal flap. We present the first case in the literature. Our proposed etiology for the respiratory failure is air tracking from the flap donor site to the pleural spaces of the thoracic cavity via the visceral or prevertebral fascia following positive pressure ventilation. PMID:25953454

  15. Modeling Common Cause Failures of Thrusters on ISS Visiting Vehicles

    NASA Technical Reports Server (NTRS)

    Haught, Megan

    2014-01-01

    This paper discusses the methodology used to model common cause failures of thrusters on the International Space Station (ISS) Visiting Vehicles. The ISS Visiting Vehicles each have as many as 32 thrusters, whose redundancy makes them susceptible to common cause failures. The Global Alpha Model (as described in NUREG/CR-5485) can be used to represent the system common cause contribution, but NUREG/CR-5496 supplies global alpha parameters for groups only up to size six. Because of the large number of redundant thrusters on each vehicle, regression is used to determine parameter values for groups of size larger than six. An additional challenge is that Visiting Vehicle thruster failures must occur in specific combinations in order to fail the propulsion system; not all failure groups of a certain size are critical.

  16. Modeling Common Cause Failures of Thrusters on ISS Visiting Vehicles

    NASA Technical Reports Server (NTRS)

    Haught, Megan; Duncan, Gary

    2014-01-01

    This paper discusses the methodology used to model common cause failures of thrusters on the International Space Station (ISS) Visiting Vehicles. The ISS Visiting Vehicles each have as many as 32 thrusters, whose redundancy and similar design make them susceptible to common cause failures. The Global Alpha Model (as described in NUREG/CR-5485) can be used to represent the system common cause contribution, but NUREG/CR-5496 supplies global alpha parameters for groups only up to size six. Because of the large number of redundant thrusters on each vehicle, regression is used to determine parameter values for groups of size larger than six. An additional challenge is that Visiting Vehicle thruster failures must occur in specific combinations in order to fail the propulsion system; not all failure groups of a certain size are critical.

  17. What Are the Signs and Symptoms of Respiratory Failure?

    MedlinePLUS

    ... underlying cause and the levels of oxygen and carbon dioxide in the blood. A low oxygen level in ... on the skin, lips, and fingernails. A high carbon dioxide level can cause rapid breathing and confusion. Some ...

  18. Treatment Failure and Mortality amongst Children with Severe Acute Malnutrition Presenting with Cough or Respiratory Difficulty and Radiological Pneumonia

    PubMed Central

    Chisti, Mohammod Jobayer; Salam, Mohammed Abdus; Bardhan, Pradip Kumar; Faruque, Abu S. G.; Shahid, Abu S. M. S. B.; Shahunja, K. M.; Das, Sumon Kumar; Hossain, Md Iqbal; Ahmed, Tahmeed

    2015-01-01

    Background Appropriate intervention is critical in reducing deaths among under-five, severe acutely malnourished (SAM) children with danger signs of severe pneumonia; however, there is paucity of data on outcome of World Health Organisation (WHO) recommended interventions of SAM children with severe pneumonia. We sought to evaluate outcome of the interventions in such children. Methods We prospectively enrolled SAM children aged 0–59 months, admitted to the Intensive Care Unit (ICU) or Acute Respiratory Infection (ARI) ward of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), between April 2011 and June 2012 with cough or respiratory difficulty and radiological pneumonia. All the enrolled children were treated with ampicillin and gentamicin, and micronutrients as recommended by the WHO. Comparison was made among pneumonic children with (n = 111) and without WHO defined danger signs of severe pneumonia (n = 296). The outcomes of interest were treatment failure (if a child required changing of antibiotics) and deaths during hospitalization. Further comparison was also made among those who developed treatment failure and who did not and among the survivors and deaths. Results SAM children with danger signs of severe pneumonia more often experienced treatment failure (58% vs. 20%; p<0.001) and fatal outcome (21% vs. 4%; p<0.001) compared to those without danger signs. Only 6/111 (5.4%) SAM children with danger signs of severe pneumonia and 12/296 (4.0%) without danger signs had bacterial isolates from blood. In log-linear binomial regression analysis, after adjusting for potential confounders, danger signs of severe pneumonia, dehydration, hypocalcaemia, and bacteraemia were independently associated both with treatment failure and deaths in SAM children presenting with cough or respiratory difficulty and radiological pneumonia (p<0.01). Conclusion and Significance The result suggests that SAM children with cough or respiratory difficulty and radiologic pneumonia who had WHO-defined danger signs of severe pneumonia more often had treatment failure and fatal outcome compared to those without the danger signs. In addition to danger signs of severe pneumonia, other common causes of both treatment failure and deaths were dehydration, hypocalcaemia, and bacteraemia on admission. The result underscores the importance for further research especially a randomized, controlled clinical trial to validate standard WHO therapy in SAM children with pneumonia especially with danger signs of severe pneumonia to reduce treatment failures and deaths. PMID:26451603

  19. [Recurrent Candida sepsis with prolonged respiratory failure and severe liver dysfunction].

    PubMed

    Lewejohann, J; Hansen, M; Zimmermann, C; Muhl, Elke; Bruch, H P

    2005-01-01

    Systemic mycoses, especially pulmonary diseases and septicemia are observed increasingly at intensive care units. Essential risk factors for development of candidosis are the expanded use of antibiotics and immunocompromised patients, caused either as a result of a severe underlying disease or iatrogenically induced after organ transplantation. Candida albicans is the most frequent pathogen in microbiological findings. Blood cultures are only positive in massive fungemia. We report a 50-year-old patient with recurrent Candida-septicemia: rupture of the distal esophagus after dilatation because of cardiac achalasia with mediastinal emphysema and mediastinitis. Severe acute respiratory distress syndrome after aspiration with septic shock and acute renal failure at the beginning. Long-term mechanical ventilation, continuous renal replacement therapy and multifarious antibiotic therapy. Early microbiological samples of several positive blood cultures and bronchoalveolar lavages revealed the presence of Candida albicans. In the further clinical course, detection of Pseudomonas species in bronchoalveolar lavages and Staphylococci as well as Enterococci in a number of positive blood cultures. Later on development of a severe liver dysfunction with test results that showed an intrahepatic cholestasis. Because of coagulation failure commencement of artificial liver support with the MARS-system (molecule adsorbent recirculating system). Decrease of high bilirubin levels was accompanied by improvement of clinical condition of the patient. In the following course, repeated severe systemic infections with phases of septicemia or rather septic shock and detection of Candida in several positive blood cultures and bronchoalveolar lavages. In each case increasing bilirubin levels with signs of intrahepatic cholestasis and each time improvement with antimycotic therapy (voriconazol, caspofungin and fluconazol). The patient showed more and more signs of immunodeficiency in the sequel. The clinical appearance of candidosis is manifold. Systemic Candida infections are frequent in patients with immunodeficiency. A recurrent Candida septicemia with prolonged respiratory failure and severe liver dysfunction in form of cholestatic hepatosis, that improved several times with antimycotic therapy in combination with evidence based intensive care measures and artificial organ support is a comparatively rare event. PMID:15826296

  20. Acute Stridor and Respiratory Failure due to Retrosternal Subglottic Stenosis of Unknown Origin

    PubMed Central

    Keijzers, Gerben; Willis, Nicola Jane; Smith, Linda

    2013-01-01

    Respiratory failure due to subglottic stenosis is a rare but serious condition. A 22-year-old male presented to the emergency department (ED) with shortness of breath, stridor, and change in tone of voice. The patient did not complain of B-symptoms (fever, weight loss, and night sweats). In the week before this presentation, he was diagnosed with an upper respiratory tract infection with associated bronchospasm and discharged on oral antibiotics and inhaled salbutamol without effect. He developed hypercapnic respiratory failure in the ED after a coughing episode. A normal nasopharyngoscopic examination and a subtle mediastinal abnormality on chest radiograph lead to a working diagnosis of retrosternal subglottic obstruction. The complexities of his airway management and suggestions for multidisciplinary approach are discussed. PMID:23956890

  1. The Relation of Respiratory Muscle Strength to Disease Severity and Abnormal Ventilation During Exercise in Chronic Heart Failure Patients

    PubMed Central

    Kasahara, Yusuke; Izawa, Kazuhiro P.; Watanabe, Satoshi; Osada, Naohiko; Omiya, Kazuto

    2015-01-01

    Background: Breathlessness is a common problem in chronic heart failure (CHF) patients, and respiratory muscle strength has been proposed to play an important role in causing breathlessness in these patients. Objectives: The aim of this study was to investigate the relation between respiratory muscle strength and the severity of CHF, and the influence of respiratory muscle strength on abnormal ventilation during exercise in CHF patients. Patients and Methods: In this case series study, we assessed clinically stable CHF outpatients (N = 66, age: 57.7 ± 14.6 years). The peak oxygen consumption (peak VO2), the slope relating minute ventilation to carbon dioxide production (VE/VCO2 slope), and the slope relating tidal volume to respiratory rate (TV/RR slope) were measured during cardiopulmonary exercise testing. Respiratory muscle strength was assessed by measuring the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). Results: The MIP and MEP decreased significantly as the New York Heart Association functional class increased (MIP, P = 0.021; MEP, P < 0.01). The MIP correlated with the TV/RR slope (r = 0.57, P < 0.001) and the VE/VCO2 slope (r = -0.44, P < 0.001), and the MEP also correlated with the TV/RR slope (r = 0.53, P < 0.001) and the VE/VCO2 slope (r = -0.25, P < 0.040). Stepwise multiple regression analysis revealed that age and MIP were statistically significant predictors of the TV/RR and VE/VCO2 slopes (both P < 0.05). Conclusions: Respiratory muscle strength is related to the severity of CHF, and associated with rapid and shallow ventilation or excessive ventilation during exercise. PMID:26528451

  2. Causes of growth failure in growth failure in a model of neonatal zinc (Zn) deficiency

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Zn deficiency is a common cause of growth failure in children in developing countrie,s and Zn supplementation can significantly improve growth of at-risk populations. Although Zn deficiency leads to anorexia and poor growth, it is unclear whether anorexia is the sole cause of poor growth. Our object...

  3. Nitrogen mustard hydrochloride-induced acute respiratory failure and myelosuppression: A case report

    PubMed Central

    ZHANG, XIAOJUAN; ZHANG, ZHIDAN; CHEN, SONG; ZHAO, DONGMEI; ZHANG, FANGXIAO; HU, ZIWEI; XIAO, FENG; MA, XIAOCHUN

    2015-01-01

    Nitrogen mustards are chemical agents that are similar to sulfur mustards, with similar toxicities. The present study describes a case of nitrogen mustard-induced acute respiratory failure and myelosuppression in a 33-year-old man. The patient, who was accidentally exposed to nitrogen mustard hydrochloride in a pharmaceutical factory, exhibited severe inhalation injury and respiratory symptoms. Laboratory tests revealed reduced white blood cell counts and lowered platelet levels during the first 6 days after the skin exposure to nitrogen mustard. Following treatment with mechanical ventilation, immunity-enhancing agents and nutritional supplements for 1 month, the patient successfully recovered and was released from hospital. PMID:26622480

  4. FAILURE OF GPS FUNCTIONING CAUSED BY EXTREME SOLAR RADIO EVENTS

    E-print Network

    FAILURE OF GPS FUNCTIONING CAUSED BY EXTREME SOLAR RADIO EVENTS E. L. Afraimovich1 , V. V. Demyanov of the Global Positioning System (GPS) during the 2006 Decem- ber 6 and 2006 December 13 solar flares (soft X at Learrmonth, the level of solar radio noise during the 6 December and 13 December events in the GPS frequency

  5. Periodic Breathing in Heart Failure Explained by Dynamic and Static Properties of Respiratory Control

    PubMed Central

    Miyamoto, Tadayoshi; Nakahara, Hidehiro; Ueda, Shinya; Manabe, Kou; Kawai, Eriko; Inagaki, Masashi; Kawada, Toru; Sugimachi, Masaru

    2015-01-01

    OBJECTIVE The respiratory operating point is determined by the interplay between the controller and plant subsystem elements within the respiratory chemoreflex feedback system. This study aimed to establish the methodological basis for quantitative analysis of the open-loop dynamic properties of the human respiratory control system and to apply the results to explore detailed mechanisms of the regulation of respiration and the possible mechanism of periodic breathing in chronic heart failure. METHODS AND RESULTS In healthy volunteers, we measured arterial CO2 partial pressure (PaCO2) and minute ventilation (V?E) to estimate the dynamic properties of the controller ( PaCO2?V?E relation) and plant ( V?E?PaCO2 relation). The dynamic properties of the controller and plant approximated first- and second-order exponential models, respectively, and were described using parameters including gain, time constant, and lag time. We then used the open-loop transfer functions to simulate the closed-loop respiratory response to an exogenous disturbance, while manipulating the parameter values to deviate from normal values but within physiological ranges. By increasing both the product of gains of the two subsystem elements (total loop gain) and the lag time, the condition of system oscillation (onset of periodic breathing) was satisfied. CONCLUSION When abnormality occurs in a part of the respiratory chemoreflex system, instability of the control system is amplified and may result in the manifestation of respiratory abnormalities such as periodic breathing. PMID:26561001

  6. Computational problems with the binomial failure rate model and incomplete common cause failure reliability data

    NASA Astrophysics Data System (ADS)

    Kvam, P. H.

    1993-09-01

    In estimating the reliability of a system of components, it is ordinarily assumed that the component lifetimes are independently distributed. This assumption usually alleviates the difficulty of analyzing complex systems, but it is seldom true that the failure of one component in an interactive system has no effect on the lifetimes of the other components. Often, two or more components will fail simultaneously due to a common cause event. Such an incident is called a common cause failure (CCF) and is now recognized as an important contribution to system failure in various applications of reliability. We examine current methods for reliability estimation of system and component lifetimes using estimators derived from the binomial failure rate model. Computational problems require a new approach, like iterative solutions via the EM algorithm.

  7. Breathing Pattern Characterization in Chronic Heart Failure Patients Using the Respiratory Flow Signal

    PubMed Central

    Garde, A.; Sörnmo, L.; Jané, R.

    2010-01-01

    This study proposes a method for the characterization of respiratory patterns in chronic heart failure (CHF) patients with periodic breathing (PB) and nonperiodic breathing (nPB), using the flow signal. Autoregressive modeling of the envelope of the respiratory flow signal is the starting point for the pattern characterization. Spectral parameters extracted from the discriminant frequency band (DB) are used to characterize the respiratory patterns. For each classification problem, the most discriminant parameter subset is selected using the leave-one-out cross-validation technique. The power in the right DB provides an accuracy of 84.6% when classifying PB vs. nPB patterns in CHF patients, whereas the power of the DB provides an accuracy of 85.5% when classifying the whole group of CHF patients vs. healthy subjects, and 85.2% when classifying nPB patients vs. healthy subjects. PMID:20614249

  8. Veno-venous extracorporeal membrane oxygenation in a patient with severe acute respiratory failure – case report

    PubMed Central

    Dec, Pawe? ?ukasz; Lesi?ska, Anna Justyna; Boche?ska, Anna; Wasilewski, Piotr; Feldyk, Grzegorz; Kubisa, Anna; Pieróg, Jaros?aw; Bielewicz, Micha?; Grodzki, Tomasz

    2015-01-01

    Acute respiratory failure resistant to conventional pulmonary therapy often requires intensive medical care. In rare cases, ventilator therapy proves insufficient, and only the option of employing veno-venous extracorporeal membrane oxygenation (ECMO V-V) remains. The present article describes the case of a 23-year-old patient who experienced severe acute respiratory distress syndrome with associated multiple organ failure. The patient was admitted to the pulmonary ward of the Alfred Soko?owski Regional Pulmonary Hospital in Szczecin-Zdunowo with suspected pneumonia of unknown etiology. After the initial 5 days of diagnostics at the pulmonary ward, the patient required a further 97 days of hospital treatment and spent 63 days at the Intensive Care Unit. There, he underwent ECMO V-V therapy lasting 22 days, which resulted in the improvement of his arterial blood gas parameters and clinical condition. PMID:26336483

  9. Postextubation laryngeal edema and stridor resulting in respiratory failure in critically ill adult patients: updated review.

    PubMed

    Pluijms, Wouter A; van Mook, Walther Nka; Wittekamp, Bastiaan Hj; Bergmans, Dennis Cjj

    2015-01-01

    Endotracheal intubation is frequently complicated by laryngeal edema, which may present as postextubation stridor or respiratory difficulty or both. Ultimately, postextubation laryngeal edema may result in respiratory failure with subsequent reintubation. Risk factors for postextubation laryngeal edema include female gender, large tube size, and prolonged intubation. Although patients at low risk for postextubation respiratory insufficiency due to laryngeal edema can be identified by the cuff leak test or laryngeal ultrasound, no reliable test for the identification of high-risk patients is currently available. If applied in a timely manner, intravenous or nebulized corticosteroids can prevent postextubation laryngeal edema; however, the inability to identify high-risk patients prevents the targeted pretreatment of these patients. Therefore, the decision to start corticosteroids should be made on an individual basis and on the basis of the outcome of the cuff leak test and additional risk factors. The preferential treatment of postextubation laryngeal edema consists of intravenous or nebulized corticosteroids combined with nebulized epinephrine, although no data on the optimal treatment algorithm are available. In the presence of respiratory failure, reintubation should be performed without delay. Application of noninvasive ventilation or inhalation of a helium/oxygen mixture is not indicated since it does not improve outcome and increases the delay to intubation. PMID:26395175

  10. Reversal of Mitochondrial Transhydrogenase Causes Oxidative Stress in Heart Failure.

    PubMed

    Nickel, Alexander G; von Hardenberg, Albrecht; Hohl, Mathias; Löffler, Joachim R; Kohlhaas, Michael; Becker, Janne; Reil, Jan-Christian; Kazakov, Andrey; Bonnekoh, Julia; Stadelmaier, Moritz; Puhl, Sarah-Lena; Wagner, Michael; Bogeski, Ivan; Cortassa, Sonia; Kappl, Reinhard; Pasieka, Bastian; Lafontaine, Michael; Lancaster, C Roy D; Blacker, Thomas S; Hall, Andrew R; Duchen, Michael R; Kästner, Lars; Lipp, Peter; Zeller, Tanja; Müller, Christian; Knopp, Andreas; Laufs, Ulrich; Böhm, Michael; Hoth, Markus; Maack, Christoph

    2015-09-01

    Mitochondrial reactive oxygen species (ROS) play a central role in most aging-related diseases. ROS are produced at the respiratory chain that demands NADH for electron transport and are eliminated by enzymes that require NADPH. The nicotinamide nucleotide transhydrogenase (Nnt) is considered a key antioxidative enzyme based on its ability to regenerate NADPH from NADH. Here, we show that pathological metabolic demand reverses the direction of the Nnt, consuming NADPH to support NADH and ATP production, but at the cost of NADPH-linked antioxidative capacity. In heart, reverse-mode Nnt is the dominant source for ROS during pressure overload. Due to a mutation of the Nnt gene, the inbred mouse strain C57BL/6J is protected from oxidative stress, heart failure, and death, making its use in cardiovascular research problematic. Targeting Nnt-mediated ROS with the tetrapeptide SS-31 rescued mortality in pressure overload-induced heart failure and could therefore have therapeutic potential in patients with this syndrome. PMID:26256392

  11. REPRESENTING COMMON-CAUSE FAILURES IN THE SAPHIRE SOFTWARE

    SciTech Connect

    Curtis L. Smith

    2008-11-01

    Currently, the risk analysis software SAPHIRE has implemented a common-cause failure (CCF) module to represent standard CCF methods such as alpha-factor and multiple Greek letter approaches. However, changes to SAPHIRE are required to support the Nuclear Regulatory Commission’s 2007 “Risk Assessment Standardization Project” CCF analysis guidance for events assessment. This guidance provides an outline of how both the nominal CCF probabilities and conditional (e.g., after a redundant component has failed) CCF probabilities should be calculated. Based upon user-provided input and extending the limitations in the current version of SAPHIRE, the CCF module calculations will be made consistent with the new guidance. The CCF modifications will involve changes to (1) the SAPHIRE graphical user interface directing how end-users and modelers interface with PRA models and (2) algorithmic changes as required. Included in the modifications will be the possibility to treat CCF probability adjustments based upon failure types (e.g., independent versus dependent) and failure modes (e.g., failure-to-run versus failure-to-start). In general, SAPHIRE is being modified to allow the risk analyst to define a CCF object. This object is defined in terms of a basic event. For the CCF object, the analyst would need to specify a minimal set of information, including: - The number of redundant components - The failure criteria (how many component have to fail) - The CCF model type (alpha-factor, MGL, or beta-factor) - The parameters (e.g., the alpha-factors) associated with the model - Staggered or non-staggered testing assumption - Default level of detail (expanded, showing all of the specific failure combinations, or not) This paper will outline both the theory behind the probabilistic calculations and the resulting implementation in the SAPHIRE software.

  12. Middle East respiratory syndrome coronavirus (MERS-CoV) causes transient lower respiratory tract infection in rhesus macaques.

    PubMed

    de Wit, Emmie; Rasmussen, Angela L; Falzarano, Darryl; Bushmaker, Trenton; Feldmann, Friederike; Brining, Douglas L; Fischer, Elizabeth R; Martellaro, Cynthia; Okumura, Atsushi; Chang, Jean; Scott, Dana; Benecke, Arndt G; Katze, Michael G; Feldmann, Heinz; Munster, Vincent J

    2013-10-01

    In 2012, a novel betacoronavirus, designated Middle East respiratory syndrome coronavirus or MERS-CoV and associated with severe respiratory disease in humans, emerged in the Arabian Peninsula. To date, 108 human cases have been reported, including cases of human-to-human transmission. The availability of an animal disease model is essential for understanding pathogenesis and developing effective countermeasures. Upon a combination of intratracheal, ocular, oral, and intranasal inoculation with 7 × 10(6) 50% tissue culture infectious dose of the MERS-CoV isolate HCoV-EMC/2012, rhesus macaques developed a transient lower respiratory tract infection. Clinical signs, virus shedding, virus replication in respiratory tissues, gene expression, and cytokine and chemokine profiles peaked early in infection and decreased over time. MERS-CoV caused a multifocal, mild to marked interstitial pneumonia, with virus replication occurring mainly in alveolar pneumocytes. This tropism of MERS-CoV for the lower respiratory tract may explain the severity of the disease observed in humans and the, up to now, limited human-to-human transmission. PMID:24062443

  13. ISS Fiber Optic Failure Investigation Root Cause Report

    NASA Technical Reports Server (NTRS)

    Leidecker, Henning; Plante, Jeannette

    2000-01-01

    In August of 1999, Boeing Corporation (Boeing) engineers began investigating failures of optical fiber being used on International Space Station flight hardware. Catastrophic failures of the fiber were linked to a defect in the glass fiber. Following several meetings of Boeing and NASA engineers and managers, Boeing created and led an investigation team, which examined the reliability of the cable installed in the U.S. Lab. NASA Goddard Space Flight Center's Components Technologies and Radiation Effects Branch (GSFC) led a team investigating the root cause of the failures. Information was gathered from: regular telecons and other communications with the investigation team, investigative trips to the cable distributor's plant, the cable manufacturing plant and the fiber manufacturing plant (including a review of build records), destructive and non-destructive testing, and expertise supplied by scientists from Dupont, and Lucent-Bell Laboratories. Several theories were established early on which were not able to completely address the destructive physical analysis and experiential evidence. Lucent suggested hydrofluoric acid (HF) etching of the glass and successfully duplicated the "rocket engine" defect. Strength testing coupled with examination of the low strength break sites linked features in the polyimide coating with latent defect sites. The information provided below explains what was learned about the susceptibility of the pre-cabled fiber to failure when cabled as it was for Space Station and the nature of the latent defects.

  14. A rare aetiology of respiratory failure in a 10-year-old boy: inflammatory myofibroblastic tumour

    PubMed Central

    Khawaja, Ali; Maheshwari, Prem Kumar; Haque, Anwarul; Zubairi, Ali Bin Sarwar

    2013-01-01

    Primary neoplasms of the respiratory tract are rarely encountered in the paediatric population. Inflammatory myofibroblastic tumour (IMT) is a rare soft tissue mesenchymal tumour but a distinct disease entity accounting for less than 1% of all primary lung tumours. We report a case of a 10-year-old boy who presented with respiratory failure and left lung collapse. On flexible fiberoptic bronchoscopy, a pedunculated mass in the lower part of the trachea originating from the left main stem bronchus was identified. The patient subsequently underwent a left-sided pneumonectomy with complete resection of the mass. The histopathological analysis was consistent with IMT. Two years of follow-up and the patient remains well. PMID:24248314

  15. Acute Unilateral Vestibular Failure Does Not Cause Spatial Hemineglect

    PubMed Central

    Conrad, Julian; Habs, Maximilian; Brandt, Thomas; Dieterich, Marianne

    2015-01-01

    Objectives Visuo-spatial neglect and vestibular disorders have common clinical findings and involve the same cortical areas. We questioned (1) whether visuo-spatial hemineglect is not only a disorder of spatial attention but may also reflect a disorder of higher cortical vestibular function and (2) whether a vestibular tone imbalance due to an acute peripheral dysfunction can also cause symptoms of neglect or extinction. Therefore, patients with an acute unilateral peripheral vestibular failure (VF) were tested for symptoms of hemineglect. Methods Twenty-eight patients with acute VF were assessed for signs of vestibular deficits and spatial neglect using clinical measures and various common standardized paper-pencil tests. Neglect severity was evaluated further with the Center of Cancellation method. Pathological neglect test scores were correlated with the degree of vestibular dysfunction determined by the subjective visual vertical and caloric testing. Results Three patients showed isolated pathological scores in one or the other neglect test, either ipsilesionally or contralesionally to the VF. None of the patients fulfilled the diagnostic criteria of spatial hemineglect or extinction. Conclusions A vestibular tone imbalance due to unilateral failure of the vestibular endorgan does not cause spatial hemineglect, but evidence indicates it causes mild attentional deficits in both visual hemifields. PMID:26247469

  16. Exogenous surfactant application in respiratory failure due to chronic obstructive pulmonary disease.

    PubMed

    Wirtz, H; Habscheid, W; Ertl, G; Schmidt, M; Kochsiek, K

    1995-01-01

    Recent results of basic research on regulation of surfactant secretion and surfactant physiology not only in the alveolus but also in peripheral small airways allow the conclusion that disorders in surfactant homeostasis may contribute to the pathophysiology of airway obstruction and hyperinflation. We therefore hypothesized that patients with respiratory failure due to obstructive lung disease may benefit from exogenous surfactant. Here we report a case that indicates the clinical situation to be considered for treatment with exogenous surfactant. The benefit for the patient was successful weaning from the ventilator. Improvements in effective compliance, resistance and blood gas parameters were observed following surfactant application. PMID:7569338

  17. Urgent awake thoracoscopic treatment of retained haemothorax associated with respiratory failure

    PubMed Central

    Cristino, Benedetto; Rogliani, Paola; Dauri, Mario

    2015-01-01

    A number of video-assisted thoracoscopic surgery (VATS) procedures are being increasingly performed by awake anesthesia in an attempt of minimizing the surgical- and anesthesia-related traumas. However, so far the usefulness of awake VATS for urgent management of retained haemothorax has been scarcely investigated. Herein we present two patients with retained haemothorax following previous thoracentesis and blunt chest trauma, respectively, who developed acute respiratory failure and underwent successful urgent awake VATS management under local anesthesia through a single trocar access. PMID:26046053

  18. Pulmonary fibrosis secondary to siderosis causing symptomatic respiratory disease: a case report

    E-print Network

    McCormick, Liam M; Goddard, Martin; Mahadeva, Ravi

    2008-08-05

    Reports Open AcceCase report Pulmonary fibrosis secondary to siderosis causing symptomatic respiratory disease: a case report Liam M McCormick*1, Martin Goddard2 and Ravi Mahadeva1 Address: 1Department of Respiratory Medicine, Addenbrooke's NHS Trust... to the inhalation of iron compounds is a rare condition which was first described in 1936 [1]. Despite striking radiological and histopatho- logical features, it has traditionally been classified as a 'benign pneumoconiosis' [2] because of the absence of associated...

  19. [Lateral Approach Tracheal Intubation in a Semi-sitting Position Utilizing a Videolaryngoscope in a Patient with Respiratory Failure due to Septic Shock].

    PubMed

    Fujiwara, Atsushi; Komasawa, Nobuyasu; Nishihara, Isao; Minami, Toshiaki

    2015-05-01

    Here we report our success in performing lateral approach tracheal intubation in a patient with severe respiratory failure due to septic shock caused by shoulder joint abscess. A 71-year-old woman presented with severe respiratory difficulty due to sepsis from a shoulder joint abscess and was scheduled for emergent drainage and irrigation. She could not breathe sufficiently in the supine position and thus maintained a semi-sitting position. She was also unable to move from the ward bed to the operating table due to severe shoulder pain. We induced anesthesia in a semi-sitting position in the ward bed. Mask ventilation was performed using the two-hand technique from the lateral approach. Tracheal intubation was also performed with a left lateral approach utilizing the Pentax-AWS Airwayscope (AWS). Lateral approach for tracheal intubation utilizing AWS may be useful in patients who present with severe respiratory difficulty. PMID:26422963

  20. [Non-invasive positive pressure mechanical ventilation in acute respiratory failure].

    PubMed

    Scala, R

    2000-10-01

    Known for two centuries, positive pressure non invasive mechanical ventilation (VMNPP) has been widely applied in acute respiratory failure (IRA) only in the last ten years. The fact that VMNPP is able to improve gas exchange by avoiding endotracheal intubation and its complications is the most attractive aspect in both general and respiratory intensive care units and in the respiratory ward. Characteristics of VMNPP (interface, ventilator and modality of ventilation), the side where it is performed as well as severity of IRA, underlying disease, and the team's experience are important factors which influence outcome. The addition of VMNPP to conventional medical therapy reduces the need for IE, mortality and hospitalisation in a selected population of BPCO patients in IRA. As there are no available data for comparison between invasive mechanical ventilation (VMI) and VMNPP, the latter has not to be considered as an alternative to VMI but able to prevent it and, even if VMNPP fails, it may be used as a weaning technique. In IRA due to other than BPCO diseases VMNPP seems not to be more effective than standard treatment in avoiding IE but it may give efficient support with fewer complications as compared to VMI. Acute cardiogenic pulmonary edema and "terminal" diseases represent some of the most interesting application fields of VMNPP in non-BPCO patients. According to the latest literature data, in this review history, technique, advantages, limits, indications, nursing and cost of VMNPP are examined. PMID:11194980

  1. 20 CFR 404.454 - Good cause for failure to make required reports.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Good cause for failure to make required... Good cause for failure to make required reports. (a) General. The failure of an individual to make a... timely report was due to good cause. Before making any penalty determination as described in §§...

  2. 20 CFR 404.454 - Good cause for failure to make required reports.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...2010-04-01 2010-04-01 false Good cause for failure to make required reports...Nonpayments of Benefits § 404.454 Good cause for failure to make required reports...failure to file a timely report was due to good cause. Before making any penalty...

  3. 20 CFR 404.454 - Good cause for failure to make required reports.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...2011-04-01 2011-04-01 false Good cause for failure to make required reports...Nonpayments of Benefits § 404.454 Good cause for failure to make required reports...failure to file a timely report was due to good cause. Before making any penalty...

  4. Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review.

    PubMed

    Fitzgerald, Marianne; Millar, Jonathan; Blackwood, Bronagh; Davies, Andrew; Brett, Stephen J; McAuley, Daniel F; McNamee, James J

    2014-01-01

    Acute respiratory distress syndrome (ARDS) continues to have significant mortality and morbidity. The only intervention proven to reduce mortality is the use of lung-protective mechanical ventilation strategies, although such a strategy may lead to problematic hypercapnia. Extracorporeal carbon dioxide removal (ECCO?R) devices allow uncoupling of ventilation from oxygenation, thereby removing carbon dioxide and facilitating lower tidal volume ventilation. We performed a systematic review to assess efficacy, complication rates, and utility of ECCO?R devices. We included randomised controlled trials (RCTs), case-control studies and case series with 10 or more patients. We searched MEDLINE, Embase, LILACS (Literatura Latino Americana em Ciências da Saúde), and ISI Web of Science, in addition to grey literature and clinical trials registries. Data were independently extracted by two reviewers against predefined criteria and agreement was reached by consensus. Outcomes of interest included mortality, intensive care and hospital lengths of stay, respiratory parameters and complications. The review included 14 studies with 495 patients (two RCTs and 12 observational studies). Arteriovenous ECCO?R was used in seven studies, and venovenous ECCO?R in seven studies. Available evidence suggests no mortality benefit to ECCO?R, although post hoc analysis of data from the most recent RCT showed an improvement in ventilator-free days in more severe ARDS. Organ failure-free days or ICU stay have not been shown to decrease with ECCOvR. Carbon dioxide removal was widely demonstrated as feasible, facilitating the use of lower tidal volume ventilation. Complication rates varied greatly across the included studies, representing technological advances. There was a general paucity of high-quality data and significant variation in both practice and technology used among studies, which confounded analysis. ECCO?R is a rapidly evolving technology and is an efficacious treatment to enable protective lung ventilation. Evidence for a positive effect on mortality and other important clinical outcomes is lacking. Rapid technological advances have led to major changes in these devices and together with variation in study design have limited applicability of analysis. Further well-designed adequately powered RCTs are needed. PMID:25033302

  5. Fatal neonatal respiratory failure in an infant with congenital hypothyroidism due to haploinsufficiency of the NKX2-1 gene: alteration of pulmonary surfactant homeostasis.

    PubMed

    Kleinlein, Barbara; Griese, Matthias; Liebisch, Gerhard; Krude, Heiko; Lohse, Peter; Aslanidis, Charalampos; Schmitz, Gerd; Peters, Jochen; Holzinger, Andreas

    2011-11-01

    Defects of the NKX2-1 gene, encoding thyroid transcription factor-1, cause brain-thyroid-lung syndrome (MIM 610978), characterised by benign hereditary chorea, congenital hypothyroidism and respiratory disease. The case of a term infant with mild primary congenital hypothyroidism and neonatal persistent respiratory failure with fatal outcome at 10 months of age despite continuous ventilatory support is described. Congenital defects of genes known to disturb surfactant protein and lipid homeostasis (SFTPB, SFTPC, ABCA3) were excluded. Hypothyroidism prompted sequencing of NKX2-1, which revealed a heterozygous 29 bp deletion (c.278_306del29) disrupting the affected allele. Analysis of bronchoalveolar lavage fluid demonstrated an abnormally low amount of surfactant protein C (SP-C) in relation to SP-B, and low levels of surfactant phospholipids, indicating disturbance of SP and lipid homeostasis as a consequence of NKX2-1 haploinsufficiency. NKX2-1 haploinsufficiency may lead to lethal respiratory failure of the newborn due to disruption of pulmonary surfactant homeostasis. NKX2-1 gene analysis should be considered when investigating irreversible respiratory insufficiency of the newborn. PMID:20584796

  6. Targeted inactivation of the murine Abca3 gene leads to respiratory failure in newborns with defective lamellar bodies

    SciTech Connect

    Hammel, Markus; Michel, Geert; Hoefer, Christina; Klaften, Matthias; Mueller-Hoecker, Josef; Angelis, Martin Hrabe de; Holzinger, Andreas . E-mail: andreas.holzinger@med.uni-muenchen.de

    2007-08-10

    Mutations in the human ABCA3 gene, encoding an ABC-transporter, are associated with respiratory failure in newborns and pediatric interstitial lung disease. In order to study disease mechanisms, a transgenic mouse model with a disrupted Abca3 gene was generated by targeting embryonic stem cells. While heterozygous animals developed normally and were fertile, individuals homozygous for the altered allele (Abca3-/-) died within one hour after birth from respiratory failure, ABCA3 protein being undetectable. Abca3-/- newborns showed atelectasis of the lung in comparison to a normal gas content in unaffected or heterozygous littermates. Electron microscopy demonstrated the absence of normal lamellar bodies in type II pneumocytes. Instead, condensed structures with apparent absence of lipid content were found. We conclude that ABCA3 is required for the formation of lamellar bodies and lung surfactant function. The phenotype of respiratory failure immediately after birth corresponds to the clinical course of severe ABCA3 mutations in human newborns.

  7. A step-by-step diagnosis of exclusion in a twin pregnancy with acute respiratory failure due to non-fatal amniotic fluid embolism: a case report

    PubMed Central

    Papaioannou, Vasilios E; Dragoumanis, Christos; Theodorou, Vassiliki; Konstantonis, Dimitrios; Pneumatikos, Ioannis

    2008-01-01

    Introduction Respiratory failure may develop during the later stages of pregnancy and is usually associated with tocolysis or other co-existing conditions such as pneumonia, sepsis, pre-eclampsia or amniotic fluid embolism syndrome. Case presentation We present the case of a 34-year-old healthy woman with a twin pregnancy at 31 weeks and 6 days who experienced acute respiratory failure, a few hours after administration of tocolysis (ritodrine), due to preterm premature rupture of the membranes. Her chest discomfort was significantly ameliorated after the ritodrine infusion was stopped and a Cesarean section was performed 48 hours later under spinal anesthesia; however, 2 hours after surgery she developed severe hypoxemia, hypotension, fever and mild coagulopathy. The patient was intubated and transferred to the intensive care unit where she made a quick and uneventful recovery within 3 days. As there was no evidence for drug- or infection-related thromboembolic or myocardial causes of respiratory failure, we conclude that our patient experienced a rare type of non-fatal amniotic fluid embolism. Conclusion In spite of the lack of solid scientific support for our diagnosis, we conclude that our patient suffered an uncommon type of amniotic fluid embolism syndrome and we believe that this report highlights the need for extreme vigilance and a high index of suspicion for such a diagnosis in any pregnant individual. PMID:18505548

  8. [Role of biomarkers in the differential diagnosis of acute respiratory failure in the immediate postoperative period of lung transplantation].

    PubMed

    Ruano, L; Sacanell, J; Roman, A; Rello, J

    2013-01-01

    Lung transplant recipients are at high risk of suffering many complications during the immediate postoperative period, such as primary graft dysfunction, acute graft rejection or infection. The most common symptom is the presence of acute respiratory failure, and the use of biomarkers could be useful for establishing an early diagnosis of these conditions. Different biomarkers have been studied, but none have proven to be the gold standard in the differential diagnosis of acute respiratory failure. This paper offers a review of the different biomarkers that have been studied in this field. PMID:23462428

  9. Acute Liver Failure Caused by Amanita phalloides Poisoning

    PubMed Central

    Santi, Luca; Maggioli, Caterina; Mastroroberto, Marianna; Tufoni, Manuel; Napoli, Lucia; Caraceni, Paolo

    2012-01-01

    Mushroom poisoning is a relatively rare cause of acute liver failure (ALF). The present paper analyzes the pathogenesis, clinical features, prognostic indicators, and therapeutic strategies of ALF secondary to ingestion of Amanita phalloides, which represents the most common and deadly cause of mushroom poisoning. Liver damage from Amanita phalloides is related to the amanitins, powerful toxins that inhibit RNA polymerase II resulting in a deficient protein synthesis and cell necrosis. After an asymptomatic lag phase, the clinical picture is characterized by gastrointestinal symptoms, followed by the liver and kidney involvement. Amatoxin poisoning may progress into ALF and eventually death if liver transplantation is not performed. The mortality rate after Amanita phalloides poisoning ranges from 10 to 20%. The management of amatoxin poisoning consists of preliminary medical care, supportive measures, detoxification therapies, and orthotopic liver transplantation. The clinical efficacy of any modality of treatment is difficult to demonstrate since randomized, controlled clinical trials have not been reported. The use of extracorporeal liver assist devices as well as auxiliary liver transplantation may represent additional therapeutic options. PMID:22811920

  10. Acute Liver Failure Caused by Amanita phalloides Poisoning.

    PubMed

    Santi, Luca; Maggioli, Caterina; Mastroroberto, Marianna; Tufoni, Manuel; Napoli, Lucia; Caraceni, Paolo

    2012-01-01

    Mushroom poisoning is a relatively rare cause of acute liver failure (ALF). The present paper analyzes the pathogenesis, clinical features, prognostic indicators, and therapeutic strategies of ALF secondary to ingestion of Amanita phalloides, which represents the most common and deadly cause of mushroom poisoning. Liver damage from Amanita phalloides is related to the amanitins, powerful toxins that inhibit RNA polymerase II resulting in a deficient protein synthesis and cell necrosis. After an asymptomatic lag phase, the clinical picture is characterized by gastrointestinal symptoms, followed by the liver and kidney involvement. Amatoxin poisoning may progress into ALF and eventually death if liver transplantation is not performed. The mortality rate after Amanita phalloides poisoning ranges from 10 to 20%. The management of amatoxin poisoning consists of preliminary medical care, supportive measures, detoxification therapies, and orthotopic liver transplantation. The clinical efficacy of any modality of treatment is difficult to demonstrate since randomized, controlled clinical trials have not been reported. The use of extracorporeal liver assist devices as well as auxiliary liver transplantation may represent additional therapeutic options. PMID:22811920

  11. CSB-PGBD3 Mutations Cause Premature Ovarian Failure

    PubMed Central

    Li, Guangyu; Tang, Tie-Shan; Zhao, Shidou; Jiao, Xue; Gong, Juanjuan; Gao, Fei; Guo, Caixia; Simpson, Joe Leigh; Chen, Zi-Jiang

    2015-01-01

    Premature ovarian failure (POF) is a rare, heterogeneous disorder characterized by cessation of menstruation occurring before the age of 40 years. Genetic etiology is responsible for perhaps 25% of cases, but most cases are sporadic and unexplained. In this study, through whole exome sequencing in a non-consanguineous family having four affected members with POF and Sanger sequencing in 432 sporadic cases, we identified three novel mutations in the fusion gene CSB-PGBD3. Subsequently functional studies suggest that mutated CSB-PGBD3 fusion protein was impaired in response to DNA damage, as indicated by delayed or absent recruitment to damaged sites. Our data provide the first evidence that mutations in the CSB-PGBD3 fusion protein can cause human disease, even in the presence of functional CSB, thus potentially explaining conservation of the fusion protein for 43 My since marmoset. The localization of the CSB-PGBD3 fusion protein to UVA-induced nuclear DNA repair foci further suggests that the CSB-PGBD3 fusion protein, like many other proteins that can cause POF, modulates or participates in DNA repair. PMID:26218421

  12. Respiratory failure, cleft palate and epilepsy in the mouse model of human Xq22.1 deletion syndrome

    PubMed Central

    Zhou, Jian; Goldberg, Ethan M.; Leu, N. Adrian; Zhou, Lei; Coulter, Douglas A.; Wang, P. Jeremy

    2014-01-01

    Chromosomal segmental deletion is a frequent cause of human diseases. A familial 1.1 Mb deletion of human chromosome Xq22.1 associates with epilepsy, cleft palate and developmental defects in heterozygous female patients. Here, we describe a mouse mutant with a targeted deletion of the syntenic segment of the mouse X chromosome that phenocopies the human syndrome. Male mice with a deletion of a 1.1 Mb Nxf2–Nxf3 X-chromosomal segment exhibit respiratory failure, neonatal lethality and cleft palate. In female mice, heterozygosity for the deletion manifests cleft palate, early postnatal lethality, postnatal growth delay and spontaneous seizures in surviving animals, apparently due to X-chromosome inactivation. Furthermore, loss of a 0.35 Mb subregion containing Armcx5, Gprasp1, Gprasp2 and Bhlhb9 is sufficient to cause the Xq22.1 syndrome phenotype. Our results support that the 1.1 Mb deletion of human Xq22.1 is the genetic cause of the associated syndrome. PMID:24569167

  13. Cheyne-Stokes respiration in patients with heart failure: prevalence, causes, consequences and treatments.

    PubMed

    Brack, Thomas; Randerath, Winfried; Bloch, Konrad E

    2012-01-01

    Cheyne-Stokes respiration (CSR) is characterized by a pattern of cyclic oscillations of tidal volume and respiratory rate with periods of hyperpnea alternating with hypopnea or apnea in patients with heart failure. CSR harms the failing heart through intermittent hypoxia brought about by apnea and hypopnea and recurrent sympathetic surges. CSR impairs the quality of life and increases cardiac mortality in patients with heart failure. Thus, CSR should actively be pursued in patients with severe heart failure. When CSR persists despite optimal therapy of heart failure, noninvasive adaptive servoventilation is currently the most promising treatment. PMID:22025128

  14. WORLD TRADE CENTER FINE PARTICULATE MATTER CAUSES RESPIRATORY TRACT HYPERRESPONSIVENESS IN MICE

    EPA Science Inventory

    World Trade Center Fine Particulate Matter Causes Respiratory Tract Hyperresponsiveness in Mice

    Stephen H. Gavett1, Najwa Haykal-Coates1, Jerry W. Highfill1, Allen D. Ledbetter1, Lung Chi Chen2, Mitchell D. Cohen2, Jack R. Harkema3, James G. Wagner3, and Daniel L. Costa1.<...

  15. Osteomalacia, severe thoracic deformities and respiratory failure in a young woman with anorexia nervosa.

    PubMed

    Watanabe, Daisuke; Hotta, Mari; Ichihara, Atsuhiro

    2015-01-01

    The recent trends in avoiding sunbathing and eating fewer fish products have resulted in a high prevalence of vitamin D deficiency in the general Japanese population. We herein report the case of a young woman with enduring anorexia nervosa (AN) who suffered from osteomalacia, thoracic deformities and respiratory failure. Her vitamin D deficiency had been overlooked for years. Although the serum 25-hyroxyvitamin D [25(OH)D] level is a marker of vitamin D stores, it is not routinely examined because the cost is not covered by the national health insurance program. However, measuring the serum 25(OH)D levels in AN patients with hypocalcemia is recommended to prevent osteomalacia and osteoporosis. PMID:25876575

  16. Eventration of diaphragm with dextrocardia and type 2 respiratory failure: A rare entity

    PubMed Central

    Mir, Mohmad Hussain; Arshad, Faheem; Bagdadi, Farhana Siraj; Nasir, Syed Aejaz; Hajni, Mubashir Rashid

    2014-01-01

    Eventration of the diaphragm is a rare condition where the muscle is permanently elevated, but retains its continuity and attachments to costal margin. In this condition, all or part of the diaphragm is largely composed of fibrous tissue with a few or no interspersed muscle fibers. It can be complete or partial. It is seldom symptomatic and often requires no treatment. We present a 70-year-old male who came with progressive breathlessness and was admitted with type 2 respiratory failure, and on evaluation was found to have complete eventration of the left diaphragm with herniation of colon and stomach in the left chest with dextrocardia. Aim of reporting this rare case is to highlight the importance of history taking, good physical examination, and imaging in the diagnosis of diaphragmatic eventration. PMID:25298947

  17. Respiratory Failure in a Term Infant with Cis and Trans Mutations in ABCA3

    PubMed Central

    Jackson, Tara; Wegner, Daniel J.; White, Frances V.; Hamvas, Aaron; Cole, F. Sessions; Wambach, Jennifer A.

    2014-01-01

    A full-term female neonate presented with persistent respiratory failure and radiologic studies consistent with surfactant deficiency. Sequencing of the ATP-binding cassette transporter A3 gene (ABCA3) revealed 3 mutations: R280C, V1399M, and Q1589X. The infant underwent bilateral lung transplantation at 9 months of age and is alive at 3 years of age. Parental sequencing demonstrated that 2 of the mutations (R280C and Q1589X) were oriented on the same allele (cis) while V1399M was oriented on the opposite allele (trans). As more than one mutation in ABCA3 can be present on the same allele, parental studies are needed to determine allelic orientation to inform clinical decision making and future reproductive counseling. PMID:25712598

  18. 20 CFR 802.218 - Failure to file papers; order to show cause.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...2011-04-01 false Failure to file papers; order to show cause. 802.218 Section...Processing § 802.218 Failure to file papers; order to show cause. (a) Failure to file any paper when due pursuant to this part,...

  19. Use of functional independence measure in rehabilitation of inpatients with respiratory failure.

    PubMed

    Pasqua, Franco; Biscione, Gian Luca; Crigna, Girolmina; Gargano, Romana; Cardaci, Vittorio; Ferri, Luigi; Cesario, Alfredo; Clini, Enrico

    2009-03-01

    Most outcomes do not deeply express the degree of disability in patients with respiratory failure (RF) following inpatient pulmonary rehabilitation (IPR). The aim of our study was to evaluate the efficacy of an IPR in patients with confirmed COPD and RF using functional independence measure (FIM) that determines the degree of disability experienced by patients and the progress they make during rehabilitation. This scale includes several items: self care, mobility, locomotion, communication and social recognition. Twenty-two patients (age 70+/-2 years, PO(2) 58.18+/-7.63mmHg, PCO(2) 46.82+/-9.11mmHg) were prospectively observed and studied. IPR included respiratory and peripheral muscle training, mucus evacuation techniques, and energy conservation techniques. FIM, Medical Research Council dyspnoea scale (MRC), St. George's Respiratory Questionnaire (SGRQ), and 6-min walking distance (6-MWD) were assessed on admission (pre) and discharge (post) from IPR. After IPR there was a statistically significant improvement (p<0.01) in all the FIM items (total score in self care, mobility, locomotion, social recognition) except for communication. Changes of MRC (pre 4.32+/-0.84; post 3.00+/-1.15, p<0.001), SGRQ (%) (pre 69.86+/-4.62; post 46.50+/-11.94, p<0.001), and 6-MWD (pre 164.54+/-98.63; post 214.32+/-97.64, p<0.001) paralleled those improvements. An inverse correlation between MRC and FIM (r=-0.5042, p=0.016) was observed. Our preliminary study has shown that the benefits of IPR in COPD with RF do not only translate in dyspnoea, exercise capacity and quality of life but also within neuromotor disabilities as assessed by FIM. Our results warrant future studies in pulmonary rehabilitation using FIM as an outcome measure. PMID:18977645

  20. Acute Respiratory Failure in Critically Ill Patients with Interstitial Lung Disease

    PubMed Central

    Zafrani, Lara; Lemiale, Virginie; Lapidus, Nathanael; Lorillon, Gwenael; Schlemmer, Benoît; Azoulay, Elie

    2014-01-01

    Background Patients with chronic known or unknown interstitial lung disease (ILD) may present with severe respiratory flares that require intensive management. Outcome data in these patients are scarce. Patients and Methods Clinical and radiological features were collected in 83 patients with ILD-associated acute respiratory failure (ARF). Determinants of hospital mortality and response to corticosteroid therapy were identified by logistic regression. Results Hospital and 1-year mortality rates were 41% and 54% respectively. Pulmonary hypertension, computed tomography (CT) fibrosis and acute kidney injury were independently associated with mortality (odds ratio (OR) 4.55; 95% confidence interval (95%CI) (1.20–17.33); OR, 7.68; (1.78–33.22) and OR 10.60; (2.25–49.97) respectively). Response to steroids was higher in patients with shorter time from hospital admission to corticosteroid therapy. Patients with fibrosis on CT had lower response to steroids (OR, 0.03; (0.005–0.21)). In mechanically ventilated patients, overdistension induced by high PEEP settings was associated with CT fibrosis and hospital mortality. Conclusion Mortality is high in ILD-associated ARF. CT and echocardiography are valuable prognostic tools. Prompt corticosteroid therapy may improve survival. PMID:25115557

  1. [Prognostic factors for COPD patients with chronic hypercapnic respiratory failure and home ventilation].

    PubMed

    Budweiser, S; Jörres, R A; Heinemann, F; Pfeifer, M

    2009-09-01

    The prevalence of patients with severe COPD and chronic hypercapnic respiratory failure (CHRF) receiving non-invasive home ventilation has greatly increased. With regard to disease severity, a multidimensional assessment seems indicated. Base excess (BE), in particular, reflects the long-term metabolic response to chronic hypercapnia and thus constitutes a promising, easily accessible, integrative marker of CHRF. Infact, BE as well as nutritional status and lung hyperinflation have been identified as independent predictors of long-term survival. In addition and in a review with the literature, a broad panel of indices including frequent comorbidities are helpful for assessment and monitoring purposes of patients with CHRF. Accordingly, in view of the patients' individual risk profile, the decision about the initiation of NIV should probably not rely solely on symptoms and chronic persistent hypercapnia but include a spectrum of factors that specifically reflect disease severity. Owing to the physiologically positive effects of NIV and according to retrospective data, patients with COPD and recurrent hypercapnic respiratory decompensation and patients with prolonged mechanical ventilation and/or difficult weaning could also be considered for long-term non-invasive ventilation. This, however, has to be corroborated in future prospective trials. PMID:19750411

  2. Respiratory failure presenting in H1N1 influenza with Legionnaires disease: two case reports

    PubMed Central

    2011-01-01

    Introduction Media sensationalism on the H1N1 outbreak may have influenced decisional processes and clinical diagnosis. Case Presentation We report two cases of patients who presented in 2009 with coexisting H1N1 virus and Legionella infections: a 69-year-old Caucasian man and a 71-year-old Caucasian woman. In our cases all the signs and symptoms, including vomiting, progressive respiratory disease leading to respiratory failure, refractory hypoxemia, leukopenia, lymphopenia, thrombocytopenia, and elevated levels of creatine kinase and hepatic aminotransferases, were consistent with critical illness due to 2009 H1N1 virus infection. Other infectious disorders may mimic H1N1 viral infection especially Legionnaires' disease. Because the swine flu H1N1 pandemic occurred in Autumn in Italy, Legionnaires disease was to be highly suspected since the peak incidence usually occurs in early fall. We do think that our immediate suspicion of Legionella infection based on clinical history and X-ray abnormalities was fundamental for a successful resolution. Conclusion Our two case reports suggest that patients with H1N1 should be screened for Legionella, which is not currently common practice. This is particularly important since the signs and symptoms of both infections are similar. PMID:22018019

  3. A new miniaturized system for extracorporeal membrane oxygenation in adult respiratory failure

    PubMed Central

    2009-01-01

    Introduction Mortality of severe acute respiratory distress syndrome in adults is still unacceptably high. Extracorporeal membrane oxygenation (ECMO) could represent an important treatment option, if complications were reduced by new technical developments. Methods Efficiency, side effects and outcome of treatment with a new miniaturized device for veno-venous extracorporeal gas transfer were analysed in 60 consecutive patients with life-threatening respiratory failure. Results A rapid increase of partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) from 64 (48 to 86) mmHg to 120 (84 to 171) mmHg and a decrease of PaCO2 from 63 (50 to 80) mmHg to 33 (29 to 39) mmHg were observed after start of the extracorporeal support (P < 0.001). Gas exchange capacity of the device averaged 155 (116 to 182) mL/min for oxygen and 210 (164 to 251) mL/min for carbon dioxide. Ventilatory parameters were reduced to a highly protective mode, allowing a fast reduction of tidal volume from 495 (401 to 570) mL to 336 (292 to 404) mL (P < 0.001) and of peak inspiratory pressure from 36 (32 to 40) cmH2O to 31 (28 to 35) cmH2O (P < 0.001). Transfusion requirements averaged 0.8 (0.4 to 1.8) units of red blood cells per day. Sixty-two percent of patients were weaned from the extracorporeal system, and 45% survived to discharge. Conclusions Veno-venous extracorporeal membrane oxygenation with a new miniaturized device supports gas transfer effectively, allows for highly protective ventilation and is very reliable. Modern ECMO technology extends treatment opportunities in severe lung failure. PMID:20017915

  4. Extracorporeal membrane oxygenation for pediatric respiratory failure: History, development and current status

    PubMed Central

    Maslach-Hubbard, Anna; Bratton, Susan L

    2013-01-01

    Extracorporeal membrane oxygenation (ECMO) is currently used to support patients of all ages with acute severe respiratory failure non-responsive to conventional treatments, and although initial use was almost exclusively in neonates, use for this age group is decreasing while use in older children remains stable (300-500 cases annually) and support for adults is increasing. Recent advances in technology include: refinement of double lumen veno-venous (VV) cannulas to support a large range of patient size, pumps with lower prime volumes, more efficient oxygenators, changes in circuit configuration to decrease turbulent flow and hemolysis. Veno-arterial (VA) mode of support remains the predominant type used; however, VV support has lower risk of central nervous injury and mortality. Key to successful survival is implementation of ECMO before irreversible organ injury develops, unless support with ECMO is used as a bridge to transplant. Among pediatric patients treated with ECMO mortality varies by pulmonary diagnosis, underlying condition, other non-pulmonary organ dysfunction as well as patient age, but has remained relatively unchanged overall (43%) over the past several decades. Additional risk factors associated with death include prolonged use of mechanical ventilation (> 2 wk) prior to ECMO, use of VA ECMO, older patient age, prolonged ECMO support as well as complications during ECMO. Medical evidence regarding daily patient management specifically related to ECMO is scant, it usually mirrors care recommended for similar patients treated without ECMO. Linkage of the Extracorporeal Life Support Organization dataset with other databases and collaborative research networks will be required to address this knowledge deficit as most centers treat only a few pediatric respiratory failure patients each year. PMID:24701414

  5. Association between prehospital vitamin D status and incident acute respiratory failure in critically ill patients: a retrospective cohort study

    PubMed Central

    Thickett, David R; Moromizato, Takuhiro; Litonjua, Augusto A; Amrein, Karin; Quraishi, Sadeq A; Lee-Sarwar, Kathleen A; Mogensen, Kris M; Purtle, Steven W; Gibbons, Fiona K; Camargo, Carlos A; Giovannucci, Edward; Christopher, Kenneth B

    2015-01-01

    Objective We hypothesise that low 25-hydroxyvitamin D (25(OH)D) levels before hospitalisation are associated with increased risk of acute respiratory failure. Design Retrospective cohort study. Setting Medical and Surgical Intensive care units of two Boston teaching hospitals. Patients 1985 critically ill adults admitted between 1998 and 2011. Interventions None. Measurements and main results The exposure of interest was prehospital serum 25(OH)D categorised as ?10?ng/mL, 11–19.9?ng/mL, 20–29.9?ng/mL and ?30?ng/mL. The primary outcome was acute respiratory failure excluding congestive heart failure determined by International Classification of Diseases Ninth Edition (ICD-9) coding and validated against the Berlin Definition of acute respiratory sistress syndrome. Association between 25(OH)D and acute respiratory failure was assessed using logistic regression, while adjusting for age, race, sex, Deyo-Charlson Index and patient type (medical vs surgical). In the cohort, the mean age was 63?years, 45% were male and 80% were white; 25(OH)D was ?10?ng/mL in 8% of patients, 11–19.9?ng/mL in 24%, 20–29.9?ng/mL in 24% and ?30?ng/mL in 44% of patients. Eighteen per cent (n=351) were diagnosed with acute respiratory failure. Compared to patients with 25(OH)D ?30?ng/mL, patients with lower 25(OH)D levels had significantly higher adjusted odds of acute respiratory failure (?10?ng/mL, OR=1.84 (95% CI 1.22 to 2.77); 11–19.9?ng/mL, OR=1.60 (95% CI 1.19 to 2.15); 20–29.9?ng/mL, OR=1.37 (95% CI 1.01 to 1.86)). Conclusions Prehospital 25(OH)D was associated with the risk of acute respiratory failure in our critically ill patient cohort. PMID:26113982

  6. Technical-Induced Hemolysis in Patients with Respiratory Failure Supported with Veno-Venous ECMO - Prevalence and Risk Factors.

    PubMed

    Lehle, Karla; Philipp, Alois; Zeman, Florian; Lunz, Dirk; Lubnow, Matthias; Wendel, Hans-Peter; Göbölös, Laszlo; Schmid, Christof; Müller, Thomas

    2015-01-01

    The aim of the study was to explore the prevalence and risk factors for technical-induced hemolysis in adults supported with veno-venous extracorporeal membrane oxygenation (vvECMO) and to analyze the effect of hemolytic episodes on outcome. This was a retrospective, single-center study that included 318 adult patients (Regensburg ECMO Registry, 2009-2014) with acute respiratory failure treated with different modern miniaturized ECMO systems. Free plasma hemoglobin (fHb) was used as indicator for hemolysis. Throughout a cumulative support duration of 4,142 days on ECMO only 1.7% of the fHb levels were above a critical value of 500 mg/l. A grave rise in fHb indicated pumphead thrombosis (n = 8), while acute oxygenator thrombosis (n = 15) did not affect fHb. Replacement of the pumphead normalized fHb within two days. Neither pump or cannula type nor duration on the first system was associated with hemolysis. Multiple trauma, need for kidney replacement therapy, increased daily red blood cell transfusion requirements, and high blood flow (3.0-4.5 L/min) through small-sized cannulas significantly resulted in augmented blood cell trauma. Survivors were characterized by lower peak levels of fHb [90 (60, 142) mg/l] in comparison to non-survivors [148 (91, 256) mg/l, p?0.001]. In conclusion, marked hemolysis is not common in vvECMO with modern devices. Clinically obvious hemolysis often is caused by pumphead thrombosis. High flow velocity through small cannulas may also cause technical-induced hemolysis. In patients who developed lung failure due to trauma, fHb was elevated independantly of ECMO. In our cohort, the occurance of hemolysis was associated with increased mortality. PMID:26606144

  7. Technical-Induced Hemolysis in Patients with Respiratory Failure Supported with Veno-Venous ECMO – Prevalence and Risk Factors

    PubMed Central

    Lehle, Karla; Philipp, Alois; Zeman, Florian; Lunz, Dirk; Lubnow, Matthias; Wendel, Hans-Peter; Göbölös, Laszlo; Schmid, Christof; Müller, Thomas

    2015-01-01

    The aim of the study was to explore the prevalence and risk factors for technical-induced hemolysis in adults supported with veno-venous extracorporeal membrane oxygenation (vvECMO) and to analyze the effect of hemolytic episodes on outcome. This was a retrospective, single-center study that included 318 adult patients (Regensburg ECMO Registry, 2009–2014) with acute respiratory failure treated with different modern miniaturized ECMO systems. Free plasma hemoglobin (fHb) was used as indicator for hemolysis. Throughout a cumulative support duration of 4,142 days on ECMO only 1.7% of the fHb levels were above a critical value of 500 mg/l. A grave rise in fHb indicated pumphead thrombosis (n = 8), while acute oxygenator thrombosis (n = 15) did not affect fHb. Replacement of the pumphead normalized fHb within two days. Neither pump or cannula type nor duration on the first system was associated with hemolysis. Multiple trauma, need for kidney replacement therapy, increased daily red blood cell transfusion requirements, and high blood flow (3.0–4.5 L/min) through small-sized cannulas significantly resulted in augmented blood cell trauma. Survivors were characterized by lower peak levels of fHb [90 (60, 142) mg/l] in comparison to non-survivors [148 (91, 256) mg/l, p?0.001]. In conclusion, marked hemolysis is not common in vvECMO with modern devices. Clinically obvious hemolysis often is caused by pumphead thrombosis. High flow velocity through small cannulas may also cause technical-induced hemolysis. In patients who developed lung failure due to trauma, fHb was elevated independantly of ECMO. In our cohort, the occurance of hemolysis was associated with increased mortality. PMID:26606144

  8. Some clinical features of liver cell failure: an appraisal of their causes.

    PubMed Central

    Read, A E

    1978-01-01

    The mechanisms underlying the cause of the major clinical features of liver cell failure are reviewed. These include jaundice, fluid retention, hepatic encephalopathy, bleeding tendency, etc. PMID:355067

  9. Dexamethasone for treatment of patients mechanically ventilated for lower respiratory tract infection caused by respiratory syncytial virus

    PubMed Central

    van Woensel, J B M; van Aalderen, W M C; de Weerd, W; Jansen, N; van Gestel, J P J; Markhorst, D; van Vught, A J; Bos, A; Kimpen, J

    2003-01-01

    Background: A study was undertaken to evaluate the efficacy of dexamethasone in patients mechanically ventilated for lower respiratory infection caused by respiratory syncytial virus (RSV-LRTI). Methods: In a multicentre randomised controlled trial patients were randomised to receive either intravenous dexamethasone (0.15 mg/kg 6 hourly for 48 hours) or placebo. End points were the duration of mechanical ventilation, length of stay (LOS) in the pediatric intensive care unit (PICU) and in hospital, and the duration of supplemental oxygen administration. Results: Thirty seven patients received dexamethasone and 45 received placebo. There was no significant difference in any of the end points between the two groups. In a post hoc analysis patients were stratified into those with mild gas exchange anomalies (PaO2/FiO2 >200 mm Hg and/or mean airway pressure ? 10 cm H2O, bronchiolitis group) and those with severe gas exchange anomalies (PaO2/FiO2 ?200 mm Hg and mean airway pressure >10 cm H2O, pneumonia group). In the 39 patients with bronchiolitis the duration of mechanical ventilation was 4.3 days shorter in the dexamethasone group than in the placebo group (4.9 v 9.2 days, 95% CI -7.8 to -0.8, p=0.02) and the duration of supplemental oxygen was 3.6 days shorter (7.7 v 11.3 days, 95% CI -8.0 to -0.1, p=0.048). No differences in end points were found in the pneumonia group. Conclusions: Dexamethasone had no beneficial effect in patients mechanically ventilated for RSV-LRTI but was found to have a beneficial effect in patients with bronchiolitis. PMID:12728156

  10. Pill Properties that Cause Dysphagia and Treatment Failure

    PubMed Central

    Fields, Jeremy; Go, Jorge T.; Schulze, Konrad S.

    2015-01-01

    Background Pills (tablets and capsules) are widely used to administer prescription drugs or to take supplements such as vitamins. Unfortunately, little is known about how much effort it takes Americans to swallow these various pills. More specifically, it is not known to what extent hard-to-swallow pills might affect treatment outcomes (eg, interfering with adherence to prescribed medications or causing clinical complications). It is also unclear which properties (eg, size, shape, or surface texture) Americans prefer or reject for their pills. To learn more about these issues, we interviewed a small group of individuals. Methods We invited individuals in waiting rooms of our tertiary health care center to participate in structured interviews about their pill-taking habits and any problems they have swallowing pills. We inquired which pill properties they believed caused swallowing problems. Participants scored capsules and pills of representative size, shape, and texture for swallowing effort and reported their personal preferences. Results Of 100 successive individuals, 99 participants completed the interview (65% women, mean age = 41 years, range = 23-77 years). Eighty-three percent took pills daily (mean 4 pills/d; 56% of those pills were prescribed by providers). Fifty-four percent of participants replied yes to the question, "Did you ever have to swallow a solid medication that was too difficult?" Four percent recounted serious complications: 1% pill esophagitis, 1% pill impaction, and 2% stopped treatments (antibiotic and prenatal supplement) because they could not swallow the prescribed pills. Half of all participants routinely resorted to special techniques (eg, plenty of liquids or repeated or forceful swallows). Sixty-one percent of those having difficulties cited specific pill properties: 27% blamed size (20% of problems were caused by pills that were too large whereas 7% complained about pills that were too small to sense); 12% faulted rough surface texture; others cited sharp edges, odd shapes, or bad taste/smell. Extra-large pills were widely loathed, with 4 out of 5 participants preferring to take 3 or more medium-sized pills instead of a single jumbo pill. Conclusions Our survey results suggest that 4 out of 5 adult Americans take several pills daily, and do so without undue effort. It also suggests that half of today’s Americans encounter pills that are hard to swallow. Up to 4% of our participants gave up on treatments because they could not swallow the prescribed pills. Up to 7% categorically rejected taking pills that are hard to swallow. Specific material properties are widely blamed for making pills hard to swallow; extra-large capsules and tablets are universally feared, whereas medium-sized pills with a smooth coating are widely preferred. Our findings suggest that health care providers could minimize treatment failures and complications by prescribing and dispensing pills that are easy to swallow. Industry and regulatory bodies may facilitate this by making swallowability an essential criterion in the design and licensing of oral medications. Such policies could lessen the burden of pill taking for Americans and improve the adherence with prescribed treatments. PMID:26543509

  11. Cost-effectiveness of Out-of-Hospital Continuous Positive Airway Pressure for Acute Respiratory Failure

    PubMed Central

    Thokala, Praveen; Goodacre, Steve; Ward, Matt; Penn-Ashman, Jerry; Perkins, Gavin D.

    2015-01-01

    Study objective We determine the cost-effectiveness of out-of-hospital continuous positive airway pressure (CPAP) compared with standard care for adults presenting to emergency medical services with acute respiratory failure. Methods We developed an economic model using a United Kingdom health care system perspective to compare the costs and health outcomes of out-of-hospital CPAP to standard care (inhospital noninvasive ventilation) when applied to a hypothetical cohort of patients with acute respiratory failure. The model assigned each patient a probability of intubation or death, depending on the patient’s characteristics and whether he or she had out-of-hospital CPAP or standard care. The patients who survived accrued lifetime quality-adjusted life-years (QALYs) and health care costs according to their age and sex. Costs were accrued through intervention and hospital treatment costs, which depended on patient outcomes. All results were converted into US dollars, using the Organisation for Economic Co-operation and Development purchasing power parities rates. Results Out-of-hospital CPAP was more effective than standard care but was also more expensive, with an incremental cost-effectiveness ratio of £20,514 per QALY ($29,720/QALY) and a 49.5% probability of being cost-effective at the £20,000 per QALY ($29,000/QALY) threshold. The probability of out-of-hospital CPAP’s being cost-effective at the £20,000 per QALY ($29,000/QALY) threshold depended on the incidence of eligible patients and varied from 35.4% when a low estimate of incidence was used to 93.8% with a high estimate. Variation in the incidence of eligible patients also had a marked influence on the expected value of sample information for a future randomized trial. Conclusion The cost-effectiveness of out-of-hospital CPAP is uncertain. The incidence of patients eligible for out-of-hospital CPAP appears to be the key determinant of cost-effectiveness. PMID:25737210

  12. The relationship of respiratory failure to the oxygen consumption of, lactate production by, and distribution of blood flow among respiratory muscles during increasing inspiratory resistance.

    PubMed Central

    Robertson, C H; Foster, G H; Johnson, R L

    1977-01-01

    An animal model was developed to determine if blood flow to the respiratory muscles limits oxygen delivery and thus work output during inspiratory resistance. With incremental increases in the rate of work of breathing to 15 times the resting level, blood flow to the diaphragm rose exponentially 26-fold. Blood flow to other inspiratory and a few expiratory muscles increased to a much smaller extent, often only at the greater work loads. Cardiac output and blood pressure did not change. Arterial-venous oxygen content difference across the diaphragm became maximal at low work rates and thereafter all increases in oxygen delivery during higher work rates were accomplished by increments in blood flow. Oxygen consumption of the respiratory musculature calculated by blood flow times oxygen extraction increased exponentially with increasing work of breathing and was less than the increase in total body oxygen consumption at each work load. Hypoxemia and respiratory acidosis occurred when the animals inspired through the highest resistance; blood flow and oxygen consumption were even higher than that observed during previous resistances and there was no evidence of a shift to anaerobic metabolsim in blood lactate and pyruvate levels. Respiratory failure did not appear to be a consequence of insufficient blood flow in this model. PMID:830663

  13. Electrical failure during cardiopulmonary bypass: an evaluation of incidence, causes, management and guidelines for preventative measures.

    PubMed

    Hargrove, M; Ramish, B C; O'Donnell, A; Aherne, T

    2002-09-01

    The incidence of electrical failure during cardiopulmonary bypass (CPB) has been reported to occur in approximately 1 per 1000 cases. While the resultant morbidity and mortality is low, electrical failure is a life-threatening scenario. We report three major electrical failures during CPB in a patient population of 3500 over a 15-year period. These cases involved mains failure and generator shut down, mains failure and generator power surge, and failure of the uninterruptable power supply (UPS), which caused protected sockets to shut down. Protocols for preventative maintenance, necessary equipment, battery backup and guidelines for the successful management of such accidents during CPB are discussed. PMID:12243442

  14. Soluble Isoform of the Receptor for Advanced Glycation End Products as a Biomarker for Postoperative Respiratory Failure after Cardiac Surgery

    PubMed Central

    Uchida, Tokujiro; Ohno, Nagara; Asahara, Miho; Yamada, Yoshitsugu; Yamaguchi, Osamu; Tomita, Makoto; Makita, Koshi

    2013-01-01

    Purpose Postoperative respiratory failure is a major problem which can prolong the stay in the intensive care unit in patients undergoing cardiac surgery. We measured the serum levels of the soluble isoform of the receptor for advanced glycation end products (sRAGE), and we studied its association with postoperative respiratory failure. Methods Eighty-seven patients undergoing elective cardiac surgery were enrolled in this multicenter observational study in three university hospitals. Serum biomarker levels were measured perioperatively, and clinical data were collected for 7 days postoperatively. The duration of mechanical ventilation was studied for 28 days. Results Serum levels of sRAGE elevated immediately after surgery (median, 1751 pg/mL; interquartile range (IQR) 1080–3034 pg/mL) compared with the level after anesthetic induction (median, 884 pg/mL; IQR, 568–1462 pg/mL). Postoperative sRAGE levels in patients undergoing off-pump coronary artery bypass grafting (median, 1193 pg/mL; IQR 737–1869 pg/mL) were significantly lower than in patients undergoing aortic surgery (median, 1883 pg/mL; IQR, 1406–4456 pg/mL; p?=?0.0024) and valve surgery (median, 2302 pg/mL; IQR, 1447–3585 pg/mL; p?=?0.0005), and postoperative sRAGE correlated moderately with duration of cardiopulmonary bypass (rs?=?0.44, p<0.0001). Receiver operating characteristic curve analysis demonstrated that postoperative sRAGE had a predictive performance with area under the curve of 0.81 (95% confidence interval 0.71–0.88) for postoperative respiratory failure, defined as prolonged mechanical ventilation >3 days. The optimum cutoff value for prediction of respiratory failure was 3656 pg/mL, with sensitivity and specificity of 62% and 91%, respectively. Conclusions Serum sRAGE levels elevated immediately after cardiac surgery, and the range of elevation was associated with the morbidity of postoperative respiratory failure. Early postoperative sRAGE levels appear to be linked to cardiopulmonary bypass, and may have predictive performance for postoperative respiratory failure; however, large-scale validation studies are needed. PMID:23894617

  15. Detection and characterization of respiratory viruses causing acute respiratory illness and asthma exacerbation in children during three different seasons (2011–2014) in Mexico City

    PubMed Central

    Moreno-Valencia, Yazmin; Hernandez-Hernandez, Victor A; Romero-Espinoza, Jose A I; Coronel-Tellez, Rodrigo H; Castillejos-Lopez, Manuel; Hernandez, Andres; Perez-Padilla, Rogelio; Alejandre-Garcia, Alejandro; de la Rosa-Zamboni, Daniela; Ormsby, Christopher E; Vazquez-Perez, Joel A

    2015-01-01

    Background Viral infections play a significant role in causing acute respiratory infections (ARIs) and exacerbations of chronic diseases. Acute respiratory infections are now the leading cause of mortality in children worldwide, especially in developing countries. Recently, human rhinovirus (HRV) infection has been emerged as an important cause of pneumonia and asthma exacerbation. Objectives To determine the role of several viral agents principally, respiratory syncytial virus, and HRV in children with ARIs and their relationship with asthma exacerbation and pneumonia. Methods Between October 2011 and March 2014, 432 nasopharyngeal samples of children <15 years of age with ARI hospitalized at a referral hospital for respiratory diseases were tested for the presence of respiratory viruses using a multiplex RT-qPCR. Clinical, epidemiological, and demographic data were collected and associated with symptomatology and viral infections. Results Viral infections were detected in at least 59·7% of the enrolled patients, with HRV (26·6%) being the most frequently detected. HRV infections were associated with clinical features of asthma and difficulty in breathing such as wheezing (P = 0·0003), supraesternal (P = 0·046), and xiphoid retraction (P = 0·030). HRV subtype C (HRV-C) infections were associated with asthma (P = 0·02). Conclusions Human rhinovirus was the virus most commonly detected in pediatric patients with ARI. There is also an association of HRV-C infection with asthma exacerbation, emphasizing the relevance of this virus in severe pediatric respiratory disease. PMID:26289993

  16. Heart Failure and Respiratory Hospitalizations Are Reduced in Patients With Heart Failure and Chronic Obstructive Pulmonary Disease With the Use of an Implantable Pulmonary Artery Pressure Monitoring Device

    PubMed Central

    Krahnke, Jason S.; Abraham, William T.; Adamson, Philip B.; Bourge, Robert C.; Bauman, Jordan; Ginn, Greg; Martinez, Fernando J.; Criner, Gerard J.

    2015-01-01

    Background Chronic obstructive pulmonary disease (COPD) is a frequent comorbidity in patients with heart failure (HF). Elevated pulmonary arterial (PA) pressure can be seen in both conditions and has been shown to predict morbidity and mortality. Methods and Results A total of 550 subjects with New York Heart Association functional class III HF were randomly assigned to the treatment (n = 270) and control (n = 280) groups in the CHAMPION Trial. Physicians had access to the PA pressure measurements in the treatment group only, in which HF therapy was used to lower the elevated pressures. HF and respiratory hospitalizations were compared in both groups. A total of 187 subjects met criteria for classification into the COPD subgroup. In the entire cohort, the treatment group had a 37% reduction in HF hospitalization rates (P < .0001) and a 49% reduction in respiratory hospitalization rates (P = .0061). In the COPD subgroup, the treatment group had a 41% reduction in HF hospitalization rates (P = .0009) and a 62% reduction in respiratory hospitalization rates (P = .0023). The rate of respiratory hospitalizations in subjects without COPD was not statistically different (P = .76). Conclusions HF management incorporating hemodynamic information from an implantable PA pressure monitor significantly reduces HF and respiratory hospitalizations in HF subjects with comorbid COPD compared with standard care. PMID:25541376

  17. [Bacterial tracheitis as the cause of acute respiratory insufficiency in 2 teenagers].

    PubMed

    Kamerbeek, A; Kneyber, M C J; Efthymiou, K M; Rinkel, R N P M; Plötz, F B

    2006-02-25

    A 13-year-old girl and a 12-year-old boy developed acute respiratory insufficiency caused by an upper airway obstruction, which necessitated intubation and mechanical ventilation. Cultures from throat swabs from the girl and boy yielded Haemophilus parainfluenzae and Streptococcus pneumoniae, respectively. Diagnoses of bacterial tracheitis were confirmed by tracheoscopy and both children were treated with antibiotics. After 11 and 4 days of mechanical ventilation, respectively, they were successfully extubated. No further complications were encountered. Bacterial tracheitis is a rare but significant cause of upper airway obstruction in children. PMID:16538845

  18. 26 CFR 301.7432-1 - Civil cause of action for failure to release a lien.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 18 2013-04-01 2013-04-01 false Civil cause of action for failure to release a... TREASURY (CONTINUED) PROCEDURE AND ADMINISTRATION PROCEDURE AND ADMINISTRATION Judicial Proceedings Civil Actions by the United States § 301.7432-1 Civil cause of action for failure to release a lien. (a)...

  19. 26 CFR 301.7432-1 - Civil cause of action for failure to release a lien.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 18 2014-04-01 2014-04-01 false Civil cause of action for failure to release a... TREASURY (CONTINUED) PROCEDURE AND ADMINISTRATION PROCEDURE AND ADMINISTRATION Judicial Proceedings Civil Actions by the United States § 301.7432-1 Civil cause of action for failure to release a lien. (a)...

  20. 26 CFR 301.7432-1 - Civil cause of action for failure to release a lien.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 18 2011-04-01 2011-04-01 false Civil cause of action for failure to release a... TREASURY (CONTINUED) PROCEDURE AND ADMINISTRATION PROCEDURE AND ADMINISTRATION Judicial Proceedings Civil Actions by the United States § 301.7432-1 Civil cause of action for failure to release a lien. (a)...

  1. 26 CFR 301.7432-1 - Civil cause of action for failure to release a lien.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 18 2012-04-01 2012-04-01 false Civil cause of action for failure to release a... TREASURY (CONTINUED) PROCEDURE AND ADMINISTRATION PROCEDURE AND ADMINISTRATION Judicial Proceedings Civil Actions by the United States § 301.7432-1 Civil cause of action for failure to release a lien. (a)...

  2. 26 CFR 301.7432-1 - Civil cause of action for failure to release a lien.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Civil cause of action for failure to release a... TREASURY (CONTINUED) PROCEDURE AND ADMINISTRATION PROCEDURE AND ADMINISTRATION Judicial Proceedings Civil Actions by the United States § 301.7432-1 Civil cause of action for failure to release a lien. (a)...

  3. Effect of selected antiasthmatic plant constituents against micro organism causing upper respiratory tract infection.

    PubMed

    Nilani, P; Duraisamy, B; Dhamodaran, P; Ravichandran, S; Elango, K

    2010-01-01

    Most exacerbations of asthma can be proven to be associated with bacterial infections and there is scientific evidence that frequent respiratory infections particularly bacterial infections provoke asthma attack. Considering these facts different plant extracts and phytoconstituents with proven anti asthmatic property had been selected for screening anti microbial activity in in-vitro models. In the present study, Coleus forskohlii Willd. extract (10% Forskolin), Piper Longum L. Extract (20% Piperine), Adathoda vasica Nees. extract (30% Vasicinone), Curcuma longa L. extract (60% Curcumin) were screened for the antibacterial activity against human pathogens causing upper respiratory infection namely Haemophilus influenzae , Streptococcus pneumoniae , Streptococcus pyrogene and Staphylococcus aureus, by taking Gentamycin, Optochin, Bacitracin and Amoxicillin as reference standards. Except for Adathoda vasica Nees. extract, all the other selected plant extracts exhibited a moderate activity antibacterial activity against selected strains. PMID:22557357

  4. Respiratory diphtheria caused by Corynebacterium ulcerans--Terre Haute, Indiana, 1996.

    PubMed

    1997-04-18

    Diphtheria is a potentially severe illness; among unvaccinated persons, the case-fatality rate may be 5%-10%, even with appropriate treatment. During 1990-1995, approximately 4000 deaths resulted from the ongoing diphtheria epidemic in the former Soviet Union. In the United States, respiratory diphtheria is rare: during 1980-1995, only 41 cases were reported. Serologic studies in the 1970s and 1980s indicated that 20%-60% of U.S. adults aged > or = 20 years lacked immunity to diphtheria. This report describes a recent case of respiratory diphtheria caused by a toxin-producing strain of Corynebacterium ulcerans. The case occurred in a resident of Indiana, and an investigation by public health authorities indicated that acquisition of the organism occurred locally in the state. PMID:9132587

  5. Congenital lobar emphysema in a Nigerian neonate: a rare cause of neonatal respiratory distress.

    PubMed

    Ogunleye, E O; Thomas, M O; Ojo, J; Olubanjo, E; Falayi, O; Osunkoya, A; Adebayo, A

    2013-01-01

    Congenital lobar emphysema (CLE) is a notable cause of respiratory distress in neonates, however it remains a diagnostic challenge due to inadequate facilities and low level of experience. The management of this condition also is a bigger challenge due to paucity of expertise and relatively non-existent well-equiped neonatal intensive care unit in this part of the world. Here we present the case of a 5- day old baby who presented at Lagoon Hospital, Apapa with history of severe respiratory distress since birth. CT scan of the chest confirmed an emphysematous left upper lobe with contralateral mediastinal shift. The baby had a left posterolateral thoracotomy with left upper lobectomy and thereafter was electively ventillated for forty eight hours in the neonatal intensive unit. He had an uneventful postoperative course and was discharged from the hospital within one week forfollow-up in the clinic. PMID:24579507

  6. Pathogenesis of nonsuppurative encephalitis caused by highly pathogenic Porcine reproductive and respiratory syndrome virus.

    PubMed

    Cao, Jianbo; Li, Bin; Fang, Liurong; Chen, Huanchun; Xiao, Shaobo

    2012-07-01

    Since 2006, an unprecedented epidemic of highly pathogenic Porcine reproductive and respiratory syndrome virus (HP-PRRSV) infection has emerged and prevailed in mainland China, causing so called high fever disease with a nervous symptom that is different from typical porcine reproductive and respiratory syndrome. To investigate this syndrome, the brains of pigs inoculated with HP-PRRSV were analyzed. The nucleic acid of HP-PRRSV was detected in brains by reverse transcription polymerase chain reaction. Histological examination demonstrated nonsuppurative encephalitis with lymphohistiocytic perivascular cuffing and infiltration of these leukocytes into the neuropil. Furthermore, transmission electron microscopy revealed that the HP-PRRSV that infected the endothelial cells crossed the blood-brain barrier into the central nervous system then induced cellular damage to neurons and neuroglial cells. These results provide a general insight into the pathway of HP-PRRSV invasion into brain tissue and the pathogenesis of nonsuppurative encephalitis. PMID:22585954

  7. Respiratory failure with hilar mass: Role of endobronchial ultrasound-guided transbronchial needle aspiration in the medical intensive care unit

    PubMed Central

    Chichra, Astha; Lama, Kimmoi Wong; Koenig, Seth J.

    2015-01-01

    We report the case of a 58-year-old man on chronic steroid therapy, who developed a rapidly progressive right upper lobe infiltrate/mass that extended into the right hilum. Respiratory failure necessitated endotracheal intubation. Broad spectrum antibiotics were initiated without clinical improvement and because of his immunosuppressive therapy opportunistic pathogens were considered. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed in the Medical Intensive Care Unit (MICU) with rapid onsite evaluation. Specimens obtained from the right hilar mass revealed organisms suspicious for cryptococcal infection, subsequently confirmed via a culture. No complications occurred during the EBUS procedure despite the patient requiring vasopressor support and 100% inspired oxygen. Little data exists regarding the use of EBUS in patients admitted to the MICU with respiratory failure of unknown etiology and mediastinal/hilar lymphadenopathy. This case illustrates the potential safe use of EBUS-TBNA in patients presenting with respiratory failure, with a mediastinal or hilar mass and suspected infectious etiology. PMID:25814808

  8. [Acetaminophen (paracetamol) causing renal failure: report on 3 pediatric cases].

    PubMed

    Le Vaillant, J; Pellerin, L; Brouard, J; Eckart, P

    2013-06-01

    Renal failure secondary to acetaminophen poisoning is rare and occurs in approximately 1-2 % of patients with acetaminophen overdose. The pathophysiology is still being debated, and renal acetaminophen toxicity consists of acute tubular necrosis, without complication if treated promptly. Renal involvement can sometimes occur without prior liver disease, and early renal manifestations usually occur between the 2nd and 7th day after the acute acetaminophen poisoning. While therapy is exclusively symptomatic, sometimes serious metabolic complications can be observed. The monitoring of renal function should therefore be considered as an integral part of the management of children with acute, severe acetaminophen intoxication. We report 3 cases of adolescents who presented with acute renal failure as a result of voluntary drug intoxication with acetaminophen. One of these 3 girls developed severe renal injury without elevated hepatic transaminases. None of the 3 girls' renal function required hemodialysis, but one of the 3 patients had metabolic complications after her acetaminophen poisoning. PMID:23628119

  9. Common atrium: a rare cause of acute decompensated heart failure.

    PubMed

    Karaye, K M; Balarabe, S A; Yakasai, M M; Suleiman, I M; Saidu, H; Bonny, Aimé

    2015-01-01

    We report a rare case of common atrium and acute decompensated heart failure most likely precipitated by acute bacterial pericarditis leading to premature death, in a 25-year-old male footballer. The silent course of the disease for decades as well as the diagnostic and management pitfalls of this case illustrates the importance of early detection by echocardiography and urgent appropriate treatment in intensive care settings to limit the poor prognosis of the condition. PMID:25763071

  10. Common Atrium: A Rare Cause of Acute Decompensated Heart Failure

    PubMed Central

    Karaye, K. M.; Balarabe, S. A.; Yakasai, M. M.; Suleiman, I. M.; Saidu, H.; Bonny, Aimé

    2015-01-01

    We report a rare case of common atrium and acute decompensated heart failure most likely precipitated by acute bacterial pericarditis leading to premature death, in a 25-year-old male footballer. The silent course of the disease for decades as well as the diagnostic and management pitfalls of this case illustrates the importance of early detection by echocardiography and urgent appropriate treatment in intensive care settings to limit the poor prognosis of the condition. PMID:25763071

  11. Mitochondrial respiratory dysfunctions of blood mononuclear cells link with cardiac disturbance in patients with early-stage heart failure

    PubMed Central

    Li, Peng; Wang, Bin; Sun, Fang; Li, Yingsha; Li, Qiang; Lang, Hongmei; Zhao, Zhigang; Gao, Peng; Zhao, Yu; Shang, Qianhui; Liu, Daoyan; Zhu, Zhiming

    2015-01-01

    Patients with cardiometabolic risk factors and asymptomatic cardiac hypertrophy are hallmarks of early-stage heart failure (HF). We hypothesized that mitochondrial respiratory dysfunctions of peripheral blood mononuclear cells (PBMCs) may be associated with inflammation and oxidative stress in early-stage HF patients complicated with cardiometabolic risk factors. Totally 49 subjects were enrolled with 25 early-stage HF patients (stages A and B) having cardiac hypertrophy and dysfunction and 24 healthy controls. It showed that excessive inflammation and reduced antioxidant capacity were closely associated with cardiac abnormalities in early-stage HF patients. Furthermore, the values of mitochondrial respiratory functional parameters R, CIOXPHOS, CIIOXPHOS, CI+IIOXPHOS, CI+IIETS and CIIETS were significantly lowered in early-stage HF patients. Interestingly, these respiratory parameters were correlated with inflammation and antioxidant capacity in participants. Finally, cardiometabolic risk factors such as salt intake and blood pressure were related to the mitochondrial respiratory dysfunctions, which were further validated by in vitro experiments. Our study indicated that cardiometabolic risk factor-mediated mitochondrial respiratory dysfunctions of PBMCs link with the cellular inflammation / oxidative stress and cardiac disturbance in early-stage HF. PMID:26018291

  12. Inhalation of Ortho-Phthalaldehyde Vapor Causes Respiratory Sensitization in Mice

    PubMed Central

    Johnson, Victor J.; Reynolds, Jeffrey S.; Wang, Wei; Fluharty, Kara; Yucesoy, Berran

    2011-01-01

    Ortho-Phthalaldehyde (OPA) has been approved for high-level sterilization of heat-sensitive medical instruments and is increasingly being used as a replacement in the healthcare industry for glutaraldehyde, a known sensitizer. Numerous case reports have been published indicating workers and patients experiencing respiratory problems, anaphylaxis, skin reactivity, and systemic antibody production. Our laboratory previously demonstrated that OPA is a dermal sensitizer in mice. The goal of the present study was to determine if OPA is a respiratory sensitizer following inhalation exposure. Mice were exposed to OPA vapor and airway and lymph nodes were examined for cytokine gene expression and alterations in lymphocyte populations. Inhalation of OPA for 3 days resulted in a concentration-dependent increase in lymphocyte proliferation, mainly B lymphocytes, in the draining lymph nodes. A secondary challenge of mice with OPA resulted in a dramatic increase in the population of B lymphocytes expressing IgE. Expression of Th2 (IL-4, IL-5, and IL-13) and anti/proinflammatory (IL-10, TNF?, and IL-1?) cytokine genes was upregulated in the lymph nodes and the nasal mucosa. Mice exposed to the higher concentrations of OPA-produced OPA-specific IgG1 antibodies indicating systemic sensitization. These findings provide evidence that OPA has the potential to cause respiratory sensitization in mice. PMID:21785612

  13. High Resource Utilization Does Not Affect Mortality in Acute Respiratory Failure Patients Managed With Tracheostomy

    PubMed Central

    Freeman, Bradley D; Stwalley, Dustin; Lambert, Dennis; Edler, Joshua; Morris, Peter E; Medvedev, Sofia; Hohmann, Samuel F; Kymes, Steven M

    2015-01-01

    BACKGROUND Tracheostomy practice in patients with acute respiratory failure (ARF) varies greatly among institutions. This variability has the potential to be reflected in the resources expended providing care. In various healthcare environments, increased resource expenditure has been associated with a favorable effect on outcome. OBJECTIVE To examine the association between institutional resource expenditure and mortality in ARF patients managed with tracheostomy. METHODS We developed analytic models employing the University Health Systems Consortium (Oakbrook, Illinois) database. Administrative coding data were used to identify patients with the principal diagnosis of ARF, procedures, complications, post-discharge destination, and survival. Mean resource intensity of participating academic medical centers was determined using risk-adjusted estimates of costs. Mortality risk was determined using a multivariable approach that incorporated patient-level demographic and clinical variables and institution-level resource intensity. RESULTS We analyzed data from 44,124 ARF subjects, 4,776 (10.8%) of whom underwent tracheostomy. Compared to low-resource-intensity settings, treatment in high-resource-intensity academic medical centers was associated with increased risk of mortality (odds ratio 1.11, 95% CI 1.05–1.76), including those managed with tracheostomy (odds ratio high-resource-intensity academic medical center with tracheostomy 1.10, 95% CI 1.04 –1.17). We examined the relationship between complication development and outcome. While neither the profile nor number of complications accumulated differed comparing treatment environments (P > .05 for both), mortality for tracheostomy patients experiencing complications was greater in high-resource-intensity (95/313, 30.3%) versus low-resource-intensity (552/2,587, 21.3%) academic medical centers (P < .001). CONCLUSIONS We were unable to demonstrate a positive relationship between resource expenditure and outcome in ARF patients managed with tracheostomy. PMID:23650434

  14. Safety of performing fiberoptic bronchoscopy in critically ill hypoxemic patients with acute respiratory failure

    PubMed Central

    Cracco, Christophe; Fartoukh, Muriel; Prodanovic, Hélène; Azoulay, Elie; Chenivesse, Cécile; Lorut, Christine; Beduneau, Gaëtan; Bui, Hoang Nam; Taille, Camille; Brochard, Laurent; Demoule, Alexandre; Maitre, Bernard

    2013-01-01

    Background Safety of fibreoptic bronchoscopy (FOB) in nonintubated critically ill patients with acute respiratory failure have not been extensively evaluated. We aimed to measure the incidence of intubation and need to increase ventilatory support following FOB and to identify predictive factors of this event. Methods A prospective multicenter observational study was carried out in 8 French adult intensive care units. 169 FOB performed in patients with a PaO2/FiO2 ratio equal or less than 300 were analyzed. Our main end point was intubation rate. The secondary end point was rate of increased ventilatory support defined as greater than a 50% increase in oxygen requirement, the need to start non invasive-positive pressure ventilation (NI-PPV) or increase NI-PPV support. Results Within 24 hours, an increase in ventilatory support was required following 59 (35%) bronchoscopies, of which 25 (15%) led to endotracheal intubation. The existence of chronic obstructive pulmonary disease (COPD) (OR:5.2 [1.6–17.8], p=0.007) or immunosuppression (OR : 5.4 [1.7–17.2], p=0.004) were significantly associated with the need for intubation in multivariable analysis. None of the baseline physiological parameters including the PaO2/FiO2 ratio was associated with intubation. Conclusion Bronchoscopy is often followed by an increase in ventilatory support in hypoxemic critically ill patients, but less frequently by the need for intubation. COPD, immunosuppression are associated with a need for invasive ventilation in the following 24 hours. PMID:23070123

  15. Total Liquid Ventilation Provides Superior Respiratory Support to Conventional Mechanical Ventilation in a Large Animal Model of Severe Respiratory Failure

    PubMed Central

    Pohlmann, Joshua R; Brant, David O; Daul, Morgan A; Reoma, Junewai L; Kim, Anne C; Osterholzer, Kathryn R; Johnson, Kent J; Bartlett, Robert H; Cook, Keith E; Hirschl, Ronald B

    2011-01-01

    Total liquid ventilation (TLV) has the potential to provide respiratory support superior to conventional mechanical ventilation (CMV) in the acute respiratory distress syndrome (ARDS). However, laboratory studies are limited to trials in small animals for no longer than 4 hours. The objective of this study was to compare TLV and CMV in a large animal model of ARDS for 24 hours. Ten sheep weighing 53 ± 4 (SD) kg were anesthetized and ventilated with 100% oxygen. Oleic acid was injected into the pulmonary circulation until PaO2:FiO2 ? 60 mmHg, followed by transition to a protective CMV protocol (n=5) or TLV (n=5) for 24 hours. Pathophysiology was recorded and the lungs were harvested for histological analysis. Animals treated with CMV became progressively hypoxic and hypercarbic despite maximum ventilatory support. Sheep treated with TLV maintained normal blood gases with statistically greater PO2 (p<10?9) and lower PCO2 (p < 10?3) than the CMV group. Survival at 24 hours in the TLV and CMV groups were 100% and 40% respectively (p< 0.05). Thus, TLV provided gas exchange superior to CMV in this laboratory model of severe ARDS. PMID:21084968

  16. A general cause based methodology for analysis of dependent failures in system risk and reliability assessments

    NASA Astrophysics Data System (ADS)

    O'Connor, Andrew N.

    Traditional parametric Common Cause Failure (CCF) models quantify the soft dependencies between component failures through the use of empirical ratio relationships. Furthermore CCF modeling has been essentially restricted to identical components in redundant formations. While this has been advantageous in allowing the prediction of system reliability with little or no data, it has been prohibitive in other applications such as modeling the characteristics of a system design or including the characteristics of failure when assessing the risk significance of a failure or degraded performance event (known as an event assessment). This dissertation extends the traditional definition of CCF to model soft dependencies between like and non-like components. It does this through the explicit modeling of soft dependencies between systems (coupling factors) such as sharing a maintenance team or sharing a manufacturer. By modeling the soft dependencies explicitly these relationships can be individually quantified based on the specific design of the system and allows for more accurate event assessment given knowledge of the failure cause. Since the most data informed model in use is the Alpha Factor Model (AFM), it has been used as the baseline for the proposed solutions. This dissertation analyzes the US Nuclear Regulatory Commission's Common Cause Failure Database event data to determine the suitability of the data and failure taxonomy for use in the proposed cause-based models. Recognizing that CCF events are characterized by full or partial presence of "root cause" and "coupling factor" a refined failure taxonomy is proposed which provides a direct link between the failure cause category and the coupling factors. This dissertation proposes two CCF models (a) Partial Alpha Factor Model (PAFM) that accounts for the relevant coupling factors based on system design and provide event assessment with knowledge of the failure cause, and (b)General Dependency Model (GDM),which uses Bayesian Network to model the soft dependencies between components. This is done through the introduction of three parameters for each failure cause that relate to component fragility, failure cause rate, and failure cause propagation probability.

  17. An Outbreak of Respiratory Tularemia Caused by Diverse Clones of Francisella tularensis

    PubMed Central

    Johansson, Anders; Lärkeryd, Adrian; Widerström, Micael; Mörtberg, Sara; Myrtännäs, Kerstin; Öhrman, Caroline; Birdsell, Dawn; Keim, Paul; Wagner, David M.; Forsman, Mats; Larsson, Pär

    2014-01-01

    Background. The bacterium Francisella tularensis is recognized for its virulence, infectivity, genetic homogeneity, and potential as a bioterrorism agent. Outbreaks of respiratory tularemia, caused by inhalation of this bacterium, are poorly understood. Such outbreaks are exceedingly rare, and F. tularensis is seldom recovered from clinical specimens. Methods. A localized outbreak of tularemia in Sweden was investigated. Sixty-seven humans contracted laboratory-verified respiratory tularemia. F. tularensis subspecies holarctica was isolated from the blood or pleural fluid of 10 individuals from July to September 2010. Using whole-genome sequencing and analysis of single-nucleotide polymorphisms (SNPs), outbreak isolates were compared with 110 archived global isolates. Results. There were 757 SNPs among the genomes of the 10 outbreak isolates and the 25 most closely related archival isolates (all from Sweden/Finland). Whole genomes of outbreak isolates were >99.9% similar at the nucleotide level and clustered into 3 distinct genetic clades. Unexpectedly, high-sequence similarity grouped some outbreak and archival isolates that originated from patients from different geographic regions and up to 10 years apart. Outbreak and archival genomes frequently differed by only 1–3 of 1 585 229 examined nucleotides. Conclusions. The outbreak was caused by diverse clones of F. tularensis that occurred concomitantly, were widespread, and apparently persisted in the environment. Multiple independent acquisitions of F. tularensis from the environment over a short time period suggest that natural outbreaks of respiratory tularemia are triggered by environmental cues. The findings additionally caution against interpreting genome sequence identity for this pathogen as proof of a direct epidemiological link. PMID:25097081

  18. Probable chronic renal failure caused by Lonomia caterpillar envenomation

    PubMed Central

    2013-01-01

    Erucism is a skin reaction to envenomation from certain poisonous caterpillar bristles. In Brazil, most reports of erucism provoked by Lonomia caterpillars are from the southern region. Most manifestations of erucism are local and include burning pain, itching, local hyperthermia and, rarely, blisters (benign symptoms with spontaneous regression in a few hours). General symptoms such as nausea and vomiting, headache, fever, myalgia, abdominal pain and conjunctivitis may also occur. Uncommon symptoms include arthritis, coagulation disorders (manifested as bruising and bleeding), intracerebral hemorrhage and acute renal failure, which comprise serious complications. The present study reports the case of 60-year-old patient from Rio de Janeiro state, Brazil, who came into contact with a caterpillar and developed, a few days later, chronic renal disease. PMID:23849585

  19. A Rapidly Fatal Sepsis Caused by Listeria Monocytogenes Type-4b in A Patient with Chronic Renal Failure

    PubMed Central

    Kose, Adem; Yakupogullari, Yusuf

    2015-01-01

    Introduction: Listeria monocytogenes is a significant zoonosis causing invasive infections in the susceptible persons. The current paper presented a patient who died due to a rapidly-progressing multiple organ failure (MOF) as a result of severe sepsis caused by L. monocytogenes. Case Presentation: A 70-years-old patient with chronic renal failure was admitted to the infectious diseases clinic due to diarrhea for one day. He was hospitalized and the body fluid samples were collected for laboratory analyses. Within few hours, his vital findings worsened, and he developed respiratory arrest. Ceftriaxone and gentamycin were administrated. However, he died due to disseminated intravascular coagulation, septic shock and meningoencephalitis at the 22nd hour of admission. Causative agent was identified as L. monocytogenes serotype-4b in post-mortem period. Discussion: L. monocytogenes can cause progressive and rapidly fatal infections in the vulnerable persons, with multisystem involvement. Since this bacterium is not susceptible to cephalosporines, it will be better to consider effective antimicrobials in the treatment of the possible cases. PMID:25969704

  20. ESTABLISHING PUBLIC POLICY AS A PRIMARY CAUSE OF ENGINEERING FAILURE IN NATIONAL INFRASTRUCTURES

    E-print Network

    Johnson, Chris

    ESTABLISHING PUBLIC POLICY AS A PRIMARY CAUSE OF ENGINEERING FAILURE IN NATIONAL INFRASTRUCTURES-reliance on automated monitoring systems. The infrastructure failure also stemmed from governmental and regulatory that distinguish these accounts stem from the authors' attitudes towards the impact that market deregulation has

  1. Multidimensional Scaling of the Causes for Success and Failure.

    ERIC Educational Resources Information Center

    Passer, Michael W.

    An experiment was performed to obtain judgments of 324 college students about a list of 18 causal explanations for good or poor performance on an examination. These stimulus causes were judged with respect to a description of two hypothetical situations in which a student either did well or did poorly on the examination. Half the sample judged the…

  2. Mechanisms of bioprosthetic heart valve failure: Fatigue causes collagen denaturation and glycosaminoglycan loss

    E-print Network

    Zand, Robert

    Mechanisms of bioprosthetic heart valve failure: Fatigue causes collagen denaturation heart valve (BPHV) degeneration, characterized by extracellular matrix deterioration, remod- eling; FTIR spectroscopy; in vitro ac- celerated fatigue; bioprosthetic heart valve degeneration

  3. First case of atypical takotsubo cardiomyopathy in a bilateral lung-transplanted patient due to acute respiratory failure.

    PubMed

    Ghadri, Jelena R; Bataisou, Roxana D; Diekmann, Johanna; Lüscher, Thomas F; Templin, Christian

    2015-10-01

    Takotsubo cardiomyopathy which is characterised by a transient left ventricular wall motion abnormality was first described in 1990. The disease is still not well known, and as such it is suggested that an emotional trigger is mandatory in this disease. We present the case of a 51-year old female patient seven years after bilateral lung transplantation, who developed acute respiratory distress syndrome and subsequently suffered from atypical takotsubo cardiomyopathy with transient severe reduction of ejection fraction and haemodynamic instability needing acute intensive care treatment. Acute respiratory failure has emerged as an important physical trigger factor in takotsubo cardiomyopathy. Little is known about the association of hypoxia and takotsubo cardiomyopathy which can elicit a life-threatening condition requiring acute intensive care. Therefore, experimental studies are needed to investigate the role of hypoxia in takotsubo cardiomyopathy. PMID:24627332

  4. Pediatric Respiratory Emergencies.

    PubMed

    Richards, Amber M

    2016-02-01

    Respiratory emergencies are 1 of the most common reasons parents seek evaluation for the their children in the emergency department (ED) each year, and respiratory failure is the most common cause of cardiopulmonary arrest in pediatric patients. Whereas many respiratory illnesses are mild and self-limiting, others are life threatening and require prompt diagnosis and management. Therefore, it is imperative that emergency clinicians be able to promptly recognize and manage these illnesses. This article reviews ED diagnosis and management of foreign body aspiration, asthma exacerbation, epiglottitis, bronchiolitis, community-acquired pneumonia, and pertussis. PMID:26614243

  5. Revision of unicompartmental knee arthroplasty: implants used and causes of failure?

    PubMed Central

    Mozella, Alan de Paula; Borges Gonçalves, Felipe; Osterno Vasconcelos, Jansen; de Araújo Barros Cobra, Hugo Alexandre

    2014-01-01

    Objective to determine the causes of unicondylar knee arthroplasty failures, as well as identify the implants used and the need of bone grafting in patients undergoing revision UKA in Center of Knee Surgery at the Instituto Nacional de Traumatologia e Ortopedia (INTO) in the period between January 1990 and January 2013. Methods a retrospective analysis of the medical documentation and imaging, determining the cause of failure of UKA and the time of its occurrence, as well as prosthetic components implanted during the review and the need for bone grafting. Results in this study, 27 UKA failures in 26 patients were included. Collapse of one or more components was the main cause of failure, occurring in 33% of patients. Aseptic failure was identified in 30% of cases, progression of osteoarthrosis in 15%, infection and pain 7% each, and osteolysis and polyethylene failure in 4% each. Early failure occurred in 41% of all revisions of UKA and late failure in 59%. 23 patients have undergone revision of UK. Conclusion in 35% of revisions the use of bone grafting was needed in tibial area; in 3 cases we needed allograft from Tissue Bank. We did not use metal increase in any of the revision. In one patient we used implant constraint for instability. PMID:26229792

  6. Common-Cause Failure Treatment in Event Assessment: Basis for a Proposed New Model

    SciTech Connect

    Dana Kelly; Song-Hua Shen; Gary DeMoss; Kevin Coyne; Don Marksberry

    2010-06-01

    Event assessment is an application of probabilistic risk assessment in which observed equipment failures and outages are mapped into the risk model to obtain a numerical estimate of the event’s risk significance. In this paper, we focus on retrospective assessments to estimate the risk significance of degraded conditions such as equipment failure accompanied by a deficiency in a process such as maintenance practices. In modeling such events, the basic events in the risk model that are associated with observed failures and other off-normal situations are typically configured to be failed, while those associated with observed successes and unchallenged components are assumed capable of failing, typically with their baseline probabilities. This is referred to as the failure memory approach to event assessment. The conditioning of common-cause failure probabilities for the common cause component group associated with the observed component failure is particularly important, as it is insufficient to simply leave these probabilities at their baseline values, and doing so may result in a significant underestimate of risk significance for the event. Past work in this area has focused on the mathematics of the adjustment. In this paper, we review the Basic Parameter Model for common-cause failure, which underlies most current risk modelling, discuss the limitations of this model with respect to event assessment, and introduce a proposed new framework for common-cause failure, which uses a Bayesian network to model underlying causes of failure, and which has the potential to overcome the limitations of the Basic Parameter Model with respect to event assessment.

  7. Ocular Tropism of Respiratory Viruses

    PubMed Central

    Rota, Paul A.; Tumpey, Terrence M.

    2013-01-01

    SUMMARY Respiratory viruses (including adenovirus, influenza virus, respiratory syncytial virus, coronavirus, and rhinovirus) cause a broad spectrum of disease in humans, ranging from mild influenza-like symptoms to acute respiratory failure. While species D adenoviruses and subtype H7 influenza viruses are known to possess an ocular tropism, documented human ocular disease has been reported following infection with all principal respiratory viruses. In this review, we describe the anatomical proximity and cellular receptor distribution between ocular and respiratory tissues. All major respiratory viruses and their association with human ocular disease are discussed. Research utilizing in vitro and in vivo models to study the ability of respiratory viruses to use the eye as a portal of entry as well as a primary site of virus replication is highlighted. Identification of shared receptor-binding preferences, host responses, and laboratory modeling protocols among these viruses provides a needed bridge between clinical and laboratory studies of virus tropism. PMID:23471620

  8. Investigation into Cause of High Temperature Failure of Boiler Superheater Tube

    NASA Astrophysics Data System (ADS)

    Ghosh, D.; Ray, S.; Roy, H.; Shukla, A. K.

    2015-04-01

    The failure of the boiler tubes occur due to various reasons like creep, fatigue, corrosion and erosion. This paper highlights a case study of typical premature failure of a final superheater tube of 210 MW thermal power plant boiler. Visual examination, dimensional measurement, chemical analysis, oxide scale thickness measurement, microstructural examination are conducted as part of the investigations. Apart from these investigations, sulfur print, Energy Dispersive spectroscopy (EDS) and X ray diffraction analysis (XRD) are also conducted to ascertain the probable cause of failure of final super heater tube. Finally it has been concluded that the premature failure of the super heater tube can be attributed to the combination of localized high tube metal temperature and loss of metal from the outer surface due to high temperature corrosion. The corrective actions have also been suggested to avoid this type of failure in near future.

  9. A method for estimating common cause failure probability and model parameters : the inverse stress-strength interference (ISSI) technique

    E-print Network

    Guey, Ching Ning

    1984-01-01

    In this study, an alternative for the analysis of common cause failures (CCFs) is investigated. The method studied consists of using the Licensee Event Report (LER) data to get single component failure probability and using ...

  10. Finite Element Creep-Fatigue Analysis of a Welded Furnace Roll for Identifying Failure Root Cause

    NASA Astrophysics Data System (ADS)

    Yang, Y. P.; Mohr, W. C.

    2015-11-01

    Creep-fatigue induced failures are often observed in engineering components operating under high temperature and cyclic loading. Understanding the creep-fatigue damage process and identifying failure root cause are very important for preventing such failures and improving the lifetime of engineering components. Finite element analyses including a heat transfer analysis and a creep-fatigue analysis were conducted to model the cyclic thermal and mechanical process of a furnace roll in a continuous hot-dip coating line. Typically, the roll has a short life, <1 year, which has been a problem for a long time. The failure occurred in the weld joining an end bell to a roll shell and resulted in the complete 360° separation of the end bell from the roll shell. The heat transfer analysis was conducted to predict the temperature history of the roll by modeling heat convection from hot air inside the furnace. The creep-fatigue analysis was performed by inputting the predicted temperature history and applying mechanical loads. The analysis results showed that the failure was resulted from a creep-fatigue mechanism rather than a creep mechanism. The difference of material properties between the filler metal and the base metal is the root cause for the roll failure, which induces higher creep strain and stress in the interface between the weld and the HAZ.

  11. A Randomized Trial of Initial Trophic versus Full-Energy Enteral Nutrition in Mechanically Ventilated Patients with Acute Respiratory Failure

    PubMed Central

    Rice, Todd W.; Mogan, Susan; Hays, Margaret A.; Bernard, Gordon R.; Jensen, Gordon L.; Wheeler, Arthur P.

    2011-01-01

    Objective Enteral nutrition is provided to mechanically ventilated patients who cannot eat normally, yet the amount of support needed is unknown. We conducted this randomized, open-label study to test the hypothesis that initial low-volume (i.e. trophic) enteral nutrition would decrease episodes of gastrointestinal intolerance/complications and improve outcomes as compared to initial full-energy enteral nutrition in patients with acute respiratory failure. Design Randomized, open-label study Patients 200 Patients with acute respiratory failure expected to require mechanical ventilation for at least 72 hours Interventions Patients were randomized to receive either initial trophic (10 ml/hr) or full-energy enteral nutrition for the initial 6 days of ventilation. Measurements and Main Results The primary outcome measure was ventilator-free days to day 28. Baseline characteristics were similar between the 98 patients randomized to trophic and the 102 patients randomized to full-energy nutrition. At enrollment, patients had a mean APACHE II score of 26.9, PaO2/FiO2 of 182 and 38% were in shock. Both groups received similar duration of enteral nutrition (5.5 vs. 5.1 days; P=0.51). The trophic group received an average of 15 ± 11% of goal calories daily through day 6 compared to 74.8 ± 38.5% (P<0.001) for the full-energy group. Both groups had a median of 23.0 ventilator-free (P=0.90) and 21.0 ICU-free days (P=0.64). Mortality to hospital discharge was 22.4% for trophic vs. 19.6% for full-energy (P=0.62). In the first 6 days, the trophic group had trends for less diarrhea (19 vs. 24% of feeding days; P=0.08) and significantly fewer episodes of elevated gastric residual volumes (2 vs. 8% of feeding days; P<0.001). Conclusions Initial trophic enteral nutrition resulted in similar clinical outcomes in mechanically ventilated patients with acute respiratory failure as early full-energy enteral nutrition but with fewer episodes of gastrointestinal intolerance. PMID:21242788

  12. An analysis of the causes of failure in high chrome oxide refractory materials from slagging gasifiers

    SciTech Connect

    Bennett, James P.; Kwong, Kyei-Sing; Powell, Cynthia A.; Thomas, Hugh; Krabbe, Rick

    2006-01-01

    High Cr2O3 refractory materials are used to line the hot face of slagging gasifiers. Gasifiers are reaction chambers that convert water, oxygen, and a carbon feedstock into CO, H2, and methane at temperatures as high as 1575DGC and pressures up to 1000 psi. Ash in the carbon feedstock liquefies, erodes and corrodes the gasifier's refractory liner, contributing to liner failure within a few months to two years. The failure of a refractory liner decreases a gasifier's on-line availability and causes costly system downtime and repairs. Many factors contribute to refractory lining failure, including slag penetration and corrosion, thermal cycling, gasifier environment, and mechanical loads. The results of refractory post-mortem failure analysis and how observations relate to gasifier service life will be discussed.

  13. Association between NOx exposure and deaths caused by respiratory diseases in a medium-sized Brazilian city.

    PubMed

    César, A C G; Carvalho, J A; Nascimento, L F C

    2015-12-01

    Exposure to nitrogen oxides (NOx) emitted by burning fossil fuels has been associated with respiratory diseases. We aimed to estimate the effects of NOx exposure on mortality owing to respiratory diseases in residents of Taubaté, São Paulo, Brazil, of all ages and both sexes. This time-series ecological study from August 1, 2011 to July 31, 2012 used information on deaths caused by respiratory diseases obtained from the Health Department of Taubaté. Estimated daily levels of pollutants (NOx, particulate matter, ozone, carbon monoxide) were obtained from the Centro de Previsão de Tempo e Estudos Climáticos Coupled Aerosol and Tracer Transport model to the Brazilian developments on the Regional Atmospheric Modeling System. These environmental variables were used to adjust the multipollutant model for apparent temperature. To estimate association between hospitalizations owing to asthma and air pollutants, generalized additive Poisson regression models were developed, with lags as much as 5 days. There were 385 deaths with a daily mean (±SD) of 1.05±1.03 (range: 0-5). Exposure to NOx was significantly associated with mortality owing to respiratory diseases: relative risk (RR)=1.035 (95% confidence interval [CI]: 1.008-1.063) for lag 2, RR=1.064 (95%CI: 1.017-1.112) lag 3, RR=1.055 (95%CI: 1.025-1.085) lag 4, and RR=1.042 (95%CI: 1.010-1.076) lag 5. A 3 µg/m3 reduction in NOx concentration resulted in a decrease of 10-18 percentage points in risk of death caused by respiratory diseases. Even at NOx concentrations below the acceptable standard, there is association with deaths caused by respiratory diseases. PMID:26421866

  14. Association between NOx exposure and deaths caused by respiratory diseases in a medium-sized Brazilian city

    PubMed Central

    César, A. C. G.; Carvalho, J. A.; Nascimento, L. F. C.

    2015-01-01

    Exposure to nitrogen oxides (NOx) emitted by burning fossil fuels has been associated with respiratory diseases. We aimed to estimate the effects of NOx exposure on mortality owing to respiratory diseases in residents of Taubaté, São Paulo, Brazil, of all ages and both sexes. This time-series ecological study from August 1, 2011 to July 31, 2012 used information on deaths caused by respiratory diseases obtained from the Health Department of Taubaté. Estimated daily levels of pollutants (NOx, particulate matter, ozone, carbon monoxide) were obtained from the Centro de Previsão de Tempo e Estudos Climáticos Coupled Aerosol and Tracer Transport model to the Brazilian developments on the Regional Atmospheric Modeling System. These environmental variables were used to adjust the multipollutant model for apparent temperature. To estimate association between hospitalizations owing to asthma and air pollutants, generalized additive Poisson regression models were developed, with lags as much as 5 days. There were 385 deaths with a daily mean (±SD) of 1.05±1.03 (range: 0-5). Exposure to NOx was significantly associated with mortality owing to respiratory diseases: relative risk (RR)=1.035 (95% confidence interval [CI]: 1.008-1.063) for lag 2, RR=1.064 (95%CI: 1.017-1.112) lag 3, RR=1.055 (95%CI: 1.025-1.085) lag 4, and RR=1.042 (95%CI: 1.010-1.076) lag 5. A 3 µg/m3 reduction in NOx concentration resulted in a decrease of 10-18 percentage points in risk of death caused by respiratory diseases. Even at NOx concentrations below the acceptable standard, there is association with deaths caused by respiratory diseases. PMID:26421866

  15. Novel ABCA3 mutations as a cause of respiratory distress in a term newborn.

    PubMed

    Gonçalves, Jean-Pierre; Pinheiro, Liliana; Costa, Miguel; Silva, Albina; Gonçalves, Augusta; Pereira, Almerinda

    2014-01-25

    We report here the case of a term female newborn that developed severe respiratory distress soon after birth. She was found to be a compound heterozygote for both novel mutations in the ABCA3 gene. ABCA3 deficiency should be considered in mature babies who develop severe respiratory distress syndrome. PMID:24269975

  16. Respiratory allergy caused by house dust mites: What do we really know?

    PubMed

    Calderón, Moisés A; Linneberg, Allan; Kleine-Tebbe, Jörg; De Blay, Frédéric; Hernandez Fernandez de Rojas, Dolores; Virchow, Johann Christian; Demoly, Pascal

    2015-07-01

    The house dust mite (HDM) is a major perennial allergen source and a significant cause of allergic rhinitis and allergic asthma. However, awareness of the condition remains generally low. This review assesses the links between exposure to HDM, development of the allergic response, and pathologic consequences in patients with respiratory allergic diseases. We investigate the epidemiology of HDM allergy to explore the interaction between mites and human subjects at the population, individual, and molecular levels. Core and recent publications were identified by using "house dust mite" as a key search term to evaluate the current knowledge of HDM epidemiology and pathophysiology. Prevalence data for HDM allergen sensitization vary from 65 to 130 million persons in the general population worldwide to as many as 50% among asthmatic patients. Heterogeneity of populations, terminology, and end points in the literature confound estimates, indicating the need for greater standardization in epidemiologic research. Exposure to allergens depends on multiple ecological strata, including climate and mite microhabitats within the domestic environment, with the latter providing opportunity for intervention measures to reduce allergen load. Inhaled mite aeroallergens are unusually virulent: they are able to activate both the adaptive and innate immune responses, potentially offering new avenues for intervention. The role of HDM allergens is crucial in the development of allergic rhinitis and asthma, but the translation of silent sensitization into symptomatic disease is still incompletely understood. Improved understanding of HDMs, their allergens, and their microhabitats will enable development of more effective outcomes for patients with HDM allergy. PMID:25457152

  17. Dome shutter failure causes longest shutdown (67-nights) ever recorded by CFHT Observatory

    NASA Astrophysics Data System (ADS)

    Look, Ivan A.; Salmon, Derrick; Bauman, Steve; Ho, Kevin; Elizares, Casey

    2014-07-01

    The dome shutter drive system for the CFHT observatory experienced two, separate, catastrophic failures recently (15 DEC 11) and (14 APR 12); leading to a full-blown, company-wide investigation to understand and determine the root cause of both failures. Multiple resources were utilized to detect and reveal clues to help determine the cause of failure. Former colleagues were consulted, video footage investigated, ammeter plots dissected, solid models developed, forensic analysis of failed parts performed, controller mock-up established; all in an attempt to gather data, better understand the system, and develop a clear path solution to resurrect the shutter and return it to normal operation. My paper will attempt to describe in detail the problems encountered, investigations performed, analysis developed, and solutions integrated.

  18. Acute Respiratory Failure Induced by Magnesium Replacement in a 62-Year-Old Woman with Myasthenia Gravis.

    PubMed

    Singh, Paramveer; Idowu, Olakunle; Malik, Imrana; Nates, Joseph L

    2015-10-01

    Magnesium is known to act at the neuromuscular junction by inhibiting the presynaptic release of acetylcholine and desensitizing the postsynaptic membrane. Because of these effects, magnesium has been postulated to potentiate neuromuscular weakness. We describe the case of a 62-year-old woman with myasthenia gravis and a metastatic thymoma who was admitted to our intensive care unit for management of a myasthenic crisis. The patient's neuromuscular weakness worsened in association with standard intravenous magnesium replacement, and the exacerbated respiratory failure necessitated intubation, mechanical ventilation, and an extended stay in the intensive care unit. The effect of magnesium replacement on myasthenia gravis patients has not been well documented, and we present this case to increase awareness and stimulate research. In addition, we discuss the relevant medical literature. PMID:26504451

  19. Acute Respiratory Failure Induced by Magnesium Replacement in a 62-Year-Old Woman with Myasthenia Gravis

    PubMed Central

    Singh, Paramveer; Idowu, Olakunle; Malik, Imrana

    2015-01-01

    Magnesium is known to act at the neuromuscular junction by inhibiting the presynaptic release of acetylcholine and desensitizing the postsynaptic membrane. Because of these effects, magnesium has been postulated to potentiate neuromuscular weakness. We describe the case of a 62-year-old woman with myasthenia gravis and a metastatic thymoma who was admitted to our intensive care unit for management of a myasthenic crisis. The patient's neuromuscular weakness worsened in association with standard intravenous magnesium replacement, and the exacerbated respiratory failure necessitated intubation, mechanical ventilation, and an extended stay in the intensive care unit. The effect of magnesium replacement on myasthenia gravis patients has not been well documented, and we present this case to increase awareness and stimulate research. In addition, we discuss the relevant medical literature. PMID:26504451

  20. Avian influenza A (H5N1) infection with respiratory failure and meningoencephalitis in a Canadian traveller

    PubMed Central

    Rajabali, Naheed; Lim, Thomas; Sokolowski, Colleen; Prevost, Jason D; Lee, Edward Z

    2015-01-01

    In an urban centre in Alberta, an otherwise healthy 28-year-old woman presented to hospital with pleuritic chest and abdominal pain after returning from Beijing, China. After several days, this was followed by headache, confusion and, ultimately, respiratory failure, coma and death. Microbiology yielded influenza A subtype H5N1 from various body sites and neuroimaging was consistent with meningoencephalitis. While H5N1 infections in humans have been reported in Asia since 1997, this is the first documented case of H5N1 influenza in the Western Hemisphere. The present case demonstrated the typical manifestation of H5N1 influenza but, for the first time, also confirmed previous suggestions from human and animal studies that H5N1 is neurotropic and can manifest with neurological symptoms and meningoencephalitis. PMID:26361492

  1. Avian influenza A (H5N1) infection with respiratory failure and meningoencephalitis in a Canadian traveller.

    PubMed

    Rajabali, Naheed; Lim, Thomas; Sokolowski, Colleen; Prevost, Jason D; Lee, Edward Z

    2015-01-01

    In an urban centre in Alberta, an otherwise healthy 28-year-old woman presented to hospital with pleuritic chest and abdominal pain after returning from Beijing, China. After several days, this was followed by headache, confusion and, ultimately, respiratory failure, coma and death. Microbiology yielded influenza A subtype H5N1 from various body sites and neuroimaging was consistent with meningoencephalitis. While H5N1 infections in humans have been reported in Asia since 1997, this is the first documented case of H5N1 influenza in the Western Hemisphere. The present case demonstrated the typical manifestation of H5N1 influenza but, for the first time, also confirmed previous suggestions from human and animal studies that H5N1 is neurotropic and can manifest with neurological symptoms and meningoencephalitis. PMID:26361492

  2. Facial Involuntary Movements and Respiratory Failure in CANOMAD, Responsive to IVIG Therapy

    PubMed Central

    Johnson, Kate; Malkan, Ashish; Shaffi, Mohamed

    2015-01-01

    CANOMAD is a rare chronic neuropathy, characterized by chronic sensory ataxia and intermittent brain stem symptoms due to antidisialosyl antibodies. The disorder results in significant morbidity but is poorly understood and often misdiagnosed. We describe a unique case of CANOMAD, associated with involuntary movements of the face; patient reported exacerbations with citrus and chocolate and respiratory muscle weakness. Our patient was initially misdiagnosed with Miller Fisher Syndrome, highlighting the need for vigilance should neurological symptoms recur in patients initially diagnosed with a Guillain Barre variant. Moreover, the optimal treatment is unknown. This patient responded remarkably to intravenous immunoglobulin and has been maintained on this treatment, without further exacerbations. PMID:26697071

  3. SIMVASTATIN TREATMENT ATTENUATES INCREASED RESPIRATORY VARIABILITY AND APNEA/HYPOPNEA INDEX IN RATS WITH CHRONIC HEART FAILURE RR

    PubMed Central

    Haack, Karla K.V.; Marcus, Noah J.; Rio, Rodrigo Del; Zucker, Irving H.; Schultz, Harold D.

    2014-01-01

    Cheyne-Stokes respiration (CSR) and cardiac arrhythmias are associated with increased morbidity and mortality in patients with congestive heart failure (CHF). Enhanced carotid body chemoreflex (CBC) sensitivity is associated with these abnormalities in CHF. Reduced carotid body nitric oxide and nitric oxide synthase (NOS) levels play an important role in the enhanced CBC. In other disease models, Simvastatin (statin) treatment increases endothelial NOS (eNOS) in part by increasing Kruppel like Factor 2 (KLF2) expression. We hypothesized that statin treatment would ameliorate enhanced CBC sensitivity as well as increased respiratory variability (RV), apnea/hypopnea index (AHI), and arrhythmia index (AI), in a rodent model of CHF. Resting breathing pattern, cardiac rhythm, and the ventilatory and carotid body (CB) chemoreceptor afferent responses to hypoxia (CBC) were assessed in rats with CHF induced by coronary ligation. CHF was associated with enhanced ventilatory and CB afferent responses to hypoxia as well as increased RV, AHI, and AI. Statin treatment prevented the increases in CBC sensitivity and the concomitant increases in RV, AHI, and AI. KLF2 and eNOS protein were decreased in the CB and nucleus tractus solitarii (NTS) of CHF animals and statin treatment increased the expression of these proteins. Our findings demonstrate that the increased CBC sensitivity, respiratory instability and cardiac arrhythmias observed in CHF are ameliorated by statin treatment and suggest that statins may be an effective treatment for CSR and arrhythmias in patient populations with high chemoreflex sensitivity. PMID:24516105

  4. Association between Sjogren's Syndrome and Respiratory Failure: Put Airway, Interstitia, and Vessels Close Together: A National Cohort Study

    PubMed Central

    Yeh, Jun-Jun; Chen, Hsuan-Ju; Li, Tsai-Chung; Wong, Yi-Sin; Tang, Hsien-Chin; Yeh, Ting-Chun; Kao, Chia-Hung

    2014-01-01

    Objectives Few studies have evaluated the association between Sjogren's syndrome (SS) and respiratory failure (RF). Thus, we conducted a retrospective national cohort study to investigate whether Sjogren's syndrome (SS) increases the risk of respiratory failure (RF). Methods The cohort consisted of 4954 newly diagnosed patients with SS but without a previous diagnosis of RF, and 19816 patients as the comparison cohort from the catastrophic illnesses registry, obtained from the 2000–2005 period. All of the study participants were followed from the index date to December 31, 2011. We analyzed the association between the risk of RF and SS by using a Cox proportional hazards regression model, controlling for sex, age, and comorbidities. Results The overall incidence rate of RF showed a 3.21-fold increase in the SS cohort compared with the comparison cohort. The adjusted HR of RF was 3.04 for the SS cohort compared with the comparison cohort, after we adjusted for sex, age, and comorbidities. The HRs of RF for patients with primary SS and secondary SS compared with the comparison cohort were 2.99 and 3.93, respectively (P for trend <.001). The HRs of RF increased as the severity of SS increased, from 2.34 for those with no inpatient care experience to 5.15 for those with inpatient care experience (P for trend <.001). Conclusion This study indicates that clinical physicians should not only consider secondary SS but also primary SS as a critical factor that increases the risk of RF. PMID:25350278

  5. Severe respiratory illness caused by a novel coronavirus, in a patient transferred to the United Kingdom from the Middle East, September 2012.

    PubMed

    Bermingham, A; Chand, M A; Brown, C S; Aarons, E; Tong, C; Langrish, C; Hoschler, K; Brown, K; Galiano, M; Myers, R; Pebody, R G; Green, H K; Boddington, N L; Gopal, R; Price, N; Newsholme, W; Drosten, C; Fouchier, R A; Zambon, M

    2012-01-01

    Coronaviruses have the potential to cause severe transmissible human disease, as demonstrated by the severe acute respiratory syndrome (SARS) outbreak of 2003. We describe here the clinical and virological features of a novel coronavirus infection causing severe respiratory illness in a patient transferred to London, United Kingdom, from the Gulf region of the Middle East. PMID:23078800

  6. [Influenza-related respiratory illnesses and associated causes among the elderly in a city in Northeast Brazil].

    PubMed

    Gomes, Aline de Andrade; Nunes, Marco Antônio Prado; Oliveira, Cristiane Costa da Cunha; Lima, Sônia Oliveira

    2013-01-01

    Nationwide influenza vaccination campaigns are held annually in Brazil during the same time of the year. This study aimed to analyze deaths from respiratory illnesses and influenza-related causes among the elderly in the city of Aracaju, capital of Sergipe State, Brazil. Data were analyzed from the following databases: Information System on Influenza Epidemiological Surveillance (SIVEP_GRIPE), Hospital Information System (SIH), Mortality Information System (SIM), and Health Informatics Department (DATASUS), from 1998 to 2007, Sergipe State Central Laboratory (LACEN-SE), and rainfall data from the National Meteorology Institute (INMET). The year 2007 showed the highest mortality rate from influenza and related causes in elderly individuals. From 1998 to 2007, mortality rates from influenza-related respiratory illnesses and associated causes in Aracaju city were higher than in the States of Brazil, indicating the need to reformulate the influenza vaccination schedule in elderly residents of this city. PMID:23370031

  7. Giant Unruptured Sinus of Valsalva Aneurysm: An Unusual Cause of Right Heart Failure

    PubMed Central

    Jugpal, Tejeshwar Singh; Dixit, Rashmi; Lohchab, Samta; Garg, Anju

    2015-01-01

    Aneurysm of sinus of Valsalva is a rare cardiac abnormality. Unruptured aneurysm of sinus of Valsalva is usually asymptomatic and often discovered incidentally. However, a large aneurysm can, in rare cases, cause compression of the ventricular outflow tract. We report a case of 17-year-old male with congestive right heart failure with a large, partially thrombosed unruptured aneurysm of the right sinus of Valsalva. The aneurysmal sac was compressing the right ventricular outflow tract causing marked dilatation of the right ventricle and atrium that was confirmed on contrast-enhanced computed tomography imaging. Unruptured sinus of Valsalva aneurysm causing right heart failure in adolescence has been rarely reported in literature. PMID:26713180

  8. [Hairdressers live dangerously. Daily exposure to chemicals can cause respiratory tract problems].

    PubMed

    Karlsson, Thomas; Tondel, Martin

    2002-05-01

    Hairdressers are regularly exposed to toxic chemicals contained in bleach, hair spray, permanent wave solutions and hair dyes. Adequate ventilation and appropriate working procedures can reduce exposure, but never completely eliminate the risk for respiratory disease. PMID:12082780

  9. The Mckittrick-Wheelock Syndrome: A Rare Cause of Severe Hydroelectrolyte Disorders and Acute Renal Failure

    PubMed Central

    Bruno, Andrea; Chimienti, Domenico; Montanaro, Alda; Prete, Fernando; Libutti, Pasquale; Lisi, Piero; Basile, Carlo

    2011-01-01

    The McKittrick-Wheelock syndrome is a rare cause of severe hydroelectrolyte disorders and fluid depletion as a result of rectal tumor hypersecretion, which can lead to acute renal failure. We report the case of a 70-year-old female who presented with hyponatremia, hypokalemia, hypochloremia, and acute renal failure, due to a watery, mucinous diarrhea. A large rectal villous adenoma was discovered on ileocolonoscopy, and definitive management was achieved by removal of the tumor. In conclusion, reversal of the biochemical derangement is the cornerstone of successful management of the McKittrick-Wheelock syndrome. Then, immediate surgical resection of the tumor is the treatment of choice. PMID:24533197

  10. Extreme windkessel effect can cause right heart failure early after truncus repair

    PubMed Central

    Vanagt, Ward Y.; Famaey, Nele; Rega, Filip; Gewillig, Marc

    2012-01-01

    An infant developed severe right heart failure early after truncal repair with a pulmonary homograft. A mechanical obstruction by narrowing could not be identified at the homograft or pulmonary arteries. However, functional obstruction was caused by an extreme windkessel effect in a massively dilated homograft that absorbed rather than transmitted the pulse wave. Effective treatment consisted of replacing the dilated homograft by a rigid aortic homograft of equal size as the initial homograft. When confronted with circulatory failure after allograft placement, the clinician should not only look for obstruction by narrowing, but also consider the windkessel phenomenon. PMID:22467005

  11. Bilateral stones as a cause of acute renal failure in the emergency department

    PubMed Central

    Alonso, Joaquín V.; cachinero, Pedro L.; Ubeda, Fran R.; Ruiz, Daniel J. L.; Blanco, Alfredo

    2014-01-01

    BACKGROUND: Acute renal failure (ARF) due to obstructive uropathy is a urological emergency. The standard radiological investigations in the emergency setting include X-ray, ultrasonography and computed tomography. But occasionally the cause of obstruction may be elusive. METHODS: We present a case of obstructive uropathy due to bilateral stones presenting as acute renal failure. The patient underwent successful shock wave lithotripsy (SWL) for dissolution of calculi. RESULTS: The patient was successfully treated, and reported asymptomatic in a follow-up. CONCLUSION: Close collaboration between nephrological, urological, and radiological services is required. PMID:25215151

  12. An Elderly Man with Fatal Respiratory Failure after Eating a Poisonous Mushroom Podostroma cornu-damae

    PubMed Central

    Jang, Juah; Yoo, Jun Jae; Kim, Mi Kang; Lee, Jae Eun; Lim, Ah Leum; Choi, Jeong-Hee; Hyun, In Gyu; Shim, Jung Weon; Shin, Ho-Seung; Han, Joungho; Seok, Soon Ja

    2013-01-01

    A 73-year-old, previously healthy man presented with nausea, vomiting, diarrhea, dry mouth and febrile sensation 3 hours after eating boiled wild mushrooms. After admission, he showed progressive severe respiratory distress, pancytopenia, azotemia, hypotension, hypoxemia and consolidation of the entire left lung on chest radiography. With a preliminary diagnosis of necrotizing pneumonia, he underwent left pneumonectomy in order to remove all necrotic lung tissue. Lung histology showed extensive hemorrhagic necrosis, massive inflammatory cell infiltration, prominent proliferation of young fibroblasts and the formation of an early-stage hyaline membrane along the alveolar wall. Despite aggressive treatment, including mechanical ventilation, continuous renal replacement therapy and administration of granulocyte colony stimulating factor and broad spectrum antibiotics, he died on hospitalization day 13. Subsequently, the mushroom was identified as Podostroma cornu-damae. This is the first case of a histological evidence of lung involvement by Podostroma cornu-damae poisoning in Korea. PMID:24416059

  13. An Elderly Man with Fatal Respiratory Failure after Eating a Poisonous Mushroom Podostroma cornu-damae.

    PubMed

    Jang, Juah; Kim, Cheol-Hong; Yoo, Jun Jae; Kim, Mi Kang; Lee, Jae Eun; Lim, Ah Leum; Choi, Jeong-Hee; Hyun, In Gyu; Shim, Jung Weon; Shin, Ho-Seung; Han, Joungho; Seok, Soon Ja

    2013-12-01

    A 73-year-old, previously healthy man presented with nausea, vomiting, diarrhea, dry mouth and febrile sensation 3 hours after eating boiled wild mushrooms. After admission, he showed progressive severe respiratory distress, pancytopenia, azotemia, hypotension, hypoxemia and consolidation of the entire left lung on chest radiography. With a preliminary diagnosis of necrotizing pneumonia, he underwent left pneumonectomy in order to remove all necrotic lung tissue. Lung histology showed extensive hemorrhagic necrosis, massive inflammatory cell infiltration, prominent proliferation of young fibroblasts and the formation of an early-stage hyaline membrane along the alveolar wall. Despite aggressive treatment, including mechanical ventilation, continuous renal replacement therapy and administration of granulocyte colony stimulating factor and broad spectrum antibiotics, he died on hospitalization day 13. Subsequently, the mushroom was identified as Podostroma cornu-damae. This is the first case of a histological evidence of lung involvement by Podostroma cornu-damae poisoning in Korea. PMID:24416059

  14. Hemodynamics of Acute Right Heart Failure in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome.

    PubMed

    McLean, Barbara

    2015-12-01

    In critically ill patients with circulatory shock, the role of the left ventricle has long been appreciated and the object of measurement and therapeutic targeting. The right ventricle is often under appreciated and dysfunction may be overlooked. Generally, the right ventricle operates passively to support the ejection of the left ventricular diastolic volume. A loss of right ventricular wall compliance secondary to pulmonary pressures may result in an alteration in the normal pressure-volume relationship, ultimately affecting the stroke volume and cardiac output. Traditional right heart filling indices may increase because of decreasing compliance, further complicating the picture. The pathophysiology of pulmonary vascular dysfunction in acute respiratory distress syndrome combined with the effects of a mean airway pressure strategy may create an acute cor pulmonale. PMID:26567491

  15. Sleep Disordered Breathing and Chronic Respiratory Failure in Patients with Chronic Pain on Long Term Opioid Therapy

    PubMed Central

    Rose, Anand R.; Catcheside, Peter G.; McEvoy, R. Doug; Paul, Denzil; Kapur, Dilip; Peak, Emily; Vakulin, Andrew; Antic, Nicholas A.

    2014-01-01

    Study Objectives: The use of opioid medication for chronic pain has been increasing. The main aim of this study was to assess how many patients on opioids for chronic pain had sleep disordered breathing (SDB) and the type of SDB. The impact of these medications on daytime arterial blood gas (ABG) measurements and psychomotor vigilance was also studied. Methods: Twenty-four patients (aged 18-75 years) on long-term opioids were prospectively recruited. Patients underwent home polysomnogram (PSG), psychomotor vigilance testing (PVT), and awake daytime ABG. Overnight PSG findings were compared to those of patients matched for age, sex, and BMI referred to our sleep service for evaluation of SDB. PVT results in the patient cohort were compared to PVT in healthy controls. Results: Forty-six percent of opioid patients had severe SDB as defined by an apnea hypopnea index (AHI) > 30/h. The severity of SDB was similar in opioid-treated pain clinic patients and sleep clinic patients (mean ± SD AHI: Opioid-treated patients 32.7 ± 25.6; Sleep Study comparator group 28.9 ± 24.6, p = 0.6). Opioid patients had a higher frequency of central apneas and a lower arousal index (CAI: 3.9 ± 8.3 vs. 0.3 ± 0.5 events/h; p = 0.004, AI 8.0 ± 4.1 vs. 20.1 ± 13.8, p < 0.001). Pain clinic patients had impaired gas exchange during sleep and wakefulness. Nine of 20 (45%) had daytime hypercapnia, indicating a surprising number were in chronic respiratory failure. Morphine equivalent doses correlated with the severity of SDB. PVT was impaired when compared to a healthy PVT comparator group (RT: Opioid-treated patients 0.43 ± 0.27: Healthy PVT comparator group 0.28 ± 0.03 sec; p < 0.001). Conclusions: Patients on long-term opioids frequently have severe SDB, which in part is central in origin. PVT was markedly impaired. Half of the patients studied have evidence of chronic ventilatory failure. Commentary: A commentary on this article appears in this issue on page 853. Citation: Rose AR, Catcheside PG, McEvoy RD, Paul D, Kapur D, Peak E, Vakulin A, Antic NA. Sleep disordered breathing and chronic respiratory failure in patients with chronic pain on long term opioid therapy. J Clin Sleep Med 2014;10(8):847-852. PMID:25126029

  16. Contribution of skeletal muscle 'ergoreceptors' in the human leg to respiratory control in chronic heart failure.

    PubMed

    Scott, A C; Francis, D P; Davies, L C; Ponikowski, P; Coats, A J; Piepoli, M F

    2000-12-15

    The role of skeletal muscle ergoreceptors (afferents sensitive to muscle contraction, differentiated into metaboreceptors, sensitive to metabolic changes, and mechanoreceptors, sensitive to mechanical changes) in the genesis of the increased ventilatory drive in chronic heart failure is controversial. We have aimed to clarify the contribution of muscle metaboreceptors in the leg to ventilation and to compare this with the contribution of mechanoreceptors. Eighteen heart failure patients and 12 controls were studied. Metaboreceptor and mechanoreceptor responses were measured in the leg by bicycle exercise with and without regional circulatory occlusion during recovery, and by active and equivalent passive limb movement, respectively.Patients, in comparison with controls, had a lower peak VO2 (Oxygen uptake) (18.1+/-1.6 vs. 24.5+/-2.5 ml min(-1) kg(-1), P< 0.05), and an evident metaboreceptor contribution to the ventilatory response (3.5+/-1.6 vs. -4.0+/-1.3 l min(-1), P<0.001). Passive limb movement increased ventilation in both patients and controls (+3.7+/-0.4 and +2.9+/-0.5 l min(-1) from baseline, P<0.003), but this was associated with an increase in VO2 (+0.1+/-0.01 and +0.1+/-0.02 l min(-1) from baseline, P<0.001). The ratio of the increase in ventilation to the increase in VO2 during passive movement was not significantly higher than that during active exercise for either patients or controls, suggesting a limited contribution from the mechanoreceptors. In chronic heart failure the presence of a muscle metaboreceptor reflex is also demonstrated in the leg, while mechanoreceptors exhibited a non-significant contribution in both patients and controls. The hypothesis of a peripheral origin of symptoms of exertional intolerance in this syndrome is confirmed as being mainly due to metabolic stimulation of the muscle metaboreceptors. PMID:11118512

  17. NASA's Evolutionary Xenon Thruster (NEXT) Power Processing Unit (PPU) Capacitor Failure Root Cause Analysis

    NASA Technical Reports Server (NTRS)

    Soeder, James F.; Scheidegger, Robert J.; Pinero, Luis R.; Birchenough, Arthur J.; Dunning, John W.

    2012-01-01

    The NASA s Evolutionary Xenon Thruster (NEXT) project is developing an advanced ion propulsion system for future NASA missions for solar system exploration. A critical element of the propulsion system is the Power Processing Unit (PPU) which supplies regulated power to the key components of the thruster. The PPU contains six different power supplies including the beam, discharge, discharge heater, neutralizer, neutralizer heater, and accelerator supplies. The beam supply is the largest and processes up to 93+% of the power. The NEXT PPU had been operated for approximately 200+ hr and has experienced a series of three capacitor failures in the beam supply. The capacitors are in the same, nominally non-critical location-the input filter capacitor to a full wave switching inverter. The three failures occurred after about 20, 30, and 135 hr of operation. This paper provides background on the NEXT PPU and the capacitor failures. It discusses the failure investigation approach, the beam supply power switching topology and its operating modes, capacitor characteristics and circuit testing. Finally, it identifies root cause of the failures to be the unusual confluence of circuit switching frequency, the physical layout of the power circuits, and the characteristics of the capacitor.

  18. NASA's Evolutionary Xenon Thruster (NEXT) Power Processing Unit (PPU) Capacitor Failure Root Cause Analysis

    NASA Technical Reports Server (NTRS)

    Soeder, James F.; Pinero, Luis; Schneidegger, Robert; Dunning, John; Birchenough, Art

    2012-01-01

    The NASA's Evolutionary Xenon Thruster (NEXT) project is developing an advanced ion propulsion system for future NASA missions for solar system exploration. A critical element of the propulsion system is the Power Processing Unit (PPU) which supplies regulated power to the key components of the thruster. The PPU contains six different power supplies including the beam, discharge, discharge heater, neutralizer, neutralizer heater, and accelerator supplies. The beam supply is the largest and processes up to 93+% of the power. The NEXT PPU had been operated for approximately 200+ hours and has experienced a series of three capacitor failures in the beam supply. The capacitors are in the same, nominally non-critical location the input filter capacitor to a full wave switching inverter. The three failures occurred after about 20, 30, and 135 hours of operation. This paper provides background on the NEXT PPU and the capacitor failures. It discusses the failure investigation approach, the beam supply power switching topology and its operating modes, capacitor characteristics and circuit testing. Finally, it identifies root cause of the failures to be the unusual confluence of circuit switching frequency, the physical layout of the power circuits, and the characteristics of the capacitor.

  19. In-vitro renal epithelial cell infection reveals a viral kidney tropism as a potential mechanism for acute renal failure during Middle East Respiratory Syndrome (MERS) Coronavirus infection

    PubMed Central

    2013-01-01

    Background The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) causes symptoms similar to Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), yet involving an additional component of acute renal failure (ARF) according to several published case reports. Impairment of the kidney is not typically seen in Coronavirus infections. The role of kidney infection in MERS is not understood. Findings A systematic review of communicated and peer-reviewed case reports revealed differences in descriptions of kidney involvement in MERS versus SARS patients. In particular, ARF in MERS patients occurred considerably earlier after a median time to onset of 11 days (SD ±2,0 days) as opposed to 20 days for SARS, according to the literature. In-situ histological staining of the respective cellular receptors for MERS- and SARS-Coronavirus showed highly similar staining patterns with a focus of a receptor-specific signal in kidney epithelial cells. Comparative infection experiments with SARS- and MERS-CoV in primary human kidney cells versus primary human bronchial epithelial cells showed cytopathogenic infection only in kidney cells, and only if infected with MERS-CoV. Kidney epithelial cells produced almost 1000-fold more infectious MERS-CoV progeny than bronchial epithelial cells, while only a small difference was seen between cell types when infected with SARS-CoV. Conclusion Epidemiological studies should analyze kidney impairment and its characteristics in MERS-CoV. Virus replication in the kidney with potential shedding in urine might constitute a way of transmission, and could explain untraceable transmission chains leading to new cases. Individual patients might benefit from early induction of renoprotective treatment. PMID:24364985

  20. Causes of two slope-failure types in continental-shelf sediment, northeastern Gulf of Alaska

    USGS Publications Warehouse

    Schwab, William C.; Lee, Homa J.

    1988-01-01

    Slumps and sediment-gravity flows have been identified in Holocene glaciomarine sediment on declivities less than 1.3 degrees on the Gulf of Alaska continental shelf. Geologic and geotechnical investigation suggest that the processes responsible for these slope failures are earthquake and storm-wave loading, coupled with cyclic degradation of the sediment-shear strength. We propose that the failure type is related to the nature of the failure load. For example, a slump that occurs approximately 30 km seaward of Icy Bay in water depth of 70 to 150 m was most likely caused by earthquake loading, whereas sediment-gravity flows on the Alsek prodelta, which occur in water depths of 35 to 80 m, probably were caused primarily by storm-wave loading. Sediment remolding and redistribution and incorporation of water, which occurs more readily during wave loading from a long storm than during the limited number of loading cycles generated by an earthquake, reduces the shear strength and increases the fluidity of the failed sediment mass. Wave-induced slope failures thereby tend to transform into sediment-gravity flows.

  1. Questioning the Role of Requirements Engineering in the Causes of Safety-Critical Software Failures

    NASA Technical Reports Server (NTRS)

    Johnson, C. W.; Holloway, C. M.

    2006-01-01

    Many software failures stem from inadequate requirements engineering. This view has been supported both by detailed accident investigations and by a number of empirical studies; however, such investigations can be misleading. It is often difficult to distinguish between failures in requirements engineering and problems elsewhere in the software development lifecycle. Further pitfalls arise from the assumption that inadequate requirements engineering is a cause of all software related accidents for which the system fails to meet its requirements. This paper identifies some of the problems that have arisen from an undue focus on the role of requirements engineering in the causes of major accidents. The intention is to provoke further debate within the emerging field of forensic software engineering.

  2. 76 FR 67764 - Common-Cause Failure Analysis in Event and Condition Assessment: Guidance and Research, Draft...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-02

    ... Common-Cause Failure Analysis in Event and Condition Assessment: Guidance and Research, Draft Report for..., Revision 0, ``Common-Cause Failure Analysis in Event and Condition Assessment: Guidance and Research, Draft..., Maryland 20852. NRC's Agencywide Documents Access and Management System (ADAMS): Publicly...

  3. Transthyretin cardiac amyloidosis: an under-diagnosed cause of heart failure

    PubMed Central

    Molina O, Gabriela; Judge, Daniel; Campbell, Wayne; Chahal, Harjit; Mugmon, Marc

    2014-01-01

    Introduction Cardiac amyloidosis is the most common cause of infiltrative cardiomyopathy and is associated with a poor prognosis. Transthyretin cardiac amyloidosis, particularly the type caused by the mutation that replaces the amino acid valine with the amino acid isoleucine at position 122 (Val122Ile), is most common among African- Americans above 65 years of age. Evidence suggests that this mutation is an important, though under-diagnosed, cause of heart failure in this population. Case presentation A 74-year-old African American male with a diagnosis of non-ischemic cardiomyopathy for several years, presented with gradually worsening dyspnea on exertion and lower extremity edema. There is no known cardiac disease in his family. An echocardiogram was done showing a decrease in ejection fraction to 30% from 45% in the span of a year. An endomyocardial biopsy analysis identified transthyretin amyloid with the Val122Ile mutation, confirming the diagnosis of familial transthyretin cardiomyopathy. Discussion Systemic amyloidosis is a group of diseases caused by the deposition of an abnormally folded, insoluble protein that can accumulate in multiple organs causing progressive and irreversible dysfunction. The mutations that most commonly induce variant transthyretin cardiac amyloidosis are Val122Ile, Val30Met and Thr60Ala. The Val122Ile mutation has been found to be present in 3–4% of the African American/Caribbean population. Conclusions Familial amyloid cardiomyopathy is an uncommonly recognized cause of heart failure in the population, and patients may wait several years before accurate diagnosis, risking additional significant irreversible deterioration. Patients that meet the high-risk profile criteria – male gender, age 65 years and older, heart failure symptoms, symmetric left ventricular (LV) hypertrophy, and moderately depressed LV function – should likely undergo additional testing for cardiac amyloidosis. PMID:25432650

  4. Upper Respiratory Tract Disease in the Gopher Tortoise Is Caused by Mycoplasma agassizii†

    PubMed Central

    Brown, M. B.; McLaughlin, G. S.; Klein, P. A.; Crenshaw, B. C.; Schumacher, I. M.; Brown, D. R.; Jacobson, E. R.

    1999-01-01

    Upper respiratory tract disease (URTD) has been observed in a number of tortoise species, including the desert tortoise (Gopherus agassizii) and the gopher tortoise (Gopherus polyphemus). Clinical signs of URTD in gopher tortoises are similar to those in desert tortoises and include serous, mucoid, or purulent discharge from the nares, excessive tearing to purulent ocular discharge, conjunctivitis, and edema of the eyelids and ocular glands. The objectives of the present study were to determine if Mycoplasma agassizii was an etiologic agent of URTD in the gopher tortoise and to determine the clinical course of the experimental infection in a dose-response infection study. Tortoises were inoculated intranasally with 0.5 ml (0.25 ml/nostril) of either sterile SP4 broth (control group; n = 10) or 108 color-changing units (CCU) (total dose) of M. agassizii 723 (experimental infection group; n = 9). M. agassizii caused clinical signs compatible with those observed in tortoises with natural infections. Clinical signs of URTD were evident in seven of nine experimentally infected tortoises by 4 weeks postinfection (p.i.) and in eight of nine experimentally infected tortoises by 8 weeks p.i. In the dose-response experiments, tortoises were inoculated intranasally with a low (101 CCU; n = 6), medium (103 CCU; n = 6), or high (105 CCU; n = 5) dose of M. agassizii 723 or with sterile SP4 broth (n = 10). At all time points p.i. in both experiments, M. agassizii could be isolated from the nares of at least 50% of the tortoises. All of the experimentally infected tortoises seroconverted, and levels of antibody were statistically higher in infected animals than in control animals for all time points of >4 weeks p.i. (P < 0.0001). Control tortoises in both experiments did not show clinical signs, did not seroconvert, and did not have detectable M. agassizii by either culture or PCR at any point in the study. Histological lesions were compatible with those observed in tortoises with natural infections. The numbers of M. agassizii 723 did not influence the clinical expression of URTD or the antibody response, suggesting that the strain chosen for these studies was highly virulent. On the basis of the results of the transmission studies, we conclude that M. agassizii is an etiologic agent of URTD in the gopher tortoise. PMID:10364595

  5. Identification of a mannheimia haemolytica genetic subtype that causes bovine respiratory disease

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Bovine respiratory disease complex (BRDC) is a serious health and economic problem that costs the United States cattle industry over a billion dollars annually. Mannheimia haemolytica is a major bacterial component of BRDC. An opportunistic pathogen, M. haemolytica resides within the upper respira...

  6. Designed for workarounds: a qualitative study of the causes of operational failures in hospitals.

    PubMed

    Tucker, Anita L; Heisler, W Scott; Janisse, Laura D

    2014-01-01

    Frontline care clinicians and staff in hospitals spend at least 10% of their time working around operational failures: situations in which information, supplies, or equipment needed for patient care are insufficient. However, little is known about underlying causes of operational failures and what hospitals can do to reduce their occurrence. To address this gap, we examined the internal supply chains at 2 hospitals with the aim of discovering organizational factors that contribute to operational failures. We conducted in-depth qualitative research, including observations and interviews of more than 80 individuals from 4 nursing units and the ancillary support departments that provide equipment and supplies needed for patient care. We found that a lack of interconnectedness among interdependent departments' routines was a major source of operational failures. The low levels of interconnectedness occurred because of how the internal supply chains were designed and managed rather than because of employee error or a shortfall in training. Thus, we propose that the time that hospital staff members spend on workarounds can be reduced through deliberate efforts to increase interconnectedness among hospitals' internal supply departments. Four dimensions of interconnectedness include: 1) hospital-level-rather than department-level-performance measures; 2) internal supply department routines that respond to specific patients' needs rather than to predetermined stocking routines; 3) knowledge that is necessary for efficient handoffs of materials that is translated across departmental boundaries; and 4) cross-departmental collaboration mechanisms that enable improvement in the flow of materials across departmental boundaries. PMID:25102517

  7. Creep-fatigue as a possible cause of dental amalgam margin failure.

    PubMed

    Williams, P T; Hedge, G L

    1985-03-01

    Fracture of the margins is the most common cause of failure of dental amalgam restorations. Both corrosion and creep have been identified as possible contributors to this type of failure. The stresses that induce creep may arise from the continued setting expansion of the amalgam, the formation of corrosion products, mastication, or from the thermal expansion of the amalgam during ingestion of hot foods. The latter two are low-frequency cyclic stresses. The amalgams used in dentistry have fusion temperatures only about 40 degrees C above mouth temperature, and they experience grain boundary sliding during creep deformation. Since grain boundary sliding, low-frequency cyclic stresses, and a temperature near the fusion temperature of the alloy are prerequisites for so-called "creep-fatigue fracture", this type of fracture may contribute to amalgam margin failure. Amalgam made from seven different alloys was condensed into stainless steel dies. After being allowed to set for seven days, the specimens were thermally cycled between 4 degrees C and 50 degrees C for 500 and 1000 cycles. Amalgam margin integrity was evaluated by scanning electron microscopy both before and after each cycling period. The amount of margin fracture was calculated after 1000 cycles. Thermal cycling of amalgam restorations placed in stainless steel dies resulted in predominantly intergranular fracturing of the amalgam margins, indicating that creep-fatigue failure may be a significant contributor to in vivo margin fracturing. PMID:3855901

  8. Designed for Workarounds: A Qualitative Study of the Causes of Operational Failures in Hospitals

    PubMed Central

    Tucker, Anita L; Heisler, W Scott; Janisse, Laura D

    2014-01-01

    Frontline care clinicians and staff in hospitals spend at least 10% of their time working around operational failures: situations in which information, supplies, or equipment needed for patient care are insufficient. However, little is known about underlying causes of operational failures and what hospitals can do to reduce their occurrence. To address this gap, we examined the internal supply chains at 2 hospitals with the aim of discovering organizational factors that contribute to operational failures. We conducted in-depth qualitative research, including observations and interviews of more than 80 individuals from 4 nursing units and the ancillary support departments that provide equipment and supplies needed for patient care. We found that a lack of interconnectedness among interdependent departments’ routines was a major source of operational failures. The low levels of interconnectedness occurred because of how the internal supply chains were designed and managed rather than because of employee error or a shortfall in training. Thus, we propose that the time that hospital staff members spend on workarounds can be reduced through deliberate efforts to increase interconnectedness among hospitals’ internal supply departments. Four dimensions of interconnectedness include: 1) hospital-level—rather than department-level—performance measures; 2) internal supply department routines that respond to specific patients’ needs rather than to predetermined stocking routines; 3) knowledge that is necessary for efficient handoffs of materials that is translated across departmental boundaries; and 4) cross-departmental collaboration mechanisms that enable improvement in the flow of materials across departmental boundaries. PMID:25102517

  9. Rocking bed and prolonged independence from nocturnal non-invasive ventilation in neurogenic respiratory failure associated with limb weakness

    PubMed Central

    Cormican, L; Higgins, S; Davidson, A; Howard, R; Williams, A

    2004-01-01

    A 40 year old mother of three with autosomal dominant scapuloperoneal muscular dystrophy presented with severe neurogenic respiratory failure requiring nocturnal non-invasive ventilation (NIV). Because of the development of profound proximal muscular weakness as a consequence of the progressive nature of her neurological disease, she eventually was unable to apply and remove the facial interface to set up her NIV circuit. She therefore became dependent on her children and carers to start and stop NIV during the night. A rocking bed was successfully employed as an alternative to nocturnal NIV. Ventilation was facilitated by the passive movement of the diaphragm as a consequence of the movement of the abdominal contents under the effect of gravity. Benefit was demonstrated objectively by pulse oximetry and subjectively by the improvement in the patient's symptomatology and continued independence at night. The ease of use of a rocking bed should be borne in mind when the necessity for nocturnal ventilatory support in neuromuscular disease results in the potential loss of independence for a patient. PMID:15192173

  10. Scrub typhus complicated by acute respiratory distress syndrome and acute liver failure: a case report from Northeast India.

    PubMed

    Goswami, Dibyajyoti; Hing, Arlangki; Das, Ananta; Lyngdoh, Monaliza

    2013-08-01

    Acute respiratory distress syndrome (ARDS) is a serious complication of scrub typhus. Only a few cases of scrub typhus complicated by ARDS have been discussed in the literature to date. Herein we report the case of a patient who presented with scrub typhus complicated by ARDS and acute liver failure (ALF) and who was successfully treated in our institute. Due to the non-specificity and diversity of the initial presenting symptoms, a lack of awareness about the disease amongst physicians, and the lack of accessibility to facilities for serodiagnosis in developing countries, there is a chance of misdiagnosis during the early stage. At the same time, early diagnosis and prompt treatment are crucial to prevent life-threatening complications. Our patient was initially misdiagnosed with a common cold and then malaria. By the time a correct diagnosis was made, complications had already developed. To the best of our knowledge, this is the first case of scrub typhus complicated by ARDS and ALF to be reported from the northeastern region of India. PMID:23402799

  11. Antiviral activity in vitro of two preparations of the herbal medicinal product Sinupret® against viruses causing respiratory infections.

    PubMed

    Glatthaar-Saalmüller, B; Rauchhaus, U; Rode, S; Haunschild, J; Saalmüller, A

    2011-12-15

    Sinupret(®), a herbal medicinal product made from Gentian root, Primula flower, Elder flower, Sorrel herb, and Verbena herb is frequently used in the treatment of acute and chronic rhinosinusitis and respiratory viral infections such as common cold. To date little is known about its potential antiviral activity. Therefore experiments have been performed to measure the antiviral activity of Sinupret(®) oral drops (hereinafter referred to as "oral drops") and Sinupret(®) dry extract (hereinafter referred to as "dry extract"), in vitro against a broad panel of both enveloped and non-enveloped human pathogenic RNA and DNA viruses known to cause infections of the upper respiratory tract: influenza A, Chile 1/83 (H1N1) virus (FluA), Porcine Influenza A/California/07/2009 (H1N1) virus (pFluA), parainfluenza type 3 virus (Para 3), respiratory syncytial virus, strain Long (RSV), human rhinovirus B subtype 14 (HRV 14), coxsackievirus subtype A9 (CA9), and adenovirus C subtype 5 (Adeno 5). Concentration-dependent antiviral activity (EC(50) between 13.8 and 124.8 ?g/ml) of Sinupret(®) was observed against RNA as well as DNA viruses independent of a viral envelope. Remarkable antiviral activity was shown against Adeno 5, HRV 14 and RSV in which dry extract was significantly superior to oral drops. This could be ascertained with different assays as plaque-reduction assays in plaque forming units (PFU), the analyses of a cytopathogenic effect (CPE) and with enzyme immunoassays (ELISA) to determine the amount of newly synthesised virus. Our results demonstrate that Sinupret(®) shows a broad spectrum of antiviral activity in vitro against viruses commonly known to cause respiratory infections. PMID:22112724

  12. Acute respiratory infection and bacteraemia as causes of non-malarial febrile illness in African children: a narrative review

    PubMed Central

    Muro, Florida; Reyburn, Rita; Reyburn, Hugh

    2015-01-01

    The replacement of “presumptive treatment for malaria” by “test before treat” strategies for the management of febrile illness is raising awareness of the importance of knowing more about the causes of illness in children who are suspected to have malaria but return a negative parasitological test. The most common cause of non-malarial febrile illness (NMFI) in African children is respiratory tract infection. Whilst the bacterial causes of NMFI are well known, the increasing use of sensitive techniques such as polymerase chain reaction (PCR) tests is revealing large numbers of viruses that are potential respiratory pathogens. However, many of these organisms are commonly present in the respiratory tract of healthy children so causality and risk factors for pneumonia remain poorly understood. Infection with a combination of viral and bacterial pathogens is increasingly recognised as important in the pathogenesis of pneumonia. Similarly, blood stream infections with organisms typically grown by aerobic culture are well known but a growing number of organisms that can be identified only by PCR, viral culture, or serology are now recognised to be common pathogens in African children. The high mortality of hospitalised children on the first or second day of admission suggests that, unless results are rapidly available, diagnostic tests to identify specific causes of illness will still be of limited use in guiding the potentially life saving decisions relating to initial treatment of children admitted to district hospitals in Africa with severe febrile illness and a negative test for malaria. Malaria control and the introduction of vaccines against Haemophilus influenzae type b and pneumococcal disease are contributing to improved child survival in Africa. However, increased parasitological testing for malaria is associated with increased use of antibiotics to which resistance is already high.

  13. Complex bladder-exstrophy-epispadias management: causes of failure of initial bladder closure.

    PubMed

    Bertin, Kouame Dibi; Serge, Kouame Yapo Guy; Moufidath, Sounkere; Maxime, Koffi; Hervé, Odehouri Koudou Thierry; Baptiste, Yaokreh Jean; Samba, Tembely; Gaudens, Dieth Atafi; Ossenou, Ouattara; Ruffin, Dick

    2014-01-01

    The success of the initial closure of the complex bladder-exstrophy remains a challenge in pediatric surgery. This study describes a personal experience of the causes of failure of the initial closure and operative morbidity during the surgical treatment of bladder-exstrophy complex. From April 2000 to March 2014, four patients aged 16 days to 7 years and 5 months underwent complex exstrophy-epispadias repair with pelvic osteotomies. There were three males and one female. Three of them had posterior pelvic osteotomy, one had anterior innominate osteotomy. Bladder Closure: Bladder closure was performed in three layers. Our first patient had initial bladder closure with polyglactin 4/0 (Vicryl ® 4/0), concerning the last three patients, initial bladder closure was performed with polydioxanone 4/0 (PDS ® 4/0). The bladder was repaired leaving the urethral stent and ureteral stents for full urinary drainage for three patients. In one case, only urethral stent was left, ureteral drainage was not possible, because stents sizes were more important than the ureteral diameter. Out of a total of four patients, initial bladder closure was completely achieved for three patients. At the immediate postoperative follow-up, two patients presented a complete disunion of the abdominal wall and bladder despite an appropriate postoperative care. The absorbable braided silk (polyglactin) used for the bladder closure was considered as the main factor in the failure of the bladder closure. The second cause of failure of the initial bladder closure was the incomplete urine drainage, ureteral catheterisation was not possible because the catheters sizes were too large compared with the diameters of the ureters. The failure of the initial bladder-exstrophy closure may be reduced by a closure with an absorbable monofilament silk and efficient urine drainage via ureteral catheterisation. PMID:25323185

  14. New disease allele and de novo mutation indicate mutational vulnerability of titin exon 343 in hereditary myopathy with early respiratory failure.

    PubMed

    Yue, Dongyue; Gao, Mingshi; Zhu, Wenhua; Luo, Sushan; Xi, Jianying; Wang, Bei; Li, Ying; Cai, Shuang; Li, Jin; Wang, Yin; Lu, Jiahong; Zhao, Chongbo

    2015-02-01

    We report two patients of Chinese ancestry with hereditary myopathy with early respiratory failure, one sporadic with atypical onset as rigid spine syndrome, the other familial with 10 years' history of hyperCKemia. Muscle biopsy was either nonspecific or typical with cytoplasmic bodies and rimmed vacuoles. Despite the phenotypic variety, both patients showed fatty infiltration of semitendinosus on muscle magnetic resonance imaging. Genetic analysis of case 1 disclosed de novo heterozygous missense mutations in the 119th fibronectin 3 domain of titin [c.90272C>T, p.P30091L]. Haplotype analysis of case 2 revealed a heterozygous missense mutation [c.90211T>C, p.C30071R] on a new disease allele incompatible with the British common haplotype. These findings suggest that hereditary myopathy with early respiratory failure is a worldwide distributed disorder and indicate the mutational vulnerability of TTN exon 343 in which de novo mutations could occur on different haplotype backgrounds. PMID:25500009

  15. Mutation of kri1l causes definitive hematopoiesis failure via PERK-dependent excessive autophagy induction

    PubMed Central

    Jia, Xiao-E; Ma, Ke; Xu, Tao; Gao, Lei; Wu, Shuang; Fu, Cong; Zhang, Wenjuan; Wang, Zhizhang; Liu, Kaiyu; Dong, Mei; Jing, Changbin; Ren, Chunguang; Dong, Zhiwei; Chen, Yi; Jin, Yi; Huang, Qiuhua; Chang, Xing; Deng, Min; Li, Li; Luo, Lingfei; Zhu, Jun; Dang, Yongjun; Chang, Hung-Chun; Zon, Leonard I; Zhou, Yi; Chen, Saijuan; Pan, Weijun

    2015-01-01

    Dysregulation of ribosome biogenesis causes human diseases, such as Diamond-Blackfan anemia, del (5q-) syndrome and bone marrow failure. However, the mechanisms of blood disorders in these diseases remain elusive. Through genetic mapping, molecular cloning and mechanism characterization of the zebrafish mutant cas002, we reveal a novel connection between ribosomal dysfunction and excessive autophagy in the regulation of hematopoietic stem/progenitor cells (HSPCs). cas002 carries a recessive lethal mutation in kri1l gene that encodes an essential component of rRNA small subunit processome. We show that Kri1l is required for normal ribosome biogenesis, expansion of definitive HSPCs and subsequent lineage differentiation. Through live imaging and biochemical studies, we find that loss of Kri1l causes the accumulation of misfolded proteins and excessive PERK activation-dependent autophagy in HSPCs. Blocking autophagy but not inhibiting apoptosis by Bcl2 overexpression can fully rescue hematopoietic defects, but not the lethality of kri1lcas002 embryos. Treatment with autophagy inhibitors (3-MA and Baf A1) or PERK inhibitor (GSK2656157), or knockdown of beclin1 or perk can markedly restore HSPC proliferation and definitive hematopoietic cell differentiation. These results may provide leads for effective therapeutics that benefit patients with anemia or bone marrow failure caused by ribosome disorders. PMID:26138676

  16. Mutation of kri1l causes definitive hematopoiesis failure via PERK-dependent excessive autophagy induction.

    PubMed

    Jia, Xiao-E; Ma, Ke; Xu, Tao; Gao, Lei; Wu, Shuang; Fu, Cong; Zhang, Wenjuan; Wang, Zhizhang; Liu, Kaiyu; Dong, Mei; Jing, Changbin; Ren, Chunguang; Dong, Zhiwei; Chen, Yi; Jin, Yi; Huang, Qiuhua; Chang, Xing; Deng, Min; Li, Li; Luo, Lingfei; Zhu, Jun; Dang, Yongjun; Chang, Hung-Chun; Zon, Leonard I; Zhou, Yi; Chen, Saijuan; Pan, Weijun

    2015-08-01

    Dysregulation of ribosome biogenesis causes human diseases, such as Diamond-Blackfan anemia, del (5q-) syndrome and bone marrow failure. However, the mechanisms of blood disorders in these diseases remain elusive. Through genetic mapping, molecular cloning and mechanism characterization of the zebrafish mutant cas002, we reveal a novel connection between ribosomal dysfunction and excessive autophagy in the regulation of hematopoietic stem/progenitor cells (HSPCs). cas002 carries a recessive lethal mutation in kri1l gene that encodes an essential component of rRNA small subunit processome. We show that Kri1l is required for normal ribosome biogenesis, expansion of definitive HSPCs and subsequent lineage differentiation. Through live imaging and biochemical studies, we find that loss of Kri1l causes the accumulation of misfolded proteins and excessive PERK activation-dependent autophagy in HSPCs. Blocking autophagy but not inhibiting apoptosis by Bcl2 overexpression can fully rescue hematopoietic defects, but not the lethality of kri1l(cas002) embryos. Treatment with autophagy inhibitors (3-MA and Baf A1) or PERK inhibitor (GSK2656157), or knockdown of beclin1 or perk can markedly restore HSPC proliferation and definitive hematopoietic cell differentiation. These results may provide leads for effective therapeutics that benefit patients with anemia or bone marrow failure caused by ribosome disorders. PMID:26138676

  17. Respiratory Viral Infection in Neonatal Piglets Causes Marked Microglia Activation in the Hippocampus and Deficits in Spatial Learning

    PubMed Central

    Elmore, Monica R. P.; Burton, Michael D.; Conrad, Matthew S.; Rytych, Jennifer L.; Van Alstine, William G.

    2014-01-01

    Environmental insults during sensitive periods can affect hippocampal development and function, but little is known about peripheral infection, especially in humans and other animals whose brain is gyrencephalic and experiences major perinatal growth. Using a piglet model, the present study showed that inoculation on postnatal day 7 with the porcine reproductive and respiratory syndrome virus (PRRSV) caused microglial activation within the hippocampus with 82% and 43% of isolated microglia being MHC II+ 13 and 20 d after inoculation, respectively. In control piglets, <5% of microglia isolated from the hippocampus were MHC II+. PRRSV piglets were febrile (p < 0.0001), anorectic (p < 0.0001), and weighed less at the end of the study (p = 0.002) compared with control piglets. Increased inflammatory gene expression (e.g., IL-1?, IL-6, TNF-?, and IFN-?) was seen across multiple brain regions, including the hippocampus, whereas reductions in CD200, NGF, and MBP were evident. In a test of spatial learning, PRRSV piglets took longer to acquire the task, had a longer latency to choice, and had a higher total distance moved. Overall, these data demonstrate that viral respiratory infection is associated with a marked increase in activated microglia in the hippocampus, neuroinflammation, and impaired performance in a spatial cognitive task. As respiratory infections are common in human neonates and infants, approaches to regulate microglial cell activity are likely to be important. PMID:24501353

  18. Respiratory depression due to unsuspected narcotic ingestion treated with naloxone.

    PubMed Central

    Curnock, D A

    1978-01-01

    Two patients are presented with respiratory depression for which no cause was apparent. Both had ingested narcotics without the parents' knowledge. Narcotic ingestion should be suspected if signs of respiratory failure with constricted pupils are present, and a diagnostic test with naloxone should be performed. PMID:686779

  19. Congenital cutaneous hemangioma causing cardiac failure: a case report and review of the literature.

    PubMed

    Weitz, Nicole A; Lauren, Christine T; Starc, Thomas J; Kandel, Jessica J; Bateman, David A; Morel, Kimberly D; Meyers, Philip M; Kadenhe-Chiweshe, Angela; Wu, June K; Garzon, Maria C

    2013-01-01

    We present a case of a large congenital hemangioma (CH) on the neck causing cardiac failure and thrombocytopenia in a female neonate. A trial of medical therapy with corticosteroids and propranolol was attempted, but the patient ultimately underwent definitive treatment with embolization and surgical resection with a positive outcome. A review of the English language literature revealed 16 previously reported cases of CHs complicated by congestive heart failure. This series supports known demographic features of CHs, including a lack of gender discrepancy and a predilection to affect the head and neck. These CHs are rarely diagnosed in utero; most patients present with a mass at birth. Cardiac failure is identified prenatally or in the first days of life. A mild to moderate thrombocytopenia and coagulopathy, which is likely transient and distinct from classic Kasabach-Merritt phenomenon, accompanies many of these cases. There is a 30% associated mortality rate. Both medical and interventional treatment modalities have been reported. Steroids are the most commonly used medication, but without any clear benefit. We hypothesize that, based on its possible mechanisms of action,propranolol may be a more effective treatment for CHs requiring treatment. As surgical intervention may be necessary, we recommend a multidisciplinary approach to treating patients with problematic CHs. PMID:23025620

  20. Human intermittent hypoxia-induced respiratory plasticity is not caused by inflammation.

    PubMed

    Beaudin, Andrew E; Waltz, Xavier; Pun, Matiram; Wynne-Edwards, Katherine E; Ahmed, Sofia B; Anderson, Todd J; Hanly, Patrick J; Poulin, Marc J

    2015-10-01

    Ventilatory instability, reflected by enhanced acute hypoxic (AHVR) and hypercapnic (AHCVR) ventilatory responses is a fundamental component of obstructive sleep apnoea (OSA) pathogenesis. Intermittent hypoxia-induced inflammation is postulated to promote AHVR enhancement in OSA, although the role of inflammation in intermittent hypoxia-induced respiratory changes in humans has not been examined. Thus, this study assessed the role of inflammation in intermittent hypoxia-induced respiratory plasticity in healthy humans.In a double-blind, placebo-controlled, randomised crossover study design, 12 males were exposed to 6?h of intermittent hypoxia on three occasions. Prior to intermittent hypoxia exposures, participants ingested (for 4??days) either placebo or the nonsteroidal anti-inflammatory drugs indomethacin (nonselective cyclooxygenase (COX) inhibitor) and celecoxib (selective COX-2 inhibitor). Pre- and post-intermittent hypoxia resting ventilation, AHVR, AHCVR and serum concentration of the pro-inflammatory cytokine tumour necrosis factor (TNF)-? were assessed.Pre-intermittent hypoxia resting ventilation, AHVR, AHCVR and TNF-? concentrations were similar across all three conditions (p?0.093). Intermittent hypoxia increased resting ventilation and the AHVR similarly across all conditions (p=0.827), while the AHCVR was increased (p=0.003) and TNF-? was decreased (p=0.006) with only selective COX-2 inhibition.These findings indicate that inflammation does not contribute to human intermittent hypoxia-induced respiratory plasticity. Moreover, selective COX-2 inhibition augmented the AHCVR following intermittent hypoxia exposure, suggesting that selective COX-2 inhibition could exacerbate OSA severity by increasing ventilatory instability. PMID:26065565

  1. [Fractured tracheostomy tube: a rare cause of respiratory distress in the tracheotomized child. Case report].

    PubMed

    Cuestas, Giselle; Martínez, Juan C; Pena, Roberto; Razetti, Juan

    2015-12-01

    Fracture and migration of the tracheotomy tube in the tracheobronchial tree is an uncommon complication of tracheotomy. Early diagnosis and proper treatment are essential because of the potential risk of fatal respiratory obstruction. Diagnosis should be suspected in all tracheotomized children undergoing breathing difficulties. It is confirmed by chest x-ray and endoscopic examination. The recommended treatment includes the endoscopic removal of the aspirated cannula through the tracheal stoma. We describe the clinical presentation and the management of a broken tracheotomy tube which was presented as a foreign body in the airway of a 18-month-old child. Recommendations for tracheostomy care are listed. PMID:26593816

  2. Wind-Turbine Gear-Box Roller-Bearing Premature-Failure Caused by Grain-Boundary Hydrogen Embrittlement

    E-print Network

    Grujicic, Mica

    Wind-Turbine Gear-Box Roller-Bearing Premature-Failure Caused by Grain-Boundary Hydrogen, 2014) To help overcome the problem of horizontal-axis wind-turbine (HAWT) gear-box roller of the damage progression in, and the final failure of a prototypical HAWT gear-box roller-bearing inner raceway

  3. [Post-infarction pseudoaneurysm of the left ventricle as a cause of heart failure. Presentation of a surgically treated case].

    PubMed

    Sani, G; Lisi, G; Mezzacapo, B

    1990-08-01

    Pseudoaneurysm of the left ventricle is an unusual complication of myocardial infarction. Surgical resection is justified by the high risk of rupture. Patients may be asymptomatic, more often a clinical state of chronic heart failure is present. We report on a patient who successfully underwent urgent resection of a large pseudoaneurysm which was the cause of acute heart failure. PMID:2272423

  4. Giant Congenital Pelvic AVM Causing Cardiac Failure, Diplegia, and Neurogenic Bladder

    PubMed Central

    Bekci, Tumay; Yucel, Serap; Turgut, Eser; Soylu, Aysegul Idil

    2015-01-01

    Summary Background Pelvic arteriovenous malformations (AVMs) are uncommon lesions and only a rare number of male cases have been reported. Their clinical presentations are variable and imaging modalities have an important place in diagnosis and treatment planning. Case Report We present the imaging findings of a giant congenital pelvic AVM that was diagnosed in a 30-year-old male patient eight years ago and which progressed despite follow-up and treatment, causing cardiac failure, diplegia, and neurogenic bladder. Conclusions Pelvic AVMs are uncommon lesions and they can present with various symptoms based on their locations and sizes. Delays in the diagnosis and treatment can cause local and systemic complications. Imaging is very important in the diagnosis of pelvic AVM. PMID:26634010

  5. 76 FR 67764 - Common-Cause Failure Analysis in Event and Condition Assessment: Guidance and Research, Draft...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-02

    ...Common-Cause Failure Analysis in Event and Condition Assessment...Song-Hua Shen, Division of Risk Analysis, Office of Nuclear Regulatory...Chief, Performance and Reliability Branch, Division of Risk Analysis, Office of Nuclear...

  6. 77 FR 5857 - Common-Cause Failure Analysis in Event and Condition Assessment: Guidance and Research, Draft...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-06

    ...Song-Hua Shen, Division of Risk Analysis, Office of Nuclear Regulatory...Common-Cause Failure Analysis in Event and Condition Assessment...Chief, Performance and Reliability Branch, Division of Risk Analysis, Office of Nuclear...

  7. Severe hypoalbuminemia is a strong independent risk factor for acute respiratory failure in COPD: a nationwide cohort study

    PubMed Central

    Chen, Char-Wen; Chen, Yih-Yuan; Lu, Chin-Li; Chen, Solomon Chih-Cheng; Chen, Yi-Jen; Lin, Ming-Shian; Chen, Wei

    2015-01-01

    Background Acute respiratory failure (ARF) is a life-threatening event, which is frequently associated with the severe exacerbations of chronic obstructive pulmonary disease (COPD). Hypoalbuminemia is associated with increased mortality in patients with COPD. However, to date, little is known regarding whether or not hypoalbuminemia is a risk factor for developing ARF in COPD. Methods We conducted a retrospective cohort study using data from the National Health Insurance system of Taiwan. A total of 42,732 newly diagnosed COPD patients (age ?40 years) from 1997 to 2011 were enrolled. Among them, 1,861 (4.36%) patients who had received albumin supplementation were defined as hypoalbuminemia, and 40,871 (95.6%) patients who had not received albumin supplementation were defined as no hypoalbuminemia. Results Of 42,732 newly diagnosed COPD patients, 5,248 patients (12.3%) developed ARF during the 6 years follow-up period. Patients with hypoalbuminemia were older, predominantly male, had more comorbidities, and required more steroid treatment and blood transfusions than patients without hypoalbuminemia. In a multivariable Cox regression analysis model, being elderly was the strongest independent risk factor for ARF (adjusted hazard ratio [HR]: 4.63, P<0.001), followed by hypoalbuminemia (adjusted HR: 2.87, P<0.001). However, as the annual average dose of albumin supplementation was higher than 13.8 g per year, the risk for ARF was the highest (adjusted HR: 11.13, 95% CI: 10.35–11.98, P<0.001). Conclusion Hypoalbuminemia is a strong risk factor for ARF in patients with COPD. Therefore, further prospective studies are required to verify whether or not albumin supplementation or nutritional support may help to reduce the risk of ARF in patients with COPD. PMID:26124654

  8. HIPK2 deficiency causes chromosomal instability by cytokinesis failure and increases tumorigenicity

    PubMed Central

    Valente, Davide; Bossi, Gianluca; Moncada, Alice; Tornincasa, Mara; Indelicato, Stefania; Piscuoglio, Salvatore; Karamitopoulou, Eva Diamantis; Bartolazzi, Armando; Pierantoni, Giovanna Maria; Fusco, Alfredo; Soddu, Silvia; Rinaldo, Cinzia

    2015-01-01

    HIPK2, a cell fate decision kinase inactivated in several human cancers, is thought to exert its oncosuppressing activity through its p53-dependent and -independent apoptotic function. However, a HIPK2 role in cell proliferation has also been described. In particular, HIPK2 is required to complete cytokinesis and impaired HIPK2 expression results in cytokinesis failure and tetraploidization. Since tetraploidy may yield to aneuploidy and chromosomal instability (CIN), we asked whether unscheduled tetraploidy caused by loss of HIPK2 might contribute to tumorigenicity. Here, we show that, compared to Hipk2+/+ mouse embryo fibroblasts (MEFs), hipk2-null MEFs accumulate subtetraploid karyotypes and develop CIN. Accumulation of these defects inhibits proliferation and spontaneous immortalization of primary MEFs whereas increases tumorigenicity when MEFs are transformed by E1A and Harvey-Ras oncogenes. Upon mouse injection, E1A/Ras-transformed hipk2-null MEFs generate tumors with genetic alterations resembling those of human cancers derived by initial tetraploidization events, such as pancreatic adenocarcinoma. Thus, we evaluated HIPK2 expression in different stages of pancreatic transformation. Importantly, we found a significant correlation among reduced HIPK2 expression, high grade of malignancy, and high nuclear size, a marker of increased ploidy. Overall, these results indicate that HIPK2 acts as a caretaker gene, whose inactivation increases tumorigenicity and causes CIN by cytokinesis failure. PMID:25868975

  9. TRMT5 Mutations Cause a Defect in Post-transcriptional Modification of Mitochondrial tRNA Associated with Multiple Respiratory-Chain Deficiencies.

    PubMed

    Powell, Christopher A; Kopajtich, Robert; D'Souza, Aaron R; Rorbach, Joanna; Kremer, Laura S; Husain, Ralf A; Dallabona, Cristina; Donnini, Claudia; Alston, Charlotte L; Griffin, Helen; Pyle, Angela; Chinnery, Patrick F; Strom, Tim M; Meitinger, Thomas; Rodenburg, Richard J; Schottmann, Gudrun; Schuelke, Markus; Romain, Nadine; Haller, Ronald G; Ferrero, Ileana; Haack, Tobias B; Taylor, Robert W; Prokisch, Holger; Minczuk, Michal

    2015-08-01

    Deficiencies in respiratory-chain complexes lead to a variety of clinical phenotypes resulting from inadequate energy production by the mitochondrial oxidative phosphorylation system. Defective expression of mtDNA-encoded genes, caused by mutations in either the mitochondrial or nuclear genome, represents a rapidly growing group of human disorders. By whole-exome sequencing, we identified two unrelated individuals carrying compound heterozygous variants in TRMT5 (tRNA methyltransferase 5). TRMT5 encodes a mitochondrial protein with strong homology to members of the class I-like methyltransferase superfamily. Both affected individuals presented with lactic acidosis and evidence of multiple mitochondrial respiratory-chain-complex deficiencies in skeletal muscle, although the clinical presentation of the two affected subjects was remarkably different; one presented in childhood with failure to thrive and hypertrophic cardiomyopathy, and the other was an adult with a life-long history of exercise intolerance. Mutations in TRMT5 were associated with the hypomodification of a guanosine residue at position 37 (G37) of mitochondrial tRNA; this hypomodification was particularly prominent in skeletal muscle. Deficiency of the G37 modification was also detected in human cells subjected to TRMT5 RNAi. The pathogenicity of the detected variants was further confirmed in a heterologous yeast model and by the rescue of the molecular phenotype after re-expression of wild-type TRMT5 cDNA in cells derived from the affected individuals. Our study highlights the importance of post-transcriptional modification of mitochondrial tRNAs for faithful mitochondrial function. PMID:26189817

  10. Living with Respiratory Failure

    MedlinePLUS

    ... Intramural Research Research Resources Research Meeting Summaries Technology Transfer Clinical Trials What Are Clinical Trials? Children & Clinical ... gas comes in can explode when exposed to heat. For more information about how to quit smoking, ...

  11. Fast detection of manufacturing systematic design pattern failures causing device yield loss

    NASA Astrophysics Data System (ADS)

    Le Denmat, Jean-Christophe; Feldman, Nelly; Riewer, Olivia; Yesilada, Emek; Vallet, Michel; Suzor, Christophe; Talluto, Salvatore

    2015-03-01

    Starting from the 45nm technology node, systematic defectivity has a significant impact on device yield loss with each new technology node. The effort required to achieve patterning maturity with zero yield detractor is also significantly increasing with technology nodes. Within the manufacturing environment, new in-line wafer inspection methods have been developed to identify device systematic defects, including the process window qualification (PWQ) methodology used to characterize process robustness. Although patterning is characterized with PWQ methodology, some questions remain: How can we demonstrate that the measured process window is large enough to avoid design-based defects which will impact the device yield? Can we monitor the systematic yield loss on nominal wafers? From device test engineering point of view, systematic yield detractors are expected to be identified by Automated Test Pattern Generator (ATPG) test results diagnostics performed after electrical wafer sort (EWS). Test diagnostics can identify failed nets or cells causing systematic yield loss [1],[2]. Convergence from device failed nets and cells to failed manufacturing design pattern are usually based on assumptions that should be confirmed by an electrical failure analysis (EFA). However, many EFA investigations are required before the design pattern failures are found, and thus design pattern failure identification was costly in time and resources. With this situation, an opportunity to share knowledge exists between device test engineering and manufacturing environments to help with device yield improvement. This paper presents a new yield diagnostics flow dedicated to correlation of critical design patterns detected within manufacturing environment, with the observed device yield loss. The results obtained with this new flow on a 28nm technology device are described, with the defects of interest and the device yield impact for each design pattern. The EFA done to validate the design pattern to yield correlation are also presented, including physical cross sections. Finally, the application of this new flow for systematic design pattern yield monitoring, compared to classic inline wafer inspection methods, is discussed.

  12. Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Failure in Postpartum Woman With Rheumatic Mitral Valve Disease: Benefit, Factors Furthering the Success of This Procedure, and Review of the Literature

    PubMed Central

    Fayad, Georges; Larrue, Benoît; Modine, Thomas; Azzaoui, Richard; Regnault, Alexi; Koussa, Mohammad; Gourlay, Terry; Fourrier, François; Decoene, Christophe; Warembourg, Henri

    2007-01-01

    Abstract: Pregnancy is a common decompensation factor for women with post-rheumatic mitral disease. However, valvular heart diseases causing severe acute respiratory distress are rare. Use of extracorporeal membrane oxygenation (ECMO) early in the event of cardiorespiratory failure after cardiac surgery may be of benefit. Indeed, ECMO cardiopulmonary bypass (CPB) support could help pulmonary recovery if the mitral pathology is involved. A 31-year-old female patient at 30 weeks of amenorrhea was admitted to the obstetrics department with 40°C hyperthermia and New York Heart Association (NYHA) class 4 dyspnea. The patient’s medical history included a post-rheumatic mitral stenosis. Blood gases showed severe hypoxemia associated with hypocapnia. The patient needed to be rapidly intubated and was placed on ventilatory support because of acute respiratory failure. Transesophageal echocardiography showed a severe mitral stenosis, mild mitral insufficiency, and diminished left ventricular function, hypokinetic, dilated right ventricle, and a severe tricuspid regurgitation. An urgent cesarean section was performed. Because of the persistent hemodynamic instability, a mitral valvular replacement and tricuspid valve annuloplasty were performed. In view of the preoperative acute respiratory distress, we decided, at the beginning of the operation, to carry on circulatory support with oxygenation through an ECMO-type CPB at the end of the operation. This decision was totally justified by the unfeasible CPB weaning off. ECMO use led to an efficient hemodynamic state without inotropic drug support. The surgical post-operative course was uneventful. Early use of cardiorespiratory support with veno-arterial ECMO allows pulmonary and right heart recovery after cardiac surgery, thus avoiding the use of inotropic drugs and complex ventilatory support. PMID:17672195

  13. A tubulointerstitial nephritis antigen gene defect causes childhood-onset chronic renal failure.

    PubMed

    Takemura, Yutaka; Koshimichi, Machiko; Sugimoto, Keisuke; Yanagida, Hidehiko; Fujita, Shinsuke; Miyazawa, Tomoki; Miyazaki, Kohei; Okada, Mitsuru; Takemura, Tsukasa

    2010-07-01

    Tubulointerstitial nephritis antigen (TIN-ag), which has been localized to the renal tubular basement membrane, is a target antigen in some forms of TIN. Physiologically, TIN-ag is thought to be important in maintaining the structure of renal tubular basement membrane. Here we describe a child with chronic renal failure showing a human TIN-ag gene (hTIN-ag) deletion. Immunohistochemical examination using an antihuman TIN-ag monoclonal antibody showed attenuation or lack of TIN-ag staining along the renal tubular basement membrane, whereas nephrocystin staining was normal in renal tubules. Polymerase chain reaction detected no amplification band corresponding to hTIN-ag in this patient. Testing for a deletion in this gene showed nearly complete deletion. By using array-comparative genomic hybridization method, large deletion of a gene mapped on chromosome 6p11-6p12 was demonstrated, corresponding to the locus where hTIN-ag is located. Therefore, an hTIN-ag defect may be a potent cause of end-stage renal failure in childhood. PMID:20157734

  14. Reversible Deterioration in Hypophosphatasia Caused by Renal Failure With Bisphosphonate Treatment.

    PubMed

    Cundy, Tim; Michigami, Toshimi; Tachikawa, Kanako; Dray, Michael; Collins, John F; Paschalis, Eleftherios P; Gamsjaeger, Sonja; Roschger, Andreas; Fratzl-Zelman, Nadja; Roschger, Paul; Klaushofer, Klaus

    2015-09-01

    Hypophosphatasia is an inborn error of metabolism caused by mutations in the ALPL gene. It is characterized by low serum alkaline phosphatase (ALP) activity and defective mineralization of bone, but the phenotype varies greatly in severity depending on the degree of residual enzyme activity. We describe a man with compound heterozygous mutations in ALPL, but no previous bone disease, who suffered numerous disabling fractures after he developed progressive renal failure (for which he eventually needed dialysis treatment) and was prescribed alendronate treatment. A bone biopsy showed marked osteomalacia with low osteoblast numbers and greatly elevated pyrophosphate concentrations at mineralizing surfaces. In vitro testing showed that one mutation, T117H, produced an ALP protein with almost no enzyme activity; the second, G438S, produced a protein with normal activity, but its activity was inhibited by raising the media phosphate concentration, suggesting that phosphate retention (attributable to uremia) could have contributed to the phenotypic change, although a pathogenic effect of bisphosphonate treatment is also likely. Alendronate treatment was discontinued and, while a suitable kidney donor was sought, the patient was treated for 6 months with teriparatide, which significantly reduced the osteomalacia. Eighteen months after successful renal transplantation, the patient was free of symptoms and the scintigraphic bone lesions had resolved. A third bone biopsy showed marked hyperosteoidosis but with plentiful new bone formation and a normal bone formation rate. This case illustrates how pharmacological (bisphosphonate treatment) and physiologic (renal failure) changes in the "environment" can dramatically affect the phenotype of a genetic disorder. PMID:25736332

  15. Acute Lung Failure

    PubMed Central

    Mac Sweeney, Rob; McAuley, Daniel F.; Matthay, Michael A.

    2013-01-01

    Lung failure is the most common organ failure seen in the intensive care unit. The pathogenesis of acute respiratory failure (ARF) can be classified as (1) neuromuscular in origin, (2) secondary to acute and chronic obstructive airway diseases, (3) alveolar processes such as cardiogenic and noncardiogenic pulmonary edema and pneumonia, and (4) vascular diseases such as acute or chronic pulmonary embolism. This article reviews the more common causes of ARF from each group, including the pathological mechanisms and the principles of critical care management, focusing on the supportive, specific, and adjunctive therapies for each condition. PMID:21989697

  16. Joint disorder; a contributory cause to reproductive failure in beef bulls?

    PubMed Central

    Persson, Ylva; Söderquist, Lennart; Ekman, Stina

    2007-01-01

    The lame sire, unsound for breeding, can cause substantial economic loss due to reduced pregnancies in the beef-producing herd. To test the hypothesis that joint disorder is a possible cause of infertility in beef sires, right and left hind limb bones from 34 beef sires were examined postmortem to identify lesions in the femorotibial, femoropatellar (stifle), tarsocrural, talocalcaneus, and proximal intertarsal (tarsal) joints. The bulls were slaughtered during or after the breeding season due to poor fertility results. Aliquots of the cauda epididymal contents taken postmortem from 26 bulls were used for sperm morphology evaluation. As a control, hind limbs (but no semen samples) from 11 beef bulls with good fertility results were included. Almost all infertile bulls (30/34) had lesions in at least one joint. Twenty-eight bulls (28/30, 93%) had lesions in the stifle joint, and 24 (24/28, 86%) of these were bilateral. Fourteen bulls (14/30, 47%) had lesions in the tarsal joint, and 10 (10/14, 71%) of these were bilateral. Four bulls (4/34, 12%) had no lesions, three bulls (3/34, 9%) had mild osteoarthritis (OA), 5 (5/34, 15%) moderate OA, 17 (17/34, 50%) severe OA and 5 (5/34, 15%) deformed OA. Almost all OA lesions (97%) were characterized as lesions secondary to osteochondrosis dissecans. All the bulls with satisfactory sperm morphology (n = 12/34) had joint lesions, with mostly severe or deformed bilateral lesions (83%). Consequently, the most likely cause of infertility in these 12 bulls was joint disease. Almost all control bulls (10/11) had OA lesions, but most of them were graded as mild (55%) or moderate (36%). None of the control bulls had severe lesions or deformed OA. We suggest that joint lesions should be taken into consideration as a contributory cause of reproductive failure in beef sires without symptoms of lameness. PMID:17983470

  17. Neurophysiological concomitants of soman-induced respiratory depression in awake, behaving guinea pigs.

    PubMed

    Chang, F C; Foster, R E; Beers, E T; Rickett, D L; Filbert, M G

    1990-02-01

    Soman-induced respiratory failure was investigated in awake, behaving guinea pigs chronically instrumented to allow concurrent recordings of medullary respiratory-related unit (RRU) activity, diaphragm electromyogram (DEMG), and electrocorticogram. Responses to soman typically began with hyperpnea. Loss of consciousness, as indicated by the development of seizure activities, took place shortly after the onset of hyperpnea. This was followed by dyspnea, hypopnea, and finally, respiratory failure. The most profound respiratory dysfunctions were seen during the development of dyspnea characterized by a progressively degenerative RRU-DEMG phase relationship (phase anomalies) and mixed patterns of ataxic breathing. Electrophysiographic records indicated that the anomalous RRU-DEMG phase phenomenon is attributable to a state of functional dissociation in some brainstem mechanisms that are normally involved in the orchestration of a synchronous respiratory drive. The failure of bulbar rhythmogenic mechanisms to maintain an orderly and synchronous recruitment of respiratory drive, which led to untimely and chaotic activations of respiratory muscles, was apparently the underlying cause of various ataxic breathing patterns and a reduced ventilatory efficiency. Spectral analyses of DEMG activities showed that, despite episodic muscle fasciculations and signs of fatigue, the functional integrity of the diaphragm was not significantly compromised by soman at a dose sufficient to produce respiratory failure. These findings not only support the notion of a relatively more important involvement of central respiratory mechanisms in soman-induced respiratory failure, but also identify a state of functional dissociation of central respiratory timing mechanisms as being a significant component in soman intoxication. PMID:2300968

  18. Bacteria Etiological Agents Causing Lower Respiratory Tract Infections and Their Resistance Patterns

    PubMed Central

    Khan, Salman; Priti, Singh; Ankit, Sachan

    2015-01-01

    Background: Lower respiratory tract infections (LTRIs) are among the most common infectious diseases with potential life-threatening complications. Methods: The study consisted of 426 patients with suspected LTRIs from mid and far western region of Nepal between September 2011 and July 2014. The specimens were collected and processed according to the standard microbiological methods at the Central Laboratory of Microbiology of Nepalgunj Medical College, Nepal. Results: Among the isolated Gram-positive organisms, Streptococcus pneumonia (n = 30, 51.7%) was the most predominant pathogen, followed by Staphylococcus aureus (n = 28, 48.3%). Among the isolated Gram-negative organisms, Pseudomonas aeruginosa (n = 71, 35.32%) was the most predominant pathogen, followed by Haemophilus influenzae (n = 68, 33.83%), Klebsiella pneumonia (n = 36, 17.19%), and Escherichia coli (n = 26, 12.94%). The pattern of resistance varied regarding the bacteria species, and there were multi-resistant isolates. Also, a significant difference (P < 0.05) was observed between males and females for each type of bacterial species. Among 259 isolates, 86 (33.20%) were from children aged 1-10 years, which were statistically significant (P < 0.05) compared to the other age groups. Conclusions: P. aeruginosa and H. influenzae (Gram-negative) and S. pnemoniae (Gram-positive) were the most common bacterial isolates recovered from LTRIs. Age group of 1-10 years old was at a higher risk. Many isolates showed appreciable levels of antibiotic resistance due to antibiotic abuse. There is a need to increase surveillance and develop better strategies to curb the increasing prevalence of LRTI in this region of Nepal. PMID:26220641

  19. [Prolonged exposure to atmospheric air pollution and mortality from respiratory causes].

    PubMed

    Eilstein, D

    2009-12-01

    Different designs can be used to analyze the relationships between respiratory mortality and long term exposure to atmospheric pollution: epidemiological studies (cohort, prevalence study) demonstrate the reality of the relationship and toxicological studies explain it. Cohort studies have the advantage of being able to take into account many confounding factors and thus avoid biases (which is not the case with prevalence studies), but require significant human and financial resources. They were first adopted in the US, but are now more often applied in Europe. The results are relatively consistent, as they all show a statistically significant association between an increase in particulate pollution and cardiopulmonary mortality. Mortality from lung cancer is also associated with long term exposition to particles and sometimes to ozone or nitrogen oxides. Cerebrovascular diseases and sudden death of young children have also been associated with particulate pollution. The relationships are more powerful for long term than short term exposure but are also linear and without threshold. In order to explain these effects (today the causality of the relationship is certain) there are many possible factors, particularly regarding particulate exposures: an increase in cardiovascular risk biomarkers (fibrinogen, white blood cells, and platelets), atherosclerosis, chronic inflammation of lung tissues increased by acute exposure, etc. More and more studies address the interaction between gene and environment and even epigenetic phenomena which could be responsible of these effects. Public Health impact could be quantified. The European E&H surveillance program Apheis, for example, estimated that if PM2.5 levels remained below 15 microg/m(3), a 30 year old person could see his life expectancy increased by 1 month to 2 years, depending on the studied city. Finally, mortality is not the only relevant indicator for health effects of air pollution. ISAAC studies address asthma, allergic rhinitis and eczema among children. PMID:20032841

  20. Compensation for occupational disease with multiple causes: the case of coal miners respiratory diseases

    SciTech Connect

    Weeks, J.L.; Wagner, G.R.

    1986-01-01

    Many diseases associated with occupational exposures are clinically indistinguishable from diseases with non-occupational causes. Given this, how are fair decisions made about eligibility for compensation. This problem is discussed in relation to the federal black lung program. Conflicting definitions of terms--coal workers pneumoconiosis as defined by the medical profession, pneumoconiosis as defined by the United States Congress, and the popular term, black lung--are important considerations in this discussion. Each is embedded in different logical interpretations of the causes of occupational disease and of disability. Alternative views are presented and critically discussed.

  1. Cost-effectiveness of noninvasive ventilation for chronic obstructive pulmonary disease-related respiratory failure in Indian hospitals without ICU facilities

    PubMed Central

    Patel, Shraddha P; Pena, Margarita E; Babcock, Charlene Irvin

    2015-01-01

    Introduction: The majority of Indian hospitals do not provide intensive care unit (ICU) care or ward-based noninvasive positive pressure ventilation (NIV). Because no mechanical ventilation or NIV is available in these hospitals, the majority of patients suffering from respiratory failure die. Objective: To perform a cost-effective analysis of two strategies (ward-based NIV with concurrent standard treatment vs standard treatment alone) in chronic obstructive pulmonary disease (COPD) respiratory failure patients treated in Indian hospitals without ICU care. Materials and Methods: A decision-analytical model was created to compare the cost-effectiveness for the two strategies. Estimates from the literature were used for parameters in the model. Future costs were discounted at 3%. All costs were reported in USD (2012). One-way, two-way, and probabilistic sensitivity analysis were performed. The time horizon was lifetime and perspective was societal. Results: The NIV strategy resulted in 17.7% more survival and was slightly more costly (increased cost of $101 (USD 2012) but resulted in increased quality-adjusted life-years (QALYs) (1.67 QALY). The cost-effectiveness (2012 USD)/QALY in the standard and NIV groups was $78/QALY ($535.02/6.82) and $75/QALY ($636.33/8.49), respectively. Incremental cost-effectiveness ratio (ICER) was only $61 USD/QALY. This was substantially lower than the gross domestic product (GDP) per capita for India (1489 USD), suggesting the NIV strategy was very cost effective. Using a 5% discount rate resulted in only minimally different results. Probabilistic analysis suggests that NIV strategy was preferred 100% of the time when willingness to pay was >$250 2012 USD. Conclusion: Ward-based NIV treatment is cost-effective in India, and may increase survival of patients with COPD respiratory failure when ICU is not available.

  2. Acute liver failure caused by mushroom poisoning: a case report and review of the literature.

    PubMed

    Erden, Abdulsamet; Esmeray, Kübra; Karagöz, Hatice; Karahan, Samet; Gümü?çü, Hasan Hüseyin; Ba?ak, Mustafa; Cetinkaya, Ali; Avc?, Deniz; Poyrazo?lu, Orhan Kür?at

    2013-01-01

    It is estimated that there are over 5,000 species of mushrooms worldwide. Some of them are edible and some are poisonous due to containing significant toxins. In more than 95% of mushroom toxicity cases, poisoning occurs as a result of misidentification of the mushroom by an amateur mushroom hunter. The severity of mushroom poisoning may vary, depending on the geographic location where the mushroom is grown, growth conditions, the amount of toxin delivered, and the genetic characteristics of the mushroom. Amanita phalloides is the most common and fatal cause of mushroom poisoning. This mushroom contains amanitins, which are powerful hepatotoxins that inhibit RNA polymerase II in liver. Mushroom poisoning is a relatively rare cause of acute liver failure. A 63-year-old male patient was admitted to the emergency room with weakness, nausea, vomiting, and diarrhea. He reported ingesting several wild mushrooms about 36 hours earlier. In this article we report a case of lethal Amanita phalloides intoxication from stored mushrooms. PMID:24294010

  3. Acute liver failure caused by mushroom poisoning: a case report and review of the literature

    PubMed Central

    Erden, Abdulsamet; Esmeray, Kübra; Karagöz, Hatice; Karahan, Samet; Gümü?çü, Hasan Hüseyin; Ba?ak, Mustafa; Çetinkaya, Ali; Avc?, Deniz; Poyrazo?lu, Orhan Kür?at

    2013-01-01

    It is estimated that there are over 5,000 species of mushrooms worldwide. Some of them are edible and some are poisonous due to containing significant toxins. In more than 95% of mushroom toxicity cases, poisoning occurs as a result of misidentification of the mushroom by an amateur mushroom hunter. The severity of mushroom poisoning may vary, depending on the geographic location where the mushroom is grown, growth conditions, the amount of toxin delivered, and the genetic characteristics of the mushroom. Amanita phalloides is the most common and fatal cause of mushroom poisoning. This mushroom contains amanitins, which are powerful hepatotoxins that inhibit RNA polymerase II in liver. Mushroom poisoning is a relatively rare cause of acute liver failure. A 63-year-old male patient was admitted to the emergency room with weakness, nausea, vomiting, and diarrhea. He reported ingesting several wild mushrooms about 36 hours earlier. In this article we report a case of lethal Amanita phalloides intoxication from stored mushrooms. PMID:24294010

  4. Acute liver failure caused by ‘fat burners’ and dietary supplements: A case report and literature review

    PubMed Central

    Radha Krishna, Y; Mittal, V; Grewal, P; Fiel, MI; Schiano, T

    2011-01-01

    Globally, people are struggling with obesity. Many effective, non-conventional methods of weight reduction, such as herbal and natural dietary supplements, are increasingly being sought. Fat burners are believed to raise metabolism, burn more calories and hasten fat loss. Despite patient perceptions that herbal remedies are free of adverse effects, some supplements are associated with severe hepatotoxicity. The present report describes a young healthy woman who presented with fulminant hepatic failure requiring emergent liver transplantation caused by a dietary supplement and fat burner containing usnic acid, green tea and guggul tree extracts. Thorough investigation, including histopathological examination, revealed no other cause of hepatotoxicity. The present case adds to the increasing number of reports of hepatotoxicity associated with dietary supplements containing usnic acid, and highlights that herbal extracts from green tea or guggul tree may not be free of adverse effects. Until these products are more closely regulated and their advertising better scrutinized, physicians and patients should become more familiar with herbal products that are commonly used as weight loss supplements and recognize those that are potentially harmful. PMID:21499580

  5. The acute respiratory distress syndrome

    PubMed Central

    Gupta, Pooja

    2015-01-01

    The acute respiratory distress syndrome (ARDS) is a major cause of acute respiratory failure. Its development leads to high rates of mortality, as well as short- and long-term complications, such as physical and cognitive impairment. Therefore, early recognition of this syndrome and application of demonstrated therapeutic interventions are essential to change the natural course of this devastating entity. In this review article, we describe updated concepts in ARDS. Specifically, we discuss the new definition of ARDS, its risk factors and pathophysiology, and current evidence regarding ventilation management, adjunctive therapies, and intervention required in refractory hypoxemia. PMID:25829644

  6. The diagnostic accuracy of chest ultrasound for CT-detected radiographic consolidation in hospitalised adults with acute respiratory failure: a systematic review

    PubMed Central

    Hew, Mark; Corcoran, John P; Harriss, Elinor K; Rahman, Najib M; Mallett, Susan

    2015-01-01

    Objectives (1) Summarise chest ultrasound accuracy to diagnose radiological consolidation, referenced to chest CT in patients with acute respiratory failure (ARF). (2) Directly compared ultrasound with chest X-ray. Setting Hospitalised patients. Participants Studies were eligible if adult participants in respiratory failure underwent chest ultrasound to diagnose consolidation referenced to CT. Exclusion: (1) not primary study, (2) not respiratory failure, (3) not chest ultrasound, (4) not consolidation, (5) translation unobtainable, (6) unable to extract data, (7) unable to obtain paper. 4 studies comprising 224 participants met inclusion. Outcome measures As planned, paired forest plots display 95% CIs of sensitivity and specificity for ultrasound and chest X-ray. Sensitivity and specificity from each study are plotted in receiver operator characteristics space. Meta-analysis was planned if studies were sufficiently homogeneous and numerous (?4). Although this numerical requirement was met, meta-analysis was prevented by heterogeneous units of analysis between studies. Results All studies were in intensive care, with either a high risk of selection bias or high applicability concerns. Studies had unclear or high risk of bias related to use of ultrasound. Only 1 study clearly performed ultrasound within 24?h of respiratory failure diagnosis. Ultrasound sensitivity ranged from 0.91 (95% CI 0.81 to 0.97) to 1.00 (95% CI 0.95 to 1.00). Specificity ranged from 0.78 (95% CI 0.52 to 0.94) to 1.00 (0.99 to 1.00). In two studies, chest X-ray had lower sensitivity than ultrasound, but there were insufficient patients to compare specificity. Conclusions Four small studies suggest ultrasound is highly sensitive and specific for consolidation in ARF, but high risk of bias and concerns about applicability in all studies may have inflated diagnostic accuracy. Further robustly designed studies are needed to define the role of ultrasound in this setting. Trial registration number http://www.crd.york.ac.uk/PROSPERO/ (CRD42013006472). PMID:25991460

  7. G-scores: a method for identifying disease-causing pathogens with application to lower respiratory tract infections.

    PubMed

    Zhang, Peng; Peng, Peichao; Wang, Lu; Kang, Yu

    2014-07-20

    Lower respiratory tract infections (LRTIs) are well known for the lack of a good diagnostic method. The main difficulty lies in the fact that there are a variety of pathogens causing LRTIs, and their management and treatment are quite different. The development of quantitative real-time loop-mediated isothermal amplification (qrt-LAMP) made it possible to rapidly amplify and quantify multiple pathogens simultaneously. The question that remains to be answered is how accurate and reliable is this method? More importantly, how are qrt-LAMP measurements utilized to inform/suggest medical decisions? When does a pathogen start to grow out of control and cause infection? Answers to these questions are crucial to advise treatment guidance for LRTIs and also helpful to design phase I/II trials or adaptive treatment strategies. In this article, our main contributions include the following two aspects. First, we utilize zero-inflated mixture models to provide statistical evidence for the validity of qrt-LAMP being used in detecting pathogens for LRTIs without the presence of a gold standard test. Our results on qrt-LAMP suggest that it provides reliable measurements on pathogens of interest. Second, we propose a novel statistical approach to identify disease-causing pathogens, that is, distinguish the pathogens that colonize without causing problems from those that rapidly grow and cause infection. We achieve this by combining information from absolute quantities of pathogens and their symbiosis information to form G-scores. Change-point detection methods are utilized on these G-scores to detect the three phases of bacterial growth-lag phase, log phase, and stationary phase. PMID:24599506

  8. Genetic disorders of neonatal respiratory function.

    PubMed

    Cole, F S; Hamvas, A; Nogee, L M

    2001-08-01

    Genetic risk for respiratory distress in infancy has been recognized with increasing frequency in neonatal intensive care units. Reports of family clusters of affected infants and of ethnic- and gender-based respiratory phenotypes point to the contribution of inheritance. Similarly, different outcomes among gestationally matched infants with comparable exposures to oxygen, mechanical ventilation, or nutritional deficiency also suggest a genetic risk for respiratory distress. Examples of inherited deficiency of surfactant protein B in both humans and genetically engineered murine lineages illustrate the importance of identifying markers of genetic risk. In contrast to developmental, inflammatory, or nutritional causes of respiratory distress that may resolve as infants mature, genetic causes result in both acute and chronic (and potentially irreversible) respiratory failure. The availability of clinically useful genetic markers of risk for respiratory distress in infancy will permit development of rational strategies for treatment of genetic lung disorders of infancy and more accurate counseling of families whose infants are at genetic risk for development of respiratory distress at birth or during early childhood. We review examples of genetic variations known to be associated with or cause respiratory distress in infancy. PMID:11477198

  9. Outflow failure caused by mesothelial cell lining sheet wrapping in a patient with peritoneal dialysis.

    PubMed

    Kang, Seok Hui; Lee, Dong Shik; Park, Jong Won

    2014-03-01

    A 60-year-old male was admitted to our hospital due to nausea and poor oral intake. He had received distal pancreatectomy due to a traffic accident 15 years ago, and therefore, had a midline abdominal scar. Peritoneal dialysis (PD) was selected for renal replacement therapy. PD catheter was inserted by a surgical method with left paramedian incision under local anesthesia. Initially, dialysate flow was good, but outflow failure developed on postoperative day nine. Even after the use of laxatives and a fibrinolytic agent to correct the catheter obstruction, the problem was not resolved. Therefore, we performed an open laparotomy. When PD catheter was examined during laparotomy, a single thick band (0.6 cm × 36 cm), without blood vessels was wrapped around it. One of the ends of this band originated from the jejunum and the other was attached on the most proximal side hole of the catheter. A band was removed surgically, and then the PD catheter was repositioned in the abdominal cavity. On post-revision Day 7, PD started again and dialysate flow was good. The pathologic finding was consistent with mesothelial cell lining sheet. Considering its location and the history of a major abdominal operation, the adhesive band or sheet may be the cause in this case. PMID:23073061

  10. Why do organizations not learn from incidents? Bottlenecks, causes and conditions for a failure to effectively learn.

    PubMed

    Drupsteen, Linda; Hasle, Peter

    2014-11-01

    If organizations would be able to learn more effectively from incidents that occurred in the past, future incidents and consequential injury or damage can be prevented. To improve learning from incidents, this study aimed to identify limiting factors, i.e. the causes of the failure to effectively learn. In seven organizations focus groups were held to discuss factors that according to employees contributed to the failure to learn. By use of a model of the learning from incidents process, the steps, where difficulties for learning arose, became visible, and the causes for these difficulties could be studied. Difficulties were identified in multiple steps of the learning process, but most difficulties became visible when planning actions, which is the phase that bridges the gap from incident investigation to actions for improvement. The main causes for learning difficulties, which were identified by the participants in this study, were tightly related to the learning process, but some indirect causes - or conditions - such as lack of ownership and limitations in expertise were also mentioned. The results illustrate that there are two types of causes for the failure to effectively learn: direct causes and indirect causes, here called conditions. By actively and systematically studying learning, more conditions might be identified and indicators for a successful learning process may be determined. Studying the learning process does, however, require a shift from learning from incidents to learning to learn. PMID:25118127

  11. A Multiple Indicators Multiple Cause (MIMIC) model of respiratory health and household factors in Chinese children: the seven Northeastern cities (SNEC) study.

    PubMed

    Dong, Guang-Hui; Qian, Zhengmin; Fu, Qiang; Wang, Jing; Trevathan, Edwin; Ma, Wenjun; Liu, Miao-Miao; Wang, Da; Ren, Wan-Hui; Ong, Kee-Hean; Ferguson, Tekeda Freeman; Riley, Erin; Simckes, Maayan

    2014-01-01

    In China, with the rapid economic development and improvement of living standards over the past few decades, the household living environment has shifted dramatically. The aim of the present study is to assess the impact of home environment factors on respiratory symptoms and asthma in Chinese children. Investigators analyzed data collected in the 25 districts from the seven Northeastern cities to examine health effects on respiratory symptoms and asthma in 31,049 children aged 2-14 years. Factor analysis was used to reduce 33 children's lifestyle and household variables to six new 'factor' variables. The multiple indicators multiple causes approach was used to examine the relationship between indoor air pollution and respiratory health status, controlling for covariates. Factor analyses generated six factor variables of potential household risk factors from an original list of 33 variables. The respiratory symptoms and asthma were significantly associated with the recent home renovation factor (estimate = 0.076, p < 0.001), pet ownership factor (estimate = 0.095, p < 0.001), environmental tobacco smoke (ETS) exposure factor (estimate = 0.181, p < 0.001) and PVC-flooring factor (estimate = 0.031, p = 0.007). Home ventilation factor was not related to any respiratory condition (estimate = 0.028, p = 0.074). Independent respiratory health effects existed for multiple household environmental factors recent home renovation, pet ownership, ETS, and PVC-flooring. PMID:23440490

  12. Respiratory dysfunction by AFG3L2 deficiency causes decreased mitochondrial calcium uptake via organellar network fragmentation

    PubMed Central

    Maltecca, Francesca; De Stefani, Diego; Cassina, Laura; Consolato, Francesco; Wasilewski, Michal; Scorrano, Luca; Rizzuto, Rosario; Casari, Giorgio

    2012-01-01

    The mitochondrial protein AFG3L2 forms homo-oligomeric and hetero-oligomeric complexes with paraplegin in the inner mitochondrial membrane, named m-AAA proteases. These complexes are in charge of quality control of misfolded proteins and participate in the regulation of OPA1 proteolytic cleavage, required for mitochondrial fusion. Mutations in AFG3L2 cause spinocerebellar ataxia type 28 and a complex neurodegenerative syndrome of childhood. In this study, we demonstrated that the loss of AFG3L2 in mouse embryonic fibroblasts (MEFs) reduces mitochondrial Ca2+ uptake capacity. This defect is neither a consequence of global alteration in cellular Ca2+ homeostasis nor of the reduced driving force for Ca2+ internalization within mitochondria, since cytosolic Ca2+ transients and mitochondrial membrane potential remain unaffected. Moreover, experiments in permeabilized cells revealed unaltered mitochondrial Ca2+ uptake speed in Afg3l2?/? cells, indicating the presence of functional Ca2+ uptake machinery. Our results show that the defective Ca2+ handling in Afg3l2?/? cells is caused by fragmentation of the mitochondrial network, secondary to respiratory dysfunction and the consequent processing of OPA1. This leaves a number of mitochondria devoid of connections to the ER and thus without Ca2+ elevations, hampering the proper Ca2+ diffusion along the mitochondrial network. The recovery of mitochondrial fragmentation in Afg3l2?/? MEFs by overexpression of OPA1 rescues the impaired mitochondrial Ca2+ buffering, but fails to restore respiration. By linking mitochondrial morphology and Ca2+ homeostasis, these findings shed new light in the molecular mechanisms underlining neurodegeneration caused by AFG3L2 mutations. PMID:22678058

  13. Common Cold Self Care The "common cold" is inflammation of the upper respiratory tract caused a variety of different viruses. Antibiotics do not

    E-print Network

    Maroncelli, Mark

    Common Cold Self Care The "common cold" is inflammation of the upper respiratory tract caused by allergies, try one of the newer non-sedating antihistamines (see details box). If from a common cold period of time (see details box next page). #12;Common Cold Self Care Continued Approved by the UHS

  14. 76 FR 70768 - Common-Cause Failure Analysis in Event and Condition Assessment: Guidance and Research, Draft...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-15

    ... (76 FR 67764). This action is necessary to correct an erroneous date for submission of comments. FOR... From the Federal Register Online via the Government Printing Office NUCLEAR REGULATORY COMMISSION Common-Cause Failure Analysis in Event and Condition Assessment: Guidance and Research, Draft Report...

  15. 77 FR 5857 - Common-Cause Failure Analysis in Event and Condition Assessment: Guidance and Research, Draft...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-06

    ...: On November 2, 2011 (76 FR 67764), the U.S. Nuclear Regulatory Commission (NRC) published for public...-2011-0254. Discussion On November 2, 2011 (76 FR 67764), the NRC published for public comment Draft... COMMISSION Common-Cause Failure Analysis in Event and Condition Assessment: Guidance and Research,...

  16. 20 CFR 416.732 - No penalty deduction if you have good cause for failure to report timely.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false No penalty deduction if you have good cause for failure to report timely. 416.732 Section 416.732 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Reports Required Penalty...

  17. Determining the Cause of a Header Failure in a Natural Gas Production Facility

    SciTech Connect

    Matthes, S.A.; Covino, B.S., Jr.; Bullard, S.J.; Ziomek-Moroz, M.; Holcomb, G.R.

    2007-03-01

    An investigation was made into the premature failure of a gas-header at the Rocky Mountain Oilfield Testing Center (RMOTC) natural gas production facility. A wide variety of possible failure mechanisms were considered: design of the header, deviation from normal pipe alloy composition, physical orientation of the header, gas composition and flow rate, type of corrosion, protectiveness of the interior oxide film, time of wetness, and erosion-corrosion. The failed header was examined using metallographic techniques, scanning electron microscopy, and microanalysis. A comparison of the failure site and an analogous site that had not failed, but exhibited similar metal thinning was also performed. From these studies it was concluded that failure resulted from erosion-corrosion, and that design elements of the header and orientation with respect to gas flow contributed to the mass loss at the failure point.

  18. Middle East respiratory syndrome.

    PubMed

    Zumla, Alimuddin; Hui, David S; Perlman, Stanley

    2015-09-01

    Middle East respiratory syndrome (MERS) is a highly lethal respiratory disease caused by a novel single-stranded, positive-sense RNA betacoronavirus (MERS-CoV). Dromedary camels, hosts for MERS-CoV, are implicated in direct or indirect transmission to human beings, although the exact mode of transmission is unknown. The virus was first isolated from a patient who died from a severe respiratory illness in June, 2012, in Jeddah, Saudi Arabia. As of May 31, 2015, 1180 laboratory-confirmed cases (483 deaths; 40% mortality) have been reported to WHO. Both community-acquired and hospital-acquired cases have been reported with little human-to-human transmission reported in the community. Although most cases of MERS have occurred in Saudi Arabia and the United Arab Emirates, cases have been reported in Europe, the USA, and Asia in people who travelled from the Middle East or their contacts. Clinical features of MERS range from asymptomatic or mild disease to acute respiratory distress syndrome and multiorgan failure resulting in death, especially in individuals with underlying comorbidities. No specific drug treatment exists for MERS and infection prevention and control measures are crucial to prevent spread in health-care facilities. MERS-CoV continues to be an endemic, low-level public health threat. However, the virus could mutate to have increased interhuman transmissibility, increasing its pandemic potential. PMID:26049252

  19. Short-term reversibility of ultrastructural changes in pulmonary capillaries caused by stress failure

    NASA Technical Reports Server (NTRS)

    Elliott, A. R.; Fu, Z.; Tsukimoto, K.; Prediletto, R.; Mathieu-Costello, O.; West, J. B.

    1992-01-01

    We previously showed that when the pulmonary capillaries in anesthetized rabbits are exposed to a transmural pressure (Ptm) of approximately 40 mmHg, stress failure of the walls occurs with disruption of the capillary endothelium, alveolar epithelium, or sometimes all layers. The present study was designed to determine whether some of the ultrastructural changes are rapidly reversible when the capillary pressure is reduced. To test this, the Ptm was raised to 52.5 cmH2O for 1 min of blood perfusion and then reduced to 12.5 cmH2O for 3 min of saline-dextran perfusion, followed by intravascular fixation at the same pressure. In another group of animals, the pressure was elevated for 1 min of blood and 3 min of saline-dextran before being reduced. The results were compared with previous studies in which the capillary pressures were maintained elevated at 52.5 cmH2O during the entire procedure. Control studies were also done at sustained low pressures. The results showed that the number of endothelial and epithelial breaks per millimeter and the total fraction area of the breaks were reduced when the pressure was lowered. For example, the number of endothelial breaks per millimeter decreased from 7.1 +/- 2.1 to 2.4 +/- 0.7, and the number of epithelial breaks per millimeter fell from 11.4 +/- 3.7 to 3.4 +/- 0.7. There was evidence that the breaks that closed were those that were initially small and were associated with an intact basement membrane. The results suggest that cells can move along their underlying matrix by rapid disengagement and reattachment of cell adhesion molecules, causing breaks to open or close within minutes.(ABSTRACT TRUNCATED AT 250 WORDS).

  20. Severe Acute Respiratory Failure due to Inhalation of Baby Powder and Successfully Treated with Venous-Venous Extracorporeal Membrane Oxygenation.

    PubMed

    Panarello, Giovanna; Occhipinti, Giovanna; Piazza, Marcello; Capitanio, Guido; Vitulo, Patrizio; Gridelli, Bruno; Pilato, Michele; Arcadipane, Antonio

    2015-12-15

    Accidental inhalation of powder is a potential problem for infants. The clinical effects of inhaling powder depend on the powder contents, degree of aspiration, and the child's underlying systemic response. We present a case of accidental inhalation of rice starch powder in a 17-month-old girl, which led to severe acute respiratory distress syndrome responsive to conventional treatment, ultimately requiring venous-venous extracorporeal membrane oxygenation. PMID:26657704

  1. Central respiratory effects versus neuromuscular actions of nerve agents.

    PubMed

    Rickett, D L; Glenn, J F; Beers, E T

    1986-01-01

    The relative contributions of peripheral neuromuscular and central nervous system components in the respiratory failure following acute exposure to organophosphorous anticholinesterase (AChE) agents remain unclear. We examined the effects of the nerve agents, soman, sarin, tabun, and VX on diaphragm contraction, diaphragm electromyogram (EMG), phrenic nerve activity, medullary respiratory-related unit activity, and airflow in the cat. The agents were infused at the rate of 1 LD50 per 15 minutes until respiratory arrest, at which time the phrenic nerve was stimulated supramaximally to test diaphragmic contraction. We found that one of the first signs of respiratory distress is disruption of the normal firing pattern of the medullary respiratory-related neurons. This is followed by changes in phrenic nerve activity, diaphragm EMG, diaphragm contraction and airflow. At the time of respiratory arrest, the medullary respiratory-related units and the phrenic nerve have stopped firing. Immediately following cessation of spontaneous respiration, the diaphragm was tested by stimulating the phrenic nerve with 2 msec pulses of 500 msec duration at 10 Hz and at 100 Hz. Stimulation at 10 Hz consistently produced a frequency-following contraction, while stimulation at 100 Hz produced a tetanic contraction. We conclude that loss of central respiratory drive is the predominant cause of nerve agent-induced respiratory failure, as the diaphragm muscle still contracts tetanically when challenged with a 100 Hz train for 500 msec at the time of respiratory arrest. PMID:3714123

  2. White-Etching Matter in Bearing Steel. Part II: Distinguishing Cause and Effect in Bearing Steel Failure

    E-print Network

    Solano-Alvarez, W.; Bhadeshia, H. K. D. H.

    2014-07-11

    of Bearing Steels ASTM STP 771: ASTM International, Philadelphia, USA, 1982: pp. 107–124. [24] K. L. Johnson: Contact Mechanics: Cambridge University Press, Cam- bridge, U. K., 1985. [25] M.-H. Evans, A. D. Richardson, I. Wang, R. J. K. Wood: Wear 2013, vol... in bearing steel Part 2: Distinguishing cause and e?ect in bearing steel failure W. Solano-Alvareza, H. K. D. H. Bhadeshiaa aMaterials Science and Metallurgy, University of Cambridge, U.K Abstract The premature failure of large bearings of the type used...

  3. Adult Respiratory Distress Syndrome Caused by 2009 H1N1 Influenza during Pregnancy: Success of ECMO for Both the Mother and the Child

    PubMed Central

    Courouble, Patricia; Geukens, Paul; Laarbaui, Fatima; Beauloye, Christophe; Van Caenegem, Olivier; Jacquet, Luc-Marie

    2011-01-01

    Abstract: Extracorporeal membrane oxygenation (ECMO) is a technique that provides support to selected patients with severe respiratory failure. During the 2009 H1N1 influenza infection outbreak, ECMO was used with a good impact on survival for pregnant women, who are at higher risk of H1N1 influenza infection. However, there is little information about the survival of fetus post-ECMO therapy in the literature. We present a case report of a pregnant patient with severe adult respiratory distress syndrome secondary to 2009 H1N1 influenza treated with ECMO. The outcome was good both for the mother and her fetus. At 1-year follow-up, her child had no neurological or clinical abnormalities. We conclude that ECMO can be used safely during pregnancy with a good neurological and clinical outcome for the fetus. PMID:21848176

  4. Unexpected ICD pulse generator failure due to electronic circuit damage caused by electrical overstress.

    PubMed

    Hauser, R G; Hayes, D L; Almquist, A K; Epstein, A E; Parsonnet, V; Tyers, G F; Vlay, S C; Schoenfeld, M H

    2001-07-01

    Because it is a lifesaving device, the unexpected failure of an ICD can be catastrophic. We report ICD electronic circuit failure due to electrical overstress damage (EOS) to the high voltage hybird circuit and other electronic components in a series of ICD pulse generator models. Data were obtained from the Multicenter Registry of Pacemaker and ICD Pacemaker and Lead Failures, and from the manufactures' adverse event reports, that were in the FDA's Manufacturer and User Facility Device Experience (MAUDE) database. Of 16 nonbattery Guidant/CPI ICD pulse generator failures reported to the registry, 6 (38%) have been confirmed by the manufacturer to be EOS related, and Guidant/CPI has reported 273 such failures to the FDA as of 12/29/00. The signs of failure included loss of telemetry and inability to deliver therapy, and some patients have experienced serious adverse events. Hybrid circuit damage may have occurred during capacitor charging or reform, and the majority appears to have happened during normal ICD function. While the incidence of this problem is unknown, a management strategy should be adopted that includes routine follow-up every 3 months and device evaluation after a shock or exposure to external defibrillation or electrosurgical devices. This study suggests that additional data are needed to determine the incidence of this problem, and that our present methods for monitoring the performance of ICD's following market release are inadequate. PMID:11475818

  5. Right Heart Failure during Veno-Venous Extracorporeal Membrane Oxygenation for H1N1 Induced Acute Respiratory Distress Syndrome: Case Report and Literature Review

    PubMed Central

    Lee, Seung-Hun; Jung, Jae-Seung; Chung, Jae-Ho; Lee, Kwang-Hyung; Kim, Hee-Jung; Son, Ho-Sung; Sun, Kyung

    2015-01-01

    A 38-year-old male was admitted with symptoms of upper respiratory infection. Despite medical treatment, his symptoms of dyspnea and anxiety became aggravated, and bilateral lung infiltration was noted on radiological imaging studies. His hypoxemia failed to improve even after the application of endotracheal intubation with mechanical ventilator care, and we therefore decided to initiate venovenous extracorporeal membrane oxygenation (VV ECMO) for additional pulmonary support. On his twentieth day of hospitalization, hypotension and desaturation (arterial saturated oxygen <85%) developed, and right ventricular failure was confirmed by two-dimensional echocardiography. Therefore, we changed from VV ECMO to venoarteriovenous (VAV) ECMO, and the patient ultimately recovered. In this case, right ventricular dysfunction and volume overloading were induced by long-term VV ECMO therapy, and we successfully treated these conditions by changing to VAV ECMO. PMID:26290843

  6. Comparative Treatment Failure Rates of Respiratory Fluoroquinolones or ?-Lactam + Macrolide Versus ?-Lactam Alone in the Treatment for Community-Acquired Pneumonia in Adult Outpatients

    PubMed Central

    Lee, Meng-Tse Gabriel; Lee, Shih-Hao; Chang, Shy-Shin; Chan, Ya-Lan; Pang, Laura; Hsu, Sue-Ming; Lee, Chien-Chang

    2015-01-01

    Abstract No comparative effectiveness study has been conducted for the following 3 antibiotics: respiratory ?uoroquinolone, ?-lactam, and ?-lactam + advanced macrolide. To gain insights into the real-world clinical effectiveness of these antibiotics for community-acquired pneumonia in adult outpatients, our study investigated the treatment failure rates in 2 million representative participants from the National Health Informatics Project (NHIP) of Taiwan. A new-user cohort design was used to follow NHIP participants from January 2000 until December 2009. Treatment failure was defined by either one of the following events: a second antibiotic prescription, hospitalization due to CAP, an emergency department visit with a diagnosis of CAP, or 30-day nonaccident-related mortality. From 2006 to 2009, we identified 9256 newly diagnosed CAP outpatients, 1602 of whom were prescribed levofloxacin, 2100 were prescribed moxifloxacin, 5049 were prescribed ?-lactam alone, and 505 were prescribed advanced macrolide + ?-lactam. Compared with the ?-lactam-based regimen, the propensity score-matched odds ratio for composite treatment failure was 0.81 (95% CI, 0.67–0.97) for moxifloxacin, 1.10 (95% CI, 0.90–1.35) for levofloxacin, and 0.95 (95% CI, 0.67–1.35) for macrolide +?-lactam. Moxifloxacin was associated with lower treatment failure rates compared with ?-lactam alone, or levofloxacin in Taiwanese CAP outpatients. However, due to inherent limitations in our claims database, more randomized controlled trials are required before coming to a conclusion on which antibiotic is more effective for Taiwanese CAP outpatients. More population-based comparative effectiveness studies are also encouraged and should be considered as an integral piece of evidence in local CAP treatment guidelines. PMID:26426664

  7. Outcomes of a Telehealth Intervention for Homebound Older Adults with Heart or Chronic Respiratory Failure: A Randomized Controlled Trial

    ERIC Educational Resources Information Center

    Gellis, Zvi D.; Kenaley, Bonnie; McGinty, Jean; Bardelli, Ellen; Davitt, Joan; Ten Have, Thomas

    2012-01-01

    Purpose: Telehealth care is emerging as a viable intervention model to treat complex chronic conditions, such as heart failure (HF) and chronic obstructive pulmonary disease (COPD), and to engage older adults in self-care disease management. Design and Methods: We report on a randomized controlled trial examining the impact of a multifaceted…

  8. Certain aspects of shock-wave motion of a medium caused by phase transitions and failure

    NASA Astrophysics Data System (ADS)

    Petrenko, A. M.; Romanov, G. S.

    1995-11-01

    The article presents the results of a numerical solution of the problem of explosion in silicate rock taking into account melting, polymorphic phase transition, and various kinds of brittle failure. We show that phase transition provides an effective increase in the stability of a medium to explosive effect, while cracking processes lead to the formation of a stable two-wave structure. A relationship between the destruction parameters and the structure of shock-wave elastic motion is established. We estimate the effect of phase transitions and failure on the spectrum of acoustic emission initiated by explosion.

  9. Examining the Causes of Memory Strength Variability: Recollection, Attention Failure, or Encoding Variability?

    ERIC Educational Resources Information Center

    Koen, Joshua D.; Aly, Mariam; Wang, Wei-Chun; Yonelinas, Andrew P.

    2013-01-01

    A prominent finding in recognition memory is that studied items are associated with more variability in memory strength than new items. Here, we test 3 competing theories for why this occurs--the "encoding variability," "attention failure", and "recollection" accounts. Distinguishing among these theories is critical…

  10. Examining the causes of memory strength variability: recollection, attention failure, or encoding variability?

    PubMed

    Koen, Joshua D; Aly, Mariam; Wang, Wei-Chun; Yonelinas, Andrew P

    2013-11-01

    A prominent finding in recognition memory is that studied items are associated with more variability in memory strength than new items. Here, we test 3 competing theories for why this occurs-the encoding variability, attention failure, and recollection accounts. Distinguishing among these theories is critical because each provides a fundamentally different account of the processes underlying recognition memory. The encoding variability and attention failure accounts propose that old item variance will be unaffected by retrieval manipulations because the processes producing this effect are ascribed to encoding. The recollection account predicts that both encoding and retrieval manipulations that preferentially affect recollection will affect memory variability. These contrasting predictions were tested by examining the effect of response speeding (Experiment 1), dividing attention at retrieval (Experiment 2), context reinstatement (Experiment 3), and increased test delay (Experiment 4) on recognition performance. The results of all 4 experiments confirm the predictions of the recollection account and are inconsistent with the encoding variability account. The evidence supporting the attention failure account is mixed, with 2 of the 4 experiments confirming the account and 2 disconfirming the account. These results indicate that encoding variability and attention failure are insufficient accounts of memory variance and provide support for the recollection account. Several alternative theoretical accounts of the results are also considered. PMID:23834057

  11. Causes of Failure in Web Applications Soila Pertet and Priya Narasimhan

    E-print Network

    failures observed in Web applications. This appendix lists over 40 incidents of real-world site outages the Thanksgiving holiday weekend in 2001, Amazon.com suffered a series of outages, which cost the retailer in Web applications. This appendix lists over 40 incidents of real-world site outages, outlining how

  12. Examining the causes of memory strength variability: Recollection, attention failure, or encoding variability?

    PubMed Central

    Koen, Joshua D.; Aly, Mariam; Wang, Wei-Chun; Yonelinas, Andrew P.

    2013-01-01

    A prominent finding in recognition memory is that studied items are associated with more variability in memory strength than new items. Here, we test three competing theories for why this occurs - the encoding variability, attention failure, and recollection accounts. Distinguishing amongst these theories is critical because each provides a fundamentally different account of the processes underlying recognition memory. The encoding variability and attention failure accounts propose that old item variance will be unaffected by retrieval manipulations because the processes producing this effect are ascribed to encoding. The recollection account predicts that both encoding and retrieval manipulations that preferentially affect recollection will affect memory variability. These contrasting predictions were tested by examining the effect of response speeding (Experiment 1), dividing attention at retrieval (Experiment 2), context reinstatement (Experiment 3), and increased test delay (Experiment 4) on recognition performance. The results of all four experiments confirmed the predictions of the recollection account, and were inconsistent with the encoding variability account. The evidence supporting the attention failure account was mixed, with two of the four experiments confirming the account and two disconfirming the account. These results indicate that encoding variability and attention failure are insufficient accounts of memory variance, and provide support for the recollection account. Several alternative theoretical accounts of the results are also considered. PMID:23834057

  13. [Subarachnoid anesthesia and peridural anesthesia: which are the causes of total failure? A clinical case].

    PubMed

    Mastroianni, A; Novelli, M T; Belforte, G; Sodano, R; Aiassa, M

    1992-11-01

    The paper reports the case of patient undergoing cystoscopy and subsequently radical cystectomy suffering from BPCO and pulmonary emphysema who received sub-arachnoid anesthesia during the first operation and peridural anesthesia during the second, with total failure both times. The techniques were correctly performed and on both occasions it was necessary to resort to general anesthesia in order to perform the operation. PMID:1294909

  14. [Acute renal failure, intravascular hemolysis and toxic hepatitis caused by repeated use of rifampicin (case report)].

    PubMed

    Sefer, S; Ivanusa, M; Kes, P; Ratkovi?-Gusi?, I; Vasilj, D

    1999-01-01

    We report the case of a 57-year-old man treated with interrupted rifampicin therapy for urinary tract tuberculosis who experienced acute renal failure, intravascular hemolysis and toxic hepatitis. This combined adverse reactions are rare. Supportive treatment with dialysis and withdrawal of rifampicin result with complete recovery. Interrupted and intermittent therapy with rifampicin should be avoided and noncompliant patients should be given alternative treatment when possible. PMID:10437356

  15. [A child with hyperpyrexia syndrome and multiple organ failure caused by and an orthopedic corset].

    PubMed

    Kopp, E F; von Rosenstiel, I A

    1996-02-24

    A 4-year-old boy who each night was placed in an orthopaedic corset because of congenital multiple arthrogryposis developed heat stroke with hyperpyrexia and multiorganic failure in a hot summer. Treatment consisted of administration of fluids, antibiotics and anticonvulsive agents; the child recovered completely. In children who are sick and have fever, the use of such corsets should temporarily be suspended. PMID:8720818

  16. A shortage of males causes female reproductive failure in yellow ground squirrels

    PubMed Central

    Vasilieva, Nina; Tchabovsky, Andrey

    2015-01-01

    Sexual conflict theory suggests that female breeding success is strongly influenced by individual life history and environmental conditions and is much less affected by mate availability. Female mating failure due to a shortage of males remains poorly studied and understood. We present data on the effects of male availability on female breeding success in a wild colony of yellow ground squirrels (Spermophilus fulvus). A female’s probability of breeding increased with the local density of males and was higher with higher male-biased operational sex ratio (OSR) but was independent of local female density, female age, and body condition, which are factors commonly assumed to influence female reproduction. The positive effect of male availability (as measured by OSR) on female breeding success was consistent across the years, and we conclude that male limitation contributes to female mating failure. This pattern, which is not commonly recorded in species with conventional sex roles, can be explained by a combination of sociodemographic and life history traits (sex differences in age of maturation, female-skewed adult sex ratio and seasonally varying OSR, solitary living at low population density, and low mobility of females combined with mate-searching tactics of males) that are not confined to S. fulvus. Our findings indicate that the role of female mating failure (due to a shortage of males) in shaping mammalian life history may be underestimated. PMID:26601284

  17. Compounds from multilayer plastic bags cause reproductive failures in artificial insemination

    NASA Astrophysics Data System (ADS)

    Nerin, C.; Ubeda, J. L.; Alfaro, P.; Dahmani, Y.; Aznar, M.; Canellas, E.; Ausejo, R.

    2014-05-01

    High levels of reproductive failure were detected in some Spanish sow farms in the Spring of 2010. Regular returns to estrus and variable reductions in litter size were observed. The problem started suddenly and did not appear to be related to the quality of the ejaculates, disease, alterations of body condition or any other apparent reasons. Subsequent studies determined that the problem was the origin of the plastic bags used for semen storage. Chemical analysis of the suspicious bags identified unexpected compounds such as BADGE, a cyclic lactone and an unknown phthalate that leached into the semen at concentrations of 0.2 to 2.5 mg/L. Spermatozoa preserved in these bags passed all of the routine quality control tests, and no differences were observed between storage in the control and suspicious bags (p > 0.05). In vitro fecundation tests and endocrine profiler panel analysis (EPP) did not show any alterations, whereas the in vivo tests confirmed the described failure. This is the first described relationship between reproductive failure and toxic compounds released from plastic bags.

  18. Compounds from multilayer plastic bags cause reproductive failures in artificial insemination.

    PubMed

    Nerin, C; Ubeda, J L; Alfaro, P; Dahmani, Y; Aznar, M; Canellas, E; Ausejo, R

    2014-01-01

    High levels of reproductive failure were detected in some Spanish sow farms in the Spring of 2010. Regular returns to estrus and variable reductions in litter size were observed. The problem started suddenly and did not appear to be related to the quality of the ejaculates, disease, alterations of body condition or any other apparent reasons. Subsequent studies determined that the problem was the origin of the plastic bags used for semen storage. Chemical analysis of the suspicious bags identified unexpected compounds such as BADGE, a cyclic lactone and an unknown phthalate that leached into the semen at concentrations of 0.2 to 2.5?mg/L. Spermatozoa preserved in these bags passed all of the routine quality control tests, and no differences were observed between storage in the control and suspicious bags (p > 0.05). In vitro fecundation tests and endocrine profiler panel analysis (EPP) did not show any alterations, whereas the in vivo tests confirmed the described failure. This is the first described relationship between reproductive failure and toxic compounds released from plastic bags. PMID:24810330

  19. Compounds from multilayer plastic bags cause reproductive failures in artificial insemination

    PubMed Central

    Nerin, C.; Ubeda, J. L.; Alfaro, P.; Dahmani, Y.; Aznar, M.; Canellas, E.; Ausejo, R.

    2014-01-01

    High levels of reproductive failure were detected in some Spanish sow farms in the Spring of 2010. Regular returns to estrus and variable reductions in litter size were observed. The problem started suddenly and did not appear to be related to the quality of the ejaculates, disease, alterations of body condition or any other apparent reasons. Subsequent studies determined that the problem was the origin of the plastic bags used for semen storage. Chemical analysis of the suspicious bags identified unexpected compounds such as BADGE, a cyclic lactone and an unknown phthalate that leached into the semen at concentrations of 0.2 to 2.5?mg/L. Spermatozoa preserved in these bags passed all of the routine quality control tests, and no differences were observed between storage in the control and suspicious bags (p > 0.05). In vitro fecundation tests and endocrine profiler panel analysis (EPP) did not show any alterations, whereas the in vivo tests confirmed the described failure. This is the first described relationship between reproductive failure and toxic compounds released from plastic bags. PMID:24810330

  20. SERCA2 Haploinsufficiency in a Mouse Model of Darier Disease Causes a Selective Predisposition to Heart Failure

    PubMed Central

    Prasad, Vikram; Lorenz, John N.; Lasko, Valerie M.; Nieman, Michelle L.; Huang, Wei; Wang, Yigang; Wieczorek, David W.; Shull, Gary E.

    2015-01-01

    Null mutations in one copy of ATP2A2, the gene encoding sarco/endoplasmic reticulum Ca2+-ATPase isoform 2 (SERCA2), cause Darier disease in humans, a skin condition involving keratinocytes. Cardiac function appears to be unimpaired in Darier disease patients, with no evidence that SERCA2 haploinsufficiency itself causes heart disease. However, SERCA2 deficiency is widely considered a contributing factor in heart failure. We therefore analyzed Atp2a2 heterozygous mice to determine whether SERCA2 haploinsufficiency can exacerbate specific heart disease conditions. Despite reduced SERCA2a levels in heart, Atp2a2 heterozygous mice resembled humans in exhibiting normal cardiac physiology. When subjected to hypothyroidism or crossed with a transgenic model of reduced myofibrillar Ca2+-sensitivity, SERCA2 deficiency caused no enhancement of the disease state. However, when combined with a transgenic model of increased myofibrillar Ca2+-sensitivity, SERCA2 haploinsufficiency caused rapid onset of hypertrophy, decompensation, and death. These effects were associated with reduced expression of the antiapoptotic Hax1, increased levels of the proapoptotic genes Chop and Casp12, and evidence of perturbations in energy metabolism. These data reveal myofibrillar Ca2+-sensitivity to be an important determinant of the cardiac effects of SERCA2 haploinsufficiency and raise the possibility that Darier disease patients are more susceptible to heart failure under certain conditions. PMID:26064889

  1. Traumatic Tension Pneumothorax as a Cause of ICD Failure: A Case Report and Review of the Literature

    PubMed Central

    2014-01-01

    Background. Tension pneumothorax can infrequently cause ventricular arrhythmias and increase the threshold of defibrillation. It should be suspected whenever there is difficulty in defibrillation for a ventricular arrhythmia. Purpose. To report a case of traumatic tension pneumothorax leading to ventricular tachycardia and causing defibrillator failure. Case. A 65-year-old African-American female was brought in to our emergency department complaining of dyspnea after being forced down by cops. She had history of mitral valve replacement for severe mitral regurgitation and biventricular implantable cardioverter defibrillator inserted for nonischemic cardiomyopathy. Shortly after arrival, she developed sustained ventricular tachycardia, causing repetitive unsuccessful ICD shocks. She was intubated and ventricular tachycardia resolved with amiodarone. Chest radiograph revealed large left sided tension pneumothorax which was promptly drained. The patient was treated for congestive heart failure; she was extubated on the third day of admission, and the chest tube was removed. Conclusion. Prompt recognition of tension pneumothorax is essential, by maintaining a high index of suspicion in patients with an increased defibrillation threshold causing ineffective defibrillations. PMID:25400953

  2. White-Etching Matter in Bearing Steel. Part II: Distinguishing Cause and Effect in Bearing Steel Failure

    NASA Astrophysics Data System (ADS)

    Solano-Alvarez, W.; Bhadeshia, H. K. D. H.

    2014-10-01

    The premature failure of large bearings of the type used in wind turbines, possibly through a mechanism called "white-structure flaking", has triggered many studies of microstructural damage associated with "white-etching areas" created during rolling contact fatigue, although whether they are symptoms or causes of failure is less clear. Therefore, some special experiments have been conducted to prove that white-etching areas are the consequence, and not the cause, of damage. By artificially introducing a fine dispersion of microcracks in the steel through heat treatment and then subjecting the sample to rolling contact fatigue, manifestations of hard white-etching matter have been created to a much greater extent than samples similarly tested without initial cracks. A wide variety of characterization tools has been used to corroborate that the white areas thus created have the same properties as reported observations on real bearings. Evidence suggests that the formation mechanism of the white-etching regions involves the rubbing and beating of the free surfaces of cracks, debonded inclusions, and voids under repeated rolling contact. It follows that the focus in avoiding early failure should be in enhancing the toughness of the bearing steel in order to avoid the initial microscopic feature event.

  3. Irreversible respiratory failure in an achondroplastic child: the importance of an early cervicomedullary decompression, and a review of the literature.

    PubMed

    Colamaria, V; Mazza, C; Beltramello, A; Polo, A; Boner, A; Antoniazzi, F; Polo, M; Luchini, P; Sgrò, V; Dalla Bernardina, B

    1991-07-01

    The authors report the case of a girl with achondroplasia suffering from a progressively worsening hypotonic quadriparesis. CT scan showed slight dilatation of ventricular and subarachnoid spaces, with well-defined evidence of cortical sulci and gyri. This aspect was compatible with the diagnosis of macrocrania and megalencephaly (CP being 51 cm). The foramen magnum was narrowed, the transverse diameter measuring 15 mm and the 50th percentile being, for age, 26 mm. Somatosensory evoked potentials (SEPs) revealed bilaterally prolonged interpeak latencies Erb-N13, slowing of central conduction time N13-N20 from right median nerve stimulation, and block from left median nerve. The suspicion of cervicomedullary compression was confirmed by MRI, showing a very marked stenosis with compression exerted by the odontoid process. Further, a stenotic cervical canal and optic nerves verticalization were manifest. The patient underwent neurosurgical decompression by suboccipital craniectomy and cervical-C1 laminectomy. In spite of treatment, both neurologic and respiratory problems (rapid, shallow and almost abdominal breathing) were unchanged. The girl died 4 1/2 months later. The authors emphasize the important role of SEPs in detection of cervicomedullary compression in achondroplastic children and also stress the necessity of an early surgical treatment as the only condition for possible clinical improvement and/or full recovery. PMID:1957977

  4. Outbreak of acute respiratory disease caused by Mycoplasma pneumoniae on board a deployed U.S. navy ship.

    PubMed

    Sliman, Joseph A; Metzgar, David; Asseff, David C; Coon, Robert G; Faix, Dennis J; Lizewski, Stephen

    2009-12-01

    We identified 179 cases of acute respiratory illness including 50 cases of radiographically confirmed pneumonia over the course of 4 months on a deployed U.S. Navy vessel. Laboratory tests showed Mycoplasma pneumoniae to be the etiological agent. This report represents the first published description of a shipboard outbreak of this pathogen. PMID:19846632

  5. The economic effect of extracorporeal membrane oxygenation to support adults with severe respiratory failure in Brazil: a hypothetical analysis

    PubMed Central

    Park, Marcelo; Mendes, Pedro Vitale; Zampieri, Fernando Godinho; Azevedo, Luciano Cesar Pontes; Costa, Eduardo Leite Vieira; Antoniali, Fernando; Ribeiro, Gustavo Calado de Aguiar; Caneo, Luiz Fernando; da Cruz Neto, Luiz Monteiro; Carvalho, Carlos Roberto Ribeiro; Trindade, Evelinda Marramon

    2014-01-01

    Objective To analyze the cost-utility of using extracorporeal oxygenation for patients with severe acute respiratory distress syndrome in Brazil. Methods A decision tree was constructed using databases from previously published studies. Costs were taken from the average price paid by the Brazilian Unified Health System (Sistema Único de Saúde; SUS) over three months in 2011. Using the data of 10,000,000 simulated patients with predetermined outcomes and costs, an analysis was performed of the ratio between cost increase and years of life gained, adjusted for quality (cost-utility), with survival rates of 40 and 60% for patients using extracorporeal membrane oxygenation. Results The decision tree resulted in 16 outcomes with different life support techniques. With survival rates of 40 and 60%, respectively, the increased costs were R$=-301.00/-14.00, with a cost of R$=-30,913.00/-1,752.00 paid per six-month quality-adjusted life-year gained and R$=-2,386.00/-90.00 per quality-adjusted life-year gained until the end of life, when all patients with severe ARDS were analyzed. Analyzing only patients with severe hypoxemia (i.e., a ratio of partial oxygen pressure in the blood to the fraction of inspired oxygen <100mmHg), the increased cost was R$=-5,714.00/272.00, with a cost per six-month quality-adjusted life-year gained of R$=-9,521.00/293.00 and a cost of R$=-280.00/7.00 per quality-adjusted life-year gained. Conclusion The cost-utility ratio associated with the use of extracorporeal membrane oxygenation in Brazil is potentially acceptable according to this hypothetical study. PMID:25295819

  6. Respiratory Complications of Organophosphorus Nerve Agent and Insecticide Poisoning. Implications for Respiratory and Critical Care

    PubMed Central

    Hulse, Elspeth J.; Davies, James O. J.; Simpson, A. John; Sciuto, Alfred M.

    2014-01-01

    Organophosphorus (OP) compound poisoning is a major global public health problem. Acute OP insecticide self-poisoning kills over 200,000 people every year, the majority from self-harm in rural Asia. Highly toxic OP nerve agents (e.g., sarin) are a significant current terrorist threat, as shown by attacks in Damascus during 2013. These anticholinesterase compounds are classically considered to cause an acute cholinergic syndrome with decreased consciousness, respiratory failure, and, in the case of insecticides, a delayed intermediate syndrome that requires prolonged ventilation. Acute respiratory failure, by central and peripheral mechanisms, is the primary cause of death in most cases. However, preclinical and clinical research over the last two decades has indicated a more complex picture of respiratory complications after OP insecticide poisoning, including onset of delayed neuromuscular junction dysfunction during the cholinergic syndrome, aspiration causing pneumonia and acute respiratory distress syndrome, and the involvement of solvents in OP toxicity. The treatment of OP poisoning has not changed over the last 50 years. However, a better understanding of the multiple respiratory complications of OP poisoning offers additional therapeutic opportunities. PMID:25419614

  7. Respiratory complications of organophosphorus nerve agent and insecticide poisoning. Implications for respiratory and critical care.

    PubMed

    Hulse, Elspeth J; Davies, James O J; Simpson, A John; Sciuto, Alfred M; Eddleston, Michael

    2014-12-15

    Organophosphorus (OP) compound poisoning is a major global public health problem. Acute OP insecticide self-poisoning kills over 200,000 people every year, the majority from self-harm in rural Asia. Highly toxic OP nerve agents (e.g., sarin) are a significant current terrorist threat, as shown by attacks in Damascus during 2013. These anticholinesterase compounds are classically considered to cause an acute cholinergic syndrome with decreased consciousness, respiratory failure, and, in the case of insecticides, a delayed intermediate syndrome that requires prolonged ventilation. Acute respiratory failure, by central and peripheral mechanisms, is the primary cause of death in most cases. However, preclinical and clinical research over the last two decades has indicated a more complex picture of respiratory complications after OP insecticide poisoning, including onset of delayed neuromuscular junction dysfunction during the cholinergic syndrome, aspiration causing pneumonia and acute respiratory distress syndrome, and the involvement of solvents in OP toxicity. The treatment of OP poisoning has not changed over the last 50 years. However, a better understanding of the multiple respiratory complications of OP poisoning offers additional therapeutic opportunities. PMID:25419614

  8. Respiratory distress in the newborn.

    PubMed

    Reuter, Suzanne; Moser, Chuanpit; Baack, Michelle

    2014-10-01

    Respiratory distress presents as tachypnea, nasal flaring, retractions, and grunting and may progress to respiratory failure if not readily recognized and managed. Causes of respiratory distress vary and may not lie within the lung. A thorough history, physical examination, and radiographic and laboratory findings will aid in the differential diagnosis. Common causes include transient tachypnea of the newborn, neonatal pneumonia, respiratory distress syndrome (RDS), and meconium aspiration syndrome (MAS). Strong evidence reveals an inverse relationship between gestational age and respiratory morbidity. (1)(2)(9)(25)(26) Expert opinion recommends careful consideration about elective delivery without labor at less than 39 weeks’ gestation. Extensive evidence, including randomized control trials, cohort studies, and expert opinion, supports maternal group B streptococcus screening, intrapartum antibiotic prophylaxis, and appropriate followup of high-risk newborns according to guidelines established by the Centers for Disease Control and Prevention. (4)(29)(31)(32)(34) Following these best-practice strategies is effective in preventing neonatal pneumonia and its complications. (31)(32)(34). On the basis of strong evidence, including randomized control trials and Cochrane Reviews, administration of antenatal corticosteroids (5) and postnatal surfactant (6) decrease respiratory morbidity associated with RDS. Trends in perinatal management strategies to prevent MAS have changed. There is strong evidence that amnioinfusion, (49) oropharyngeal and nasopharyngeal suctioning at the perineum, (45) or intubation and endotracheal suctioning of vigorous infants (46)(47) do not decrease MAS or its complications. Some research and expert opinion supports endotracheal suctioning of nonvigorous meconium-stained infants (8) and induction of labor at 41 weeks’ gestation (7) to prevent MAS. PMID:25274969

  9. Relationship of skeletal muscle metaboreceptors in the upper and lower limbs with the respiratory control in patients with heart failure.

    PubMed

    Scott, Adam C; Davies, L Ceri; Coats, Andrew J S; Piepoli, Massimo

    2002-01-01

    Increased activity of muscle metaboreceptors (afferents sensitive to muscle contraction that are responsible for the ventilatory responses to exercise) has been proposed in patients with chronic heart failure (CHF) to constitute a missing link between muscle metabolic abnormalities and exercise overventilation. We looked at this reflex overactivation to determine if it is systemic or limited to a single muscle region in the same human subject. This was done by comparing the metaboreflex response of ventilatory control in the lower and upper limbs in CHF patients and healthy controls. Groups of 15 stable CHF patients (63.7+/-2.7 years) and eight control subjects (69.8+/-1.8 years) performed both leg and arm metaboreflex tests. These metaboreflex tests involved two 5 min episodes of bicycle or handgrip exercise: on one occasion after the exercise the subjects recovered normally, while on the other occasion tourniquet cuffs were inflated around the exercising limb to supra-systolic pressure at the onset of recovery to obtain a regional circulatory occlusion, which isolates and maintains the stimulation of the metaboreflex after exercise. The contribution of the metaboreflex to exercise ventilation was computed as the absolute increment of peak ventilation that was maintained by regional circulatory occlusion. The metaboreceptor contribution to the ventilatory response to both leg exercise (patients, 5.3+/-1.6 litres/min; controls, 0.2+/-0.7 litres/min) and arm exercise (patients, 3.7+/-1.0 litres/min; controls, 0.02+/-0.4 litres/min) was significantly higher in CHF patients (P<0.05). A significant correlation was present between metaboreflex responses to arm and leg exercises (r=0.4, P<0.05). Metaboreflex responses during both types of exercise were inversely correlated with peak oxygen uptake (leg, r=-0.43, P<0.05; arm, r=-0.633, P=0.0009), but only the reflex during arm exercise was correlated with the .V(E) (ventilation)/.V(CO)(2) (CO(2) production) slope (r=0.576, P<0.005). Thus the metaboreflex system is systemically overactive and may potentially contribute to exercise intolerance during both lower- and upper-limb efforts in CHF. This suggests a unique mechanism responsible for overactivation of this system in the skeletal muscle of heart failure patients. PMID:11749657

  10. Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure: a Cochrane systematic review

    PubMed Central

    Burns, Karen E.A.; Meade, Maureen O.; Premji, Azra; Adhikari, Neill K.J.

    2014-01-01

    Background: Noninvasive ventilation has been studied as a means of reducing complications among patients being weaned from invasive mechanical ventilation. We sought to summarize evidence comparing noninvasive and invasive weaning and their effects on mortality. Methods: We identified relevant randomized and quasirandomized trials through searches of databases, conference proceedings and grey literature. We included trials comparing extubation and immediate application of noninvasive ventilation with continued invasive weaning in adults on mechanical ventilation. Two reviewers each independently screened citations, assessed trial quality and abstracted data. Our primary outcome was mortality. Results: We identified 16 trials involving 994 participants, most of whom had chronic obstructive pulmonary disease (COPD). Compared with invasive weaning, noninvasive weaning significantly reduced mortality (risk ratio [RR] 0.53, 95% confidence interval [CI] 0.36 to 0.80), weaning failures (RR 0.63, 95% CI 0.42 to 0.96), ventilator-associated pneumonia (RR 0.25, 95% CI 0.15 to 0.43), length of stay in the intensive care unit (mean difference [MD] ?5.59 d, 95% CI ?7.90 to ?3.28) and in hospital (MD ?6.04 d, 95% CI ?9.22 to ?2.87), and total duration of mechanical ventilation (MD ?5.64 d, 95% CI ?9.50 to ?1.77). Noninvasive weaning had no significant effect on the duration of ventilation related to weaning, but significantly reduced rates of tracheostomy (RR 0.19, 95% CI 0.08 to 0.47) and reintubation (RR 0.65, 95% CI 0.44 to 0.97). Mortality benefits were significantly greater in trials enrolling patients with COPD than in trials enrolling mixed patient populations (RR 0.36 [95% CI 0.24 to 0.56] v. RR 0.81 [95% CI 0.47 to 1.40]). Interpretation: Noninvasive weaning reduces rates of death and pneumonia without increasing the risk of weaning failure or reintubation. In subgroup analyses, mortality benefits were significantly greater in patients with COPD. PMID:24324020

  11. An investigation of the causes of failure of flexible thermal protection materials in an aerodynamic environment

    NASA Technical Reports Server (NTRS)

    Coe, Charles F.

    1987-01-01

    Tests of small panels of advanced flexible reusable surface insulation (AFRSI) were conducted using a small wind tunnel that was designed to simulate Space Shuttle Orbiter entry mean-flow and pulsating aerodynamic loads. The wind tunnel, with a 3 inch wide by 1.75 inch high by 7.5 inch long test section, proved to be capable of continuous flow at dynamic pressures q near 580 psf with fluctuating pressures over 2 psi RMS at an excitation frequency f sub E of 200 Hz. For this investigation, however, the wind tunnel was used to test entry-temperature preconditioned and heat-cleaned AFRSI at q = 280 psf, Prms was nearly equal to 1.2 psi and f sub E = 200 Hz. The objective of these tests was to determine the mechanism of failure of AFRSI at Orbiter entry conditions. Details of the test apparatus and test results are presented.

  12. Loss of motoneuron-specific microRNA-218 causes systemic neuromuscular failure.

    PubMed

    Amin, Neal D; Bai, Ge; Klug, Jason R; Bonanomi, Dario; Pankratz, Matthew T; Gifford, Wesley D; Hinckley, Christopher A; Sternfeld, Matthew J; Driscoll, Shawn P; Dominguez, Bertha; Lee, Kuo-Fen; Jin, Xin; Pfaff, Samuel L

    2015-12-18

    Dysfunction of microRNA (miRNA) metabolism is thought to underlie diseases affecting motoneurons. One miRNA, miR-218, is abundantly and selectively expressed by developing and mature motoneurons. Here we show that mutant mice lacking miR-218 die neonatally and exhibit neuromuscular junction defects, motoneuron hyperexcitability, and progressive motoneuron cell loss, all of which are hallmarks of motoneuron diseases such as amyotrophic lateral sclerosis and spinal muscular atrophy. Gene profiling reveals that miR-218 modestly represses a cohort of hundreds of genes that are neuronally enriched but are not specific to a single neuron subpopulation. Thus, the set of messenger RNAs targeted by miR-218, designated TARGET(218), defines a neuronal gene network that is selectively tuned down in motoneurons to prevent neuromuscular failure and neurodegeneration. PMID:26680198

  13. Regulated cell death and inflammation: an auto-amplification loop causes organ failure.

    PubMed

    Linkermann, Andreas; Stockwell, Brent R; Krautwald, Stefan; Anders, Hans-Joachim

    2014-11-01

    Regulated cell death (RCD) is either immunologically silent or immunogenic. RCD in parenchymal cells may lead to the release of damage- associated molecular patterns that drive both tissue inflammation and the activation of further pathways of RCD. Following an initial event of regulated necrosis, RCD and inflammation can induce each other and drive a local auto-amplification loop that leads to exaggerated cell death and inflammation. In this Opinion article, we propose that such crosstalk between pro-inflammatory and RCD pathways has pathophysiological relevance in solid organ failure, transplantation and cancer. In our opinion, clinicians should not only prescribe immunosuppressive treatments to disrupt this circuit, but also implement the neglected therapeutic option of adding compounds that interfere with RCD. PMID:25324125

  14. Structured literature review of responses of cattle to viral and bacterial pathogens causing bovine respiratory disease complex.

    PubMed

    Grissett, G P; White, B J; Larson, R L

    2015-01-01

    Bovine respiratory disease (BRD) is an economically important disease of cattle and continues to be an intensely studied topic. However, literature summarizing the time between pathogen exposure and clinical signs, shedding, and seroconversion is minimal. A structured literature review of the published literature was performed to determine cattle responses (time from pathogen exposure to clinical signs, shedding, and seroconversion) in challenge models using common BRD viral and bacterial pathogens. After review a descriptive analysis of published studies using common BRD pathogen challenge studies was performed. Inclusion criteria were single pathogen challenge studies with no treatment or vaccination evaluating outcomes of interest: clinical signs, shedding, and seroconversion. Pathogens of interest included: bovine viral diarrhea virus (BVDV), bovine herpesvirus type 1 (BHV-1), parainfluenza-3 virus, bovine respiratory syncytial virus, Mannheimia haemolytica, Mycoplasma bovis, Pastuerella multocida, and Histophilus somni. Thirty-five studies and 64 trials were included for analysis. The median days to the resolution of clinical signs after BVDV challenge was 15 and shedding was not detected on day 12 postchallenge. Resolution of BHV-1 shedding resolved on day 12 and clinical signs on day 12 postchallenge. Bovine respiratory syncytial virus ceased shedding on day 9 and median time to resolution of clinical signs was on day 12 postchallenge. M. haemolytica resolved clinical signs 8 days postchallenge. This literature review and descriptive analysis can serve as a resource to assist in designing challenge model studies and potentially aid in estimation of duration of clinical disease and shedding after natural pathogen exposure. PMID:25929158

  15. Energy Expenditure at Rest and during Walking in Patients with Chronic Respiratory Failure: A Prospective Two-Phase Case-Control Study

    PubMed Central

    Crisafulli, Ernesto; Beneventi, Claudio; Bortolotti, Veronica; Kidonias, Nicoletta; Fabbri, Leonardo M.; Chetta, Alfredo; Clini, Enrico M.

    2011-01-01

    Background Measurements of Energy Expenditure (EE) at rest (REE) and during physical activities are increasing in interest in chronic patients. In this study we aimed at evaluating the validity/reliability of the SenseWear®Armband (SWA) device in terms of REE and EE during assisted walking in Chronic Respiratory Failure (CRF) patients receiving long-term oxygen therapy (LTOT). Methodology/Principal Findings In a two-phase prospective protocol we studied 40 severe patients and 35 age-matched healthy controls. In phase-1 we determined the validity and repeatability of REE measured by SWA (REEa) in comparison with standard calorimetry (REEc). In phase-2 we then assessed EE and Metabolic Equivalents-METs by SWA during the 6-minute walking test while breathing oxygen in both assisted (Aid) or unassisted (No-Aid) modalities. When compared with REEc, REEa was slightly lower in patients (1351±169 vs 1413±194 kcal/day respectively, p<0.05), and less repeatable than in healthy controls (0.14 and 0.43 coefficient respectively). COPD patients with CRF patients reported a significant gain with Aid as compared with No-Aid modality in terms of meters walked, perceived symptoms and EE. Conclusions/Significance SWA provides a feasible and valid method to assess the energy expenditure in CRF patients on LTOT, and it shows that aided walking results in a substantial energy saving in this population. PMID:21909356

  16. Failure of PCR-Based IS6110 Analysis To Detect Vertebral Spondylodiscitis Caused by Mycobacterium bovis

    PubMed Central

    Steensels, Deborah; Fauville-Dufaux, Maryse; Boie, Johan

    2013-01-01

    Mycobacterium bovis is responsible for a zoonosis originating in cattle. We report a case of a man with vertebral spondylodiscitis caused by Mycobacterium bovis. Diagnosis was complicated because of the lack of IS6110. These strains are rare, but microbiologists should be aware of their existence. PMID:23135943

  17. Spectral transfer function analysis of respiratory hemodynamic fluctuations predicts end-diastolic stiffness in preserved ejection fraction heart failure.

    PubMed

    Abdellatif, Mahmoud; Leite, Sara; Alaa, Mohamed; Oliveira-Pinto, José; Tavares-Silva, Marta; Fontoura, Dulce; Falcão-Pires, Inês; Leite-Moreira, Adelino F; Lourenço, André P

    2016-01-01

    Preserved ejection fraction heart failure (HFpEF) diagnosis remains controversial, and invasive left ventricular (LV) hemodynamic evaluation and/or exercise testing is advocated by many. The stiffer HFpEF myocardium may show impaired stroke volume (SV) variation induced by fluctuating LV filling pressure during ventilation. Our aim was to investigate spectral transfer function (STF) gain from end-diastolic pressure (EDP) to indexed SV (SVi) in experimental HFpEF. Eighteen-week-old Wistar-Kyoto (WKY) and ZSF1 lean (ZSF1 Ln) and obese rats (ZSF1 Ob) randomly underwent LV open-chest (OC, n = 8 each group) or closed-chest hemodynamic evaluation (CC, n = 6 each group) under halogenate anesthesia and positive-pressure ventilation at constant inspiratory pressure. Beat-to-beat fluctuations in hemodynamic parameters during ventilation were assessed by STF. End-diastolic stiffness (?i) and end-systolic elastance (Eesi) for indexed volumes were obtained by inferior vena cava occlusion in OC (multibeat) or single-beat method estimates in CC. ZSF1 Ob showed higher EDP spectrum (P < 0.001), higher STF gain between end-diastolic volume and EDP, and impaired STF gain between EDP and SVi compared with both hypertensive ZSF1 Ln and normotensive WKY controls (P < 0.001). Likewise ?i was only higher in ZSF1 Ob while Eesi was raised in both ZSF1 groups. On multivariate analysis ?i and not Eesi correlated with impaired STF gain from EDP to SVi (P < 0.001), and receiver-operating characteristics analysis showed an area under curve of 0.89 for higher ?i prediction (P < 0.001). Results support further clinical testing of STF analysis from right heart catheterization-derived EDP surrogates to noninvasively determined SV as screening/diagnostic tool to assess myocardial stiffness in HFpEF. PMID:26475584

  18. The NO/ONOO-Cycle as the Central Cause of Heart Failure

    PubMed Central

    Pall, Martin L.

    2013-01-01

    The NO/ONOO-cycle is a primarily local, biochemical vicious cycle mechanism, centered on elevated peroxynitrite and oxidative stress, but also involving 10 additional elements: NF-?B, inflammatory cytokines, iNOS, nitric oxide (NO), superoxide, mitochondrial dysfunction (lowered energy charge, ATP), NMDA activity, intracellular Ca2+, TRP receptors and tetrahydrobiopterin depletion. All 12 of these elements have causal roles in heart failure (HF) and each is linked through a total of 87 studies to specific correlates of HF. Two apparent causal factors of HF, RhoA and endothelin-1, each act as tissue-limited cycle elements. Nineteen stressors that initiate cases of HF, each act to raise multiple cycle elements, potentially initiating the cycle in this way. Different types of HF, left vs. right ventricular HF, with or without arrhythmia, etc., may differ from one another in the regions of the myocardium most impacted by the cycle. None of the elements of the cycle or the mechanisms linking them are original, but they collectively produce the robust nature of the NO/ONOO-cycle which creates a major challenge for treatment of HF or other proposed NO/ONOO-cycle diseases. Elevated peroxynitrite/NO ratio and consequent oxidative stress are essential to both HF and the NO/ONOO-cycle. PMID:24232452

  19. Respiratory System

    MedlinePLUS

    ... this page from the NHLBI on Twitter. The Respiratory System The respiratory system is made up of organs ... vessels, and the muscles that enable breathing. The Respiratory System Figure A shows the location of the respiratory ...

  20. GABAB receptor deficiency causes failure of neuronal homeostasis in hippocampal networks

    PubMed Central

    Vertkin, Irena; Styr, Boaz; Slomowitz, Edden; Ofir, Nir; Shapira, Ilana; Berner, David; Fedorova, Tatiana; Laviv, Tal; Barak-Broner, Noa; Greitzer-Antes, Dafna; Gassmann, Martin; Bettler, Bernhard; Lotan, Ilana; Slutsky, Inna

    2015-01-01

    Stabilization of neuronal activity by homeostatic control systems is fundamental for proper functioning of neural circuits. Failure in neuronal homeostasis has been hypothesized to underlie common pathophysiological mechanisms in a variety of brain disorders. However, the key molecules regulating homeostasis in central mammalian neural circuits remain obscure. Here, we show that selective inactivation of GABAB, but not GABAA, receptors impairs firing rate homeostasis by disrupting synaptic homeostatic plasticity in hippocampal networks. Pharmacological GABAB receptor (GABABR) blockade or genetic deletion of the GB1a receptor subunit disrupts homeostatic regulation of synaptic vesicle release. GABABRs mediate adaptive presynaptic enhancement to neuronal inactivity by two principle mechanisms: First, neuronal silencing promotes syntaxin-1 switch from a closed to an open conformation to accelerate soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) complex assembly, and second, it boosts spike-evoked presynaptic calcium flux. In both cases, neuronal inactivity removes tonic block imposed by the presynaptic, GB1a-containing receptors on syntaxin-1 opening and calcium entry to enhance probability of vesicle fusion. We identified the GB1a intracellular domain essential for the presynaptic homeostatic response by tuning intermolecular interactions among the receptor, syntaxin-1, and the CaV2.2 channel. The presynaptic adaptations were accompanied by scaling of excitatory quantal amplitude via the postsynaptic, GB1b-containing receptors. Thus, GABABRs sense chronic perturbations in GABA levels and transduce it to homeostatic changes in synaptic strength. Our results reveal a novel role for GABABR as a key regulator of population firing stability and propose that disruption of homeostatic synaptic plasticity may underlie seizure's persistence in the absence of functional GABABRs. PMID:26056260

  1. GABAB receptor deficiency causes failure of neuronal homeostasis in hippocampal networks.

    PubMed

    Vertkin, Irena; Styr, Boaz; Slomowitz, Edden; Ofir, Nir; Shapira, Ilana; Berner, David; Fedorova, Tatiana; Laviv, Tal; Barak-Broner, Noa; Greitzer-Antes, Dafna; Gassmann, Martin; Bettler, Bernhard; Lotan, Ilana; Slutsky, Inna

    2015-06-23

    Stabilization of neuronal activity by homeostatic control systems is fundamental for proper functioning of neural circuits. Failure in neuronal homeostasis has been hypothesized to underlie common pathophysiological mechanisms in a variety of brain disorders. However, the key molecules regulating homeostasis in central mammalian neural circuits remain obscure. Here, we show that selective inactivation of GABAB, but not GABA(A), receptors impairs firing rate homeostasis by disrupting synaptic homeostatic plasticity in hippocampal networks. Pharmacological GABA(B) receptor (GABA(B)R) blockade or genetic deletion of the GB(1a) receptor subunit disrupts homeostatic regulation of synaptic vesicle release. GABA(B)Rs mediate adaptive presynaptic enhancement to neuronal inactivity by two principle mechanisms: First, neuronal silencing promotes syntaxin-1 switch from a closed to an open conformation to accelerate soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) complex assembly, and second, it boosts spike-evoked presynaptic calcium flux. In both cases, neuronal inactivity removes tonic block imposed by the presynaptic, GB(1a)-containing receptors on syntaxin-1 opening and calcium entry to enhance probability of vesicle fusion. We identified the GB(1a) intracellular domain essential for the presynaptic homeostatic response by tuning intermolecular interactions among the receptor, syntaxin-1, and the Ca(V)2.2 channel. The presynaptic adaptations were accompanied by scaling of excitatory quantal amplitude via the postsynaptic, GB(1b)-containing receptors. Thus, GABA(B)Rs sense chronic perturbations in GABA levels and transduce it to homeostatic changes in synaptic strength. Our results reveal a novel role for GABA(B)R as a key regulator of population firing stability and propose that disruption of homeostatic synaptic plasticity may underlie seizure's persistence in the absence of functional GABA(B)Rs. PMID:26056260

  2. [Acute respiratory distress syndrome].

    PubMed

    Gaudry, Stéphane; Ricard, Jean-Damien; Dreyfuss, Didier

    2012-11-01

    Acute respiratory distress syndrome (ARDS) is a permeability pulmonary edema due to lung injury from various causes. In 2012, a new definition, taking into account the degree of hypoxemia and the level of positive end-expiratory pressure (PEEP), was published. In addition to progress in the support of organ failures in intensive care, mortality in patients suffering from ARDS has decreased significantly. This improved prognosis is also due to the advent of protective mechanical ventilation that has limited ventilator-induced lung injury (VILI). The treatment of ARDS consists on causative treatment and a strategy of protective ventilation associated with a PEEP level between 10 and 15 cm H20 and the use of prone position or inhaled nitric oxide in the severest cases. The role of extracorporeal membrane oxygenation as adjuvant therapy in ARDS remains unclear. PMID:23272466

  3. Feasibility study on full closed-loop control ventilation (IntelliVent-ASV™) in ICU patients with acute respiratory failure: a prospective observational comparative study

    PubMed Central

    2013-01-01

    Introduction IntelliVent-ASV™ is a full closed-loop ventilation mode that automatically adjusts ventilation and oxygenation parameters in both passive and active patients. This feasibility study compared oxygenation and ventilation settings automatically selected by IntelliVent-ASV™ among three predefined lung conditions (normal lung, acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD)) in active and passive patients. The feasibility of IntelliVent-ASV™ use was assessed based on the number of safety events, the need to switch to conventional mode for any medical reason, and sensor failure. Method This prospective observational comparative study included 100 consecutive patients who were invasively ventilated for less than 24 hours at the time of inclusion with an expected duration of ventilation of more than 12 hours. Patients were ventilated using IntelliVent-ASV™ from inclusion to extubation. Settings, automatically selected by the ventilator, delivered ventilation, respiratory mechanics, and gas exchanges were recorded once a day. Results Regarding feasibility, all patients were ventilated using IntelliVent-ASV™ (392 days in total). No safety issues occurred and there was never a need to switch to an alternative ventilation mode. The fully automated ventilation was used for 95% of the total ventilation time. IntelliVent-ASV™ selected different settings according to lung condition in passive and active patients. In passive patients, tidal volume (VT), predicted body weight (PBW) was significantly different between normal lung (n = 45), ARDS (n = 16) and COPD patients (n = 19) (8.1 (7.3 to 8.9) mL/kg; 7.5 (6.9 to 7.9) mL/kg; 9.9 (8.3 to 11.1) mL/kg, respectively; P 0.05). In passive ARDS patients, FiO2 and positive end-expiratory pressure (PEEP) were statistically higher than passive normal lung (35 (33 to 47)% versus 30 (30 to 31)% and 11 (8 to 13) cmH2O versus 5 (5 to 6) cmH2O, respectively; P< 0.05). Conclusions IntelliVent-ASV™ was safely used in unselected ventilated ICU patients with different lung conditions. Automatically selected oxygenation and ventilation settings were different according to the lung condition, especially in passive patients. Trial Registration ClinicalTrials.gov: NCT01489085 PMID:24025234

  4. Comments on serious anaphylaxis caused by nine Chinese herbal injections used to treat common colds and upper respiratory tract infections.

    PubMed

    Ji, Kunmei; Chen, Jiajie; Li, Meng; Liu, Zhigang; Xia, Lixin; Wang, Chunbo; Zhan, Zhengke; Wu, Xuli

    2009-11-01

    Reports describing severe allergic shock and fatality following treatment of a common cold or upper respiratory tract infection (URTI) with a Chinese herbal injection were collected. Our analysis of the risks associated with this treatment suggested that the potential risk of serious, or even lethal, anaphylaxis should preclude its use in treating common colds and URTIs. In light of our findings herein, we propose the following five suggestions for improving the clinical safety of delivering Chinese herbal injections as medical treatments. First, Chinese herbal injections should not be delivered in the clinic to treat patients in accordance with Bian zheng lun zhi (broad-spectrum application based on holistic Traditional Chinese Medicine (TCM) theory and methodology), but rather they should be administered to target specific indicated disease processes. Second, Chinese herbal injection indications should be based on the results of double-blind randomized controlled clinical trials. Third, Chinese herbal injections should be used only in cases involving severe disease or to rescue patients in critical condition; they should not be used to treat mild, relatively innocuous diseases, such as common colds and upper respiratory tract infections, given the risk of doing harm. Fourth, Chinese herbal injection formulas should include materials from only a single or a small number of plant sources in known quantities. Fifth, more studies examining the toxicology and allergenic potential of Chinese herbal injections are needed. PMID:19559066

  5. Tissue factor pathway inhibitor prevents airway obstruction, respiratory failure and death due to sulfur mustard analog inhalation

    SciTech Connect

    Rancourt, Raymond C. Veress, Livia A. Ahmad, Aftab Hendry-Hofer, Tara B. Rioux, Jacqueline S. Garlick, Rhonda B. White, Carl W.

    2013-10-01

    Sulfur mustard (SM) inhalation causes airway injury, with enhanced vascular permeability, coagulation, and airway obstruction. The objective of this study was to determine whether recombinant tissue factor pathway inhibitor (TFPI) could inhibit this pathogenic sequence. Methods: Rats were exposed to the SM analog 2-chloroethyl ethyl sulfide (CEES) via nose-only aerosol inhalation. One hour later, TFPI (1.5 mg/kg) in vehicle, or vehicle alone, was instilled into the trachea. Arterial O{sub 2} saturation was monitored using pulse oximetry. Twelve hours after exposure, animals were euthanized and bronchoalveolar lavage fluid (BALF) and plasma were analyzed for prothrombin, thrombin–antithrombin complex (TAT), active plasminogen activator inhibitor-1 (PAI-1) levels, and fluid fibrinolytic capacity. Lung steady-state PAI-1 mRNA was measured by RT-PCR analysis. Airway-capillary leak was estimated by BALF protein and IgM, and by pleural fluid measurement. In additional animals, airway cast formation was assessed by microdissection and immunohistochemical detection of airway fibrin. Results: Airway obstruction in the form of fibrin-containing casts was evident in central conducting airways of rats receiving CEES. TFPI decreased cast formation, and limited severe hypoxemia. Findings of reduced prothrombin consumption, and lower TAT complexes in BALF, demonstrated that TFPI acted to limit thrombin activation in airways. TFPI, however, did not appreciably affect CEES-induced airway protein leak, PAI-1 mRNA induction, or inhibition of the fibrinolytic activity present in airway surface liquid. Conclusions: Intratracheal administration of TFPI limits airway obstruction, improves gas exchange, and prevents mortality in rats with sulfur mustard-analog-induced acute lung injury. - Highlights: • TFPI administration to rats after mustard inhalation reduces airway cast formation. • Inhibition of thrombin activation is the likely mechanism for limiting casts. • Rats given TFPI had improved tissue oxygenation, and mortality was prevented.

  6. Failure of Amino Acid Homeostasis Causes Cell Death following Proteasome Inhibition

    PubMed Central

    Suraweera, Amila; Münch, Christian; Hanssum, Ariane; Bertolotti, Anne

    2012-01-01

    Summary The ubiquitin-proteasome system targets many cellular proteins for degradation and thereby controls most cellular processes. Although it is well established that proteasome inhibition is lethal, the underlying mechanism is unknown. Here, we show that proteasome inhibition results in a lethal amino acid shortage. In yeast, mammalian cells, and flies, the deleterious consequences of proteasome inhibition are rescued by amino acid supplementation. In all three systems, this rescuing effect occurs without noticeable changes in the levels of proteasome substrates. In mammalian cells, the amino acid scarcity resulting from proteasome inhibition is the signal that causes induction of both the integrated stress response and autophagy, in an unsuccessful attempt to replenish the pool of intracellular amino acids. These results reveal that cells can tolerate protein waste, but not the amino acid scarcity resulting from proteasome inhibition. PMID:22959274

  7. Root-cause failure analysis of photocurrent loss in polythiophene:fullerene-based inverted solar cells.

    PubMed

    Voroshazi, Eszter; Uytterhoeven, Griet; Cnops, Kjell; Conard, Thierry; Favia, Paola; Bender, Hugo; Muller, Robert; Cheyns, David

    2015-01-14

    Metal oxide transport layers have played a crucial role in recent progress in organic photovoltaic (OPV) device stability. Here, we measure the stability of inverted and encapsulated polythiophene:fullerene cells with MoO3/Ag/Al composite anode in operational conditions combining solar radiation and 65 °C. Performance loss of over 50% in the first 100 h of the aging is dominated by a drop in the short-circuit current (Jsc). We reveal a concurrent loss in reflectance from 85% to 50% above 650 nm, which is below the optical gap of the used photoactive materials, hence, excluding any major degradation in the bulk of this layer. Correlating the responses of aged devices to a series of test structures comprised of ITO/ZnO cathode, MoO3/Ag, and MoO3/Ag/Al anodes and their combinations with the active layer allowed us to identify that the presence of Al causes the reduced reflectance in these devices, independent of the presence of the active layer. Systematic single-stress aging on the test structures further indicates that elevated heat is the cause of the reflectance loss. Cross-section transmission electron microscopy coupled with elemental analysis revealed the unsuspected role of Al; notably, it diffuses through the entire 150 nm thick Ag layer and accumulates at the MoO3/Ag interface. Moreover, XRD analysis of the aged MoO3/Ag/Al anode indicates the formation of Ag2Al alloy. Depth profiling with X-ray photoelectron spectroscopy advanced our understanding by confirming the formation of Ag-Al intermetallic alloy and the presence of oxidized Al only at the MoO3/Ag interface suggesting a concomitant reduction of MoO3 to most probably MoO2. This latter compound is less reflective than MoO3, which can explain the reduced reflectance in aged devices as proven by optical simulations. On the basis of these results, we could estimate that 20% of the loss in Jsc is ascribed to reduction of MoO3 triggered by its direct contact with Al. PMID:25536872

  8. Restoration of nuclear-import failure caused by triple A syndrome and oxidative stress

    SciTech Connect

    Kiriyama, Takao; Hirano, Makito Asai, Hirohide; Ikeda, Masanori; Furiya, Yoshiko; Ueno, Satoshi

    2008-10-03

    Triple A syndrome is an autosomal recessive neurological disease, mimicking motor neuron disease, and is caused by mutant ALADIN, a nuclear-pore complex component. We recently discovered that the pathogenesis involved impaired nuclear import of DNA repair proteins, including DNA ligase I and the cerebellar ataxia causative protein aprataxin. Such impairment was overcome by fusing classical nuclear localization signal (NLS) and 137-aa downstream sequence of XRCC1, designated stretched NLS (stNLS). We report here that the minimum essential sequence of stNLS (mstNLS) is residues 239-276, downsized by more than 100 aa. mstNLS enabled efficient nuclear import of DNA repair proteins in patient fibroblasts, functioned under oxidative stress, and reduced oxidative-stress-induced cell death, more effectively than stNLS. The stress-tolerability of mstNLS was also exerted in control fibroblasts and neuroblastoma cells. These findings may help develop treatments for currently intractable triple A syndrome and other oxidative-stress-related neurological diseases, and contribute to nuclear compartmentalization study.

  9. A novel mutation in STXBP1 causing epileptic encephalopathy (late onset infantile spasms) with partial respiratory chain complex IV deficiency.

    PubMed

    Barcia, G; Barnerias, C; Rio, M; Siquier-Pernet, K; Desguerre, I; Colleaux, L; Munnich, A; Rotig, A; Nabbout, R

    2013-12-01

    STXBP1 (MUNC18.1), encoding syntaxin binding protein 1, has been reported in Ohtahara syndrome, a rare epileptic encephalopathy with suppression burst pattern on EEG, in patients with infantile spasms and in a few patients with nonsyndromic mental retardation without epilepsy. We report a patient who presented late onset infantile spasms. Epilepsy was controlled but the patient developed severe mental delay. A first diagnosis of mitochondrial disease was based on clinical presentation and on a partial deficit of respiratory chain complex IV, but molecular screening for mitochondrial genes was negative. The sequencing of STXBP1 gene found a de novo nonsense mutation (c.585C>G/p.Tyr195X). This observation widens the clinical spectrum linked to STXBP1 mutations with the description of a patient with late onset infantile spasms. It raises the question of the value of epilepsy genes screening in patients with uncertain, partial or unconfirmed mitochondrial dysfunction. PMID:24095819

  10. Mechanical failure characterization of optical components caused by laser induced damage initiated at contaminants

    SciTech Connect

    Faux, D. R., LLNL

    1997-12-01

    The goal of this research is to quantify by numerical techniques the effects of surface and subsurface absorbing defects on damage initiation and growth in high power laser optical components. The defects include laser absorbing spots (e.g., surface particulate contamination) and surface damage regions (e.g., micro-cracks and voids) which are present due to environmental exposure and fabrication processes. This report focuses on three sources of contamination that can cause damage to optical components: (1) Front surface particle contamination, (2) Back surface particle contamination, and (3) Subsurface particle contamination. The DYNA2D (non-linear structural mechanics) code was used to model the growth of damage in the glass substrate. The damage in the nominally transparent glass substrate as a result of front surface particle contamination was found to be dependent on the magnitude of the resultant pressure pulse applied to the particle and the initial area of contact between the particle and glass substrate. The pressures generated from a back surface particle being blown off the surface provided sufficient loading to severely damage (crack) the glass substrate. A subsurface Ceria dioxide particle showed a strong surface interaction that influenced the formation and direction of the damage (cracking) that ultimately resulted in the blow-out of the damaged material leaving a relatively clean crater in the glass. Crater shape and size was determined. Since fused silica is the most transparent, and therefore laser damage resistant, of the optical materials, it is used for the most at-risk optical elements. The present studies are for a fused silica substrate. Some oxides such as Ceria are transparent in the infrared and visible, but absorbing in the UV part of the spectrum. Because ICF lasers like NIF use frequency tripling, effects of such oxides must be included.

  11. Zinc deficiency during in vitro maturation of porcine oocytes causes meiotic block and developmental failure.

    PubMed

    Jeon, Yubyeol; Yoon, Junchul David; Cai, Lian; Hwang, Seon-Ung; Kim, Eunhye; Zheng, Zhong; Jeung, Euibae; Lee, Eunsong; Hyun, Sang-Hwan

    2015-10-01

    The present study investigated the effects of zinc deficiency during in vitro maturation (IVM) of porcine oocytes. Zinc deficiency was induced by administering the membrane?permeable zinc chelator N,N,N',N'?tetrakis?(2?pyridylmethyl)?ethylendiamine (TPEN). First, the effects of zinc deficiency during IVM on a TPEN?treated group and a TPEN+zinc-treated group compared with a control group were assessed. The oocyte maturation rates and subsequent embryonic developmental competence of the TPEN+zinc?treated oocytes were similar to those of the control oocytes (metaphase II [MII] rate, 93.0 and 92.7%, respectively, and blastocyst [BL] formation rate, 42.0 and 40.0%, respectively). These results were significantly different from those obtained for the TPEN?treated oocytes (MII rate, 0.61%; BL formation rate, 0%). Although the TPEN?treated oocytes were arrested at metaphase I (MI), the distribution of microtubules was normal. However, microfilament formation was abnormal in the TPEN?treated oocytes. Furthermore, the effect of a temporary zinc deficiency during IVM on oocyte maturation and subsequent embryonic development was assessed. TPEN (10 µM) was added to the IVM medium for 0, 7, 15 or 22 h. The 0 h?treated oocytes showed an 83.9% MII rate, while the 7 h?treated oocytes had a significantly lower MII rate (44.8%). Most of the 15- and 22 h?treated oocytes were arrested at MI (MI rate: 98.0 and 97.2%, respectively; MII rate, 0% in both groups). Reductions in the BL formation were dependent on the TPEN treatment duration (29.3, 9.2, 0, and 0% after 0, 7, 15 and 22 h, respectively). In conclusion, zinc is an essential element for successful oocyte maturation and embryonic development in pigs. Zinc deficiency caused a meiotic block and had lasting effects on early embryonic development. PMID:26238161

  12. Effects of nutraceutical diet integration, with coenzyme Q10 (Q-Ter multicomposite) and creatine, on dyspnea, exercise tolerance, and quality of life in COPD patients with chronic respiratory failure

    PubMed Central

    2013-01-01

    Background The protein-calorie malnutrition, resulting in muscle mass loss, frequently occurs in severe COPD patients with chronic respiratory failure (CRF), causing dyspnea, reduced exercise tolerance and impaired quality of life. The cause of this occurrence is an intake-output energy imbalance. A documented deficit of phosphocreatine and reduced mithocondrial energy production can contribute to this imbalance. Aim of this study is to verify whether a dietary supplementation with creatine and coenzyme Q10, important mitochondrial function factors, is able to influence this mechanism leading to a dyspnea reduction and improving exercise tolerance and quality of life. Methods 55 COPD patients with chronic respiratory failure (in long term O2 therapy), in stable phase of the disease and without severe comorbidities were assigned (double-blind, randomized) to: group A (30 patients) with daily dietary supplementation with Creatine 340 mg + 320 mg Coenzyme Q-Ter (Eufortyn®, Scharper Therapeutics Srl) for 2 months whereas Group B (25 patients) received placebo. All patients continued the same diet, rehabilitation and therapy during the study. At recruitment (T0) and after 2 months (T1), patients were submitted to medical history, anthropometry (BMI), bioelectrical impedance, arterial blood gas analysis, evaluation of dyspnea (VAS, Borg, BDI, MRC) and functional independence (ADL), 6-minute walk test (6MWT) and quality of life questionnaire (SGRQ). At 6 months and 1 year, a telephone follow up was conducted on exacerbations number. Results No significant difference was detected at baseline (T0) in the 2 groups. After 2 months of therapy (T1) the FFMI increased in the daily dietary supplementation group (+ 3.7 %) and decreased in the placebo group (- 0.6 %), resulting in a statistically significant (p < 0.001) treatment difference. Statistically significant treatment differences, favouring daily dietary supplementation group, were also seen for the 6MWT comparison. Group A patients also showed significant: 1) improvement in the degree of dyspnea (VAS: p < 0.05; Borg: p < 0.05; MRC: p < 0.001; BDI1: p < 0.05; BDI3: p < 0.03), and independence level in activities of daily living (p < 0.03); 2) improvement in quality of life in activity section (- 6.63 pt) and in total score (- 5.43 pt); 3) exacerbation number decrease (p < 0.02). No significant differences were found (end of study vs baseline) in group B. Conclusions The nutraceutical diet integration with Q-Ter and creatine, in COPD patients with CRF in O2TLT induced an increasing lean body mass and exercise tolerance, reducing dyspnea, quality of life and exacerbations. These results provide a first demonstration that acting on protein synthesis and muscular efficiency can significantly modify the systemic consequences of the disease. PMID:23800154

  13. How Is Respiratory Failure Treated?

    MedlinePLUS

    ... mattress on a motorized platform. The mattress gently rocks back and forth. When your head rocks down, the organs in your abdomen and your ... slide up, helping you exhale. When your head rocks up, the organs in your abdomen and your ...

  14. How Is Respiratory Failure Diagnosed?

    MedlinePLUS

    ... are. Diagnostic Tests To check the oxygen and carbon dioxide levels in your blood, you may have: Pulse ... gas test. This test measures the oxygen and carbon dioxide levels in your blood. A blood sample is ...

  15. [Respiratory insufficiency in adults with diphtheric polyneuropathy].

    PubMed

    Popova, L M; Avdiunina, I A; Alferova, V P; Piradov, M A; Pavlov, E V; Plekhanova, S A

    1996-01-01

    Twenty-five adult patients with grave diphtheric polyneuropathy after toxic diphtheria were followed up. Two symptom complexes of neurologic disorders leading to the development of peripheral respiratory failure of different severity were distinguished: 1) predominating glossopharyngeal paralysis and 2) combination of glossopharyngeal paralysis with grave generalized sensorimotor polyneuropathy (with pareses and paralyses of the respiratory muscles). The major quantitative parameters of pulmonary functions associated with various manifestations of respiratory failure are characterized. The significance of information on the type of dysfunction of vocal cords is emphasized. A high efficacy of a complex of respiratory reanimation used in the treatment of patients with peripheral respiratory failure is demonstrated. PMID:8754164

  16. Difficult identification of Haemophilus influenzae, a typical cause of upper respiratory tract infections, in the microbiological diagnostic routine.

    PubMed

    Hinz, Rebecca; Zautner, Andreas Erich; Hagen, Ralf Matthias; Frickmann, Hagen

    2015-03-01

    Haemophilus influenzae is a key pathogen of upper respiratory tract infections. Its reliable discrimination from nonpathogenic Haemophilus spp. is necessary because merely colonizing bacteria are frequent at primarily unsterile sites. Due to close phylogenetic relationship, it is not easy to discriminate H. influenzae from the colonizer Haemophilus haemolyticus. The frequency of H. haemolyticus isolations depends on factors like sampling site, patient condition, and geographic region. Biochemical discrimination has been shown to be nonreliable. Multiplex PCR including marker genes like sodC, fucK, and hpd or sequencing of the 16S rRNA gene, the P6 gene, or multilocus-sequence-typing is more promising. For the diagnostic routine, such techniques are too expensive and laborious. If available, matrix-assisted laser-desorption-ionization time-of-flight mass spectrometry is a routine-compatible option and should be used in the first line. However, the used database should contain well-defined reference spectra, and the spectral difference between H. influenzae and H. haemolyticus is small. Fluorescence in-situ hybridization is an option for less well-equipped laboratories, but the available protocol will not lead to conclusive results in all instances. It can be used as a second line approach. Occasional ambiguous results have to be resolved by alternative molecular methods like 16S rRNA gene sequencing. PMID:25883794

  17. Difficult identification of Haemophilus influenzae, a typical cause of upper respiratory tract infections, in the microbiological diagnostic routine

    PubMed Central

    Hinz, Rebecca; Zautner, Andreas Erich; Hagen, Ralf Matthias

    2015-01-01

    Haemophilus influenzae is a key pathogen of upper respiratory tract infections. Its reliable discrimination from nonpathogenic Haemophilus spp. is necessary because merely colonizing bacteria are frequent at primarily unsterile sites. Due to close phylogenetic relationship, it is not easy to discriminate H. influenzae from the colonizer Haemophilus haemolyticus. The frequency of H. haemolyticus isolations depends on factors like sampling site, patient condition, and geographic region. Biochemical discrimination has been shown to be nonreliable. Multiplex PCR including marker genes like sodC, fucK, and hpd or sequencing of the 16S rRNA gene, the P6 gene, or multilocus-sequence-typing is more promising. For the diagnostic routine, such techniques are too expensive and laborious. If available, matrix-assisted laser-desorption–ionization time-of-flight mass spectrometry is a routine-compatible option and should be used in the first line. However, the used database should contain well-defined reference spectra, and the spectral difference between H. influenzae and H. haemolyticus is small. Fluorescence in-situ hybridization is an option for less well-equipped laboratories, but the available protocol will not lead to conclusive results in all instances. It can be used as a second line approach. Occasional ambiguous results have to be resolved by alternative molecular methods like 16S rRNA gene sequencing. PMID:25883794

  18. Novel mouse model of left ventricular pressure overload and infarction causing predictable ventricular remodelling and progression to heart failure.

    PubMed

    Weinheimer, Carla J; Lai, Ling; Kelly, Daniel P; Kovacs, Attila

    2015-01-01

    Mouse surgical models are important tools for evaluating mechanisms of human cardiac disease. The clinically relevant comorbidities of hypertension and ischaemia have not been explored in mice. We have developed a surgical approach that combines transverse aortic constriction and distal left anterior coronary ligation (MI) to produce a gradual and predictable progression of adverse left ventricular (LV) remodelling that leads to heart failure (HF). Mice received either sham, MI alone, transverse aortic constriction alone or HF surgery. Infarct size and LV remodelling were evaluated by serial 2-D echocardiograms. Transverse aortic constriction gradients were measured by the Doppler velocity-time integral ratio between constricted and proximal aortic velocities. At 4 weeks, hearts were weighed and analysed for histology and brain natriuretic peptide, a molecular marker of HF. Echocardiographic analysis of segmental wall motion scores showed similarly small apical infarct sizes in the MI and HF groups at day 1 postsurgery. MI alone showed little change in infarct size over 4 weeks (0.26 ± 0.02 to 0.27 ± 0.04, P = 0.77); however, HF mice showed infarct expansion (0.25 ± 0.06 to 0.39 ± 0.09, P < 0.05). HF mice also showed LV remodelling with increases in LV volumes (1 day = 36.5 ± 5.2 mL, 28 days = 89.1 ± 16.0 mL) versus no significant changes in the other groups. Furthermore, systolic function progressively deteriorated in the HF group only (ejection fraction, 1 day = 55.6 ± 3.6%, 28 days = 17.6 ± 4.1%, P < 0.05) with an increase of brain natriuretic peptide by 3.5-fold. This surgical model of pressure overload in the setting of a small infarction causes progressive deterioration of cardiac structural and functional properties, and provides a clinically relevant tool to study adverse LV remodelling and heart failure. PMID:25311547

  19. What Causes Heart Failure?

    MedlinePLUS

    ... Guidelines Resources Continuing Education Researchers Funding Training & Career Development Division of Intramural Research Research Resources Research Meeting Summaries Technology Transfer Clinical Trials What Are Clinical Trials? Children & Clinical Studies NHLBI Trials Clinical Trial Websites News & ...

  20. Development of acute pancreatitis caused by sodium valproate in a patient with bipolar disorder on hemodialysis for chronic renal failure: a case report

    PubMed Central

    2014-01-01

    Background Cases of acute pancreatitis caused by sodium valproate (VPA) have been reported by many authors thus far. However, most of these were cases with epilepsy. Chronic renal failure is also regarded as a risk factor for acute pancreatitis. Here, we report a case of acute pancreatitis development due to VPA in a patient with bipolar disorder on hemodialysis for chronic renal failure. Case presentation The patient was a 52-year-old Japanese male who was diagnosed as bipolar disorder on hemodialysis for renal failure. He was treated with VPA and manic symptoms gradually stabilized. However, the patient complained of severe abdominal pain. Blood amylase was found to be markedly high, and computed tomography revealed pancreatomegaly and an increased amount of peripancreatic fat. Hence, we diagnosed the case as acute pancreatitis caused by VPA. We discontinued oral medication, and he was started on a pancreatic enzyme inhibitor, antibiotics, and transfusion, and he showed improvement. Conclusion It has been reported that acute pancreatitis induced by VPA is caused by intermediate metabolites of VPA. We consider that patients with renal failure are prone to pancreatitis caused by VPA because of the accumulation of these intermediate metabolites. We need close monitoring for serious adverse effects such as pancreatitis when we prescribe VPA to patients with bipolar disorder on hemodialysis for chronic renal failure, although VPA is safer than other mood stabilizers. PMID:24679075

  1. Hypothyroidism minimizes the effects of acute hepatic failure caused by endoplasmic reticulum stress and redox environment alterations in rats.

    PubMed

    Blas-Valdivia, Vanessa; Cano-Europa, Edgar; Martinez-Perez, Yoalli; Lezama-Palacios, Ruth; Franco-Colin, Margarita; Ortiz-Butron, Rocio

    2015-10-01

    The aim of this study was to investigate if a protective effect from hypothyroidism in acute liver failure resulted from reduced endoplasmic reticulum stress and changes to the redox environment. Twenty male Sprague-Dawley rats were divided in four groups: (1) euthyroid (sham surgery), (2) hypothyroid, (3) euthyroid (sham surgery)+thioacetamide and (4) hypothyroid+thioacetamide. Hypothyroidism was confirmed two weeks after thyroidectomy, and thioacetamide (TAA) (400mg/kg, ip) was administrated to the appropriate groups for three days with supportive therapy. Grades of encephalopathy in all animals were determined using behavioral tests. Animals were decapitated and their blood was obtained to assess liver function. The liver was dissected: the left lobe was used for histology and the right lobe was frozen for biochemical assays. Body weight, rectal temperature and T4 concentration were lower in hypothyroid groups. When measurements of oxidative stress markers, redox environment, ?-glutamylcysteine synthetase and glutathione-S-transferase were determined, we observed that hypothyroid animals with TAA compensated better with oxidative damage than euthyroid animals treated with TAA. Furthermore, we measured reduced expressions of GADD34, caspase-12 and GRP78 and subsequently less hypothyroidism-induced cellular damage in hypothyroid animals. We conclude that hypothyroidism protects against hepatic damage caused by TAA because it reduces endoplasmic reticulum stress and changes to the redox environment. PMID:26238033

  2. Proper Criteria of Nonlinear Optical Crystals for Space Laser Systems and the Possible Causes for Space Laser Failures

    NASA Technical Reports Server (NTRS)

    Abdeldayem, Hossin A.; Dowdye, Edward; Jamison, Tracee; Canham, John

    2005-01-01

    NASA is striving to develop a scientific understanding of the universe and the Earth-Sun System and its response to natural or human-induced changes. Space lasers are vital tools for NASA's missions to advance our understanding of space research and improving our prediction capability for climate, weather, and natural hazards. Unfortunately, several past space missions that utilized lasers proved to be short-lived and unreliable. In this paper, we are reporting the results of our investigations on several nonlinear optical crystals, which are vital components in space lasers. Examples of these investigations are: The correlation of the phase diagrams of nonlinear crystals and its durability, the effect of radiating these crystals by high-energy beams of protons and gamma on their second harmonic efficiency, and measurements of the high-energy and low-energy thresholds for each crystal before and after irradiation. A set of proper criteria for these crystals will be presented. We will also discuss the possible causes of failures in a space laser and propose a solution to a contamination problem in all future space lasers.

  3. While soil-applied herbicides can be quite valuable in weed control, misuse can cause crop injury or failure to control weeds. This guide

    E-print Network

    Maxwell, Bruce D.

    While soil-applied herbicides can be quite valuable in weed control, misuse can cause crop injury or failure to control weeds. This guide is an overview of factors that influence the fate, effectiveness-Applied Herbicides by Fabián D. Menalled, Extension Cropland Weeds Specialist, and William E. Dyer, Professor, Weed

  4. On the Over-Emphasis of Human `Error' As A Cause of Aviation Accidents: `Systemic Failures' and `Human Error' in US NTSB and Canadian TSB Aviation Reports

    E-print Network

    Johnson, Chris

    -1- On the Over-Emphasis of Human `Error' As A Cause of Aviation Accidents: `Systemic Failures' and `Human Error' in US NTSB and Canadian TSB Aviation Reports 1996-2003 C.W. Johnson Dept of Computing claimed that up to 80% of all aviation accidents are attributed to human `error' (Johnson, 2003). This has

  5. Re-emergent Human Adenovirus Genome Type 7d Caused an Acute Respiratory Disease Outbreak in Southern China After a Twenty-one Year Absence

    PubMed Central

    Zhao, Suhui; Wan, Chengsong; Ke, Changwen; Seto, Jason; Dehghan, Shoaleh; Zou, Lirong; Zhou, Jie; Cheng, Zetao; Jing, Shuping; Zeng, Zhiwei; Zhang, Jing; Wan, Xuan; Wu, Xianbo; Zhao, Wei; Zhu, Li; Seto, Donald; Zhang, Qiwei

    2014-01-01

    Human adenoviruses (HAdVs) are highly contagious pathogens causing acute respiratory disease (ARD), among other illnesses. Of the ARD genotypes, HAdV-7 presents with more severe morbidity and higher mortality than the others. We report the isolation and identification of a genome type HAdV-7d (DG01_2011) from a recent outbreak in Southern China. Genome sequencing, phylogenetic analysis, and restriction endonuclease analysis (REA) comparisons with past pathogens indicate HAdV-7d has re-emerged in Southern China after an absence of twenty-one years. Recombination analysis reveals this genome differs from the 1950s-era prototype and vaccine strains by a lateral gene transfer, substituting the coding region for the L1 52/55?kDa DNA packaging protein from HAdV-16. DG01_2011 descends from both a strain circulating in Southwestern China (2010) and a strain from Shaanxi causing a fatality and outbreak (Northwestern China; 2009). Due to the higher morbidity and mortality rates associated with HAdV-7, the surveillance, identification, and characterization of these strains in population-dense China by REA and/or whole genome sequencing are strongly indicated. With these accurate identifications of specific HAdV types and an epidemiological database of regional HAdV pathogens, along with the HAdV genome stability noted across time and space, the development, availability, and deployment of appropriate vaccines are needed. PMID:25482188

  6. Experimental heart failure causes depression-like behavior together with differential regulation of inflammatory and structural genes in the brain

    PubMed Central

    Frey, Anna; Popp, Sandy; Post, Antonia; Langer, Simon; Lehmann, Marc; Hofmann, Ulrich; Sirén, Anna-Leena; Hommers, Leif; Schmitt, Angelika; Strekalova, Tatyana; Ertl, Georg; Lesch, Klaus-Peter; Frantz, Stefan

    2014-01-01

    Background: Depression and anxiety are common and independent outcome predictors in patients with chronic heart failure (CHF). However, it is unclear whether CHF causes depression. Thus, we investigated whether mice develop anxiety- and depression-like behavior after induction of ischemic CHF by myocardial infarction (MI). Methods and Results: In order to assess depression-like behavior, anhedonia was investigated by repeatedly testing sucrose preference for 8 weeks after coronary artery ligation or sham operation. Mice with large MI and increased left ventricular dimensions on echocardiography (termed CHF mice) showed reduced preference for sucrose, indicating depression-like behavior. 6 weeks after MI, mice were tested for exploratory activity, anxiety-like behavior and cognitive function using the elevated plus maze (EPM), light-dark box (LDB), open field (OF), and object recognition (OR) tests. In the EPM and OF, CHF mice exhibited diminished exploratory behavior and motivation despite similar movement capability. In the OR, CHF mice had reduced preference for novelty and impaired short-term memory. On histology, CHF mice had unaltered overall cerebral morphology. However, analysis of gene expression by RNA-sequencing in prefrontal cortical, hippocampal, and left ventricular tissue revealed changes in genes related to inflammation and cofactors of neuronal signal transduction in CHF mice, with Nr4a1 being dysregulated both in prefrontal cortex and myocardium after MI. Conclusions: After induction of ischemic CHF, mice exhibited anhedonic behavior, decreased exploratory activity and interest in novelty, and cognitive impairment. Thus, ischemic CHF leads to distinct behavioral changes in mice analogous to symptoms observed in humans with CHF and comorbid depression. PMID:25400562

  7. BEEHAVE: a systems model of honeybee colony dynamics and foraging to explore multifactorial causes of colony failure

    PubMed Central

    Becher, Matthias A; Grimm, Volker; Thorbek, Pernille; Horn, Juliane; Kennedy, Peter J; Osborne, Juliet L

    2014-01-01

    A notable increase in failure of managed European honeybee Apis mellifera L. colonies has been reported in various regions in recent years. Although the underlying causes remain unclear, it is likely that a combination of stressors act together, particularly varroa mites and other pathogens, forage availability and potentially pesticides. It is experimentally challenging to address causality at the colony scale when multiple factors interact. In silico experiments offer a fast and cost-effective way to begin to address these challenges and inform experiments. However, none of the published bee models combine colony dynamics with foraging patterns and varroa dynamics. We have developed a honeybee model, BEEHAVE, which integrates colony dynamics, population dynamics of the varroa mite, epidemiology of varroa-transmitted viruses and allows foragers in an agent-based foraging model to collect food from a representation of a spatially explicit landscape. We describe the model, which is freely available online (www.beehave-model.net). Extensive sensitivity analyses and tests illustrate the model's robustness and realism. Simulation experiments with various combinations of stressors demonstrate, in simplified landscape settings, the model's potential: predicting colony dynamics and potential losses with and without varroa mites under different foraging conditions and under pesticide application. We also show how mitigation measures can be tested. Synthesis and applications. BEEHAVE offers a valuable tool for researchers to design and focus field experiments, for regulators to explore the relative importance of stressors to devise management and policy advice and for beekeepers to understand and predict varroa dynamics and effects of management interventions. We expect that scientists and stakeholders will find a variety of applications for BEEHAVE, stimulating further model development and the possible inclusion of other stressors of potential importance to honeybee colony dynamics. PMID:25598549

  8. v-Src causes delocalization of Mklp1, Aurora B, and INCENP from the spindle midzone during cytokinesis failure

    SciTech Connect

    Soeda, Shuhei; Nakayama, Yuji; Honda, Takuya; Aoki, Azumi; Tamura, Naoki; Abe, Kohei; Fukumoto, Yasunori; Yamaguchi, Naoto

    2013-06-10

    Src-family tyrosine kinases are aberrantly activated in cancers, and this activation is associated with malignant tumor progression. v-Src, encoded by the v-src transforming gene of the Rous sarcoma virus, is a mutant variant of the cellular proto-oncogene c-Src. Although investigations with temperature sensitive mutants of v-Src have shown that v-Src induces many oncogenic processes, the effects on cell division are unknown. Here, we show that v-Src inhibits cellular proliferation of HCT116, HeLa S3 and NIH3T3 cells. Flow cytometry analysis indicated that inducible expression of v-Src results in an accumulation of 4N cells. Time-lapse analysis revealed that binucleation is induced through the inhibition of cytokinesis, a final step of cell division. The localization of Mklp1, which is essential for cytokinesis, to the spindle midzone is inhibited in v-Src-expressing cells. Intriguingly, Aurora B, which regulates Mklp1 localization at the midzone, is delocalized from the spindle midzone and the midbody but not from the metaphase chromosomes upon v-Src expression. Mklp2, which is responsible for the relocation of Aurora B from the metaphase chromosomes to the spindle midzone, is also lost from the spindle midzone. These results suggest that v-Src inhibits cytokinesis through the delocalization of Mklp1 and Aurora B from the spindle midzone, resulting in binucleation. -- Highlights: • v-Src inhibits cell proliferation of HCT116, HeLa S3 and NIH3T3 cells. • v-Src induces binucleation together with cytokinesis failure. • v-Src causes delocalization of Mklp1, Aurora B and INCENP from the spindle midzone.

  9. Grain dust originating from organic and conventional farming as a potential source of biological agents causing respiratory diseases in farmers

    PubMed Central

    Cholewa, Gra?yna; Krasowska, Ewelina; Chmielewska-Badora, Jolanta; Zwoli?ski, Jacek; Sobczak, Pawe?

    2013-01-01

    Introduction Agricultural producers are exposed to a number of different health risks associated with their work environment. Aim The objective of the study was to assess the degree of colonization by fungi in terms of quantity and in terms of variety of species the samples taken from the settled dust from combine threshing of rye cultivation from organic and conventional farms in the Province of Lublin. Material and methods This paper is a preliminary quantitative assessment of the species of fungi colonizing the samples of settled dust collected during combine threshing from organic and conventional farms in the Province of Lublin. One of the stages of the project was the classification of biosafety BSL (biosafety level) of selected isolates and API ZYM tests to evaluate the potential ability of isolates to cause adverse health effects. To determine the concentration and composition of fungi in collected samples plate dilution method was used with two media: Malt Agar and Potato Dextrose Agar. Results Most commonly isolated fungi in settled dust samples collected during combine threshing from organic farms, on PDA medium were: Alternaria alternata and Aureobasidium pullulans. Cultures on MA medium were dominated by Alternaria alternata, Mycelia sterilia and Fusarium poae. In samples of dust from conventional crops, the predominant species was Alternaria alternata on PDA medium and on MA medium. Conclusions The obtained results show a potential risk of people involved in agricultural work. PMID:24493998

  10. Association of the Endobiont Double-Stranded RNA Virus LRV1 With Treatment Failure for Human Leishmaniasis Caused by Leishmania braziliensis in Peru and Bolivia.

    PubMed

    Adaui, Vanessa; Lye, Lon-Fye; Akopyants, Natalia S; Zimic, Mirko; Llanos-Cuentas, Alejandro; Garcia, Lineth; Maes, Ilse; De Doncker, Simonne; Dobson, Deborah E; Arevalo, Jorge; Dujardin, Jean-Claude; Beverley, Stephen M

    2016-01-01

    Cutaneous and mucosal leishmaniasis, caused in South America by Leishmania braziliensis, is difficult to cure by chemotherapy (primarily pentavalent antimonials [Sb(V)]). Treatment failure does not correlate well with resistance in vitro, and the factors responsible for treatment failure in patients are not well understood. Many isolates of L. braziliensis (>25%) contain a double-stranded RNA virus named Leishmaniavirus 1 (LRV1), which has also been reported in Leishmania guyanensis, for which an association with increased pathology, metastasis, and parasite replication was found in murine models. Here we probed the relationship of LRV1 to drug treatment success and disease in 97 L. braziliensis-infected patients from Peru and Bolivia. In vitro cultures were established, parasites were typed as L. braziliensis, and the presence of LRV1 was determined by reverse transcription-polymerase chain reaction, followed by sequence analysis. LRV1 was associated significantly with an increased risk of treatment failure (odds ratio, 3.99; P = .04). There was no significant association with intrinsic Sb(V) resistance among parasites, suggesting that treatment failure arises from LRV1-mediated effects on host metabolism and/or parasite survival. The association of LRV1 with clinical drug treatment failure could serve to guide more-effective treatment of tegumentary disease caused by L. braziliensis. PMID:26123565

  11. Study of the causes and identification of the dominant mechanisms of failure of bellows expansion joints used in district heating system pipelines at MOEK

    NASA Astrophysics Data System (ADS)

    Tomarov, G. V.; Nikolaev, A. E.; Semenov, V. N.; Shipkov, A. A.; Shepelev, S. V.

    2015-06-01

    The results of laboratory studies of material properties and of numerical and analytical investigations to assess the stress-strain state of the metal of the bellows expansion joints used in the district heating system pipelines at MOEK subjected to corrosion failure are presented. The main causes and the dominant mechanisms of failure of the expansion joints have been identified. The influence of the initial crevice defects and the operating conditions on the features and intensity of destruction processes in expansion joints used in the district heating system pipelines at MOEK has been established.

  12. A Mid-Layer Model for Human Reliability Analysis: Understanding the Cognitive Causes of Human Failure Events

    SciTech Connect

    Stacey M. L. Hendrickson; April M. Whaley; Ronald L. Boring; James Y. H. Chang; Song-Hua Shen; Ali Mosleh; Johanna H. Oxstrand; John A. Forester; Dana L. Kelly; Erasmia L. Lois

    2010-06-01

    The Office of Nuclear Regulatory Research (RES) is sponsoring work in response to a Staff Requirements Memorandum (SRM) directing an effort to establish a single human reliability analysis (HRA) method for the agency or guidance for the use of multiple methods. As part of this effort an attempt to develop a comprehensive HRA qualitative approach is being pursued. This paper presents a draft of the method’s middle layer, a part of the qualitative analysis phase that links failure mechanisms to performance shaping factors. Starting with a Crew Response Tree (CRT) that has identified human failure events, analysts identify potential failure mechanisms using the mid-layer model. The mid-layer model presented in this paper traces the identification of the failure mechanisms using the Information-Diagnosis/Decision-Action (IDA) model and cognitive models from the psychological literature. Each failure mechanism is grouped according to a phase of IDA. Under each phase of IDA, the cognitive models help identify the relevant performance shaping factors for the failure mechanism. The use of IDA and cognitive models can be traced through fault trees, which provide a detailed complement to the CRT.

  13. Comparison of exercise capacity in COPD and other etiologies of chronic respiratory failure requiring non-invasive mechanical ventilation at home: retrospective analysis of 1-year follow-up

    PubMed Central

    Salturk, Cuneyt; Karakurt, Zuhal; Takir, Huriye Berk; Balci, Merih; Kargin, Feyza; Mocin, Ozlem Yaz?c?oglu; Gungor, Gokay; Ozmen, Ipek; Oztas, Selahattin; Yalcinsoy, Murat; Evin, Ruya; Ozturk, Murat; Adiguzel, Nalan

    2015-01-01

    Introduction The objective of this study was to compare the change in 6-minute walking distance (6MWD) in 1 year as an indicator of exercise capacity among patients undergoing home non-invasive mechanical ventilation (NIMV) due to chronic hypercapnic respiratory failure (CHRF) caused by different etiologies. Methods This retrospective cohort study was conducted in a tertiary pulmonary disease hospital in patients who had completed 1-year follow-up under home NIMV because of CHRF with different etiologies (ie, chronic obstructive pulmonary disease [COPD], obesity hypoventilation syndrome [OHS], kyphoscoliosis [KS], and diffuse parenchymal lung disease [DPLD]), between January 2011 and January 2012. The results of arterial blood gas (ABG) analyses and spirometry, and 6MWD measurements with 12-month interval were recorded from the patient files, in addition to demographics, comorbidities, and body mass indices. The groups were compared in terms of 6MWD via analysis of variance (ANOVA) and multiple linear regression (MLR) analysis (independent variables: analysis age, sex, baseline 6MWD, baseline forced expiratory volume in 1 second, and baseline partial carbon dioxide pressure, in reference to COPD group). Results A total of 105 patients with a mean age (± standard deviation) of 61±12 years of whom 37 had COPD, 34 had OHS, 20 had KS, and 14 had DPLD were included in statistical analysis. There were no significant differences between groups in the baseline and delta values of ABG and spirometry findings. Both univariate ANOVA and MLR showed that the OHS group had the lowest baseline 6MWD and the highest decrease in 1 year (linear regression coefficient ?24.48; 95% CI ?48.74 to ?0.21, P=0.048); while the KS group had the best baseline values and the biggest improvement under home NIMV (linear regression coefficient 26.94; 95% CI ?3.79 to 57.66, P=0.085). Conclusion The 6MWD measurements revealed improvement in exercise capacity test in CHRF patients receiving home NIMV treatment on long-term depends on etiological diagnoses. PMID:26648713

  14. Respiratory dysfunction in patients severely affected by GNE myopathy (distal myopathy with rimmed vacuoles).

    PubMed

    Mori-Yoshimura, Madoka; Oya, Yasushi; Hayashi, Yukiko K; Noguchi, Satoru; Nishino, Ichizo; Murata, Miho

    2013-01-01

    GNE myopathy is a rare and mildly progressive autosomal recessive myopathy caused by GNE mutations. Respiratory dysfunction has not been reported in GNE myopathy patients. In this study, we retrospectively reviewed the respiratory function of 39 severely affected GNE myopathy patients (13 men, 26 women) from medical records, and compared these parameters with various other patient characteristics (e.g., GNE mutations, age at onset, creatine kinase levels, and being wheelchair-bound) for correlations. The mean % forced vital capacity [FVC] was 92 (26) (range, 16-128). In 12/39 (31%) patients, %FVC was <80%. Of these 12 patients, 11 (92%) were entirely wheelchair-dependent. These patients exhibited significantly earlier onset (20 [4] vs. 30 [8] years, p<0.001) and lower creatine kinase levels (56 [71] vs. 279 [185] IU/L) than patients with normal respiratory function. Two patients exhibited severe respiratory failure and required non-invasive positive pressure ventilation. Patients with a homozygous mutation in the N-acetylmannosamine kinase domain exhibited lower %FVC, while only one compound heterozygous patient with separate mutations in the uridinediphosphate-N-acetylglucosamine 2-epimerase and the N-acetylmannosamine kinase domains had respiratory dysfunction. Our results collectively suggest that GNE myopathy can cause severe respiratory failure. Respiratory dysfunction should be carefully monitored in patients with advanced GNE myopathy characterized by early onset and homozygous homozygous mutations in the N-acetylmannosamine kinase domain. PMID:23127962

  15. Mitochondrial Respiratory Defect Causes Dysfunctional Lactate Turnover via AMP-activated Protein Kinase Activation in Human-induced Pluripotent Stem Cell-derived Hepatocytes.

    PubMed

    Im, Ilkyun; Jang, Mi-Jin; Park, Seung Ju; Lee, Sang-Hee; Choi, Jin-Ho; Yoo, Han-Wook; Kim, Seyun; Han, Yong-Mahn

    2015-12-01

    A defective mitochondrial respiratory chain complex (DMRC) causes various metabolic disorders in humans. However, the pathophysiology of DMRC in the liver remains unclear. To understand DMRC pathophysiology in vitro, DMRC-induced pluripotent stem cells were generated from dermal fibroblasts of a DMRC patient who had a homoplasmic mutation (m.3398T?C) in the mitochondrion-encoded NADH dehydrogenase 1 (MTND1) gene and that differentiated into hepatocytes (DMRC hepatocytes) in vitro. DMRC hepatocytes showed abnormalities in mitochondrial characteristics, the NAD(+)/NADH ratio, the glycogen storage level, the lactate turnover rate, and AMPK activity. Intriguingly, low glycogen storage and transcription of lactate turnover-related genes in DMRC hepatocytes were recovered by inhibition of AMPK activity. Thus, AMPK activation led to metabolic changes in terms of glycogen storage and lactate turnover in DMRC hepatocytes. These data demonstrate for the first time that energy depletion may lead to lactic acidosis in the DMRC patient by reduction of lactate uptake via AMPK in liver. PMID:26491018

  16. Respiratory Therapists

    MedlinePLUS

    ... on how to stop smoking. <- Summary Work Environment -> Work Environment About this section Respiratory therapists treat patients ... registered nurses , physicians and surgeons , and medical assistants . Work Schedules Most respiratory therapists work full time. Because ...

  17. Respiratory system

    NASA Technical Reports Server (NTRS)

    Bartlett, R. G., Jr.

    1973-01-01

    The general anatomy and function of the human respiratory system is summarized. Breathing movements, control of breathing, lung volumes and capacities, mechanical relations, and factors relevant to respiratory support and equipment design are discussed.

  18. Mortality from heart failure, acute myocardial infarction and other ischaemic heart disease in England and Oxford: a trend study of multiple-cause-coded death certification

    PubMed Central

    Rahimi, Kazem; Duncan, Marie; Pitcher, Alex; Emdin, Connor A; Goldacre, Michael J

    2015-01-01

    Background Age-standardised death rates from acute myocardial infarction (AMI) and ischaemic heart disease (IHD) have been declining in most developed countries. However, the magnitude of such reductions and how they impact on death from heart failure are less certain. We sought to assess and compare temporal trends in mortality from heart failure, AMI and non-AMI IHD over a 30-year period in England. Methods We analysed death registration data for multiple-cause-coded mortality for all deaths in people aged 35?years and over in England from 1995 to 2010, population 52 million, and in a regional population (Oxford region) from 1981 to 2010, population 2.5 million, for which data on all causes of death were available. Results Considering all ages and both sexes combined, during the 30-year observation period, age-standardised and sex-standardised mortality rates based on all certified causes of death declined by 60% for heart failure, 80% for AMI and 46% for non-AMI IHD. These longer term trends observed in the Oxford region were consistent with those for the whole of England from 1995 to 2010, with no evidence of a plateau in recent years. Although proportional reductions in rates differed by age and sex, even in those aged 85?years or more, there were substantial reductions in mortality rates in the all-England data set (50%, 66% and 20% for heart failure, AMI and non-AMI IHD, respectively). Conclusions This study shows large and sustained reductions in age-specific and sex-specific and standardised death rates from heart failure, as well as from AMI and non-AMI IHD, over a 30-year period in England. PMID:26136081

  19. Acute kidney failure

    MedlinePLUS

    Kidney failure; Renal failure; Renal failure - acute; ARF; Kidney injury - acute ... There are many possible causes of kidney damage. They include: ... cholesterol (cholesterol emboli) Decreased blood flow due to very ...

  20. Differential Effects of Endotracheal Suctioning on Gas Exchanges in Patients with Acute Respiratory Failure under Pressure-Controlled and Volume-Controlled Ventilation

    PubMed Central

    Liu, Xiao-Wei; Jin, Yan; Ma, Tao; Qu, Bo; Liu, Zhi

    2015-01-01

    This study was conducted to evaluate the effects of open endotracheal suctioning on gas exchange and respiratory mechanics in ARF patients under the modes of PCV or VCV. Ninety-six ARF patients were treated with open endotracheal suctioning and their variations in respiratory mechanics and gas exchange after the suctions were compared. Under PCV mode, compared with the initial level of tidal volume (VT), ARF patients showed 30.0% and 27.8% decrease at 1?min and 10?min, respectively. Furthermore, the initial respiratory system compliance (Crs) decreased by 29.6% and 28.5% at 1?min and 10?min, respectively. Under VCV mode, compared with the initial level, 38.6% and 37.5% increase in peak airway pressure (PAP) were found at 1?min and 10?min, respectively. Under PCV mode, the initial PaO2 increased by 6.4% and 10.2 % at 3?min and 10?min, respectively, while 18.9% and 30.6% increase of the initial PaO2 were observed under VCV mode. Summarily, endotracheal suctioning may impair gas exchange and decrease lung compliance in ARF patients receiving mechanical ventilation under both PCV and VCV modes, but endotracheal suctioning effects on gas exchange were more severe and longer-lasting under PCV mode than VCV. PMID:25954759

  1. Respiratory diseases of global consequence

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Respiratory diseases are one of the two major categories of poultry diseases that cause the most severe economic losses globally (the other being enteric disease). The economic impact of respiratory disease is both direct, from the production losses caused by primary disease and indirect from preve...

  2. Respiratory diseases of global consequence

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Respiratory diseases are one of the two major categories of poultry diseases that cause the most severe economic losses globally, both as enzootic diseases and as causes of epizootics. Some respiratory diseases are of such importance they are reportable to the World Organization for Animal Health (O...

  3. The effects of mechanical ventilation on the development of Acute Respiratory Distress Syndrome

    E-print Network

    Jia, Xiaoming, M. Eng. Massachusetts Institute of Technology

    2007-01-01

    Acute Respiratory Distress Syndrome (ARDS) is a severe lung illness characterized by inflammation and fluid accumulation in the respiratory system. Historically, ARDS and other forms of respiratory failure have been treated ...

  4. Mutations in NDUFB11, encoding a complex I component of the mitochondrial respiratory chain, cause microphthalmia with linear skin defects syndrome.

    PubMed

    van Rahden, Vanessa A; Fernandez-Vizarra, Erika; Alawi, Malik; Brand, Kristina; Fellmann, Florence; Horn, Denise; Zeviani, Massimo; Kutsche, Kerstin

    2015-04-01

    Microphthalmia with linear skin defects (MLS) syndrome is an X-linked male-lethal disorder also known as MIDAS (microphthalmia, dermal aplasia, and sclerocornea). Additional clinical features include neurological and cardiac abnormalities. MLS syndrome is genetically heterogeneous given that heterozygous mutations in HCCS or COX7B have been identified in MLS-affected females. Both genes encode proteins involved in the structure and function of complexes III and IV, which form the terminal segment of the mitochondrial respiratory chain (MRC). However, not all individuals with MLS syndrome carry a mutation in either HCCS or COX7B. The majority of MLS-affected females have severe skewing of X chromosome inactivation, suggesting that mutations in HCCS, COX7B, and other as-yet-unidentified X-linked gene(s) cause selective loss of cells in which the mutated X chromosome is active. By applying whole-exome sequencing and filtering for X-chromosomal variants, we identified a de novo nonsense mutation in NDUFB11 (Xp11.23) in one female individual and a heterozygous 1-bp deletion in a second individual, her asymptomatic mother, and an affected aborted fetus of the subject's mother. NDUFB11 encodes one of 30 poorly characterized supernumerary subunits of NADH:ubiquinone oxidoreductase, known as complex I (cI), the first and largest enzyme of the MRC. By shRNA-mediated NDUFB11 knockdown in HeLa cells, we demonstrate that NDUFB11 is essential for cI assembly and activity as well as cell growth and survival. These results demonstrate that X-linked genetic defects leading to the complete inactivation of complex I, III, or IV underlie MLS syndrome. Our data reveal an unexpected role of cI dysfunction in a developmental phenotype, further underscoring the existence of a group of mitochondrial diseases associated with neurocutaneous manifestations. PMID:25772934

  5. Mutations in NDUFB11, Encoding a Complex I Component of the Mitochondrial Respiratory Chain, Cause Microphthalmia with Linear Skin Defects Syndrome

    PubMed Central

    van Rahden, Vanessa A.; Fernandez-Vizarra, Erika; Alawi, Malik; Brand, Kristina; Fellmann, Florence; Horn, Denise; Zeviani, Massimo; Kutsche, Kerstin

    2015-01-01

    Microphthalmia with linear skin defects (MLS) syndrome is an X-linked male-lethal disorder also known as MIDAS (microphthalmia, dermal aplasia, and sclerocornea). Additional clinical features include neurological and cardiac abnormalities. MLS syndrome is genetically heterogeneous given that heterozygous mutations in HCCS or COX7B have been identified in MLS-affected females. Both genes encode proteins involved in the structure and function of complexes III and IV, which form the terminal segment of the mitochondrial respiratory chain (MRC). However, not all individuals with MLS syndrome carry a mutation in either HCCS or COX7B. The majority of MLS-affected females have severe skewing of X chromosome inactivation, suggesting that mutations in HCCS, COX7B, and other as-yet-unidentified X-linked gene(s) cause selective loss of cells in which the mutated X chromosome is active. By applying whole-exome sequencing and filtering for X-chromosomal variants, we identified a de novo nonsense mutation in NDUFB11 (Xp11.23) in one female individual and a heterozygous 1-bp deletion in a second individual, her asymptomatic mother, and an affected aborted fetus of the subject’s mother. NDUFB11 encodes one of 30 poorly characterized supernumerary subunits of NADH:ubiquinone oxidoreductase, known as complex I (cI), the first and largest enzyme of the MRC. By shRNA-mediated NDUFB11 knockdown in HeLa cells, we demonstrate that NDUFB11 is essential for cI assembly and activity as well as cell growth and survival. These results demonstrate that X-linked genetic defects leading to the complete inactivation of complex I, III, or IV underlie MLS syndrome. Our data reveal an unexpected role of cI dysfunction in a developmental phenotype, further underscoring the existence of a group of mitochondrial diseases associated with neurocutaneous manifestations. PMID:25772934

  6. Comparative Treatment Failure Rates of Respiratory Fluoroquinolones or ?-Lactam + Macrolide Versus ?-Lactam Alone in the Treatment for Community-Acquired Pneumonia in Adult Outpatients: An Analysis of a Nationally Representative Claims Database.

    PubMed

    Lee, Meng-Tse Gabriel; Lee, Shih-Hao; Chang, Shy-Shin; Chan, Ya-Lan; Pang, Laura; Hsu, Sue-Ming; Lee, Chien-Chang

    2015-09-01

    No comparative effectiveness study has been conducted for the following 3 antibiotics: respiratory fluoroquinolone, ?-lactam, and ?-lactam + advanced macrolide. To gain insights into the real-world clinical effectiveness of these antibiotics for community-acquired pneumonia in adult outpatients, our study investigated the treatment failure rates in 2 million representative participants from the National Health Informatics Project (NHIP) of Taiwan.A new-user cohort design was used to follow NHIP participants from January 2000 until December 2009. Treatment failure was defined by either one of the following events: a second antibiotic prescription, hospitalization due to CAP, an emergency department visit with a diagnosis of CAP, or 30-day nonaccident-related mortality.From 2006 to 2009, we identified 9256 newly diagnosed CAP outpatients, 1602 of whom were prescribed levofloxacin, 2100 were prescribed moxifloxacin, 5049 were prescribed ?-lactam alone, and 505 were prescribed advanced macrolide + ?-lactam. Compared with the ?-lactam-based regimen, the propensity score-matched odds ratio for composite treatment failure was 0.81 (95% CI, 0.67-0.97) for moxifloxacin, 1.10 (95% CI, 0.90-1.35) for levofloxacin, and 0.95 (95% CI, 0.67-1.35) for macrolide +?-lactam.Moxifloxacin was associated with lower treatment failure rates compared with ?-lactam alone, or levofloxacin in Taiwanese CAP outpatients. However, due to inherent limitations in our claims database, more randomized controlled trials are required before coming to a conclusion on which antibiotic is more effective for Taiwanese CAP outpatients. More population-based comparative effectiveness studies are also encouraged and should be considered as an integral piece of evidence in local CAP treatment guidelines. PMID:26426664

  7. Respiratory Syncytial Virus Infection (RSV): Infection and Incidence

    MedlinePLUS

    ... Links Unexplained Respiratory Disease Outbreaks Red Book® Online Infection and Incidence Recommend on Facebook Tweet Share Compartir RSV can cause upper respiratory infections (such as colds) and lower respiratory tract infections ( ...

  8. Detection of respiratory pathogens in aerosols from acutely infected pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Infectious agents that cause respiratory disease in pigs include porcine reproductive respiratory syndrome virus (PRRSV), porcine circovirus type 2 (PCV2), swine influenza virus (SIV), porcine respiratory corona virus (PRCV), Mycoplasma hyopneumoniae, and Bordetella bronchiseptica. The objective of...

  9. Upper respiratory tract infections.

    PubMed

    Jain, N; Lodha, R; Kabra, S K

    2001-12-01

    Acute respiratory infections accounts for 20-40% of outpatient and 12-35% of inpatient attendance in a general hospital. Upper respiratory tract infections including nasopharyngitis, pharyngitis, tonsillitis and otitis media constitute 87.5% of the total episodes of respiratory infections. The vast majority of acute upper respiratory tract infections are caused by viruses. Common cold is caused by viruses in most circumstances and does not require antimicrobial agent unless it is complicated by acute otitis media with effusion, tonsillitis, sinusitis, and lower respiratory tract infection. Sinusitis is commonly associated with common cold. Most instances of rhinosinusitis are viral and therefore, resolve spontaneously without antimicrobial therapy. The most common bacterial agents causing sinusitis are S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus and S. pyogenes. Amoxycillin is antibacterial of choice. The alternative drugs are cefaclor or cephalexin. The latter becomes first line if sinusitis is recurrent or chronic. Acute pharyngitis is commonly caused by viruses and does not need antibiotics. About 15% of the episodes may be due to Group A beta hemolytic streptococcus (GABS). Early initiation of antibiotics in pharyngitis due to GABS can prevent complications such as acute rheumatic fever. The drug of choice is penicillin for 10-14 days. The alternative medications include oral cephalosporins (cefaclor, cephalexin), amoxicillin or macrolides. PMID:11838568

  10. Application of Failure Mode and Effect Analysis (FMEA), cause and effect analysis, and Pareto diagram in conjunction with HACCP to a corn curl manufacturing plant.

    PubMed

    Varzakas, Theodoros H; Arvanitoyannis, Ioannis S

    2007-01-01

    The Failure Mode and Effect Analysis (FMEA) model has been applied for the risk assessment of corn curl manufacturing. A tentative approach of FMEA application to the snacks industry was attempted in an effort to exclude the presence of GMOs in the final product. This is of crucial importance both from the ethics and the legislation (Regulations EC 1829/2003; EC 1830/2003; Directive EC 18/2001) point of view. The Preliminary Hazard Analysis and the Fault Tree Analysis were used to analyze and predict the occurring failure modes in a food chain system (corn curls processing plant), based on the functions, characteristics, and/or interactions of the ingredients or the processes, upon which the system depends. Critical Control points have been identified and implemented in the cause and effect diagram (also known as Ishikawa, tree diagram, and the fishbone diagram). Finally, Pareto diagrams were employed towards the optimization of GMOs detection potential of FMEA. PMID:17457722

  11. Types of Heart Failure

    MedlinePLUS

    ... causing congestion in the body's tissues. Often swelling (edema) results. Most often there's swelling in the legs ... person is lying down. This is called pulmonary edema and if left untreated can cause respiratory distress. ...

  12. Serial Analysis of the Gut and Respiratory Microbiome in Cystic Fibrosis in Infancy: Interaction between Intestinal and Respiratory Tracts and Impact of Nutritional Exposures

    PubMed Central

    Madan, J. C.; Koestler, D. C.; Stanton, B. A.; Davidson, L.; Moulton, L. A.; Housman, M. L.; Moore, J. H.; Guill, M. F.; Morrison, H. G.; Sogin, M. L.; Hampton, T. H.; Karagas, M. R.; Palumbo, P. E.; Foster, J. A.; Hibberd, P. L.; O’Toole, G. A.

    2012-01-01

    ABSTRACT Pulmonary damage caused by chronic colonization of the cystic fibrosis (CF) lung by microbial communities is the proximal cause of respiratory failure. While there has been an effort to document the microbiome of the CF lung in pediatric and adult patients, little is known regarding the developing microflora in infants. We examined the respiratory and intestinal microbiota development in infants with CF from birth to 21 months. Distinct genera dominated in the gut compared to those in the respiratory tract, yet some bacteria overlapped, demonstrating a core microbiota dominated by Veillonella and Streptococcus. Bacterial diversity increased significantly over time, with evidence of more rapidly acquired diversity in the respiratory tract. There was a high degree of concordance between the bacteria that were increasing or decreasing over time in both compartments; in particular, a significant proportion (14/16 genera) increasing in the gut were also increasing in the respiratory tract. For 7 genera, gut colonization presages their appearance in the respiratory tract. Clustering analysis of respiratory samples indicated profiles of bacteria associated with breast-feeding, and for gut samples, introduction of solid foods even after adjustment for the time at which the sample was collected. Furthermore, changes in diet also result in altered respiratory microflora, suggesting a link between nutrition and development of microbial communities in the respiratory tract. Our findings suggest that nutritional factors and gut colonization patterns are determinants of the microbial development of respiratory tract microbiota in infants with CF and present opportunities for early intervention in CF with altered dietary or probiotic strategies. PMID:22911969

  13. A case of acetaminophen (paracetamol) causing renal failure without liver damage in a child and review of literature.

    PubMed

    Ozkaya, Ozan; Genc, Gurkan; Bek, Kenan; Sullu, Yurdanur

    2010-01-01

    Acetaminophen (paracetamol) is a widely used drug and known as a safety antipyretic and analgesic drug in childhood. Acetaminophen-associated liver damage is more recognized than kidney damage. Nephrotoxicity and hepatotoxicity can be seen together after acetaminophen overdose, but renal damage without liver damage is a rarely seen entity in all age groups being reported more rarely in childhood. We present here a 16-year-old girl with renal failure without liver damage because of acetaminophen toxicity and a review of literature for pathophysiological mechanisms, clinical course, treatment, and outcome. PMID:20863222

  14. Treatable renal failure found in non-ambulatory Duchenne muscular dystrophy patients.

    PubMed

    Motoki, Takahiro; Shimizu-Motohashi, Yuko; Komaki, Hirofumi; Mori-Yoshimura, Madoka; Oya, Yasushi; Takeshita, Eri; Ishiyama, Akihiko; Saito, Takashi; Nakagawa, Eiji; Sugai, Kenji; Murata, Miho; Sasaki, Masayuki

    2015-10-01

    Duchenne muscular dystrophy (DMD) is a progressive muscular disorder in which respiratory and heart failures are the main causes of death. Intensive intervention in respiratory and cardiac function has dramatically improved the prognosis; however, dysfunction in other multiple organs may emerge in the later stages of the disease. We report the case of four non-ambulatory DMD patients who presented with renal failure. Common findings included decreased fluid intake, use of diuretics, and presence of chronic heart failure. The levels of serum cystatin C (CysC), a marker of kidney function unaffected by reduced muscle mass, were elevated in all four patients. In two patients, renal failure improved by increasing fluid intake, and discontinuing or reducing the dose of diuretics. The findings suggest that non-ambulatory DMD patients are at a risk of reduced kidney perfusion, which potentially leads to prerenal failure. Therefore, in DMD patients, dehydration signs and CysC levels should be monitored. PMID:26298609

  15. Right heart failure in acute respiratory distress syndrome: An unappreciated albeit a potential target for intervention in the management of the disease

    PubMed Central

    Biswas, Abhishek

    2015-01-01

    Mortality from acute respiratory distress syndrome (ARDS) has gone down recently. In spite of this trend, the absolute numbers continue to be high even with improvements in ventilator strategies and a better understanding of fluid management with this disease. A possible reason for this could be an under-recognized involvement of the pulmonary vasculature and the right side of the heart in ARDS. The right heart is not designed to function under situations leading to acute elevations in afterload as seen in ARDS, and hence it decompensates. This brief review focuses on the magnitude of the problem, its detection in the intensive care unit, and recognizes the beneficial effect of prone-positioning on the pulmonary vasculature and right heart.

  16. Risk assessment of Giardia from a full scale MBR sewage treatment plant caused by membrane integrity failure.

    PubMed

    Zhang, Yu; Chen, Zhimin; An, Wei; Xiao, Shumin; Yuan, Hongying; Zhang, Dongqing; Yang, Min

    2015-04-01

    Membrane bioreactors (MBR) are highly efficient at intercepting particles and microbes and have become an important technology for wastewater reclamation. However, many pathogens can accumulate in activated sludge due to the long residence time usually adopted in MBR, and thus may pose health risks when membrane integrity problems occur. This study presents data from a survey on the occurrence of water-borne Giardia pathogens in reclaimed water from a full-scale wastewater treatment plant with MBR experiencing membrane integrity failure, and assessed the associated risk for green space irrigation. Due to membrane integrity failure, the MBR effluent turbidity varied between 0.23 and 1.90 NTU over a period of eight months. Though this turbidity level still met reclaimed water quality standards (?5 NTU), Giardia were detected at concentrations of 0.3 to 95 cysts/10 L, with a close correlation between effluent turbidity and Giardia concentration. All ?-giardin gene sequences of Giardia in the WWTP influents were genotyped as Assemblages A and B, both of which are known to infect humans. An exponential dose-response model was applied to assess the risk of infection by Giardia. The risk in the MBR effluent with chlorination was 9.83×10(-3), higher than the acceptable annual risk of 1.0×10(-4). This study suggested that membrane integrity is very important for keeping a low pathogen level, and multiple barriers are needed to ensure the biological safety of MBR effluent. PMID:25872734

  17. [Respiratory emergencies in childhood].

    PubMed

    Rossi, R; Altemeyer, K H

    1991-04-20

    The most important maneuvers of primary treatment of respiratory emergencies in childhood are the securement of free airways, provision of oxygen and (medicamentous) tranquilization of the child. The most common causes of these emergencies are fulminant (infectious) diseases of the upper and lower airways, a particularly significant aspect being the considerable mucosal swelling as compared with adults. Aspiration of foreign bodies is a further cause of acute, life-threatening respiratory distress. Treatment requires a systematic examination and circumspection to achieve in the shortest time adequate temporary improvement until more extensive measures can be performed in the hospital. PMID:1855754

  18. 320 NATURE MEDICINE VOLUME 5 NUMBER 3 MARCH 1999 Heart failure is a leading cause of cardiovascular mortality in the

    E-print Network

    Campbell, Kevin P.

    muscular dystrophy8 , and missense mutations that affect the function of dystrophin in Becker's muscular dystrophy8 cause cardiomyopathy9 . X-linked dilated cardiomyopathy can occur because of mutations

  19. Respiratory acidosis

    MedlinePLUS

    ... such as bicarbonate, that help restore the body's acid-base balance. Acute respiratory acidosis is a condition in ... Effros RM, Swenson ER. Acid-base balance. In: Mason RJ, Broaddus CV, ... Textbook of Respiratory Medicine . 5th ed. Philadelphia, PA: ...

  20. Acute right ventricular failure caused by concomitant coronary and pulmonary embolism: successful treatment with endovascular coronary and pulmonary thrombectomy

    PubMed Central

    Koul, Sasha; Roijer, Anders; Holmqvist, Jasminka; Keussen, Inger; Cwikiel, Wojciech; Öhlin, Bertil; Erlinge, David

    2013-01-01

    Patent foramen ovale (PFO) is present in approximately 25% of the general population. PFO is characterized by intermittent shunting of blood from the right to the left atrium, especially in the context of increased right-sided filling pressures, with risk of paradoxical embolism. We describe a 69-year-old woman presenting with acute chest pain, severe dyspnoea, and acute inferolateral ST-segment elevation on the electrocardiogram. The patient was diagnosed with myocardial infarction and failure of the right cardiac ventricle, which was considered to be secondary to extensive pulmonary embolism leading to increased filling pressures and paradoxical coronary embolism. The patient underwent emergent percutaneous interventions with coronary thrombus extraction and pulmonary thrombus fragmentation and local thrombolysis. The patient was free of symptoms at follow up 6 months later and echocardiography showed substantially improved right ventricular function. We discuss issues related to the diagnosis, treatment, and secondary prevention for patients with concomitant pulmonary and coronary arterial thrombosis. PMID:24222822

  1. Stress Analysis and Testing at the Marshall Space Flight Center to Study Cause and Corrective Action of Space Shuttle External Tank Stringer Failures

    NASA Technical Reports Server (NTRS)

    Wingate, Robert J.

    2012-01-01

    After the launch scrub of Space Shuttle mission STS-133 on November 5, 2010, large cracks were discovered in two of the External Tank intertank stringers. The NASA Marshall Space Flight Center, as managing center for the External Tank Project, coordinated the ensuing failure investigation and repair activities with several organizations, including the manufacturer, Lockheed Martin. To support the investigation, the Marshall Space Flight Center formed an ad-hoc stress analysis team to complement the efforts of Lockheed Martin. The team undertook six major efforts to analyze or test the structural behavior of the stringers. Extensive finite element modeling was performed to characterize the local stresses in the stringers near the region of failure. Data from a full-scale tanking test and from several subcomponent static load tests were used to confirm the analytical conclusions. The analysis and test activities of the team are summarized. The root cause of the stringer failures and the flight readiness rationale for the repairs that were implemented are discussed.

  2. [The relevance of a decline in renal function for risk of renal failure, cardiovascular events and all-cause mortality].

    PubMed

    Bots, Michiel L; Blankestijn, Peter J

    2015-01-01

    It is well established that the presence of impaired renal function is associated with an increased risk of end-stage renal disease, cardiovascular events and all-cause mortality. Irrespective of the starting level of renal function, a decline in renal function over two years is a relevant and strong risk factor for end-stage renal disease, cardiovascular death and all-cause mortality. Even a decline of 20 to 30 per cent is associated with to a considerable increased risk and requires further attention. PMID:26374717

  3. Novel Receptor-Derived Cyclopeptides to Treat Heart Failure Caused by Anti-?1-Adrenoceptor Antibodies in a Human-Analogous Rat Model

    PubMed Central

    Boivin, Valérie; Beyersdorf, Niklas; Palm, Dieter; Nikolaev, Viacheslav O.; Schlipp, Angela; Müller, Justus; Schmidt, Doris; Kocoski, Vladimir; Kerkau, Thomas; Hünig, Thomas; Ertl, Georg; Lohse, Martin J.; Jahns, Roland

    2015-01-01

    Despite recent therapeutic advances the prognosis of heart failure remains poor. Recent research suggests that heart failure is a heterogeneous syndrome and that many patients have stimulating auto-antibodies directed against the second extracellular loop of the ?1 adrenergic receptor (?1EC2). In a human-analogous rat model such antibodies cause myocyte damage and heart failure. Here we used this model to test a novel antibody-directed strategy aiming to prevent and/or treat antibody-induced cardiomyopathy. To generate heart failure, we immunised n = 76/114 rats with a fusion protein containing the human ?1EC2 (amino-acids 195–225) every 4 weeks; n = 38/114 rats were control-injected with 0.9% NaCl. Intravenous application of a novel cyclic peptide mimicking ?1EC2 (?1EC2-CP, 1.0 mg/kg every 4 weeks) or administration of the ?1-blocker bisoprolol (15 mg/kg/day orally) was initiated either 6 weeks (cardiac function still normal, prevention-study, n = 24 (16 treated vs. 8 untreated)) or 8.5 months after the 1st immunisation (onset of cardiomyopathy, therapy-study, n = 52 (40 treated vs. 12 untreated)); n = 8/52 rats from the therapy-study received ?1EC2-CP/bisoprolol co-treatment. We found that ?1EC2-CP prevented and (alone or as add-on drug) treated antibody-induced cardiac damage in the rat, and that its efficacy was superior to mono-treatment with bisoprolol, a standard drug in heart failure. While bisoprolol mono-therapy was able to stop disease-progression, ?1EC2-CP mono-therapy -or as an add-on to bisoprolol- almost fully reversed antibody-induced cardiac damage. The cyclo¬peptide acted both by scavenging free anti-?1EC2-antibodies and by targeting ?1EC2-specific memory B-cells involved in antibody-production. Our model provides the basis for the clinical translation of a novel double-acting therapeutic strategy that scavenges harmful anti-?1EC2-antibodies and also selectively depletes memory B-cells involved in the production of such antibodies. Treatment with immuno-modulating cyclopeptides alone or as an add-on to ?1-blockade represents a promising new therapeutic option in immune-mediated heart failure. PMID:25700031

  4. Novel receptor-derived cyclopeptides to treat heart failure caused by anti-?1-adrenoceptor antibodies in a human-analogous rat model.

    PubMed

    Boivin, Valérie; Beyersdorf, Niklas; Palm, Dieter; Nikolaev, Viacheslav O; Schlipp, Angela; Müller, Justus; Schmidt, Doris; Kocoski, Vladimir; Kerkau, Thomas; Hünig, Thomas; Ertl, Georg; Lohse, Martin J; Jahns, Roland

    2015-01-01

    Despite recent therapeutic advances the prognosis of heart failure remains poor. Recent research suggests that heart failure is a heterogeneous syndrome and that many patients have stimulating auto-antibodies directed against the second extracellular loop of the ?1 adrenergic receptor (?1EC2). In a human-analogous rat model such antibodies cause myocyte damage and heart failure. Here we used this model to test a novel antibody-directed strategy aiming to prevent and/or treat antibody-induced cardiomyopathy. To generate heart failure, we immunised n = 76/114 rats with a fusion protein containing the human ?1EC2 (amino-acids 195-225) every 4 weeks; n = 38/114 rats were control-injected with 0.9% NaCl. Intravenous application of a novel cyclic peptide mimicking ?1EC2 (?1EC2-CP, 1.0 mg/kg every 4 weeks) or administration of the ?1-blocker bisoprolol (15 mg/kg/day orally) was initiated either 6 weeks (cardiac function still normal, prevention-study, n = 24 (16 treated vs. 8 untreated)) or 8.5 months after the 1st immunisation (onset of cardiomyopathy, therapy-study, n = 52 (40 treated vs. 12 untreated)); n = 8/52 rats from the therapy-study received ?1EC2-CP/bisoprolol co-treatment. We found that ?1EC2-CP prevented and (alone or as add-on drug) treated antibody-induced cardiac damage in the rat, and that its efficacy was superior to mono-treatment with bisoprolol, a standard drug in heart failure. While bisoprolol mono-therapy was able to stop disease-progression, ?1EC2-CP mono-therapy -or as an add-on to bisoprolol- almost fully reversed antibody-induced cardiac damage. The cyclo¬peptide acted both by scavenging free anti-?1EC2-antibodies and by targeting ?1EC2-specific memory B-cells involved in antibody-production. Our model provides the basis for the clinical translation of a novel double-acting therapeutic strategy that scavenges harmful anti-?1EC2-antibodies and also selectively depletes memory B-cells involved in the production of such antibodies. Treatment with immuno-modulating cyclopeptides alone or as an add-on to ?1-blockade represents a promising new therapeutic option in immune-mediated heart failure. PMID:25700031

  5. The recent accumulation of snow in many areas throughout New York state has caused some agricultural buildings to fail. Failure can be the result of several items linked to the snow load present

    E-print Network

    Walter, M.Todd

    1 The recent accumulation of snow in many areas throughout New York state has caused some agricultural buildings to fail. Failure can be the result of several items linked to the snow load present construction · Actual snow load exceeds design snow load · Imbalance of snow load on roof · Failure of one key

  6. Severe acute respiratory syndrome (SARS)

    MedlinePLUS

    Severe acute respiratory syndrome (SARS) is a serious form of pneumonia . It is caused by a virus that was first identified ... chap 366. McIntosh K, Perlman S. Coronaviruses, including severe ... syndrome (SARS)and Middle East respiratory syndrome (MERS). In: ...

  7. Association between Highly Active Antiretroviral Therapy and Type of Infectious Respiratory Disease and All-Cause In-Hospital Mortality in Patients with HIV/AIDS: A Case Series

    PubMed Central

    Báez-Saldaña, Renata; Villafuerte-García, Adriana; Cruz-Hervert, Pablo; Delgado-Sánchez, Guadalupe; Ferreyra-Reyes, Leticia; Ferreira-Guerrero, Elizabeth; Mongua-Rodríguez, Norma; Montero-Campos, Rogelio; Melchor-Romero, Ada; García-García, Lourdes

    2015-01-01

    Background Respiratory manifestations of HIV disease differ globally due to differences in current availability of effective highly active antiretroviral therapy (HAART) programs and epidemiology of infectious diseases. Objective To describe the association between HAART and discharge diagnosis and all-cause in-hospital mortality among hospitalized patients with infectious respiratory disease and HIV/AIDS. Material and Methods We retrospectively reviewed the records of patients hospitalized at a specialty hospital for respiratory diseases in Mexico City between January 1st, 2010 and December 31st, 2011. We included patients whose discharge diagnosis included HIV or AIDS and at least one infectious respiratory diagnosis. The information source was the clinical chart. We analyzed the association between HAART for 180 days or more and type of respiratory disease using polytomous logistic regression and all-cause hospital mortality by multiple logistic regressions. Results We studied 308 patients, of whom 206 (66.9%) had been diagnosed with HIV infection before admission to the hospital. The CD4+ lymphocyte median count was 68 cells/mm3 [interquartile range (IQR): 30–150]. Seventy-five (24.4%) cases had received HAART for more than 180 days. Pneumocystis jirovecii pneumonia (PJP) (n = 142), tuberculosis (n = 63), and bacterial community-acquired pneumonia (n = 60) were the most frequent discharge diagnoses. Receiving HAART for more than 180 days was associated with a lower probability of PJP [Adjusted odd ratio (aOR): 0.245, 95% Confidence Interval (CI): 0.08–0.8, p = 0.02], adjusted for sociodemographic and clinical covariates. HAART was independently associated with reduced odds (aOR 0.214, 95% CI 0.06–0.75) of all-cause in-hospital mortality, adjusting for HIV diagnosis previous to hospitalization, age, access to social security, low socioeconomic level, CD4 cell count, viral load, and discharge diagnoses. Conclusions HAART for 180 days or more was associated with 79% decrease in all-cause in-hospital mortality and lower frequency of PJP as discharge diagnosis. The prevalence of poorly controlled HIV was high, regardless of whether HIV was diagnosed before or during admission. HIV diagnosis and treatment resources should be improved, and strengthening of HAART program needs to be promoted. PMID:26379281

  8. Understand Your Risk for Heart Failure

    MedlinePLUS

    ... Tools & Resources Stroke More Causes and Risks for Heart Failure Updated:Sep 29,2015 Who Develops Heart Failure ( ... HF. This content was last reviewed April 2015. Heart Failure • Home • About Heart FailureCauses and Risks for ...

  9. A physically-based method for predicting peak discharge of floods caused by failure of natural and constructed earthen dams

    USGS Publications Warehouse

    Walder, J.S.; O'Connor, J. E.; Costa, J.E.

    1997-01-01

    We analyse a simple, physically-based model of breach formation in natural and constructed earthen dams to elucidate the principal factors controlling the flood hydrograph at the breach. Formation of the breach, which is assumed trapezoidal in cross-section, is parameterized by the mean rate of downcutting, k, the value of which is constrained by observations. A dimensionless formulation of the model leads to the prediction that the breach hydrograph depends upon lake shape, the ratio r of breach width to depth, the side slope ?? of the breach, and the parameter ?? = (V.D3)(k/???gD), where V = lake volume, D = lake depth, and g is the acceleration due to gravity. Calculations show that peak discharge Qp depends weakly on lake shape r and ??, but strongly on ??, which is the product of a dimensionless lake volume and a dimensionless erosion rate. Qp(??) takes asymptotically distinct forms depending on whether < ??? 1 or < ??? 1. Theoretical predictions agree well with data from dam failures for which k could be reasonably estimated. The analysis provides a rapid and in many cases graphical way to estimate plausible values of Qp at the breach.We analyze a simple, physically-based model of breach formation in natural and constructed earthen dams to elucidate the principal factors controlling the flood hydrograph at the breach. Formation of the breach, which is assumed trapezoidal in cross-section, is parameterized by the mean rate of downcutting, k, the value of which is constrained by observations. A dimensionless formulation of the model leads to the prediction that the breach hydrograph depends upon lake shape, the ratio r of breach width to depth, the side slope ?? of the breach, and the parameter ?? = (V/D3)(k/???gD), where V = lake volume, D = lake depth, and g is the acceleration due to gravity. Calculations show that peak discharge Qp depends weakly on lake shape r and ??, but strongly on ??, which is the product of a dimensionless lake volume and a dimensionless erosion rate. Qp(??) takes asymptotically distinct forms depending on whether ?????1 or ?????1. Theoretical predictions agree well with data from dam failures for which k could be reasonably estimated. The analysis provides a rapid and in many cases graphical way to estimate plausible values of Qp at the breach.

  10. Chagas disease as a cause of heart failure and ventricular arrhythmias in patients long removed from endemic areas: an emerging problem in Europe.

    PubMed

    Vannucchi, Vieri; Tomberli, Benedetta; Zammarchi, Lorenzo; Fornaro, Alessandra; Castelli, Gabriele; Pieralli, Filippo; Berni, Andrea; Yacoub, Sophie; Bartoloni, Alessandro; Olivotto, Iacopo

    2015-12-01

    Chagas disease is a parasitic disease caused by the protozoan Trypanosoma cruzi. In endemic areas (South and Central America), Chagas disease represents a relevant public health issue, and is the most frequent cause of cardiomyopathy. In nonendemic areas, such as Europe, Chagas disease represents an emerging problem following the establishment of sizeable communities from Brazil and Bolivia. Chagas cardiomyopathy represents the most frequent and serious complication of chronic Chagas disease, affecting about 20-30% of patients, potentially leading to heart failure, arrhythmias, thromboembolism, stroke and sudden death. Because late complications of Chagas disease may develop several years or even decades after the acute infection, it may be extremely challenging to reach the correct diagnosis in patients long removed from the countries of origin. We report two examples of Chagas cardiomyopathy in South American women permanently residing in Italy for more than 20 years, presenting with cardiac manifestations ranging from left ventricular dysfunction and heart failure to isolated ventricular arrhythmias. The present review emphasizes that Chagas disease should be considered as a potential diagnosis in patients from endemic areas presenting with 'idiopathic' cardiac manifestations, even when long removed from their country of origin, with potential implications for treatment and control of Chagas disease transmission. PMID:25022923

  11. Medium-term cost-effectiveness of an automated non-invasive ventilation outpatient set-up versus a standard fixed level non-invasive ventilation inpatient set-up in obese patients with chronic respiratory failure: a protocol description

    PubMed Central

    Mandal, S; Arbane, G; Murphy, P; Elliott, M W; Janssens, J P; Pepin, J L; Muir, J F; Cuvelier, A; Polkey, M; Parkin, D; Douiri, A; Hart, N

    2015-01-01

    Introduction Obesity is an escalating issue, with an accompanying increase in referrals of patients with obesity-related respiratory failure. Currently, these patients are electively admitted to hospital for initiation of non-invasive ventilation (NIV), but it is unknown whether outpatient initiation is as effective as inpatient set-up. We hypothesise that outpatient set-up using an autotitrating NIV device will be more cost-effective than a nurse-led inpatient titration and set-up. Methods and analysis We will undertake a multinational, multicentre randomised controlled trial. Participants will be randomised to receive the usual inpatient set-up, which will include nurse-led initiation of NIV or outpatient set-up with an automated NIV device. They will be stratified according to the trial site, gender and previous use of NIV or continuous positive airway pressure. Assuming a 10% dropout rate, a total sample of 82 patients will be required. Cost-effectiveness will be evaluated using standard treatment costs and health service utilisation as well as health-related quality of life measures (severe respiratory insufficiency (SRI) and EuroQol-5 dimensions (EQ-5D)). A change in the SRI questionnaire will be based on the analysis of covariance adjusting for the baseline measurements between the two arms of patients. Ethics and dissemination This study has been approved by the Westminster National Research Ethics Committee (11/LO/0414) and is the trial registered on the UKCRN portfolio. The trial is planned to start in January 2015 with publication of the trial results in 2017. Trial registration number ISRCTN 51420481. PMID:25908673

  12. A physically-based method for predicting peak discharge of floods caused by failure of natural and constructed earthen dams

    USGS Publications Warehouse

    Walder, J.S.

    1997-01-01

    We analyse a simple, physically-based model of breach formation in natural and constructed earthen dams to elucidate the principal factors controlling the flood hydrograph at the breach. Formation of the breach, which is assumed trapezoidal in cross-section, is parameterized by the mean rate of downcutting, k, the value of which is constrained by observations. A dimensionless formulation of the model leads to the prediction that the breach hydrograph depends upon lake shape, the ratio r of breach width to depth, the side slope ?? of the breach, and the parameter ?? = (V/ D3)(k/???gD), where V = lake volume, D = lake depth, and g is the acceleration due to gravity. Calculations show that peak discharge Qp depends weakly on lake shape r and ??, but strongly on ??, which is the product of a dimensionless lake volume and a dimensionless erosion rate. Qp(??) takes asymptotically distinct forms depending on whether ?? > 1. Theoretical predictions agree well with data from dam failures for which k could be reasonably estimated. The analysis provides a rapid and in many cases graphical way to estimate plausible values of Qp at the breach.

  13. Aggressive Zero Balance Ultrafiltration on CPB in Patients with Renal Failure May Cause Cerebral Edema: A Theoretical Analysis

    PubMed Central

    Fontaine, Eustace J.; Warwick, Richard; Sastry, Priya; Poullis, Michael

    2008-01-01

    Abstract: The objective of this study was to determine the brain volume changes that occur secondary to hemofiltration during cardiopulmonary bypass in patients with renal failure. We hypothesized that in patients with elevated urea levels, quick aggressive hemofiltration could be associated with cerebral edema. We constructed a simple two-compartment model similar to the urea kinetic model developed by Depner. Intracellular urea exit was assumed to be minimal based on known urea redistribution times. Calculations were based on a 70-kg patient, with an intracellular volume of 25 L, extracellular volume of 15 L, and a preoperative urea of 40 mmol/L filtered to a post-procedure urea of 6 mmol/L. Analysis showed that a standard size 1500-mL human brain filtered from a preoperative urea of 40 to 6 mmol/L over a short period will expand by 59 mL secondary to the osmotic disequilibrium secondary to hemofiltration (p < .05). The higher the preoperative urea, the larger the fluid shift. This figure does not include the cerebral edema component that is known to arise secondary to cardiopulmonary bypass. Significant cerebral edema theoretically occurs secondary to hemofiltration during cardiopulmonary bypass. More detailed mathematical urea kinetic analysis and clinical correlation are needed. PMID:19192751

  14. Elec 331 -Respiratory System Respiratory & CV Systems

    E-print Network

    Pulfrey, David L.

    Elec 331 - Respiratory System 1 Respiratory & CV Systems · Transport ­ Pump · Distribution) during heavy breathing Transport (Respiratory) Natural state of lung #12;Elec 331 - Respiratory System 2: Distribution Exchange Respiratory (Air) #12;Elec 331 - Respiratory System 3 SRC: PNP, p.554 CO2 O2 Cardio

  15. Neuromuscular complications in the ICU: the spectrum of critical illness-related conditions causing muscular weakness and weaning failure.

    PubMed

    Hund, E F

    1996-03-01

    Muscular weakness and atrophy in intensive care patients has long been attributed to a combination of immobilization and cataboly. More recently, it has become apparent that specific injuries to the peripheral nerve, the neuromuscular junction and the muscle are more likely causes of weakness in these patients. Clinically, delayed weaning from the ventilator and prolonged neurologic rehabilitation are the most important consequences. Detailed electrodiagnostic examination is necessary for accurate diagnosis. In selected patients, a combined muscle and nerve biopsy is helpful. In this review, I describe the current knowledge of neuromuscular complications in patients with long-term treatment in the intensive care unit. PMID:8815155

  16. Porcine Reproductive and Respiratory Syndrome 

    E-print Network

    Lawhorn, D. Bruce

    2001-07-25

    Porcine reproductive and respiratory syndrome (PRRS) is becoming one of the most economically significant diseases of swine. It causes weak, stillborn and mummified pigs, and sometimes losses of entire litters. This publication describes the disease...

  17. CADMIUM AS A RESPIRATORY TOXICANT

    EPA Science Inventory

    Cadmium is a major respiratory toxicant as evidenced by numerous human and animal studies. Controlled animal inhalation studies provide supporting evidence to the associations observed in epidemiological studies that Cd has the potential to cause lung fibrosis, emphysema, cancer,...

  18. Rates of antimicrobial resistance among common bacterial pathogens causing respiratory, blood, urine, and skin and soft tissue infections in pediatric patients.

    PubMed

    Jones, M E; Karlowsky, J A; Draghi, D C; Thornsberry, C; Sahm, D F; Bradley, J S

    2004-06-01

    Antimicrobial resistance patterns among the principal bacterial pathogens from infections of the respiratory tract, blood, skin and soft tissue, and urinary tract of pediatric patients from the USA, Canada, Germany, France, and Italy were studied using the The Surveillance Network (TSN) database. Among Streptococcus pneumoniae isolates from respiratory tract infections, the prevalence of high-level penicillin resistance (MIC>/=2 microg/ml) ranged from 1.1 (Italy) to 36.2% (USA); erythromycin resistance was higher, ranging from 13.4 (Germany) to 63.8% (France). The prevalence of beta-lactamase-positive Haemophilus influenzae among isolates from lower respiratory tract infections ranged from <10 (Italy and Germany) to 38.4% (USA). Among isolates from blood and skin and soft tissue infections, the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) ranged from 7.2% (Canada and Germany) to 27.3% (Italy). The prevalence of Escherichia coli and Klebsiella pneumoniae with putative extended-spectrum beta-lactamases among isolates from blood, urinary tract, and skin and soft tissue infections ranged from 0 (Germany and France) to 29.6% (Italy). With the exception of pseudomonal infections or infections with MRSA, amoxicillin-clavulanate retained moderate activity, whilst ceftriaxone and cefepime were the most effective broad-spectrum injectable agents. Meropenem was the most effective agent against Pseudomonas aeruginosa with <5% resistance. Low levels of resistance, along with acceptable safety profiles and the availability of convenient oral formulations, continue to support the use of ceftriaxone, cefepime, amoxicillin-clavulanate, and meropenem as viable options for the treatment of infections in pediatric patients. PMID:15156358

  19. Loss of protein phosphatase 6 in oocytes causes failure of meiosis II exit and impaired female fertility.

    PubMed

    Hu, Meng-Wen; Wang, Zhen-Bo; Teng, Yan; Jiang, Zong-Zhe; Ma, Xue-Shan; Hou, Ning; Cheng, Xuan; Schatten, Heide; Xu, Xingzhi; Yang, Xiao; Sun, Qing-Yuan

    2015-10-15

    Dynamic protein phosphorylation and dephosphorylation, mediated by a conserved cohort of protein kinases and phosphatases, regulate cell cycle progression. Among the well-known PP2A-like protein phosphatases, protein phosphatase 6 (PP6) has been analyzed in mammalian mitosis, and Aurora A has recently been identified as its key substrate. However, the functions of PP6 in meiosis are still entirely unknown. To identify the physiological role of PP6 in female gametogenesis, Ppp6c(F/F) mice were first generated and crossed with Zp3-Cre mice to selectively disrupt Ppp6c expression in oocytes. Here, we report for the first time that PP6c is dispensable for oocyte meiotic maturation but essential for exit from meiosis II (MII) after fertilization. Depletion of PP6c caused an abnormal MII spindle and disrupted MII cytokinesis, resulting in zygotes with high risk of aneuploidy and defective early embryonic development, and thus severe subfertility. We also reveal that PP6 inactivation interferes with MII spindle formation and MII exit owing to increased Aurora A activity, and that Aurora A inhibition with MLN8237 can rescue the PP6c depletion phenotype. In conclusion, our findings uncover a hitherto unknown role for PP6 as an indispensable regulator of oocyte meiosis and female fertility. PMID:26349807

  20. Worsening of Renal Function During 1 Year After Hospital Discharge Is a Strong and Independent Predictor of All?Cause Mortality in Acute Decompensated Heart Failure

    PubMed Central

    Ueda, Tomoya; Kawakami, Rika; Sugawara, Yu; Okada, Sadanori; Nishida, Taku; Onoue, Kenji; Soeda, Tsunenari; Okayama, Satoshi; Takeda, Yukiji; Watanabe, Makoto; Kawata, Hiroyuki; Uemura, Shiro; Saito, Yoshihiko

    2014-01-01

    Background Renal impairment is a common comorbidity and the strongest risk factor for poor prognosis in acute decompensated heart failure (ADHF). In clinical practice, renal function is labile during episodes of ADHF, and often worsens after discharge. The significance of worsening of renal function (WRF) after discharge has not been investigated as extensively as baseline renal function at admission or WRF during hospitalization. Methods and Results Among 611 consecutive patients with ADHF emergently admitted to our hospital, 233 patients with 3 measurements of serum creatinine (SCr) level measurements (on admission, at discharge, and 1 year after discharge) were included in the present study. Patients were divided into 2 groups according to the presence or absence of WRF at 1 year after discharge (1y?WRF), defined as an absolute increase in SCr >0.3 mg/dL (>26.5 ?mol/L) plus a ?25% increase in SCr at 1 year after discharge compared to the SCr value at discharge. All?cause and cardiovascular mortality were assessed as adverse outcomes. During a mean follow?up of 35.4 months, 1y?WRF occurred in 48 of 233 patients. There were 66 deaths from all causes. All?cause and cardiovascular mortality were significantly higher in patients with 1y?WRF (log?rank P<0.0001 and P<0.0001, respectively) according to Kaplan–Meier analysis. In a multivariate Cox proportional hazards model, 1y?WRF was a strong and independent predictor of all?cause and cardiovascular mortality. Hemoglobin and B?type natriuretic peptide at discharge, as well as left ventricular ejection fraction <50%, were independent predictors of 1y?WRF. Conclusions In patients with ADHF, 1y?WRF is a strong predictor of all?cause and cardiovascular mortality. PMID:25370599

  1. Failure of cerebellar patients to time finger opening precisely causes ball high-low inaccuracy in overarm throws.

    PubMed

    Timmann, D; Watts, S; Hore, J

    1999-07-01

    We investigated the idea that the cerebellum is required for precise timing of fast skilled arm movements by studying one situation where timing precision is required, namely finger opening in overarm throwing. Specifically, we tested the hypothesis that in overarm throws made by cerebellar patients, ball high-low inaccuracy is due to disordered timing of finger opening. Six cerebellar patients and six matched control subjects were instructed to throw tennis balls at three different speeds from a seated position while angular positions in three dimensions of five arm segments were recorded at 1,000 Hz with the search-coil technique. Cerebellar patients threw more slowly than controls, were markedly less accurate, had more variable hand trajectories, and showed increased variability in the timing, amplitude, and velocity of finger opening. Ball high-low inaccuracy was not related to variability in the height or direction of the hand trajectory or to variability in finger amplitude or velocity. Instead, the cause was variable timing of finger opening and thereby ball release occurring on a flattened arc hand trajectory. The ranges of finger opening times and ball release times (timing windows) for 95% of the throws were on average four to five times longer for cerebellar patients; e.g., across subjects mean ball release timing windows for throws made under the medium-speed instruction were 11 ms for controls and 55 ms for cerebellar patients. This increased timing variability could not be explained by disorder in control of force at the fingers. Because finger opening in throwing is likely controlled by a central command, the results implicate the cerebellum in timing the central command that initiates finger opening in this fast skilled multijoint arm movement. PMID:10400939

  2. Bacterial Cooperation Causes Systematic Errors in Pathogen Risk Assessment due to the Failure of the Independent Action Hypothesis

    PubMed Central

    Cornforth, Daniel M.; Matthews, Andrew; Brown, Sam P.; Raymond, Ben

    2015-01-01

    The Independent Action Hypothesis (IAH) states that pathogenic individuals (cells, spores, virus particles etc.) behave independently of each other, so that each has an independent probability of causing systemic infection or death. The IAH is not just of basic scientific interest; it forms the basis of our current estimates of infectious disease risk in humans. Despite the important role of the IAH in managing disease interventions for food and water-borne pathogens, experimental support for the IAH in bacterial pathogens is indirect at best. Moreover since the IAH was first proposed, cooperative behaviors have been discovered in a wide range of microorganisms, including many pathogens. A fundamental principle of cooperation is that the fitness of individuals is affected by the presence and behaviors of others, which is contrary to the assumption of independent action. In this paper, we test the IAH in Bacillus thuringiensis (B.t), a widely occurring insect pathogen that releases toxins that benefit others in the inoculum, infecting the diamondback moth, Plutella xylostella. By experimentally separating B.t. spores from their toxins, we demonstrate that the IAH fails because there is an interaction between toxin and spore effects on mortality, where the toxin effect is synergistic and cannot be accommodated by independence assumptions. Finally, we show that applying recommended IAH dose-response models to high dose data leads to systematic overestimation of mortality risks at low doses, due to the presence of synergistic pathogen interactions. Our results show that cooperative secretions can easily invalidate the IAH, and that such mechanistic details should be incorporated into pathogen risk analysis. PMID:25909384

  3. Bacterial Cooperation Causes Systematic Errors in Pathogen Risk Assessment due to the Failure of the Independent Action Hypothesis.

    PubMed

    Cornforth, Daniel M; Matthews, Andrew; Brown, Sam P; Raymond, Ben

    2015-04-01

    The Independent Action Hypothesis (IAH) states that pathogenic individuals (cells, spores, virus particles etc.) behave independently of each other, so that each has an independent probability of causing systemic infection or death. The IAH is not just of basic scientific interest; it forms the basis of our current estimates of infectious disease risk in humans. Despite the important role of the IAH in managing disease interventions for food and water-borne pathogens, experimental support for the IAH in bacterial pathogens is indirect at best. Moreover since the IAH was first proposed, cooperative behaviors have been discovered in a wide range of microorganisms, including many pathogens. A fundamental principle of cooperation is that the fitness of individuals is affected by the presence and behaviors of others, which is contrary to the assumption of independent action. In this paper, we test the IAH in Bacillus thuringiensis (B.t), a widely occurring insect pathogen that releases toxins that benefit others in the inoculum, infecting the diamondback moth, Plutella xylostella. By experimentally separating B.t. spores from their toxins, we demonstrate that the IAH fails because there is an interaction between toxin and spore effects on mortality, where the toxin effect is synergistic and cannot be accommodated by independence assumptions. Finally, we show that applying recommended IAH dose-response models to high dose data leads to systematic overestimation of mortality risks at low doses, due to the presence of synergistic pathogen interactions. Our results show that cooperative secretions can easily invalidate the IAH, and that such mechanistic details should be incorporated into pathogen risk analysis. PMID:25909384

  4. Ejection Fraction Heart Failure Measurement

    MedlinePLUS

    ... Blood Pressure Tools & Resources Stroke More Ejection Fraction Heart Failure Measurement Updated:Sep 29,2015 The ejection fraction ( ... below you agree to the Terms and Conditions Heart Failure • Home • About Heart FailureCauses and Risks for ...

  5. Class of dependent failures

    SciTech Connect

    Papazoglou, I.A.

    1981-01-01

    The purpose of this paper is to analyze the effect on the reliability of redundant systems of a class of dependent failures that are due to causes internal to the system (sympathetic failures). A general Markovian model that can incorporate both common cause (externally generated) and sympathetic failures is developed. The model includes the ..beta..-factor model and the Marshall-Olkin model as special cases. Three specialized versions of the general model are presented. It is shown that sympathetic failures can restrict the achievable reliability of a system beyond the limit set by common cause failures.

  6. A respiratory gas exchange catheter: In vitro and in vivo tests in large animals

    E-print Network

    Federspiel, William J.

    reduction in the therapy of respiratory failure. Conclusions: Progress has been made toward developingA respiratory gas exchange catheter: In vitro and in vivo tests in large animals Brack G. Hattler, PhD Brian Frankowski, AD William J. Federspiel, PhD Objectives: Acute respiratory failure

  7. Respiratory Home Health Care

    MedlinePLUS

    ... Healthy Living > Living With Lung Disease > Respiratory Home Health Care Font: Aerosol Delivery Oxygen Resources Immunizations Pollution Nutrition ... Disease Articles written by Respiratory Experts Respiratory Home Health Care Respiratory care at home can contribute to improved ...

  8. Kidney Failure

    MedlinePLUS

    ... Details» www.kidneyfund.org > Kidney Disease > Kidney Failure Kidney Failure Kidney failure is when your kidneys stop ... are the tests for kidney failure? How is kidney failure (ESRD) different from chronic kidney disease (CKD)? ...

  9. Integrated DNA and RNA extraction and purification on an automated microfluidic cassette from bacterial and viral pathogens causing community-acquired lower respiratory tract infections.

    PubMed

    Van Heirstraeten, Liesbet; Spang, Peter; Schwind, Carmen; Drese, Klaus S; Ritzi-Lehnert, Marion; Nieto, Benjamin; Camps, Marta; Landgraf, Bryan; Guasch, Francesc; Corbera, Antoni Homs; Samitier, Josep; Goossens, Herman; Malhotra-Kumar, Surbhi; Roeser, Tina

    2014-05-01

    In this paper, we describe the development of an automated sample preparation procedure for etiological agents of community-acquired lower respiratory tract infections (CA-LRTI). The consecutive assay steps, including sample re-suspension, pre-treatment, lysis, nucleic acid purification, and concentration, were integrated into a microfluidic lab-on-a-chip (LOC) cassette that is operated hands-free by a demonstrator setup, providing fluidic and valve actuation. The performance of the assay was evaluated on viral and Gram-positive and Gram-negative bacterial broth cultures previously sampled using a nasopharyngeal swab. Sample preparation on the microfluidic cassette resulted in higher or similar concentrations of pure bacterial DNA or viral RNA compared to manual benchtop experiments. The miniaturization and integration of the complete sample preparation procedure, to extract purified nucleic acids from real samples of CA-LRTI pathogens to, and above, lab quality and efficiency, represent important steps towards its application in a point-of-care test (POCT) for rapid diagnosis of CA-LRTI. PMID:24615272

  10. [Respiratory complications after transfusion].

    PubMed

    Bernasinski, M; Mertes, P-M; Carlier, M; Dupont, H; Girard, M; Gette, S; Just, B; Malinovsky, J-M

    2014-05-01

    Respiratory complications of blood transfusion have several possible causes. Transfusion-Associated Circulatory Overload (TACO) is often the first mentioned. Transfusion-Related Acute Lung Injury (TRALI), better defined since the consensus conference of Toronto in 2004, is rarely mentioned. French incidence is low. Non-hemolytic febrile reactions, allergies, infections and pulmonary embolism are also reported. The objective of this work was to determine the statistical importance of the different respiratory complications of blood transfusion. This work was conducted retrospectively on transfusion accidents in six health centers in Champagne-Ardenne, reported to Hemovigilance between 2000 and 2009 and having respiratory symptoms. The analysis of data was conducted by an expert committee. Eighty-three cases of respiratory complications are found (316,864 blood products). We have counted 26 TACO, 12 TRALI (only 6 cases were identified in the original investigation of Hemovigilance), 18 non-hemolytic febrile reactions, 16 cases of allergies, 5 transfusions transmitted bacterial infections and 2 pulmonary embolisms. Six new TRALI were diagnosed previously labeled TACO for 2 of them, allergy and infection in 2 other cases and diagnosis considered unknown for the last 2. Our study found an incidence of TRALI 2 times higher than that reported previously. Interpretation of the data by a multidisciplinary committee amended 20% of diagnoses. This study shows the imperfections of our system for reporting accidents of blood transfusion when a single observer analyses the medical records. PMID:24814817

  11. Respiratory Distress

    NASA Technical Reports Server (NTRS)

    1976-01-01

    The University of Miami School of Medicine asked the Research Triangle Institute for assistance in improvising the negative pressure technique to relieve respiratory distress in infants. Marshall Space Flight Center and Johnson Space Center engineers adapted this idea to the lower-body negative-pressure system seals used during the Skylab missions. Some 20,000 babies succumb to respiratory distress in the U.S. each year, a condition in which lungs progressively lose their ability to oxygenate blood. Both positive and negative pressure techniques have been used - the first to force air into lungs, the second to keep infant's lungs expanded. Negative pressure around chest helps the baby expand his lungs and maintain proper volume of air. If doctors can keep the infant alive for four days, the missing substance in the lungs will usually form in sufficient quantity to permit normal breathing. The Skylab chamber and its leakproof seals were adapted for medical use.

  12. Surveillance for emerging respiratory viruses.

    PubMed

    Al-Tawfiq, Jaffar A; Zumla, Alimuddin; Gautret, Philippe; Gray, Gregory C; Hui, David S; Al-Rabeeah, Abdullah A; Memish, Ziad A

    2014-10-01

    Several new viral respiratory tract infectious diseases with epidemic potential that threaten global health security have emerged in the past 15 years. In 2003, WHO issued a worldwide alert for an unknown emerging illness, later named severe acute respiratory syndrome (SARS). The disease caused by a novel coronavirus (SARS-CoV) rapidly spread worldwide, causing more than 8000 cases and 800 deaths in more than 30 countries with a substantial economic impact. Since then, we have witnessed the emergence of several other viral respiratory pathogens including influenza viruses (avian influenza H5N1, H7N9, and H10N8; variant influenza A H3N2 virus), human adenovirus-14, and Middle East respiratory syndrome coronavirus (MERS-CoV). In response, various surveillance systems have been developed to monitor the emergence of respiratory-tract infections. These include systems based on identification of syndromes, web-based systems, systems that gather health data from health facilities (such as emergency departments and family doctors), and systems that rely on self-reporting by patients. More effective national, regional, and international surveillance systems are required to enable rapid identification of emerging respiratory epidemics, diseases with epidemic potential, their specific microbial cause, origin, mode of acquisition, and transmission dynamics. PMID:25189347

  13. Causes and predictors of hospital readmissions in patients older than 65 years hospitalized for heart failure with preserved left ventricular ejection fraction in western Romania

    PubMed Central

    Mavrea, Adelina Marioara; Dragomir, Tiberiu; Bordejevic, Diana Aurora; Tomescu, Mirela Cleopatra; Ancusa, Oana; Marincu, Iosif

    2015-01-01

    Background Heart failure with preserved ejection fraction (HFpEF) is more frequent in the elderly and is associated with important economic implications because of repetitive and prolonged hospitalizations, due to both cardiovascular and noncardiovascular causes. Purpose To identify the causes, as well as the clinical and biological markers, that could be used as predictors of hospital readmissions in HFpEF patients aged ?65 years. Patients and methods Consecutive eligible patients hospitalized for a first heart failure (HF) episode were prospectively included and divided into one of two age groups (elderly: ?65 years; and nonelderly: <65 years). The clinical features, therapeutic approaches, and clinical outcomes during the 1-year follow-up period were analyzed. Results A total of 178 patients were included, with a mean age of 64.6±8.6 years; 80 (45%) were women. A total of 98 patients (55%) were aged ?65 years, and 80 (45%) were aged <65 years. In the group aged ?65 years, 58 patients (59%) were women, while in the group aged <65 years, 22 patients (28%) were women (P=0.0001). During the 1-year follow-up, no patients died or were lost to follow-up. Moreover, 116 (65%) of the HFpEF patients experienced hospital readmissions. The elderly patients had a significantly higher readmission rate (73% vs 55%, respectively; P<0.02); readmissions due to aggravated HF were significantly more frequent in this age group (41% vs 18%, respectively; P<0.002). Multivariate logistic regression analysis indicated that the independent predictors of readmission due to HF aggravation included plasma levels of brain natriuretic peptide >450 pg/mL (P<0.01) and N-terminal-pro-brain natriuretic peptide >477 pg/mL (P<0.02) in the elderly group, while in the nonelderly group, the independent predictors of this outcome were a New York Heart Association functional class of IV at initial hospitalization (P<0.04), as well as plasma levels of brain natriuretic peptide >390 pg/mL (P=0.03) and tumor necrosis factor (TNF)-? >7.1 pg/mL (P<0.001). Readmissions due to noncardiovascular causes were independently predicted by plasma levels of TNF-? >10 pg/mL in the elderly (P=0.003) and of interleukin (IL)-6 >1.9 pg/mL in the nonelderly (P<0.04). Conclusion We conclude that in HFpEF patients aged ?65 years, the main cause of rehospitalization during the 1-year follow-up was HF aggravation. The risk of this outcome was independently predicted by increased levels of cardiac peptides, while the risk of noncardiovascular readmissions was predicted by increased levels of inflammatory biomarkers. Increased TNF-? levels predicted both cardiovascular and noncardiovascular readmissions, while increased levels of high-sensitivity C-reactive protein did not predict any of these outcomes in our study. PMID:26124651

  14. Dysrhythmias of the respiratory oscillator

    NASA Astrophysics Data System (ADS)

    Paydarfar, David; Buerkel, Daniel M.

    1995-03-01

    Breathing is regulated by a central neural oscillator that produces rhythmic output to the respiratory muscles. Pathological disturbances in rhythm (dysrhythmias) are observed in the breathing pattern of children and adults with neurological and cardiopulmonary diseases. The mechanisms responsible for genesis of respiratory dysrhythmias are poorly understood. The present studies take a novel approach to this problem. The basic postulate is that the rhythm of the respiratory oscillator can be altered by a variety of stimuli. When the oscillator recovers its rhythm after such perturbations, its phase may be reset relative to the original rhythm. The amount of phase resetting is dependent upon stimulus parameters and the level of respiratory drive. The long-range hypothesis is that respiratory dysrhythmias can be induced by stimuli that impinge upon or arise within the respiratory oscillator with certain combinations of strength and timing relative to the respiratory cycle. Animal studies were performed in anesthetized or decerebrate preparations. Neural respiratory rhythmicity is represented by phrenic nerve activity, allowing use of open-loop experimental conditions which avoid negative chemical feedback associated with changes in ventilation. In animal experiments, respiratory dysrhythmias can be induced by stimuli having specific combinations of strength and timing. Newborn animals readily exhibit spontaneous dysrhythmias which become more prominent at lower respiratory drives. In human subjects, swallowing was studied as a physiological perturbation of respiratory rhythm, causing a pattern of phase resetting that is characterized topologically as type 0. Computational studies of the Bonhoeffer-van der Pol (BvP) equations, whose qualitative behavior is representative of many excitable systems, supports a unified interpretation of these experimental findings. Rhythmicity is observed when the BvP model exhibits recurrent periods of excitation alternating with refractory periods. The same system can be perturbed to a state in which amplitude of oscillation is attenuated or abolished. We have characterized critical perturbations which induce transitions between these two states, giving rise to patterns of dysrhythmic activity that are similar to those seen in the experiments. We illustrate the importance of noise in initiation and termination of rhythm, comparable to normal respiratory rhythm intermixed with spontaneous dysrhythmias. In the BvP system the incidence and duration of dysrhythmia is shown to be strongly influenced by the level of noise. These studies should lead to greater understanding of rhythmicity and integrative responses of the respiratory control system, and provide insight into disturbances in control mechanisms that cause apnea and aspiration in clinical disease states.

  15. Evaluation of Fiber Bundle Rotation for Enhancing Gas Exchange in a Respiratory Assist Catheter

    PubMed Central

    Eash, Heide J.; Mihelc, Kevin M.; Frankowski, Brain J.; Hattler, Brack G.; Federspiel, William J.

    2007-01-01

    Supplemental oxygenation and carbon dioxide removal through an intravenous respiratory assist catheter can be used as a means of treating patients with acute respiratory failure. We are beginning development efforts toward a new respiratory assist catheter with an insertional size <25F, which can be inserted percutaneously. In this study, we evaluated fiber bundle rotation as an improved mechanism for active mixing and enhanced gas exchange in intravenous respiratory assist catheters. Using a simple test apparatus of a rotating densely packed bundle of hollow fiber membranes, water and blood gas exchange levels were evaluated at various rotation speeds in a mock vena cava. At 12,000 RPM, maximum CO2 gas exchange rates were 449 and 523 mL/min per m², water and blood, respectively, but the rate of increase with increasing rotation rate diminished beyond 7500 RPM. These levels of gas exchange efficiency are two? to threefold greater than achieved in our previous respiratory catheters using balloon pulsation for active mixing. In preliminary hemolysis tests, which monitored plasma?free hemoglobin levels in vitro over a period of 6 hours, we established that the rotating fiber bundle per se did not cause significant blood hemolysis compared with an intra?aortic balloon pump. Accordingly, fiber bundle rotation appears to be a potential mechanism for increasing gas exchange and reducing insertional size in respiratory catheters. PMID:17515731

  16. Frequent respiratory tract infections in the canine model of X-linked ectodermal dysplasia are not caused by an immune deficiency

    PubMed Central

    Casal, Margret L.; Mauldin, Elizabeth A.; Ryan, Sara; Scheidt, Jennifer L.; Kennedy, Jeffrey; Moore, Peter F.; Felsburg, Peter J.

    2012-01-01

    As in many human patients with X-linked hypohidrotic ectodermal dysplasia (XHED), XHED dogs are at an increased risk for pulmonary disorders. Localized immune system defects had been suspected previously in affected dogs because of frequent infections and unexpected deaths due to opportunistic respiratory tract infections. Experiments were designed to examine systemic and localized humoral and cellular responses, development and function of T cells, and thymic morphology. All dogs used in these experiments were clinically healthy at the time of examination and their immune responses were compared to normal littermates. Serum immunoglobulin concentrations differed somewhat between normal dogs and dogs affected with XHED but they were all within normal ranges. The XHED dogs responded appropriately to vaccination with tetanus toxoid suggesting normal systemic B and plasma cell function. Thymic morphology was compared between normal and affected dogs and T cells were assessed for functionality. Numbers and phenotypes of T and B cells in blood and thymus of affected dogs were within normal limits suggesting normal development of T cells. Cytotoxic and phagocytic ability of macrophages and neutrophils was also normal in affected dogs. In contrast, the secretory IgA concentrations found in affected dogs were significantly higher than in normal dogs, while lacrimal secretions were significantly decreased. These results suggest a compensatory mechanism for secretory IgA, so that the total amount equals that in normal dogs. The results presented in this study indicate that the XHED dogs have a relatively intact immune system and suggest that the same is true for humans with the homologous form of XHED. PMID:15946744

  17. [Two cases of acute respiratory distress syndrome related to zinc fumes and zinc dust inhalation].

    PubMed

    Ishimoto, Hiroshi; Yatera, Kazuhiro; Oda, Keishi; Kawanami, Toshinori; Soda, Hiroshi; Kohno, Shigeru; Mukae, Hiroshi

    2014-06-01

    Two cases of acute respiratory distress syndrome related to zinc fume inhalation and zinc powder inhalation are presented. Case 1 demonstrated acute respiratory symptoms during the work of distortion correction of iron boards, coated with a rust preventative including rich zinc using an acetylene gas burner. Case 2 occurred after the work of applying a rust preventative that included zinc powder, mainly using an airless compressor. Since both were working in a boathouse, without using protective equipment, the possible causes of Case 1 and 2 were inhalation exposure to zinc fumes and zinc powder, respectively. The two patients showed similar clinical courses, including favorable treatment outcomes, mimicking acute respiratory failure complicated by a metal fume fever. PMID:24930880

  18. Bovine model of respiratory syncytial virus infection.

    PubMed

    Taylor, Geraldine

    2013-01-01

    Bovine respiratory syncytial virus (BRSV), which is an important cause of respiratory disease in young calves, is genetically and antigenically closely related to human (H)RSV. The epidemiology and pathogenesis of infection with these viruses are similar. The viruses are host-specific and infection produces a spectrum of disease ranging from subclinical to severe bronchiolitis and pneumonia, with the peak incidence of severe disease in individuals less than 6 months of age. BRSV infection in calves reproduces many of the clinical signs associated with HRSV in infants, including fever, rhinorrhoea, coughing, harsh breath sounds and rapid breathing. Although BRSV vaccines have been commercially available for decades, there is a need for greater efficacy. The development of effective BRSV and HRSV vaccines face similar challenges, such as the need to vaccinate at an early age in the presence of maternal antibodies, the failure of natural infection to prevent reinfection, and a history of vaccine-augmented disease. Neutralising monoclonal antibodies (mAbs) to the fusion (F) protein of HRSV, which can protect infants from severe HRSV disease, recognise the F protein of BRSV, and vice versa. Furthermore, bovine and human CD8(+) T-cells, which are known to be important in recovery from RSV infection, recognise similar proteins that are conserved between HRSV and BRSV. Therefore, not only can the bovine model of RSV be used to evaluate vaccine concepts, it can also be used as part of the preclinical assessment of certain HRSV candidate vaccines. PMID:24362697

  19. Middle East respiratory syndrome (MERS)

    PubMed Central

    Cunha, Cheston B; Opal, Steven M

    2014-01-01

    Coronaviruses have traditionally been associated with mild upper respiratory tract infections throughout the world. In the fall of 2002, a new coronavirus emerged in in Asia causing severe viral pneumonia, i.e., severe acute respiratory syndrome (SARS). Nearly a decade following the SARS epidemic, a new coronavirus causing severe viral pneumonia has emerged, i.e., middle east respiratory syndrome (MERS). Since the initial case of MERS-CoV occurred in June of 2012 in Saudi Arabia there have been 688 confirmed cases and 282 deaths in 20 countries.   Although both SARS and MERS are caused by coronaviruses, SARS was characterized by efficient human transmission and relatively low mortality rate. In contrast, MERS is relatively inefficiently transmitted to humans but has a high mortality rate. Given the potential overlap in presentation and manifestation, it is important to understand the clinical and epidemiologic differences between MERS, SARS and influenza. PMID:25089913

  20. Improvement in the accuracy of respiratory-gated radiation therapy using a respiratory guiding system

    NASA Astrophysics Data System (ADS)

    Kang, Seong-Hee; Kim, Dong-Su; Kim, Tae-Ho; Suh, Tae-Suk; Yoon, Jai-Woong

    2013-01-01

    The accuracy of respiratory-gated radiation therapy (RGRT) depends on the respiratory regularity because external respiratory signals are used for gating the radiation beam at particular phases. Many studies have applied a respiratory guiding system to improve the respiratory regularity. This study aims to evaluate the effect of an in-house-developed respiratory guiding system to improve the respiratory regularity for RGRT. To verify the effectiveness of this system, we acquired respiratory signals from five volunteers. The improvement in respiratory regularity was analyzed by comparing the standard deviations of the amplitudes and the periods between free and guided breathing. The reduction in residual motion at each phase was analyzed by comparing the standard deviations of sorted data within each corresponding phase bin as obtained from free and guided breathing. The results indicate that the respiratory guiding system improves the respiratory regularity, and that most of the volunteers showed significantly less average residual motion at each phase. The average residual motion measured at phases of 40, 50, and 60%, which showed lower variation than other phases, were, respectively, reduced by 41, 45, and 44% during guided breathing. The results show that the accuracy of RGRT can be improved by using the in-house-developed respiratory guiding system. Furthermore, this system should reduce artifacts caused by respiratory motion in 4D CT imaging.

  1. Influence of Androgen Deprivation Therapy on All-Cause Mortality in Men With High-Risk Prostate Cancer and a History of Congestive Heart Failure or Myocardial Infarction

    SciTech Connect

    Nguyen, Paul L.; Chen, Ming-Hui; Beckman, Joshua A.; Beard, Clair J.; Martin, Neil E.; Choueiri, Toni K.; Hu, Jim C.; Dosoretz, Daniel E.; Moran, Brian J.; Salenius, Sharon A.; Braccioforte, Michelle H.; Kantoff, Philip W.; D'Amico, Anthony V.; Ennis, Ronald D.

    2012-03-15

    Purpose: It is unknown whether the excess risk of all-cause mortality (ACM) observed when androgen deprivation therapy (ADT) is added to radiation for men with prostate cancer and a history of congestive heart failure (CHF) or myocardial infarction (MI) also applies to those with high-risk disease. Methods and Materials: Of 14,594 men with cT1c-T3aN0M0 prostate cancer treated with brachytherapy-based radiation from 1991 through 2006, 1,378 (9.4%) with a history of CHF or MI comprised the study cohort. Of these, 22.6% received supplemental external beam radiation, and 42.9% received a median of 4 months of neoadjuvant ADT. Median age was 71.8 years. Median follow-up was 4.3 years. Cox multivariable analysis tested for an association between ADT use and ACM within risk groups, after adjusting for treatment factors, prognostic factors, and propensity score for ADT. Results: ADT was associated with significantly increased ACM (adjusted hazard ratio [AHR] = 1.76; 95% confidence interval [CI], 1.32-2.34; p = 0.0001), with 5-year estimates of 22.71% with ADT and 11.62% without ADT. The impact of ADT on ACM by risk group was as follows: high-risk AHR = 2.57; 95% CI, 1.17-5.67; p = 0.019; intermediate-risk AHR = 1.75; 95% CI, 1.13-2.73; p = 0.012; low-risk AHR = 1.52; 95% CI, 0.96-2.43; p = 0.075). Conclusions: Among patients with a history of CHF or MI treated with brachytherapy-based radiation, ADT was associated with increased all-cause mortality, even for patients with high-risk disease. Although ADT has been shown in Phase III studies to improve overall survival in high-risk disease, the small subgroup of high-risk patients with a history of CHF or MI, who represented about 9% of the patients, may be harmed by ADT.

  2. What causes an icy fault to slip? Investigating the depth and frictional conditions for tidally driven Coulomb failure along major strike-slip faults of Europa and Ganymede

    NASA Astrophysics Data System (ADS)

    Cameron, Marissa E.; Smith-Konter, Bridget R.; Pappalardo, Robert T.

    2014-11-01

    The surfaces of Europa and Ganymede display strike-slip fractures, presumably arising from a combination of global and local stress sources. To better understand the role of tidal stress sources and implications for strike-slip faulting on these icy bodies, we investigate the relationship between shear and normal stresses at several major fault zones: Agenor Linea, Rhadamanthys Linea, Agave/Asterius Lineae, and Astypalaea Linea (on Europa), and Dardanus Sulcus (on Ganymede). Assuming tidal diurnal and non-synchronous rotation (NSR) stresses as plausible mechanisms for strike-slip tectonism, here we investigate the mechanics of Coulomb shear failure. We consider a range of friction coefficients (µf = 0.2 - 0.6) and fault depths (0 - 6 km) to evaluate how failure predictions vary between the satellites and as a function of depth, ice friction, geographic location, and fault geometry. Assuming present-day orbital eccentricities, our results indicate that the conditions for failure at depth are not met for any of the fault systems if subject to diurnal stresses only. Alternatively, models that include both diurnal and NSR stresses readily generate stress magnitudes that could permit shear failure. On Europa, shear failure is easily activated and failure extends to depths ranging from 3 - 6 km when a low coefficient of friction (µf = 0.2) is assumed. On Ganymede, failure is limited to even shallower depths (< 2 km). A high coefficient of friction (µf = 0.6) limits failure depths to < 3 km on Europa faults and discourages strike-slip faulting completely on Ganymede. Based on these results, we infer that the conditions for shear failure are potentially met along at least these five studied systems, and possibly others in the outer solar system, if NSR is adopted as a driving stress mechanism and the coefficient of friction is low.

  3. Metallization failures

    NASA Technical Reports Server (NTRS)

    Beatty, R.

    1971-01-01

    Metallization-related failure mechanisms were shown to be a major cause of integrated circuit failures under accelerated stress conditions, as well as in actual use under field operation. The integrated circuit industry is aware of the problem and is attempting to solve it in one of two ways: (1) better understanding of the aluminum system, which is the most widely used metallization material for silicon integrated circuits both as a single level and multilevel metallization, or (2) evaluating alternative metal systems. Aluminum metallization offers many advantages, but also has limitations particularly at elevated temperatures and high current densities. As an alternative, multilayer systems of the general form, silicon device-metal-inorganic insulator-metal, are being considered to produce large scale integrated arrays. The merits and restrictions of metallization systems in current usage and systems under development are defined.

  4. 38 CFR 4.97 - Schedule of ratings-respiratory system.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... involved 6847Sleep Apnea Syndromes (Obstructive, Central, Mixed): Chronic respiratory failure with carbon... Asymptomatic but with documented sleep disorder breathing 0 1 Review for entitlement to special...

  5. A genetic hypothesis for cause of death during the 1952 London Fog.

    PubMed

    Mage, D T; Donner, E M

    1995-11-01

    Analysis of autopsied cause of death during the London Fog of 1952 indicates that mortality from all respiratory causes, sudden and delayed, had a consistent male fraction of 0.622. Sudden death from heart failure had a similar male fraction of 0.612. However, heart failures after the first day of illness had a male fraction of 0.48. This significant difference in male fraction between sudden (0.61) and delayed (0.48) heart failure suggests different terminal events. Coronary sudden death may be attributable to right-sided heart failure, and the delayed form may be attributable to left-sided failure leading to pulmonary congestion. The male fraction in sudden respiratory and sudden cardiac deaths (0.612) is exactly the same as the male fraction in sudden infant death syndrome-0.612 - which has been posited as being X-linked. It is hypothesized that the same X-linked gene responsible for the 0.612 male fraction in sudden infant death syndrome may be a factor in the respiratory and sudden cardiac mortalities during the London Fog. PMID:8748092

  6. Respiratory syncytial virus infection in cattle

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Bovine respiratory syncytial virus (bRSV) is a cause of respiratory disease in cattle world-wide. It has an integral role in enzootic pneumonia in young dairy calves and summer pneumonia in nursing beef calves. Furthermore, bRSV infection can predispose calves to secondary bacterial infection by org...

  7. Case Study of the Failure of two 13.8kV Control & Metering Transformers that caused significant Equipment Damage

    SciTech Connect

    Dreifuerst, G R; Chew, D B; Mangonon, H L; Swyers, P W

    2011-08-25

    The degradation and failure of cast-coil epoxy windings within 13.8kV control power transformers and metering potential transformers has been shown to be dangerous to both equipment and personnel, even though best industrial design practices were followed. Accident scenes will be examined for two events at a U.S. Department of Energy laboratory. Failure modes will be explained and current design practices discussed with changes suggested to prevent a recurrence and to minimize future risk. New maintenance philosophies utilizing partial discharge testing of the transformers as a prediction of end-of-life will be examined.

  8. Protective ventilation of patients with acute respiratory distress syndrome.

    PubMed

    Moloney, E D; Griffiths, M J D

    2004-02-01

    The majority of patients with acute respiratory distress syndrome (ARDS) require mechanical ventilation. This support provides time for the lungs to heal, but the adverse effects of mechanical ventilation significantly influence patient outcome. Traditionally, these were ascribed to mechanical effects, such as haemodynamic compromise from decreased venous return or gross air leaks induced by large transpulmonary pressures. More recently, however, the ARDS Network study has established the clinical importance of lowering the tidal volume to limit overdistension of the lung when ventilating patients with ARDS. This study suggests that ventilator-associated lung injury (VALI) caused by overdistension of the lung contributes to the mortality of patients with ARDS. Moreover, the results from clinical and basic research have revealed more subtle types of VALI, including upregulation of the inflammatory response in the injured and overdistended lung. This not only damages the lung, but the overflow of inflammatory mediators into the systemic circulation may explain why most patients who die with ARDS succumb to multi-organ failure rather than respiratory failure. The results of these studies, the present understanding of the pathophysiology of VALI, and protective ventilatory strategies are reviewed. PMID:14722180

  9. Recurrent Respiratory Papillomatosis or Laryngeal Papillomatosis

    MedlinePLUS

    ... in the respiratory tract, their presence in the larynx (voice box) causes the most frequent problems, a ... patient’s nose or mouth and then view the larynx on a monitor. Some medical professionals use a ...

  10. Heart Failure

    MedlinePLUS

    ... version of this page please turn Javascript on. Heart Failure What is Heart Failure? In heart failure, the heart cannot pump ... the lungs, where it picks up oxygen. The Heart's Pumping Action In normal hearts, blood vessels called ...

  11. Heart Failure

    MedlinePLUS

    MENU Return to Web version Heart Failure Overview What is heart failure? Despite the way it sounds, the term "heart failure" simply means ... you were born with) Diabetes Thyroid problems Diagnosis & Tests How will my doctor know if I have ...

  12. Heart Failure Questions to Ask Your Doctor

    MedlinePLUS

    ... Pressure High Blood Pressure Tools & Resources Stroke More Heart Failure Questions to Ask Your Doctor Updated:Oct 1, ... Pressure Tracker (PDF) Find additional helpful resources here Heart Failure • Home • About Heart FailureCauses and Risks for ...

  13. Advances in the management of acute liver failure

    PubMed Central

    Wang, Da-Wei; Yin, Yi-Mei; Yao, Yong-Ming

    2013-01-01

    Acute liver failure (ALF) is an uncommon but dramatic clinical syndrome characterized by hepatic encephalopathy and a bleeding tendency due to abrupt loss of liver function caused by massive or submassive liver necrosis in a patient with a previously healthy liver. The causes of ALF encompass a wide variety of toxic, viral, metabolic, vascular and autoimmune insults to the liver, and identifying the correct cause can be difficult or even impossible. Many patients with ALF develop a cascade of serious complications involving almost every organ system, and death is mostly due to multi-organ failure, hemorrhage, infection, and intracranial hypertension. Fortunately, the outcome of ALF has been improved in the last 3 decades through the specific treatment for the disease of certain etiology, and the advanced intensive care management. For most severely affected patients who fail to recover after treatment, rapid evaluation for transfer to a transplantation center and consideration for liver transplantation is mandatory so that transplantation can be applied before contraindications develop. This review focuses on the recent advances in the understanding of various contributing etiologies, the administration of etiology-specific treatment to alleviate the liver injury, and the management of complications (e.g., encephalopathy, coagulopathy, cardiovascular instability, respiratory failure, renal failure, sepsis and metabolic disturbance) in patients with ALF. Assessment of the need for liver transplantation is also presented. PMID:24222950

  14. Cardiac Overexpression of Constitutively Active Galpha q Causes Angiotensin II Type1 Receptor Activation, Leading to Progressive Heart Failure and Ventricular Arrhythmias in Transgenic Mice

    PubMed Central

    Matsushita, Naoko; Kashihara, Toshihide; Shimojo, Hisashi; Suzuki, Satoshi; Nakada, Tsutomu; Takeishi, Yasuchika; Mende, Ulrike; Taira, Eiichi; Yamada, Mitsuhiko; Sanbe, Atsushi; Hirose, Masamichi

    2014-01-01

    Background Transgenic mice with transient cardiac expression of constitutively active Galpha q (G?q-TG) exhibt progressive heart failure and ventricular arrhythmias after the initiating stimulus of transfected constitutively active G?q becomes undetectable. However, the mechanisms are still unknown. We examined the effects of chronic administration of olmesartan on heart failure and ventricular arrhythmia in G?q-TG mice. Methodology/Principal Findings Olmesartan (1 mg/kg/day) or vehicle was chronically administered to G?q-TG from 6 to 32 weeks of age, and all experiments were performed in mice at the age of 32 weeks. Chronic olmesartan administration prevented the severe reduction of left ventricular fractional shortening, and inhibited ventricular interstitial fibrosis and ventricular myocyte hypertrophy in G?q-TG. Electrocardiogram demonstrated that premature ventricular contraction (PVC) was frequently (more than 20 beats/min) observed in 9 of 10 vehicle-treated G?q-TG but in none of 10 olmesartan-treated G?q-TG. The collected QT interval and monophasic action potential duration in the left ventricle were significantly shorter in olmesartan-treated G?q-TG than in vehicle-treated G?q-TG. CTGF, collagen type 1, ANP, BNP, and ?-MHC gene expression was increased and olmesartan significantly decreased the expression of these genes in G?q-TG mouse ventricles. The expression of canonical transient receptor potential (TRPC) 3 and 6 channel and angiotensin converting enzyme (ACE) proteins but not angiotensin II type 1 (AT1) receptor was increased in G?q-TG ventricles compared with NTG mouse ventricles. Olmesartan significantly decreased TRPC6 and tended to decrease ACE expressions in G?q-TG. Moreover, it increased AT1 receptor in G?q-TG. Conclusions/Significance These findings suggest that angiotensin II type 1 receptor activation plays an important role in the development of heart failure and ventricular arrhythmia in G?q-TG mouse model of heart failure. PMID:25171374

  15. On mechanisms triggering the levees failure along the Foenna stream on 1st January 2006 and which caused the flooding in the urban area of Sinalunga, Tuscany Region (Italy). A case study

    NASA Astrophysics Data System (ADS)

    Camici, Stefania; Moramarco, Tommaso; Brocca, Luca; Melone, Florisa; Lapenna, Vincenzo; Perrone, Angela; Loperte, Antonio

    2010-05-01

    On 1st January 2006, during an ordinary flood event, a levee failure along the Foenna stream caused the flooding in the urban area of Sinalunga, a small town located in Tuscany region (Italy). The event was monitored by a public agency with the responsibility for the control and maintenance of the natural channel networks. Long time before of flooding, people living in the surrounding area of the stream blamed the presence of wild animals and of numerous burrows along the levees. Although the numerous actions of maintenance along the levees mainly for removing the burrows, a levee seepage occurred during that flood. The presence of an outflow located on the downstream face, almost 2 m below the levee top, caused the spurt of brown water denoting the presence of sediment erosion. On the upstream face of levee, a little hole of about 30 cm at the same height of the outflow was discovered. Although the agency workers tried to close the hole by using appropriate blankets, in short time the top of the levee subsided and the overtopping flow caused a trapezoidal breach typical for an earth-fill embankment. The formation of breach was so fast that in a little more of one hour the urban area near to the Foenna stream was flooded causing high economic damages. Mechanisms triggered the levees failure are the object of this work. The analysis of the event has been first addressed to assess the state of-fact of levees conditions along the Foenna stream, thus to understand how much the activity of wild animals, in particular that of porcupine, may have affected the hydraulic safety of the embankment. At the purpose, after the event, topographical surveys of cross sections have been done along with tomographic surveys by geoelectric technique for investigating the possible presence, besides of burrows, also of tunnels dug into the levees by animals. Then, the analysis of hydrometeorological conditions of the event has allowed to better understand the evolution of the flood and if its magnitude was able to affect the hydraulic holding of levees. Finally, the seepage vulnerability of these levees has been also assessed to address their hydraulic safety applying two models based on a steady and unsteady infiltration, respectively. Based on the obtained results, the following findings can be drawn. 1) The levees failure near the Sinalunga urban area is certainly due to the presence of the porcupine burrow at middle height of upstream face of levee that has addressed the flow into the embankment and then triggered the seepage phenomenon. 2) The works of the maintenance finalized to the closure of the burrows carried out before of the flood event were necessary but not sufficient to prevent the failure of levees. 3) To prevent the failure due to burrows presence, the levees maintenance should have been addressed through both the closure of burrows and the capture of wild animals; if this action had been done for the Foenna stream then the probability of failure would have been truly low. This last aspect has been also inferred through geoelectrical tomography surveys that showed the possible presence of at least two tunnels along both faces of levees, so emphasizing as the various closure of burrows made in the past by maintenance agency were totally useless. 4) The seepage vulnerability analysis has shown that levees might be to risk of failure for floods whose durations are consistent with the ones might occur in the Foenna basin. However, for this particular event the levees failure can be only ascribed to wild animals activity, seeing that the seepage was caused by a burrow hole.

  16. Student Handbook Respiratory Therapy Program

    E-print Network

    Student Handbook Respiratory Therapy Program Department of Cardiopulmonary Science School of Allied .......................................................................................................... 2 Respiratory Therapy Program Accreditation .................................................................. 2 Respiratory Therapy Program Goal and Objectives

  17. Liver Failure in Pregnancy.

    PubMed

    Bacak, Stephen J; Thornburg, Loralei L

    2016-01-01

    Acute liver failure is a rare but life-threatening medical emergency in pregnancy whose true incidence remains unknown. Many cases of acute liver failure are caused by pregnancy-related conditions such as acute fatty liver of pregnancy and HELLP syndrome. However, acute deterioration in liver function can also be caused by drug overdose, viral infections, and an exacerbation of underlying chronic liver disease. This article provides an overview of the normal liver changes that occur during pregnancy, and summarizes the most common conditions and general management strategies of liver failure during pregnancy. PMID:26600444

  18. Practical approach to management of respiratory complications in neurological disorders

    PubMed Central

    Mangera, Zaheer; Panesar, Gurkirat; Makker, Himender

    2012-01-01

    Patients with certain neurological diseases are at increased risk of developing chest infections as well as respiratory failure due to muscular weakness. In particular, patients with certain neuromuscular disorders are at higher risk. These conditions are often associated with sleep disordered breathing. It is important to identify patients at risk of respiratory complications early in the course of their disease, although patients with neuromuscular disorders often present in the acute setting with respiratory involvement. This review of the respiratory complications of neurological disorders, with a particular focus on neuromuscular disorders, explores why this happens and looks at how to recognize, investigate, and manage these patients effectively. PMID:22505823

  19. Unrecognized catatonia as a cause for delayed weaning in Intensive Care Unit

    PubMed Central

    Gupta, Rupesh; Saigal, Saurabh; Joshi, Rajnish; Tagore, Praveen; Rai, Nirendra; Prasad, Krishna

    2015-01-01

    The cause of altered sensorium in critical care settings includes metabolic derangements, drug and toxin overdose, central nervous system infections, neurodegenerative disorders, vascular events, hypo-perfusion states, and septic encephalopathy. Here, we present a case of an elderly woman who presented to us with altered sensorium with respiratory failure requiring mechanical ventilation. Her metabolic parameters, imaging, and cerebrospinal fluid study were all normal despite that she continued to remain in altered sensorium and had an unrecognized behavioral state that delayed her weaning.

  20. Change in failure stress on the southern San Andreas fault system caused by the 1992 magnitude = 7.4 Landers earthquake

    USGS Publications Warehouse

    Stein, R.S.; King, G.C.P.; Lin, J.

    1992-01-01

    The 28 June Landers earthquake brought the San Andreas fault significantly closer to failure near San Bernardino, a site that has not sustained a large shock since 1812. Stress also increased on the San Jacinto fault near San Bernardino and on the San Andreas fault southeast of Palm Springs. Unless creep or moderate earthquakes relieve these stress changes, the next great earthquake on the southern San Andreas fault is likely to be advanced by one to two decades. In contrast, stress on the San Andreas north of Los Angeles dropped, potentially delaying the next great earthquake there by 2 to 10 years.

  1. Warning Signs of Heart Failure

    MedlinePLUS

    Warning Signs of Heart Failure Updated:Sep 30,2015 By themselves, any one sign of heart failure may not be cause for alarm. But ... below you agree to the Terms and Conditions Heart Failure Questions to Ask Your Doctor Use these questions ...

  2. Pediatric feline upper respiratory disease.

    PubMed

    Sykes, Jane E

    2014-03-01

    Infectious feline upper respiratory tract disease (URTD) continues to be a widespread and important cause of morbidity and mortality in kittens. Multiple pathogens can contribute to URTD in kittens, and coinfections are common in overcrowded environments and contribute to increased disease severity. Worldwide, the most prevalent pathogens are feline herpesvirus-1 and feline calicivirus. Primary bacterial causes of URTD in cats include Bordetella bronchiseptica, Chlamydia felis, and Mycoplasma species. Streptococcus canis and Streptococcus equi subspecies zooepidemicus occasionally play a role as primary pathogens in shelter situations and catteries. This article reviews the major causes of disease in kittens, and provides an update on treatment and prevention strategies. PMID:24580994

  3. Avian respiratory system disorders

    USGS Publications Warehouse

    Olsen, G.H.

    1989-01-01

    Diagnosing and treating respiratory diseases in avian species requires a basic knowledge about the anatomy and physiology of this system in birds. Differences between mammalian and avian respiratory system function, diagnosis, and treatment are highlighted.

  4. MSFC Respiratory Protection Services

    NASA Technical Reports Server (NTRS)

    CoVan, James P.

    1999-01-01

    An overview of the Marshall Space Flight Center Respiratory Protection program is provided in this poster display. Respiratory protection personnel, building, facilities, equipment, customers, maintenance and operational activities, and Dynatech fit testing details are described and illustrated.

  5. Respiratory Mechanisms of Support

    E-print Network

    Kay, Mark A.

    the respiratory system is working to compensate for a metabolic issue so as to normalize the blood pH. HCO3 - 22Respiratory Mechanisms of Support Nasal Cannula Hi Flow Nasal Cannula CPAP Continuous positive for toxicity Usually 5-20 +ppm ABG Interpretations Respiratory Acidosis:pCO2 pH *impaired ventilation (example

  6. Acute hemolysis and renal failure following discontinuous use of rifampin.

    PubMed

    Levine, M; Collin, K; Kassen, B O

    1991-01-01

    Rifampin is frequently used in the treatment of mycobacterial infections. Intermittent or discontinuous therapy with rifampin has been associated with systemic symptoms referred to as the "flu syndrome" and, less frequently, acute hemolysis and acute renal failure. We report the case of a 73-year-old woman who experienced acute hemolysis and renal failure while being treated with rifampin and ethambutol for a respiratory infection caused by Mycobacterium fortuitum and M. avium-intracellulare. This patient had interrupted her therapy for periods of one week or more due to a rash and flu-like symptoms, which she ascribed to her medications. A review of the literature indicated that these adverse effects of rifampin appear to be immunologically mediated and that the symptoms of the flu syndrome may be due to mild intravascular hemolysis. Intermittent therapy with rifampin should be avoided and noncompliant patients should be given alternative treatment when possible. PMID:1949931

  7. Dynamic obstruction induced by systolic anterior motion of the mitral valve in a volume-depleted left ventricle: an unexpected cause of acute heart failure in a patient with chronic obstructive pulmonary disease

    PubMed Central

    Kim, Suji; Kim, So Jeong; Kim, Jina; Yoon, Phillhoon; Park, Jeongwoong

    2015-01-01

    Systolic anterior motion (SAM) of the mitral valve (MV) and left ventricular outflow tract (LVOT) dynamic obstruction (DO) typically occur in hypertrophic cardiomyopathy; however, they can appear in an apparently normal heart in association with changes in cardiac loading conditions and/or hyperdynamic left ventricular (LV) performance. Meanwhile, chronic obstructive pulmonary disease (COPD) can impair LV filling by elevating pulmonary vascular resistance. The authors report a case of transient acute heart failure caused by LVOT DO resulting from SAM of the MV in a severely volume-depleted LV in a patient with acute COPD exacerbation.

  8. Functional electrical stimulation: restoration of respiratory function.

    PubMed

    Onders, Raymond P

    2012-01-01

    Tetraplegia can lead to chronic respiratory failure. The need for tracheostomy mechanical ventilation significantly increases the cost of care, decreases the quality of life of the patient, and decreases life expectancy in spinal cord injury (SCI) because of pneumonias. Phrenic nerve stimulation was initially developed in the 1960s and diaphragm pacing was developed in the 1990s; both have the ability to remove a patient from positive pressure ventilation and allow them to breathe with their own diaphragm, decreasing posterior lung lobe atelectasis and pneumonia risk. This chapter summarizes the current surgical techniques, ventilator weaning options, and long-term results of functional electrical stimulation in restoring respiratory function. PMID:23098719

  9. Birth and pathogenesis of rogue respiratory viruses.

    PubMed

    Safronetz, David; Feldmann, Heinz; de Wit, Emmie

    2015-01-01

    Emerging infectious diseases of zoonotic origin are shaping today's infectious disease field more than ever. In this article, we introduce and review three emerging zoonotic viruses. Novel hantaviruses emerged in the Americas in the mid-1990s as the cause of severe respiratory infections, designated hantavirus pulmonary syndrome, with case fatality rates of around 40%. Nipah virus emerged a few years later, causing respiratory infections and encephalitis in Southeast Asia, with case fatality rates ranging from 40% to more than 90%. A new coronavirus emerged in 2012 on the Arabian Peninsula with a clinical syndrome of acute respiratory infections, later designated as Middle East respiratory syndrome (MERS), and an initial case fatality rate of more than 40%. Our current state of knowledge on the pathogenicity of these three severe, emerging viral infections is discussed. PMID:25423349

  10. Update on viral diseases of the equine respiratory tract.

    PubMed

    Gilkerson, James R; Bailey, Kirsten E; Diaz-Méndez, Andrés; Hartley, Carol A

    2015-04-01

    Many viral agents have been associated with respiratory disease of the horse. The most important viral causes of respiratory disease in horses are equine influenza and the equine alphaherpesviruses. Agents such as equine viral arteritis virus, African horse sickness virus, and Hendra virus establish systemic infections. Clinical signs of disease resulting from infection with these agents can manifest as respiratory disease, but the respiratory tract is not the major body system affected by these viruses. Treatment of viral respiratory disease is generally limited to supportive therapies, whereas targeted antimicrobial therapy is effective in cases of bacterial infection. PMID:25648568

  11. Glycopyrrolate-induced respiratory arrest: an unusual side effect.

    PubMed

    D'souza, S; Gowler, V

    2015-03-01

    A descriptive case report of a 22-year-old woman, scheduled for elective laparotomy who had a respiratory arrest after premedication with inj glycopyrrolate and ondansetron. Respiratory arrest is an uncommon side effect of glycopyrrolate with very few published reports. Ondansteron can also cause respiratory arrest, however is most often associated with bradycardia. This patient had tachycardia and respiratory arrest and is suggestive of glycopyrrolate-induced respiratory arrest. This case report highlights the importance of strict vigilance by the anaesthesiologist even during premedication. PMID:25557856

  12. What Causes Pericarditis?

    MedlinePLUS

    ... cases, the cause of pericarditis (both acute and chronic) is unknown. Viral infections are likely a common cause of pericarditis, although the virus may never be found. Pericarditis often occurs after a respiratory ... cases of chronic, or recurring, pericarditis are thought to be the ...

  13. Graphical Displays Assist In Analysis Of Failures

    NASA Technical Reports Server (NTRS)

    Pack, Ginger; Wadsworth, David; Razavipour, Reza

    1995-01-01

    Failure Environment Analysis Tool (FEAT) computer program enables people to see and better understand effects of failures in system. Uses digraph models to determine what will happen to system if set of failure events occurs and to identify possible causes of selected set of failures. Digraphs or engineering schematics used. Also used in operations to help identify causes of failures after they occur. Written in C language.

  14. Mechanical Properties of Respiratory Muscles

    PubMed Central

    Sieck, Gary C.; Ferreira, Leonardo F.; Reid, Michael B.; Mantilla, Carlos B.

    2014-01-01

    Striated respiratory muscles are necessary for lung ventilation and to maintain the patency of the upper airway. The basic structural and functional properties of respiratory muscles are similar to those of other striated muscles (both skeletal and cardiac). The sarcomere is the fundamental organizational unit of striated muscles and sarcomeric proteins underlie the passive and active mechanical properties of muscle fibers. In this respect, the functional categorization of different fiber types provides a conceptual framework to understand the physiological properties of respiratory muscles. Within the sarcomere, the interaction between the thick and thin filaments at the level of cross-bridges provides the elementary unit of force generation and contraction. Key to an understanding of the unique functional differences across muscle fiber types are differences in cross-bridge recruitment and cycling that relate to the expression of different myosin heavy chain isoforms in the thick filament. The active mechanical properties of muscle fibers are characterized by the relationship between myoplasmic Ca2+ and cross-bridge recruitment, force generation and sarcomere length (also cross-bridge recruitment), external load and shortening velocity (cross-bridge cycling rate), and cross-bridge cycling rate and ATP consumption. Passive mechanical properties are also important reflecting viscoelastic elements within sarcomeres as well as the extracellular matrix. Conditions that affect respiratory muscle performance may have a range of underlying pathophysiological causes, but their manifestations will depend on their impact on these basic elemental structures. PMID:24265238

  15. Preliminary results: Root cause investigation of orbital anomalies and failures in NASA standard 50 ampere-hour nickel-cadmium batteries

    NASA Technical Reports Server (NTRS)

    Toft, Mark R.

    1993-01-01

    Two lots of NASA standard 50 A.H. Ni-Cd battery cells, manufactured by Gates Aerospace Batteries and built into batteries by McDonnell Douglas, have experienced significant performance problems. The two lots were used on the Compton Gamma Ray Observatory and the Upper Atmosphere Research Satellite. Both of these satellites are Low Earth Orbital (LEO) satellites containing batteries on a parallel bus charged to NASA standard V/T curves using a NASA standard power regulator. The following preliminary conclusions were reached: (1) several plate and cell parameters have migrated within their spec limits over the years (in some cases, from one extreme to the other); (2) several parametric relationships, not generally monitored and therefore not under specification control, have also migrated over the years; (3) many of these changes appear to have taken place as a natural consequence of changes in GE/GAB materials and processes; (4) several of these factors may be 'conspiring' to aggravate known cell failure mechanisms (factors such as heavier plate, less teflon and/or less-uniform teflon, and less electrolyte) but all are still in spec (where specs exist); (5) the weight of the evidence collected to characterize the anomalies and to characterize the negative electrode itself, strongly suggests that alterations to the structure, composition, uniformity, and efficiency of the negative electrode are at the heart of the battery performance problems currently being experienced; and (6) further investigation at all levels (plate, cell, battery, and system) continues to be warranted.

  16. Incipient failure detection.

    NASA Technical Reports Server (NTRS)

    Griswold, J. W.

    1971-01-01

    In connection with the preparation for long-range space missions it is highly important to be able to identify potentially failure prone equipment in advance of the launch commitment. Physical phenomena investigated for this purpose include X-ray and gamma radiation, electrical noise, IR and UV radiation, and vibration energy. The technique selected must be capable of detecting the onset and evaluating the progression of conditions that represent basic causes which could lead to failure. As a result of the investigation, techniques based on acoustic energy release were selected as the most promising for incipient failure detection.

  17. Subcutaneous Emphysema in Acute Asthma: A Cause for Concern?

    PubMed

    Mitchell, Patrick D; King, Thomas J; O'Shea, Donal B

    2015-08-01

    Pneumomediastinum has been described in patients with asthma. In this case report, we describe a young patient who presented to our medical assessment unit with an asthma exacerbation and progressive dyspnea. The patient developed pneumomediastinum, a rare complication of an asthma exacerbation. Pneumomediastinum is usually characterized by chest pain, dyspnea, and neck swelling caused by subcutaneous emphysema. Although the condition is usually benign and treatment is primarily supportive, surgical intervention may be needed if the patient develops hemodynamic compromise or respiratory failure through mechanisms similar to those seen in a tension pneumothorax. PMID:25605959

  18. Case study: Asphyxia caused by inspissated oral and nasopharyngeal secretions.

    PubMed

    Prahlow, Joseph A; Prahlow, Tamara J; Rakow, Rex J; Prahlow, Nathan D

    2009-06-01

    An institutionalized man with severe mental disability and cerebral palsy, admitted from the ED with suspected aspiration pneumonia, died after a long struggle with respiratory difficulties. The cause of death was determined to be asphyxia resulting from a complete obstruction of the posterior pharynx and upper larynx by thickened oral and nasopharyngeal secretions. Although airway obstruction is common in people with motor or neurologic disorders and in those who are chronically debilitated or institutionalized, food and foreign matter are not the only culprits. This case serves to remind clinicians that a failure to provide good oral care and adequate hydration is not only poor practice but can result in death. PMID:19478604

  19. Airway Reflux, Cough and Respiratory Disease

    PubMed Central

    Molyneux, Ian D.; Morice, Alyn H.

    2011-01-01

    It is increasingly accepted that the effects of gastro-oesophageal reflux are not limited to the gastrointestinal tract. The adjacent respiratory structures are also at risk from material ejected from the proximal oesophagus as a result of the failure of anatomical and physiological barriers. There is evidence of the influence of reflux on several respiratory and otorhinological conditions and although in many cases the precise mechanism has yet to be elucidated, the association alone opens potential novel avenues of therapy to clinicians struggling to treat patients with apparently intractable respiratory complaints. This review provides a description of the airway reflux syndrome, its effects on the lung and current and future therapeutic options. PMID:23251752

  20. Ampoule Failure System

    NASA Technical Reports Server (NTRS)

    Watring, Dale A. (Inventor); Johnson, Martin L. (Inventor)

    1996-01-01

    An ampoule failure system for use in material processing furnaces comprising a containment cartridge and an ampoule failure sensor. The containment cartridge contains an ampoule of toxic material therein and is positioned within a furnace for processing. An ampoule failure probe is positioned in the containment cartridge adjacent the ampoule for detecting a potential harmful release of toxic material therefrom during processing. The failure probe is spaced a predetermined distance from the ampoule and is chemically chosen so as to undergo a timely chemical reaction with the toxic material upon the harmful release thereof. The ampoule failure system further comprises a data acquisition system which is positioned externally of the furnace and is electrically connected to the ampoule failure probe so as to form a communicating electrical circuit. The data acquisition system includes an automatic shutdown device for shutting down the furnace upon the harmful release of toxic material. It also includes a resistance measuring device for measuring the resistance of the failure probe during processing. The chemical reaction causes a step increase in resistance of the failure probe whereupon the automatic shutdown device will responsively shut down the furnace.

  1. Development of animal models for the acute respiratory distress syndrome

    PubMed Central

    Bastarache, Julie A.; Blackwell, Timothy S.

    2009-01-01

    Injury to the lung parenchyma results in the acute respiratory distress syndrome (ARDS), which is a common and life-threatening cause of respiratory failure and mortality that develops after a variety of insults, including sepsis, multiple trauma, pneumonia, aspiration of gastric contents and severe burns. The pathogenesis of ARDS is complex with loss of the alveolar-capillary barrier and flooding of the airspaces with protein-rich fluid; injury to the alveolar epithelium; an influx of neutrophils and macrophages; and fibrin deposition as a result of activation of coagulation and inhibition of fibrinolysis. These changes develop over hours to a few days after the initiating event and often take days or weeks to resolve. Despite decades of research, there is only one therapy (low tidal volume ventilation) that has been shown to reduce mortality in ARDS. Further research into the pathogenesis of this devastating condition is crucial for the development of novel and specific therapies that target specific disease mechanisms. Unfortunately, no single animal model of ARDS replicates the complex pathophysiological changes seen in patients. This is a severe limitation in the study of ARDS and has impaired scientific and therapeutic progress in this field. Here, we discuss the primary features of this syndrome, highlight limitations of current animal models and suggest new approaches to investigate key components of pathogenesis. Hopefully, as new technologies and approaches emerge, barriers to scientific progress in ARDS will be overcome. PMID:19407329

  2. Respiratory tract infections in the military environment.

    PubMed

    Korzeniewski, Krzysztof; Nitsch-Osuch, Aneta; Konior, Monika; Lass, Anna

    2015-04-01

    Military personnel fighting in contemporary battlefields as well as those participating in combat training are at risk of contracting respiratory infections. Epidemiological studies have demonstrated that soldiers deployed to the harsh environment have higher rates of newly reported respiratory symptoms than non-deployers. Acute respiratory diseases are the principle reason for outpatient treatment and hospitalization among military personnel, with an incidence exceeding that of the adult civilian population by up to three-fold. Adenoviruses, influenza A and B viruses, Streptococcus pneumoniae, Streptococcus pyogenes, coronaviruses and rhinoviruses have been identified as the main causes of acute respiratory infections among the military population. Although infective pathogens have been extensively studied, a significant proportion of illnesses (over 40%) have been due to unknown causative agents. Other health hazards, which can lead to respiratory illnesses among troops, are extreme air temperatures, desert dust, emissions from burn pits, industrial pollutants, and airborne contaminants originating from degraded soil. Limited diagnostic capabilities, especially inside the area of operations, make it difficult to accurately estimate the exact number of respiratory diseases in the military environment. The aim of the study was to discuss the occurrence of respiratory tract infections in army personnel, existing risk factors and preventive measures. PMID:25278277

  3. Role of seasonal influenza in the aetiology of hospitalised acute lower respiratory infections in young children 

    E-print Network

    Nair, Harish

    2013-07-06

    Background Respiratory viruses are a leading cause of acute lower respiratory infections (ALRI) in young children. The role of seasonal influenza virus in childhood ALRI is generally underappreciated. This is because ...

  4. Respiratory syncytial virus vaccine development

    PubMed Central

    Hurwitz, Julia L

    2011-01-01

    Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract viral disease in infants and young children. Presently, there are no explicit recommendations for RSV treatment apart from supportive care. The virus is therefore responsible for an estimated 160,000 deaths per year worldwide. Despite half a century of dedicated research, there remains no licensed vaccine product. Herein are described past and current efforts to harness innate and adaptive immune potentials to combat RSV. A plethora of candidate vaccine products and strategies are reviewed. The development of a successful RSV vaccine may ultimately stem from attention to historical lessons, in concert with an integral partnering of immunology and virology research fields. PMID:21988307

  5. The human respiratory gate

    PubMed Central

    Eckberg, Dwain L

    2003-01-01

    Respiratory activity phasically alters membrane potentials of preganglionic vagal and sympathetic motoneurones and continuously modulates their responsiveness to stimulatory inputs. The most obvious manifestation of this ‘respiratory gating’ is respiratory sinus arrhythmia, the rhythmic fluctuations of electrocardiographic R–R intervals observed in healthy resting humans. Phasic autonomic motoneurone firing, reflecting the throughput of the system, depends importantly on the intensity of stimulatory inputs, such that when levels of stimulation are low (as with high arterial pressure and sympathetic activity, or low arterial pressure and vagal activity), respiratory fluctuations of sympathetic or vagal firing are also low. The respiratory gate has a finite capacity, and high levels of stimulation override the ability of respiration to gate autonomic responsiveness. Autonomic throughput also depends importantly on other factors, including especially, the frequency of breathing, the rate at which the gate opens and closes. Respiratory sinus arrhythmia is small at rapid, and large at slow breathing rates. The strong correlation between systolic pressure and R–R intervals at respiratory frequencies reflects the influence of respiration on these two measures, rather than arterial baroreflex physiology. A wide range of evidence suggests that respiratory activity gates the timing of autonomic motoneurone firing, but does not influence its tonic level. I propose that the most enduring significance of respiratory gating is its use as a precisely controlled experimental tool to tease out and better understand otherwise inaccessible human autonomic neurophysiological mechanisms. PMID:12626671

  6. The human respiratory gate

    NASA Technical Reports Server (NTRS)

    Eckberg, Dwain L.

    2003-01-01

    Respiratory activity phasically alters membrane potentials of preganglionic vagal and sympathetic motoneurones and continuously modulates their responsiveness to stimulatory inputs. The most obvious manifestation of this 'respiratory gating' is respiratory sinus arrhythmia, the rhythmic fluctuations of electrocardiographic R-R intervals observed in healthy resting humans. Phasic autonomic motoneurone firing, reflecting the throughput of the system, depends importantly on the intensity of stimulatory inputs, such that when levels of stimulation are low (as with high arterial pressure and sympathetic activity, or low arterial pressure and vagal activity), respiratory fluctuations of sympathetic or vagal firing are also low. The respiratory gate has a finite capacity, and high levels of stimulation override the ability of respiration to gate autonomic responsiveness. Autonomic throughput also depends importantly on other factors, including especially, the frequency of breathing, the rate at which the gate opens and closes. Respiratory sinus arrhythmia is small at rapid, and large at slow breathing rates. The strong correlation between systolic pressure and R-R intervals at respiratory frequencies reflects the influence of respiration on these two measures, rather than arterial baroreflex physiology. A wide range of evidence suggests that respiratory activity gates the timing of autonomic motoneurone firing, but does not influence its tonic level. I propose that the most enduring significance of respiratory gating is its use as a precisely controlled experimental tool to tease out and better understand otherwise inaccessible human autonomic neurophysiological mechanisms.

  7. [Microbiological diagnosis of viral respiratory infections].

    PubMed

    Eiros, José M; Ortiz de Lejarazu, Raúl; Tenorio, Alberto; Casas, Inmaculada; Pozo, Francisco; Ruiz, Guillermo; Pérez-Breña, Pilar

    2009-03-01

    Acute respiratory infection is the most common disease occurring over a person's lifetime, with etiological variations determined mainly by age, environmental circumstances, the healthcare setting, and the underlying pathology. More than 200 different viruses distributed in six viral families have been implicated in the pathogenesis of respiratory tract infection. These facts are generating an increasing diagnostic demand that should be incorporated into the healthcare setting without delay. To meet this demand, the Spanish Society of Infectious Diseases and Clinical Microbiology has updated its Standard Procedure for the microbiological diagnosis of viral respiratory infection. This document contains an update primarily of infections caused by influenza viruses, and secondarily, infections due to other conventional and emerging respiratory viruses. In all cases, the methods for direct virological diagnosis (cell culture, and detection of antigens and nucleic acid) are reviewed, with special reference to techniques for molecular detection and genetic characterization. PMID:19306718

  8. Occupational respiratory diseases in the South African mining industry

    PubMed Central

    Nelson, Gill

    2013-01-01

    Background Crystalline silica and asbestos are common minerals that occur throughout South Africa, exposure to either causes respiratory disease. Most studies on silicosis in South Africa have been cross-sectional and long-term trends have not been reported. Although much research has been conducted on the health effects of silica dust and asbestos fibre in the gold-mining and asbestos-mining sectors, little is known about their health effects in other mining sectors. Objective The aims of this thesis were to describe silicosis trends in gold miners over three decades, and to explore the potential for diamond mine workers to develop asbestos-related diseases and platinum mine workers to develop silicosis. Methods Mine workers for the three sub-studies were identified from a mine worker autopsy database at the National Institute for Occupational Health. Results From 1975 to 2007, the proportions of white and black gold mine workers with silicosis increased from 18 to 22% and from 3 to 32% respectively. Cases of diamond and platinum mine workers with asbestos-related diseases and silicosis, respectively, were also identified. Conclusion The trends in silicosis in gold miners at autopsy clearly demonstrate the failure of the gold mines to adequately control dust and prevent occupational respiratory disease. The two case series of diamond and platinum mine workers contribute to the evidence for the risk of asbestos-related diseases in diamond mine workers and silicosis in platinum mine workers, respectively. The absence of reliable environmental dust measurements and incomplete work history records impedes occupational health research in South Africa because it is difficult to identify and/or validate sources of dust exposure that may be associated with occupational respiratory disease. PMID:23364097

  9. RESPIRATORY CARE BACHELOR'S DEGREE PROGRAM

    E-print Network

    Nicholson, Bruce J.

    Therapists (CRT), which is the entry-level to practice respiratory therapy, and the Registry Examination for Advanced Respiratory Therapists (RRT), required for advanced-level respiratory therapy practice givenRESPIRATORY CARE BACHELOR'S DEGREE PROGRAM Respiratory therapists evaluate and treat all types

  10. Respiratory distress during endoscopy--report of an unusual case.

    PubMed

    Narendranathan, M; Kalam, A

    1987-09-01

    A 30 year old man developed severe respiratory distress during upper gastrointestinal endoscopy. He had a short oesophagus and part of the stomach was intrathoracic. Air-insufflation during endoscopy caused distension of the stomach inside the chest leading to respiratory distress. When part of the stomach is intrathoracic, the endoscopist should be cautious and the possibility of respiratory embarrassment kept in mind during air-insufflation. PMID:3444807

  11. Consensus document for the prevention of respiratory infections in adults.

    PubMed

    Froes, F; Diniz, A; Robalo Cordeiro, C; Serrado, M; Ramalho de Almeida, A

    2014-01-01

    Infectious diseases are one of the principle causes of morbidity, mortality and drain on health resources worldwide. In recent years there has been an increase in the impact of respiratory infections, particularly in the Portuguese population. It is for this reason that the Portuguese Respiratory Society has presented a series of recommendations for the prevention of respiratory infections in adults. These recommendations include both general measures and vaccinations for flu and pneumococcal pneumonia. PMID:24613252

  12. Postperfusion lung syndrome: Respiratory mechanics, respiratory indices and biomarkers

    PubMed Central

    Yuan, Shi-Min

    2015-01-01

    Postperfusion lung syndrome is rare but lethal. Secondary inflammatory response was the popularly accepted theory for the underlying etiology. Respiratory index (RI) and arterial oxygen tension/fractional inspired oxygen can be reliable indices for the diagnosis of this syndrome as X-ray appearance is always insignificant at the early stage of the onset. Evaluations of extravascular lung water content and pulmonary compliance are also helpful in the definite diagnosis. Multiorgan failure and triple acid-base disturbances that might develop secondary to postperfusion lung syndrome are responsible for the poor prognosis and increased mortality rather than postperfusion lung syndrome itself. Mechanical ventilation with low tidal volume (TV) and proper positive end-expiratory pressure can be an effective treatment strategy. Use of ulinastatin and propofol may benefit the patients through different mechanisms. PMID:26229556

  13. Primary defect of congenital dyserythropoietic anemia type II. Failure in glycosylation of erythrocyte lactosaminoglycan proteins caused by lowered N-acetylglucosaminyltransferase II.

    PubMed

    Fukuda, M N; Dell, A; Scartezzini, P

    1987-05-25

    Congenital dyserythropoietic anemia type II or hereditary erythroblastic multinuclearity with positive acidified serum test (HEMPAS) is a genetic disease caused by membrane abnormality. Previously we have found that Band 3 and Band 4.5 are not glycosylated by lactosaminoglycans in HEMPAS erythrocytes, whereas normally these proteins have lactosaminoglycans (Fukuda, M. N., Papayannopoulou, T., Gordon-Smith, E. C., Rochant, H., and Testa, U. (1984) Br. J. Haematol. 56, 55-68). In order to find out where glycosylation of lactosaminoglycans stops, we have analyzed the carbohydrate structures of HEMPAS Band 3. By fast atom bombardment-mass spectrometry, methylation analysis, and hydrazinolysis followed by exoglycosidase treatments, the following structure was elucidated: (formula; see text) N-Linked glycopeptides synthesized in vitro by reticulocyte microsomes from HEMPAS were shown to be predominantly the above short oligosaccharide, whereas those from normal reticulocytes contain large molecular weight carbohydrates. The N-acetylglucosaminyltransferase II, which transfers N-acetylglucosamine to the C-2 position of the Man alpha 1----6Man beta 1----arm of the biantennary core structure, was therefore examined by using Man alpha 1----6(GlcNAc beta 1----2Man alpha 1----3)Man beta 1----4GlcNAc beta 1----4GlcNAcol as an acceptor. N-Acetylglucosaminyltransferase II activity was demonstrated in the lymphocyte microsome fraction from normal individuals. However, this enzyme activity was found to be decreased in those from HEMPAS patients. These results suggest that the primary defect of HEMPAS lies in the lowered activity of N-acetylglucosaminyltransferase II. PMID:2953718

  14. Respiratory Care Therapist.

    ERIC Educational Resources Information Center

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This document, which is designed for use in developing a tech prep competency profile for the occupation of respiratory care therapist, lists technical competencies and competency builders for 18 units pertinent to the health technologies cluster in general as well as those specific to the occupation of respiratory care therapist. The following…

  15. Lungs and Respiratory System

    MedlinePLUS

    ... Self Smart Snacking Losing Weight Safely Lungs and Respiratory System KidsHealth > Teens > Body > Body Basics Library > Lungs and ... didn't breathe, you couldn't live. Lungs & Respiratory System Basics Each day we breathe about 20,000 ...

  16. Middle East Respiratory Syndrome (MERS)

    MedlinePLUS

    ... Search The CDC Cancel Submit Search The CDC Middle East Respiratory Syndrome (MERS) Note: Javascript is disabled or ... CDC.gov . Recommend on Facebook Tweet Share Compartir Middle East Respiratory Syndrome (MERS) is a viral respiratory illness ...

  17. Extracorporeal life support for acute respiratory distress syndromes

    PubMed Central

    Hayes, Don; Tobias, Joseph D.; Kukreja, Jasleen; Preston, Thomas J.; Yates, Andrew R.; Kirkby, Stephen; Whitson, Bryan A.

    2013-01-01

    The morbidity and mortality of acute respiratory distress syndrome remain to be high. Over the last 50 years, the clinical management of these patients has undergone vast changes. Significant improvement in the care of these patients involves the development of mechanical ventilation strategies, but the benefits of these strategies remain controversial. With a growing trend of extracorporeal support for critically ill patients, we provide a historical review of extracorporeal membrane oxygenation (ECMO) including its failures and successes as well as discussing extracorporeal devices now available or nearly accessible while examining current clinical indications and trends of ECMO in respiratory failure. PMID:23922607

  18. Respiratory analysis system and method

    NASA Technical Reports Server (NTRS)

    Liu, F. F. (inventor)

    1973-01-01

    A system is described for monitoring the respiratory process in which the gas flow rate and the frequency of respiration and expiration cycles can be determined on a real time basis. A face mask is provided with one-way inlet and outlet valves where the gas flow is through independent flowmeters and through a mass spectrometer. The opening and closing of a valve operates an electrical switch, and the combination of the two switches produces a low frequency electrical signal of the respiratory inhalation and exhalation cycles. During the time a switch is operated, the corresponsing flowmeter produces electric pulses representative of the flow rate; the electrical pulses being at a higher frequency than that of the breathing cycle and combined with the low frequency signal. The high frequency pulses are supplied to conventional analyzer computer which also receives temperature and pressure inputs and computes mass flow rate and totalized mass flow of gas. From the mass spectrometer, components of the gas are separately computed as to flow rate. The electrical switches cause operation of up-down inputs of a reversible counter. The respective up and down cycles can be individually monitored and combined for various respiratory measurements.

  19. Severe Respiratory Distress in a Child with Pulmonary Idiopathic Hemosiderosis Initially Presenting with Iron-Deficiency Anemia

    PubMed Central

    Potalivo, A.; Finessi, L.; Facondini, F.; Lupo, A.; Andreoni, C.; Giuliani, G.; Cavicchi, C.

    2015-01-01

    Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of alveolar hemorrhage in children but should be considered in children with anemia of unknown origin who develop respiratory complications. It is commonly characterized by the triad of recurrent hemoptysis, diffuse parenchymal infiltrates, and iron-deficiency anemia. Pathogenesis is unclear and diagnosis may be difficult along with a variable clinical course. A 6-year-old boy was admitted to the hospital with a severe iron-deficiency anemia, but he later developed severe acute respiratory failure and hemoptysis requiring intubation and mechanical ventilation. The suspicion of IPH led to the use of immunosuppressive therapy with high dose of corticosteroids with rapid improvement in clinical condition and discharge from hospital. PMID:26634166

  20. Upper Respiratory Infections Approved by the UHS Patient Education Committee

    E-print Network

    Maroncelli, Mark

    Upper Respiratory Infections Approved by the UHS Patient Education Committee: Reviewed 10/09/13 Page 1 of 2 Types of Upper Respiratory Infections The common cold syndrome is caused by one of many is killed by your immune system. Antibiotics are not effective in treating the common cold. Cold symptoms

  1. Heart Failure in South America

    PubMed Central

    Bocchi, Edimar Alcides

    2013-01-01

    Continued assessment of temporal trends in mortality and epidemiology of specific heart failure in South America is needed to provide a scientific basis for rational allocation of the limited health care resources, and strategies to reduce risk and predict the future burden of heart failure. The epidemiology of heart failure in South America was reviewed. Heart failure is the main cause of hospitalization based on available data from approximately 50% of the South American population. The main etiologies of heart failure are ischemic, idiopathic dilated cardiomyopathy, valvular, hypertensive and chagasic etiologies. In endemic areas, Chagas heart disease may be responsible by 41% of the HF cases. Also, heart failure presents high mortality especially in patients with Chagas etiology. Heart failure and etiologies associated with heart failure may be responsible for 6.3% of causes of deaths. Rheumatic fever is the leading cause of valvular heart disease. However, a tendency to reduction of HF mortality due to Chagas heart disease from 1985 to 2006, and reduction in mortality due to HF from 1999 to 2005 were observed in selected states in Brazil. The findings have important public health implications because the allocation of health care resources, and strategies to reduce risk of heart failure should also consider the control of neglected Chagas disease and rheumatic fever in South American countries. PMID:23597301

  2. Heart failure - fluids and diuretics

    MedlinePLUS

    When you have heart failure, your heart does not pump out enough blood. This causes fluids to build up in your body. If you ... the amount of fluids you drink: When your heart failure is not very bad, you may not have ...

  3. Heart Failure

    MedlinePLUS

    ... this? Submit What's this? Submit Button Related CDC Web Sites Heart Disease Stroke High Blood Pressure Salt ... to Prevent and Control Chronic Diseases Million Hearts® Web Sites with More Information About Heart Failure For ...

  4. Kidney Failure

    MedlinePLUS

    ... Dialysis or Transplant Paying for Kidney Failure Treatment Contact Us Health Information Center Phone: 1-800-860- ... to share this content freely. October 2, 2013 Contact Us Health Information Center Phone: 1-800-860- ...

  5. Detection, pathogenesis, and therapy of respiratory syncytial virus infections.

    PubMed Central

    Welliver, R C

    1988-01-01

    Respiratory syncytial virus (RSV) infection is a major cause of serious lower respiratory disease in infancy and early childhood. The unique pathogenesis of lower respiratory illness due to RSV offers some intriguing clues to the role of the human immune system in both protection against and development of respiratory illness. More than any other virus, rapid diagnostic techniques have been especially successful in identifying RSV infection. Many of these techniques could be easily adaptable to diagnosis of influenza virus infection and other agents. Finally, ribavirin therapy of RSV infection represents one of the few instances in which antiviral therapy has been shown to be effective for respiratory illnesses. Fundamental observations in these areas in the case of RSV infection open up new and exciting pathways for investigation of respiratory infection due to other viral, chlamydial, and mycoplasmal agents. PMID:3060243

  6. Common mechanisms of compensatory respiratory plasticity in spinal neurological disorders

    PubMed Central

    Johnson, Rebecca A.; Mitchell, Gordon S.

    2013-01-01

    In many neurological disorders that disrupt spinal function and compromise breathing (e.g. ALS, cervical spinal injury, MS), patients often maintain ventilatory capacity well after the onset of severe CNS pathology. In progressive neurodegenerative diseases, patients ultimately reach a point where compensation is no longer possible, leading to catastrophic ventilatory failure. In this brief review, we consider evidence that common mechanisms of compensatory respiratory plasticity preserve breathing capacity in diverse clinical disorders, despite the onset of severe pathology (e.g. respiratory motor neuron denervation and/or death). We propose that a suite of mechanisms, operating at distinct sites in the respiratory control system, underlies compensatory respiratory plasticity, including: 1) increased (descending) central respiratory drive, 2) motor neuron plasticity, 3) plasticity at the neuromuscular junction or spared respiratory motor neurons, and 4) shifts in the balance from more to less severely compromised respiratory muscles. To establish this framework, we contrast three rodent models of neural dysfunction, each posing unique problems for the generation of adequate inspiratory motor output: 1) respiratory motor neuron death, 2) de- or dysmyelination of cervical spinal pathways, and 3) cervical spinal cord injury, a neuropathology with components of demyelination and motor neuron death. Through this contrast, we hope to understand the multilayered strategies used to “fight” for adequate breathing in the face of mounting pathology. PMID:23727226

  7. Rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating heart failure from pulmonary disease as the cause of acute dyspnea in the emergency setting

    PubMed Central

    2012-01-01

    Background Rapid and accurate diagnosis and management can be lifesaving for patients with acute dyspnea. However, making a differential diagnosis and selecting early treatment for patients with acute dyspnea in the emergency setting is a clinical challenge that requires complex decision-making in order to achieve hemodynamic balance, improve functional capacity, and decrease mortality. In the present study, we examined the screening potential of rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating acute heart failure syndromes (AHFS) from primary pulmonary disease in patients with acute dyspnea in the emergency setting. Methods Between March 2011 and March 2012, 90 consecutive patients (45 women, 78.1?±?9.9?years) admitted to the emergency room of our hospital for acute dyspnea were enrolled. Within 30?minutes of admission, all patients underwent conventional physical examination, rapid ultrasound (lung-cardiac-inferior vena cava [LCI] integrated ultrasound) examination with a hand-held device, routine laboratory tests, measurement of brain natriuretic peptide, and chest X-ray in the emergency room. Results The final diagnosis was acute dyspnea due to AHFS in 53 patients, acute dyspnea due to pulmonary disease despite a history of heart failure in 18 patients, and acute dyspnea due to pulmonary disease in 19 patients. Lung ultrasound alone showed a sensitivity, specificity, negative predictive value, and positive predictive value of 96.2, 54.0, 90.9, and 75.0%, respectively, for differentiating AHFS from pulmonary disease. On the other hand, LCI integrated ultrasound had a sensitivity, specificity, negative predictive value, and positive predictive value of 94.3, 91.9, 91.9, and 94.3%, respectively. Conclusions Our study demonstrated that rapid evaluation by LCI integrated ultrasound is extremely accurate for differentiating acute dyspnea due to AHFS from that caused by primary pulmonary disease in the emergency setting. PMID:23210515

  8. Planning Ahead: Advanced Heart Failure

    MedlinePLUS

    ... aspects of the dying process. In advanced heart failure, care options at the end of life include: Turning off an implantable cardioverter defibrillator : Electrical shocks from an ICD can cause unnecessary suffering for patients and families near the ...

  9. Respiratory Strategies and Airway Management in Patients with Pulmonary Alveolar Proteinosis: A Review

    PubMed Central

    Vymazal, Tomas; Krecmerova, Martina

    2015-01-01

    Background. Pulmonary alveolar proteinosis is a rare disorder characterized by a large accumulation of lipoproteinaceous material within the alveoli. This causes respiratory failure due to a restriction of gas exchange and changes in the ventilation/perfusion ratio. Treatment methods include noninvasive pharmacological approaches and invasive procedures, such as whole-lung lavage under general anesthesia. Methods. Based on the literature search using free-term key words, we have analyzed published articles concerning the perioperative management of adult and pediatric patients with pulmonary alveolar proteinosis. Results and Discussion. In total, 184 publications were analyzed. Only a few manuscripts were related to anesthetic, respiratory, and airway management in patients suffering from pulmonary alveolar proteinosis. Airway should be strictly separated using a double-lumen tube. Respiratory strategies involve the use of manual clapping, continuous positive airway pressure, high-frequency jet ventilation of the affected lung, and employment of venovenous extracorporeal membrane oxygenation in the most serious of cases. Conclusion. The goal of this review is to summarize the current published information about an anesthetic management strategy with a focus on airway management, ventilation, and oxygenation techniques in PAP patients. PMID:26495308

  10. Non-invasive Measurements of Energy Expenditure and Respiratory Quotient by Respiratory Mass Spectrometry in Children on Extracorporeal Membrane Oxygenation-A Pilot Study.

    PubMed

    Li, Xiaohui; Yu, Xiaoyang; Cheypesh, Andriy; Li, Jia

    2015-09-01

    Extracorporeal membrane oxygenation (ECMO) provides temporary life-saving support for pediatric patients with severe cardiac failure, but causes metabolic disturbances and altered nutritional requirements. However, few studies have addressed the optimal energy supply to meet the demand of these children, largely due to technical difficulties with their invasive nature. We have adapted respiratory mass spectrometry to continuously measure O2 consumption and CO2 production in the gas exchange across the ECMO oxygenator, as well as that across the ventilator. This study aimed to assess energy expenditure (EE) and respiratory quotient (RQ) in children on ECMO. Five children (aged 0.3 to 36 months, median 20) were studied between Day 1 and Day 6 on ECMO. EE and RQ were measured in sequential fashion at the child's native lungs and ECMO oxygenator using respiratory mass spectrometry. Measurements were collected at 4-h intervals, with the means in 24?h representing the values of each day. Each child's caloric and protein intakes were recorded for each day. Between ECMO Days 1 and 6, there was a small but significant increase in EE from 40 to 46?kcal/kg/day (P?=?0.03). In comparison, the caloric intake significantly increased by twice as much as EE from 30 to 61?kcal/kg/day (P?=?0.017). As a result, RQ significantly increased from 0.6 to 1.0 (P?Respiratory mass spectrometry is feasible to provide a unique and safe technique to measure EE and RQ in patients on ECMO. Without this knowledge, inadequate feeding may occur. Further studies are warranted in a larger patient population to provide better information to guide clinical practice in this special group of critically ill children. PMID:25940695

  11. Lungs and Respiratory System

    MedlinePLUS

    ... mucus is produced. The person develops a bad cough to get rid of the mucus. Cigarette smoking ... respiratory infection. Symptoms may include a mild fever, cough, headache, runny nose, sneezing, and sore throat. Cough . ...

  12. Mechanisms of Heart Failure in Obesity

    PubMed Central

    Ebong, Imo A.; Goff, David C.; Rodriguez, Carlos J.; Chen, Haiying; Bertoni, Alain G.

    2014-01-01

    Heart failure is a leading cause of morbidity and mortality and its prevalence continues to rise. Because obesity has been linked with heart failure, the increasing prevalence of obesity may presage further rise in heart failure in the future. Obesity-related factors are estimated to cause 11% of heart failure cases in men and 14% in women. Obesity may result in heart failure by inducing hemodynamic and myocardial changes that lead to cardiac dysfunction, or due to an increased predisposition to other heart failure risk factors. Direct cardiac lipotoxicity has been described where lipid accumulation in the heart results in cardiac dysfunction inexplicable of other heart failure risk factors. In this overview, we discussed various pathophysiological mechanisms that could lead to heart failure in obesity, including the molecular mechanisms underlying cardiac lipotoxicity. We defined the obesity paradox and enumerated various premises for the paradoxical associations observed in the relationship between obesity and heart failure. PMID:25434909

  13. Failures in Phase III: Causes and Consequences.

    PubMed

    Seruga, Bostjan; Ocana, Alberto; Amir, Eitan; Tannock, Ian F

    2015-10-15

    Phase III randomized controlled trials (RCT) in oncology fail to lead to registration of new therapies more often than RCTs in other medical disciplines. Most RCTs are sponsored by the pharmaceutical industry, which reflects industry's increasing responsibility in cancer drug development. Many preclinical models are unreliable for evaluation of new anticancer agents, and stronger evidence of biologic effect should be required before a new agent enters the clinical development pathway. Whenever possible, early-phase clinical trials should include pharmacodynamic studies to demonstrate that new agents inhibit their molecular targets and demonstrate substantial antitumor activity at tolerated doses in an enriched population of patients. Here, we review recent RCTs and found that these conditions were not met for most of the targeted anticancer agents, which failed in recent RCTs. Many recent phase III RCTs were initiated without sufficient evidence of activity from early-phase clinical trials. Because patients treated within such trials can be harmed, they should not be undertaken. The bar should also be raised when making decisions to proceed from phase II to III and from phase III to marketing approval. Many approved agents showed only better progression-free survival than standard treatment in phase III trials and were not shown to improve survival or its quality. Introduction of value-based pricing of new anticancer agents would dissuade the continued development of agents with borderline activity in early-phase clinical trials. When collaborating with industry, oncologists should be more critical and better advocates for cancer patients. Clin Cancer Res; 21(20); 4552-60. ©2015 AACR.See all articles in this CCR Focus section, "Innovations to Speed Drug Development." PMID:26473191

  14. Respiratory Illness in Saskatoon Infants: The Impact of Housing and Neighbourhood Characteristics

    ERIC Educational Resources Information Center

    Wright, Judith; Muhajarine, Nazeem

    2008-01-01

    Respiratory illness is an important childhood illness and a significant cause of infant mortality. This study examined the relationship between neighbourhood level variables and rates of respiratory illness for children less than 2 years of age, born in Saskatoon between 1992 and 1994. Rates of respiratory illness, as measured by proportion of…

  15. Renal Failure in Pregnancy.

    PubMed

    Balofsky, Ari; Fedarau, Maksim

    2016-01-01

    Renal failure during pregnancy affects both mother and fetus, and may be related to preexisting disease or develop secondary to diseases of pregnancy. Causes include hypovolemia, sepsis, shock, preeclampsia, thrombotic microangiopathies, and renal obstruction. Treatment focuses on supportive measures, while pharmacologic treatment is viewed as second-line therapy, and is more useful in mitigating harmful effects than treating the underlying cause. When supportive measures and pharmacotherapy prove inadequate, dialysis may be required, with the goal being to prolong pregnancy until delivery is feasible. Outcomes and recommendations depend primarily on the underlying cause. PMID:26600445

  16. Indoor Fungal Exposure and Allergic Respiratory Disease.

    PubMed

    Osborne, Nicholas J; Thornton, Christopher R; Sharpe, Richard A

    2015-12-01

    A gathering body of evidence has repeatedly revealed associations between indoor fungi and initiation, promotion, and exacerbation of allergic respiratory disease. The relationship between the exposure and outcome are complicated by the difficulties in measuring both exposure and outcome, the multifactorial nature of the disease, and the wide range of potential confounders. New technologies are becoming available that may enable better measurement of exposure and tighter case definitions so as to build more confidence in the associations discovered. The growing strength of the evidence base will aid the design of future public health interventions and generate new hypotheses on the cause of the rapid increase in allergic respiratory disease prevalence. PMID:26492877

  17. Vaccines for the prevention of respiratory viral infections: problems and current status.

    PubMed

    Olszewska, Wieslawa; Helson, Rebecca; Openshaw, Peter J M

    2004-06-01

    Acute respiratory virus infections cause the majority of lower respiratory tract illnesses and hospitalisations of infants and the elderly. The emergence of new respiratory viruses and a high probability that influenza will cause further pandemics highlights the necessity for developing better preventative strategies. Although there is a clear and pressing need for vaccines to prevent respiratory syncytial virus, rhinoviruses, coronaviruses, parainfluenza and human metapneumovirus, progress has been extremely slow. This review presents the current status of vaccine development for respiratory viral diseases and outlines novel approaches for the future. PMID:15174954

  18. BIOASSAY VESSEL FAILURE ANALYSIS

    SciTech Connect

    Vormelker, P

    2008-09-22

    Two high-pressure bioassay vessels failed at the Savannah River Site during a microwave heating process for biosample testing. Improper installation of the thermal shield in the first failure caused the vessel to burst during microwave heating. The second vessel failure is attributed to overpressurization during a test run. Vessel failure appeared to initiate in the mold parting line, the thinnest cross-section of the octagonal vessel. No material flaws were found in the vessel that would impair its structural performance. Content weight should be minimized to reduce operating temperature and pressure. Outer vessel life is dependent on actual temperature exposure. Since thermal aging of the vessels can be detrimental to their performance, it was recommended that the vessels be used for a limited number of cycles to be determined by additional testing.

  19. [Acute liver failure].

    PubMed

    Alberto, Sara Folgado; Pires, S Sousa; Figueiredo, A; Deus, J Ramos de

    2009-01-01

    Acute liver failure refers to the rapid development of severe acute liver injury with impaired synthetic function in a patient who previously had a normal liver or a well compensated liver disease. Its aetiology is diversified and it provides one of the best indicators of prognosis thus being crucial its quick identification. Because it can progress to multiple organ failure syndrome these patients should be managed in an Intensive Care Unit. The first therapeutic approach consists of intensive care support until treatment for specific aetiologies can be started. Besides encephalopathy, many other complications can develop causing the high rates of morbidity and mortality of acute liver failure and so they need tight surveillance and treatment. Liver support systems are therapeutic options still in study and without proven success in a long term period which makes hepatic transplantation the final therapeutic. Given the wide limitations of hepatic transplantation the final decision is based on a correct diagnosis and prognostic scoring systems. PMID:20350465

  20. Shigellosis with resultant septic shock and renal failure.

    PubMed

    Moralez, Elba Iris; Lofland, Denene

    2011-01-01

    Septic shock is a rare, potentially life-threatening complication of bacterial dysentery. The clinical presentation of septic shock includes hypotension, bleeding, hypoxia, acidosis, and jaundice. Historically gram-negative organisms were the most frequent cause of nosocomial bloodstream infections. However isolation of gram-positive organisms has become increasingly frequent with Staphylococcus species accounting for over one half of all nosocomial bloodstream pathogens. Bacterial dysentery is an acute diarrheal illness characterized by abdominal cramping, fever, and the production of mucoid, bloody stools. Laboratory findings include positive stool culture and increased leukocytes in direct fecal exam. Chemistry and hematology values may be abnormal. The disease is usually self-limiting but administration of antibiotics and rehydration therapy may be warranted in severe cases. This case study describes a 53 year old male who presented with diarrhea and diabetic acidosis and subsequently developed respiratory distress and renal failure due to shigellosis. Discussion of disease pathogenesis and treatment are provided. PMID:21905580

  1. Primary Ciliary Dyskinesia and Neonatal Respiratory Distress

    PubMed Central

    Mullowney, Tara; Manson, David; Kim, Raymond; Stephens, Derek; Shah, Vibhuti

    2014-01-01

    BACKGROUND AND OBJECTIVE: Primary ciliary dyskinesia (PCD) is a rare inherited disease affecting motile cilia lining the respiratory tract. Despite neonatal respiratory distress as an early feature, diagnosis is typically delayed until late childhood. Our objective was to identify characteristics that differentiate PCD from common causes of term neonatal respiratory distress. METHODS: This was a case-control study. Patients with PCD born after 1994 attending a regional PCD clinic who had a history of neonatal respiratory distress (n = 46) were included. Controls (n = 46), term neonates with respiratory distress requiring a chest radiograph, were randomly selected from hospital birth records and matched on gender, birth month/year, and mode of delivery. Multiple logistic regression was used to determine the association between neonatal characteristics and PCD diagnosis. The diagnostic performance of the best predictive variables was estimated by calculating sensitivity and specificity. RESULTS: PCD cases required more oxygen therapy (39 cases, 29 controls, P = .01), longer duration of oxygen therapy (PCD mean = 15.2 days, control mean = 0.80 days, P < .01), had later onset of neonatal respiratory distress (PCD median = 12 hours, control median = 1 hour, P < .001), and higher frequency of lobar collapse and situs inversus (PCD = 70% and 48% respectively, control = 0% for both, P < .001). Situs inversus, lobar collapse, or oxygen need for >2 days had 87% (95% confidence interval: 74–94) sensitivity and 96% (95% confidence interval: 85–99) specificity for PCD. CONCLUSIONS: When encountering term neonates with unexplained respiratory distress, clinicians should consider PCD in those with lobar collapse, situs inversus, and/or prolonged oxygen therapy (>2 days). PMID:25422025

  2. Incorporating Classification Uncertainty in Competing- risks Nest- failure Analysis

    EPA Science Inventory

    Nesting birds risk nest failure due to many causes. Though partitioning risk of failure among causes has long been of interest to ornithologists, formal methods for estimating competing risk have been lacking.

  3. Obesity and heart failure.

    PubMed

    De Pergola, Giovanni; Nardecchia, Adele; Giagulli, Vito Angelo; Triggiani, Vincenzo; Guastamacchia, Edoardo; Minischetti, Manuela Castiglione; Silvestris, Franco

    2013-03-01

    Epidemiological studies have recently shown that obesity, and abdominal obesity in particular, is an independent risk factor for the development of heart failure (HF). Higher cardiac oxidative stress is the early stage of heart dysfunction due to obesity, and it is the result of insulin resistance, altered fatty acid and glucose metabolism, and impaired mitochondrial biogenesis. Extense myocyte hypertrophy and myocardial fibrosis are early microscopic changes in patients with HF, whereas circumferential strain during the left ventricular (LV) systole, LV increase in both chamber size and wall thickness (LV hypertrophy), and LV dilatation are the early macroscopic and functional alterations in obese developing heart failure. LV hypertrophy leads to diastolic dysfunction and subendocardial ischemia in obesity, and pericardial fat has been shown to be significantly associated with LV diastolic dysfunction. Evolving abnormalities of diastolic dysfunction may include progressive hypertrophy and systolic dysfunction, and various degrees of eccentric and/or concentric LV hypertrophy may be present with time. Once HF is established, overweight and obese have a better prognosis than do their lean counterparts with the same level of cardiovascular disease, and this phenomenon is called "obesity paradox". It is mainly due to lower muscle protein degradation, brain natriuretic peptide circulating levels and cardio-respiratory fitness than normal weight patients with HF. PMID:23369137

  4. Kidney (Renal) Failure

    MedlinePLUS

    ... News Physician Resources Professions Site Index A-Z Kidney Failure Kidney failure, also known as renal failure, ... evaluated? How is kidney failure treated? What is kidney (renal) failure? The kidneys are designed to maintain ...

  5. Heart failure - overview

    MedlinePLUS

    CHF; Congestive heart failure; Left-sided heart failure; Right-sided heart failure - Cor pulmonale; Cardiomyopathy - heart failure ... Heart failure is often a long-term (chronic) condition, but it may come on suddenly. It can ...

  6. The global burden of respiratory disease-impact on child health.

    PubMed

    Zar, Heather J; Ferkol, Thomas W

    2014-05-01

    Respiratory disease is the major cause of mortality and morbidity worldwide, with infants and young children especially susceptible. The spectrum of disease ranges from acute infections to chronic non-communicable diseases. Five respiratory conditions dominate-acute respiratory infections, chronic obstructive pulmonary disease, asthma, tuberculosis (TB), and lung cancer. Pneumonia remains the predominant cause of childhood mortality, causing nearly 1.3 million deaths each year, most of which are preventable. Asthma is the commonest non-communicable disease in children. Pediatric TB constitutes up to 20% of the TB caseload in high incidence countries. Environmental exposures such as tobacco smoke, indoor air pollution, and poor nutrition are common risk factors for acute and chronic respiratory diseases. Pediatric and adult respiratory disease is closely linked. Early childhood respiratory infection or environmental exposures may lead to chronic disease in adulthood. Childhood immunization can effectively reduce the incidence and severity of childhood pneumonia; childhood immunization is also effective for reducing pneumonia in the elderly. The Forum of International Respiratory Societies (FIRS), representing the major respiratory societies worldwide, has produced a global roadmap of respiratory diseases, Respiratory Disease in the World: Realities of Today-Opportunities for Tomorrow. This highlights the burden of respiratory diseases globally and contains specific recommendations for effective strategies. Greater availability and upscaled implementation of effective strategies for prevention and management of respiratory diseases is needed worldwide to improve global health and diminish the current inequities in health care worldwide. PMID:24610581

  7. [Treatment of acute circulatory failure (shock) in childhood].

    PubMed

    Miranda, R

    1975-01-01

    The concept of shock is discussed emphazising the microcirculatory disturbance implied with the resulting failure in tissular perfussion and its consequences (hypoxia, acidosis, enzymatic damage, metabolic changes). Its causes are outlined (cardiogenic, hypovolemic, septic, neurogenic, anaphylactic, endocrine); its phases, vasoconstriction, precapillary dilatiation and pooling, disseminated intravascular coagulation and hemorrhages following hypocoagulability due to an excessive consumption of factors and the fundamental elements of the clinical picture. Treatment is analyzed outstanding the necessity of an adequate and urgent correction of the disturbance in volume, stressing the importance of supplying about 400 ml. x m-2 during the first hour and the necessary monitoring of central venous pressure as the best index to control perfussed fluids. Indications for electrolytic solutions are given, including blood, platelets, plasms, albumin, dextran and manitol. The fact that respiratory failure following "shock lung" is stressed as the main cause of death and the different procedures of management are described (ventilation, intubation, oxygen therapy, tracheostomy, mechanical ventilation and use of respirators, specially the Bird type). Vasodilator drugs are described together with their indications; also, contraindications of vasoconstrictive drugs. Several complications, such as disseminated intravascular coagulation, acute adrenal failure, acute renal failure and arrhythmia are mentioned together with basic elements for prevention and treatment. Emphasis is placed on the serial control of several elementsusing a special counter in their outline: sensory, respiration including type, rythm and rate, cyanosis, central venous pressure, pulse, color of the skin, capillary filling, temperature, arterial pressure, diuresis, weight, and hydration. A careful hydrous balance is stressed. It is handled in the same counter PMID:1056188

  8. Winning the fight against boiler tube failure

    SciTech Connect

    Cohen, J.; Dooley, B.

    1986-12-01

    Eliminating boiler tube failures could be worth $5 billion a year to the electric power industry. The causes and cures for the great majority of these ubiquitous failures are now known, with implications for change ranging from senior management to the maintenance crew. Methods for preventing boiler tube failure are discussed.

  9. Respiratory cryptosporidiosis in chickens.

    PubMed

    Goodwin, M A; Latimer, K S; Brown, J; Steffens, W L; Martin, P W; Resurreccion, R S; Smeltzer, M A; Dickson, T G

    1988-12-01

    In order to better characterize spontaneous respiratory cryptosporidiosis in chickens, a retrospective examination of histopathology reports from the Georgia Poultry Laboratories for an 18-mo period (4/1/86 to 9/30/87) was made; 12 cases were found. Collected data were analyzed and certain epidemiologic and histologic features were identified. Eleven of the 12 cases involved broiler type chickens. The ages of chickens with respiratory cryptosporidiosis were evenly distributed between 17 and 52 days of age. The infected birds were always clinically ill. Viruses or bacteria or both often accompanied respiratory Cryptosporidium sp. infections. Histologic lesions (including those of ciliary-adherent bacteria) are described. As the inflammatory response in infected organs became progressively nonpurulent (lymphocytes and plasma cells predominate), numbers of Cryptosporidium diminished. Cytologic preparations were useful for making diagnoses of respiratory cryptosporidiosis in chickens. Identification of epidemiologic features of respiratory cryptosporidiosis, and improved ability to make accurate and prompt diagnoses of Cryptosporidium sp. infection, are vital for a more complete understanding of the impact of this disease on poultry health. PMID:3241775

  10. Possible role of mtDNA depletion and respiratory chain defects in aristolochic acid I-induced acute nephrotoxicity

    SciTech Connect

    Jiang, Zhenzhou Bao, Qingli Sun, Lixin Huang, Xin Wang, Tao Zhang, Shuang Li, Han Zhang, Luyong

    2013-01-15

    This report describes an investigation of the pathological mechanism of acute renal failure caused by toxic tubular necrosis after treatment with aristolochic acid I (AAI) in Sprague–Dawley (SD) rats. The rats were gavaged with AAI at 0, 5, 20, or 80 mg/kg/day for 7 days. The pathologic examination of the kidneys showed severe acute tubular degenerative changes primarily affecting the proximal tubules. Supporting these results, we detected significantly increased concentrations of blood urea nitrogen (BUN) and creatinine (Cr) in the rats treated with AAI, indicating damage to the kidneys. Ultrastructural examination showed that proximal tubular mitochondria were extremely enlarged and dysmorphic with loss and disorientation of their cristae. Mitochondrial function analysis revealed that the two indicators for mitochondrial energy metabolism, the respiratory control ratio (RCR) and ATP content, were reduced in a dose-dependent manner after AAI treatment. The RCR in the presence of substrates for complex I was reduced more significantly than in the presence of substrates for complex II. In additional experiments, the activity of respiratory complex I, which is partly encoded by mitochondrial DNA (mtDNA), was more significantly impaired than that of respiratory complex II, which is completely encoded by nuclear DNA (nDNA). A real-time PCR assay revealed a marked reduction of mtDNA in the kidneys treated with AAI. Taken together, these results suggested that mtDNA depletion and respiratory chain defects play critical roles in the pathogenesis of kidney injury induced by AAI, and that the same processes might contribute to aristolochic acid-induced nephrotoxicity in humans. -- Highlights: ? AAI-induced acute renal failure in rats and the proximal tubule was the target. ? Tubular mitochondria were morphologically aberrant in ultrastructural examination. ? AAI impair mitochondrial bioenergetic function and mtDNA replication.

  11. Assessment and management of respiratory function in patients with Duchenne muscular dystrophy: current and emerging options

    PubMed Central

    LoMauro, Antonella; D’Angelo, Maria Grazia; Aliverti, Andrea

    2015-01-01

    Duchenne muscular dystrophy (DMD) is an X-linked myopathy resulting in progressive weakness and wasting of all the striated muscles including the respiratory muscles. The consequences are loss of ambulation before teen ages, cardiac involvement and breathing difficulties, the main cause of death. A cure for DMD is not currently available. In the last decades the survival of patients with DMD has improved because the natural history of the disease can be changed thanks to a more comprehensive therapeutic approach. This comprises interventions targeted to the manifestations and complications of the disease, particularly in the respiratory care. These include: 1) pharmacological intervention, namely corticosteroids and idebenone that significantly reduce the decline of spirometric parameters; 2) rehabilitative intervention, namely lung volume recruitment techniques that help prevent atelectasis and slows the rate of decline of pulmonary function; 3) scoliosis treatment, namely steroid therapy that is used to reduce muscle inflammation/degeneration and prolong ambulation in order to delay the onset of scoliosis, being an additional contribution to the restrictive lung pattern; 4) cough assisted devices that improve airway clearance thus reducing the risk of pulmonary infections; and 5) non-invasive mechanical ventilation that is essential to treat nocturnal hypoventilation, sleep disordered breathing, and ultimately respiratory failure. Without any intervention death occurs within the first 2 decades, however, thanks to this multidisciplinary therapeutic approach life expectancy of a newborn with DMD nowadays can be significantly prolonged up to his fourth decade. This review is aimed at providing state-of-the-art methods and techniques for the assessment and management of respiratory function in DMD patients. PMID:26451113

  12. Assessment and management of respiratory function in patients with Duchenne muscular dystrophy: current and emerging options.

    PubMed

    LoMauro, Antonella; D'Angelo, Maria Grazia; Aliverti, Andrea

    2015-01-01

    Duchenne muscular dystrophy (DMD) is an X-linked myopathy resulting in progressive weakness and wasting of all the striated muscles including the respiratory muscles. The consequences are loss of ambulation before teen ages, cardiac involvement and breathing difficulties, the main cause of death. A cure for DMD is not currently available. In the last decades the survival of patients with DMD has improved because the natural history of the disease can be changed thanks to a more comprehensive therapeutic approach. This comprises interventions targeted to the manifestations and complications of the disease, particularly in the respiratory care. These include: 1) pharmacological intervention, namely corticosteroids and idebenone that significantly reduce the decline of spirometric parameters; 2) rehabilitative intervention, namely lung volume recruitment techniques that help prevent atelectasis and slows the rate of decline of pulmonary function; 3) scoliosis treatment, namely steroid therapy that is used to reduce muscle inflammation/degeneration and prolong ambulation in order to delay the onset of scoliosis, being an additional contribution to the restrictive lung pattern; 4) cough assisted devices that improve airway clearance thus reducing the risk of pulmonary infections; and 5) non-invasive mechanical ventilation that is essential to treat nocturnal hypoventilation, sleep disordered breathing, and ultimately respiratory failure. Without any intervention death occurs within the first 2 decades, however, thanks to this multidisciplinary therapeutic approach life expectancy of a newborn with DMD nowadays can be significantly prolonged up to his fourth decade. This review is aimed at providing state-of-the-art methods and techniques for the assessment and management of respiratory function in DMD patients. PMID:26451113

  13. Stress failure of pulmonary capillaries: role in lung and heart disease

    NASA Technical Reports Server (NTRS)

    West, J. B.; Mathieu-Costello, O.

    1992-01-01

    Pulmonary capillaries have extremely thin walls to allow rapid exchange of respiratory gases across them. Recently it has been shown that the wall stresses become very large when the capillary pressure is raised, and in anaesthetised rabbits, ultrastructural damage to the walls is seen at pressures of 40 mm Hg and above. The changes include breaks in the capillary endothelial layer, alveolar epithelial layer, and sometimes all layers of the wall. The strength of the thin part of the capillary wall can be attributed to the type IV collagen in the extracellular matrix. Stress failure of pulmonary capillaries results in a high-permeability form of oedema, or even frank haemorrhage, and is apparently the mechanism of neurogenic pulmonary oedema and high-altitude pulmonary oedema. It also explains the exercise-induced pulmonary haemorrhage that occurs in all racehorses. Several features of mitral stenosis are consistent with stress failure. Overinflation of the lung also leads to stress failure, a common cause of increased capillary permeability in the intensive care environment. Stress failure also occurs if the type IV collagen of the capillary wall is weakened by autoantibodies as in Goodpasture's syndrome. Neutrophil elastase degrades type IV collagen and this may be the starting point of the breakdown of alveolar walls that is characteristic of emphysema. Stress failure of pulmonary capillaries is a hitherto overlooked and potentially important factor in lung and heart disease.

  14. Heart Failure Cardiovascular Features of Heart Failure

    E-print Network

    Morrell, Christopher H.

    Heart Failure Cardiovascular Features of Heart Failure With Preserved Ejection Fraction Versus of patients with heart failure with preserved ejection fraction (HFpEF) that differ from those in individuals failure. Background Heart failure with preserved ejection fraction often develops in HLVH patients

  15. Immune responses of infants to infection with respiratory viruses and live attenuated respiratory virus candidate vaccines.

    PubMed

    Crowe, J E

    1998-01-01

    Respiratory viruses such as respiratory syncytial virus (RSV), the parainfluenza viruses (PIV), and the influenza viruses cause severe lower respiratory tract diseases in infants and children throughout the world. Experimental live attenuated vaccines for each of these viruses are being developed for intranasal administration in the first weeks or months of life. A variety of promising RSV, PIV-3, and influenza virus vaccine strains have been developed by classical biological methods, evaluated extensively in preclinical and clinical studies, and shown to be attenuated and genetically stable. The ongoing clinical evaluation of these vaccine candidates, coupled with recent major advances in the ability to develop genetically engineered viruses with specified mutations, may allow the rapid development of respiratory virus strains that possess ideal levels of replicative capacity and genetic stability in vivo. A major remaining obstacle to successful immunization of infants against respiratory virus associated disease may be the relatively poor immune response of very young infants to primary virus infection. This paper reviews the immune correlates of protection against disease caused by these viruses, immune responses of infants to naturally-acquired infection, and immune responses of infants to experimental infection with candidate vaccine viruses. PMID:9711783

  16. Respiratory Resistance In Family Therapy

    ERIC Educational Resources Information Center

    Beck, Michael J.

    1975-01-01

    Patients' respiratory problems may interfere with their talking in therapy sessions. Interventions by the therapist must be based on an understanding of the underlying dynamics which produced the respiratory problem. (Author)

  17. Respiratory Diseases of Poultry

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A new Respiratory Diseases of Poultry CRIS will be established effective October 1, 2006. Initially, the disease agents to be studied will include Ornithobacterium rhinotracheale (ORT), Bordetella avium (BART) and Pasteurella multocida. The research will focus on development of more effective vacc...

  18. Respiratory Muscle Plasticity

    PubMed Central

    Gransee, Heather M.; Mantilla, Carlos B.; Sieck, Gary C.

    2014-01-01

    Muscle plasticity is defined as the ability of a given muscle to alter its structural and functional properties in accordance with the environmental conditions imposed on it. As such, respiratory muscle is in a constant state of remodeling, and the basis of muscle’s plasticity is its ability to change protein expression and resultant protein balance in response to varying environmental conditions. Here, we will describe the changes of respiratory muscle imposed by extrinsic changes in mechanical load, activity, and innervation. Although there is a large body of literature on the structural and functional plasticity of respiratory muscles, we are only beginning to understand the molecular-scale protein changes that contribute to protein balance. We will give an overview of key mechanisms regulating protein synthesis and protein degradation, as well as the complex interactions between them. We suggest future application of a systems biology approach that would develop a mathematical model of protein balance and greatly improve treatments in a variety of clinical settings related to maintaining both muscle mass and optimal contractile function of respiratory muscles. PMID:23798306

  19. Textbook of respiratory medicine

    SciTech Connect

    Murray, J.F.; Nadel, J.

    1987-01-01

    This book presents a clinical reference of respiratory medicine. It also details basic science aspects of pulmonary physiology and describes recently developed, sophisticated diagnostic tools and therapeutic methods. It also covers anatomy, physiology, pharmacology, and pathology; microbiologic, radiologic, nuclear medicine, and biopsy methods for diagnosis.

  20. The Epidemiology and Outcome of Prehospital Respiratory Distress

    PubMed Central

    Prekker, Matthew E.; Feemster, Laura C.; Hough, Catherine L.; Carlbom, David; Crothers, Kristina; Au, David H.; Rea, Thomas D.; Seymour, Christopher W.

    2014-01-01

    Objectives Patients with respiratory distress often seek emergency medical care, and are transported by emergency medical services (EMS). EMS encounters with patients in respiratory distress have not been well described. The study objective was to characterize the epidemiology of prehospital respiratory distress and subsequent patient outcomes. Methods This was a population-based cohort study of non-injured adults transported by EMS to any of 16 hospitals between 2002 and 2006. EMS records were linked to hospital administrative data for encounters categorized by EMS personnel as primarily “respiratory distress” in nature. The authors described prehospital patient and encounter characteristics, interventions, hospital discharge diagnoses (using ICD-9-CM codes), and patient outcomes. The association between prehospital variables, defined a priori, and hospital admission were described using multivariable logistic regression. Results There were 19,858 EMS encounters, of which 166,908 were for respiratory distress (11.9%, 95% confidence interval [CI] = 11.7% to 12.1%). Half of the patients were admitted to the hospital (n = 9,964), one-third of those required intensive care (n = 3,094), and 10% of hospitalized patients died prior to discharge (n = 948). Fifteen percent of hospitalized patients received invasive mechanical ventilation (n = 1,501), over half of whom were intubated during prehospital care (n = 896). The most common primary discharge diagnoses among prehospital respiratory distress patients admitted to the hospital were congestive heart failure (16%), pneumonia (15%), chronic obstructive pulmonary disease (13%), and acute respiratory failure (13%). Few EMS patients with respiratory distress were coded with a primary diagnosis of acute myocardial infarction (3.5%, n = 350), or underwent percutaneous coronary intervention (0.7%, n = 71). In a multivariable regression model, prehospital factors that were independently associated with hospital admission included initial respiratory rate (odds ratio [OR] 1.29 for an increase in respiratory rate of five breaths per minute, 95% CI = 1.24 to 1.35), and an encounter that originated at a nursing home (OR 2.80, 95% CI = 2.28 to 3.43). Conclusions In a ppulation-based cohort, EMS personnel commonly encounter prehospital respiratory distress among medical patients, many of whom require hospital admission to the intensive care unit. These data may help to inform targeted therapy or more efficient triage and transport decisions. PMID:24842506