Sample records for respiratory failure caused

  1. Respiratory Failure

    MedlinePLUS

    Respiratory failure happens when not enough oxygen passes from your lungs into your blood. Your body's organs, such ... brain, need oxygen-rich blood to work well. Respiratory failure also can happen if your lungs can't ...

  2. 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

  3. Veno-venous extracorporeal membrane oxygenation (ECMO) for acute respiratory failure caused by liver abscess.

    PubMed

    Katsuhara, Kazuhiro; Nakada, Taka-Aki; Yamada, Mami; Fuse, Takashi; Idoguchi, Koji; Matsuoka, Tetsuya

    2015-06-01

    Liver abscess remains a life-threatening disease, particularly when it results in systemic organ failure necessitating intensive care. Only few cases of respiratory failure caused by liver abscess and treated with veno-venous extracorporeal membrane oxygenation (ECMO) have been reported. Here we present a case of liver abscess with rapid progression of multiple organ dysfunction, including severe acute respiratory failure on admission to the intensive care unit (ICU). Upon admission, we immediately initiated artificial organ support systems, including ventilator, continuous renal replacement therapy, and cardiovascular drug infusion for septic multiple organ failure and source control. Despite this initial management, respiratory failure deteriorated and V-V ECMO was introduced. The case developed abdominal compartment syndrome, for which we performed a bedside decompressive laparotomy in the ICU. The case gradually recovered from multiple organ failure and was discharged from the ICU on day 22 and from the hospital on day 53. Since liver abscess is potentially lethal and respiratory failure on admission is an additional risk factor of mortality, V-V ECMO may serve as an adjunctive choice of artificial organ support for cases of severe acute respiratory failure caused by liver abscess. PMID:25420925

  4. Determinants of Noninvasive Ventilation Outcomes during an Episode of Acute Hypercapnic Respiratory Failure in Chronic Obstructive Pulmonary Disease: The Effects of Comorbidities and Causes of Respiratory Failure

    PubMed Central

    Pacilli, Angela Maria Grazia; Valentini, Ilaria; Carbonara, Paolo; Marchetti, Antonio; Nava, Stefano

    2014-01-01

    Objectives. To investigate the effect of the cause of acute respiratory failure and the role of comorbidities both acute and chronic on the outcome of COPD patients admitted to Respiratory Intensive Care Unit (RICU) with acute respiratory failure and treated with NIV. Design. Observational prospective study. Patients and Methods. 176 COPD patients consecutively admitted to our RICU over a period of 3 years and treated with NIV were evaluated. In all patients demographic, clinical, and functional parameters were recorded including the cause of acute respiratory failure, SAPS II score, Charlson comorbidity index, and further comorbidities not listed in the Charlson index. NIV success was defined as clinical improvement leading to discharge to regular ward, while exitus or need for endotracheal intubation was considered failure. Results. NIV outcome was successful in 134 patients while 42 underwent failure. Univariate analysis showed significantly higher SAP II score, Charlson index, prevalence of pneumonia, and lower serum albumin level in the failure group. Multivariate analysis confirmed a significant predictive value for pneumonia and albumin. Conclusions. The most important determinants of NIV outcome in COPD patients are the presence of pneumonia and the level of serum albumin as an indicator of the patient nutritional status. PMID:24563868

  5. Immeasurable levels of serum phosphate--an unidentified cause of respiratory failure in a diabetic patient.

    PubMed

    Spicek-Macan, Jasna; Hodoba, Nevenka; Kolari?, Nevenka; Nikoli?, Igor; Majeri?-Kogler, Visnja; Popovi?-Grle, Sanja

    2010-12-01

    We report a case of immeasurable levels of serum phosphate in a patient with juvenile type Diabetes mellitus and diabetic ketoacidosis who developed respiratory failure. A 27-year-old female with juvenile type insulin-dependent Diabetes mellitus was admitted because of suspected acute mediastinitis and respiratory failure, probably, among other responsible factors, caused and complicated by undetectable levels of serum phosphate. The serum phosphate concentration three days after aggressive treatment was only 0.2 mmol/L. Furthermore, a significant improvement in weakness and lethargy was observed. To the best of our knowledge, this is the first described case of immeasurable levels of serum phosphate. In patients with Diabetes mellitus, serum phosphate concentrations should be routinely checked in order to avoid additional complications. PMID:21874739

  6. Diaphragmatic paralysis due to spinal muscular atrophy. An unrecognised cause of respiratory failure in infancy?

    Microsoft Academic Search

    R C McWilliam; D Gardner-Medwin; D Doyle; J B Stephenson

    1985-01-01

    An unusual form of spinal muscular atrophy presenting with respiratory failure was observed in four infants from two families. In one, whose death was attributed to pneumonia, the diagnosis was inferred retrospectively after two siblings died from an identical illness and were shown to have diaphragmatic paralysis and the typical electrophysiological and histological features of spinal muscular atrophy. Other signs

  7. Respiratory muscle failure.

    PubMed

    Rochester, D F; Arora, N S

    1983-05-01

    The diseases which are commonly complicated by hypercapnic respiratory failure also compromise the respiratory muscles in several ways. Increased work of breathing, mechanical disadvantage, neuromuscular disease, impaired nutritional status, shock, hypoxemia, acidosis, and deficiency of potassium, magnesium, and inorganic phosphorus are the major non-neurologic factors which contribute to respiratory muscle fatigue and failure. Respiratory muscle fatigue has two components. High frequency fatigue occurs rapidly with intense contractile efforts but is usually not severe. It also recovers rapidly with rest. Low frequency fatigue develops more slowly but is severe and requires hours for recovery. Since the spontaneous rate of neural stimulation is predominantly in the low frequency range, this component of fatigue is of particular clinical importance. Fatigue of the inspiratory muscles leads to acute respiratory acidosis, but before carbon dioxide retention occurs, it can be recognized from characteristic symptoms and signs. These include dyspnea which responds to mechanical ventilation, rapid shallow breathing, and asynchronous movements of the chest and abdomen. Inspiratory muscle fatigue must be treated by putting these muscles to rest, by mechanically supporting ventilation. In addition, underlying metabolic nutritional and circulatory abnormalities must be corrected and infection treated. Aminophylline and isoproterenol can restore inspiratory muscle contractility, but controlled clinical trials remain to be done regarding their application in acute and chronic respiratory failure. Inspiratory muscle training improves strength and endurance in patients with obstructive lung disease, cystic fibrosis, and spinal cord injury, but does not always improve physical exercise performance. Again, more work is needed to develop the indications for inspiratory muscle training and to determine the optimum type and duration of the training regimen. PMID:6341727

  8. Exome sequencing identifies titin mutations causing hereditary myopathy with early respiratory failure (HMERF) in families of diverse ethnic origins

    PubMed Central

    2013-01-01

    Background Hereditary myopathy with early respiratory failure (HMERF) was described in several North European families and recently linked to a titin gene (TTN) mutation. We independently studied HMERF-like diseases with the purpose to identify the cause, refine diagnostic criteria, and estimate the frequency of this disease among myopathy patients of various ethnic origins. Methods Whole exome sequencing analysis was carried out in a large U.S. family that included seven members suffering from skeletal muscle weakness and respiratory failure. Subsequent mutation screening was performed in further 45 unrelated probands with similar phenotypes. Studies included muscle strength evaluation, nerve conduction studies and concentric needle EMG, respiratory function test, cardiologic examination, and muscle biopsy. Results A novel TTN p.Gly30150Asp mutation was identified in the highly conserved A-band of titin that co-segregated with the disease in the U.S. family. Screening of 45 probands initially diagnosed as myofibrillar myopathy (MFM) but excluded based on molecular screening for the known MFM genes led to the identification of a previously reported TTN p.Cys30071Arg mutation in one patient. This same mutation was also identified in a patient with suspected HMERF. The p.Gly30150Asp and p.Cys30071Arg mutations are localized to a side chain of fibronectin type III element A150 of the 10th C-zone super-repeat of titin. Conclusions Missense mutations in TTN are the cause of HMERF in families of diverse origins. A comparison of phenotypic features of HMERF caused by the three known TTN mutations in various populations allowed to emphasize distinct clinical/pathological features that can serve as the basis for diagnosis. The newly identified p.Gly30150Asp and the p.Cys30071Arg mutation are localized to a side chain of fibronectin type III element A150 of the 10th C-zone super-repeat of titin. PMID:23514108

  9. [Etiology and pathogenesis of acute respiratory failure].

    PubMed

    Ziliene, Violeta; Kondrotas, Anatolijus Juozas; Kevelaitis, Egidijus

    2004-01-01

    The aim of this study was to determine factors influencing acute respiratory failure and pathogenesis according to literature and clinical findings in critically ill patients. The term "respiratory failure" implies the inability to maintain either the normal delivery of oxygen to tissues and release or the normal removal of carbon dioxide from the tissues. There are many patients suffering from acute respiratory failure caused by nosocomial pneumonia, septic syndrome, aspiration, interstitial or alveolar lung edema, thromboembolism of a. pulmonalis, polytrauma and lung contusion, acute respiratory distress syndrome, long-term mechanical ventilation of the lungs, acute lung injury, status asthmaticus, rather massive transfusions of blood products, and lipid embolism in the intensive care unit. There are actually three processes involved: the transfer of oxygen across the alveolus, the transport to the tissues (by cardiac output), and the removal of carbon dioxide from blood into the alveolus with subsequent exhalation into the environment. Failure of any step in this process can lead to respiratory failure. Long-term hypoxia causes ischemic changes and dysfunction of brain, heart, kidney, lungs and can worsen the course of disease or cause higher mortality. It is important to determine the pathogenetic mechanisms of acute respiratory failure, estimate the main parameters and their interrelations and prescribe proper treatment. PMID:15064552

  10. 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

  11. Noninvasive ventilation in acute hypercapnic respiratory failure.

    PubMed

    Pisani, Lara; Nava, Stefano

    2014-08-01

    Noninvasive mechanical ventilation (NIV) improves gas exchange and clinical outcome in various types of acute respiratory failure. Acute exacerbation of chronic obstructive pulmonary disease is a frequent cause of acute hypercapnic respiratory failure (AHRF). According to several randomized controlled trials, the addition of NIV to standard medical therapy reduces mortality, intubation rate, and hospital length of stay in these patients. Indications for the use of NIV have expanded over the past decade. In this article, we discuss the clinical indications and goals of NIV in the management of AHRF. PMID:25111646

  12. A new disease allele for the p.C30071R mutation in titin causing hereditary myopathy with early respiratory failure.

    PubMed

    Pfeffer, Gerald; Sambuughin, Nyamkhishig; Olivé, Montse; Tyndel, Felix; Toro, Camilo; Goldfarb, Lev G; Chinnery, Patrick F

    2014-03-01

    Hereditary myopathy with early respiratory failure is an autosomal dominant myopathy caused by mutations in the 119th fibronectin-3 domain of titin. To date all reported patients with the most common mutation in this domain (p.C30071R) appear to share ancestral disease alleles. We undertook this study of two families with the p.C30071R mutation to determine whether they share the same haplotype as previously reported British families or whether the mutation arose as a de novo event. We sequenced the 119th fibronectin-3 domain in these two probands and flanking polymorphisms associated with the British haplotype in hereditary myopathy with early respiratory failure. A family of Indian descent had a haplotype that was not compatible with the British shared haplotype. Cloning of the 119th fibronectin-3 domain in this patient demonstrated polymorphisms rs191484894 and novel noncoding variant c.90225C>T on the same allele as the mutation, which is distinct from previously reported British families. This proves that the p.C30071R mutation itself (rather than the haplotype containing this mutation) causes hereditary myopathy with early respiratory failure and suggests its independent origin in different ethnic groups. PMID:24444549

  13. Noninvasive ventilation in acute respiratory failure.

    PubMed

    Mehta, S; Hill, N S

    1996-06-01

    Noninvasive PPV has been employed for decades in patients with chronic respiratory failure. Increasing use in patients with acute respiratory failure is a more recent phenomenon, mainly because of advances in noninvasive interfaces and ventilator modes. Noninvasive PPV delivered by nasal or oronasal mask has been demonstrated to reduce the need for endotracheal intubation, decrease lengths of stay in the ICU and hospital, and possibly reduce mortality. In the acute care setting, evidence now demonstrates the efficacy of noninvasive PPV for acute exacerbations of COPD, pulmonary edema, pulmonary contusions, and acute respiratory failure in patients who decline or who are not believed to be candidates for intubation. No firm conclusions can yet be made regarding patients with respiratory failure due to other causes, but studies suggest that noninvasive PPV may also be of benefit in patients with postoperative respiratory insufficiency, chest wall disease, and cystic fibrosis. Several factors are vital to the success of this therapy, including careful patient selection, properly timed intervention, a comfortable, well-fitting interface, patient coaching and encouragement, and careful monitoring. Noninvasive ventilation should be used as a way to avoid endotracheal intubation rather than as an alternative. Accordingly, a trial of noninvasive ventilation should be instituted in the course of acute respiratory failure before respiratory arrest is imminent, to provide ventilatory assistance while the factors responsible for the respiratory failure are aggressively treated. Moreover, the authors favor conservative management with expeditious intubation in patients who have other conditions that place them at risk during use of noninvasive ventilation or in patients failing to respond to noninvasive PPV. Noninvasive PPV clearly represents an important addition to the techniques available to manage patients with acute respiratory failure; however, because most studies have been retrospective and uncontrolled, many issues remain unresolved. Further controlled studies are needed to confirm the safety and efficacy of noninvasive PPV, evaluate the most appropriate selection of patients and timing of intervention, define the best type of interface, and assess the costs of noninvasive PPV in comparison with conventional therapy. PMID:9390883

  14. Noninvasive Ventilation for Acute Respiratory Failure

    Microsoft Academic Search

    L. Brochard; J. Mancebo; M. W. Elliott

    2002-01-01

    Noninvasive ventilation for acute respiratory failure. L. Brochard, J. Mancebo, M.W. Elliott. #ERS Journals Ltd 2002. ABSTRACT: Noninvasive ventilation (NIV) has emerged as a significant advance in the management of respiratory failure. There is now a wide body of prospective randomized-controlled trial data to support its use, particularly in the management of patients with acute or respiratory failure due to

  15. 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.

  16. Chronic inflammatory demyelinating polyneuropathy and respiratory failure.

    PubMed

    Henderson, Robert D; Sandroni, Paola; Wijdicks, Eelco F M

    2005-10-01

    Neuromuscular respiratory failure is not considered to be a clinical feature of chronic inflammatory demyelinating polyneuropathy (CIDP). We present 4 patients with CIDP who required respiratory assistance and mechanical ventilation. Two patients needed emergent intubation and one patient lapsed in a stupor from hypercapnia. Respiratory failure in CIDP should be considered exceptional, but more formal studies in CIDP may be needed to assess its prevalence. PMID:15940387

  17. Acute Antiarrhythmic Effects of Bi-Level Positive Airway Pressure Ventilation in Patients with Acute Respiratory Failure Caused by Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial

    Microsoft Academic Search

    Maurizio Marvisi; Marco Brianti; Giuseppe Marani; Gabriele Turrini; Paolo Zambrelli; Corrado Ajolfi; Roberto Delsignore

    2004-01-01

    Background: Cardiac arrhythmias are common in patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure (ARF) and may be life threatening. Recently, non-invasive positive pressure ventilation has been advanced as a useful tool in COPD patients with ARF. This method can affect global cardiac performance through its effects on many determinants of cardiac function and may be helpful

  18. Overwhelming respiratory failure associated with Legionella pneumophila.

    PubMed

    Dahmash, N S; Gad-El-Rab, M O; Al-Hajjaj, M S

    1994-05-01

    Four patients were admitted to the medical intensive care unit at King Khalid University Hospital (KKUH) with overwhelming respiratory failure. Extensive investigations revealed serological evidence of Legionella infection. Three patients required intubation and mechanical ventilation. All patients received erythromycin; rifampin was added to two patients. Two patients survived and two patients died. We report, for the first time in Saudi Arabia, four cases of Legionella pneumophila with severe respiratory failure. PMID:17586893

  19. Respiratory failure in the elderly patient.

    PubMed

    Muir, Jean-François; Lamia, Bouchra; Molano, Carlos; Cuvelier, Antoine

    2010-10-01

    Respiratory failure frequently complicates the care of elderly patients with or without chronic lung disease. Recent advances in techniques and applications of noninvasive ventilation provide an exceedingly useful means of managing respiratory compromise, and the clinical utilization of noninvasive mechanical ventilation has transformed the prognosis of acute and chronic respiratory failure in this age group. The majority of elderly patients can recover from an acute respiratory failure episode if adequate support is provided, although some may require long-term ventilatory assistance. Such assistance may be provided in the home setting if an adequate support system is available. As the size of the elderly population grows, an increased number of elderly patients with multifactorial respiratory failure will undoubtedly require episodic or sustained ventilatory assistance, and noninvasive ventilation can be provided for various forms of acute and chronic respiratory failure, including advanced chronic obstructive pulmonary disease, other parenchymal lung disease, and chest wall deformities. Health care organizations must incorporate long-term care facilities with ventilatory support capabilities into their health management strategies. PMID:20941663

  20. Poison hemlock-induced respiratory failure in a toddler.

    PubMed

    West, Patrick L; Horowitz, B Zane; Montanaro, Marc T; Lindsay, James N

    2009-11-01

    The ingestion of poison hemlock, or Conium maculatum, is described in a 2-year-old boy. He had the onset of abdominal pain and weakness after being fed C. maculatum picked by his sister from the roadside 2 hours earlier. He had a rapidly progressive muscular weakness and was intubated for respiratory failure. His symptoms completely resolved within 24 hours of the ingestion. Conium maculatum is a common weed that causes toxicity by its primary toxin, coniine, which stimulates nicotinic receptors and causes a syndrome of rapidly progressive muscle weakness and paralysis. We describe the course of a benign-appearing plant ingestion resulting in respiratory failure. PMID:19915429

  1. Living and dying with respiratory failure: facilitating decision making

    Microsoft Academic Search

    Anita K Simonds

    2004-01-01

    Respiratory failure is a predictable cause of death in end stage lung disease including COPD and neuromuscular disorders, and the symptom burden for these individuals in the last six months of life is significant. Palliative care services are less well-developed for patients with chronic disorders compared to those with malignant disease; and communication problems can be compounded by a mismatch

  2. MODELING CARDIOVASCULAR AND RESPIRATORY DYNAMICS IN CONGESTIVE HEART FAILURE

    E-print Network

    Olufsen, Mette Sofie

    ]. Respiratory changes duiring sleep combined with these cardiovascular and control sensitivity changes can, Respiratory modeling, Parameter estimation, Model validation, Sensitivity analysis, Subset selection. 1 #12MODELING CARDIOVASCULAR AND RESPIRATORY DYNAMICS IN CONGESTIVE HEART FAILURE LAURA M. ELLWEIN1

  3. SURGICAL DISORDERS CAUSING NEONATAL RESPIRATORY DISTRESS

    Microsoft Academic Search

    ROLF L. SCHAPIRO; EDWARD T. EVANS; M. D. IOWA

    ESPIRATORY distress in the newborn is a common problem confronting the pediatrician who frequently enlists the radiologist's help in the diagnosis of its etiology. It is imperative that the radiol- ogist recognize especially those causes of respiratory distress which are amenable to-indeed require-immediate surgical al- leviation. For this reason, a review of the more common surgical lesions causing respiratory distress

  4. Chronic inflammatory demyelinating polyneuropathy and respiratory failure

    Microsoft Academic Search

    Robert D. Henderson; Paola Sandroni; Eelco F. M. Wijdicks

    2005-01-01

    Neuromuscular respiratory\\u000afailure is not considered to\\u000abe a clinical feature of chronic inflammatory\\u000ademyelinating\\u000apolyneuropathy (CIDP). We present\\u000a4 patients with CIDP who required\\u000arespiratory assistance and\\u000amechanical ventilation. Two patients\\u000aneeded emergent intubation\\u000aand one patient lapsed in a stupor\\u000afrom hypercapnia. Respiratory failure\\u000ain CIDP should be considered\\u000aexceptional, but more formal studies\\u000ain CIDP may be

  5. H1N1 Influenza Viral Infection in a Postpartum Young Woman Causes Respiratory Failure: What the Care Providers Ought to Know?

    PubMed

    Aloizos, Stavros; Aravosita, Paraskevi; Mystakelli, Christina; Kanna, Efthymia; Gourgiotis, Stavros

    2012-01-01

    Pregnant and postpartum women are considered a population at increased risk of hospitalization of H1N1 infection. We report the case of a young postpartum woman, who developed evidence of respiratory failure reaching the point of requiring intubation due to an H1N1 influenza virus infection two days after a caesarean delivery. We emphasize the diagnosis, management, and the outcome focusing on the question "what the care providers, including obstetric health care workers, ought to know?" Diagnostic and management strategy for pregnant or postpartum women with novel influenza A (H1N1) viral infection and increased awareness amongst patients and health care professionals may result in improved survival. PMID:23150842

  6. H1N1 Influenza Viral Infection in a Postpartum Young Woman Causes Respiratory Failure: What the Care Providers Ought to Know?

    PubMed Central

    Aloizos, Stavros; Aravosita, Paraskevi; Mystakelli, Christina; Kanna, Efthymia; Gourgiotis, Stavros

    2012-01-01

    Pregnant and postpartum women are considered a population at increased risk of hospitalization of H1N1 infection. We report the case of a young postpartum woman, who developed evidence of respiratory failure reaching the point of requiring intubation due to an H1N1 influenza virus infection two days after a caesarean delivery. We emphasize the diagnosis, management, and the outcome focusing on the question “what the care providers, including obstetric health care workers, ought to know?” Diagnostic and management strategy for pregnant or postpartum women with novel influenza A (H1N1) viral infection and increased awareness amongst patients and health care professionals may result in improved survival. PMID:23150842

  7. Acute exacerbations and respiratory failure in chronic obstructive pulmonary disease.

    PubMed

    MacIntyre, Neil; Huang, Yuh Chin

    2008-05-01

    Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) describe the phenomenon of sudden worsening in airway function and respiratory symptoms in patients with COPD. These exacerbations can range from self-limited diseases to episodes of florid respiratory failure requiring mechanical ventilation. The average patient with COPD experiences two such episodes annually, and they account for significant consumption of health care resources. Although bacterial infections are the most common causes of AECOPD, viral infections and environmental stresses are also implicated. AECOPD episodes can be triggered or complicated by other comorbidities, such as heart disease, other lung diseases (e.g., pulmonary emboli, aspiration, pneumothorax), or systemic processes. Pharmacologic management includes bronchodilators, corticosteroids, and antibiotics in most patients. Oxygen, physical therapy, mucolytics, and airway clearance devices may be useful in selected patients. In hypercapneic respiratory failure, noninvasive positive pressure ventilation may allow time for other therapies to work and thus avoid endotracheal intubation. If the patient requires invasive mechanical ventilation, the focus should be on avoiding ventilator-induced lung injury and minimizing intrinsic positive end-expiratory pressure. These may require limiting ventilation and "permissive hypercapnia." Although mild episodes of AECOPD are generally reversible, more severe forms of respiratory failure are associated with a substantial mortality and a prolonged period of disability in survivors. PMID:18453367

  8. Noninvasive ventilation in acute respiratory failure.

    PubMed

    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

  9. 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

  10. [Acute renal failure caused by viper: report of 48 cases].

    PubMed

    Zou, R L; Zhang, Y M

    1994-02-01

    Viper is common in China and its secretion is a mixture consisting of both hemo-toxin and neuro-toxin that cause acute renal failure and respiratory paralysis. In 4860 cases of snake-bites treated from 1984 to 1991, 48 (0.99%) resulted in acute renal failure. After treatment, 43 cases were completely recovered and 5 (10.4%) died of serious failure. Because the toxicity of viper directly attacks both kidneys and toxaemia may cause massive hemolysis to rapidly develop acute renal failure. Instant etiological treatment, alkalization urine, peritoneal dialysis are necessary to sustain the function of heart, liver and lung. PMID:7924665

  11. [Respiratory failure in polymyositis and dermatomyositis: differential diagnosis between pulmonary infection and interstitial pneumonitis].

    PubMed

    Amano, K; Maruyama, H; Mori, S; Takeuchi, T

    1998-05-01

    Pulmonary diseases are important cause of morbidity and mortality in patients with PM/DM. Thirteen (27%) out of 49 PM/DM patients in the study had developed respiratory failure. Respiratory failure resulted form interstitial pneumonitis (i.p.) in 6, pulmonary infection in 2 and both in 5 patients with PM/DM. Respiratory failure was fatal in PM/DM patients with pulmonary diseases and eleven of the 13 patients expired. More importantly, 2 PM/DM patients with respiratory failure had responded to chemotherapy, if it was due to pulmonary infection. Accordingly, it is almost important to distinguish i.p. and infection for the cause of respiratory failure. However, plain chest X-ray as well as standard laboratory tests failed to differentiate i.p. and pulmonary infection. On the other hand, high resolution CT of the lungs, serum endotoxin and serum beta-D-glucan were found to be useful for the differentiation of these conditions associated with respiratory failure in PM/DM patients. And additionally low serum level of IgG and lymphopenia at the onset of respiratory failure may suggest that the patients may have pulmonary infection rather than i.p. PMID:9642942

  12. The successful treatment of hypercapnic respiratory failure with oral modafinil.

    PubMed

    Parnell, Helen; Quirke, Ginny; Farmer, Sally; Adeyemo, Sumbo; Varney, Veronica

    2014-01-01

    Hypercapnic respiratory failure is common in advanced chronic obstructive pulmonary disease and is usually treated by nasal ventilation. Not all patients requiring such ventilation can tolerate it, with anxiety and phobia influencing their reaction, along with treatment failure. We report the case histories of six patients with hypercapnic respiratory failure who were at risk of death due to refusal of nasal ventilation or its failure despite ongoing treatment. We report their improvement with oral modafinil 200 mg tablets used as a respiratory stimulant, which led to discharge, improved arterial blood gases, and offset further admissions with hypercapnic respiratory failure. This drug is licensed for narcolepsy and is said to stimulate the respiratory system via the central nervous system. Its use in respiratory failure is an unlicensed indication, and there are no case reports or studies of such use in the literature. Its respiratory stimulant effects appear better than those with protriptyline, which was a drug previously used until its production was discontinued. Our findings suggest that a study of modafinil in hypercapnic respiratory failure would be warranted, especially for patients with treatment failure or intolerance to nasal ventilation. This may offer a way of shortening hospital stay, improving outcome and quality of life, and reducing death and readmissions. PMID:24812505

  13. Severe respiratory failure associated with influenza B virus infection

    PubMed Central

    Kato, Shinpei; Fujisawa, Tomoyuki; Enomoto, Noriyuki; Inui, Naoki; Nakamura, Yutaro; Suda, Takafumi

    2015-01-01

    A 72-year-old man who had been diagnosed with type B influenza infection and high fever 4 days previously was admitted to our hospital. He presented with severe respiratory insufficiency; chest computed tomography (CT) revealed extensive ground-glass opacity in lung fields on both sides. Although peramivir and antibiotics were administered, reticular shadows on chest CT worsened and respiratory insufficiency deteriorated. The patient fulfilled the criteria for severe acute respiratory distress syndrome. Despite multimodal therapy, including noninvasive positive pressure ventilation, polymyxin B-immobilized fiber column hemoperfusion, and methylprednisolone infusion, his general condition gradually deteriorated. He died of respiratory failure on day 129. Pathology findings of the lungs during autopsy showed diffuse alveolar damage. To our knowledge, this is the first report of severe respiratory failure after type B influenza infection. Clinicians should be aware of the potential for fatal respiratory failure in cases of type B as well as type A influenza infections.

  14. Severe respiratory failure associated with influenza B virus infection.

    PubMed

    Kato, Shinpei; Fujisawa, Tomoyuki; Enomoto, Noriyuki; Inui, Naoki; Nakamura, Yutaro; Suda, Takafumi

    2015-06-01

    A 72-year-old man who had been diagnosed with type B influenza infection and high fever 4 days previously was admitted to our hospital. He presented with severe respiratory insufficiency; chest computed tomography (CT) revealed extensive ground-glass opacity in lung fields on both sides. Although peramivir and antibiotics were administered, reticular shadows on chest CT worsened and respiratory insufficiency deteriorated. The patient fulfilled the criteria for severe acute respiratory distress syndrome. Despite multimodal therapy, including noninvasive positive pressure ventilation, polymyxin B-immobilized fiber column hemoperfusion, and methylprednisolone infusion, his general condition gradually deteriorated. He died of respiratory failure on day 129. Pathology findings of the lungs during autopsy showed diffuse alveolar damage. To our knowledge, this is the first report of severe respiratory failure after type B influenza infection. Clinicians should be aware of the potential for fatal respiratory failure in cases of type B as well as type A influenza infections. PMID:26090113

  15. Prevention of nosocomial infections in acute respiratory failure patients

    Microsoft Academic Search

    E. Girou

    2003-01-01

    Patients with acute respiratory failure are predisposed to acquire nosocomial infection primarily because they may need ventilatory support, usually invasive mechanical ventilation. The presence of an endotracheal tube impairs natural defences of the respiratory tract and favours airways colonisation and lung infection. Cross transmission of microorganisms may also occur via contaminated hands of healthcare workers that manipulate invasive devices. Thus,

  16. Probabilistic common-cause failures analysis

    Microsoft Academic Search

    Liudong Xing; Wendai Wang

    2008-01-01

    Common-cause failures (CCF) are simultaneous failures of multiple components within a system due to a common-cause or a shared root cause. CCF can contribute significantly to the overall system unreliability. Therefore, it is important to incorporate CCF into the system reliability analysis. Traditional CCF analyses have assumed that the occurrence of a common-cause results in the deterministic\\/guaranteed failure of components

  17. RISK FACTORS FOR HYPOXEMIA AND RESPIRATORY FAILURE IN RESPIRATORY SYNCYTIAL VIRUS BRONCHIOLITIS

    Microsoft Academic Search

    PWK Chan; FYL Lok; SB Khatijah

    2002-01-01

    Respiratory syncytial virus (RSV) bronchiolitis is a common infection in young children and may result in hospitalization. We examined the incidence of, and risk factors associated with, hypoxemia and respiratory failure in 216 children aged < 24 months admitted consecutively for proven RSV bronchiolitis. Hypoxemia was defined as SpO 2 < 90% in room air and severe RSV bronchiolitis requiring

  18. B3. electrical overstress (EOS) failure causes and failure analysis

    Microsoft Academic Search

    Ted Dangelmayer

    2008-01-01

    During this highly interactive workshop you will learn about the causes of EOS and what is known about its failure analysis. A panel of industry experts will help lead the discussion and attendees will be encouraged to actively participate. A number of common root causes will be discussed, failure analysis differentiation from ESD as well as a less well known

  19. Respiratory failure and sleep in neuromuscular disease

    Microsoft Academic Search

    P T Bye; E R Ellis; F G Issa; P M Donnelly; C E Sullivan

    1990-01-01

    Sleep hypoxaemia in non-rapid eye movement (non-REM) and rapid eye movement (REM) sleep was examined in 20 patients with various neuromuscular disorders with reference to the relation between oxygen desaturation during sleep and daytime lung and respiratory muscle function. All the patients had all night sleep studies performed and maximum inspiratory and expiratory mouth pressures (PI and Pemax), lung volumes,

  20. Gene therapy: a novel way to treat respiratory failure?

    PubMed

    Kamoun, Pierre P

    2014-06-01

    Respiratory failure leads to tissue hypoxia and subsequent organ damage. The crocodile hemoglobin affinity for oxygen is significantly reduced in the presence of CO2, allowing crocodiles to stay under water for more than 1h. The crocodile bicarbonate effect can possibly be transplanted into the human hemoglobin by replacing only five and seven amino acid residues in the ?-globin and ?-globin chains, respectively. The resulting hybrid formed by these modified chains has been named Scuba hemoglobin. The in vitro production of Scuba hemoglobin by human hematopoietic stem cells and their reintroduction into the blood could be an interesting tool to improve tissue oxygenation in patients suffering from respiratory failure. PMID:24679667

  1. 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

  2. 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.

  3. Acute hypoxemic respiratory failure in children: case mix and the utility of respiratory severity indices

    Microsoft Academic Search

    M. J. Peters; R. C. Tasker; K. M. Kiff; R. Yates; D. J. Hatch

    1998-01-01

    Objective: Acute hypoxemic respiratory failure (AHRF) is a common reason for emergency pediatric intensive care. An objective assessment\\u000a of disease severity from acute physiological parameters would be of value in clinical practice and in the design of clinical\\u000a trials. We hypothesised that there was a difference in the best early respiratory indices in those who died compared with\\u000a those who

  4. Structures for common-cause failure analysis

    SciTech Connect

    Vaurio, J.K.

    1981-01-01

    Common-cause failure methodology and terminology have been reviewed and structured to provide a systematical basis for addressing and developing models and methods for quantification. The structure is based on (1) a specific set of definitions, (2) categories based on the way faults are attributable to a common cause, and (3) classes based on the time of entry and the time of elimination of the faults. The failure events are then characterized by their likelihood or frequency and the average residence time. The structure provides a basis for selecting computational models, collecting and evaluating data and assessing the importance of various failure types, and for developing effective defences against common-cause failure. The relationships of this and several other structures are described.

  5. Bench-to-bedside review: Weaning failure – should we rest the respiratory muscles with controlled mechanical ventilation?

    Microsoft Academic Search

    Theodoros Vassilakopoulos; Spyros Zakynthinos; Charis Roussos

    2005-01-01

    The use of controlled mechanical ventilation (CMV) in patients who experience weaning failure after a spontaneous breathing trial or after extubation is a strategy based on the premise that respiratory muscle fatigue (requiring rest to recover) is the cause of weaning failure. Recent evidence, however, does not support the existence of low frequency fatigue (the type of fatigue that is

  6. 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

  7. Chronic sublethal stress causes bee colony failure

    PubMed Central

    Bryden, John; Gill, Richard J; Mitton, Robert A A; Raine, Nigel E; Jansen, Vincent A A; Hodgson, David

    2013-01-01

    Current bee population declines and colony failures are well documented yet poorly understood and no single factor has been identified as a leading cause. The evidence is equivocal and puzzling: for instance, many pathogens and parasites can be found in both failing and surviving colonies and field pesticide exposure is typically sublethal. Here, we investigate how these results can be due to sublethal stress impairing colony function. We mathematically modelled stress on individual bees which impairs colony function and found how positive density dependence can cause multiple dynamic outcomes: some colonies fail while others thrive. We then exposed bumblebee colonies to sublethal levels of a neonicotinoid pesticide. The dynamics of colony failure, which we observed, were most accurately described by our model. We argue that our model can explain the enigmatic aspects of bee colony failures, highlighting an important role for sublethal stress in colony declines. PMID:24112478

  8. Pulverizer failure cause analysis. Final report

    Microsoft Academic Search

    K. L. Maloney; R. C. Benson

    1979-01-01

    Large coal pulverizers have been identified by EEI surveys as one of the main systems responsible for lost steam generation capacity of large coal fired utility boilers. This report contains the results of a 16 month study to examine the problem of pulverizer outages and to identify root cause failure modes for the major mill types currently in service. A

  9. NIV-Helmet in Severe Hypoxemic Acute Respiratory Failure

    PubMed Central

    Martins, Joana; Nunes, P.; Silvestre, C.; Abadesso, C.; Loureiro, H.; Almeida, H.

    2015-01-01

    Noninvasive ventilation (NIV) is a method to be applied in acute respiratory failure, given the possibility of avoiding tracheal intubation and conventional ventilation. A previous healthy 5-month-old boy developed low-grade intermittent fever, flu-like symptoms, and dry cough for 3 days. On admission, he showed severe respiratory distress with SpO2/FiO2 ratio of 94. Subsequent evaluation identified an RSV infection complicated with an increase of inflammatory parameters (reactive C protein 15?mg/dL). Within the first hour after NIV-helmet CPAP SpO2/FiO2 ratio increased to 157. This sustained improvement allowed the continuing of this strategy. After 102?h, he was disconnected from the helmet CPAP device. The NIV use in severe hypoxemic acute respiratory failure should be carefully monitored as the absence of clinical improvement has a predictive value in the need to resume to intubation and mechanical ventilation. We emphasize that SpO2/FiO2 ratio is a valuable monitoring instrument. Helmet interface use represents a more comfortable alternative for providing ventilatory support, particularly to small infants, which constitute a sensitive group within pediatric patients. PMID:26000189

  10. Oronasal mask versus helmet in acute hypercapnic respiratory failure.

    PubMed

    Pisani, Lara; Mega, Chiara; Vaschetto, Rosanna; Bellone, Andrea; Scala, Raffaele; Cosentini, Roberto; Musti, Muriel; Del Forno, Manuela; Grassi, Mario; Fasano, Luca; Navalesi, Paolo; Nava, Stefano

    2015-03-01

    The choice of the interface for noninvasive ventilation (NIV) is a key factor in NIV success. We hypothesised that a new helmet specifically design to improve performance in hypercapnic patients would be clinically equivalent to a standard oronasal mask. In a multicentre, short-term, physiological, randomised trial in chronic obstructive pulmonary disease patients facing an acute hypercapnic respiratory failure episode, we compared the changes in arterial blood gases (ABGs) and tolerance score obtained using the helmet or mask, and, as secondary end-points, dyspnoea, vital signs, early NIV discontinuation and rate of intubation. 80 patients were randomly assigned to receive NIV either with the helmet (n=39) or mask (n=41), using an intensive care unit ventilator. Compared with baseline, in the first 6 h, NIV improved ABGs, dyspnoea and respiratory rate (p<0.05) in both groups. Changes in ABGs and discomfort were similar with the two groups, while dyspnoea decreased more (p<0.005) using the mask. The rate of intubation and the need for interface change during the whole period of NIV were very low and not different between groups. The new helmet may be a valid alternative to a mask in improving ABGs and achieving a good tolerance during an episode of acute hypercapnic respiratory failure. PMID:25504992

  11. 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.

  12. Noninvasive ventilation in acute respiratory failure from respiratory syncytial virus bronchiolitis

    PubMed Central

    Nizarali, Zahara; Cabral, Marta; Silvestre, Catarina; Abadesso, Clara; Nunes, Pedro; Loureiro, Helena; Almeida, Helena

    2012-01-01

    Objectives The present study focused on respiratory syncytial virus bronchiolitis with respiratory failure. The aim of the study was to determine whether noninvasive ventilation reduces the need for endotracheal intubation or slows the clinical progression of acute respiratory syncytial virus bronchiolitis by reducing the incidence of infectious complications. Methods The present study was a retrospective cohort study. Cohort A was comprised of children who were admitted to the pediatric intensive and special care unit from 2003-2005 before starting noninvasive ventilation; cohort B was comprised of children who were admitted to the pediatric intensive and special care unit from 2006-2008 after starting noninvasive ventilation. With the exception of noninvasive ventilation, the therapeutic support was the same for the two groups. All children who were diagnosed with respiratory syncytial virus bronchiolitis and respiratory failure between November 2003 and March 2008 were included in the cohort. Demographic, clinical and blood gas variables were analyzed. Results A total of 162 children were included; 75% of the subjects were less than 3 months old. Group A included 64 children, and group B included 98 children. In group B, 34 of the children required noninvasive ventilation. The distributions of the variables age, preterm birth, congenital heart disease, cerebral palsy and chronic lung disease were similar between the two groups. On admission, the data for blood gas analysis and the number of apneas were not significantly different between the groups. In group B, fewer children required invasive ventilation (group A: 12/64 versus group B: 7/98; p=0.02), and there was a reduction in the number of cases of bacterial pneumonia (group A: 19/64 versus group B: 12/98; p=0.008). There was no record of mortality in either of the groups. Conclusion By comparing children with the same disease both before and after noninvasive ventilation was used for ventilation support, we verified a reduction in infectious complications and cases requiring intubation. PMID:23917936

  13. Multicenter, randomized, controlled study of porcine surfactant in severe respiratory syncytial virus-induced respiratory failure.

    PubMed

    Luchetti, Marco; Ferrero, Federica; Gallini, Carla; Natale, Alfonso; Pigna, Antonia; Tortorolo, Luca; Marraro, Giuseppe

    2002-07-01

    OBJECTIVE: Recently, natural exogenous surfactant replacement has been used in experimental models and clinical trials for the treatment of severe respiratory syncytial virus (RSV) disease. The present study was aimed at verifying this hypothesis and confirming the results of our previous pilot study by assessing the effect of surfactant treatment in mechanically ventilated infants with severe RSV-induced respiratory failure. DESIGN: Multicenter, randomized, controlled study. SETTING: Six pediatric intensive care units staffed by full-time intensive care physicians. PATIENTS: A total of 40 infants (20 treated and 20 controls) with RSV-induced respiratory failure requiring conventional mechanical ventilation (CMV) were randomly assigned to either exogenous surfactant (treated group) or conventional treatment (control group) over a 1-yr period. INTERVENTIONS: Fifty milligrams per kilogram of body weight of porcine-derived natural surfactant (Curosurf) was administered. The drug was instilled by means of a syringe attached to a small suction catheter inserted into the endotracheal tube down to its tip, momentarily disconnecting the patient from CMV. Main Outcome Measures: The assessment consisted of the following outcome variables: duration of CMV, length of intensive care unit stay, gas exchange, respiratory mechanics, re-treatment need, complications, and mortality. RESULTS: The two groups were similar with regard to demographics, Pediatric Risk of Mortality scores, and baseline Pao(2)/Fio(2), Paco(2), and ventilator settings. A marked increase in Pao(2)/Fio(2) and decrease in Paco(2) were observed in the treated group after surfactant administration. Hemodynamic parameters remained unchanged throughout the study period. Peak inspiratory pressure and static compliance were similar at baseline in the two groups. A decrease in peak inspiratory pressure and increase in static compliance were observed in the treated group after surfactant administration. Among surfactant-treated patients, 15 received the treatment within 24 hrs of admission, whereas the remainder (five patients) were treated later. Among children who were treated later, three needed an additional dose of surfactant. None of the children treated within 24 hrs needed an additional dose. Duration of CMV and length of stay in the intensive care unit were significantly shorter in the treated group (4.6 +/- 0.8 and 6.4 +/- 0.9 days, respectively) compared with the control group (5.8 +/- 0.7 and 8.2 +/- 1.1 days, respectively) (p <.0001). No relevant complications were observed, and all the infants survived. CONCLUSIONS: Consistent with our previous study and others, this study shows that surfactant therapy improves gas exchange and respiratory mechanics and shortens CMV and intensive care unit stay in infants with severe RSV-induced respiratory failure. PMID:12780967

  14. Determinants of Noninvasive Ventilation Success or Failure in Morbidly Obese Patients in Acute Respiratory Failure

    PubMed Central

    Lemyze, Malcolm; Taufour, Pauline; Duhamel, Alain; Temime, Johanna; Nigeon, Olivier; Vangrunderbeeck, Nicolas; Barrailler, Stéphanie; Gasan, Gaëlle; Pepy, Florent; Thevenin, Didier; Mallat, Jihad

    2014-01-01

    Purpose Acute respiratory failure (ARF) is a common life-threatening complication in morbidly obese patients with obesity hypoventilation syndrome (OHS). We aimed to identify the determinants of noninvasive ventilation (NIV) success or failure for this indication. Methods We prospectively included 76 consecutive patients with BMI>40 kg/m2 diagnosed with OHS and treated by NIV for ARF in a 15-bed ICU of a tertiary hospital. Results NIV failed to reverse ARF in only 13 patients. Factors associated with NIV failure included pneumonia (n?=?12/13, 92% vs n?=?9/63, 14%; p<0.0001), high SOFA (10 vs 5; p<0.0001) and SAPS2 score (63 vs 39; p<0.0001) at admission. These patients often experienced poor outcome despite early resort to endotracheal intubation (in-hospital mortality, 92.3% vs 17.5%; p<0.001). The only factor significantly associated with successful response to NIV was idiopathic decompensation of OHS (n?=?30, 48% vs n?=?0, 0%; p?=?0.001). In the NIV success group (n?=?63), 33 patients (53%) experienced a delayed response to NIV (with persistent hypercapnic acidosis during the first 6 hours). Conclusions Multiple organ failure and pneumonia were the main factors associated with NIV failure and death in morbidly obese patients in hypoxemic ARF. On the opposite, NIV was constantly successful and could be safely pushed further in case of severe hypercapnic acute respiratory decompensation of OHS. PMID:24819141

  15. Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies

    PubMed Central

    2014-01-01

    Background Identifying the predictors of noninvasive ventilation (NIV) failure has attracted significant interest because of the strong link between failure and poor outcomes. However, very little attention has been paid to the timing of the failure. This narrative review focuses on the causes of NIV failure and risk factors and potential remedies for NIV failure, based on the timing factor. Results The possible causes of immediate failure (within minutes to <1 h) are a weak cough reflex, excessive secretions, hypercapnic encephalopathy, intolerance, agitation, and patient-ventilator asynchrony. The major potential interventions include chest physiotherapeutic techniques, early fiberoptic bronchoscopy, changing ventilator settings, and judicious sedation. The risk factors for early failure (within 1 to 48 h) may differ for hypercapnic and hypoxemic respiratory failure. However, most cases of early failure are due to poor arterial blood gas (ABGs) and an inability to promptly correct them, increased severity of illness, and the persistence of a high respiratory rate. Despite a satisfactory initial response, late failure (48 h after NIV) can occur and may be related to sleep disturbance. Conclusions Every clinician dealing with NIV should be aware of these risk factors and the predicted parameters of NIV failure that may change during the application of NIV. Close monitoring is required to detect early and late signs of deterioration, thereby preventing unavoidable delays in intubation. PMID:24520952

  16. 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

  17. Monocyte Interleukin?12 Production Is Inversely Related to Duration of Respiratory Failure in Respiratory Syncytial Virus Bronchiolitis

    Microsoft Academic Search

    L. Bont; A Kavelaars

    2000-01-01

    The correlation of clinical and immunological parameters with the duration of respiratory failure was investigated to identify factors determining the clinical outcome of respiratory syncytial virus (RSV) bronchiolitis necessitating mechanical ventilation. At initiation of me- chanical ventilation in 30 patients with RSV, production of interleukin (IL)-12 and IL-10 was measured in 48-h peripheral blood cell cultures that were stimulated with

  18. Titin mutation segregates with hereditary myopathy with early respiratory failure

    PubMed Central

    Pfeffer, Gerald; Elliott, Hannah R.; Griffin, Helen; Barresi, Rita; Miller, James; Marsh, Julie; Evilä, Anni; Vihola, Anna; Hackman, Peter; Straub, Volker; Dick, David J.; Horvath, Rita; Santibanez-Koref, Mauro; Udd, Bjarne

    2012-01-01

    In 2001, we described an autosomal dominant myopathy characterized by neuromuscular ventilatory failure in ambulant patients. Here we describe the underlying genetic basis for the disorder, and we define the neuromuscular, respiratory and radiological phenotype in a study of 31 mutation carriers followed for up to 31 years. A combination of genome-wide linkage and whole exome sequencing revealed the likely causal genetic variant in the titin (TTN) gene (g.274375T>C; p.Cys30071Arg) within a shared haplotype of 2.93 Mbp on chromosome 2. This segregated with the phenotype in 21 individuals from the original family, nine subjects in a second family with the same highly selective pattern of muscle involvement on magnetic resonance imaging and a third familial case with a similar phenotype. Comparing the mutation carriers revealed novel features not apparent in our original report. The clinical presentation included predominant distal, proximal or respiratory muscle weakness. The age of onset was highly variable, from early adulthood, and including a mild phenotype in advanced age. Muscle weakness was earlier onset and more severe in the lower extremities in nearly all patients. Seven patients also had axial muscle weakness. Respiratory function studies demonstrated a gradual deterioration over time, reflecting the progressive nature of this condition. Cardiomyopathy was not present in any of our patients despite up to 31 years of follow-up. Magnetic resonance muscle imaging was performed in 21 affected patients and revealed characteristic abnormalities with semitendinosus involvement in 20 of 21 patients studied, including 3 patients who were presymptomatic. Diagnostic muscle histopathology most frequently revealed eosinophilic inclusions (inclusion bodies) and rimmed vacuoles, but was non-specific in a minority of patients. These findings have important clinical implications. This disease should be considered in patients with adult-onset proximal or distal myopathy and early respiratory failure, even in the presence of non-specific muscle pathology. Muscle magnetic resonance imaging findings are characteristic and should be considered as an initial investigation, and if positive should prompt screening for mutations in TTN. With 363 exons, screening TTN presented a major challenge until recently. However, whole exome sequencing provides a reliable cost-effective approach, providing the gene of interest is adequately captured. PMID:22577215

  19. Acute Respiratory Failure in Patients with Severe Community-acquired Pneumonia A Prospective Randomized Evaluation of Noninvasive Ventilation

    Microsoft Academic Search

    MARCO CONFALONIERI; ALFREDO POTENA; GIORGIO CARBONE; ROSSANA DELLA PORTA; ELIZABETH A. TOLLEY; G. UMBERTO MEDURI

    In uncontrolled studies, noninvasive positive pressure ventilation (NPPV) was found useful in avoid- ing endotracheal intubation in patients with acute respiratory failure (ARF) caused by severe commu- nity-acquired pneumonia (CAP). We conducted a prospective, randomized study comparing stan- dard treatment plus NPPV delivered through a face mask to standard treatment alone in patients with severe CAP and ARF. Patients fitting

  20. Bronchopulmonary dysplasia. Chronic pulmonary disease following neonatal respiratory failure.

    PubMed

    Nickerson, B G

    1985-04-01

    Infants with respiratory failure in the first weeks of life may develop a chronic pulmonary condition called bronchopulmonary dysplasia. Their lungs have areas of atelectasis and areas of air trapping from variable obstruction of the airways. These infants may be dependent on supplemental oxygen or a ventilator and may require hospitalization for months, and have symptoms of airway obstruction which last for years. They require meticulous medical management to avoid a number of common complications such as patent ductus arteriosus, cor pulmonale, tracheal stenosis, recurrent aspiration, and death. The condition of most infants improves over the first two years. Preliminary studies suggest that their exercise and pulmonary function is usually close to normal by school-age. The long-term implications for the increasing number of children with this disease who will soon reach adulthood are still unknown. PMID:3884289

  1. Is outcome from ARDS related to the severity of respiratory failure?

    Microsoft Academic Search

    M. Ferring; J. L. Vincent

    1997-01-01

    The characteristics and outcome of acute respiratory distress syn- drome (ARDS) may have changed with time. Some studies have reported that mor- tality is more commonly related to the development of sepsis\\/multiple organ failure (MOF), and others that it is related to the severity of acute respiratory failure (ARF). The present study evaluates the relative importance of the two phenomena

  2. Noninvasive ventilation for acute respiratory failure: a prospective randomised placebo-controlled trial

    Microsoft Academic Search

    F. Thys; J. Roeseler; M. Reynaert; G. Liistro; D. O. Rodenstein

    2002-01-01

    Noninvasive ventilation for acute respiratory failure: a prospective randomised placebo- controlled trial. F. Thys, J. Roeseler, M. Reynaert, G. Liistro, D.O. Rodenstein. #ERS Journals Ltd 2002. ABSTRACT: The aim of the present study was to clarify whether the known effects of noninvasive positive-pressure ventilation (NPPV) in patients with respiratory failure are real or due to placebo effects and whether early

  3. Neonatal Respiratory Failure: A 12Month Clinical Epidemiologic Study From 2004 to 2005 in China

    Microsoft Academic Search

    Liling Qian; Cuiqing Liu; Wanzhu Zhuang; Yunxia Guo; Jialin Yu; Hanqiang Chen; Sannan Wang; Zhenlang Lin; Shiwen Xia; Xiaohong Liu; Chao Chen; Bo Sun

    2009-01-01

    OBJECTIVES.In the past decade, neonatal special care services in China have been established, during which time various therapies for neonatal respiratory failure have been introduced. The objective of this study was to investigate the incidence, man- agement, outcome, and cost of neonatal respiratory failure treated by mechanical ventilation in 23 tertiary NICUs of major hospitals in southeastern and midwestern China.

  4. Non-invasive ventilation with bubble CPAP is feasible and improves respiratory physiology in hospitalised Malawian children with acute respiratory failure.

    PubMed

    Walk, J; Dinga, P; Banda, C; Msiska, T; Chitsamba, E; Chiwayula, N; Lufesi, N; Mlotha-Mitole, R; Costello, A; Phiri, A; Colbourn, T; McCollum, E D; Lang, H J

    2014-11-30

    Background: In low-income countries and those with a high prevalence of HIV, respiratory failure is a common cause of death in children. However, the role of non-invasive ventilation with bubble continuous positive airway pressure (bCPAP) in these patients is not well established. Methods: A prospective observational study of bCPAP was undertaken between July and September 2012 in 77 Malawian children aged 1 week to 14 years with progressive acute respiratory failure despite oxygen and antimicrobial therapy. Results: Forty-one (53%) patients survived following bCPAP treatment, and an HIV-uninfected single-organ disease subgroup demonstrated bCPAP success in 14 of 17 (82%). Compared with children aged ?60 months, infants of 0-2 months had a 93% lower odds of bCPAP failure (odds ratio 0·07, 95% confidence interval 0·004-1·02, P ?=? 0·05). Following commencement of bCPAP, respiratory physiology improved, the average respiratory rate decreased from 61 to 49 breaths/minute (P ?=? 0·0006), and mean oxygen saturation increased from 92·1% to 96·1% (P ?=? 0·02). Conclusions: bCPAP was well accepted by caregivers and patients and can be feasibly implemented into a tertiary African hospital with high-risk patients and limited resources. PMID:25434361

  5. 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.

  6. Acute or chronic respiratory failure. Assessment and management of patients with COPD in the emergency setting.

    PubMed

    Schmidt, G A; Hall, J B

    1989-06-16

    Patients with acute or chronic respiratory failure exhibit severe pulmonary impairment as a baseline characteristic. Additional minor insults can precipitate cardiopulmonary failure that requires hospital admission and possibly mechanical ventilation. Our approach to these patients emphasizes evaluation of the imbalance between neuromuscular competence and mechanical load on the respiratory system. In this way, reversible factors can be identified and corrected before they progress to inspiratory muscle fatigue and respiratory failure. For cases in which deterioration is inexorable, guidelines for mechanical ventilation are given and approaches to eventual liberation from the ventilator are reviewed. PMID:2657124

  7. DEFORMATION AND FAILURE CAUSED BY GRAIN BOUNDARY SLIDING AND BRITTLE CRACKING

    E-print Network

    Evans, Anthony G.

    2013-01-01

    DEFORMATION AND FAILURE CAUSED BY GRAIN BOUNDARY SLIDING AND BRITTLEDEFORMATION AND FAILURE CAUSED BY GRAIN BOUNDARY SLIDING AND BRITTLEDEFORMATION AND FAILURE CAUSED BY GRAIN BOUNDARY SLIDING AND BRITTLE

  8. Emergency escape surgery for a gastro-bronchial fistula with respiratory failure that developed after esophagectomy.

    PubMed

    Ibuki, Yuta; Hamai, Yoichi; Hihara, Jun; Taomoto, Junya; Kishimoto, Ichiko; Miyata, Yoshihiro; Okada, Morihito

    2015-03-01

    A gastro-bronchial fistula (GBF) is a rare complication after esophageal reconstruction using a gastric tube, but it can cause severe pneumonia, and the surgical procedure is challenging. We herein describe a patient who was successfully managed using a two-stage operation for a GBF. Because the patient had life-threatening pneumonia and respiratory failure caused by the GBF, we first transected the duodenum, established a cervical esophagostomy and gastrostomy and placed a decompression catheter in the gastric tube without a thoracotomy. The patient recovered from pneumonia after the resolution of the salivary inflow and digestive juice reflux into the lungs through the GBF. Two months later, an esophageal bypass was achieved by reconstructing the esophagus using a long segment of pedicled jejunum. The patient was discharged 38 days thereafter. Appropriate treatment for GBF should be tailored to individual patients based on their current status and disease severity. PMID:24449022

  9. Common environmental allergens causing respiratory allergy in India.

    PubMed

    Singh, A B; Kumar, Pawan

    2002-03-01

    Respiratory allergy affects all age groups but the children are the worst affected by the respiratory allergy. Bioparticles from different biological sources are the main cause of allergy. Pollen grains, fungal spores, insect and other materials of biological origin form the most important allergen load in the air. For the efficient diagnosis of the allergy and its effective treatment it is very important to know about the prevalence, seasonal and annual variations of aeroallergens of the area. India being the climatically diversed country, there is diversity in the flora and fauna of different parts of the country. Atmospheric surveys carried out in different parts of India reveal that, Alanus nitida, Amarantus spinosus, Argemone mexicana Cocos nucifera, Betula utilis, Borasus flabellifer, Caraica papaya, Cedrus deodara, Cassia fistula, Parthenium, Chenopodium album, Dodonaea viscosa, Malotus phillipensis, Plantago ovata, Prosopis juliflora, Ricinus communis, Holoptelea intergifolia are the allergenically important pollens of the country. Among the fungal aeroallergens, Alternaria, Candida aibieans, Aspergillus versicolor, Aspergillus terreus, Aspergillus japonicus, Cladosporium cladosporoides, Fusarium roseum, Ganoderma lucidum,Neurospora sitophila Helminthosporium, Ustilago trtici, Uromyses are important allergens. Dust mites D. farinae, D.pteronyssinus are also important source of inhalant allergens particularly in the coastal areas of the country. Cockroaches, beetles, weevils, mosquitoes, house flies also contribute towards the aeroallergen load and are allergenically implicated. Avoidance of the indoor and outdoor aeroallergens is recommended for better management of respiratory allergy. PMID:12003301

  10. 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

  11. Palliative Care and Dyspnea Management in Patients with Hematological Malignancies and Acute Respiratory Failure

    Microsoft Academic Search

    Amy P. Abernethy; Jane L. Wheeler; David C. Currow

    \\u000a In some patients with hematological malignancies and acute respiratory failure, the clinical emphasis shifts toward palliation.\\u000a In the palliative care phase, the goals of care move from cure of disease to improvement of the patient’s experience of living\\u000a and of dying, and optimization of the patient’s quality of life. Dyspnea, which frequently accompanies respiratory failure,\\u000a is particularly prevalent and distressing

  12. Telemedicine system for the care of patients with neuromuscular disease and chronic respiratory failure

    PubMed Central

    Morete, Emilio; González, Francisco

    2014-01-01

    Introduction Neuromuscular diseases cause a number of limitations which may be improved by using a telemedicine system. These include functional impairment and dependence associated with muscle weakness, the insidious development of respiratory failure and episodes of exacerbation. Material and methods The present study involved three patients with severe neuromuscular disease, chronic respiratory failure and long-term mechanical ventilation, who were followed up using a telemedicine platform. The telemedicine system is based on videoconferencing and telemonitoring of cardiorespiratory variables (oxygen saturation, heart rate, blood pressure and electrocardiogram). Two different protocols were followed depending on whether the patient condition was stable or unstable. Results Over a period of 5 years, we analyzed a series of variables including use of the system, patient satisfaction and clinical impact. Overall we performed 290 videoconference sessions, 269 short monitoring oximetry measurements and 110 blood pressure measurements. With respect to the clinical impact, after enrolment in the telemedicine program, the total number of hospital admissions fell from 18 to 3. Conclusions Our findings indicate that the system was user friendly for patients and care givers. Patient satisfaction scores were acceptable. The telemedicine system was effective for the home treatment of three patients with severe neuromuscular diseases and reduced the need for hospital admissions. PMID:25395959

  13. Inhaled prostacyclin and high-frequency oscillatory ventilation in a premature infant with respiratory syncytial virus-associated respiratory failure.

    PubMed

    Gupta, Manoj; Guertin, Stephen; Martin, Steve; Omar, Said

    2012-08-01

    In a 29-day-old premature infant with respiratory syncytial virus (RSV) pneumonia, we have shown an additive effect of high-frequency oscillatory ventilation (HFOV) and continuous inhalation of prostacyclin (iPGI(2)) with improvement of ventilation and oxygenation. The addition of continuous inhaled iPGI(2) to HFOV was beneficial in the treatment of hypoxemic respiratory failure owing to RSV-associated pneumonia. The improvement in alveolar recruitment by increasing lung expansion by HFOV along with less ventilation-perfusion mismatch by iPGI(2) appears to be responsible for the synergistic effect and favorable clinical outcome. We conclude that the combined therapy of HFOV and continuous inhaled iPGI(2) may be considered in RSV-associated hypoxemic respiratory failure in pediatric patients. PMID:22753555

  14. Partial 3-methylcrotonyl-CoA carboxylase deficiency in an infant with fatal outcome due to progressive respiratory failure

    Microsoft Academic Search

    U. N. Wiesmann; T. Suormala; J. Pfenninger; E. R. Baumgartner

    1998-01-01

    Isolated partial 3-methylcrotonyl-CoA carboxylase (MCC) deficiency has been described to be the cause for a distinct relatively\\u000a mild clinical picture in a single patient. We describe another patient with isolated partial MCC deficiency who suffered from\\u000a failure to thrive, muscular hypotonia and progressive respiratory insufficiency with fatal outcome at the age of 6.5 months.\\u000a MCC deficiency was suspected at 3

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

    PubMed

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

    2014-07-01

    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

  16. Relationships between ventilatory impairment, sleep hypoventilation and type 2 respiratory failure.

    PubMed

    Hillman, David; Singh, Bhajan; McArdle, Nigel; Eastwood, Peter

    2014-11-01

    Conditions that increase load on respiratory muscles and/or reduce their capacity to cope with this load predispose to type 2 (hypercapnic) respiratory failure. In its milder forms, this imbalance between load and capacity may primarily manifest as sleep hypoventilation which, if untreated, can increase the likelihood of wakeful respiratory failure. Such problems are commonly seen in progressive respiratory neuromuscular disorders, morbid obesity and chronic obstructive pulmonary disease, either separately or together. Identifying patients at risk can be important in determining whether and when to intervene with treatments such as non-invasive ventilatory assistance. Measurements of wakeful respiratory function are fundamental to this risk assessment. These issues are reviewed in this paper. PMID:25219542

  17. Chronic respiratory failure due to toxic epidermal necrosis in a 10 year old girl.

    PubMed

    Thimmesch, M; Gilbert, A; Tuerlinckx, D; Bodart, E

    2015-02-01

    Toxic epidermal necrosis is a severe mucocutaneous disease with a high mortality rate. A third of the patients surviving the acute phase will develop pulmonary complications. The most frequent complication is bronchiolitis obliterans. Despite well-conducted treatment, in most cases, lung injury often leads to chronic respiratory failure. We describe here the case of a young patient that presented a toxic epidermal necrosis at the age of 3 years. Poor therapeutic compliance result in chronic respiratory failure and after 7 years of follow-up, pulmonary transplant remains the only long-term alternative. Close monitoring of respiratory symptoms in the course of toxic epidermal necrosis, intense treatment as soon as they appear and a long-term follow-up are essential to postpone chronic respiratory failure. PMID:25324191

  18. 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 ...

  19. Human Respiratory Syncytial Virus Memphis 37 Causes Acute Respiratory Disease in Perinatal Lamb Lung

    PubMed Central

    van Geelen, Albert; Gallup, Jack M.; Kienzle, Thomas; Shelly, Daniel A.; Cihlar, Tomas; King, Robert R.; Ackermann, Mark R.

    2014-01-01

    Abstract Respiratory syncytial virus (RSV) is the leading cause of hospitalization due to respiratory illness among infants and young children of industrialized countries. There is a lack of understanding of the severe disease mechanisms as well as limited treatment options, none of which are fully satisfactory. This is partly due to lack of a relevant animal model of perinatal RSV infection that mimics moderate to severe disease in infants. We and others have shown mild disease in perinatal lambs with either a bovine or a human A2 strain of RSV. The Memphis 37 clinical strain of human RSV has been used to produce mild to moderate upper respiratory disease in healthy adult volunteers. We hypothesized that the Memphis 37 strain of RSV would infect perinatal lambs and produce clinical disease similar to that in human infants. Perinatal (3- to 5-day-old) lambs were inoculated intranasally with 2?mL/nostril of 1×105 focus-forming units (FFU)/mL (n=2) or 2.1×108 FFU/mL (n=3) of RSV Memphis 37. Clinical signs, gross and histological lesions, and immune and inflammatory responses were assessed. Memphis 37 caused moderate to severe gross and histologic lesions along with increased mRNA expression of macrophage inflammatory protein. Clinically, four of the five infected lambs had a mild to severe increase in expiratory effort. Intranasally administered RSV strain Memphis 37 infects neonatal lambs with gross, histologic, and immune responses similar to those observed in human infants. PMID:24804166

  20. Failure Causes of a Polymer Resettable Circuit Protection Device

    NASA Astrophysics Data System (ADS)

    Cheng, Shunfeng; Tom, Kwok; Pecht, Michael

    2012-09-01

    As a circuit protection device, failure or abnormal behavior of polymer positive-temperature-coefficient resettable devices can cause damage to circuits. Identification of failure modes and determination of failure causes are necessary to improve the reliability of resettable circuit protection devices and understand their limitations. In this study, a series of experiments was conducted to identify the failure modes of polymer positive-temperature- coefficient resettable circuit protection devices. The causes of failures of a polymer positive-temperature-coefficient resettable circuit protection device were determined by failure analyses, including analysis of the increase in surface temperature using an infrared camera, interconnection analysis using cross-sectioning and environmental scanning electron microscopy, analysis of the microstructures of carbon-black-filled polymer composite, thermal property analysis of the polymer composite, and coefficient of thermal expansion analysis of different parts of the resettable circuit protection device.

  1. Acute respiratory distress syndrome and acute renal failure from Plasmodium ovale infection with fatal outcome

    PubMed Central

    2013-01-01

    Background Plasmodium ovale is one of the causative agents of human malaria. Plasmodium ovale infection has long been thought to be non-fatal. Due to its lower morbidity, P. ovale receives little attention in malaria research. Methods Two Malaysians went to Nigeria for two weeks. After returning to Malaysia, they fell sick and were admitted to different hospitals. Plasmodium ovale parasites were identified from blood smears of these patients. The species identification was further confirmed with nested PCR. One of them was successfully treated with no incident of relapse within 12-month medical follow-up. The other patient came down with malaria-induced respiratory complication during the course of treatment. Although parasites were cleared off the circulation, the patient’s condition worsened. He succumbed to multiple complications including acute respiratory distress syndrome and acute renal failure. Results Sequencing of the malaria parasite DNA from both cases, followed by multiple sequence alignment and phylogenetic tree construction suggested that the causative agent for both malaria cases was P. ovale curtisi. Discussion In this report, the differences between both cases were discussed, and the potential capability of P. ovale in causing severe complications and death as seen in this case report was highlighted. Conclusion Plasmodium ovale is potentially capable of causing severe complications, if not death. Complete travel and clinical history of malaria patient are vital for successful diagnoses and treatment. Monitoring of respiratory and renal function of malaria patients, regardless of the species of malaria parasites involved is crucial during the course of hospital admission. PMID:24180319

  2. 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.

  3. [Anesthetic management for a patient with chronic expanding hematoma of the thorax associated with respiratory failure].

    PubMed

    Kurotaki, Kenji; Yoshida, Akiko; Ito, Yosuke; Nagaya, Kei

    2015-01-01

    Chronic expanding hematoma (CEH) of the thorax is an intractable disease which induces long-standing growing hematoma after tuberculosis or thoracic surgery. It causes respiratory failure and heart failure by compressing the mediastinum. A 68-year-old man with a history of tuberculosis during childhood had suffered from progressive exertional dyspnea for 20 years. Because a huge hematoma occupying whole right thoracic cavity compressed the heart and the trachea to the left, he was scheduled for extrapleural pneumonectomy. Bronchial arterial embolization was performed preoperatively to prevent hemoptysis and reduce intraoperative blood loss. There was no problem in the airway management using a double lumen endotracheal tube. However, severe hypotension and a decrease in cardiac index were observed due to excessive bleeding, leading to total blood loss of 11,000 g. In addition, surgical manipulation caused abrupt severe hypotension. Monitoring of arterial pressure-based cardiac output and deep body temperature was useful for the hemodynamic management during the operation. The successful postoperative course resulted in remarkable improvement of Huge-Jones dyspnea criteria from IV to II. In the anesthetic management of CEH precautions should be taken against the excessive intraoperative bleeding and abrupt hemodynamic changes. PMID:25868208

  4. [Hospital management of acute respiratory failure: the role of the pulmonologist and of the respiratory intensive care unit].

    PubMed

    Scala, Raffaele

    2009-04-01

    Acute respiratory failure (ARF) is one of the most common and severe urgencies of the modern medicine which may require the application of mechanical ventilation and a careful monitoring of the patient's conditions. With the popularity of non-invasive ventilation and the interest of the pulmonologist for the care of the respiratory critical patient, in Italy there has been the spreading of Respiratory Intensive Care Units (RICU), which are as intermediate specialist structures in terms of intensity of care between the General Intensive Care Unit and the ordinary ward. In this article, the author analysed the cultural, scientific and organizational aspects of the central role played by the pulmonologist who's working in the RICU in the complex intra-hospital multi-disciplinary management of ARF. PMID:19554918

  5. Failure of automobile seat belts caused by polymer degradation

    Microsoft Academic Search

    J. M. Henshaw; V. Wood; A. C. Hall

    1999-01-01

    This paper analyzes the failure of a particular brand of automobile seat belts. The failures described were part of what nearly became the most expensive and widespread automobile recall in U.S. history, affecting about 8.8 x 106 vehicles and with a potential total cost of U.S. $109 . The failures were caused by the degradation and fracture of the seat

  6. Primary ovarian failure caused by a solvent containing 2-bromopropane

    Microsoft Academic Search

    Jung-Min Koh; Chul-Hee Kim; Sung Kwan Hong; Young Tak Kim; On Ja Kim; Ghi Su Kim

    1998-01-01

    Sixteen Korean female laborers who had been exposed to a cleaning solvent composed mainly of 2-bromopropane developed primary ovarian failure. Histologic findings from these patients' ovaries were similar to those observed in ovarian failure caused by radiation or chemotherapy, i.e., reduced number and developmental arrest of primary follicles, interstitial fibrosis and hyalinization of blood vessels. We followed their clinical course

  7. Severe Transient Cardiac Failure Caused by Placental Chorangiosis

    Microsoft Academic Search

    Thomas Schmitz; Bernd Opgen-Rhein; Peter Kroschwald; Gunnar Schroeder; Sven Weber; Christoph Czernik; Michael Obladen

    2007-01-01

    Background: Chorangiomas are villous capillary tumors of the placenta with high impact on neonatal morbidity and mortality. Cardiac complications have occasionally been reported. Objective: To elucidate clinical features, diagnosis and treatment of cardiac failure caused by chorangiomas. Method:We report a case of a newborn, in whom massive chorangiomas were associated with severe cardiac failure, anemia, and thrombocytopenia. Results: Chorangiosis was

  8. Extracorporeal membrane oxygenation for severe acute respiratory failure

    Microsoft Academic Search

    Klaus Lewandowski

    2000-01-01

    Extracorporeal membrane oxygenation (ECMO) is a technique for providing life support, in case the natural lungs are failing and are not able to maintain a sufficient oxygenation of the body's organ systems. ECMO technique was an adaptation of conventional cardiopulmonary bypass technique and introduced into treatment of severe acute respiratory distress syndrome (ARDS) in the 1970s. The intial reports of

  9. Noninvasive Ventilation in Childhood Acute Neuromuscular Respiratory Failure: A Pilot Study

    Microsoft Academic Search

    M. Piastra; M. Antonelli; E. Caresta; A. Chiaretti; G. Polidori; G. Conti

    2006-01-01

    Background: Over a 36-month study period, 10 nonconsecutive neuromuscular pediatric patients (6 infants, mean age 10.16 months, and 4 children, mean age 9.3 years) presenting with acute respiratory failure (ARF) were treated by noninvasive positive pressure ventilation (NPPV). All patients required immediate respiratory support and fulfilled our intubation criteria. Objective: The aim of the study was to verify if early

  10. Noninvasive Positive Pressure Ventilation in Acute Respiratory Failure of Chronic Obstructive Pulmonary Disease

    Microsoft Academic Search

    H. E. Clark; P. G. Wilcox

    1997-01-01

    .   Noninvasive positive pressure ventilation (NPPV) has reemerged as an effective strategy for reducing morbidity and mortality\\u000a associated with acute exacerbations of chronic obstructive pulmonary disease (COPD). During acute respiratory failure, dynamic\\u000a hyperinflation, intrinsic PEEP, and increased airway resistance result in a mechanical workload that exceeds inspiratory muscle\\u000a capacity. NPPV provides augmentation of alveolar ventilation and respiratory muscle rest. Observational,

  11. Emerging indications for extracorporeal membrane oxygenation in adults with respiratory failure.

    PubMed

    Abrams, Darryl; Brodie, Daniel

    2013-08-01

    Recent advances in technology have spurred the increasing use of extracorporeal membrane oxygenation (ECMO) in patients with severe hypoxemic respiratory failure. However, this accounts for only a small percentage of patients with respiratory failure. We envision the application of ECMO in many other forms of respiratory failure in the coming years. Patients with less severe forms of acute respiratory distress syndrome, for instance, may benefit from enhanced lung-protective ventilation with the very low tidal volumes made possible by direct carbon dioxide removal from the blood. For those in whom hypercapnia predominates, extracorporeal support will allow for the elimination of invasive mechanical ventilation in some cases. The potential benefits of ECMO may be further enhanced by improved techniques, which facilitate active mobilization. Although ECMO for these and other expanded applications is under active investigation, it has yet to be proven beneficial in these settings in rigorous controlled trials. Ultimately, with upcoming and future technological advances, there is the promise of true destination therapy, which could lead to a major paradigm shift in the management of respiratory failure. PMID:23952860

  12. 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

  13. 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

  14. Ventilatory strategies in patients with sepsis and respiratory failure

    Microsoft Academic Search

    Dean R. Hess; B. Taylor Thompson

    2005-01-01

    Patients with sepsis may require mechanical ventilation due to the acute respiratory distress syndrome (ARDS). It has become\\u000a increasingly accepted that mechanical ventilation can contribute to lung injury in these patients. The modern concept of ventilator-induced\\u000a lung injury is described in the context of alveolar over-distention (volutrauma), alveolar de-recruitment (atelectrauma),\\u000a and biochemical injury and inflammation to the lung parenchyma (biotrauma).

  15. Inverse ratio ventilation compared with PEEP in adult respiratory failure

    Microsoft Academic Search

    A. G. H. Cole; S. F. Weller; M. K. Sykes

    1984-01-01

    We have compared the cardiorespiratory effects of an inspiratory: expiratory (I:E) ratio of 4:1 with a ratio of 1:2 in 10 adult patients requiring intermittent positive pressure ventilation (IPPV) for acute respiratory insufficiency. Further comparisons were made with IPPV with positive end-expiratory pressure (PEEP) which was adjusted to achieve an equal external end-expiratory volume (EEEV) to that produced by the

  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. Respiratory failure or impairment in amyotrophic lateral sclerosis

    Microsoft Academic Search

    Deborah F. Gelanis

    2001-01-01

    Opinion statement  \\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a •Respiratory complications account for the majority of deaths occurring in patients suffering from amyotrophic lateral sclerosis\\u000a (ALS). Patients normally succumb to their illness within an average of 3 to 5 years from the time of diagnosis from complications\\u000a such as hypoventilation, hypoxemia, hypercarbia, aspiration, and other pneumonia and pulmonary emboli [1]. Although invariably\\u000a disabling, ALS need not

  18. CT in the evaluation of patients on ECMO due to acute respiratory failure

    Microsoft Academic Search

    Marika Lidegran; Kenneth Palmér; Håkan Jorulf; Viveka Lindén

    2002-01-01

    Background. In patients with acute severe respiratory failure (ARF) treated with extracorporeal membrane oxygenation (ECMO) the radiological evaluation has until now almost exclusively relied on bedside radiography and US. At St. Göran\\/Karolinska ECMO centre CT has become a routine complement to bedside examinations. Objective. To review retrospectively the frequency, indications and findings on CT of patients with ARF on ECMO

  19. Noninvasive Ventilation in Chronic Respiratory Failure: Effects on Quality of Life

    Microsoft Academic Search

    Vassiliki Tsolaki; Chaido Pastaka; Konstantinos Kostikas; Eleni Karetsi; Andreas Dimoulis; Andriani Zikiri; Aggela Koutsokera; Konstantinos I. Gourgoulianis

    2011-01-01

    Background: Noninvasive ventilation (NIV) has been found to be an essential technique to treat chronic respiratory failure (CRF) resulting from restrictive thoracic disorders (RTD). The last decades were characterized by the expansion of NIV to treat patients suffering from various other conditions, such as chronic obstructive pulmonary disease (COPD) and obesity hypoventilation syndrome (OHS). Objectives: The aim of this study

  20. Noninvasive Ventilation in Severe Hypoxemic Respiratory Failure A Randomized Clinical Trial

    Microsoft Academic Search

    Miquel Ferrer; Antonio Esquinas; Miguel Leon; Gumersindo Gonzalez; Antonio Alarcon; Antoni Torres

    The efficacy of noninvasive ventilation (NIV) to avoid intubation and improve survival was assessed in 105 patients with severe acute hypoxemic respiratory failure (arterial O2 tension or saturation per- sistently 60 mm Hg or less or 90% or less, respectively; breathing conventional Venturi oxygen at a maximal concentration (50%)), excluding hypercapnia, admitted into intensive care units of three hospitals. Patients

  1. Mortality of Neonatal Respiratory Failure Related to Socioeconomic Factors in Hebei Province of China

    Microsoft Academic Search

    Li Ma; Cuiqing Liu; Yuqi Wang; Shufang Li; Shufen Zhai; Xiaofeng Gu; Fang Liu; Aixia Yan; Wei Guo; Yingyu Li; Min Xiao; Jianying Yin; Yanzhi Li; Xia Liu; Rong Wang; Haresh Kirpalani; Bo Sun

    2011-01-01

    Dramatic progress has occurred in neonatal intensive care in tertiary centers in mid-eastern China. We investigated the characteristics of neonatal respiratory failure (NRF) including the incidence, management, outcomes and costs in 14 neonatal intensive care units (NICUs) of Hebei, a province at an intermediate economic level in China. Over a period of 12 consecutive months in 2007–2008, perinatal data were

  2. Respiratory failure in a patient with antecedent poliomyelitis: Amyotrophic lateral sclerosis or post-polio syndrome?

    Microsoft Academic Search

    Shin-ichi Terao; Naofumi Miura; Aiji Noda; Mari Yoshida; Yoshio Hashizume; Hiroshi Ikeda; Gen Sobue

    2006-01-01

    We report a 69-year-old man who developed paralytic poliomyelitis in childhood and then decades later suffered from fatal respiratory failure. Six months before this event, he had progressive weight loss and shortness of breath. He had severe muscular atrophy of the entire right leg as a sequela of the paralytic poliomyelitis. He showed mild weakness of the facial muscle and

  3. The Circulating Glycosaminoglycan Signature of Respiratory Failure in Critically Ill Adults*

    PubMed Central

    Schmidt, Eric P.; Li, Guoyun; Li, Lingyun; Fu, Li; Yang, Yimu; Overdier, Katherine H.; Douglas, Ivor S.; Linhardt, Robert J.

    2014-01-01

    Systemic inflammatory illnesses (such as sepsis) are marked by degradation of the endothelial glycocalyx, a layer of glycosaminoglycans (including heparan sulfate, chondroitin sulfate, and hyaluronic acid) lining the vascular lumen. We hypothesized that different pathophysiologic insults would produce characteristic patterns of released glycocalyx fragments. We collected plasma from healthy donors as well as from subjects with respiratory failure due to altered mental status (intoxication, ischemic brain injury), indirect lung injury (non-pulmonary sepsis, pancreatitis), or direct lung injury (aspiration, pneumonia). Mass spectrometry was employed to determine the quantity and sulfation patterns of circulating glycosaminoglycans. We found that circulating heparan sulfate fragments were significantly (23-fold) elevated in patients with indirect lung injury, while circulating hyaluronic acid concentrations were elevated (32-fold) in patients with direct lung injury. N-Sulfation and tri-sulfation of heparan disaccharides were significantly increased in patients with indirect lung injury. Chondroitin disaccharide sulfation was suppressed in all groups with respiratory failure. Plasma heparan sulfate concentrations directly correlated with intensive care unit length of stay. Serial plasma measurements performed in select patients revealed that circulating highly sulfated heparan fragments persisted for greater than 3 days after the onset of respiratory failure. Our findings demonstrate that circulating glycosaminoglycans are elevated in patterns characteristic of the etiology of respiratory failure and may serve as diagnostic and/or prognostic biomarkers of critical illness. PMID:24509853

  4. Non-invasive ventilation in chronic obstructive pulmonary disease: management of acute type 2 respiratory failure.

    PubMed

    Roberts, C M; Brown, J L; Reinhardt, A K; Kaul, S; Scales, K; Mikelsons, C; Reid, K; Winter, R; Young, K; Restrick, L; Plant, P K

    2008-10-01

    Non-invasive ventilation (NIV) in the management of acute type 2 respiratory failure in patients with chronic obstructive pulmonary disease (COPD) represents one of the major technical advances in respiratory care over the last decade. This document updates the 2002 British Thoracic Society guidance and provides a specific focus on the use of NIV in COPD patients with acute type 2 respiratory failure. While there are a variety of ventilator units available most centres now use bi-level positive airways pressure units and this guideline refers specifically to this form of ventilatory support although many of the principles encompassed are applicable to other forms of NIV. The guideline has been produced for the clinician caring for COPD patients in the emergency and ward areas of acute hospitals. PMID:18975486

  5. Strontium causes osteomalacia in chronic renal failure rats

    Microsoft Academic Search

    Iris Schrooten; Walter Cabrera; William G. Goodman; Simonne Dauwe; Ludwig V. Lamberts; Rita Marynissen; Walter Dorriné; Marc E. De Broe; Patrick C D’Haese

    1998-01-01

    Strontium causes osteomalacia in chronic renal failure rats.BackgroundWe recently reported an association between increased bone strontium (Sr) levels and osteomalacia in dialysis patients.MethodsTo delineate whether or not Sr acts as a causal factor in the development of osteomalacia, we devised the following study: four groups of chronic renal failure (CRF) rats were given Sr, aluminum (Al), both of these compounds

  6. Estimators for the binomial failure rate common cause model

    SciTech Connect

    Atwood, C.L.

    1980-03-01

    In Vesely's binomial failure rate model, a system of m components is hit by random shocks which may cause components simultaneously to fail, each component equal probability. Individual components may also fail when no shock has occurred. The data possibilities considered are that caused of single failures are identifiable (as shock or not) or not identifiable. Given data from such a system, non-Bayesian and Bayesian point and interval estimators are found for the various quantities of interest. Residual analyses and hypothesis tests are presented for checking the model assumptions. An example is worked out.

  7. Acute respiratory failure induced by bleomycin and hyperoxia

    SciTech Connect

    Goad, M.E.P.

    1985-01-01

    Bleomycin, a chemotherapeutic agent, and oxygen at concentrations greater than 20%, induce acute pulmonary damage separately and when administered together. The interaction of 5 U/kg intratracheal bleomycin and 24 hours of exposure to 80% oxygen in hamsters produces delayed onset acute respiratory distress syndrome three days after treatment. As little as 12 hours of 80% O/sub 2/ exposure, after intratracheal bleomycin, induces severe pulmonary damage. Lung lesions are characterized as diffuse alveolar damage. Significantly pulmonary edema, measured by iodine-125-bovine serum albumin and technetium-99m-diethylenetriaminepentaacetate, occurs 72 hours after treatment. Lesions progress from focal mild alveolar interstitial and air-space macrophage and granulocyte infiltrates at 24 hours to marked infiltrates and severe interstitial and air space edema with hemorrhages and hyaline membranes at 96 hours. Significant changes measured by electron microscopy morphometry are increases in volume fractions of neutrophils, alveolar tissue and mononuclear leukocytes. Surfactant assay of bronchoalveolar lavage fluid shows a marked decrease in the lecithin/sphingomyelin ratio at 72 hours. Proposed mechanisms of bleomycin and hyperoxia synergism include enhanced production of superoxide radicals either directly or indirectly by increasing neutrophil activity or numbers, or by alteration of cell mediators. The pulmonary edema, without evidence of severe morphological changes, may be secondary to alterations of transalveolar transport mechanisms.

  8. Intramural tracheal haematoma causing acute respiratory obstruction in a dog.

    PubMed

    Pink, J J

    2006-03-01

    Respiratory obstruction resulting from a discrete haematoma within the dorsal tracheal membrane was seen in an 11-year-old neutered female greyhound that had been involved in a fight two days earlier. There was no history or evidence of rodenticide toxicity or other coagulopathy, and it is suggested that the tracheal haematoma resulted from trauma. A right third intercostal thoracotomy was performed and this allowed resection of the haematoma from within the dorsal membrane of the cranial thoracic trachea, relieving the obstruction with no subsequent signs of dyspnoea. Intramural haematoma should be considered as a rare differential diagnosis for dogs presenting with acute respiratory obstruction. PMID:16512849

  9. Technetium-99m-methylene Diphosphonate Uptake in Hepatic Necrosis Secondary to Respiratory Failure.

    PubMed

    Mahajan, Madhuri Shimpi; Digamber, Negi S; Sharma, Rajkumar

    2013-09-01

    Tc-99m methylene diphosphonate (MDP) bone scintigraphy has long been used for the evaluation of benign as well as malignant skeletal conditions. However, non-osseous tracer uptake on a bone scan is an unusual finding. On one hand, there is a need for awareness of the pathophysiologic basis underlying such uptake, as it may be of critical clinical relevance in the evaluation of the patient. On the other hand, some alterations in biodistribution may be of little clinical significance, but have deleterious consequences on the quality of the bone study. Recognition of these abnormalities will reduce errors and provide important clinical information. We described a case of 57-year-old male patient with history of carcinoma base of tongue, where a 99mTc-MDP bone Scintigraphy was performed for metastasis survey. It revealed avascular necrosis of head of right femur. In addition incidentally demonstrated diffuse increased pathologic uptake of Tc-99m-MDP in the liver and multiple foci in bilateral lungs. This article reviews several possible reasons for such diffuse hepatic uptake. In the present case diffuse hepatic necrosis secondary to respiratory failure due to bilateral miliary pulmonary metastasis is considered to be the cause of the diffuse liver uptake of 99mTc-MDP. PMID:25165422

  10. Neuromuscular blocking agents in the management of respiratory failure. Indications and treatment guidelines.

    PubMed

    Sapirstein, A; Hurford, W E

    1994-10-01

    Local custom continues to dictate the clinical use of NMBDs in critically ill patients with respiratory failure. The safety of long-term administration of NMBDs to critically ill patients remains of great concern. Studies that clearly delineate the cause of severe myopathies and neuropathies in critically ill paralyzed patients remain to be performed. Because it appears these disorders may be related to the administration of drugs with steroidal structure, we believe it is prudent to avoid such drugs, if possible, in critically ill patients. We therefore continue to use curare, a nonsteroidal drug with a long history of safety, for long-term paralysis in these patients. Similarly, we believe that it is prudent to monitor the efficacy of NMBDs via the routine use of ulnar nerve stimulation. Patient movement in the face of adequate neuromuscular blockade as assessed by ulnar nerve stimulation then can be treated by deepening the level of sedation rather than by continually increasing the dose of the NMBD. PMID:8000929

  11. Technetium-99m-methylene Diphosphonate Uptake in Hepatic Necrosis Secondary to Respiratory Failure

    PubMed Central

    Mahajan, Madhuri Shimpi; Digamber, Negi S.; Sharma, Rajkumar

    2013-01-01

    Tc-99m methylene diphosphonate (MDP) bone scintigraphy has long been used for the evaluation of benign as well as malignant skeletal conditions. However, non-osseous tracer uptake on a bone scan is an unusual finding. On one hand, there is a need for awareness of the pathophysiologic basis underlying such uptake, as it may be of critical clinical relevance in the evaluation of the patient. On the other hand, some alterations in biodistribution may be of little clinical significance, but have deleterious consequences on the quality of the bone study. Recognition of these abnormalities will reduce errors and provide important clinical information. We described a case of 57-year-old male patient with history of carcinoma base of tongue, where a 99mTc-MDP bone Scintigraphy was performed for metastasis survey. It revealed avascular necrosis of head of right femur. In addition incidentally demonstrated diffuse increased pathologic uptake of Tc-99m-MDP in the liver and multiple foci in bilateral lungs. This article reviews several possible reasons for such diffuse hepatic uptake. In the present case diffuse hepatic necrosis secondary to respiratory failure due to bilateral miliary pulmonary metastasis is considered to be the cause of the diffuse liver uptake of 99mTc-MDP. PMID:25165422

  12. An Expert System for Test Failure Root Cause Discovery

    Microsoft Academic Search

    Gary Fix

    2010-01-01

    This paper presents a prototype of an expert system to assist in the discovery and analysis of test failure root cause. The prototype application is most useful in a software development scenario where dedicated software test engineers are employed for testing activities, and these test engineers do not have an intimate knowledge of the internal design and implementation of the

  13. Congestive heart failure caused by vitamin D deficiency?

    PubMed

    Brunvand, L; Hågå, P; Tangsrud, S E; Haug, E

    1995-01-01

    We describe a child, 3.5 months old, with severe vitamin D deficiency, profound hypocalcaemia, hyperphosphataemia, dilated left ventricle, severely reduced myocardial contractility and congestive heart failure. She also had depressed thyroid function with subnormal thyroxine and non-detectable serum thyrotropin (TSH) levels. The child promptly responded to calcium infusions, conventional anticongestive therapy and calcitriol. She is now 3 years old and received no medication. Myocardial function is normal but she has motor delay. We believe that her transitory congestive heart failure was caused by severe vitamin D deficiency with profound hypocalcaemia. PMID:7734890

  14. [Tracheal agenesis. A rare cause of respiratory insufficiency in neonates].

    PubMed

    Schummer, W; Schummer, C; Klemm, P; Brodhun, M; Neumann, R; Bondartschuk, M; Koscielny, S; Hübler, A

    2006-12-01

    Tracheal agenesis is a very rare congenital anomaly that occurs isolated or in combination with other anomalies. It presents immediately after birth with an absolute respiratory insufficiency and lack of crying. The immediate precise anatomical classification of the anomaly is crucial in order to decide if surgical therapy is possible. This report describes a newborn boy with tracheal agenesis type II. The diagnosis was confirmed by spiral computed tomography and a selection of the pictures is presented. The treatment was discontinued due to a lack of therapeutical options. Based on this case report we discuss the special situation of this rare anomaly. Interesting information on tracheal agenesis was gathered, the differential diagnosis of respiratory insufficiency of the newborn is summarised and a modified algorithm of the current newborn resuscitation guidelines of the American Heart Association is presented. PMID:16941161

  15. Safety and efficacy of a sustained inflation for alveolar recruitment in adults with respiratory failure

    Microsoft Academic Search

    S. E. Lapinsky; M. Aubin; S. Mehta; P. Boiteau; A. S. Slutsky

    1999-01-01

    Objective: To assess the safety and efficacy of a sustained inflation, used as a lung volume recruitment maneuver in ventilated patients\\u000a with hypoxemic respiratory failure.¶Design: Prospective data collection as part of a quality assurance program following introduction of a lung volume recruitment guideline\\u000a in the intensive care unit.¶Setting: Academic medical-surgical critical care unit.¶Patients: Hypoxemic patients with bilateral pulmonary infiltrates. Patients

  16. Steroids in full term infants with respiratory failure and pulmonary hypertension due to meconium aspiration syndrome

    Microsoft Academic Search

    David Eustace da Costa; Arun Kumar Nair; Mangalore Govind Pai; Saleh Mohammed Al Khusaiby

    2001-01-01

    Persistent pulmonary hypertension of the newborn (PPHN) due to meconium aspiration syndrome (MAS), has a high morbidity and\\u000a mortality especially in centres with limited access to extra-corporeal membrane oxygenation or nitric oxide therapy. In such\\u000a a setting, we conducted a pilot study to evaluate the effect of dexamethasone on severe respiratory failure with PPHN due\\u000a to MAS with a view

  17. Timing of recovery of lung function after severe hypoxemic respiratory failure in children

    Microsoft Academic Search

    N. D. B. Golder; R. C. Tasker

    1998-01-01

    Objective: To describe the timing of recovery of lung function after severe acute hypoxemic respiratory failure (AHRF) in children.\\u000a Design: A serial observational follow-up study of clinical and lung function measurements up to 53 months after acute illness. Setting: University pediatric intensive care unit in a national children's hospital. Patients: Five critically ill children aged 5–14 years. Interventions: None Results:

  18. Disease-related response to inhaled nitric oxide in newborns with severe hypoxaemic respiratory failure

    Microsoft Academic Search

    J.-C. Mercier; T. Lacaze; L. Storme; J.-C. Rozé; A. Tuan Dinh-Xuan; M. Dehan

    1998-01-01

    Inhaled nitric oxide (iNO) has been shown to improve oxygenation in severe persistent pulmonary hypertension of the newborn\\u000a (PPHN). However, PPHN is often associated with various lung diseases. Thus, response to iNO may depend upon the aetiology\\u000a of neonatal acute respiratory failure. A total of 150 (29 preterm and 121 term) newborns with PPHN were prospectively enrolled\\u000a on the basis

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

    PubMed Central

    de Wit, Emmie; Rasmussen, Angela L.; Falzarano, Darryl; Bushmaker, Trenton; 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.

    2013-01-01

    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 × 106 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

  20. Distempter Vaccination of Dogs: Factors Which Could Cause Vaccine Failure

    PubMed Central

    Povey, R. Charles

    1986-01-01

    Distemper vaccination failures are uncommon. A number of factors which could cause such failure are discussed. The blocking effect of maternal antibody can be expected in 50% of pups at six weeks but is not important after 12 weeks. Among intercurrent infections, the immunosuppressive effect of parvovirus has the potential to precipitate vaccine-induced distemper. Corticosteroids at levels up to 10 mg/kg do not interfere with successful distemper vaccination. Anesthesia or surgery has little effect but use of chloramphenicol or tetracyclines should be avoided. High environmental temperatures can lead to vaccine failure, as can vitamin E deficiency. Excessive environmental exposure to virulent distemper virus can overcome levels of protection which would be adequate under normal circumstances. PMID:17422690

  1. 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.

  2. Analysis of the causes of pump failure and differences of failure characteristics.

    PubMed

    Korving, H; Ottenhoff, E C; Korving, H

    2008-01-01

    It is generally accepted that sewage pumping stations are directly responsible for affecting sewer system performance in terms of combined sewer overflows and flooding. However, the specific causes of pump failure are unknown. This paper presents the analysis of pump failure data provided by four sewer management authorities in The Netherlands. Pump failures have been studied accounting for the nature of failures, operation and maintenance procedures of the management authority, ageing of the pumps and changes in the environment of pumps. Pumps have been clustered on the basis of specific characteristics of their 'environment', including pump age, operating time, pump capacity and degree of pollution of the sewage. The analysis shows that the well known 'bathtub' type failure rate curve can describe failures of sewage pumps. The impact of the degree of pollution of the sewage, however, is less clear. Operating time and total pumping capacity show no correlation with failure rate. Consequently, further research using data mining techniques is needed to separate the impact of the different aspects of the environment of a pump. PMID:18469401

  3. Impact of Positive End-expiratory Pressure on Chest Wall and Lung Pressure-Volume Curve in Acute Respiratory Failure

    Microsoft Academic Search

    MARIO MERGONI; ALESSANDRA MARTELLI; ANNALISA VOLPI; STEFANIA PRIMAVERA; PAOLO ZUCCOLI; ANDREA ROSSI

    To investigate whether chest-wall mechanics could affect the total respiratory system pressure-vol- ume (P-V) curve in patients with acute respiratory failure (ARF), and particularly the lower inflection point (LIP) of the curve, we drew the total respiratory system, lung, and chest-wall P-V curves (P-Vrs, P-V L , and P-Vw, respectively) for 13 patients with ARF, using the supersyringe method together

  4. Predictive Significance of the Six-Minute Walk Distance for Long-Term Survival in Chronic Hypercapnic Respiratory Failure

    Microsoft Academic Search

    Stephan Budweiser; Felix Heidtkamp; Rudolf A. Jörres; Frank Heinemann; Michael Arzt; Stephan Schroll; Kathrin Schmidbauer; Andre P. Hitzl; Michael Pfeifer

    2008-01-01

    Background: The 6-min walk distance (6-MWD) is a global marker of functional capacity and prognosis in chronic obstructive pulmonary disease (COPD), but less explored in other chronic respiratory diseases. Objective: To study the role of 6-MWD in chronic hypercapnic respiratory failure (CHRF). Methods: In 424 stable patients with CHRF and non-invasive ventilation (NIV) comprising COPD (n = 197), restrictive diseases

  5. Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success

    Microsoft Academic Search

    N Ambrosino; K Foglio; F Rubini; E Clini; S Nava; M Vitacca

    1995-01-01

    BACKGROUND--Non-invasive mechanical ventilation is increasingly used in the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to identify simple parameters to predict the success of this technique. METHODS--Fifty nine episodes of acute respiratory failure in 47 patients with COPD treated with non-invasive mechanical ventilation were analysed, considering each one

  6. Respiratory illness caused by overheating of polyvinyl chloride.

    PubMed

    Froneberg, B; Johnson, P L; Landrigan, P J

    1982-08-01

    On 9 August 1979, 62 (30.8%) of 201 workers and one of 60 management personnel in a polyvinyl chloride (PVC) fabricating plant developed acute upper and lower respiratory irritation, headache, nausea, and fainting. All were taken to hospital; none died. Sixty of the patients were women. Interviews two weeks later with 57 affected and 14 unaffected workers disclosed that illness had followed exposure to fumes from an overheated (362 degrees C) PVC extruding machine. Fumes were emitted from 1100 until 1150; cases occurred from 1100 until late afternoon. All workers who became ill worked west of the overheated extruder, and the affected manager had visited that area. The earliest cases occurred closest to the machine, and incidence decreased (from 53.3% to 15.4%) with distance westward. This pattern was consistent with plant ventilation. Incidence rates in men and women did not differ (p greater than 0.1). At two and 14 weeks, pulmonary function testing of workers with persistent pulmonary symptoms showed abnormalities in 13 of 16 and in 9 of 11 respectively; the group with persistent symptoms contained an excess of non-smokers and of those with previous respiratory illnesses. One kilogram of PVC heated to 300 degrees C releases an estimated 12.9 g of hydrochloric acid (HCl) and 4.9 g of carbon monoxide (CO). We attributed the outbreak to exposure to toxic HCl and CO and rejected the hypothesis of mass psychogenic illness. PMID:7093150

  7. Successful management of a dog that had severe rhabdomyolysis with myocardial and respiratory failure.

    PubMed

    Wells, Raegan J; Sedacca, Cassidy D; Aman, Anna M; Hackett, Timothy B; Twedt, David C; Shelton, G Diane

    2009-04-15

    CASE DESCRIPTION - A 6-year-old castrated male Llewelyn Setter was evaluated because of an acute onset of myalgia and respiratory distress. CLINICAL FINDINGS - Physical examination revealed a stiff stilted gait, swollen muscles that appeared to cause signs of pain, panting, and ptyalism. The dog had a decrease in palpebral reflexes bilaterally and a decrease in myotatic reflexes in all 4 limbs. The panniculus reflex was considered normal, and all other cranial nerve reflexes were intact. Serum biochemical analysis revealed markedly high cardiac troponin-I concentration and creatine kinase and aspartate aminotransferase activities. Urinalysis revealed myoglobinuria. Results for thoracic and abdominal radiography, blood pressure measurement, and an ECG were within anticipated limits. Echocardiographic findings were consistent with secondary systolic myocardial failure. Arterial blood gas analysis confirmed hypoxemia and hypoventilation. The dog had negative results when tested for infectious diseases. Examination of skeletal muscle biopsy specimens identified necrotizing myopathy. TREATMENT AND OUTCOME - Treatment included ventilatory support; IV administration of an electrolyte solution supplemented with potassium chloride; administration of dantrolene; vasopressor administration; parenteral administration of nutrients; use of multimodal analgesics; administration of clindamycin, furosemide, mannitol, and enrofloxacin; and dietary supplementation with L-carnitine and coenzyme Q(10). Other medical interventions were not required, and the dog made a rapid and complete recovery. CLINICAL RELEVANCE - Necrotizing myopathy resulting in rhabdomyolysis and myoglobinuria can lead to life-threatening physical and biochemical abnormalities. Making a correct diagnosis is essential, and patients require intensive supportive care. The prognosis can be excellent for recovery, provided there is no secondary organ dysfunction. PMID:19366338

  8. 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.

  9. Respiratory Failure

    MedlinePLUS

    ... occur if your lungs can't properly remove carbon dioxide (a waste gas) from your blood. Too much carbon dioxide in your blood can harm your body's ... problems—a low oxygen level and a high carbon dioxide level in the blood—can occur at ...

  10. Detailed analysis of mitochondrial respiratory chain defects caused by loss of PINK1.

    PubMed

    Amo, Taku; Saiki, Shinji; Sawayama, Tadashi; Sato, Shigeto; Hattori, Nobutaka

    2014-09-19

    Mutations in PTEN-induced putative kinase 1 (PINK1) cause recessive forms of Parkinson's disease (PD). PINK1 acts upstream of parkin, regulating mitochondrial elimination (mitophagy) in cultured cells treated with mitochondrial uncouplers that cause mitochondrial depolarization. PINK1 loss-of-function decreases mitochondrial membrane potential, resulting in mitochondrial dysfunction, although the exact function of PINK1 in mitochondria has not been fully elucidated. We have previously found that PINK1 deficiency causes a decrease in mitochondrial membrane potential, which is not due to a proton leak, but to respiratory chain defects. Here, we examine mitochondrial respiratory chain defects in PINK1-deficient cells, and find both complex I and complex III are defective. These results suggest that mitochondrial respiratory chain defects may be associated with PD pathogenesis caused by mutations in the PINK1 gene. PMID:25092611

  11. High frequency oscillatory ventilation for respiratory failure due to RSV bronchiolitis

    Microsoft Academic Search

    Michel E. Berner; Sylviane Hanquinet; Peter C. Rimensberger

    2008-01-01

    Objective  To describe the time course of high frequency oscillatory ventilation (HFOV) in respiratory syncytial virus (RSV) bronchiolitis.\\u000a \\u000a \\u000a \\u000a Design  Retrospective charts review.\\u000a \\u000a \\u000a \\u000a Setting  A tertiary paediatric intensive care unit.\\u000a \\u000a \\u000a \\u000a Patients and participants  Infants with respiratory failure due to RSV infection.\\u000a \\u000a \\u000a \\u000a Intervention  HFOV.\\u000a \\u000a \\u000a \\u000a Measurements and results  Pattern of lung disease, ventilatory settings, blood gases, infant’s vital parameters, sedation and analgesia during the periods\\u000a of conventional mechanical ventilation

  12. [Home mechanical ventilation : Invasive and noninvasive ventilation therapy for chronic respiratory failure].

    PubMed

    Huttmann, S E; Storre, J H; Windisch, W

    2015-06-01

    Home mechanical ventilation represents a valuable therapeutic option to improve alveolar ventilation in patients with chronic respiratory failure. For this purpose both invasive ventilation via tracheostomy and noninvasive ventilation via facemasks are available. The primary goal of home mechanical ventilation is a reduction of symptoms, improvement of quality of life and in many cases reduction of mortality. Elective establishment of home mechanical ventilation is typically provided for noninvasive ventilation in respect to clinical symptoms and partial pressure of carbon dioxide depending on the underlying disease. However, invasive mechanical ventilation is increasingly being used to continue ventilatory support in polymorbid patients following unsuccessful weaning. Recommendations and guidelines have been published by the German Respiratory Society (DGP). PMID:26065554

  13. Pathogenesis and Causes of Premature Ovarian Failure: An Update

    PubMed Central

    Ebrahimi, Mahbod; Akbari Asbagh, Firoozeh

    2011-01-01

    Premature ovarian failure (POF) affects 1% of young women. This condition has significant psychological sequelae and major health implications. POF seriously interferes with fertility and family planning. Diverse etiologies are associated with POF. Literature review related to the causes and pathogenesis of POF, cited between the year 1900 and May 2010. POF may be either spontaneous or induced. The known causes include: Genetic disorders, which could involve the X chromosome or autosomes. However, the growing body of literature demonstrates a list of newly discovered mutations that may be responsible for causing POF. Most of these mutations are extremely rare, and most cases of POF are still considered to be idiopathic.Autoimmune causes; there is some evidence of an association of POF with lymphocytic oophoritis and other autoimmune disorders. Antiovarian antibodies are reported in POF, but their specificity and pathogenic role are obscure.Iatrogenic causes; chemotherapy, radiotherapy and pelvic surgery can lead to POF.Infectious Causes; some viral and microbial infections can be followed by POF.Environmental toxins, such as cigarette smoking are reported as risk factors of spontaneous POF.Idiopathic; in most cases, no identifiable etiology can be recognized after complete evaluation. PMID:24963360

  14. 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

  15. Prognostic value of extravascular lung water index in critically ill children with acute respiratory failure

    Microsoft Academic Search

    Riccardo Lubrano; Corrado Cecchetti; Marco Elli; Caterina Tomasello; Giuliana Guido; Matteo Di Nardo; Raffaele Masciangelo; Elisabetta Pasotti; Maria Antonietta Barbieri; Elena Bellelli; Nicola Pirozzi

    2011-01-01

    Purpose  In critically ill adults, a reduction in the extravascular lung water index (EVLWi) decreases time on mechanical ventilation\\u000a and improves survival. The purpose of this study is to assess the prognostic value of EVLWi in critically ill children with\\u000a acute respiratory failure and investigate its relationships with PaO2, PaO2\\/FiO2 ratio, A-aDO2, oxygenation index (OI), mean airway pressure, cardiac index, pulmonary

  16. Incidence and causes of non-invasive mechanical ventilation failure after initial success

    Microsoft Academic Search

    Maurizio Moretti; Carmela Cilione; Auro Tampieri; Claudio Fracchia; Alessandro Marchioni; Stefano Nava

    2000-01-01

    BACKGROUNDThe rate of failure of non-invasive mechanical ventilation (NIMV) in patients with chronic obstructive pulmonary disease (COPD) with acute respiratory insufficiency ranges from 5% to 40%. Most of the studies report an incidence of “late failure” (after >48 hours of NIMV) of about 10–20%. The recognition of this subset of patients is critical because prolonged application of NIMV may unduly

  17. Respiratory controversies in the critical care setting. Should noninvasive positive-pressure ventilation be used in all forms of acute respiratory failure?

    PubMed

    Hess, Dean R; Fessler, Henry E

    2007-05-01

    Noninvasive positive-pressure ventilation (NPPV) has been a major advance in the management of acute respiratory failure. Over the past decade alone, NPPV has been the subject of over 1,500 scientific papers, including 14 meta-analyses. NPPV's utility in many clinical settings has been well established, with demonstration in randomized trials of lower intubation rate, mortality, hospital stay, and advantages in other important clinical outcomes. However, it is still used in a minority of patients with acute respiratory failure. While there probably are situations in which NPPV is commonly under-utilized, there are other situations in which it is unlikely to be of benefit or likely to inflict harm. This paper debates the data for and against the more widespread application of NPPV. It will assist the clinician to identify both good and poor candidates for NPPV and thereby devote respiratory care resources where they will be most effective, and optimize patient outcomes. PMID:17484789

  18. Predictors of Death or Bronchopulmonary Dysplasia in Preterm Infants with Respiratory Failure

    PubMed Central

    Ambalavanan, Namasivayam; Van Meurs, Krisa P.; Perritt, Rebecca; Carlo, Waldemar A.; Ehrenkranz, Richard A.; Stevenson, David K.; Lemons, James A.; Poole, W. Kenneth; Higgins, Rosemary D.

    2009-01-01

    Objectives To identify the variables that predict death/physiologic BPD in preterm infants with severe respiratory failure. Study Design The study was a secondary analysis of data from the NICHD Neonatal Research Network trial of inhaled nitric oxide (iNO) in preterm infants. Stepwise logistic regression models and Classification and Regression Tree (CART) models were developed for the outcome of death or physiologic BPD (O2 at 36 weeks’ postmenstrual age). Results Death and/or BPD was associated with lower birth weight, higher oxygen requirement, male gender, additional surfactant doses, higher oxygenation index, and outborn status, but not the magnitude of response in PaO2 to iNO. The positive predictive value of the CART model was 82% at 95% sensitivity. Conclusions The major factors associated with death/BPD were an increased severity of respiratory failure, lower birth weight, male gender, and outborn status, but not the magnitude of initial response to iNO. PMID:18337740

  19. 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

  20. Just a sore throat? Uncommon causes of significant respiratory disease

    PubMed Central

    Wahab, Dalia; Bichard, Julia; Shah, Anand; Mann, Bhupinder

    2013-01-01

    We present two uncommon underlying causes of a sore throat which, if missed or delayed in diagnosis, can lead to disastrous consequences. Our first case is of Lemierre's syndrome diagnosed in a 21-year-old man presenting with a 5-day history of sore throat, fever, right-sided pleuritic chest pain and bilateral pulmonary nodules on CT imaging. Fusobacterium necrophorum cultured from peripheral blood and an occluded left internal jugular vein on ultrasound lead to an eventual diagnosis. Our second case presents a 29-year-old woman with a 5-day history of sore throat, fever and right-sided pleuritic chest pain. A left-sided quinsy was diagnosed and aspirated and the patient was discharged home. She represented shortly with worsening pleuritic pain and was found to have a right-sided pleural effusion with descending mediastinitis originating from the tonsillar abscess. Delayed diagnosis resulted in open thoracotomy, decortication and prolonged intravenous antibiotics. PMID:23632177

  1. Physiological effects and optimisation of nasal assist-control ventilation for patients with chronic obstructive pulmonary disease in respiratory failure

    Microsoft Academic Search

    C. Girault; V. Chevron; J. C. Richard; I. Daudenthun; P. Pasquis; J. Leroy; G. Bonmarchand

    1997-01-01

    BACKGROUND: A study was undertaken to investigate the effects of non-invasive assist-control ventilation (ACV) by nasal mask on respiratory physiological parameters and comfort in acute on chronic respiratory failure (ACRF). METHODS: Fifteen patients with chronic obstructive pulmonary disease (COPD) were prospectively and randomly assigned to two non-invasive ventilation (NIV) sequences in spontaneous breathing (SB) and ACV mode. ACV settings were

  2. Negative pressure ventilation versus conventional mechanical ventilation in the treatment of acute respiratory failure in COPD patients

    Microsoft Academic Search

    A. Corrado; M. Gorini; R. Ginanni; C. Pelagatti; G. Villella; U. Buoncristiano; F. Guidi; E. Pagni; A. Peris; E. De Paola

    1998-01-01

    This case-control study was aimed to evaluate the effectiveness of nega- tive pressure ventilation (NPV) versus conventional mechanical ventilation (CMV) for the treatment of acute respiratory failure (ARF) in patients with chronic obstructive pulmonary disease (COPD) admitted to a respiratory intermediate intensive care unit (RIICU) and four general intensive care units (ICU). Twenty-six COPD patients in ARF admitted in 1994-95

  3. Recurrent respiratory distress and cardiopulmonary arrest caused by megaoesophagus secondary to achalasia?

    PubMed Central

    Mabvuure, Nigel Tapiwa; Hey, Shi Ying; Forshaw, Matthew

    2014-01-01

    INTRODUCTION Respiratory distress and arrest from tracheal compression secondary to megaoesophagus are rare complications of achalasia. We present the case of a man with end-stage achalasia who required oesophagectomy to prevent recurrent life-threatening tracheal compression and respiratory arrest. A literature review is also presented. PRESENTATION OF CASE A 40-year old man presented with post-prandial stridor which resolved spontaneously, later being diagnosed with achalasia. He underwent pneumatic dilatation year later, intended as definitive treatment. Despite intervention, the patient had developed megaoesophagus. One month later he presented with tracheal compression and cardiorespiratory arrest but was successfully resuscitated. He subsequently underwent elective oesophagectomy. DISCUSSION Over 40 case reports of achalasia presenting with stridor have been published. However, only three cases (all female, age range, 35–79 years old) of cardiac, respiratory or cardiorespiratory arrest have been published. The definitive treatments received by these patients were botulinum toxin injections, open Heller cardiomyotomy with Dor fundoplication and pneumatic dilatation. None of these patients suffered recurrent respiratory distress following definitive treatment. The patient currently reported was unique as he suffered cardiorespiratory arrest following an intended definitive treatment, pneumatic dilatation. As such oesophagectomy was considered the greatest risk-reduction intervention. CONCLUSION Oesophagectomy should be considered for patients with end-stage achalasia and mega-oesophagus causing respiratory compromise to avoid potential fatal complications such as tracheal compression and subsequent respiratory arrest. PMID:25128729

  4. Etiology and Outcome of Patients with HIV Infection and Respiratory Failure Admitted to the Intensive Care Unit

    PubMed Central

    Ahmad, Noeen; Butala, Ashvin; Flores, Rosemarie; Tran, Truc; Llosa, Alfonso; Fishkin, Edward

    2013-01-01

    Background. Although access to HAART has prolonged survival and improved quality of life, HIV-infected patients with severe immunosuppression or comorbidities may develop complications that require critical care support. Our objective is to evaluate the etiology of respiratory failure in patients with HIV infection admitted to the ICU, its relationship with the T-lymphocytes cell count as well as the use of HAART, and its impact on outcome. Methods. A single-center, prospective, and observational study among all patients with HIV-infection and respiratory failure admitted to the ICU from December 1, 2011, to February 28, 2013, was conducted. Results. A total of 42 patients were admitted during the study period. Their median CD4 cell count was 123 cells/?L (mean 205.7, range 2.0–694.0), with a median HIV viral load of 203.5 copies/mL (mean 58,676, range <20–367,649). At the time of admission, 23 patients (54.8%) were receiving HAART. Use of antiretroviral therapy at ICU admission was not associated with survival, but it was associated with higher CD4 cell counts and lower HIV viral loads. Twenty-five patients (59.5%) had respiratory failure secondary to non-HIV-related diseases. Mechanical ventilation was required in 36 patients (85.1%). Thirteen patients (31.0%) died. Conclusions. Noninfectious etiologies of respiratory failure account for majority of HIV-infected patients admitted to ICU. Increased mortality was observed among patients with sepsis as etiology of respiratory failure (HIV related and non-AIDS related), in those receiving mechanical ventilation, and in patients with decreased CD4 cell count. Survival was not associated with the use of HAART. Complementary studies are warranted to address the impact of HAART on outcomes of HIV-infected patients with respiratory failure admitted to ICU. PMID:24065988

  5. Respiratory distress in a child caused by lipoma of the esophagus

    Microsoft Academic Search

    Lubna Samad; Mohsin Ali; Hasan Ramzi; Yasmeen Akbani

    1999-01-01

    A 6-year-old girl with a 2-year history of respiratory distress is described in this report. On investigation, a mass occupying the proximal half of the esophageal lumen, which was causing compression of the mediastinum, was found. It was removed surgically by a thoracic approach. On histological examination it was confirmed to be a lipoma of the esophagus. The child had

  6. Real time prediction approach for floods caused by failure of natural dams due to overtopping

    Microsoft Academic Search

    Hongbo Ma; Xudong Fu

    This paper presents a real time prediction approach for floods caused by failure of natural dams due to overtopping. The approach adopts the observed outflow data of the preceding failure process for calibrating a simulation model, and the calibrated model is then implemented to predict the remaining failure process and flood characteristics. A widely used parametric model of dam failure

  7. Different approaches for probability of common cause failure on demand calculations for safety integrity systems

    Microsoft Academic Search

    Josef Börcsök; Peter Holub

    2008-01-01

    The common cause failures (ccf) are the biggest part when calculating the probability of failure for redundant safety integrity systems. A ccf can occur, when a random hardware failure leads to a failure of several components. There are several methods to calculate the probability of ccf. Three models will be shown in this paper, with the help of which the

  8. Functional and histopathological identification of the respiratory failure in a DMSXL transgenic mouse model of myotonic dystrophy

    PubMed Central

    Panaite, Petrica-Adrian; Kuntzer, Thierry; Gourdon, Geneviève; Lobrinus, Johannes Alexander; Barakat-Walter, Ibtissam

    2013-01-01

    SUMMARY Acute and chronic respiratory failure is one of the major and potentially life-threatening features in individuals with myotonic dystrophy type 1 (DM1). Despite several clinical demonstrations showing respiratory problems in DM1 patients, the mechanisms are still not completely understood. This study was designed to investigate whether the DMSXL transgenic mouse model for DM1 exhibits respiratory disorders and, if so, to identify the pathological changes underlying these respiratory problems. Using pressure plethysmography, we assessed the breathing function in control mice and DMSXL mice generated after large expansions of the CTG repeat in successive generations of DM1 transgenic mice. Statistical analysis of breathing function measurements revealed a significant decrease in the most relevant respiratory parameters in DMSXL mice, indicating impaired respiratory function. Histological and morphometric analysis showed pathological changes in diaphragmatic muscle of DMSXL mice, characterized by an increase in the percentage of type I muscle fibers, the presence of central nuclei, partial denervation of end-plates (EPs) and a significant reduction in their size, shape complexity and density of acetylcholine receptors, all of which reflect a possible breakdown in communication between the diaphragmatic muscles fibers and the nerve terminals. Diaphragm muscle abnormalities were accompanied by an accumulation of mutant DMPK RNA foci in muscle fiber nuclei. Moreover, in DMSXL mice, the unmyelinated phrenic afferents are significantly lower. Also in these mice, significant neuronopathy was not detected in either cervical phrenic motor neurons or brainstem respiratory neurons. Because EPs are involved in the transmission of action potentials and the unmyelinated phrenic afferents exert a modulating influence on the respiratory drive, the pathological alterations affecting these structures might underlie the respiratory impairment detected in DMSXL mice. Understanding mechanisms of respiratory deficiency should guide pharmaceutical and clinical research towards better therapy for the respiratory deficits associated with DM1. PMID:23180777

  9. Mitigation of Manhole Events Caused by Secondary Cable Failure

    NASA Astrophysics Data System (ADS)

    Zhang, Lili

    "Manhole event" refers to a range of phenomena, such as smokers, fires and explosions which occur on underground electrical infrastructure, primarily in major cities. The most common cause of manhole events is decomposition of secondary cable initiated by an electric fault. The work presented in this thesis addresses various aspects related to the evolution and mitigation of the manhole events caused by secondary cable insulation failure. Manhole events develop as a result of thermal decomposition of organic materials present in the cable duct and manholes. Polymer characterization techniques are applied to intensively study the materials properties as related to manhole events, mainly the thermal decomposition behaviors of the polymers present in the cable duct. Though evolved gas analysis, the combustible gases have been quantitatively identified. Based on analysis and knowledge of field conditions, manhole events is divided into at least two classes, those in which exothermic chemical reactions dominate and those in which electrical energy dominates. The more common form of manhole event is driven by air flow down the duct. Numerical modeling of smolder propagation in the cable duct demonstrated that limiting air flow is effective in reducing the generation rate of combustible gas, in other words, limiting manhole events to relatively minor "smokers". Besides manhole events, another by-product of secondary cable insulation breakdown is stray voltage. The danger to personnel due to stray voltage is mostly caused by the 'step potential'. The amplitude of step potential as a result of various types of insulation defects is calculated using Finite Element Analysis (FEA) program.

  10. [Recruiting maneuver used in the treatment of respiratory heart failure in cardiosurgical patients].

    PubMed

    Eremenko, A A; Levikov, D I; Zorin, D E; Egorov, V M; Borisov, R Iu

    2006-01-01

    The possibility of performing the recruiting artificial ventilation technique with a high plateau and positive end-expiratory pressure was studied in 32 cardiosurgical patients, including those with cardiovascular insufficiency. The lung opening maneuver, by using the artificial ventilation adjustable by pressure and the monitoring peak pressure, PDKV, tidal volume, and dynamic compliance, by accurately determining the points of opening and closure is the method of choice in alveolar recruitment. This method permits a significant improvement of arterial oxygenation and dynamic compliance of the lung in patients with acute respiratory failure. This maneuver using the high airway pressures adversely affects hemodynamics particularly in patients with lowered reserves of the cardiovascular system. In this connection, a careful monitoring of hemodynamic parameters is required for the timely provision of cardiotonic and vasopressor support. PMID:17288264

  11. 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

  12. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis

    Microsoft Academic Search

    Josephine V Lightowler; Mark W Elliott

    2003-01-01

    Objectives To determine the effectiveness of non›invasive positive pressure ventilation (NPPV) in the management of respiratory failure secondary to acute exacerbation of chronic obstructive pulmonary disease. Design Systematic review of randomised controlled trials that compared NPPV and usual medical care with usual medical care alone in patients admitted to hospital with respiratory failure resulting from an exacerbation of chronic obstructive

  13. Are COPD Patients with Nocturnal REM Sleep-Related Desaturations More Prone to Developing Chronic Respiratory Failure Requiring Long-Term Oxygen Therapy?

    Microsoft Academic Search

    Margherita Sergi; Maurizio Rizzi; Arnaldo Andreoli; Marica Pecis; Claudio Bruschi; Francesco Fanfulla

    2002-01-01

    Background: Nocturnal oxygen desaturations (NOD), especially during REM sleep, have been described in patients with COPD. However, the role of NOD in the evolution of COPD to chronic respiratory failure has not been well studied. Objective: The aim of our study was to evaluate whether NOD is a risk factor for the development of chronic respiratory failure in COPD patients.

  14. Inter-hospital transportation of patients with severe acute respiratory failure on extracorporeal membrane oxygenation - national and international experience

    Microsoft Academic Search

    V. Lindén; K. Palmér; J. Reinhard; R. Westman; H. Ehrén; T. Granholm; B. Frenckner

    2001-01-01

    Objective: To evaluate the experiences and results from inter-hospital transportation of patients with acute respiratory failure on extracorporeal membrane oxygenation (ECMO). Design: Observational, descriptive study. Setting: Tertiary referral center in a University Hospital. Subjects and methods: When standard ECMO criteria were fulfilled and the patient considered too unstable for a conventional transport, the mobile ECMO team cannulated the patient for

  15. Compariso of two different modes for noninvasive mechanical ventilation in chronic respiratory failure: volume versus pressure controlled device

    Microsoft Academic Search

    B. Schönhofer; M. Sonneborn; P. Haidl; H. Böhrer; D. Köhler

    1997-01-01

    Comparison of two different modes for noninvasive mechanical ventilation in chronic respiratory failure: volume versus pressure controlled device. B. Schönhofer, M. Sonneborn, P. Haidl, H. Böhrer, D. Köhler. ©ERS Journals Ltd 1997. ABSTRACT: The most commonly used mode of noninvasive mechanical ventila- tion (NMV) is volume-controlled intermittent positive pressure ventilation (IPPV). Pressure support ventilation has recently become increasingly popular, but

  16. 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.

  17. Analysis of possible failure mechanisms and root failure causes in power plant components using neural networks and structural failure database

    Microsoft Academic Search

    S. Yoshimura; A. S. Jovanovic

    1996-01-01

    This paper describes analyses of cast studies on failure of structural components in power plants using hierarchical (multilayer) neural networks. Using selected test data about case studies stored in the structural failure database of a knowledge-based system, the network is trained: either to predict possible failure mechanisms like creep, overheating (OH), or overstressing (OS)-induced failure (network of Type A), or

  18. Structure–Activity Model of Chemicals That Cause Human Respiratory Sensitization

    Microsoft Academic Search

    Cynthia Graham; Herbert S. Rosenkranz; Meryl H. Karol

    1997-01-01

    We report a structure–activity model of chemicals with the potential to cause respiratory allergy developed through the CASE\\/MultiCASE systems. Chemicals documented to elicit a decrease in FEV1of ?20% within 24 h of inhalation provocation challenge were used to form a learning set. Additional requirements for inclusion in the learning set were that chemicals had at least two contiguous nonhydrogen atoms

  19. Respiratory Infections Cause the Release of Extracellular Vesicles: Implications in Exacerbation of Asthma/COPD

    PubMed Central

    Eltom, Suffwan; Dale, Nicole; Raemdonck, Kristof R. G.; Stevenson, Christopher S.; Snelgrove, Robert J.; Sacitharan, Pradeep K.; Recchi, Chiara; Wavre-Shapton, Silene; McAuley, Daniel F.; O'Kane, Cecilia; Belvisi, Maria G.; Birrell, Mark A.

    2014-01-01

    Background Infection-related exacerbations of respiratory diseases are a major health concern; thus understanding the mechanisms driving them is of paramount importance. Despite distinct inflammatory profiles and pathological differences, asthma and COPD share a common clinical facet: raised airway ATP levels. Furthermore, evidence is growing to suggest that infective agents can cause the release of extracellular vesicle (EVs) in vitro and in bodily fluids. ATP can evoke the P2X7/caspase 1 dependent release of IL-1?/IL-18 from EVs; these cytokines are associated with neutrophilia and are increased during exacerbations. Thus we hypothesized that respiratory infections causes the release of EVs in the airway and that the raised ATP levels, present in respiratory disease, triggers the release of IL-1?/IL-18, neutrophilia and subsequent disease exacerbations. Methods To begin to test this hypothesis we utilised human cell-based assays, ex vivo murine BALF, in vivo pre-clinical models and human samples to test this hypothesis. Results Data showed that in a murine model of COPD, known to have increased airway ATP levels, infective challenge causes exacerbated inflammation. Using cell-based systems, murine models and samples collected from challenged healthy subjects, we showed that infection can trigger the release of EVs. When exposed to ATP the EVs release IL-1?/IL-18 via a P2X7/caspase-dependent mechanism. Furthermore ATP challenge can cause a P2X7 dependent increase in LPS-driven neutrophilia. Conclusions This preliminary data suggests a possible mechanism for how infections could exacerbate respiratory diseases and may highlight a possible signalling pathway for drug discovery efforts in this area. PMID:24972036

  20. Severe acute respiratory syndrome caused by the influenza A (H1N1) virus.

    PubMed

    Ribeiro, Sandra Aparecida; Brasileiro, Graziela Sgreccia; Soleiman, Luciana Novaes Campello; Silva, Cristiano Cruz; Kavaguti, Cláudio Shoki

    2010-01-01

    In view of the pandemic caused by a new virus, influenza A (H1N1), we report the case of a 56-year-old patient without relevant risk factors and with severe acute respiratory syndrome resulting from infection with this virus. We present the results of laboratory tests and the imaging findings (chest X-ray and CT scans). The evolution was favorable, and the patient was discharged after 14 days. PMID:20625677

  1. Naturally occurring respiratory disease in a kennel caused by Bordetella bronchiseptica.

    PubMed

    Bemis, D A; Carmichael, L E; Appel, M J

    1977-04-01

    The role of Bordetella bronchiseptica as a primary pathogen in nautrally occurring respiratory disease of dogs has been in question since its original isolation in 1911. A study to determine the incidence of B. bronchiseptica in a closed breeding kennel has revealed that the frequency of such isolations is closely associated with mild respiratory disease characterized by a moist, sometimes productive, cough. Infection with B. bronchiseptica usually occurred shortly after weaning and produced illness which lasted for one to two weeks. The organisms, however, continued to be shed for two to three months, and important factor in maintaining the infection in this kennel. Adult dogs sampled at frequent intervals did not harbor B. bronchiseptica in spite of their almost constant exposure to heavily infected pups; immunity to reinfection, therefore, appeared to develop. The involvement of several known canine respiratory viral agents was excluded by virus isolation and serological techniques. It therefore was concluded that B. bronchiseptica was the primary cause of respiratory disease in this large breeding kennel. PMID:870289

  2. [Congenital pulmonary lymphangiectasis: an unusual cause of respiratory distress in neonates].

    PubMed

    Nouri-Merchaoui, S; Mahdhaoui, N; Yacoubi, M-T; Seboui, H

    2012-04-01

    Congenital pulmonary lymphangiectasis (CPL) is a rare condition in neonates characterized by abnormal dilatation of the lymphatics draining the interstitial and subpleural spaces of the lungs. Diagnosis is difficult in the neonatal period because respiratory features and radiological findings are not specific of the disease. Definitive diagnosis of CPL can be made only by pathologic examinations. We report a case of a male near-term neonate presenting with severe respiratory distress at birth. The initial chest X-ray showed frosted glass-like infiltrates with air bronchogram suggesting a maternofetal infection or respiratory distress syndrome. The infant required mechanical ventilation and chest tube insertion for right then bilateral pneumothorax. The child died 15 days later in spite of optimal high-frequency ventilation, bilateral pneumothorax drainage, and hemodynamic support. Autopsy revealed features consistent with the diagnosis of CPL. Although CPL is very rare, we should be aware that it is a possible cause of severe unexplained respiratory distress in neonates. PMID:22381667

  3. 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

  4. Discovery of root causes of system failures by means of analysis of repair records

    Microsoft Academic Search

    Tsai-Ching Lu; K. Wojtek Przytula

    2010-01-01

    Repair records constitute an invaluable source of information for early detection of systematic failures, despite issues such as inherent noise and missing data. In this paper, we present methodology and algorithms for mining repair records to discover root causes of system failure. We employ both domain-driven and data-driven clustering approaches to reduce data noise and to consider system failures at

  5. Respiratory depression caused by either morphine microinjection or repetitive electrical stimulation in the region of the nucleus parabrachialis of cats

    Microsoft Academic Search

    Kunihiro Eguchi; Eiko Tadaki; Dante Simbulan Jr; Takao Kumazawa

    1987-01-01

    In chloralose-urethane anesthetized, vagotomized, paralyzed and artificially ventilated cats, respiratory response to either repetitive electrical stimulation or micro-injection of morphine in the rostral pons was studied by recording the phrenic nerve discharges. In the region of the nucleus parabrachialis (PBN) and its ventral reticular formation, electrical stimulation delivered in 20 successive expiratory periods caused the respiratory depression to last long

  6. Fatal respiratory failure during a "technical" rebreather dive at extreme pressure.

    PubMed

    Mitchell, Simon J; Cronjé, Frans J; Meintjes, W A Jack; Britz, Hermie C

    2007-02-01

    A diving fatality at the extreme depth of 264 m fresh water is described. The diver was equipped with an underwater video camera which recorded events leading to his death. These events corroborated predictions about respiratory complications at extreme pressure made by early researchers. Review of the video and relevant literature resulted in the following physiological interpretation: an increase in respired gas density during descent caused a progressive increase in resistance to flow in both the airways and the breathing circuit. Initially, this was associated with a shift to ventilation at higher lung volumes, a relative degree of hypoventilation, and mild permissive hypercapnia. The promotion of turbulent airway flow by increasing gas density resulted in effort-independent expiratory flow at lower flow rates than usual. The consequent inability to match ventilation to the demands of physical work at the bottom precipitated a spiraling crisis of dyspnea, increasing PaCO2, and wasted respiratory effort, thus producing more CO2. Extreme hypercapnia eventually led to unconsciousness. This tragic case provides a timely and salient lesson to a growing population of deep "technical" divers that there are physiological limitations that must be understood and considered when planning extreme dives. PMID:17310877

  7. Vaccine failure caused an outbreak of equine influenza in Croatia

    Microsoft Academic Search

    Ljubo Barbic; Josip Madic; Nenad Turk; Janet Daly

    2009-01-01

    In April 2004 an outbreak of equine influenza occurred at the Zagreb hippodrome, Croatia. Clinical respiratory disease of the same intensity was recorded in vaccinated and non-vaccinated horses. The equine influenza vaccine used in Croatia at the time of the outbreak contained the strains A\\/equine\\/Miami\\/63 (H3N8), A\\/equine\\/Fontainebleau\\/79 (H3N8) and A\\/equine\\/Prague\\/56 (H7N7). At the same time, the usual strains in vaccines

  8. 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

  9. De Novo Uroplakin IIIa Heterozygous Mutations Cause Human Renal Adysplasia Leading to Severe Kidney Failure

    Microsoft Academic Search

    Dagan Jenkins; Maria Bitner-Glindzicz; Sue Malcolm; Chih-Chi A. Hu; Jennifer Allison; Paul J. D. Winyard; Ambrose M. Gullett; David F. M. Thomas; Rachel A. Belk; Sally A. Feather; Tung-Tien Sun; Adrian S. Woolf

    Human renal adysplasia usually occurs sporadically, and bilateral disease is the most common cause of childhood end-stage renal failure, a condition that is lethal without intervention using dialysis or transplantation. De novo heterozygous mutations in Uroplakin IIIa (UPIIIa) are reported in four of 17 children with kidney failure caused by renal adysplasia in the absence of an overt urinary tract

  10. Present situation and cause analysis of diversion dam failures in Japan

    Microsoft Academic Search

    Hajime Miwa; Eiichi Kurashima

    2003-01-01

    Diversion dams are settled in river channels to dam water. They obstruct flood flow and also affect sediment movement on riverbeds. Dam structures break due to local scouring of the riverbed caused by local flow around them. The causes of such failures should be studied by investigating how flow meanders over alternate bars during floods. Diversion dam failures are classified

  11. Correlating failures with asynchronous changes for root cause analysis in enterprise environments

    Microsoft Academic Search

    Manoj K. Agarwal; Venkateswara Reddy Madduri

    2010-01-01

    In enterprise environments, it is critical to find the root cause of performance failures as quickly as possible. More often, root cause for these failures are the change events that are done deliberately by system administrator to fix existing problems in the system. However, these changes may themselves manifest as faults with the change in operating conditions over time. Hence,

  12. Successful allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia during respiratory failure and invasive mechanical ventilation.

    PubMed

    Boehm, Alexandra; Rabitsch, Werner; Locker, Gottfried J; Worel, Nina; Robak, Oliver; Laczika, Klaus F; Staudinger, Thomas; Bojic, Andja; Siersch, Viktoria; Valent, Peter; Sperr, Wolfgang R

    2011-06-01

    Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative treatment option for various hematologic disorders. However, life-threatening adverse events resulting from treatment-related toxicity, severe infections, and/or graft-versus-host disease (GvHD) can occur. We report on a 64-year-old patient suffering from secondary acute myeloid leukemia (AML) who underwent successful allogeneic HSCT while on invasive mandatory ventilation (IMV). The patient received reduced intensity conditioning (RIC) according to the FLAMSA-protocol. Acute respiratory failure occurred one day before scheduled HSCT. Following emergency endotracheal intubation the patient was transferred to the intensive care unit (ICU). Because of respiratory deterioration, stem cell infusion was postponed. After stabilization of respiratory parameters, HSCT was performed during IMV which was continued for seven days. Following hematopoietic regeneration the patient was discharged in good condition on day 35 after HSCT. This case illustrates that intubation and mechanical ventilation do not necessarily exclude leukemic patients from HSCT. PMID:21633813

  13. World Trade Center fine particulate matter causes respiratory tract hyperresponsiveness in mice.

    PubMed

    Gavett, Stephen H; Haykal-Coates, Najwa; Highfill, Jerry W; Ledbetter, Allen D; Chen, Lung Chi; Cohen, Mitchell D; Harkema, Jack R; Wagner, James G; Costa, Daniel L

    2003-06-01

    Pollutants originating from the destruction of the World Trade Center (WTC) in New York City on 11 September 2001 have been reported to cause adverse respiratory responses in rescue workers and nearby residents. We examined whether WTC-derived fine particulate matter [particulate matter with a mass median aerodynamic diameter < 2.5 microm (PM2.5)] has detrimental respiratory effects in mice to contribute to the risk assessment of WTC-derived pollutants. Samples of WTC PM2.5 were derived from settled dust collected at several locations around Ground Zero on 12 and 13 September 2001. Aspirated samples of WTC PM2.5 induced mild to moderate degrees of pulmonary inflammation 1 day after exposure but only at a relatively high dose (100 microg). This response was not as great as that caused by 100 microg PM2.5 derived from residual oil fly ash (ROFA) or Washington, DC, ambient air PM [National Institute of Standards and Technology, Standard Reference Material (SRM) 1649a]. However, this same dose of WTC PM2.5 caused airway hyperresponsiveness to methacholine aerosol comparable to that from SRM 1649a and to a greater degree than that from ROFA. Mice exposed to lower doses by aspiration or inhalation exposure did not develop significant inflammation or hyperresponsiveness. These results show that exposure to high levels of WTC PM2.5 can promote mechanisms of airflow obstruction in mice. Airborne concentrations of WTC PM2.5 that would cause comparable doses in people are high (approximately 425 microg/m3 for 8 hr) but conceivable in the aftermath of the collapse of the towers when rescue and salvage efforts were in effect. We conclude that a high-level exposure to WTC PM2.5 could cause pulmonary inflammation and airway hyperresponsiveness in people. The effects of chronic exposures to lower levels of WTC PM2.5, the persistence of any respiratory effects, and the effects of coarser WTC PM are unknown and were not examined in these studies. Degree of exposure and respiratory protection, individual differences in sensitivity to WTC PM2.5, and species differences in responses must be considered in assessing the risks of exposure to WTC PM2.5. PMID:12782502

  14. Dilated Cardiomyopathies as a Cause of Congestive Heart Failure

    Microsoft Academic Search

    Bernhard Maisch; Arsen D. Risti?; Günter Hufnagel; Reinhard Funck; Peter Alter; Daniela Tontsch; Sabine Pankuweit

    2002-01-01

    Definition and Classification: Cardiomyopathies are disorders affecting the heart muscle that frequently result in congestive heart failure. Five major forms are recognized: dilated, hypertrophic, restrictive, right ventricular, and nonclassifiable cardiomyopathies with distinct hemodynamic properties. Furthermore, the new WHO\\/WHF definition also comprises inflammatory cardiomyopathy, defined as myocarditis in association with cardiac dysfunction. Idiopathic, autoimmune, and infectious forms of inflammatory cardiomyopathy were

  15. 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

  16. Comparison of two non-bronchoscopic methods for evaluating inflammation in patients with acute hypoxaemic respiratory failure

    Microsoft Academic Search

    Giuseppe Colucci; Guido Domenighetti; Roberto Della Bruna; Josè Bonilla; Costanzo Limoni; Michael A Matthay; Thomas R Martin

    2009-01-01

    INTRODUCTION: The simple bedside method for sampling undiluted distal pulmonary edema fluid through a normal suction catheter (s-Cath) has been experimentally and clinically validated. However, there are no data comparing non-bronchoscopic bronchoalveolar lavage (mini-BAL) and s-Cath for assessing lung inflammation in acute hypoxaemic respiratory failure. We designed a prospective study in two groups of patients, those with acute lung injury

  17. 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

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

    PubMed

    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

  19. 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

  20. Myxoedema coma: an almost forgotten, yet still existing cause of multiorgan failure.

    PubMed

    Salomo, Louise Havkrog; Laursen, Adam Hoegsbro; Reiter, Nanna; Feldt-Rasmussen, Ulla

    2014-01-01

    A 48-year-old man was admitted to department of emergency medicine at a tertiary referral hospital due to dizziness and fatigue. Clinical features on admission were non-pitting oedema, dry skin, very sparse hair, a hoarse voice, hypothermia (rectal temperature 28.7°C), macroglossia, sinus bradycardia and slow cerebration. Blood tests revealed severe hypothyroidism. During admission, the patient developed respiratory failure, renal failure, bleeding symptoms and diffuse colitis. The patient was treated with hydrocortisone and levothyroxine and he survived miraculously. This case describes a patient with myxoedema coma with severe hypothermia and cardiac involvement with development of multiorgan dysfunction all linked to the severe depletion of triiodothyronine. PMID:24481020

  1. Causes of failure and life expectancy of the ileoanal pouch

    Microsoft Academic Search

    S. Körsgen; M. R. B. Keighley

    1997-01-01

    .   180 ileoanal pouches constructed over 10 years and followed for at least 2 years (154 for Inflammatory Bowel Disease (IBD)\\u000a and 26 for Familial Adenomatous Polyposis (FAP)) were reviewed. 23 pouches have been excised to date, 8 remain defunctioned\\u000a (pouch failure FAP 7.7%, IBD 18.8%). The reasons for excision were: ischemia (n = 6), pelvic sepsis (n = 5),

  2. Randomized, Multicenter Trial of Conventional Ventilation Versus High-Frequency Oscillatory Ventilation for the Early Management of Respiratory Failure in Term or Near-Term Infants in Colombia

    Microsoft Academic Search

    Mario A Rojas; Juan M Lozano; María X Rojas; Carl L Bose; Martín A Rondón; Gloria Ruiz; Juan G Piñeros; Catherine Rojas; Guillermo Robayo; Angela Hoyos; Luz Astrid Celis; Sergio Torres; Janet Correa

    2005-01-01

    OBJECTIVE:To determine the efficacy and safety of high-frequency oscillatory ventilation (HFOV) compared to conventional ventilation (CV) for the treatment of respiratory failure in term and near-term infants in Colombia.STUDY DESIGN:Eligible infants with moderate to severe respiratory failure were randomized to early treatment with CV or HFOV. Ventilator management and general patient care were standardized. The main outcome was neonatal death

  3. Exhaled nitric oxide in neonates with or without hypoxemic respiratory failure

    PubMed Central

    Liu, Li-juan; Gao, Xi-rong; Wu, Pan-pan; Qian, Li-ling; Chen, Chao; Sun, Bo

    2011-01-01

    BACKGROUND: Exhaled nitric oxide (eNO) is one of the airway condensate derived markers, reflecting mainly airway inflammation in asthma and other lung diseases. The changes of eNO levels as pathophysiology of neonatal hypoxemic respiratory failure (HRF) in early postnatal life have not been thoroughly studied. The present study was to establish a method for measuring eNO concentrations in neonates with or without HRF. METHODS: Twenty-two newborn infants with HRF and 26 non-NRF controls were included within the first 24 hours of postnatal life. Their eNO levels were detected with a rapid-response chemiluminescence analyzer daily during the first week of their postnatal life, and lung mechanics and gas exchange efficiency were monitored at the same time, such as pulse oxygen saturation (SpO2), inspired fraction of oxygen (FiO2) and other parameters. RESULTS: During the first two days of postnatal life, eNO values of HRF neonates were significantly higher than those of the control neonates (day 1, 7.9±3.2 vs. 5.8±1.8 parts per billion [ppb], P<0.05; day 2, 8.8±3.2 vs. 6.0±2.4 ppb, P<0.05), but there were no significant differences in the following days. With SpO2/FiO2 increasing, difference of eNO values between the HRF and non-HRF neonates became narrowed, but there was still a two-fold difference of eNO/[SpO2/(FiO2×100)] on days 5-7. CONCLUSION: We established a method for measuring eNO and found difference in neonates with or without HRF, which diminished with prolonged postnatal days, reflecting pathophysiological characteristics of HRF. PMID:25215009

  4. Root Causes of Component Failures Program: Methods and applications

    SciTech Connect

    Satterwhite, D G; Cadwallader, L C; Vesely, W E; Meale, B M

    1986-12-01

    This report contains information pertaining to definitions, methodologies, and applications of root cause analysis. Of specific interest, and highlighted throughout the discussion, are applications pertaining to current and future Nuclear Regulatory Commission (NRC) light water reactor safety programs. These applications are discussed in view of addressing specific program issues under NRC consideration and reflect current root cause analysis capabilities.

  5. 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.

  6. 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

  7. The pulmonary physician in critical care. 11: critical care management of respiratory failure resulting from COPD.

    PubMed

    Davidson, A C

    2002-12-01

    Survival to hospital discharge of patients suffering exacerbations of COPD is better than other medical causes for ICU admission. Although non-invasive ventilation (NIV) may prevent progression to tracheal intubation, its failure in most cases should lead to a period of controlled mechanical ventilation aiming for early extubation, possibly supported by NIV and tracheostomy if this fails. A greater understanding of the physiological principles behind ventilatory support of patients with COPD should reduce patient-ventilator disharmony and avoid the excessive use of sedation. The risk of nosocomial infection increases with the length of time the patient remains in the ICU and commonly further prolongs the period of ventilator dependency. Weaning centres with an emphasis on general rehabilitation may offer the best support for such individuals. PMID:12454305

  8. Is lactic acidosis a cause of exercise induced hyperventilation at the respiratory compensation point?

    PubMed Central

    Meyer, T; Faude, O; Scharhag, J; Urhausen, A; Kindermann, W

    2004-01-01

    Objectives: The respiratory compensation point (RCP) marks the onset of hyperventilation ("respiratory compensation") during incremental exercise. Its physiological meaning has not yet been definitely determined, but the most common explanation is a failure of the body's buffering mechanisms which leads to metabolic (lactic) acidosis. It was intended to test this experimentally. Methods: During a first ramp-like exercise test on a cycle ergometer, RCP (range: 2.51–3.73 l*min–1 oxygen uptake) was determined from gas exchange measurements in five healthy subjects (age 26–42; body mass index (BMI) 20.7–23.9 kg*m–2; VO2peak 51.3–62.1 ml*min–1*kg–1). On the basis of simultaneous determinations of blood pH and base excess, the necessary amount of bicarbonate to completely buffer the metabolic acidosis was calculated. This quantity was administered intravenously in small doses during a second, otherwise identical, exercise test. Results: In each subject sufficient compensation for the acidosis, that is, a pH value constantly above 7.37, was attained during the second test. A delay but no disappearance of the hyperventilation was present in all participants when compared with the first test. RCP occurred on average at a significantly (p = 0.043) higher oxygen uptake (+0.15 l*min–1) compared with the first test. Conclusions: For the first time it was directly demonstrated that exercise induced lactic acidosis is causally involved in the hyperventilation which starts at RCP. However, it does not represent the only additional stimulus of ventilation during intense exercise. Muscle afferents and other sensory inputs from exercising muscles are alternative triggering mechanisms. PMID:15388552

  9. 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

  10. Differential Ability of Occupational Chemical Contact and Respiratory Allergens to Cause Immediate and Delayed Dermal Hypersensitivity Reactions in Mice

    Microsoft Academic Search

    R. J. Dearman; J. A. Mitchell; D. A. Basketter; I. Kimber

    1992-01-01

    Trimellitic anhydride (TMA) is known to cause occupational respiratory allergy associated with the presence of specific IgE antibody. Other chemicals, such as 2,4-dinitrochlorobenzene (DNCB), while exhibiting a clear potential for contact sensitization, apparently lack the ability to induce respiratory allergy in man. It has been shown previously that although both chemicals are immunogenic in mice, each provoking contact sensitization, exposure

  11. Respiratory epithelial cytotoxicity and membrane damage (holes) caused by amine-modified nanoparticles.

    PubMed

    Ruenraroengsak, Pakatip; Novak, Pavel; Berhanu, Deborah; Thorley, Andrew J; Valsami-Jones, Eugenia; Gorelik, Julia; Korchev, Yuri E; Tetley, Teresa D

    2012-02-01

    The respiratory epithelium is a significant target of inhaled, nano-sized particles, the biological reactivity of which will depend on its physicochemical properties. Surface-modified, 50 and 100 nm, polystyrene latex nanoparticles (NPs) were used as model particles to examine the effect of particle size and surface chemistry on transformed human alveolar epithelial type 1-like cells (TT1). Live images of TT1 exposed to amine-modified NPs taken by hopping probe ion conductance microscopy revealed severe damage and holes on cell membranes that were not observed with other types of NPs. This paralleled induction of cell detachment, cytotoxicity and apoptotic (caspase-3/7 and caspase-9) cell death, and increased release of CXCL8 (IL-8). In contrast, unmodified, carboxyl-modified 50 nm NPs and the 100 nm NPs did not cause membrane damage, and were less reactive. Thus, the susceptibility and membrane damage to respiratory epithelium following inhalation of NPs will depend on both surface chemistry (e.g., cationic) and nano-size. PMID:21352086

  12. CpG motifs in bacterial DNA cause inflammation in the lower respiratory tract.

    PubMed Central

    Schwartz, D A; Quinn, T J; Thorne, P S; Sayeed, S; Yi, A K; Krieg, A M

    1997-01-01

    Since unmethylated CpG motifs are more frequent in DNA from bacteria than vertebrates, and the unmethylated CpG motif has recently been reported to have stimulatory effects on lymphocytes, we speculated that bacterial DNA may induce inflammation in the lower respiratory tract through its content of unmethylated CpG motifs. To determine the role of bacterial DNA in lower airway inflammation, we intratracheally instilled prokaryotic and eukaryotic DNA in C3H/HeBFEJ mice and performed whole lung lavage 4 h after the exposure. Heat denatured, single stranded Escherichia coli genomic DNA (0.06 ng endotoxin/microg DNA) was compared to heat denatured, single stranded calf thymus DNA (0.007 endotoxin/microg DNA). 10 microg of bacterial DNA, in comparison to 10 microg of calf thymus DNA, resulted in a fourfold increase in the concentration of cells (P = 0.0002), a fivefold increase in the concentration of neutrophils (P = 0.0002), a 50-fold increase in the concentration of TNF-alpha (P = 0.001), and a fourfold increase in the concentration of both IL-6 (P = 0.0003) and macrophage inflammatory protein-2 (P = 0.0001) in the lavage fluid. Importantly, instillation of 0.60 ng of E. coli LPS resulted in a negligible inflammatory response. To test whether the stimulatory effects of bacterial DNA are due to its unmethylated CpG dinucleotides, we methylated the bacterial DNA and also prepared 20 base pair oligonucleotides with and without CpG motifs. In comparison to instillation of untreated bacterial DNA, methylation of the bacterial DNA resulted in a significant reduction in the concentration of cells and cytokines in the lower respiratory tract. Moreover, oligonucleotides containing embedded unmethylated CpG motifs resulted in inflammation in the lower respiratory tract that was indistinguishable from that observed with untreated bacterial DNA. In contrast, oligonucleotides without the embedded CpG motifs or with embedded but methylated CpG motifs resulted in significantly less inflammation in the lower respiratory tract. The possible relevance of these data to human disease was shown by extracting and analyzing DNA in sputum from patients with cystic fibrosis (CF). Approximately 0.1 to 1% of this sputum DNA was bacterial. Intratracheal instillation of highly purified CF sputum DNA caused acute inflammation similar to that induced by bacterial DNA. These findings suggest that bacterial DNA, and unmethylated CpG motifs in particular, may play an important pathogenic role in inflammatory lung disease. PMID:9202058

  13. First Neisseria gonorrhoeae strain with resistance to cefixime causing gonorrhoea treatment failure in Austria, 2011.

    PubMed

    Unemo, M; Golparian, D; Stary, A; Eigentler, A

    2011-01-01

    We describe the first cefixime-resistant Neisseria gonorrhoeae strain in Austria that caused treatment failure.It follows the first five cases in Europe of cefixime treatment failure, reported in Norway in 2010 and the United Kingdom in 2011. Effective treatment of gonorrhoea is crucial for public health control and, at present, requires substantially enhanced awareness, more frequent test-of-cure, interaction with experts after therapeutic failure, tracing and therapy of contacts, and surveillance of gonococcal antimicrobial resistance and treatment failures worldwide. PMID:22085601

  14. Does metabolic failure at the synapse cause Alzheimer's disease?

    PubMed

    Engel, Peter A

    2014-12-01

    Alzheimer’s disease (AD) a neurodegenerative disorder of widely distributed cortical networks evolves over years while A beta (Ab) oligomer neurotoxicity occurs within seconds to minutes. This disparity combined with disappointing outcomes of anti-amyloid clinical trials challenges the centrality of Ab as principal mediator of neurodegeneration. Reconsideration of late life AD as the end-product of intermittent regional failure of the neuronal support system to meet the needs of vulnerable brain areas offers an alternative point of view. This model introduces four ideas: (1) That Ab is a synaptic signaling peptide that becomes toxic in circumstances of metabolic stress. (2) That intense synaptic energy and maintenance requirements of cortical hubs may exceed resources during peak demand initiating a neurotoxic cascade in these selectively vulnerable regions. (3) That axonal transport to and from neuron soma cannot account fully for high mitochondrial densities and other requirements of distant terminal axons. (4) That neurons as specialists in information management, delegate generic support functions to astrocytes and other cell types. Astrocytes use intercellular transport by exosomes and tunneling nanotubes (TNTs) to deliver mitochondria, substrates and protein reprocessing services to axonal sites distant from neuronal soma. This viewpoint implicates the brain’s support system and its disruption by various age and disease-related insults as significant mediators of neurodegenerative disease. A better understanding of this system should broaden concepts of neurodegeneration and facilitate development of effective treatments. PMID:25456790

  15. The Effect of Respiratory Scoring on the Diagnosis and Classification of Sleep Disordered Breathing in Chronic Heart Failure

    PubMed Central

    Ward, Neil R.; Roldao, Vitor; Cowie, Martin R.; Rosen, Stuart D.; McDonagh, Theresa A.; Simonds, Anita K.; Morrell, Mary J.

    2013-01-01

    Study Objectives: To evaluate the effect of respiratory scoring criteria on diagnosis and classification of sleep disordered breathing (SDB) in chronic heart failure (CHF). Design: Cross-sectional observational study. Setting: Heart failure and general cardiology clinics at two London hospitals. Patients or Participants: One hundred eighty stable patients with CHF and a median age of 69.6 y, 86% male. Interventions: SDB was diagnosed by polysomnography. The apnea-hypopnea index (AHI) was initially scored using a conservative hypopnea definition of a ? 50% decrease in nasal airflow with a ? 4% oxygen desaturation. The AHI was rescored with hypopnea defined according to the American Academy of Sleep Medicine (AASM) alternative scoring rule, requiring an associated ? 3% oxygen desaturation or arousal. SDB was defined as AHI ? 15/h. Diagnosis and classification of SDB as obstructive sleep apnea (OSA) or central sleep apnea (CSA) with each rule were compared. The effect of mixed apneas on classification of SDB as CSA or OSA was also investigated. Measurements and Results: Median AHI increased from 9.3/h to 13.8/h (median difference 4.6/h) when the AASM alternative rule was used to score hypopneas. SDB prevalence increased from 29% to 46% with the alternative scoring rule (P < 0.001). Classification of SDB as OSA or CSA was not significantly altered by hypopnea scoring rules or the categorization of mixed apneas. Conclusion: Hypopnea scoring rules can significantly influence the apnea-hypopnea index and diagnosis of sleep disordered breathing in chronic heart failure but do not alter the classification as obstructive sleep apnea or central sleep apnea. Standardization of hypopnea scoring rules is important to ensure consistency in diagnosis of sleep disordered breathing in chronic heart failure patients. Citation: Ward NR; Roldao V; Cowie MR; Rosen SD; McDonagh TA; Simonds AK; Morrell MJ. The effect of respiratory scoring on the diagnosis and classification of sleep disordered breathing in chronic heart failure. SLEEP 2013;36(9):1341-1348. PMID:23997367

  16. Genetic ablation of VIAAT in glycinergic neurons causes a severe respiratory phenotype and perinatal death.

    PubMed

    Rahman, Jamilur; Besser, Stefanie; Schnell, Christian; Eulenburg, Volker; Hirrlinger, Johannes; Wojcik, Sonja M; Hülsmann, Swen

    2014-07-16

    Both glycinergic and GABAergic neurons require the vesicular inhibitory amino acid transporter (VIAAT) for synaptic vesicle filling. Presynaptic GABA concentrations are determined by the GABA-synthesizing enzymes glutamate decarboxylase (GAD)65 and GAD67, whereas the presynaptic glycine content depends on the plasma membrane glycine transporter 2 (GlyT2). Although severely impaired, glycinergic transmission is not completely absent in GlyT2-knockout mice, suggesting that other routes of glycine uptake or de novo synthesis of glycine exist in presynaptic terminals. To investigate the consequences of a complete loss of glycinergic transmission, we generated a mouse line with a conditional ablation of VIAAT in glycinergic neurons by crossing mice with loxP-flanked VIAAT alleles with a GlyT2-Cre transgenic mouse line. Interestingly, conditional VIAAT knockout (VIAAT cKO) mice were not viable at birth. In addition to the dominant respiratory failure, VIAAT cKO showed an umbilical hernia and a cleft palate. Immunohistochemistry revealed an almost complete depletion of VIAAT in the brainstem. Electrophysiology revealed the absence of both spontaneous glycinergic and GABAergic inhibitory postsynaptic currents from hypoglossal motoneurons. Our results demonstrate that the deletion of VIAAT in GlyT2-Cre expressing neurons also strongly affects GABAergic transmission and suggest a large overlap of the glycinergic and the GABAergic neuron population during early development in the caudal parts of the brain. PMID:25027639

  17. 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.

  18. Respiratory failure associated with the lipodystrophy syndrome in an HIV-positive patient with compromised lung function.

    PubMed

    Press, N; Montessori, V; Bai, T R; Montaner, J

    2001-01-01

    Protease inhibitors, used as treatment in human immunodeficiency virus (HIV) infection, are associated with a syndrome of peripheral lipodystrophy, central adiposity, hyperlipidemia and insulin resistance. An HIV-positive patient with chronic obstructive pulmonary disease is presented who developed the lipodystrophy syndrome that is associated with the use of protease inhibitors. It is postulated that the lipodystrophy syndrome further compromised his lung function, leading to respiratory failure. Patients who have pulmonary disease and are taking protease inhibitors require monitoring of clinical status and pulmonary function tests. PMID:11521144

  19. Clinical signs and economic losses caused by porcine reproductive and respiratory syndrome virus in a large breeding farm

    Microsoft Academic Search

    Zygmunt Pejsak; Tomasz Stadejek; Iwona Markowska-Daniel

    1997-01-01

    In July of 1994 an acute onset of maternal reporductive failure occurred in a 2,330 sow farrow-to-finish farm. Clinical signs observed in the affected sows were typical for porcine reproductive and respiratory syndrome (PRRS). During the first 6 weeks of the epizootic 1,117 sows farrowed; 216 (19.33%) farrowed before the 110th day of gestation. The majority of piglets born before

  20. Causes of dysregulation of lipid metabolism in chronic renal failure.

    PubMed

    Vaziri, Nosratola D

    2009-01-01

    End-stage renal disease (ESRD) is associated with accelerated atherosclerosis and premature death from cardiovascular disease. These events are driven by oxidative stress inflammation and lipid disorders. ESRD-induced lipid abnormalities primarily stem from dysregulation of high-density lipoprotein (HDL), triglyceride-rich lipoprotein metabolism, and oxidative modification of lipoproteins. In this context, production and plasma concentration of Apo-I and Apo-II are reduced, HDL maturation is impaired, HDL composition is altered, HDL antioxidant and anti-inflammatory functions are depressed, clearance of triglyceride-rich lipoproteins and their atherogenic remnants is impaired, their composition is altered, and their plasma concentration is elevated in ESRD. The associated defect in HDL maturation is largely caused by acquired lecithin-cholesterol acyltransferase deficiency while its triglyceride enrichment is due to hepatic lipase deficiency. Hypertriglyceridemia, abnormal composition, and impaired clearance of triglyceride-rich lipoproteins and their remnants are mediated by down-regulation of lipoprotein lipase, hepatic lipase, very low-density lipoprotein (VLDL) receptor, and LDL receptor-related protein, relative reduction in ApoC-II/ApoC-III ratio, up-regulation of acyl-CoA cholesterol acyltransferase, and elevated plasma level of cholesterol ester-poor prebeta HDL. Impaired clearance and accumulation of oxidation-prone VLDL and chylomicron remnants and abnormal LDL composition in the face of oxidative stress and inflammation favors their uptake by macrophages and resident cells in the artery wall. The effect of heightened influx of lipids is compounded by impaired HDL-mediated reverse cholesterol transport leading to foam cell formation which is the central event in atherosclerosis plaque formation and subsequent plaque rupture, thrombosis, and tissue damage. PMID:20017835

  1. Miliary tuberculosis and adult respiratory distress syndrome

    Microsoft Academic Search

    A. Roglan Piqueras; L. Marruecos; A. Artigas; C. Rodriguez

    1987-01-01

    Although, miliary tuberculosis is an unusual cause of severe acute respiratory failure, we describe nine patients with miliary tuberculosis who developed adult respiratory distress syndrome. This complication occurred in seven patients despite treatment with antituberculous drugs. In two patients who developed the syndrome, miliary tuberculosis was diagnosed only at postmortem. The presence of pulmonary hypertension in all cases and disseminated

  2. Pneumocystis carinii Infection Causes Lung Lesions Historically Attributed to Rat Respiratory Virus

    PubMed Central

    Livingston, Robert S; Besch-Williford, Cynthia L; Myles, Matthew H; Franklin, Craig L; Crim, Marcus J; Riley, Lela K

    2011-01-01

    Idiopathic lung lesions characterized by dense perivascular cuffs of lymphocytes and a lymphohistiocytic interstitial pneumonia have been noted in research rats since the 1990s. Although the etiology of this disease has remained elusive, a putative viral etiology was suspected and the term ‘rat respiratory virus’ (RRV) has been used in reference to this disease agent. The purpose of this study was to determine whether Pneumocystis carinii infection in immunocompetent rats can cause idiopathic lung lesions previously attributed to RRV. In archived paraffin-embedded lungs (n = 43), a significant association was seen between idiopathic lung lesions and Pneumocystis DNA detected by PCR. In experimental studies, lung lesions of RRV developed in 9 of 10 CD rats 5 wk after intratracheal inoculation with P. carinii. No lung lesions developed in CD rats (n = 10) dosed with a 0.22-µm filtrate of the P. carinii inoculum, thus ruling out viral etiologies, or in sham-inoculated rats (n = 6). Moreover, 13 of 16 CD rats cohoused with immunosuppressed rats inoculated with P. carinii developed characteristic lung lesions from 3 to 7 wk after cohousing, whereas no lesions developed in rats cohoused with immunosuppressed sham-inoculated rats (n = 7). Both experimental infection studies revealed a statistically significant association between lung lesion development and exposure to P. carinii. These data strongly support the conclusion that P. carinii infection in rats causes lung lesions that previously have been attributed to RRV. PMID:21819681

  3. Diffuse large B-cell lymphoma causing acute liver failure: a rare case of survival.

    PubMed

    Kapuria, Devika; Strasser, Kristen; Qasem, Abdulraheem

    2015-01-01

    Acute liver failure is a rare but life-threatening illness with an incidence of 2-8 per million population. The most common causes of acute liver failure include drug ingestion and viral hepatitis followed by ischaemic hepatocellular injury and, less commonly, malignancy. Our patient presented with acute liver failure, which was found to be secondary to hepatic infiltration by diffuse large B-cell lymphoma. He received early treatment and has been in remission for more than a year after his initial presentation. To the best of our knowledge, our patient is the second reported survivor of acute liver failure caused by malignant hepatic infiltration by diffuse large B-cell lymphoma. PMID:25969490

  4. Acute Respiratory Distress Syndrome Caused by Pulmonary and Extrapulmonary Disease Different Syndromes?

    Microsoft Academic Search

    LUCIANO GATTINONI; PAOLO PELOSI; PETER M. SUTER; ALESSIA PEDOTO; PAOLA VERCESI; ALFREDO LISSONI

    To assess the possible differences in respiratory mechanics between the acute respiratory distress syndrome (ARDS) originating from pulmonary disease (ARDS p ) and that originating from extrapul- monary disease (ARDS exp ) we measured the total respiratory system (Est,rs), chest wall (Est,w) and lung (Est,L) elastance, the intra-abdominal pressure (IAP), and the end-expiratory lung volume (EELV) at 0, 5, 10,

  5. Single Device Characterization by Nano-probing to Identify Failure Root Cause

    Microsoft Academic Search

    Chao-Chi Wu; Jon C. Lee; Jung-Hsiang Chuang; Tsung-Te Li

    2005-01-01

    In general failure analysis cases, a less invasive fault isolation approach can be utilized to resolve a visual root cause defect. In the case of nano technology, visual defects are not readily resolved, due to an increase in non-visible defects. The non-visible defects result in a lower success rate since conventional FA methods\\/tools are not efficient in identifying the failure

  6. Acute Failure of Catheter Ablation for Ventricular Tachycardia Due to Structural Heart Disease: Causes and Significance

    PubMed Central

    Tokuda, Michifumi; Kojodjojo, Pipin; Tung, Stanley; Tedrow, Usha B.; Nof, Eyal; Inada, Keiichi; Koplan, Bruce A.; Michaud, Gregory F.; John, Roy M.; Epstein, Laurence M.; Stevenson, William G.

    2013-01-01

    Background Acute end points of catheter ablation for ventricular tachycardia (VT) remain incompletely defined. The aim of this study is to identify causes for failure in patients with structural heart disease and to assess the relation of this acute outcome to longer?term management and outcomes. Methods and Results From 2002 to 2010, 518 consecutive patients (84% male, 62±14 years) with structural heart disease underwent a first ablation procedure for sustained VT at our institution. Acute ablation failure was defined as persistent inducibility of a clinical VT. Acute ablation failure was seen in 52 (10%) patients. Causes for failure were: intramural free wall VT in 13 (25%), deep septal VT in 9 (17%), decision not to ablate due to proximity to the bundle of His, left phrenic nerve, or a coronary artery in 3 (6%), and endocardial ablation failure with inability or decision not to attempt to access the epicardium in 27 (52%) patients. In multivariable analysis, ablation failure was an independent predictor of mortality (hazard ratio 2.010, 95% CI 1.147 to 3.239, P=0.004) and VT recurrence (hazard ratio 2.385, 95% CI 1.642 to 3.466, P<0.001). Conclusions With endocardial or epicardial ablation, or both, acute ablation failure was seen in 10% of patients, largely due to anatomic factors. Persistence of a clinical VT is associated with recurrence and comparatively higher mortality. PMID:23727700

  7. An Indian hospital study of viral causes of acute respiratory infection in children

    Microsoft Academic Search

    A. JAIN; A. PANDE; P. K. MISRA; A. MATHURt; U. C. CHATURVEDI

    1991-01-01

    Summary. From Sept. 1986 to Jan. 1989, a hospital-based study was conducted on 736 children, under 5 years of age, with acute respiratory infection. Nasopharyngeal secretions were examined for viruses by culture and by immunofluorescence. Viruses were detected in 22% of specimens : respiratory syncytial(5%), parainfluenza (5%), influenza A (4%), influenza B (273, adenovirus (373, measles (3%). The highest rates

  8. Common-Cause Failure Analysis for Reactor Protection System Reliability Studies

    SciTech Connect

    Gentillon, C.; Rasmuson, D.; Eide, S.; Wierman, T.

    1999-08-01

    Analyses were performed of the safety-related performance of the reactor protection system (RPS) at U.S. Westinghouse and General Electric commercial reactors during the period 1984 through 1995. RPS operational data from these reactors were collected from the Nuclear Plant Reliability Data System (NPRDS) and Licensee Event Reports (LER). The common-cause failure (CCF) modeling in the fault trees developed for these studies and the analysis and use of common-cause failure data were sophisticated, state-of-the-art efforts. The overall CCF effort helped to test and expand the limits of the U.S. Nuclear Regulatory Commission's CCF methodology.

  9. Heart failure caused by hookworm infection possibly associated with organic food consumption.

    PubMed

    Kajiya, Takashi; Kuroda, Atsushi; Hokonohara, Daisuke; Tei, Chuwa

    2006-01-01

    An 87-year-old man with heart failure caused by severe anemia was referred to our hospital. Gastroenteroscopy revealed the existence of several parasites in the duodenum. Examination of the stool by a formalin-ethyl acetate concentration technique detected hookworm eggs. After a single dose of pyrantel pamoate, his symptoms including dyspnea on exertion and edema diminished. And also hemoglobin and B-type natriuretic peptide (BNP) had improved dramatically. Hookworm infection is an extremely rare cause of heart failure, and furthermore this parasitic infection is not common in advanced countries. We suggest the possible relationship between parasite infection and organic foods. PMID:16880709

  10. 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

    2014-11-22

    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

  11. 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 ...

  12. Otalgia and eschar in the external auditory canal in scrub typhus complicated by acute respiratory distress syndrome and multiple organ failure

    PubMed Central

    2011-01-01

    Background Scrub typhus, a mite-transmitted zoonosis caused by Orientia tsutsugamushi, is an endemic disease in Taiwan and may be potentially fatal if diagnosis is delayed. Case presentations We encountered a 23-year-old previously healthy Taiwanese male soldier presenting with the right ear pain after training in the jungle and an eleven-day history of intermittent high fever up to 39°C. Amoxicillin/clavulanate was prescribed for otitis media at a local clinic. Skin rash over whole body and abdominal cramping pain with watery diarrhea appeared on the sixth day of fever. He was referred due to progressive dyspnea and cough for 4 days prior to admission in our institution. On physical examination, there were cardiopulmonary distress, icteric sclera, an eschar in the right external auditory canal and bilateral basal rales. Laboratory evaluation revealed thrombocytopenia, elevation of liver function and acute renal failure. Chest x-ray revealed bilateral diffuse infiltration. Doxycycline was prescribed for scrub typhus with acute respiratory distress syndrome and multiple organ failure. Fever subsided dramatically the next day and he was discharged on day 7 with oral tetracycline for 7 days. Conclusion Scrub typhus should be considered in acutely febrile patients with multiple organ involvement, particularly if there is an eschar or a history of environmental exposure in endemic areas. Rapid and accurate diagnosis, timely administration of antibiotics and intensive supportive care are necessary to decrease mortality of serious complications of scrub typhus. PMID:21450057

  13. 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.

  14. Analysis of the causes of failure in high chrome oxide refractory materials from slagging gasifiers

    SciTech Connect

    Bennett, J.P.; Kwong, K.-S.; Powell, C.A.; Thomas, H.; Krabbe, R.A.

    2006-03-01

    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 1575oC 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.

  15. Biallelic Mutations in NBAS Cause Recurrent Acute Liver Failure with Onset in Infancy.

    PubMed

    Haack, Tobias B; Staufner, Christian; Köpke, Marlies G; Straub, Beate K; Kölker, Stefan; Thiel, Christian; Freisinger, Peter; Baric, Ivo; McKiernan, Patrick J; Dikow, Nicola; Harting, Inga; Beisse, Flemming; Burgard, Peter; Kotzaeridou, Urania; Kühr, Joachim; Himbert, Urban; Taylor, Robert W; Distelmaier, Felix; Vockley, Jerry; Ghaloul-Gonzalez, Lina; Zschocke, Johannes; Kremer, Laura S; Graf, Elisabeth; Schwarzmayr, Thomas; Bader, Daniel M; Gagneur, Julien; Wieland, Thomas; Terrile, Caterina; Strom, Tim M; Meitinger, Thomas; Hoffmann, Georg F; Prokisch, Holger

    2015-07-01

    Acute liver failure (ALF) in infancy and childhood is a life-threatening emergency. Few conditions are known to cause recurrent acute liver failure (RALF), and in about 50% of cases, the underlying molecular cause remains unresolved. Exome sequencing in five unrelated individuals with fever-dependent RALF revealed biallelic mutations in NBAS. Subsequent Sanger sequencing of NBAS in 15 additional unrelated individuals with RALF or ALF identified compound heterozygous mutations in an additional six individuals from five families. Immunoblot analysis of mutant fibroblasts showed reduced protein levels of NBAS and its proposed interaction partner p31, both involved in retrograde transport between endoplasmic reticulum and Golgi. We recommend NBAS analysis in individuals with acute infantile liver failure, especially if triggered by fever. PMID:26073778

  16. CAUSES AND PREVENTION OF VIBRATION INDUCED FAILURES IN SUBMERGIBLE OILWELL PUMPING EQUIPMENT

    Microsoft Academic Search

    T. R. Brinner; F. T. Traylor; R. E. Stewart

    1982-01-01

    Vibration phenomena in Electric Submergible Pumping Systems is rarely identified as the cause of premature system failure. This is the result of a number of factors. The first is a lack of sensed and recorded downhole operational parameters pertinent to the mechanical condition of the machine. The second arises from the practice of attempting restart several times before pulling a

  17. Failure to respond to endogenous or exogenous melatonin may cause nonphotoresponsiveness in Harlan Sprague Dawley rats

    Microsoft Academic Search

    Matthew Rocco Price; Julie Anita Marie Kruse; M Eric Galvez; Annaka M Lorincz; Mauricio Avigdor; Paul D Heideman

    2005-01-01

    BACKGROUND: Responsiveness to changing photoperiods from summer to winter seasons is an important but variable physiological trait in most temperate-zone mammals. Variation may be due to disorders of melatonin secretion or excretion, or to differences in physiological responses to similar patterns of melatonin secretion and excretion. One potential cause of nonphotoresponsiveness is a failure to secrete or metabolize melatonin in

  18. Direct likelihood inference and sensitivity analysis for competing risks regression with missing causes of failure.

    PubMed

    Moreno-Betancur, Margarita; Rey, Grégoire; Latouche, Aurélien

    2015-06-01

    Competing risks arise in the analysis of failure times when there is a distinction between different causes of failure. In many studies, it is difficult to obtain complete cause of failure information for all individuals. Thus, several authors have proposed strategies for semi-parametric modeling of competing risks when some causes of failure are missing under the missing at random (MAR) assumption. As many authors have stressed, while semi-parametric models are convenient, fully-parametric regression modeling of the cause-specific hazards (CSH) and cumulative incidence functions (CIF) may be of interest for prediction and is likely to contribute towards a fuller understanding of the time-dynamics of the competing risks mechanism. We propose a so-called "direct likelihood" approach for fitting fully-parametric regression models for these two functionals under MAR. The MAR assumption not being verifiable from the observed data, we propose an approach for performing sensitivity analyses to assess the robustness of inferences to departures from this assumption. The method relies on so-called "pattern-mixture models" from the missing data literature and was evaluated in a simulation study. This sensitivity analysis approach is applicable to various competing risks regression models (fully-parametric or semi-parametric, for the CSH or the CIF). We illustrate the proposed methods with the analysis of a breast cancer clinical trial, including suggestions for ad hoc graphical goodness-of-fit assessments under MAR. PMID:25761785

  19. Common root causes of recent failures of flanges in pressure vessels subjected to dynamic loads

    Microsoft Academic Search

    J. L. Otegui; P. G. Fazzini; A. Márquez

    2009-01-01

    Present rules in fabrication codes are aimed to reduce the probability of fatigue cracks in flanges welded to pressure vessels subjected to cyclic pressure or vibrations. Yet, several leaks and ruptures have recently occurred at flanges in pressure vessels and pipes. A review of three cases is presented, which involved five failures; their common root causes are discussed, and the

  20. Study on the root causes for the premature failure of an aircraft turbine blade

    Microsoft Academic Search

    E. Silveira; G. Atxaga; E. Erauzkin; A. M. Irisarri

    2009-01-01

    A study on the root causes of the premature failure of a set of blades belonging to the high pressure turbine of an aircraft engine has been carried out. These blades were manufactured using a precipitation hardened nickel base alloy. The study consisted in a fractographic analysis by scanning electron microscopy and a microstructural examination by optical and scanning electron

  1. [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

  2. MafB deficiency causes defective respiratory rhythmogenesis and fatal central apnea at birth

    Microsoft Academic Search

    Bruno Blanchi; Louise M Kelly; Jean-Charles Viemari; Isabelle Lafon; Henri Burnet; Michelle Bévengut; Silke Tillmanns; Laurent Daniel; Thomas Graf; Gerard Hilaire; Michael H Sieweke

    2003-01-01

    The genetic basis for the development of brainstem neurons that generate respiratory rhythm is unknown. Here we show that mice deficient for the transcription factor MafB die from central apnea at birth and are defective for respiratory rhythmogenesis in vitro. MafB is expressed in a subpopulation of neurons in the preBötzinger complex (preBötC), a putative principal site of rhythmogenesis. Brainstems

  3. Noninvasive Mechanical Ventilation in the Weaning of Patients with Respiratory Failure Due to Chronic Obstructive Pulmonary Disease A Randomized, Controlled Trial

    Microsoft Academic Search

    Stefano Nava; Nicolino Ambrosino; Enrico Clini; Maurizio Prato; Giacomo Orlando; Michele Vitacca; Paolo Brigada; Claudio Fracchia; Fiorenzo Rubini

    Background: In patients with acute exacerbations of chronic obstructive pulmonary disease, mechanical venti­ lation is often needed. The rate of weaning failure is high in these patients, and prolonged mechanical ventilation increases intubation-associated complications. Objective: To determine whether noninvasive ventila­ tion improves the outcome of weaning from invasive me­ chanical ventilation. Design: Multicenter, randomized trial. Setting: Three respiratory intensive care

  4. Domiciliary nocturnal intermittent positive pressure ventilation in patients with respiratory failure due to severe COPD: long term follow up and effect on survival

    Microsoft Academic Search

    S E Jones; S Packham; M Hebden; A P Smith

    1998-01-01

    BACKGROUNDThere is increasing interest in the use of non-invasive nocturnal intermittent positive pressure ventilation (NIPPV) in the management of patients with chronic hypercapnoeic (type II) respiratory failure. Although this treatment enables patients requiring mechanical ventilatory support to be treated more readily at home, few studies have been done to demonstrate its long term benefits in chronic obstructive pulmonary disease (COPD)

  5. 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

  6. A robust Bayesian approach to modeling epistemic uncertainty in common-cause failure models

    SciTech Connect

    Matthias C. M. Troffaes; Gero Walter; Dana Kelly

    2014-05-01

    In a standard Bayesian approach to the alpha-factor model for common-cause failure, a precise Dirichlet prior distribution models epistemic uncertainty in the alpha-factors. This Dirichlet prior is then updated with observed data to obtain a posterior distribution, which forms the basis for further inferences. In this paper, we adapt the imprecise Dirichlet model of Walley to represent epistemic uncertainty in the alpha-factors. In this approach, epistemic uncertainty is expressed more cautiously via lower and upper expectations for each alpha-factor, along with a learning parameter which determines how quickly the model learns from observed data. For this application, we focus on elicitation of the learning parameter, and find that values in the range of 1 to 10 seem reasonable. The approach is compared with Kelly and Atwood's minimally informative Dirichlet prior for the alpha-factor model, which incorporated precise mean values for the alpha-factors, but which was otherwise quite diffuse. Next, we explore the use of a set of Gamma priors to model epistemic uncertainty in the marginal failure rate, expressed via a lower and upper expectation for this rate, again along with a learning parameter. As zero counts are generally less of an issue here, we find that the choice of this learning parameter is less crucial. Finally, we demonstrate how both epistemic uncertainty models can be combined to arrive at lower and upper expectations for all common-cause failure rates. Thereby, we effectively provide a full sensitivity analysis of common-cause failure rates, properly reflecting epistemic uncertainty of the analyst on all levels of the common-cause failure model.

  7. 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

  8. Premature Ovarian Failure: A Critical Condition in The Reproductive Potential with Various Genetic Causes

    PubMed Central

    Pouresmaeili, Farkhondeh; Fazeli, Zahra

    2014-01-01

    Premature ovarian failure (POF) is identified as a heterogeneous disorder leading to amenorrhea and ovarian failure before the age of 40 years. The first known symptom of the disease is having irregular menstrual periods. The phenotype appearance of POF depends significantly on the variations in hormones. Low levels of gonadal hormones (estrogens and inhibins) and increased level of gonadotropins [luteinizing hormone (LH) and Follicle stimulating hormone (FSH)] (hypergonadotropic amenorrhea) are well documented as causes of POF. There is an association between the failure of germ cell development and complete ovarian failure, and consistently decreased number of germ cells is more likely associated with partial ovarian failure resulting in secondary amenorrhea. A literature review on recent findings about POF and its association with genomic alterations in terms of genes and chromosomes. POF is a complex heterogeneous disorder. Some of POF cases are carriers of a single gene mutation inherited in an autosomal or X-linked manner while a number of patients suffer from a chromosome abnormality like Turner syndrome in mosaic form and manifest secondary amenorrhea associated with ovarian dysgenesis. Among many of the known involved genes in POF development, several are prove to be positively associated to the disease development in different populations. While there is a promising association between X chromosome anomalies and specific gene mutations with POF, genome-wide analysis could prove a powerful tool for identifying the most important candidate genes that influence POF manifestation. PMID:24696764

  9. Common cause failure probabilities in standby safety system fault tree analysis with testing—scheme and timing dependencies

    Microsoft Academic Search

    J. K. Vaurio

    2003-01-01

    Modelling and quantification of common cause failures (CCFs) in redundant standby safety systems can be implemented by implicit or explicit fault tree techniques. Common cause event probabilities are derived for both methods for systems with time-related CCFs modelled by general multiple failure rates. The probabilities are determined so that the correct time-average risk can be obtained by a single computation.

  10. Upper respiratory tract infection caused by Cryptosporidium baileyi in three mixed bred falcons

    Microsoft Academic Search

    Y. R. A. van Zeeland; N. J. Schoemaker; M. J. L. Kik

    2008-01-01

    Three mixed-bred raptors (Falco rusticolus × Falco cherrug) from a German falcon breeder were presented with a history of respiratory distress. In one bird a laryngeal stridor was noted, and oral examination revealed an epiglottal swelling. In the other two birds, nasal discharge and sneezing were the main clinical symptoms. Nasal flushing samples and biopsies were collected for pathologic, bacteriologic,

  11. 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...

  12. Analysis of causes that led to Evyn Vaughn's respiratory arrest, intracranial and retinal bleeding, and death

    Microsoft Academic Search

    Mohammed Ali Al-Bayati

    Evyn, a 14-month-old male, suffered from respiratory arrest on April 21, 2007, and was taken to the Northwest Texas Hospital. He was treated with several medications but he did not show an improvement. He was pronounced brain dead on April 22. Evyn was given heparin (3600 units IV) and his major organs were harvested for donations. At autopsy, the medical

  13. Failure of zinc gluconate in treatment of acute upper respiratory tract infections.

    PubMed Central

    Smith, D S; Helzner, E C; Nuttall, C E; Collins, M; Rofman, B A; Ginsberg, D; Goswick, C B; Magner, A

    1989-01-01

    Zinc is a trace metal with in vitro activity against rhinovirus, the major etiologic agent in acute upper respiratory tract infections (URIs). A previous trial of zinc gluconate supported its efficacy in treating URIs, but the effectiveness of blinding was uncertain. We conducted a prospective randomized trial of zinc gluconate versus a taste-matched placebo of sucrose octaacetate. Lozenges containing either 23 mg of elemental zinc or placebo were taken every 2 h. Eleven URI symptoms were rated daily on a scale of 0 (not present) to 3 (severe). Duration of illness, reflected in the proportion of subjects remaining symptomatic on each day, was not significantly reduced (maximum difference of 12.6% on day 7, P = 0.09; 95% confidence interval, -6 to 31%) by either treatment. Severity of illness, assessed by using a summed severity score, was reduced incrementally by 7 to 8% on days 5 to 7 (P = 0.02) in subjects taking zinc. Adverse effects, mostly nausea and altered taste, were reported by 50% of subjects taking zinc. We conclude that while zinc gluconate may produce a small reduction in overall severity of symptoms, this is not clinically significant. Given the additional high incidence of adverse effects, zinc gluconate cannot be recommended for use in the treatment of acute URIs. PMID:2665639

  14. Failure of zinc gluconate in treatment of acute upper respiratory tract infections.

    PubMed

    Smith, D S; Helzner, E C; Nuttall, C E; Collins, M; Rofman, B A; Ginsberg, D; Goswick, C B; Magner, A

    1989-05-01

    Zinc is a trace metal with in vitro activity against rhinovirus, the major etiologic agent in acute upper respiratory tract infections (URIs). A previous trial of zinc gluconate supported its efficacy in treating URIs, but the effectiveness of blinding was uncertain. We conducted a prospective randomized trial of zinc gluconate versus a taste-matched placebo of sucrose octaacetate. Lozenges containing either 23 mg of elemental zinc or placebo were taken every 2 h. Eleven URI symptoms were rated daily on a scale of 0 (not present) to 3 (severe). Duration of illness, reflected in the proportion of subjects remaining symptomatic on each day, was not significantly reduced (maximum difference of 12.6% on day 7, P = 0.09; 95% confidence interval, -6 to 31%) by either treatment. Severity of illness, assessed by using a summed severity score, was reduced incrementally by 7 to 8% on days 5 to 7 (P = 0.02) in subjects taking zinc. Adverse effects, mostly nausea and altered taste, were reported by 50% of subjects taking zinc. We conclude that while zinc gluconate may produce a small reduction in overall severity of symptoms, this is not clinically significant. Given the additional high incidence of adverse effects, zinc gluconate cannot be recommended for use in the treatment of acute URIs. PMID:2665639

  15. Reliability-based fatigue failure analysis for causes assessment of a collapsed steel truss bridge

    Microsoft Academic Search

    Hyo-Nam Cho; Jong-Kwon Lim; Hyun-Ho Choi

    2001-01-01

    This paper is intended to demonstrate conventional and reliability-based approaches to the collapse cause assessment in order to identify the effects of mis-installed bracket and H-beam members on the collapse of a steel truss bridge over the Han river in Korea only 15 years after opening to traffic. Based on extensive numerical investigations with parametric studies on various possible failure

  16. Common cause and common sense, designing failure out of your safety instrumented systems (SIS)

    Microsoft Academic Search

    Angela E Summers; Glenn Raney

    1999-01-01

    The ANSI\\/ISA S84.01-1996 and IEC 61508 (draft) standards provide guidelines for the design, installation, operation, maintenance and testing of safety instrumented systems (SIS). As part of the SIS lifecycle design process, the SIS should be evaluated not only for its safety integrity level (SIL), but also for its potential for common cause failure (CCF). A CCF occurs when a single

  17. 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

  18. Diencephalic syndrome: a frequently neglected cause of failure to thrive in infants

    PubMed Central

    Kim, Ahlee; Moon, Jin Soo; Yang, Hye Ran; Chang, Ju Young; Ko, Jae Sung

    2015-01-01

    Purpose Diencephalic syndrome is an uncommon cause of failure to thrive in early childhood that is associated with central nervous system neoplasms in the hypothalamic-optic chiasmatic region. It is characterized by complex signs and symptoms related to hypothalamic dysfunction; such nonspecific clinical features may delay diagnosis of the brain tumor. In this study, we analyzed a series of cases in order to define characteristic features of diencephalic syndrome. Methods We performed a retrospective study of 8 patients with diencephalic syndrome (age, 5-38 months). All cases had presented to Seoul National University Children's Hospital between 1995 and 2013, with the chief complaint of poor weight gain. Results Diencephalic syndrome with central nervous system (CNS) neoplasm was identified in 8 patients. The mean age at which symptoms were noted was 18±10.5 months, and diagnosis after symptom onset was made at the mean age of 11±9.7 months. The mean z score was -3.15±1.14 for weight, -0.12±1.05 for height, 1.01±1.58 for head circumference, and -1.76±1.97 for weight-for-height. Clinical features included failure to thrive (n=8), hydrocephalus (n=5), recurrent vomiting (n=5), strabismus (n=2), developmental delay (n=2), hyperactivity (n=1), nystagmus (n=1), and diarrhea (n=1). On follow-up evaluation, 3 patients showed improvement and remained in stable remission, 2 patients were still receiving chemotherapy, and 3 patients were discharged for palliative care. Conclusion Diencephalic syndrome is a rare cause of failure to thrive, and diagnosis is frequently delayed. Thus, it is important to consider the possibility of a CNS neoplasm as a cause of failure to thrive and to ensure early diagnosis. PMID:25729396

  19. Full-Genome Analysis of a Canine Pneumovirus Causing Acute Respiratory Disease in Dogs, Italy

    PubMed Central

    Decaro, Nicola; Pinto, Pierfrancesco; Mari, Viviana; Elia, Gabriella; Larocca, Vittorio; Camero, Michele; Terio, Valentina; Losurdo, Michele; Martella, Vito; Buonavoglia, Canio

    2014-01-01

    An outbreak of canine infectious respiratory disease (CIRD) associated to canine pneumovirus (CnPnV) infection is reported. The outbreak occurred in a shelter of the Apulia region and involved 37 out of 350 dogs that displayed cough and/or nasal discharge with no evidence of fever. The full-genomic characterisation showed that the causative agent (strain Bari/100-12) was closely related to CnPnVs that have been recently isolated in the USA, as well as to murine pneumovirus, which is responsible for respiratory disease in mice. The present study represents a useful contribution to the knowledge of the pathogenic potential of CnPnV and its association with CIRD in dogs. Further studies will elucidate the pathogenicity and epidemiology of this novel pneumovirus, thus addressing the eventual need for specific vaccines. PMID:24400129

  20. Validation of the verbal autopsy method to ascertain acute respiratory infection as cause of death

    Microsoft Academic Search

    Leticia Rodriguez; Hortensia Reyes; Patricia Tome; Cecilia Ridaura; Sergio Flores; Hector Guiscafre

    1998-01-01

    The validity of the Verbal Autopsy (VA) in death due to acute respiratory infection (ARI), Was tested in 36 children who died\\u000a by any acute infectious disease as stated by the necropsy diagnosis, at two public hospitals in Mexico City; the illness started\\u000a at home. Clinical data obtained through VA were compared with diagnoses of necropsies, which were considered as

  1. 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

  2. NALP3-mediated inflammation is a principal cause of progressive renal failure in oxalate nephropathy.

    PubMed

    Knauf, Felix; Asplin, John R; Granja, Ignacio; Schmidt, Insa M; Moeckel, Gilbert W; David, Rachel J; Flavell, Richard A; Aronson, Peter S

    2013-11-01

    Oxalate nephropathy with renal failure is caused by multiple disorders leading to hyperoxaluria due to either overproduction of oxalate (primary hyperoxaluria) or excessive absorption of dietary oxalate (enteric hyperoxaluria). To study the etiology of renal failure in crystal-induced kidney disease, we created a model of progressive oxalate nephropathy by feeding mice a diet high in soluble oxalate (high oxalate in the absence of dietary calcium). Renal histology was characterized by intratubular calcium-oxalate crystal deposition with an inflammatory response in the surrounding interstitium. Oxalate nephropathy was not found in mice fed a high oxalate diet that also contained calcium. NALP3, also known as cryopyrin, has been implicated in crystal-associated diseases such as gout and silicosis. Mice fed the diet high in soluble oxalate demonstrated increased NALP3 expression in the kidney. Nalp3-null mice were completely protected from the progressive renal failure and death that occurred in wild-type mice fed the diet high in soluble oxalate. NALP3 deficiency did not affect oxalate homeostasis, thereby excluding differences in intestinal oxalate handling to explain the observed phenotype. Thus, progressive renal failure in oxalate nephropathy results primarily from NALP3-mediated inflammation. PMID:23739234

  3. Intraabdominal infection: Pulmonary failure

    Microsoft Academic Search

    C. Runcie; G. Ramsay

    1990-01-01

    Since its first description in 1967, the mortality of the adult respiratory distress syndrome (ARDS) has remained unchanged despite the increasing sophistication of supportive techniques. Few patients now die of refractory hypoxemia, the majority succumbing to the multiple systems organ failure syndrome, commonly due to sepsis. Sepsis is both the most common cause of ARDS, usually involving the abdomen, and

  4. Alveolar Macrophages Are Essential for Protection from Respiratory Failure and Associated Morbidity following Influenza Virus Infection

    PubMed Central

    Schneider, Christoph; Nobs, Samuel P.; Heer, Alex K.; Kurrer, Michael; Klinke, Glynis; van Rooijen, Nico; Vogel, Johannes; Kopf, Manfred

    2014-01-01

    Alveolar macrophages (AM) are critical for defense against bacterial and fungal infections. However, a definitive role of AM in viral infections remains unclear. We here report that AM play a key role in survival to influenza and vaccinia virus infection by maintaining lung function and thereby protecting from asphyxiation. Absence of AM in GM-CSF-deficient (Csf2?/?) mice or selective AM depletion in wild-type mice resulted in impaired gas exchange and fatal hypoxia associated with severe morbidity to influenza virus infection, while viral clearance was affected moderately. Virus-induced morbidity was far more severe in Csf2?/? mice lacking AM, as compared to Batf3-deficient mice lacking CD8?+ and CD103+ DCs. Csf2?/? mice showed intact anti-viral CD8+ T cell responses despite slightly impaired CD103+ DC development. Importantly, selective reconstitution of AM development in Csf2rb?/? mice by neonatal transfer of wild-type AM progenitors prevented severe morbidity and mortality, demonstrating that absence of AM alone is responsible for disease severity in mice lacking GM-CSF or its receptor. In addition, CD11c-Cre/Ppargfl/fl mice with a defect in AM but normal adaptive immunity showed increased morbidity and lung failure to influenza virus. Taken together, our results suggest a superior role of AM compared to CD103+ DCs in protection from acute influenza and vaccinia virus infection-induced morbidity and mortality. PMID:24699679

  5. [Quality of results of therapy of acute respiratory failure : changes over a period of two decades].

    PubMed

    Briegel, I; Dolch, M; Irlbeck, M; Hauer, D; Kaufmann, I; Schelling, G

    2013-04-01

    Progress in intensive care (ICU) treatment of acute respiratory distress syndrome (ARDS) over the last 20 years includes the introduction of extracorporeal membrane oxygenation (ECMO) for CO2 removal and the widespread use of evidence-based lung-protective ventilatory strategies. Little is known, however, about whether these changes have resulted in improvements in short-term and long-term outcome of acute respiratory distress syndrome (ARDS) within the two decades after introduction. In a retrospective study 167 long-term survivors of severe ARDS who were transferred to the clinic for anesthesiology of the University of Munich, Campus Großhadern by means of specialized intensive care unit (ICU) transport teams and treated over a period of 20 years (1985-2005) were evaluated to investigate whether significant improvements in outcome as a consequence of the above mentioned progress in ARDS therapy have occurred. The ARDS patient cohort studied was characterized with regard to demographic variables, initial acute physiology and chronic health evaluation (APACHE) II score, duration of ICU treatment, the duration of mechanical ventilation and mortality. Data on long-term outcome were collected in a subcohort (n = 125) of patients who responded to mailed questionnaires and included health-related quality of life (HRQL, SF-36 questionnaire), symptoms of post-traumatic stress disorder (PTSD), traumatic memories from ICU treatment (PTSS-10 instrument) and current state of employment. During the observation period no significant changes regarding patient age (39 ± 16 years, mean ± SD), disease severity on admission to the ICU (APACHE II scores 22 ± 5), duration of ICU treatment (47 ± 39 days) or duration of mechanical ventilation (39 ± 38 days) were found. Overall ICU mortality during the two decades was 37.3 % (range 25.0 %-38.1 %) between 1995 and 2001 and a non-significant increase in values between 36.8 % and 58.3 % during the time interval from 2002 und 2005. The paO2/FIO2-ratio on ICU admittance improved significantly between 1990 and 2000 (69 ± 5 between 1990 and 1994 versus 101 ± 12 between 1995 and 2000, p < 0.01) and remained nearly unchanged thereafter. Long-term outcome was evaluated on average 5.0 ± 3.1 years after discharge from the ICU. During the time period between 1985 and 1994 survivors of ARDS showed significant impairments in all 8 categories of the SF-36 HRQL instrument when compared to an age and sex-matched normal population with maximal differences regarding physical function (z = -1.01), general health perception (z = -1.17) and mental health (z = -1.3). Patients who were treated from 1995 to 2005 were still impaired in 7 out of 8 categories of HRQL but reported significantly better mental health (49.6 ± 16.5 vs. 68.6 ± 17.8, p < 0,01) and better physical function than individuals from the previous decade (49.6 ± 16.5 vs. 73.4 ± 27.5, p = 0,03). The difference of mental health was no longer significant when compared to a healthy age and sex matched control group (p = 0.14) but the difference in physical function still was (z = -0.48, p < 0.01). The incidence of severe post-traumatic stress defined as a PTSS-10 score ? 35 was 20.4 % and remained unchanged throughout the 2 decades of observation. The PTSS-10 scores correlated with the number of traumatic memories present (r = 0.43, p < 0.01, n = 125). More than 50 % of long-term survivors were able to return to full time work with no significant changes during the 2 decades of observation. The introduction of new modalities of ARDS treatment were associated with higher paO2/FIO2-ratios on ICU admittance but had no effect on short-term outcomes including duration of ICU therapy, mechanical ventilation or mortality. The ARDS patients are still at risk for post-traumatic stress and persistent impairments in HRQL. Apart from some improvements in HRQL, the outcome of ARDS therapy remained largely unchanged during two decades. PMID:23558717

  6. Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients.

    PubMed

    Combes, Alain; Brodie, Daniel; Bartlett, Robert; Brochard, Laurent; Brower, Roy; Conrad, Steve; De Backer, Daniel; Fan, Eddy; Ferguson, Niall; Fortenberry, James; Fraser, John; Gattinoni, Luciano; Lynch, William; MacLaren, Graeme; Mercat, Alain; Mueller, Thomas; Ogino, Mark; Peek, Giles; Pellegrino, Vince; Pesenti, Antonio; Ranieri, Marco; Slutsky, Arthur; Vuylsteke, Alain

    2014-09-01

    The use of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure (ARF) in adults is growing rapidly given recent advances in technology, even though there is controversy regarding the evidence justifying its use. Because ECMO is a complex, high-risk, and costly modality, at present it should be conducted in centers with sufficient experience, volume, and expertise to ensure it is used safely. This position paper represents the consensus opinion of an international group of physicians and associated health-care workers who have expertise in therapeutic modalities used in the treatment of patients with severe ARF, with a focus on ECMO. The aim of this paper is to provide physicians, ECMO center directors and coordinators, hospital directors, health-care organizations, and regional, national, and international policy makers a description of the optimal approach to organizing ECMO programs for ARF in adult patients. Importantly, this will help ensure that ECMO is delivered safely and proficiently, such that future observational and randomized clinical trials assessing this technique may be performed by experienced centers under homogeneous and optimal conditions. Given the need for further evidence, we encourage restraint in the widespread use of ECMO until we have a better appreciation for both the potential clinical applications and the optimal techniques for performing ECMO. PMID:25062496

  7. Capabilities of a mobile extracorporeal membrane oxygenation service for severe respiratory failure delivered by intensive care specialists.

    PubMed

    Sherren, P B; Shepherd, S J; Glover, G W; Meadows, C I S; Langrish, C; Ioannou, N; Wyncoll, D; Daly, K; Gooby, N; Agnew, N; Barrett, N A

    2015-06-01

    We conducted a single-centre observational study of retrievals for severe respiratory failure over 12 months. Our intensivist-delivered retrieval service has mobile extracorporeal membrane oxygenation capabilities. Sixty patients were analysed: 34 (57%) were female and the mean (SD) age was 44.1 (13.6) years. The mean (SD) PaO2 /FI O2 ratio at referral was 10.2 (4.1) kPa and median (IQR [range]) Murray score was 3.25 (3.0-3.5 [1.5-4.0]). Forty-eight patients (80%) required veno-venous extracorporeal membrane oxygenation at the referring centre. There were no cannulation or extracorporeal membrane oxygenation-related complications. The median (IQR [range]) retrieval distance was 47.2 (14.9-77.0 [2.3-342.0]) miles. There were no major adverse events during retrieval. Thirty-seven patients (77%) who received extracorporeal membrane oxygenation survived to discharge from the intensive care unit and 36 patients (75%) were alive after six months. Senior intensivist-initiated and delivered mobile extracorporeal membrane oxygenation is safe and associated with a high incidence of survival. PMID:25850687

  8. Prolonged extracorporeal membrane oxygenator support among neonates with acute respiratory failure: a review of the Extracorporeal Life Support Organization registry.

    PubMed

    Prodhan, Parthak; Stroud, Michael; El-Hassan, Nahed; Peeples, Sarah; Rycus, Peter; Brogan, Thomas V; Tang, Xinyu

    2014-01-01

    The objective of this study was to identify types of neonatal diseases associated with prolonged (?21 days) extracorporeal membrane oxygenation (ECMO), characteristics of survivors and nonsurvivors among those requiring prolonged ECMO, and factors associated with mortality. Data were obtained from the Extracorporeal Life Support Organization registry over the period from January 1, 1998, through December 31, 2011, for all neonates (age <31 days), with respiratory failure as the indication for ECMO. The primary outcome was survival to hospital discharge. Survivors and nonsurvivors were compared for 1) patient demographics, 2) primary diagnosis, 3) pre-ECMO clinical course and therapies, and 4) ECMO course and associated complications. The most common diagnosis associated with prolonged ECMO support in neonates is congenital diaphragmatic hernia (CDH; 69%). Infants with meconium aspiration syndrome had the highest survival rate (71%) compared with other diagnoses analyzed (26.3%; p < 0.001). Nonsurvivors were more likely to experience complications on ECMO, and multivariate analysis showed that the need for inotropes while on ECMO support (odds ratio, 2.2 [95% confidence interval, 1.3-3.7]; p = 0.003) was independently associated with mortality. Neonates requiring prolonged ECMO support have a 24% survival to discharge. Many of these cases involve CDH. Complications are common with prolonged ECMO, but only receipt of inotropes was shown to be independently associated with mortality. This report may help guide clinical decision making and family counseling for neonates requiring prolonged ECMO support. PMID:24270231

  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. 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

  11. Whole-thorax irradiation induces hypoxic respiratory failure, pleural effusions and cardiac remodeling

    PubMed Central

    Medhora, Meetha; Gao, Feng; Glisch, Chad; Narayanan, Jayashree; Sharma, Ashish; Harmann, Leanne M.; Lawlor, Michael W.; Snyder, Laura A.; Fish, Brian L.; Down, Julian D.; Moulder, John E.; Strande, Jennifer L.; Jacobs, Elizabeth R.

    2015-01-01

    To study the mechanisms of death following a single lethal dose of thoracic radiation, WAG/RijCmcr (Wistar) rats were treated with 15 Gy to the whole thorax and followed until they were morbid or sacrificed for invasive assays at 6 weeks. Lung function was assessed by breathing rate and arterial oxygen saturation. Lung structure was evaluated histologically. Cardiac structure and function were examined by echocardiography. The frequency and characteristics of pleural effusions were determined. Morbidity from 15 Gy radiation occurred in all rats 5 to 8 weeks after exposure, coincident with histological pneumonitis. Increases in breathing frequencies peaked at 6 weeks, when profound arterial hypoxia was also recorded. Echocardiography analysis at 6 weeks showed pulmonary hypertension and severe right ventricular enlargement with impaired left ventricular function and cardiac output. Histologic sections of the heart revealed only rare foci of lymphocytic infiltration. Total lung weight more than doubled. Pleural effusions were present in the majority of the irradiated rats and contained elevated protein, but low lactate dehydrogenase, when compared with serum from the same animal. Pleural effusions had a higher percentage of macrophages and large monocytes than neutrophils and contained mast cells that are rarely present in other pathological states. Lethal irradiation to rat lungs leads to hypoxia with infiltration of immune cells, edema and pleural effusion. These changes may contribute to pulmonary vascular and parenchymal injury that result in secondary changes in heart structure and function. We report that conditions resembling congestive heart failure contribute to death during radiation pneumonitis, which indicates new targets for therapy. PMID:25368342

  12. Control rod trip failures. Salem 1: the cause, response and potential fixes

    SciTech Connect

    Hall, R.E.; Boccio, J.L.; Luckas, W.J.

    1983-01-01

    Although the failure to trip or scram represents a single class of initiators, the actual events of each transient are operationally unique and require individual human response. The operational team's reaction to the challenge can be successful, in very short response times, and without complete diagnosis of the event's root cause. This underscores the need for a better basic understanding of the team response patterns in such cases, to allow designs, procedures, and training to take advantage of it. In addition, as one analyzes the recent failure at the Salem 1 reactor, it becomes obvious that the optimization of test and maintenance practices are essential and the use of time dependent reliability analyses lend themselves nicely to such calculations.

  13. Multiple imputation methods for inference on cumulative incidence with missing cause of failure.

    PubMed

    Lee, Minjung; Cronin, Kathleen A; Gail, Mitchell H; Dignam, James J; Feuer, Eric J

    2011-11-01

    Analysis of cumulative incidence (sometimes called absolute risk or crude risk) can be difficult if the cause of failure is missing for some subjects. Assuming missingness is random conditional on the observed data, we develop asymptotic theory for multiple imputation methods to estimate cumulative incidence. Covariates affect cause-specific hazards in our model, and we assume that separate proportional hazards models hold for each cause-specific hazard. Simulation studies show that procedures based on asymptotic theory have near nominal operating characteristics in cohorts of 200 and 400 subjects, both for cumulative incidence and for prediction error. The methods are illustrated with data on survival after breast cancer, obtained from the National Surgical Adjuvant Breast and Bowel Project (NSABP). PMID:22028204

  14. Comparison of two non-bronchoscopic methods for evaluating inflammation in patients with acute hypoxaemic respiratory failure

    PubMed Central

    2009-01-01

    Introduction The simple bedside method for sampling undiluted distal pulmonary edema fluid through a normal suction catheter (s-Cath) has been experimentally and clinically validated. However, there are no data comparing non-bronchoscopic bronchoalveolar lavage (mini-BAL) and s-Cath for assessing lung inflammation in acute hypoxaemic respiratory failure. We designed a prospective study in two groups of patients, those with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) and those with acute cardiogenic lung edema (ACLE), designed to investigate the clinical feasibility of these techniques and to evaluate inflammation in both groups using undiluted sampling obtained by s-Cath. To test the interchangeability of the two methods in the same patient for studying the inflammation response, we further compared mini-BAL and s-Cath for agreement of protein concentration and percentage of polymorphonuclear cells (PMNs). Methods Mini-BAL and s-Cath sampling was assessed in 30 mechanically ventilated patients, 21 with ALI/ARDS and 9 with ACLE. To analyse agreement between the two sampling techniques, we considered only simultaneously collected mini-BAL and s-Cath paired samples. The protein concentration and polymorphonuclear cell (PMN) count comparisons were performed using undiluted sampling. Bland-Altman plots were used for assessing the mean bias and the limits of agreement between the two sampling techniques; comparison between groups was performed by using the non-parametric Mann-Whitney-U test; continuous variables were compared by using the Student t-test, Wilcoxon signed rank test, analysis of variance or Student-Newman-Keuls test; and categorical variables were compared by using chi-square analysis or Fisher exact test. Results Using protein content and PMN percentage as parameters, we identified substantial variations between the two sampling techniques. When the protein concentration in the lung was high, the s-Cath was a more sensitive method; by contrast, as inflammation increased, both methods provided similar estimates of neutrophil percentages in the lung. The patients with ACLE showed an increased PMN count, suggesting that hydrostatic lung edema can be associated with a concomitant inflammatory process. Conclusions There are significant differences between the s-Cath and mini-BAL sampling techniques, indicating that these procedures cannot be used interchangeably for studying the lung inflammatory response in patients with acute hypoxaemic lung injury. PMID:19671148

  15. The effects and safety of dexibuprofen compared with ibuprofen in febrile children caused by upper respiratory tract infection

    PubMed Central

    Yoon, Jong Seo; Jeong, Dae-Chul; Oh, Jae-Won; Lee, Keun Young; Lee, Hyun Seung; Koh, Young Yull; Kim, Jin Tack; Kang, Jin Han; Lee, Joon Sung

    2008-01-01

    WHAT IS ALREADY KNOWN ABOUT THIS SUBJECTThe analgesic and anti-inflammatory efficacy of dexibuprofen compared with ibuprofen in adults with osteoarthritis, rheumatoid arthritis and dental pain. WHAT THIS STUDY ADDSDexibuprofen is as effective and tolerable as ibuprofen, and a dose of 5 mg kg?1 of dexibuprofen would be sufficient to control fever caused by upper respiratory tract infection in children. AIM To evaluate the antipyretic efficacy and tolerability of dexibuprofen compared with ibuprofen in children with fever caused by upper respiratory tract infection (URTI). METHODS The study population consisted of children aged 6 months to 14 years. At the time of visit to the hospital, the children had fever; the cause of fever was determined to be URTI by a paediatrician based on history taking and physical examination. The study was a multicentre, randomized, double-blind, controlled parallel group, comparative, Phase 3 clinical trial, conducted at three hospitals. By using a computer-based random assignment program, the subjects were allocated to the following three groups: 5 mg kg?1 dexibuprofen group, 7 mg kg?1 dexibuprofen group, and 10 mg kg?1 ibuprofen group. RESULTS In the clinical trial of the antipyretic action of dexibuprofen in patients with fever caused by URTI, there was no statistically significant difference in maximal decrease of temperature and mean time to become apyrexial among the 5 mg kg?1 dexibuprofen, 7 mg kg?1 dexibuprofen and 10 mg kg?1 ibuprofen groups (P > 0.05). There also was no significant difference in adverse drug reaction (P > 0.05). CONCLUSIONS Dexibuprofen is as effective and tolerable as ibuprofen. A dose of 5 mg kg?1 and 7 mg kg?1 dexibuprofen in place of 10 mg kg?1 ibuprofen would be sufficient to control fever caused by URTI in children. PMID:19032727

  16. Managing acute respiratory failure during exacerbation of chronic obstructive pulmonary disease.

    PubMed

    Schumaker, Greg L; Epstein, Scott K

    2004-07-01

    Exacerbations of chronic obstructive pulmonary disease (COPD) are a major health problem, causing more than half a million hospital admissions per year in the United States. Although overall mortality is low, it is substantially higher with severe exacerbations that require intensive care and mechanical ventilation. The majority of COPD exacerbations result from infection, with typical bacterial organisms most commonly identified. Numerous randomized controlled trials and meta-analyses have documented the benefits of antibiotics, low-flow oxygen, and systemic corticosteroids, and the therapeutic equivalency of the major classes of bronchodilators (short-acting beta-agonist and anticholinergics). Randomized controlled trials also demonstrate that noninvasive ventilation can decrease the incidence of intubation, shorten stay, reduce infectious complications, and improve survival. Although patients who require intubation have the worst prognosis, the vast majority of them can be successfully liberated from mechanical ventilation. For invasively ventilated patients the clinical emphasis should be on improving patient-ventilator interaction and avoiding dynamic hyperinflation (intrinsic positive end-expiratory pressure). PMID:15222909

  17. (m, M) Machining system with two unreliable servers, mixed spares and common-cause failure

    NASA Astrophysics Data System (ADS)

    Jain, Madhu; Mittal, Ragini; Kumari, Rekha

    2015-04-01

    This paper deals with multi-component machine repair model having provision of warm standby units and repair facility consisting of two heterogeneous servers (primary and secondary) to provide repair to the failed units. The failure of operating and standby units may occur individually or due to some common cause. The primary server may fail partially following full failure whereas secondary server faces complete failure only. The life times of servers and operating/standby units and their repair times follow exponential distribution. The successive over relaxation (SOR) technique has been used to obtain the steady state queue size distribution of the number of failed units in the system. To explore the system characteristics, various performance indices such as expected number of failed units in the queue, throughput, etc. have been obtained. Numerical results have been provided to illustrate the computational tractability of the proposed SOR technique. To examine the effect of system descriptors on the performance indices, the sensitivity analysis is also performed.

  18. Effect of Different Levels of Pressure Support and Proportional Assist Ventilation on Breathing Pattern, Work of Breathing and Gas Exchange in Mechanically Ventilated Hypercapnic COPD Patients with Acute Respiratory Failure

    Microsoft Academic Search

    F. Passam; S. Hoing; G. Prinianakis; N. Siafakas; J. Milic-Emili; D. Georgopoulos

    2003-01-01

    Background: Proportional assist ventilation (PAV) has been shown to maintain better patient-ventilator synchrony than pressure support ventilation (PSV); however, its clinical advantage regarding invasive ventilation of COPD patients has not been clarified. Objectives: To compare the effect of PAV and PSV on respiratory parameters of hypercapnic COPD patients with acute respiratory failure (ARF). Methods: Nine intubated hypercapnic COPD patients were

  19. Root-cause failure analysis: fossil-fired power plant draft fans. Final report

    SciTech Connect

    Anson, D.; Pierson, W.; Dufrane, K.; Stember, L.; Kaiser, W.; Koenig, M.; Hochstettler, W.

    1983-07-01

    This report deals with the collection and analysis of fan related outage experiences on 61 large fossil fired steam power plants. These experiences were compiled by direct-personal contacts with the utility staffs, and have been recorded in an automated data base. The analysis covered both the breakdown of the data to provide a ranking of the outage causes related to their impact on production, and a systematic search for generic root causes. Although this search was limited by the extent of plant records, it was possible to identify the major problems leading to full or partial failures. Recommendations are made for both short term corrective measures and for longer term research efforts that would improve significantly the reliability of fan systems.

  20. Structure and inhibition of EV-D68, a virus that causes respiratory illness in children.

    PubMed

    Liu, Yue; Sheng, Ju; Fokine, Andrei; Meng, Geng; Shin, Woong-Hee; Long, Feng; Kuhn, Richard J; Kihara, Daisuke; Rossmann, Michael G

    2015-01-01

    Enterovirus D68 (EV-D68) is a member of Picornaviridae and is a causative agent of recent outbreaks of respiratory illness in children in the United States. We report here the crystal structures of EV-D68 and its complex with pleconaril, a capsid-binding compound that had been developed as an anti-rhinovirus drug. The hydrophobic drug-binding pocket in viral protein 1 contained density that is consistent with a fatty acid of about 10 carbon atoms. This density could be displaced by pleconaril. We also showed that pleconaril inhibits EV-D68 at a half-maximal effective concentration of 430 nanomolar and might, therefore, be a possible drug candidate to alleviate EV-D68 outbreaks. PMID:25554786

  1. Clinical Features of Patients on Home Oxygen Therapy Due to Chronic Respiratory Failure at One University Hospital

    PubMed Central

    Kim, Kyoung Hee; Park, Tae Yun; Kim, Eun Sun; Chung, Keun Bum; Lee, Sang-Min; Yim, Jae-Joon; Yoo, Chul-Gyu; Kim, Young Whan; Han, Sung Koo

    2012-01-01

    Background/Aims Home oxygen therapy (HOT) costs a great deal every year and demand for the service is growing. In Korea, health insurance has covered HOT since November 1, 2006. The objective of this study was to evaluate clinical features of patients who used long-term HOT due to chronic respiratory failure and to determine the appropriateness of oxygen prescriptions. Methods Between November 2006 and April 2010, patients prescribed long-term HOT were enrolled in the study at a tertiary university referral hospital and their medical records and telephone survey information were evaluated. In total, 340 patients were evaluated retrospectively. Results Regarding the initial indications for HOT, their mean PaO2 was 49.8 mmHg and mean SpO2 was 82.2%. Underlying diseases included chronic obstructive pulmonary disease (COPD, 19.8%), lung cancer (12.6%), and interstitial lung disease (11.2%). The admission rate within 1 year was 53.4% and the average number of admissions was 1.64/patient. Other underlying diseases for which oxygen was prescribed, despite not meeting the insurance coverage criteria, were lung cancer (36.6%) and interstitial pneumonia (16.6%). Conclusions Home oxygen prescriptions have increased since health insurance coverage was extended. However, cases of oxygen prescriptions frequently do not meet the coverage criteria. It is important to discuss extending the coverage criteria to other disease groups, such as interstitial lung disease and lung cancer, in terms of cost-effectiveness. Further, physicians prescribing oxygen therapy should be educated regarding the criteria. PMID:23019396

  2. 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.

  3. CO boiler reliability: examination of failure mechanisms, root causes, corrective actions and monitoring required

    SciTech Connect

    Mort, T.; Rogers, M.E.; Skinner, B.; Parson, R. [Syncrude Canada Ltd., Fort McMurray, Alberta (Canada)

    1995-12-01

    The waste gas streams from upgrading processes pass as primary energy sources to two CO boilers. As Upgrading feed rates have increased, the volume flow rate, and properties of the streams have changed to such extent that the boilers have suffered severe reliability problems due to the new, and adverse fireside conditions. Heat flux rates have increased in critical sections of the boiler with consequent disruption in thermal hydraulic flow in water and steam circuits. Departure from nucleate boiling (DNB) and steam blanketing in generating bank tubes have resulted, causing treatment chemicals to precipitate, deposit, and react on the internal surfaces of the water wall tubes. This paper discusses the use of computational fluid dynamic simulation and other techniques to assess water and fireside conditions for the original, current, and future operating conditions (prior to and post boiler design modifications). The engineered changes required to correct the combustion and thermal hydraulic problems are described, as well as the rationale for introducing equilibrium phosphate treatment as the boiler water chemistry control corrective action. Micro-Raman spectroscopy was used for the first time to confirm the presence of maricite when investigating the root cause of generating bank tube failures. Maricite is one of the definitive corrosion products resulting from acid phosphate corrosion. The paper also discusses the use of the latest Electrical Power Research Institute guidelines for failure mechanism identification in boiler tubes and for monitoring cycle chemistry.

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

    PubMed

    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

    2015-04-30

    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

  5. Signal failure of type 2 comprehensive unattended sleep studies in patients with suspected respiratory sleep disordered breathing

    Microsoft Academic Search

    Ahmed S. BaHammam

    2005-01-01

    We designed this study to assess the signal failure and sensor loss of unattended type 2 comprehensive polysomnography (PSG) and compared that with in-lab attended PSG. Type 2 PSG was performed for 41 patients. The signal failure was estimated and compared to the signal failure in 60 patients for the in-lab PSGs. The signal failure in each individual electroencephalographic (EEG)

  6. Nest success, cause-specific nest failure, and hatchability of aquatic birds at selenium-contaminated Kesterson Reservoir and a reference site

    USGS Publications Warehouse

    Ohlendorf, H.M.; Hothem, R.L.; Welsh, D.

    1989-01-01

    Nest success and causes of failure varied by species, site, and year. The most important causes of nest failure were predation, desertion, and water level changes. Embryotoxicity was the most important cause of nest failure in eared grebes at Kesterson Reservoir.

  7. Failure of continuous venovenous hemofiltration to prevent death in paraquat poisoning

    Microsoft Academic Search

    Ja-Ryong Koo; Jin-Cheol Kim; Jong-Woo Yoon; Gheun-Ho Kim; Rho-Won Jeon; Hyung-Jik Kim; Dong-Wan Chae; Jung-Woo Noh

    2002-01-01

    Paraquat poisoning is characterized by multiorgan failure and pulmonary fibrosis with respiratory failure. Multiorgan failure with circulatory collapse is a major cause of early death within 3 days of paraquat ingestion. Recent studies suggested that continuous venovenous hemofiltration (CVVH) had a role in the treatment of multiorgan failure by promoting hemodynamic stability. We therefore evaluated the effect of prophylactic CVVH

  8. Upper respiratory tract infection caused by Cryptosporidium baileyi in three mixed-bred falcons (Falco rusticolus x Falco cherrug).

    PubMed

    van Zeeland, Y R A; Schoemaker, N J; Kik, M J L; van der Giessend, J W B

    2008-06-01

    Three mixed-bred raptors (Falco rusticolus x Falco cherrug) from a German falcon breeder were presented with a history of respiratory distress. In one bird a laryngeal stridor was noted, and oral examination revealed an epiglottal swelling. In the other two birds, nasal discharge and sneezing were the main clinical symptoms. Nasal flushing samples and biopsies were collected for pathologic, bacteriologic, and parasitologic examination. Results confirmed a cryptosporidial infection. Polymerase chain reaction (PCR) and DNA analysis identified the causative agent to be Cryptosporidium baileyi. No cryptosporidia were detected in fecal samples, indicating the infection was confined to the respiratory system. Analysis of prey animals (pigeons, quail) failed to identify the source of infection. Treatment was initiated with paromomycin in all three birds, whereas in two birds an additional therapy with azithromycin was given. However, no clinical improvement was seen after several weeks of treatment, and the birds either died or were euthanatized. To the authors' knowledge, these are the first confirmed cases of disease caused by cryptosporidia in the order of Falconiformes. PMID:18646471

  9. Veno-venous extracorporeal membrane oxygenation using a double-lumen bi-caval cannula for severe respiratory failure post total artificial heart implantation.

    PubMed

    Miessau, J; Yang, Q; Unai, S; Entwistle, Jwc; Cavarocchi, N C; Hirose, H

    2015-07-01

    We report a unique utilization of a double-lumen, bi-caval Avalon cannula for veno-venous (VV) extracorporeal membrane oxygenation (ECMO) during placement of a total artificial heart (TAH, SynCardia, Tucson, AZ). A 22-year-old female with post-partum cardiomyopathy was rescued on veno-arterial (VA) ECMO because of cardiogenic shock. The inability to wean ECMO necessitated implantation of the TAH as a bridge to transplant. In addition, the patient continued to have respiratory failure and concomitant VV ECMO was planned with the implant. During TAH implantation, the Avalon cannula was placed percutaneously from the right internal jugular vein into the inferior vena cava (IVC) under direct vision while the right atrium was open. During VV ECMO support, adequate flows on both ECMO and TAH were maintained without adverse events. VV ECMO was discontinued, without reopening the chest, once the patient's respiratory failure improved. However, the patient subsequently developed a profound respiratory acidosis and required VV ECMO for CO2 removal. The Avalon cannula was placed in the femoral vein to avoid accessing the internal jugular vein and risking damage to the TAH. The patient's oxygenation eventually improved and the cannula was removed at the bedside. The patient was supported for 22 days on VV ECMO and successfully weaned from the ventilator prior to her orthotropic heart transplantation. PMID:25239275

  10. 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.

  11. Analysis of ammonium sulfate circulation tank failure -- Possible causes and their remediation

    SciTech Connect

    O`Hearn, R.J. [Acme Steel, Chicago, IL (United States)

    1997-12-31

    Acme steel manufactures a liquid solution of ammonium sulphate by scrubbing the coke oven gas with a dilute solution of sulphuric acid. When the bath reaches a predetermined specific gravity, it is isolated from the system, neutralized with aqua ammonia, pumped to the shipping tanks, re-charged with water and acid, then placed back in service. To improve the ammonia removal efficiency, three circulation tanks are used in this system. In June 1996, the volume of two of the sulfate solution tanks in the ammonia removal plant were increased by two different pressure events. The first tank was damaged by pressure that was not relieved due to a plugged vent line. The second tank was damaged by a pressure event generated during the process of making ammonium sulfate. This paper will discuss the cause of the second tank`s failure, and the design solution to restart the operation of the plant.

  12. Squamous cell carcinoma of unknown origin metastasising to the right atrium causing acute heart failure.

    PubMed

    Sladden, David; Yamagata, Kentaro; Pllaha, Elton; Busuttil, Walter

    2015-01-01

    We describe a case of metastasis to the heart, which was initially suspected to be a myxoma, causing acute right heart failure. Emergency surgery was carried out by opening the right atrium and superior vena cava, and debulking the tumour in a piecemeal fashion, providing temporary relief of symptoms. The histology showed this to be metastatic squamous cell carcinoma possibly of head and neck origin. This is extremely rare, with few published cases. Full endoscopic and CT, including positron emission tomography CT, investigation of the head and neck was performed with no primary findings. Only two such cases of squamous cell carcinoma of unknown origin metastasising to the heart have been described, and, in both cases, the patients died within several weeks of diagnosis. This patient remains alive 2?months postoperatively and is receiving radiotherapy to the chest, but his prognosis remains poor. PMID:26101300

  13. 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

  14. The acute respiratory distress syndrome.

    PubMed

    Modrykamien, Ariel M; Gupta, Pooja

    2015-04-01

    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

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

    PubMed Central

    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. PMID:2933965

  16. 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.

  17. Non-Invasive Ventilation (NIV) and Homeostatic Model Assessment (HOMA) Index in Stable Chronic Obstructive Pulmonary Disease (COPD) Patients with Chronic Hypercapnic Respiratory Failure: A Pilot Study.

    PubMed

    Dimoulis, Andreas; Pastaka, Chaido; Tsolaki, Vasiliki; Tsilioni, Irini; Pournaras, Spyridon; Liakos, Nikolaos; Georgoulias, Panagiotis; Gourgoulianis, Konstantinos

    2014-11-21

    Abstract The effects of Non-invasive Ventilation (NIV) on Insulin Resistance (IR) in stable Chronic Obstructive Pulmonary Disease (COPD) patients have not been fully explored. The aim of this study was to assess the effects of NIV on IR and adiponectin levels during one year application of NIV in stable COPD patients with Chronic Hypercapnic Respiratory Failure. Twenty-five (25) stable COPD patients with Chronic Hypercapnic Respiratory Failure and with no self-reported comorbidities completed the study. NIV was administered in the spontaneous/timed mode via a full face mask using a bi-level positive airway pressure system. Spirometry, blood pressure, arterial blood gases, dyspnea, daytime sleepiness, serum fasting glucose and insulin levels were assessed. IR was assessed with the calculation of the Homeostatic Model Assessment (HOMA) index. Adiponectin was measured with radioimmunoassay. Study participants were re-evaluated on the first, third, sixth, ninth and twelfth month after the initial evaluation. There was a significant improvement in FEV1 values from the first month (34.1 ± 11.6% vs 37 ± 12.3%, p = 0.05). There was a significant decrease in IR by the ninth month of NIV use (3.4 ± 2.3 vs 2.2 ± 1.4, p < 0.0001), while adiponectin levels significantly improved from the first month of NIV use. Stepwise regression analysis revealed that baseline HOMA index was associated with paCO2 (? = 0.07 ± 0.02, p = 0.001), while baseline adiponectin levels were associated with FVC (? = 0.05 ± 0.02, p = 0.035) and the concentration of serum bicarbonate (HCO3-) (-? = 0.18 ± 0.06, p = 0.002). Insulin sensitivity and glucose metabolism as well as adiponectin levels improved along with the improvements in respiratory failure. PMID:25415619

  18. Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure: results of an Italian referral ECMO center

    PubMed Central

    2011-01-01

    Background Since the first outbreak of a respiratory illness caused by H1N1 virus in Mexico, several reports have described the need of intensive care or extracorporeal membrane oxygenation (ECMO) assistance in young and often healthy patients. Here we describe our experience in H1N1-induced ARDS using both ventilation strategy and ECMO assistance. Methods Following Italian Ministry of Health instructions, an Emergency Service was established at the Careggi Teaching Hospital (Florence, Italy) for the novel pandemic influenza. From Sept 09 to Jan 10, all patients admitted to our Intensive Care Unit (ICU) of the Emergency Department with ARDS due to H1N1 infection were studied. All ECMO treatments were veno-venous. H1N1 infection was confirmed by PCR assayed on pharyngeal swab, subglottic aspiration and bronchoalveolar lavage. Lung pathology was evaluated daily by lung ultrasound (LUS) examination. Results A total of 12 patients were studied: 7 underwent ECMO treatment, and 5 responded to protective mechanical ventilation. Two patients had co-infection by Legionella Pneumophila. One woman was pregnant. In our series, PCR from bronchoalveolar lavage had a 100% sensitivity compared to 75% from pharyngeal swab samples. The routine use of LUS limited the number of chest X-ray examinations and decreased transportation to radiology for CT-scan, increasing patient safety and avoiding the transitory disconnection from ventilator. No major complications occurred during ECMO treatments. In three cases, bleeding from vascular access sites due to heparin infusion required blood transfusions. Overall mortality rate was 8.3%. Conclusions In our experience, early ECMO assistance resulted safe and feasible, considering the life threatening condition, in H1N1-induced ARDS. Lung ultrasound is an effective mean for daily assessment of ARDS patients. PMID:21223541

  19. 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

  20. Acute liver failure caused by 'fat burners' and dietary supplements: a case report and literature review.

    PubMed

    Yellapu, Radha K; Mittal, Vivek; Grewal, Priya; Fiel, Mariaisabel; Schiano, Thomas

    2011-03-01

    Globally, people are struggling with obesity. Many effective, nonconventional 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

  1. Mutation in mitochondrial ribosomal protein S7 (MRPS7) causes congenital sensorineural deafness, progressive hepatic and renal failure and lactic acidemia.

    PubMed

    Menezes, Minal J; Guo, Yiran; Zhang, Jianguo; Riley, Lisa G; Cooper, Sandra T; Thorburn, David R; Li, Jiankang; Dong, Daoyuan; Li, Zhijun; Glessner, Joseph; Davis, Ryan L; Sue, Carolyn M; Alexander, Stephen I; Arbuckle, Susan; Kirwan, Paul; Keating, Brendan J; Xu, Xun; Hakonarson, Hakon; Christodoulou, John

    2015-04-15

    Functional defects of the mitochondrial translation machinery, as a result of mutations in nuclear-encoded genes, have been associated with combined oxidative phosphorylation (OXPHOS) deficiencies. We report siblings with congenital sensorineural deafness and lactic acidemia in association with combined respiratory chain (RC) deficiencies of complexes I, III and IV observed in fibroblasts and liver. One of the siblings had a more severe phenotype showing progressive hepatic and renal failure. Whole-exome sequencing revealed a homozygous mutation in the gene encoding mitochondrial ribosomal protein S7 (MRPS7), a c.550A>G transition that encodes a substitution of valine for a highly conserved methionine (p.Met184Val) in both affected siblings. MRPS7 is a 12S ribosomal RNA-binding subunit of the small mitochondrial ribosomal subunit, and is required for the assembly of the small ribosomal subunit. Pulse labeling of mitochondrial protein synthesis products revealed impaired mitochondrial protein synthesis in patient fibroblasts. Exogenous expression of wild-type MRPS7 in patient fibroblasts rescued complexes I and IV activities, demonstrating the deleterious effect of the mutation on RC function. Moreover, reduced 12S rRNA transcript levels observed in the patient's fibroblasts were also restored to normal levels by exogenous expression of wild-type MRPS7. Our data demonstrate the pathogenicity of the identified MRPS7 mutation as a novel cause of mitochondrial RC dysfunction, congenital sensorineural deafness and progressive hepatic and renal failure. PMID:25556185

  2. Failure of the crossover pipes used in the PK-39-IIM boiler middle radiant part and a numerical analysis of the factors caused this failure

    NASA Astrophysics Data System (ADS)

    Baranov, V. N.; Gorb, A. A.; Nikolaev, S. F.

    2013-06-01

    The consequences resulting from an emergency failure of one subflow in the middle radiant part of a modernized PK-39-IIM boiler occurred during one of its first startups after the erection are presented. A numerical analysis of the factors that caused this failure is carried out. The calculation was carried out in accordance with the recommendations suggested in the standard method of hydraulic design. It is shown that at a load equal to 40% of its nominal value, increment of heat absorption in the subflow equal to 586 kJ/kg (140 kcal/kg), and heat absorption nonuniformity coefficient in the misaligned element equal to 1.5, the temperature of medium downstream of the subflow is equal to 670°C (operating conditions close to those under which the failure occurred).

  3. Acute intermittent porphyria causes hepatic mitochondrial energetic failure in a mouse model.

    PubMed

    Homedan, Chadi; Laafi, Jihane; Schmitt, Caroline; Gueguen, Naïg; Lefebvre, Thibaud; Karim, Zoubida; Desquiret-Dumas, Valérie; Wetterwald, Céline; Deybach, Jean-Charles; Gouya, Laurent; Puy, Hervé; Reynier, Pascal; Malthièry, Yves

    2014-06-01

    Acute intermittent porphyria (AIP), an inherited hepatic disorder, is due to a defect of hydroxymethylbilane synthase (HMBS), an enzyme involved in heme biosynthesis. AIP is characterized by recurrent, life-threatening attacks at least partly due to the increased hepatic production of 5-aminolaevulinic acid (ALA). Both the mitochondrial enzyme, ALA synthase (ALAS) 1, involved in the first step of heme biosynthesis, which is closely linked to mitochondrial bioenergetic pathways, and the promise of an ALAS1 siRNA hepatic therapy in humans, led us to investigate hepatic energetic metabolism in Hmbs KO mice treated with phenobarbital. The mitochondrial respiratory chain (RC) and the tricarboxylic acid (TCA) cycle were explored in the Hmbs(-/-) mouse model. RC and TCA cycle were significantly affected in comparison to controls in mice treated with phenobarbital with decreased activities of RC complexes I (-52%, (**)p<0.01), II (-50%, (**)p<0.01) and III (-55%, (*)p<0.05), and decreased activity of ?-ketoglutarate dehydrogenase (-64%, (*)p<0.05), citrate synthase (-48%, (**)p<0.01) and succinate dehydrogenase (-53%, (*)p<0.05). Complex II-driven succinate respiration was also significantly affected. Most of these metabolic alterations were at least partially restored after the phenobarbital arrest and heme arginate administration. These results suggest a cataplerosis of the TCA cycle induced by phenobarbital, caused by the massive withdrawal of succinyl-CoA by ALAS induction, such that the TCA cycle is unable to supply the reduced cofactors to the RC. This profound and reversible impact of AIP on mitochondrial energetic metabolism offers new insights into the beneficial effect of heme, glucose and ALAS1 siRNA treatments by limiting the cataplerosis of TCA cycle. PMID:24727425

  4. [Respiratory tract diseases caused by chemically irritating or toxic pollutants at the work site].

    PubMed

    Baur, X

    1995-05-01

    Update statistics of job-related diseases show there is still a high level in reported and also in recognised and financially compensated airway diseases caused by the action of chemically irritating or toxic substances during work. Most reported cases occur in the chemical and metal processing industries. Main triggering substances are said to be isocyanates, aerosols of pollutants produced during welding, cutting, casting or moulding (smoke), by solvents and hair dyes. Experiments prove that a variety of these noxious substances produce dose-dependent hypersensitivity of the bronchial system. Long-term monitoring of granary workers clearly points to both the possibility of and the need for early diagnosis followed by mandatory and immediate abstention from further exposure to avoid occurrence of irreversible disease patterns. Work-related health risks over and above job-conditioned diseases must be generally included in the protective measures in accordance with the new EC guidelines. PMID:7610103

  5. 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

  6. Anastomoses of the Ovarian and Uterine Arteries: A Potential Pitfall and Cause of Failure of Uterine Embolization

    SciTech Connect

    Matson, Matthew [Department of Radiology, St. George's Hospital, Blackshaw Road, London, SW17 OQT (United Kingdom); Nicholson, Anthony [Department of Radiology, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ (United Kingdom); Belli, Anna-Maria [Department of Radiology, St. George's Hospital, Blackshaw Road, London, SW17 OQT (United Kingdom)

    2000-09-15

    Four women with symptomatic uterine fibroids were treated by uterine artery embolization (UAE). In all cases both uterine arteries were embolized via a single femoral puncture with polyvinyl alcohol using a selective catheter technique. In three cases, the ovarian artery was not visible on the initial angiogram before embolization, but appeared after the second uterine artery had been treated. In one case of clinical failure following UAE, a repeat angiogram demonstrated filling of the fibroids from the ovarian artery. Anastomoses between uterine and ovarian arteries may cause problems for radiologists performing UAE and are a potential cause of treatment failure.

  7. Validity of Methods to Predict the Respiratory Sensitizing Potential of Chemicals: A Study with a Piperidinyl Chlorotriazine Derivative That Caused an Outbreak of Occupational Asthma

    Microsoft Academic Search

    Jeroen A. J. Vanoirbeek; Cindy Mandervelt; Albert R. Cunningham; Peter H. M. Hoet; Haiyan Xu; Hadewijch M. Vanhooren; Benoit Nemery

    2003-01-01

    A piperidinyl chlorotriazine (PCT) derivative, used as a plastic UV-stabilizer, caused an outbreak of occupational asthma. We verified, in BALB\\/c mice, the sensitizing potential of PCT in comparison to a known respiratory sensitizer (toluene diisocya- nate (TDI)) and a known dermal sensitizer (oxazolone), using three different methods in order to evaluate the validity of current models of sensitization. These included

  8. Foreign Body or Hypersensitivity Granuloma of the Inner Ear following Cochlear Implantation. One possible cause of a soft failure?

    PubMed Central

    Nadol, Joseph B.; Eddington, Donald K.; Burgess, Barbara J.

    2014-01-01

    Hypothesis A tissue response in the form of foreign body or a hypersensitivity reaction to cochlear implantation is common and may be one possible cause of a soft failure of cochlear implantation. Background Following a successful cochlear implantation, delayed failure may occur. The causes of a “soft” failure, that is one in which device malfunction cannot be proven, are unknown. Methods The histopathology of the temporal bones of a patient who in life had suffered a soft failure following cochlear implantation was described. In addition, the temporal bones of 8 other subjects who in life had undergone cochlear implantation were studied for evidence of a foreign body or hypersensitivity reaction. Results In the case report, a necrotizing granulomatous giant cell reaction surrounded the cochlear implant electrode track through the mastoid, middle ear, and into the cochlea in both ears. There was osteolysis of the cribrose area, otic capsule and bone between the facial nerve and cochlea, and destruction of the organ of Corti and spiral ganglion. In the additional 8 cases studied, a similar, although less pronounced, foreign body or hypersensitivity reaction was seen in 6 (75%) of the cases. Conclusions A foreign body or hypersensitivity reaction in the form of giant cells and lymphocytic cell infiltration is common following cochlear implantation and may be one possible cause of soft failure. PMID:18997635

  9. A Procedure for Estimating Loss of Life Caused by Dam Failure

    Microsoft Academic Search

    W. J. Graham

    1999-01-01

    ABSTRACT Risk assessments,and other dam safety studies often require that,an estimate,be made,of the,number,of fatalities,that would result from dam failure. To assist in this effort, an extensive,evaluation,of dam,failures,and,the,factors,that contributed,to loss,of life,was,conducted. Every,U.S. dam,failure,that,resulted,in more,than,50

  10. Severe Congenital Myasthenia Gravis of the Presynaptic Type with Choline Acetyltransferase Mutation in a Chinese Infant with Respiratory Failure

    Microsoft Academic Search

    Wai L. Yeung; Ching W. Lam; Lai W. E. Fung; Kam L. E. Hon; Pak C. Ng

    2009-01-01

    We report a severe case of congenital myasthenia gravis in a Chinese newborn who presented with complete ptosis, severe hypotonia, dysphagia and respiratory insufficiency with recurrent apnea that required mechanical ventilatory support since birth. Routine neurophysiologic studies, including the 3-Hz repetitive stimulation test and electromyogram were normal. Neostigmine and edrophonium tests were also negative. However, decremental response to 3-Hz stimulation

  11. 20 CFR 416.732 - No penalty deduction if you have good cause for failure to report timely.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...obligation to make a required report; or (ii) You did not intentionally...purposely fail to make a required report. However, in either case we may require that you refund...overpayment caused by your failure to report. See subpart E of this...

  12. CALCULATION OF DISCHARGE OF DEBRIS FLOWS CAUSED BY MORAINE-DAM FAILURE AT MIDUI GULLY, TIBET, CHINA

    Microsoft Academic Search

    X. Q. CHEN; P. CUI; N. S. CHEN; J. GARDNER

    Debris flows caused by moraine-dam failure are common on the Qinghai-Tibet Plateau in China. Peak discharges of debris flows should be predicted to evaluate the risk to people and property in valleys below the moraine dams. On the basis of the critical wave method, we have reduced a new series of formulas about the peak discharge of debris flow, including

  13. THE PREDICTION OF FLASH FLOOD CAUSED BY DAM FAILURE A CASE STUDY AT THE THE THA DAN DAM, THAILAND

    Microsoft Academic Search

    Pakorn PETCHPRAYOON

    The Tha Dan Dam, Nayok Province, was selected as a case study to predict flood disaster caused by dam failure and overflow through spillway. It is a roller-compacted concrete dam with 114 meters above the mean sea level of ridge height and 224 million m3 of volume capacity. The objectives of this study were to predict the characteristics of flood

  14. Middle East Respiratory Syndrome (MERS)

    MedlinePLUS

    Middle East Respiratory Syndrome Coronavirus; MERS-CoV; Novel coronavirus; nCoV ... Middle East Respiratory Syndrome (MERS) is a severe respiratory illness. It causes fever, coughing, and shortness of breath. About 30% of people who have gotten ...

  15. Methods for predicting peak discharge of floods caused by failure of natural and constructed earthen dams

    Microsoft Academic Search

    Joseph S. Walder; Jim E. O'Connor

    1997-01-01

    Floods from failures of natural and constructed dams constitute a widespread hazard to people and property. Expeditious means of assessing flood hazards are necessary, particularly in the case of natural dams, which may form suddenly and unexpectedly. We revise statistical relations (derived from data for past constructed and natural dam failures) between peak discharge (Qp) and water volume released (V0)

  16. Massive infiltration of liver by metastatic adenocarcinoma: a rare cause of acute hepatic failure.

    PubMed

    Varghese, Joy; Jayanthi, Venkataraman; Patra, Susma; Rela, Mohamed

    2012-09-01

    Acute liver cell failure can occur by diffuse infiltration of malignant cells in liver parenchyma. The malignant cells might be either primary hepatocellular carcinoma or metastatic liver disease. Mostly, CT abdomen with intravenous contrast fails to detect liver malignancy. We report a case of liver metastasis masquerading as fulminant hepatic failure. PMID:25755446

  17. One novel and one recurrent mutation in IGHMBP2 gene, causing severe spinal muscular atrophy respiratory distress 1 with onset soon after birth.

    PubMed

    Litvinenko, Ivan; Kirov, Andrey Ventsislavov; Georgieva, Ralitsa; Todorov, Tihomir; Malinova, Zornitsa; Mitev, Vanyo; Todorova, Albena

    2014-06-01

    A family with 2 siblings with severe spinal muscular atrophy with respiratory distress 1 (SMARD1) was genetically proved to be caused by mutations in IGHMBP2 gene. Both patients developed progressive muscular weakness and respiratory distress and died before 6 months of age. One novel deletion, c.780delG;p.(Gln260Hisfs*24), inherited from the father and a nonsense mutation, c.1488C>A;p.(Cys496*), inherited from the mother were detected. An attempt was made to correlate the genetic-clinical data available in the literature. The clinical case presented in this study might be considered as the most severe form of spinal muscular atrophy respiratory distress 1 reported so far, presumably because of the total absence of IGHMBP2 enzyme activity. PMID:23449687

  18. 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.

  19. Digoxin Use and Lower 30-Day All-Cause Readmission for Medicare Beneficiaries Hospitalized for Heart Failure

    PubMed Central

    Ahmed, Ali; Bourge, Robert C.; Fonarow, Gregg C.; Patel, Kanan; Morgan, Charity J.; Fleg, Jerome L.; Aban, Inmaculada B.; Love, Thomas E.; Yancy, Clyde W.; Deedwania, Prakash; van Veldhuisen, Dirk J.; Filippatos, Gerasimos S.; Anker, Stefan D.; Allman, Richard M.

    2013-01-01

    BACKGROUND Heart failure is the leading cause for hospital readmission, the reduction of which is a priority under the Affordable Care Act. Digoxin reduces 30-day all-cause hospital admission in chronic systolic heart failure. Whether digoxin is effective in reducing readmission after hospitalization for acute decompensation remains unknown. METHODS Of the 5153 Medicare beneficiaries hospitalized for acute heart failure and not receiving digoxin, 1054 (20%) received new discharge prescriptions for digoxin. Propensity scores for digoxin use, estimated for each of the 5153 patients, were used to assemble a matched cohort of 1842 (921 pairs) patients (mean age, 76 years; 56% women; 25% African American) receiving and not receiving digoxin, who were balanced on 55 baseline characteristics. RESULTS 30-day all-cause readmission occurred in 17% and 22% of matched patients receiving and not receiving digoxin, respectively (hazard ratio {HR} for digoxin, 0.77; 95% confidence interval {CI}, 0.63–0.95). This beneficial association was observed only in those with ejection fraction <45% (HR, 0.63; 95% CI, 0.47–0.83), but not in those with ejection fraction ?45% (HR, 0.91; 95% CI, 0.60–1.37; p for interaction, 0.145), a difference that persisted throughout first 12-month post-discharge (p for interaction, 0.019). HRs (95% CIs) for 12-month heart failure readmission and all-cause mortality were 0.72 (0.61–0.86) and 0.83 (0.70–0.98), respectively. CONCLUSIONS In Medicare beneficiaries with systolic heart failure, a discharge prescription of digoxin was associated with lower 30-day all-cause hospital readmission, which was maintained at 12 months, and was not at the expense of higher mortality. Future randomized controlled trials are needed to confirm these findings. PMID:24257326

  20. [Neuromuscular disease: respiratory clinical assessment and follow-up].

    PubMed

    Martínez Carrasco, C; Villa Asensi, J R; Luna Paredes, M C; Osona Rodríguez de Torres, F B; Peña Zarza, J A; Larramona Carrera, H; Costa Colomer, J

    2014-10-01

    Patients with neuromuscular disease are an important group at risk of frequently suffering acute or chronic respiratory failure, which is their main cause of death. They require follow-up by a pediatric respiratory medicine specialist from birth or diagnosis in order to confirm the diagnosis and treat any respiratory complications within a multidisciplinary context. The ventilatory support and the cough assistance have improved the quality of life and long-term survival for many of these patients. In this paper, the authors review the pathophysiology, respiratory function evaluation, sleep disorders, and the most frequent respiratory complications in neuromuscular diseases. The various treatments used, from a respiratory medicine point of view, will be analyzed in a next paper. PMID:24709048

  1. Short communication Vaccine failure caused an outbreak of equine influenza in Croatia

    Microsoft Academic Search

    Ljubo Barbic; Josip Madic; Nenad Turk; Janet Daly

    In April 2004 an outbreak of equine influenza occurred at the Zagreb hippodrome, Croatia. Clinical respiratory disease of the same intensity was recorded in vaccinated and non-vaccinated horses. The equine influenza vaccine used in Croatia at the time of the outbreak contained the strains A\\/equine\\/Miami\\/63 (H3N8), A\\/equine\\/Fontainebleau\\/79 (H3N8) and A\\/ equine\\/Prague\\/56 (H7N7). At the same time, the usual strains in

  2. Acute disseminated encephalomyelitis (ADEM) following a H3N3 parainfluenza virus infection in a pregnant asthmatic woman with respiratory failure.

    PubMed

    Zeb, Qaiser; Alegria, Ana

    2014-01-01

    This case report relates to a 31-year-old pregnant woman, asthmatic, admitted to the intensive care unit with respiratory failure, secondary to a viral community-acquired pneumonia. A type 3 (H3N3) parainfluenza virus RNA was isolated in her throat swab. The patient developed neurological symptoms (behavioural changes, irritability, agitation and impaired consciousness) while being weaned off sedation and ventilatory support. Cerebrospinal fluid was clear with an opening pressure of 26 cm H2O. Brain MRI showed features compatible with acute disseminated encephalomyelitis. Immune screen and EEG were normal. She was treated with intravenous methylprednisolone followed by oral prednisolone. The patient made an almost full neurological recovery within 4 weeks after starting on steroids. The patient delivered a healthy baby at 38 weeks gestation. This case highlights the importance to keep in mind rare conditions that need early recognition and prompt treatment. Brain MRI is the key to early diagnosis and treatment. PMID:25281245

  3. Use of HFPV for Adults with ARDS: The Protocolized Use of High-Frequency Percussive Ventilation for Adults with Acute Respiratory Failure Treated with Extracorporeal Membrane Oxygenation.

    PubMed

    Michaels, Andrew J; Hill, Jon G; Sperley, Bernie P; Young, Brian P; Ogston, Tawyna L; Wiles, Connor L; Rycus, Peter; Shanks, Tanya R; Long, William B; Morgan, Lori J; Bartlett, Robert H

    2015-01-01

    Historically, patients on extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome have received ventilatory "lung rest" with conventional or high-frequency oscillating ventilators. We present a series of adults treated with high-frequency percussive ventilation (HFPV) to enhance recovery and recruitment during ECMO. Adult respiratory patients, treated between January 2009 and December 2012 were cared for with a combination of standard ECMO practices and a protocol of recruitment strategies, including HFPV. Data are reported as mean ± standard error of the mean, percentage, or median. Comparisons are made by ? for categorical variables and by t-test and Mann-Whitney test for continuous variables. Significance is noted at the 95% confidence level (p < 0.05). There were 39 HFPV patients. They were 39.9 ± 2.2 years of age and had 3.0 ± 0.37 days of mechanical ventilation before the initiation of ECMO. Their pre-ECMO PaO2 to FiO2 ratio (PF ratio) was 52.3 ± 3.0 and their pCO2 was 50.22 ± 2.4. HFPV patients required a mean of 143.1 ± 17.6 hours and a median of 106 hours (range 45.75-350.25) of ECMO support and had a 62% survival to discharge. The post-ECMO PF ratio in the HFPV cohort was 301.8 ± 16.7. A protocolized practice of active recruitment that includes HFPV is associated with reduced duration of ECMO support in adults with respiratory failure. PMID:25635932

  4. Miliary tuberculosis and adult respiratory distress syndrome.

    PubMed

    Piqueras, A R; Marruecos, L; Artigas, A; Rodriguez, C

    1987-01-01

    Although, miliary tuberculosis is an unusual cause of severe acute respiratory failure, we describe nine patients with miliary tuberculosis who developed adult respiratory distress syndrome. This complication occurred in seven patients despite treatment with antituberculous drugs. In two patients who developed the syndrome, miliary tuberculosis was diagnosed only at postmortem. The presence of pulmonary hypertension in all cases and disseminated intravascular coagulation in seven cases suggests a possible pathophysiologic relationship with severe pulmonary vascular damage. The high mortality rate (88.8%) was associated with nonpulmonary organ system failure. Miliary tuberculosis should be considered in patients with adult respiratory distress syndrome of unknown etiology, and simple diagnostic procedures such as sputum, bronchial brushing, and gastric examination should be followed by invasive diagnostic procedures to confirm this etiology. Since untreated miliary tuberculosis is usually fatal, early recognition of this disease is of great importance, and specific therapy may play a lifesaving role. PMID:3584648

  5. 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…

  6. A 27-year-old woman presenting with refractory hypoxaemic respiratory failure, haemoptysis and thyrotoxicosis: a rare manifestation of propylthiouracil therapy.

    PubMed

    Ortiz-Diaz, Enrique O

    2014-01-01

    Pulmonary manifestations of hyperthyroidism not only include pulmonary hypertension and hydrostatic pulmonary oedema, but also treatment/drug-associated pulmonary diseases have to be considered as an exclusion diagnosis. A 27-year-old woman with hypoxaemic respiratory failure under an arterial-venous extra-corporeal membrane oxygenator (AV-ECMO) was admitted to the intensive care unit (ICU). The patient had progressive dyspnoea with haemoptysis, palpitations and failure to thrive. The patient had Graves' disease treated previously with propylthiouracil (PTU). Diffuse alveolar haemorrhage is a non-specific syndrome characterised by evidence of diffuse alveolar damage, exclusion of infectious aetiology and progressively bloodier bronchoalveolar lavage (and/or 20% hemosiderin laden macrophages on cytological examination). PTU associated perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) vasculitis appears to be more common in younger female patients presenting with leukocytoclastic vasculitis, myalgias and arthralgias. The latter compared to non-drug associated ANCA vasculitis which are more common in older males with visceral involvement. PTU-induced ANCA vasculitis prognosis appears to be better compared to primary ANCA syndromes. PMID:25150234

  7. Congenital coronary artery fistulae: a rare cause of heart failure in adults

    PubMed Central

    2014-01-01

    Coronary artery fistulae are uncommon, reported in 0.25% of patients undergoing coronary angiography. Two patients with congenital coronary artery fistula and coronary artery disease who presented with symptoms of exacerbated congestive heart failure out of proportion to their atherosclerotic burden were successfully treated by epicardial fistula ligation and coronary artery bypass grafting with marked improvement in functional status. PMID:24886594

  8. The Dhammic Framework for Understanding the Cause of System Project Failures from Buddhist

    E-print Network

    Thomborson, Clark

    the informational aspects of cognitive processes, with applications in the engineering of complex systems. Human to avoid failures in systems engineering. Keywords--Cognitive Informatics (CI), Dhammic Framework, Layered, and their engineering applications via an interdisciplinary approach". Bo Zhang, in a recent position statement

  9. Undetected supraventricular tachycardia causing congestive heart failure: a pitfall of remote monitoring system.

    PubMed

    Nakabayashi, Keisuke; Sugiura, Ryo; Oka, Toshiaki

    2015-01-01

    Remote monitoring systems with automated clinician alerts are a milestone development for implantable cardiovascular devices, and improve the quality of life for patients and physicians by reducing the number of conventional clinic visits. In addition, remote monitoring systems can detect many bradyarrhythmias and tachyarrhythmias earlier than traditional methods, although these devices are not perfect. We report the case of an 80-year-old woman with an implanted pacemaker and a remote monitoring system that failed to report acute heart failure at 10?months after implantation. ECG and telemetry revealed relatively slow supraventricular tachycardia, which did not trigger the alert, and catheter ablation successfully controlled the heart failure. Subsequent analysis revealed that the monitoring function had detected the arrhythmia as frequent premature ventricular contraction, although the arrhythmia did not trigger the automated clinician alert. Therefore, remote monitoring systems with accurate settings are essential, although conventional monitoring methods are still important for some patients. PMID:26156839

  10. Nail patella syndrome: a rare cause of renal failure in a young adult

    PubMed Central

    Senguttuvan, Nagendra Boopathy; Sivaraman, Arjun; Kandasamy, Devasenathipathy; Marimuthu, Kanniraj

    2011-01-01

    Nail Patella Syndrome (NPS) is a rare hereditary disease affecting multiple systems with predominant involvement of Kidney, Bones and Nails and Eyes. We report a case of NPS which presented as renal failure in a 22 year old male. The patient was admitted with decreased urine output and features of fluid overload and was being evaluated for renal failure. Physical examination revealed associated bony deformities which raised the suspicion of NPS as a possible etiology. This was confirmed by the radiological evaluation which showed the classical features of NPS. Though NPS is a rare clinical condition, physicians should complete knowledge about the components of NPS for appropriate diagnosis and for early detection of other systems involvement. PMID:22145064

  11. Methods 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.

    1997-01-01

    Floods from failures of natural and constructed dams constitute a widespread hazard to people and property. Expeditious means of assessing flood hazards are necessary, particularly in the case of natural dams, which may form suddenly and unexpectedly. We revise statistical relations (derived from data for past constructed and natural dam failures) between peak discharge (Q(p)) and water volume released (V(0)) or drop in lake level (d) but assert that such relations, even when cast into a dimensionless form, are of limited utility because they fail to portray the effect of breach-formation rate. We then analyze a simple, physically based model of dam-breach formation to show that the hydrograph at the breach depends primarily on a dimensionless parameter ?? = kV0/g1/2d7/2, where k is the mean erosion rate of the breach and g is acceleration due to gravity. The functional relationship between Q(p) and ?? takes asymptotically distinct forms depending on whether ?? > 1 (relatively fast breach formation or large lake volume). Theoretical predictions agree well with data from dam failures for which k, and thus ??, can be estimated. The theory thus provides a rapid means of predicting the plausible range of values of peak discharge at the breach in an earthen dam as long as the impounded water volume and the water depth at the dam face can be estimated.

  12. 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.

  13. 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

  14. 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

  15. 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

  16. Failure in generating hemopoietic stem cells is the primary cause of death from cytomegalovirus disease in the immunocompromised host

    PubMed Central

    1988-01-01

    We have shown in a murine model system for cytomegalovirus (CMV) disease in the immunocompromised host that CMV infection interferes with the earliest detectable step in hemopoiesis, the generation of the stem cell CFU-S-I, and thereby prevents the autoreconstitution of bone marrow after sublethal irradiation. The antihemopoietic effect could not be ascribed to a direct infection of stem cells. The failure in hemopoiesis was prevented by adoptive transfer of antiviral CD8+ T lymphocytes and could be overcome by syngeneic bone marrow transplantation. CD8+ T lymphocytes and bone marrow cells both mediated survival, although only CD8+ T lymphocytes were able to limit virus multiplication in host tissues. We concluded that not the cytopathic effect of virus replication in host tissues, but the failure in hemopoiesis, is the primary cause of death in murine CMV disease. PMID:2896757

  17. Acute liver failure caused by severe acute hepatitis B: a case series from a multi-center investigation

    PubMed Central

    2014-01-01

    Background Few data can be available regarding acute liver failure (ALF) caused by severe acute hepatitis B up to now. This study aims to report such cases from China. Findings We conducted a multi-center investigation on ALF from 7 tertiary hospitals in different areas of China. A total of 11 patients with ALF caused by severe acute hepatitis B were finally identified. In these patients, there were 10 male and 1 female patients. As a serious complication, apparent hemorrhage occurred in 9 patients. Eventually, in these 11 patients, 4 survived and 7 died. 4 died of heavy bleeding, 2 died of systemic inflammatory response syndrome and 1 died of irreversible coma. No patients received liver transplantation. Conclusions ALF caused by severe acute hepatitis B is worthy of formal studies based on its rarity and severity. PMID:24958233

  18. Plasma metabonomics study on Chinese medicine syndrome evolution of heart failure rats caused by LAD ligation

    PubMed Central

    2014-01-01

    Background Chinese medicine syndromes (Zheng) in many disease models are not clearly characterized or validated, and the concepts of Chinese medicine syndromes are confounding and controversial. Metabonomics has been applied to the evaluation and classification of the Chinese medicine syndromes both in clinical and nonclinical studies. In this study, we aim to investigate the evolution of the Chinese medicine syndrome in myocardial infarction induced heart failure and to confirm the feasibility of the Zheng classification by plasma metabonomics in a syndrome and disease combination animal model. Methods The heart failure (HF) model was induced by ligation of the left anterior descending coronary artery (LAD) in Sprague–Dawley rats. The rats were divided into the following two groups: the HF model group (LAD ligation) and the sham operated group. GC-MS was used with pattern recognition technology and principal component analysis (PCA) to analyze the plasma samples at 4, 21 and 45 day after operation. Results It was determined that the period from 7 to 28 days was the stable time window of ischemic heart failure with qi deficiency and blood stasis syndrome (QDBS), and the qi deficiency syndrome occurred at 1 to 4 days and 45 to 60 days after operation. The results exhibited 5 plasma metabolite changes in the same trend at 4 and 21 day after the LAD operation, 7 at 21 and 45 day, and 2 at 4 and 45 day. No metabolite showed the same change at all of the 3 time points. At day 21 (the QDBS syndrome time point) after operation, 4 plasma metabolites showed the same trends with the results of our previous study on patients with the blood stasis syndrome. Conclusions The syndrome diagnosis is reliable in the HF rat model in this study. Plasma metabolites can provide a basis for the evaluation of Chinese medicine syndrome animal models. PMID:25012233

  19. Simultaneous detection and high-throughput identification of a panel of RNA viruses causing respiratory tract infections.

    PubMed

    Li, Haijing; McCormac, Melinda A; Estes, R Wray; Sefers, Susan E; Dare, Ryan K; Chappell, James D; Erdman, Dean D; Wright, Peter F; Tang, Yi-Wei

    2007-07-01

    Clinical presentations for viral respiratory tract infections are often nonspecific, and a rapid, high-throughput laboratory technique that can detect a panel of common viral pathogens is clinically desirable. We evaluated two multiplex reverse transcription-PCR (RT-PCR) products coupled with microarray-based systems for simultaneous detection of common respiratory tract viral pathogens. The NGEN respiratory virus analyte-specific assay (Nanogen, San Diego, CA) detects influenza A virus (Flu-A) and Flu-B, parainfluenza virus 1 (PIV-1), PIV-2, and PIV-3, and respiratory syncytial virus (RSV), while the ResPlex II assay (Genaco Biomedical Products, Inc., Huntsville, AL) detects Flu-A, Flu-B, PIV-1, PIV-2, PIV-3, PIV-4, RSV, human metapneumovirus (hMPV), rhinoviruses (RhVs), enteroviruses (EnVs), and severe acute respiratory syndrome (SARS) coronavirus (CoV). A total of 360 frozen respiratory specimens collected for a full year were tested, and results were compared to those obtained with a combined reference standard of cell culture and monoplex real-time TaqMan RT-PCR assays. NGEN and ResPlex II gave comparable sensitivities for Flu-A (82.8 to 86.2%), Flu-B (90.0 to 100.0%), PIV-1 (87.5 to 93.8%), PIV-3 (66.7 to 72.2%), and RSV (63.3 to 73.3%); both assays achieved excellent specificities (99.1 to 100.0%) for these five common viruses. The ResPlex II assay detected hMPV in 13 (3.6%) specimens, with a sensitivity of 80.0% and specificity of 99.7%. The ResPlex II assay also differentiated RSV-A and RSV-B and gave positive results for RhV and EnV in 31 (8.6%) and 19 (5.3%) specimens, respectively. PIV-2, PIV-4, and SARS CoV were not detected in the specimens tested. The two systems can process 80 (NGEN) and 96 (ResPlex II) tests per run, with a hands-on time of approximately 60 min and test turnaround times of 6 h (ResPlex II) and 9 h (NGEN). Multiple-panel testing detected an additional unsuspected 9 (3.4%) PIV-1 and 10 (3.7%) PIV-3 infections. While test sensitivities for RSV and PIV-3 need improvement, both the NGEN and ResPlex II assays provide user-friendly and high-throughput tools for simultaneous detection and identification of a panel of common respiratory viral pathogens in a single test format. The multiplex approach enhances diagnosis through detection of respiratory viral etiologic agents in cases in which the presence of the agent was not suspected and a test was not ordered by the clinicians. PMID:17507510

  20. Association of adult respiratory distress syndrome (ARDS) with thoracic irradiation (RT)

    SciTech Connect

    Byhardt, R.W.; Abrams, R.; Almagro, U.

    1988-12-01

    The authors report two cases of apparent adult respiratory distress syndrome (ARDS) following limited thoracic irradiation for lung cancer. Respiratory failure followed rapidly after irradiation with diffuse bilateral infiltrates, both in and out of the irradiated volume along with progressive hypoxemia unresponsive to oxygen management. Other potential causes of lung injury such as lymphangitic tumor, cardiac failure, and infections were excluded by both premortem and postmortem examination. Autopsy findings in both irradiated and unirradiated volumes of lung were consistent with hyaline membrane changes. The possible relationship between radiation therapy to limited lung volumes and the development of adult respiratory distress syndrome is discussed.

  1. A review of poisonous plants that cause reproductive failure and malformations in the ruminants of Brazil.

    PubMed

    Riet-Correa, Franklin; Medeiros, Rosane M T; Schild, Ana Lucia

    2012-04-01

    The objective of this review is to provide a report on toxic plants causing reproductive problems in ruminants in Brazil. Aspidosperma pyrifolium causes abortion or stillbirth in goats, as well as most likely in sheep and cattle, in the semiarid regions of Northeastern Brazil. Intoxications by Ateleia glazioveana, Tetrapterys acutifolia and T. multiglandulosa result in abortion and neonatal mortality in cattle and sheep, and the same signs have been experimentally observed in goats. These three plants can also cause cardiac fibrosis and a nervous disease with spongiosis of the central nervous system. Other plants known to cause abortion include Enterolobium contortisiliquum, E. gummiferum, Stryphnodendron coriaceum, S. obovatum and S. fissuratum. These plants can also cause digestive signs and photosensitization. Abortions have been reported in animals intoxicated by nitrates and nitrites as well. Infertility, abortions and the birth of weak offspring have been reported in animals intoxicated by plants containing swainsonine, including Ipomoea spp., Turbina cordata and Sida carpinifolia. Trifolium subterraneum causes estrogenism in cattle. Mimosa tenuiflora and, most likely, M. ophthalmocentra cause malformations and embryonic mortality in goats, sheep and cattle in the semiarid regions of Northeastern Brazil. PMID:22147504

  2. 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

    2015-05-01

    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

  3. A rare case of extensive diffuse nonpigmented villonodular synovitis as a cause of total knee arthroplasty failure

    PubMed Central

    Tosun, Hac? Bayram; Uluda?, Abuzer; Serbest, Sancar; Gümü?ta?, Seyitali; Erdo?du, ?brahim Halil

    2014-01-01

    INTRODUCTION Nonpigmented villonodular synovitis (non-PVNS) is a benign proliferative disease involving the synovium. It is a rare condition that is little recognized. Non-PVNS has been reported as a cause of total knee replacement failure. PRESENTATION OF CASE We report a case of extensive diffuse non-PVNS in a patient with tibial component loosening after total knee replacement and review the related literature. DISCUSSION It is reported that pigmented villonodular synovitis (PVNS) occurs less frequently than non-PVNS after knee replacement. However, there are many more case reports of PVNS than non-PVNS after knee arthroplasty in the English-language literature. CONCLUSION Previously, there were no reported cases of extensive diffuse non-PVNS after total knee arthroplasty (TKA). This case study highlights an unusual case of non-PVNS as a cause of TKA failure. We propose that non-PVNS should be considered as a differential diagnosis in patients after TKA who present with recurrent pain and effusion/hemarthrosis of the knee, and that it is one of the causes of implant loosening after TKA. PMID:24892248

  4. Unexpected causes of pulmonary hypertension in a previously healthy Thai rural man with right-sided heart failure

    PubMed Central

    Angkananard, Teeranan; Chonmaitree, Piyanant; Petborom, Pichaya

    2014-01-01

    Patient Male, 52 Final Diagnosis: Pulmonary hypertension Symptoms: Diarrhea • dyspnea • jaundice Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Unusual clinical course Background: Hyperthyroidism is one of the important causes of high-output failure and reversible pulmonary artery hypertension. Severe pulmonary artery hypertension is rarely found in associated with hyperthyroidism due to the small number of cases reported. We present an interesting case with multiple unexpected findings of the possible causes of severe pulmonary artery hypertension: hyperthyroidism, pulmonary embolism, and ostium secundum atrial septal defect. Case Report: We present the case of a previously healthy rural Thai man who progressively developed dyspnea on exertion, chronic diarrhea, and jaundice for the previous 3 months. Physical examination revealed right-sided predominate chronic heart failure with signs of pulmonary hypertension. The investigation demonstrated autoimmune hyperthyroidism, cholestatic jaundice, moderate tricuspid regurgitation, ostium secundum atrial septal defect, and severe pulmonary artery hypertension. After treatment with an anti-thyroid drug and closure of the ostium secundum atrial septal defect, his symptoms of jaundice and pulmonary artery pressure were completely resolved. Conclusions: Severe pulmonary artery hypertension may not solely be a result of hyperthyroidism. Further investigation for other causes is recommended. PMID:24808937

  5. Boiler tube failures at New Boston: a root-cause analysis. Final report

    Microsoft Academic Search

    R. E. Land; A. E. Jr. Tome; R. Adams; P. A. Flaherty; P. Johnson

    1985-01-01

    In-depth root-cause analysis of equipment problems at power stations is an effective means of maintaining and improving availability. An earlier EPRI study, ''Utility-Oriented Approach for Root-Cause Analysis of Power Plant Equipment Problems,'' proposed a general approach to problem analysis for use by utilities. This report presents the results of a study intended both to test and refine that approach by

  6. Key Performance Outcomes of Patient Safety Curricula: Root Cause Analysis, Failure Mode and Effects Analysis, and Structured Communications Skills

    PubMed Central

    2011-01-01

    As colleges and schools of pharmacy develop core courses related to patient safety, course-level outcomes will need to include both knowledge and performance measures. Three key performance outcomes for patient safety coursework, measured at the course level, are the ability to perform root cause analyses and healthcare failure mode effects analyses, and the ability to generate effective safety communications using structured formats such as the Situation-Background-Assessment-Recommendation (SBAR) situational briefing model. Each of these skills is widely used in patient safety work and competence in their use is essential for a pharmacist's ability to contribute as a member of a patient safety team. PMID:22102754

  7. 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

  8. Refractory Hypertension: Evidence of Heightened Sympathetic Activity as a Cause of Antihypertensive Treatment Failure.

    PubMed

    Dudenbostel, Tanja; Acelajado, Maria C; Pisoni, Roberto; Li, Peng; Oparil, Suzanne; Calhoun, David A

    2015-07-01

    Refractory hypertension is an extreme phenotype of treatment failure defined as uncontrolled blood pressure in spite of ?5 classes of antihypertensive agents, including chlorthalidone and a mineralocorticoid receptor antagonist. A prospective evaluation of possible mechanisms of refractory hypertension has not been done. The goal of this study was to test for evidence of heightened sympathetic tone as indicated by 24-hour urinary normetanephrine levels, clinic and ambulatory heart rate (HR), HR variability, arterial stiffness as indexed by pulse wave velocity, and systemic vascular resistance compared with patients with controlled resistant hypertension. Forty-four consecutive patients, 15 with refractory and 29 with controlled resistant hypertension, were evaluated prospectively. Refractory hypertensive patients were younger (48±13.3 versus 56.5±14.1 years; P=0.038) and more likely women (80.0 versus 51.9%; P=0.047) compared with patients with controlled resistant hypertension. They also had higher urinary normetanephrine levels (464.4±250.2 versus 309.8±147.6 µg per 24 hours; P=0.03), higher clinic HR (77.8±7.7 versus 68.8±7.6 bpm; P=0.001) and 24-hour ambulatory HR (77.8±7.7 versus 68.8±7.6; P=0.0018), higher pulse wave velocity (11.8±2.2 versus 9.4±1.5 m/s; P=0.009), reduced HR variability (4.48 versus 6.11; P=0.03), and higher systemic vascular resistance (3795±1753 versus 2382±349 dyne·s·cm(5)·m(2); P=0.008). These findings are consistent with heightened sympathetic tone being a major contributor to antihypertensive treatment failure and highlight the need for effective sympatholytic therapies in patients with refractory hypertension. PMID:25987662

  9. 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

  10. Extracorporeal membrane oxygenation as a platform for recovery: a case report of a child with pulmonary hemorrhage, refractory hypoxemic respiratory failure, and new onset goodpasture syndrome.

    PubMed

    Dalabih, Abdallah; Pietsch, John; Jabs, Kathy; Hardison, Daphne; Bridges, Brian C

    2012-06-01

    We report a case of a 9-year-old female with acute pulmonary hemorrhage and refractory hypoxemic respiratory failure secondary to Goodpasture syndrome (GS). After failing treatment with high frequency oscillatory ventilation and inhaled nitric oxide, she was successfully managed with venovenous extracorporeal membrane oxygenation (VV ECMO). The patient's weight at the time of cannulation was 31 kg. A 19 French 18 cm (arterial) Biomedicus cannula was inserted in the right internal jugular vein and used as the drain. A 17 French 50 cm (venous) Biomedicus cannula was inserted in the right femoral vein and used as the return. Then the patient was anticoagulated with 100 units/kg of intravenous heparin and the circuit was primed with one unit of packed red blood cells. VV ECMO was performed with an SIII Sorin roller head pump with integrated servo regulator and a Quadrox D Bioline coated oxygenator. Despite systemic anticoagulation with heparin, the patient's pulmonary hemorrhage resolved. Extracorporeal membrane oxygenation served as a platform through which we were able to provide renal replacement therapy and plasmapheresis. The patient was successfully discharged home with normal pulmonary function. PMID:22893987

  11. Non-specific effects of 4-chloro- m-cresol may cause calcium flux and respiratory burst in human neutrophils

    Microsoft Academic Search

    Carl J. Hauser; Kolenkode B. Kannan; Edwin A. Deitch; Kiyoshi Itagaki

    2005-01-01

    We examined the effects of 4-chloro-m-cresol (4-CmC, a potent and specific activator of ryanodine receptors) on Ca2+-release\\/influx and respiratory burst in freshly isolated human PMN as well as HL60 cells. 4-CmC induces Ca2+ store-depletion in a dose-dependent manner at concentrations between 400?M and 3mM, however no dose-dependent effect on Ca2+-influx was found. 4-CmC depleted Ca2+ stores that were shared with

  12. Polyflavonoid tannins — a main cause of soft-rot failure in CCA-treated timber

    Microsoft Academic Search

    A. Pizzi; A. Jansen

    1986-01-01

    Polyflavonoid tannins are proven to be fast-reacting with CCA solutions and hence, to be strong competitors of the structural wood constituents for fixation of CCA preservatives. The consequence of this effect is that even relatively small amounts of tannin cause severe undertreatment of the structural wood constituents which in turn badly affects the long term durability of CCA treated timber.

  13. When Remembering Causes Forgetting: Retrieval-Induced Forgetting as Recovery Failure

    ERIC Educational Resources Information Center

    Bauml, Karl-Heinz; Zellner, Martina; Vilimek, Roman

    2005-01-01

    Retrieval practice on a subset of previously learned material can cause forgetting of the unpracticed material and make it inaccessible to consciousness. Such inaccessibility may arise because the material is no longer sampled from the set of to-be-recalled items, or, though sampled, its representation is not complete enough to be recovered into…

  14. Oral administration of live attenuated Salmonella enterica serovar Typhimurium expressing chicken interferon-? alleviates clinical signs caused by respiratory infection with avian influenza virus H9N2.

    PubMed

    Rahman, Md Masudur; Uyangaa, Erdenebileg; Han, Young Woo; Kim, Seong Bum; Kim, Jin Hyoung; Choi, Jin Young; Yoo, Dong Jin; Hong, Jin Tae; Han, Sang-Bae; Kim, Bumseok; Kim, Koanhoi; Eo, Seong Kug

    2011-12-29

    Low pathogenic avian influenza (LPAI) H9N2 has attracted considerable attention due to severe commercial losses in the poultry industry. Furthermore, avian influenza virus (AIV) H9N2-infected chickens can be a reservoir for viral transmission to mammals including pigs and humans, complicating control of viral mutants. Chicken interferon-alpha (chIFN-?) may be useful as an exogenous antiviral agent to control AIV H9N2 infection. However, a superior vehicle for administration of chIFN-? is needed because of challenges of protein stability, production cost, and labor associated with mass administration. Presently, oral administration of single dose of attenuated Salmonella enterica serovar Typhimurium expressing chIFN-? alleviated clinical signs and histopathological changes caused by respiratory infection with AIV H9N2 and reduced the excretion of virus in cloacal swab samples. Similarly, chickens administered S. enterica serovar Typhimurium expressing chIFN-? showed inhibited replication of AIV H9N2 in several different tissues including trachea, lung, cecal tonsil, and brain. Furthermore, immune responses specific for challenged AIV H9N2 were enhanced in chickens administered S. enterica serovar Typhimurium expressing chIFN-?, as determined by hemagglutination inhibition assay of sera, proliferation and IFN-? and interleukin-4 expression by AIV H9N2 antigen-stimulated peripheral blood mononuclear cells and splenocytes. Therefore, oral administration of S. enterica serovar Typhimurium expressing chIFN-? can successfully control clinical signs caused by respiratory infection with AIV H9N2, which provides valuable insight into the use of attenuated Salmonella vaccine as an oral delivery system of chIFN-? to prevent the replication of AIV H9N2 in respiratory tract. PMID:21764226

  15. Neospora caninum infection as a cause of reproductive failure in a sheep flock.

    PubMed

    González-Warleta, Marta; Castro-Hermida, José Antonio; Regidor-Cerrillo, Javier; Benavides, Julio; Álvarez-García, Gema; Fuertes, Miguel; Ortega-Mora, Luis Miguel; Mezo, Mercedes

    2014-01-01

    Neospora caninum has been detected only sporadically in cases of ovine abortion, and it has therefore traditionally been considered as an unimportant parasite in small ruminants. This study was carried out with the aim of identifying the pathogen causing serious reproductive problems on a commercial sheep farm. Sera from all rams and ewes tested negative for antibodies against Border disease virus, Schmallenberg virus and Coxiella burnetii, and infections by these agents were therefore ruled out. Nevertheless, seropositivity to N. caninum and/or Toxoplasma gondii was detected, although the seroprevalence was higher in the case of N. caninum. The percentage of lambings and the number of lambs per dam were significantly lower in ewes that were seropositive to N. caninum while no effect on these parameters was detected in ewes that were seropositive to T. gondii. There was also no evidence of infection by T. gondii in the foetal/lamb tissues analyzed by PCR and/or immunohistopathological techniques. On the contrary, the DNA of N. caninum was detected in 13 out of 14 foetuses/lambs descendant from dams seropositive to this parasite. Characteristic lesions caused by N. caninum and/or its antigen were also detected. Genotyping of the N. caninum DNA revealed only two closely related microsatellite multilocus genotypes. The results clearly demonstrate that infection by N. caninum was the cause of the low reproductive performance of this sheep flock. PMID:25158756

  16. 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

  17. 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 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

  18. 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

  19. [Postoperative respiratory insufficiency and its treatment].

    PubMed

    Kösek, V; Wiebe, K

    2015-05-01

    The development of a postoperative respiratory insufficiency is typically caused by several factors and include patient-related risks, the extent of the procedure and postoperative complications. Morbidity and mortality rates in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are high. It is important to have consistent strategies for prevention and preoperative conditioning is essential primarily for high-risk patients. Treatment of established postoperative lung failure requires early tracheotomy, protective ventilation (tidal volume 6 ml/kg body weight), elevated positive end expiratory pressure (PEEP, 10-20 mmH2O), recurrent bronchoscopy and early patient mobilization. In critical cases an extracorporeal lung assist is considered to be beneficial as a bridge to recovery and for realizing a protective ventilation protocol. Different systems with separate indications are available. The temporary application of a lung assist allows thoracic surgery to be performed safely in patients presenting with insufficient respiratory function. PMID:25801596

  20. Postmortem volumetric CT data analysis of pulmonary air/gas content with regard to the cause of death for investigating terminal respiratory function in forensic autopsy.

    PubMed

    Sogawa, Nozomi; Michiue, Tomomi; Ishikawa, Takaki; Kawamoto, Osamu; Oritani, Shigeki; Maeda, Hitoshi

    2014-08-01

    Postmortem CT (PMCT) is useful to investigate air/gas distribution and content in body cavities and viscera. The present study investigated the procedure to estimate total lung air/gas content and aeration ratio as possible indices of terminal respiratory function, using three-dimensional (3-D) PMCT data analysis of forensic autopsy cases without putrefactive gas formation (within 3 days postmortem, n=75), and analyzed the volumetric data with regard to the cause of death. When 3-D bilateral lung images were reconstructed using an image analyzer, combined lung volume was larger in drowning (n=12) than in alcohol/sedative-hypnotic intoxication (n=8) and sudden cardiac death (SCD; n=10), and intermediate in other cases, including mechanical asphyxiation (n=12), fire fatalities due to burns (n=6) and carbon monoxide intoxication (n=7), fatal methamphetamine abuse (n=7), hyperthermia (heatstroke; n=6) and fatal hypothermia (cold exposure; n=7). Air/gas content of the lung as detected using HU interval between -2000 and -400 ('effective' lung aeration areas) and between -2000 and -191 (total lung aeration areas) as well as the ratios to total lung volume ('effective' and total lung aeration ratios, respectively) was higher in mechanical asphyxiation, drowning, fatal burns and hypothermia (cold exposure) than in SCD, and was intermediate in other cases. 'Effective' and total lung aeration ratios may be useful for comparisons between specific causes of death to discriminate between hypothermia (cold exposure) and drug intoxication, and between SCD and other causes of death, respectively. These findings provide interesting insights into potential efficacy of PMCT data analyses of lung volume and CT density as well as lung air/gas content and aeration ratio with regard to the cause of death, as possible indicators of terminal respiratory function, as part of virtual autopsy of the viscera in situ. PMID:24905153

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

    SciTech Connect

    Rancourt, Raymond C., E-mail: raymond.rancourt@ucdenver.edu; Veress, Livia A., E-mail: livia.veress@ucdenver.edu; Ahmad, Aftab, E-mail: aftab.ahmad@ucdenver.edu; Hendry-Hofer, Tara B., E-mail: tara.hendry-hofer@ucdenver.edu; Rioux, Jacqueline S., E-mail: jacqueline.rioux@ucdenver.edu; Garlick, Rhonda B., E-mail: rhonda.garlick@ucdenver.edu; White, Carl W., E-mail: carl.w.white@ucdenver.edu

    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.

  2. [A case of agranulocytosis caused by rifampicin during treatment of tuberculous lymphadenitis in a chronic renal failure patient].

    PubMed

    Sugiyama, Masafumi

    2012-11-01

    A 52-year-old woman was admitted to our hospital because of intermittent high fever and chronic renal failure. Computed tomography of the thorax showed swelling of the paratracheal lymph nodes that was confirmed by gallium scintigraphy. Biopsy of the supraclavicular lymph node on the right side showed necrotizing lymphadenitis with Langhans giant cells surrounded by epithelioid cells. Anti-tuberculosis treatment, including isoniazid, rifampicin, ethambutol, and pyrazinamide was initiated. One month after treatment, the patient developed agranulocytosis (white blood cell [WBC], 2100 cells/microl; neutrophils, 5%) accompanied by severe diarrhea. Bone marrow histology showed poor development of granulocytes, but no atypical cells were observed. Therefore, rifampicin was discontinued, and treatment with granulocyte colony-stimulating factor (G-CSF) was initiated. Subsequently, the white blood cell count and the proportion of neutrophils increased to 12500 cells/microL and 80%, respectively. Rifampicin in the anti-tuberculosis chemotherapy regimen was replaced with levofloxacin. This is a rare case of agranulocytosis caused by rifampicin administered during anti-tuberculosis treatment in a chronic renal failure patient. PMID:23367831

  3. 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

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

    SciTech Connect

    Kiriyama, Takao [Department of Neurology, Faculty of Medicine, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8522 (Japan); Hirano, Makito [Department of Neurology, Faculty of Medicine, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8522 (Japan)], E-mail: hirano_makto@yahoo.co.jp; Asai, Hirohide; Ikeda, Masanori; Furiya, Yoshiko; Ueno, Satoshi [Department of Neurology, Faculty of Medicine, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8522 (Japan)

    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.

  5. Human metapneumovirus and human coronavirus infection and pathogenicity in Saudi children hospitalized with acute respiratory illness

    PubMed Central

    Al Hajjar, Sami; Al Thawadi, Sahar; Al Seraihi, Amal; Al Muhsen, Saleh; Imambaccus, Hala

    2011-01-01

    BACKGROUND AND OBJECTIVES: Human metapneumovirus (hMPV) and the Netherlands human coronavirus (HCoV-NL63) have been isolated from children with respiratory tract infection. The prevalence of these viruses has not been reported from Saudi Arabia. We sought to determine whether hMPV and HCoV-NL63 are responsible for acute respiratory illness and also to determine clinical features and severity of illness in the hospitalized pediatric patient population. DESIGN AND SETTING: Prospective hospital-based study from July 2007 to November 2008. PATIENTS AND METHODS: Nasopharyngeal specimens from children less than 16 years old who were suffering from acute respiratory diseases were tested for hMPV and HCoV-NL63 by reverse transcriptase–polymerase chain reaction. Samples were collected from July 2007 to November 2008. RESULTS: Both viruses were found among Saudi children with upper and lower respiratory tract diseases during the autumn and winter of 2007 and 2008, contributing to 11.1% of all viral diagnoses, with individual incidences of 8.3% (hMPV) and 2.8% (HCoV-NL63) among 489 specimens. Initial symptoms included fever, cough, and nasal congestion. Lower respiratory tract disease occurs in immunocompromised individuals and those with underlying conditions. Clinical findings of respiratory failure and culture-negative shock were established in 7 children infected with hMPV and having hematologic malignancies, myelofibrosis, Gaucher disease, and congenital immunodeficiency; 2 of the 7 patients died with acute respiratory failure. All children infected with HCoV-NL63 had underlying conditions; 1 of the 4 patients developed respiratory failure. CONCLUSION: hMPV and HCoV-NL63 are important causes of acute respiratory illness among hospitalized Saudi children. hMPV infection in the lower respiratory tract is associated with morbidity and mortality in immunocompromised children. HCoV-NL63 may cause severe lower respiratory disease with underlying conditions. PMID:21911992

  6. 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

  7. Development of a Western Blot Assay for Detection of Antibodies against Coronavirus Causing Severe Acute Respiratory Syndrome

    PubMed Central

    He, Qigai; Chong, Kooi Hoong; Hee Chng, Hiok; Leung, Bernard; Ee Ling, Ai; Wei, Ting; Chan, Shzu-Wei; Eong Ooi, Eng; Kwang, Jimmy

    2004-01-01

    To identify a major antigenic determinant for use in the development of a rapid serological diagnostic test for severe acute respiratory syndrome (SARS) coronavirus infection and to study the immune response during SARS coronavirus infection in humans, we cloned the full length and six truncated fragments of the nucleocapsid gene, expressed them, and purified them as glutathione S-transferase-tagged recombinant proteins. The reactivities of the recombinant proteins to a panel of antibodies containing 33 SARS coronavirus-positive sera and 66 negative sera and to antibodies against other animal coronaviruses were screened. A truncated 195-amino-acid fragment from the C terminus of the nucleocapsid protein (N195) was identified that had a strong ability to detect antibodies against SARS coronavirus. No cross-reaction was found between the N195 protein and antibodies against chicken, pig, and canine coronaviruses. The N195 protein was used to develop a Western blot assay to detect antibodies against SARS coronavirus in 274 clinically blinded samples. The specificity and sensitivity of this test were 98.3 and 90.9%, respectively. The correlation between our Western blotting assay and an immunofluorescence assay (IFA) was also analyzed. The results of our Western blot assay and IFA for the detection of SARS coronavirus-positive sera were the same. Thus, the N195 protein was identified as a suitable protein to be used as an antigen in Western blot and other possible assays for the detection of SARS coronavirus infection. PMID:15013997

  8. Effect of inhaled nitric oxide on respiratory mechanics in ventilated infants with RSV bronchiolitis

    Microsoft Academic Search

    N. R. Patel; J. Hammer; S. Nichani; A. Numa; C. J. L. Newth

    1999-01-01

    Objective: To evaluate the bronchodilator effect of inhaled nitric oxide (NO) in infants with respiratory failure caused by respiratory\\u000a syncytial virus (RSV) bronchiolitis and to compare the effect with the one obtained by salbutamol. Design: Prospective study. Setting: Pediatric intensive care unit of a university children's hospital. Patients: Twelve acutely ill, intubated infants (mean age 4.5 months, mean weight 4.9

  9. How Is Respiratory Failure Diagnosed?

    MedlinePLUS

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

  10. 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 ...

  11. Human Respiratory Syncytial Virus Memphis 37 Grown in HEp-2 Cells Causes more Severe Disease in Lambs than Virus Grown in Vero Cells

    PubMed Central

    Derscheid, Rachel J.; van Geelen, Albert; McGill, Jodi L.; Gallup, Jack M.; Cihlar, Tomas; Sacco, Randy E.; Ackermann, Mark R.

    2013-01-01

    Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis in infants and young children. A small percentage of these individuals develop severe and even fatal disease. To better understand the pathogenesis of severe disease and develop therapies unique to the less-developed infant immune system, a model of infant disease is needed. The neonatal lamb pulmonary development and physiology is similar to that of infants, and sheep are susceptible to ovine, bovine, or human strains of RSV. RSV grown in Vero (African green monkey) cells has a truncated attachment G glycoprotein as compared to that grown in HEp-2 cells. We hypothesized that the virus grown in HEp-2 cells would cause more severe clinical symptoms and cause more severe pathology. To confirm the hypothesis, lambs were inoculated simultaneously by two different delivery methods (intranasal and nebulized inoculation) with either Vero-grown or HEp-2-grown RSV Memphis 37 (M37) strain of virus to compare viral infection and disease symptoms. Lambs infected with HEp-2 cell-derived virus by either intranasal or nebulization inoculation had significantly higher levels of viral RNA in lungs as well as greater clinical disease including both gross and histopathologic lesions compared to lambs similarly inoculated with Vero-grown virus. Thus, our results provide convincing in vivo evidence for differences in viral infectivity that corroborate previous in vitro mechanistic studies demonstrating differences in the G glycoprotein expression by RSV grown in Vero cells. PMID:24284879

  12. 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

  13. Heart Failure

    MedlinePLUS

    Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Heart failure does not mean that your heart has stopped ... Tiredness and shortness of breath Common causes of heart failure are coronary artery disease, high blood pressure and ...

  14. Mechanical analysis of congestive heart failure caused by bundle branch block based on an electromechanical canine heart model

    NASA Astrophysics Data System (ADS)

    Dou, Jianhong; Xia, Ling; Zhang, Yu; Shou, Guofa; Wei, Qing; Liu, Feng; Crozier, Stuart

    2009-01-01

    Asynchronous electrical activation, induced by bundle branch block (BBB), can cause reduced ventricular function. However, the effects of BBB on the mechanical function of heart are difficult to assess experimentally. Many heart models have been developed to investigate cardiac properties during BBB but have mainly focused on the electrophysiological properties. To date, the mechanical function of BBB has not been well investigated. Based on a three-dimensional electromechanical canine heart model, the mechanical properties of complete left and right bundle branch block (LBBB and RBBB) were simulated. The anatomical model as well as the fiber orientations of a dog heart was reconstructed from magnetic resonance imaging (MRI) and diffusion tensor MRI (DT-MRI). Using the solutions of reaction-diffusion equations and with a strategy of parallel computation, the asynchronous excitation propagation and intraventricular conduction in BBB was simulated. The mechanics of myocardial tissues were computed with time-, sarcomere length-dependent uniaxial active stress initiated at the time of depolarization. The quantification of mechanical intra- and interventricular asynchrony of BBB was then investigated using the finite-element method with an eight-node isoparametric element. The simulation results show that (1) there exists inter- and intraventricular systolic dyssynchrony during BBB; (2) RBBB may have more mechanical synchrony and better systolic function of the left ventricle (LV) than LBBB; (3) the ventricles always move toward the early-activated ventricle; and (4) the septum experiences higher stress than left and right ventricular free walls in BBB. The simulation results validate clinical and experimental recordings of heart deformation and provide regional quantitative estimates of ventricular wall strain and stress. The present work suggests that an electromechanical heart model, incorporating real geometry and fiber orientations, may be helpful for better understanding of the mechanical implications of congestive heart failure (CHF) caused by BBB.

  15. Hematopoietic RIPK1 deficiency results in bone marrow failure caused by apoptosis and RIPK3-mediated necroptosis

    PubMed Central

    Roderick, Justine E.; Hermance, Nicole; Zelic, Matija; Simmons, Matthew J.; Polykratis, Apostolos; Pasparakis, Manolis; Kelliher, Michelle A.

    2014-01-01

    Receptor-interacting serine/threonine-protein kinase 1 (RIPK1) is recruited to the TNF receptor 1 to mediate proinflammatory signaling and to regulate TNF-induced cell death. RIPK1 deficiency results in postnatal lethality, but precisely why Ripk1?/? mice die remains unclear. To identify the lineages and cell types that depend on RIPK1 for survival, we generated conditional Ripk1 mice. Tamoxifen administration to adult RosaCreERT2Ripk1fl/fl mice results in lethality caused by cell death in the intestinal and hematopoietic lineages. Similarly, Ripk1 deletion in cells of the hematopoietic lineage stimulates proinflammatory cytokine and chemokine production and hematopoietic cell death, resulting in bone marrow failure. The cell death reflected cell-intrinsic survival roles for RIPK1 in hematopoietic stem and progenitor cells, because Vav-iCre Ripk1fl/fl fetal liver cells failed to reconstitute hematopoiesis in lethally irradiated recipients. We demonstrate that RIPK3 deficiency partially rescues hematopoiesis in Vav-iCre Ripk1fl/fl mice, showing that RIPK1-deficient hematopoietic cells undergo RIPK3-mediated necroptosis. However, the Vav-iCre Ripk1fl/fl Ripk3?/? progenitors remain TNF sensitive in vitro and fail to repopulate irradiated mice. These genetic studies reveal that hematopoietic RIPK1 deficiency triggers both apoptotic and necroptotic death that is partially prevented by RIPK3 deficiency. Therefore, RIPK1 regulates hematopoiesis and prevents inflammation by suppressing RIPK3 activation. PMID:25246544

  16. Re-emergent human adenovirus genome type 7d caused an acute respiratory disease outbreak in Southern China after a twenty-one year absence.

    PubMed

    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

  17. 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

  18. 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

  19. Acute respiratory fatality associated with exposure to sheet metal and cadmium fumes

    SciTech Connect

    Fuortes, L.; Leo, A.; Ellerbeck, P.G.; Friell, L.A. (University of Iowa, Iowa City (USA))

    1991-01-01

    The authors report on a case of an acute fatality characterized by abdominal pain and respiratory failure occurring soon after beginning to weld and solder galvanized sheet metal. Heating of galvanized sheet metal is a recognized cause of metal fume fever, data from this patient suggests an additional and unrecognized risk for cadmium poisoning.

  20. 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

  1. v-Src causes delocalization of Mklp1, Aurora B, and INCENP from the spindle midzone during cytokinesis failure

    SciTech Connect

    Soeda, Shuhei [Department of Molecular Cell Biology, Graduate School of Pharmaceutical Sciences, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba 260-8675 (Japan); Nakayama, Yuji, E-mail: nakayama@mb.kyoto-phu.ac.jp [Department of Molecular Cell Biology, Graduate School of Pharmaceutical Sciences, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba 260-8675 (Japan); Department of Biochemistry and Molecular Biology, Kyoto Pharmaceutical University, 5 Nakauchi-cho, Misasagi, Yamashina-ku, Kyoto 607-8414 (Japan); Honda, Takuya; Aoki, Azumi; Tamura, Naoki; Abe, Kohei; Fukumoto, Yasunori [Department of Molecular Cell Biology, Graduate School of Pharmaceutical Sciences, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba 260-8675 (Japan); Yamaguchi, Naoto, E-mail: nyama@faculty.chiba-u.jp [Department of Molecular Cell Biology, Graduate School of Pharmaceutical Sciences, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba 260-8675 (Japan)

    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.

  2. H4N8 subtype avian influenza virus isolated from shorebirds contains a unique PB1 gene and causes severe respiratory disease in mice

    PubMed Central

    Bui, Vuong N.; Ogawa, Haruko; Xininigen; Karibe, Kazuji; Matsuo, Kengo; Awad, Sanaa S. A.; Minoungou, Germaine L.; Yoden, Satoshi; Haneda, Hiroaki; Ngo, Lai H.; Tamaki, Shio; Yamamoto, Yu; Nakamura, Kikuyasu; Saito, Keisuke; Watanabe, Yukiko; Runstadler, Jonathan; Huettman, Falk; Happ, George M.; Imai, Kunitoshi

    2011-01-01

    H4N8 subtype avian influenza viruses were isolated from shorebirds in eastern Hokkaido. All the isolates shared >99.7% nucleotide homology, and all the viral genes except for PB1 were highly related to those of A/red-necked stint/Australia/1/04. Thus, the isolates were regarded as PB1 reassortants. The most similar PB1 gene was identified in A/mallard/New Zealand/1615-17/04 (H4N6) with nucleotide homology of 90.9%. BALB/c mice intranasally inoculated with the H4N8 isolates developed severe respiratory disease, which eventually led to death in some mice. Virus was isolated from the lungs, and viral antigen was detected in the lungs with pneumonia. Other H4 subtype viruses tested did not cause any symptoms in mice, although these viruses were also isolated from the lungs. The PB2 gene of the H4N8 isolates contains K482R, but not the E627K or D701N substitutions. The PB1-F2 gene of the isolates consists of a 101-amino acid unique sequence, but lacks the N66S mutation. PMID:22192630

  3. 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.

  4. Malfunctioning of the Iron–Sulfur Cluster Assembly Machinery in Saccharomyces cerevisiae Produces Oxidative Stress via an Iron-Dependent Mechanism, Causing Dysfunction in Respiratory Complexes

    PubMed Central

    Gomez, Mauricio; Pérez-Gallardo, Rocío V.; Sánchez, Luis A.; Díaz-Pérez, Alma L.; Cortés-Rojo, Christian; Meza Carmen, Victor; Saavedra-Molina, Alfredo; Lara-Romero, Javier; Jiménez-Sandoval, Sergio; Rodríguez, Francisco; Rodríguez-Zavala, José S.; Campos-García, Jesús

    2014-01-01

    Biogenesis and recycling of iron–sulfur (Fe–S) clusters play important roles in the iron homeostasis mechanisms involved in mitochondrial function. In Saccharomyces cerevisiae, the Fe–S clusters are assembled into apoproteins by the iron–sulfur cluster machinery (ISC). The aim of the present study was to determine the effects of ISC gene deletion and consequent iron release under oxidative stress conditions on mitochondrial functionality in S. cerevisiae. Reactive oxygen species (ROS) generation, caused by H2O2, menadione, or ethanol, was associated with a loss of iron homeostasis and exacerbated by ISC system dysfunction. ISC mutants showed increased free Fe2+ content, exacerbated by ROS-inducers, causing an increase in ROS, which was decreased by the addition of an iron chelator. Our study suggests that the increment in free Fe2+ associated with ROS generation may have originated from mitochondria, probably Fe–S cluster proteins, under both normal and oxidative stress conditions, suggesting that Fe–S cluster anabolism is affected. Raman spectroscopy analysis and immunoblotting indicated that in mitochondria from SSQ1 and ISA1 mutants, the content of [Fe–S] centers was decreased, as was formation of Rieske protein-dependent supercomplex III2IV2, but this was not observed in the iron-deficient ATX1 and MRS4 mutants. In addition, the activity of complexes II and IV from the electron transport chain (ETC) was impaired or totally abolished in SSQ1 and ISA1 mutants. These results confirm that the ISC system plays important roles in iron homeostasis, ROS stress, and in assembly of supercomplexes III2IV2 and III2IV1, thus affecting the functionality of the respiratory chain. PMID:25356756

  5. 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.

  6. Wind-Turbine Gear-Box Roller-Bearing Premature-Failure Caused by Grain-Boundary Hydrogen Embrittlement: A Multi-physics Computational Investigation

    NASA Astrophysics Data System (ADS)

    Grujicic, M.; Chenna, V.; Galgalikar, R.; Snipes, J. S.; Ramaswami, S.; Yavari, R.

    2014-11-01

    To help overcome the problem of horizontal-axis wind-turbine (HAWT) gear-box roller-bearing premature-failure, the root causes of this failure are currently being investigated using mainly laboratory and field-test experimental approaches. In the present work, an attempt is made to develop complementary computational methods and tools which can provide additional insight into the problem at hand (and do so with a substantially shorter turn-around time). Toward that end, a multi-physics computational framework has been developed which combines: (a) quantum-mechanical calculations of the grain-boundary hydrogen-embrittlement phenomenon and hydrogen bulk/grain-boundary diffusion (the two phenomena currently believed to be the main contributors to the roller-bearing premature-failure); (b) atomic-scale kinetic Monte Carlo-based calculations of the hydrogen-induced embrittling effect ahead of the advancing crack-tip; and (c) a finite-element analysis of the damage progression in, and the final failure of a prototypical HAWT gear-box roller-bearing inner raceway. Within this approach, the key quantities which must be calculated using each computational methodology are identified, as well as the quantities which must be exchanged between different computational analyses. The work demonstrates that the application of the present multi-physics computational framework enables prediction of the expected life of the most failure-prone HAWT gear-box bearing elements.

  7. Feline respiratory disease complex.

    PubMed

    Cohn, Leah A

    2011-11-01

    Feline respiratory disease complex (FRDC) refers to the characteristic acute presentation of a contagious respiratory or ocular disease caused by one or multiple pathogens. Environmental and host factors impact the transmission, clinical presentation, preventive strategy, and treatment of affected cats. The FRDC is especially problematic in settings where large numbers of cats cohabit, including animal shelters, catteries, and semi-feral colonies. Although elimination of FRDC is an unrealistic goal, improved understanding can lead to strategies to minimize disease impact. PMID:22041216

  8. Myopericarditis caused by cyclophosphamide used to mobilize peripheral blood stem cells in a myeloma patient with renal failure.

    PubMed

    Yamamoto, R; Kanda, Y; Matsuyama, T; Oshima, K; Nannya, Y; Suguro, M; Chizuka, A; Hamaki, T; Takezako, N; Miwa, A; Kami, M; Mori, S; Kojima, T; Saito, K; Itaoka, Y; Kashida, M

    2000-09-01

    Cyclophosphamide (CPA) is widely used for peripheral blood stem cell mobilization, and a dose adjustment of CPA in the presence of renal failure has not been suggested. However, we describe a myeloma patient with renal failure (serum creatinine 4.2 mg/dl, creatinine clearance 11.2 ml/min) receiving CPA 2 g/m2 for 2 days, who developed unexpectedly severe toxicity, including myopericarditis and prolonged myelosuppression. The serial serum concentrations of CPA metabolites were persistently much higher than those in a myeloma patient with normal renal function. We consider, therefore, that the dose of CPA should be reduced in the presence of severe renal failure when used as high-dose therapy or to mobilize peripheral blood stem cells. PMID:11041571

  9. 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

  10. 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...

  11. Caldera resurgence as a possible cause of slope failure in volcanic areas: the Ischia island case history

    Microsoft Academic Search

    Sandro de Vita; Della Seta Marta; Fredi Paola; Marotta Enrica; Orsi Giovanni; Sansivero Fabio

    2010-01-01

    Slope instability in active volcanic areas is a factor of major hazard to be considered. Due to their rapid growth and deformation, active volcanoes experience gravitational disequilibrium and periodical structural failures. Depending on the geodynamic framework of a volcano, nature, style of activity and climatic conditions, slope instability occurs at different scales, from relatively small-volume mass movements to huge lahars

  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. Respiratory Rhythm

    Microsoft Academic Search

    Christopher A Del Negro; Consuelo Morgado-Valle; Jack L Feldman

    2002-01-01

    We tested the hypothesis that pacemaker neurons generate breathing rhythm in mammals. We monitored respiratory-related motor nerve rhythm in neonatal rodent slice preparations. Blockade of the persistent sodium current (INaP), which was postulated to underlie voltage-dependent bursting in respiratory pacemaker neurons, with riluzole (?200 ?M) did not alter the frequency of respiratory-related motor output. Yet, in every pacemaker neuron recorded

  14. Livedoid Vasculopathy and Mononeuritis Multiplex, with a Fulminant Hepatic Failure which was caused by Herpes Simplex Hepatitis: A Case Report.

    PubMed

    Pai B, Sathish; Pai, Kanthilatha

    2013-05-01

    Livedoid vasculopathy with mononeuritis multiplex is a rare association. We are presenting a case of an unusual association of livedoid vasculopathy with mononeuritis multiplex, who developed fulminant hepatic failure which was secondary to Herpes simplex virus (HSV) hepatitis, while she was on treatment with immunosuppressants. Her skin biopsy and immunofluorescence studies showed the features of vasculitis. A biopsy from the sural nerve showed the features of chronic vasculitis. PMID:23814745

  15. Livedoid Vasculopathy and Mononeuritis Multiplex, with a Fulminant Hepatic Failure which was caused by Herpes Simplex Hepatitis: A Case Report

    PubMed Central

    Pai B, Sathish; Pai, Kanthilatha

    2013-01-01

    Livedoid vasculopathy with mononeuritis multiplex is a rare association. We are presenting a case of an unusual association of livedoid vasculopathy with mononeuritis multiplex, who developed fulminant hepatic failure which was secondary to Herpes simplex virus (HSV) hepatitis, while she was on treatment with immunosuppressants. Her skin biopsy and immunofluorescence studies showed the features of vasculitis. A biopsy from the sural nerve showed the features of chronic vasculitis. PMID:23814745

  16. Plasma amino acids and protein levels in chronic renal failure and changes caused by oral supplements of essential amino acids.

    PubMed

    Young, G A; Keogh, J B; Parsons, F M

    1975-06-01

    1. Plasma amino acids and six proteins have been measured in patients with chronic renal failure receiving low protein diets before and after oral supplementation with essential amino acids. 2. All the patients on low protein diets had a lower percentage of essential amino acids in their plasma than normal subjects but after supplementation, plasma levels increased significantly with minimal increase in non-essential amino acids or urea nitrogen. 3. Mean levels of plasma transferrin, complement C3 and globulin Gc were lower and plasma prealbumin higher in patients than in normal subjects. Plasma complement C4 and albumin were not different from normal. 4. Seven out of nine patients who tolerated the supplementation showed a significant increase in plasma transferrin, prealbumin and complement C3 but not in complement C4, globulin Gc or albumin. 5. Correlations between the percentage of essential amino acids and each of plasma transferrin, prealbumin and complement C3 and also between several of the plasma proteins further substantiate their value in the assessment of dietary intake in chronic renal failure. 6. The value of amino acid supplementation on low protein diets in chronic renal failure is discussed in relation to these observations. PMID:1132152

  17. 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

  18. 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: ...

  19. Protection against soman-induced neuropathology and respiratory failure: a comparison of the efficacy of diazepam and avizafone in guinea pig.

    PubMed

    Taysse, L; Daulon, S; Delamanche, S; Bellier, B; Breton, P

    2006-08-01

    The purpose of this study was to compare the efficacy of diazepam and the pro-diazepam avizafone in preventing the severity of soman-induced pathology in guinea pig. Survival, respiration and seizures of experimental animals were investigated with on-line monitoring of respiratory and EEG parameters. Guinea pigs were pretreated with pyridostigmine (0.1mg/kg i.m.) and 30 min later challenged with 1 or 2 LD50 soman. One minute after intoxication they were treated with atropine (3 or 33.8 mg/kg), pralidoxime chloride (32 mg/kg) and either diazepam (2 mg/kg), avizafone (3.5 mg/kg) or saline solution. The highest dose of atropine (33.8 mg/kg) gave a protective effect in groups treated without anticonvulsants by reducing the severity of clinical signs and death within 24 h but also by decreasing seizure occurrence and brain injuries. When injected at the similar molar dose of 7 micromoles/kg, the protection of anticonvulsants against soman neurotoxicity was higher with the atropine/pralidoxime/avizafone combination than with atropine/pralidoxime/diazepam. Indeed, when atropine was used at the lowest dose, avizafone was found to prevent early mortality and seizures occurrence with better efficacy than diazepam. On the other hand, when added to the therapy, the both anticonvulsants did not prevent the moderate EEG depression (reduction of amplitude by 30-52%) observed under 2 LD50 soman. Moreover, the number of animals suffering from respiratory distress (defined as a decrease of minute ventilation of more than 20% from the baseline value) was enhanced when diazepam or avizafone were used in the therapy. This effect was dependent on the atropine dose and the nature of the anticonvulsant. The beneficial effects of the different therapeutics tested were assessed and compared to the previous data obtained with the same therapies against sarin and from the pharmacokinetics properties of the atropine/diazepam mixture. PMID:16784801

  20. Marathoners or couch potatoes: What is the role of exercise in the management of heart failure?

    Microsoft Academic Search

    Eugene E. Wolfel

    2005-01-01

    Patients with chronic heart failure have diminished exercise capacity as a major aspect of their clinical syndrome, regardless\\u000a of the cause of their left ventricular contractile dysfunction. The mechanisms for the reduction in exercise capacity are\\u000a multifactorial and include central cardiac, peripheral vascular, respiratory, and skeletal muscle maladaptations that accompany\\u000a the pathophysiology of heart failure. Increased sympathetic nervous system activity

  1. A case of peritoneal TB causing renal failure in a patient with rheumatoid arthritis and initial negative PPD after treatment with infliximab.

    PubMed

    Sharma, Abhishek; Dubey, Divyanshu; Janga, Kalyan; Greenberg, Sheldon

    2014-07-01

    Opportunistic infection and reactivation of latent infection has been reported with use of monoclonal TNF alpha antibodies used for treatment of severe rheumatoid arthritis. We present a case of peritoneal tuberculosis (TB) causing renal failure secondary to ureteral constriction in a patient who had been treated with infliximab for rheumatoid arthritis. We suggest that physicians should be aware of the increased risk of false negative and false positive TST and IGRA among patients treated with monoclonal TNF alpha antibodies and should regularly look for usual and unusual symptoms of TB in this patient population. PMID:24960622

  2. 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

  3. Severe acute respiratory syndrome

    Microsoft Academic Search

    Y Guan; K Y Yuen; J S M Peiris

    2004-01-01

    Severe acute respiratory syndrome (SARS) was caused by a previously unrecognized animal coronavirus that exploited opportunities provided by 'wet markets' in southern China to adapt to become a virus readily transmissible between humans. Hospitals and international travel proved to be 'amplifiers' that permitted a local outbreak to achieve global dimensions. In this review we will discuss the substantial scientific progress

  4. 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

  5. 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

  6. Original article Bovine respiratory syncytial virus

    E-print Network

    Boyer, Edmond

    antibodies and suggest a widespread BRSV infection in the cattle population of Uruguay. respiratory syncytial. INTRODUCTION Bovine Respiratory Syncytial Virus (BRSV) is the major cause of acute respi- ratory diseaseOriginal article Bovine respiratory syncytial virus: first serological evidence in Uruguay Mauro

  7. Management of respiratory disease in psittacine birds

    Microsoft Academic Search

    Martin Lawton

    1999-01-01

    RESPIRATORY disease, the most common presenting clinical condition in parrots (Psittaciformes), has a variety of possible causes including infectious, non-infectious, systemic, metabolic and nutritional problems, all of which may be exacerbated by incorrect environmental temperature and humidity. Due to the unique and complex respiratory system of birds, avian respiratory diseases are often more serious than those affecting mammals; the high

  8. Bovine Respiratory Disease Max Irsik DVM, MAB

    E-print Network

    Watson, Craig A.

    categories, upper respiratory tract infections, infections of the larynx and lower respiratory tract. Diphtheria is an infection of the larynx and may occur alone or along with other respiratory infections. There are often loud noises during breathing, and the swollen larynx may severely restrict air flow, causing death

  9. [Life quality of patients with muscular failure, using permanent respiratory support, seen from their point of view. 1. Information, choice and quality of life].

    PubMed

    Jøors, E; Steffensen, B

    1992-03-16

    Sixteen patients with neuromuscular disease receiving long-term assisted ventilation participated in a combined questionnaire/interview investigation with the purpose of illustrating: 1. What information the patient had received prior to institution of the respirator treatment, 2. The difficult choice which had to be made, 3. Whether life as a severely disabled person with assisted ventilation is worth living, and 4. The factors on which successful respirator treatment depends. It is concluded that the general information on use of assisted ventilation should be implemented at an early stage, preferably before problems of respiratory insufficiency occur, and that information should be carried out by people other than merely professionals and be as broad and truthful as possible in order to provide the disabled person with sufficient foundation and sufficient time to consider his personal choice of potential respirator treatment. Further, it is concluded that life for these sixteen ventilator-dependent persons definitely is worth living. The fact that the respirator implies the prospect of longer life, partly freed from symptoms of hypoventilation, means that they have got strength and time for education, work, family and dreams. No correlation was found between the success of the respirator treatment and the patients' sense of achieved quality of life and factors such as age, family-/working situation, extent of disability etc., and professionals should not attach importance to such factors in the selection of "suitable" patients for assisted ventilation. PMID:1553767

  10. Safety and efficacy of bronchoalveolar lavage using a laryngeal mask airway in cases of acute hypoxaemic respiratory failure with diffuse lung infiltrates.

    PubMed

    Matsumoto, Takafumi; Sato, Yoko; Fukuda, Satoshi; Katayama, Shinshu; Miyazaki, Yuya; Ozaki, Makoto; Kotani, Toru

    2015-01-01

    Objective Fibre-optic bronchoscopy with bronchoalveolar lavage (FOB-BAL) is an important tool for diagnosing and selecting treatment for acutely hypoxaemic patients with diffuse lung infiltrates. However, FOB-BAL carries a risk of significant hypoxaemia and subsequent tracheal intubation during and after the procedure. The application of FOB-BAL using a laryngeal mask airway (LMA) in combination with continuous positive airway pressure (CPAP) may minimize the incidence of hypoxaemia; however, the safety and efficacy of this procedure have not been investigated. Methods A retrospective chart review was performed from April to September 2013. Data regarding the recovered volume of BAL fluid, incidence of tracheal intubation within eight hours after the completion of FOB-BAL, respiratory and haemodynamic parameters and treatment modifications were collected for the evaluation. Results Ten trials of FOB-BAL using an LMA and CPAP were performed in nine patients with severe acute hypoxaemia associated with diffuse lung infiltrates. The BAL fluid recovery rate was 56%, and the procedure was completed without subsequent complications. In addition, the percutaneous arterial oxygen saturation decreased to 95.7%±3.8%, although it was never lower than 90.0% during the procedure, and no patients required intubation. Furthermore, the arterial blood pressure significantly but transiently decreased due to sedation, and the procedure yielded diagnostic information in all nine patients. Conclusion FOB-BAL using LMA and CPAP appears to be safe and effective in patients who develop severe acute hypoxaemia. PMID:25832933

  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. Application of Failure Mode and Effect Analysis (FMEA) and cause and effect analysis in conjunction with ISO 22000 to a snails (Helix aspersa) processing plant; A case study.

    PubMed

    Arvanitoyannis, Ioannis S; Varzakas, Theodoros H

    2009-08-01

    Failure Mode and Effect Analysis (FMEA) has been applied for the risk assessment of snails manufacturing. A tentative approach of FMEA application to the snails industry was attempted in conjunction with ISO 22000. Preliminary Hazard Analysis was used to analyze and predict the occurring failure modes in a food chain system (snails 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 fishbone diagram). In this work a comparison of ISO22000 analysis with HACCP is carried out over snails processing and packaging. However, the main emphasis was put on the quantification of risk assessment by determining the RPN per identified processing hazard. Sterilization of tins, bioaccumulation of heavy metals, packaging of shells and poisonous mushrooms, were the processes identified as the ones with the highest RPN (280, 240, 147, 144, respectively) and corrective actions were undertaken. Following the application of corrective actions, a second calculation of RPN values was carried out leading to considerably lower values (below the upper acceptable limit of 130). It is noteworthy that the application of Ishikawa (Cause and Effect or Tree diagram) led to converging results thus corroborating the validity of conclusions derived from risk assessment and FMEA. Therefore, the incorporation of FMEA analysis within the ISO22000 system of a snails processing industry is considered imperative. PMID:19582641

  13. Respiratory System

    NSDL National Science Digital Library

    Jim Bidlack

    The purpose, components, and functions of the respiratory system are presented in this learning through disussion and visualizations. Participants learn about the nasal cavity, pharynx, larynx, trachea, bronchi, bronchioles, and alveoli.

  14. 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.

  15. 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.

  16. Failure of high-dose daptomycin for bacteremia caused by daptomycin-susceptible Enterococcus faecium harboring LiaSR substitutions.

    PubMed

    Munita, Jose M; Mishra, Nagendra N; Alvarez, Danya; Tran, Truc T; Diaz, Lorena; Panesso, Diana; Reyes, Jinnethe; Murray, Barbara E; Adachi, Javier A; Bayer, Arnold S; Arias, Cesar A

    2014-11-01

    High-dose daptomycin (DAP) therapy failed in a neutropenic patient with bloodstream infection caused by a DAP-susceptible Enterococcus faecium (minimum inhibitory concentration, 3 µg/mL) harboring genetic changes associated with DAP resistance, with persistent bacteremia and selection of additional resistances. Daptomycin monotherapy should be used cautiously against DAP-susceptible E. faecium strains with minimum inhibitory concentrations >2 µg/mL. PMID:25107294

  17. [Venovenous extracorporeal membrane oxygenation (ECMO) with a heparin-lock bypass system. An effective addition in the treatment of acute respiratory failure (ARDS)].

    PubMed

    Manert, W; Haller, M; Briegel, J; Hummel, T; Kilger, E; Polasek, J; Forst, H; Peter, K

    1996-05-01

    Mortality of severe acute respiratory distress syndrome (ARDS) in Germany is about 60%. Respiratory therapy can make the lung injury worse by high positive airway pressures, high tidal volumes and high inspiratory oxygen concentrations. Extracorporeal membrane oxygenation (ECMO) was employed to reduce aggressive mechanical ventilation, but it has not been proved to be superior to conventional ventilation. However, encouraged by recently developed improvements in the technique and concept of ECMO, we introduced this therapy into our program for the treatment of ARDS. PATIENTS AND METHODS. All patients with severe ARDS (lung injury score > 2.5) admitted to our multidisciplinary intensive care unit from March 1992 to March 1995 were evaluated prospectively. After admission, the patients first underwent a conventional therapeutic approach, including pressure-controlled inverse-ratio ventilation, permissive hypercapnia, changes in body position (in particular, the prone position), negative fluid balance, anti-biotics, and low-dose hydrocortisone infusion. ECMO via a covalently heparin-coated, venovenous bypass-system with a vortex pump and two membrane lungs was performed if ARDS did not improve after 24-96 h of conventional therapy and if two of three of the slow-entry criteria for ECMO were fulfilled: (1) PaO2/FiO2 < 150 mmHg at PEEP > 5 mbar; (2) semistatic compliance < 30 ml/mbar; (3) right-left shunt > 30%. Only in cases of life-threatening hypoxemia (PaO2 < 50 mmHg at FiO2 1.0 and PEEP > 5 mbar for > 2 h (fast-entry criteria) was ECMO instituted immediately. RESULTS. Sixty patients fulfilled the entry criteria for our study. Thirty-nine patients were treated with a conventional protocol, 37 after improvement of ARDS and 2 who had not improved but in whom there were contraindications to the use of ECMO. ECMO was performed in 10 patients who had not improved, but who fulfilled the slow-entry criteria and in 11 primarily hypoxemic patients who fulfilled the fast-entry criteria. The survival rate was 30/39 (77%) for the conventional therapy group, 6/10 (60%) for the slow-entry group, and 11/11 (100%) for the fast-entry group. The onset of ECMO allowed a significant decrease in peak and mean airway pressures, tidal volume, ventilatory rate, minute volume and inspiratory oxygen concentration. Sufficient gas exchange was provided, and pulmonary artery pressures significantly decreased on bypass. The most frequent complications on bypass were pneumothorax (15/21 patients) and bleeding (7/21 patients). CONCLUSION. In comparison with the historical results at our own institution, the present study demonstrates an improvement in the survival rate from 56% to 78% since ECMO has become available. We conclude that venovenous ECMO with a heparin-bonded bypass circuit is an effective additional option for the treatment of patients with severe ARDS. PMID:8779403

  18. Ventilatory failure, ventilator support, and ventilator weaning.

    PubMed

    Tobin, Martin J; Laghi, Franco; Jubran, Amal

    2012-10-01

    The development of acute ventilatory failure represents an inability of the respiratory control system to maintain a level of respiratory motor output to cope with the metabolic demands of the body. The level of respiratory motor output is also the main determinant of the degree of respiratory distress experienced by such patients. As ventilatory failure progresses and patient distress increases, mechanical ventilation is instituted to help the respiratory muscles cope with the heightened workload. While a patient is connected to a ventilator, a physician's ability to align the rhythm of the machine with the rhythm of the patient's respiratory centers becomes the primary determinant of the level of rest accorded to the respiratory muscles. Problems of alignment are manifested as failure to trigger, double triggering, an inflationary gas-flow that fails to match inspiratory demands, and an inflation phase that persists after a patient's respiratory centers have switched to expiration. With recovery from disorders that precipitated the initial bout of acute ventilatory failure, attempts are made to discontinue the ventilator (weaning). About 20% of weaning attempts fail, ultimately, because the respiratory controller is unable to sustain ventilation and this failure is signaled by development of rapid shallow breathing. Substantial advances in the medical management of acute ventilatory failure that requires ventilator assistance are most likely to result from research yielding novel insights into the operation of the respiratory control system. PMID:23720268

  19. Meta-analysis of the effects of carvedilol versus metoprolol on all-cause mortality and hospitalizations in patients with heart failure.

    PubMed

    Briasoulis, Alexandros; Palla, Mohan; Afonso, Luis

    2015-04-15

    Long-term treatment with appropriate doses of carvedilol or metoprolol is currently recommended for patients with heart failure with reduced ejection fraction (HFrEF) to decrease the risk of death, hospitalizations, and patients' symptoms. It remains unclear if the ? blockers used in patients with HFrEF are equal or carvedilol is superior to metoprolol types. We performed a meta-analysis of the comparative effects of carvedilol versus metoprolol tartrate and succinate on all-cause mortality and/or hospitalization. We conducted an Embase and MEDLINE search for prospective controlled trials and cohort studies of patients with HFrEF who were received to treatment with carvedilol versus metoprolol. We identified 4 prospective controlled and 6 cohort studies with 30,943 patients who received carvedilol and 69,925 patients on metoprolol types (tartrate and succinate) with an average follow-up duration of 36.4 months. All-cause mortality was reduced in prospective studies with carvedilol versus metoprolol tartrate. Neither all-cause mortality nor hospitalizations were significantly different between carvedilol and metoprolol succinate in the cohort studies. In conclusion, in patients with HFrEF, carvedilol and metoprolol succinate have similar effects in reducing all-cause mortality. PMID:25708861

  20. Use of heliox delivered via high-flow nasal cannula to treat an infant with coronavirus-related respiratory infection and severe acute air-flow obstruction.

    PubMed

    Morgan, Sherwin E; Vukin, Kirissa; Mosakowski, Steve; Solano, Patti; Stanton, Lolita; Lester, Lucille; Lavani, Romeen; Hall, Jesse B; Tung, Avery

    2014-11-01

    Heliox, a helium-oxygen gas mixture, has been used for many decades to treat obstructive pulmonary disease. The lower density and higher viscosity of heliox relative to nitrogen-oxygen mixtures can significantly reduce airway resistance when an anatomic upper air-flow obstruction is present and gas flow is turbulent. Clinically, heliox can decrease airway resistance in acute asthma in adults and children and in COPD. Heliox may also enhance the bronchodilating effects of ?-agonist administration for acute asthma. Respiratory syndromes caused by coronavirus infections in humans range in severity from the common cold to severe acute respiratory syndrome associated with human coronavirus OC43 and other viral strains. In infants, coronavirus infection can cause bronchitis, bronchiolitis, and pneumonia in variable combinations and can produce enough air-flow obstruction to cause respiratory failure. We describe a case of coronavirus OC43 infection in an infant with severe acute respiratory distress treated with heliox inhalation to avoid intubation. PMID:25118308

  1. The association of comorbid diabetes mellitus and symptoms of depression with all-cause mortality and cardiac rehospitalization in patients with heart failure

    PubMed Central

    Reeves, Geri C; Frazier, Susan K; Watkins, John F; Lennie, Terry A; Moser, Debra K

    2015-01-01

    Background More than 22% of individuals with diabetes mellitus have concomitant heart failure (HF), and the prevalence of diabetes in those with HF is nearly triple that of individuals without HF. Comorbid depressive symptoms are common in diabetes and HF. Depressive symptoms are an independent predictor of mortality in individuals with diabetes alone, as well as those with HF alone and are a predictor of rehospitalization in those with HF. However, the association of comorbid HF, diabetes and depressive symptoms with all-cause mortality and rehospitalization for cardiac causes has not been determined. Objective The purpose of this study was to evaluate the association of comorbid HF, diabetes and depression with all-cause mortality and rehospitalization for cardiac cause. Method Patients provided data at baseline about demographic and clinical variables and depressive symptoms; patients were followed for at least 2?years. Participants were divided into four groups based on the presence and absence of diabetes and depressive symptoms. Cox regression analysis was used to determine whether comorbid diabetes and depressive symptoms independently predicted all-cause mortality and cardiac rehospitalization in these patients with HF. Results Patients (n=663) were primarily male (69%), white (76%), and aged 61±13?years. All-cause mortality was independently predicted by the presence of concomitant diabetes and depressive symptoms (HR 3.71; 95% CI 1.49 to 9.25; p=0.005), and depressive symptoms alone (HR 2.29; 95% CI 0.94 to 5.40; p=0.05). The presence of comorbid diabetes and depressive symptoms was also an independent predictor of cardiac rehospitalization (HR 2.36; 95% CI 1.27 to 4.39; p=0.007). Conclusions Comorbid diabetes and depressive symptoms are associated with poorer survival and rehospitalization in patients with HF; effective strategies to regularly evaluate and effectively manage these comorbid conditions are necessary to improve survival and reduce rehospitalization rates.

  2. Nonfermenting Gram-negative Bacilli other than Pseudomonas aeruginosa and Acinetobacter Spp. Causing Respiratory Tract Infections in a Tertiary Care Center

    PubMed Central

    Chawla, Kiran; Vishwanath, Shashidhar; Munim, Frenil C

    2013-01-01

    Background: Nonfermenting gram-negative bacilli have emerged as important healthcare-associated pathogens. It is important to correctly identify all clinically significant nonfermenting gram-negative bacilli considering the intrinsic multidrug resistance exhibited by these bacteria. Materials and Methods: A retrospective study was undertaken to identify the various nonfermenting gram-negative bacilli other than Pseudomonas aeruginosa and Acinetobacter spp. isolated from respiratory samples (n = 9363), to understand their clinical relevance and to analyze their antibiotic susceptibility pattern. Results: Nonfermenting gram-negative bacilli were isolated from 830 (16.4%) samples showing significant growth. Thirty-three (4%) isolates constituted nonfermenting gram-negative bacilli other than P. aeruginosa and Acinetobacter spp. Stenotrophomonas maltophilia (15, 45.5%) was the most common isolate followed by Burkholderia cepacia (4, 12.1%), Sphingomonas paucimobilis (3, 9.1%), and Achromobacter xylosoxidans (3, 9.1%). On the basis of clinicomicrobiological correlation, pathogenicity was observed in 69.7% (n = 23) isolates. Timely and correct treatment resulted in clinical improvement in 87.9% cases. Conclusion: Any nonfermenting gram-negative bacilli isolated from respiratory tract infection should not be ignored as mere contaminant, but correlated clinically for its pathogenic potential and identified using standard methods so as to institute appropriate and timely antibiotic coverage. PMID:24672175

  3. Acute renal failure in a child with thrombocytopenic purpura caused by acute Epstein-Barr virus infection after treatment with anti-D immunoglobulin.

    PubMed

    Kossiva, Lydia; Kyriakou, Dimitrios; Mitsioni, Andromachi; Garoufi, Anastasia

    2013-06-01

    Immune thrombocytopenia (ITP) in children is usually a benign, self-limiting disorder. An acute Epstein-Barr virus (EBV) infection usually causes atypical lymphocytosis and mild decrease in platelets. Severe thrombocytopenia is an extremely rare complication. Anti-D immunoglobulin has been used for treatment of ITP in Rh(D)-positive nonsplenectomized patients. Severe hemolysis and acute renal failure are extremely rare complications that may be aggravated by the presence of an acute EBV infection. It is believed that anti-D immunoglobulin triggers an unusual virus-induced immune response causing hemolysis. We present a 4-year-old girl with ITP caused by an acute EBV infection that developed acute kidney injury following treatment with anti-D immunoglobulin. The patient recovered completely from thrombocytopenia and renal dysfunction. Intravascular hemolysis and acute kidney injury are consistent with anti-D immunoglobulin mechanism of action. Pediatric patients treated with anti-D immunoglobulin for ITP should be closely monitored for signs and symptoms of hemolysis that may be aggravated by the presence of EBV infection leading to impaired renal function. PMID:23736070

  4. BMP15 c.-9C>G promoter sequence variant may contribute to the cause of non-syndromic premature ovarian failure.

    PubMed

    Fonseca, Dora Janeth; Ortega-Recalde, Oscar; Esteban-Perez, Clara; Moreno-Ortiz, Harold; Patiño, Liliana Catherine; Bermúdez, Olga María; Ortiz, Angela María; Restrepo, Carlos M; Lucena, Elkin; Laissue, Paul

    2014-11-01

    BMP15 has drawn particular attention in the pathophysiology of reproduction, as its mutations in mammalian species have been related to different reproductive phenotypes. In humans, BMP15 coding regions have been sequenced in large panels of women with premature ovarian failure (POF), but only some mutations have been definitely validated as causing the phenotype. A functional association between the BMP15 c.-9C>G promoter polymorphism and cause of POF have been reported. The aim of this study was to determine the potential functional effect of this sequence variant on specific BMP15 promoter transactivation disturbances. Bioinformatics was used to identify transcription factor binding sites located on the promoter region of BMP15. Reverse transcription polymerase chain reaction was used to study specific gene expression in ovarian tissue. Luciferase reporter assays were used to establish transactivation disturbances caused by the BMP15 c.-9C>G variant. The c.-9C>G variant was found to modify the PITX1 transcription factor binding site. PITX1 and BMP15 co-expressed in human and mouse ovarian tissue, and PITX1 transactivated both BMP15 promoter versions (-9C and -9G). It was found that the BMP15 c.-9G allele was related to BMP15 increased transcription, supporting c.-9C>G as a causal agent of POF. PMID:25246117

  5. 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

  6. Prognostic respiratory parameters in heart failure patients with and without exercise oscillatory ventilation - a systematic review and descriptive meta-analysis.

    PubMed

    Cornelis, Justien; Taeymans, Jan; Hens, Wendy; Beckers, Paul; Vrints, Christiaan; Vissers, Dirk

    2015-03-01

    The purpose of this review was to describe the occurrence of prognostic variables as derived from cardiopulmonary exercise testing (CPET) in patients with heart failure (HF), presenting exercise oscillatory ventilation (EOV) compared to patients without EOV. The effect of EOV on peak oxygen consumption (VO2), minute ventilation/carbon dioxide production (VE/VCO2) slope, oxygen uptake efficiency slope (OUES), rest and peak pulmonary end-tidal carbon dioxide pressure (PETCO2) was meta-analysed. A systematic search strategy was performed in five databases (Pubmed, Cochrane Library, PEDro, Science Direct and Web of Science) assessing 252 articles for eligibility. Nineteen citations met the inclusion criteria totalling 3032 patients with HF (EOV=1111; non-EOV=1921). The risk of bias was assessed by two researchers. Extracted data were pooled using random or fixed effects meta-analysis, if appropriate. The level of significance was set at p?0.05. Overall, the presentation of EOV significantly indicated aggravated prognostic markers. Subgroup analysis revealed left ventricular ejection fraction (LVEF) and mode of CPET protocol as independent factors, whereas defining EOV significantly influenced the results. A meta-analysis of studies reporting hazard ratios for cardiovascular events demonstrated that HF patients with EOV run a fourfold risk for an adverse event compared to HF patients without EOV. In general, these findings suggest that the presence of EOV in patients with HF is associated with a deterioration of the prognostic CPET parameters. Furthermore, EOV can occur in HF patients with reduced as well as preserved ejection fraction. Further research on defining and assessing EOV in a more accurate and reproducible way is required. PMID:25616233

  7. Air quality models and unusually large ozone increases: Identifying model failures, understanding environmental causes, and improving modeled chemistry

    NASA Astrophysics Data System (ADS)

    Couzo, Evan A.

    Several factors combine to make ozone (O3) pollution in Houston, Texas, unique when compared to other metropolitan areas. These include complex meteorology, intense clustering of industrial activity, and significant precursor emissions from the heavily urbanized eight-county area. Decades of air pollution research have borne out two different causes, or conceptual models, of O 3 formation. One conceptual model describes a gradual region-wide increase in O3 concentrations "typical" of many large U.S. cities. The other conceptual model links episodic emissions of volatile organic compounds to spatially limited plumes of high O3, which lead to large hourly increases that have exceeded 100 parts per billion (ppb) per hour. These large hourly increases are known to lead to violations of the federal O 3 standard and impact Houston's status as a non-attainment area. There is a need to further understand and characterize the causes of peak O 3 levels in Houston and simulate them correctly so that environmental regulators can find the most cost-effective pollution controls. This work provides a detailed understanding of unusually large O 3 increases in the natural and modeled environments. First, we probe regulatory model simulations and assess their ability to reproduce the observed phenomenon. As configured for the purpose of demonstrating future attainment of the O3 standard, the model fails to predict the spatially limited O3 plumes observed in Houston. Second, we combine ambient meteorological and pollutant measurement data to identify the most likely geographic origins and preconditions of the concentrated O3 plumes. We find evidence that the O3 plumes are the result of photochemical activity accelerated by industrial emissions. And, third, we implement changes to the modeled chemistry to add missing formation mechanisms of nitrous acid, which is an important radical precursor. Radicals control the chemical reactivity of atmospheric systems, and perturbations to radical budgets can shift chemical pathways. The mechanism additions increase the concentrations of nitrous acid, especially right after sunrise. The overall effect on O3 is small (up to three ppb), but we demonstrate the successful implementation of a surface sub-model that chemically processes adsorbed compounds. To our knowledge, this is the first time that chemical processing on surfaces has been used in a three-dimensional regulatory air quality model.

  8. Respiratory problems in renal transplant recipients admitted to intensive care during long-term follow-up.

    PubMed

    Candan, S; Pirat, A; Varol, G; Torgay, A; Zeyneloglu, P; Arslan, G

    2006-06-01

    Cardiovascular disease, malignancies, and infectious complications are major causes of morbidity and mortality of renal transplant recipients. Mortality rates vary between 16% and 40% in an intensive care unit (ICU). The aims of this study were to identify the types incidences of respiratory problems that affected renal transplant recipients admitted to the ICU during long-term follow-up thereby determining the impact of respiratory problems on mortality. We reviewed the data for 34 recipients who had 39 ICU admissions from January 2000 through December 2003. Twenty-four admissions (61.5%) had at least one respiratory problem at admission or developed at least one during the ICU stay. The most frequent problem was pneumonia (n=18, 46.2% of the 39 readmissions), followed by acute respiratory failure (n=10, 25.6%), atelectasis (n=9, 23.1%), pleural effusion (n=8, 20.5%), and pulmonary edema (n=2, 5.1%). The patients who had respiratory problems showed a significantly higher mortality rate than those who did not have respiratory problems (66.6% versus 26.6%, respectively; P<.05). The overall mortality rate was 58.8% (20 patients). Thus, infectious and respiratory problems are the most frequent indications for admission and the most common problems during an ICU stay. The prognosis for patients who either have a respiratory problem upon admission to the ICU or develop one during the ICU stay is poor. PMID:16797301

  9. Respiratory effects of intravenous midazolam.

    PubMed

    Zacharias, M; Hunter, K M; Parkinson, R

    1996-09-01

    Thirty-four healthy, young-adult patients receiving intravenous midazolam for third-molar surgery had their respiratory parameters measured by respiratory inductive plethysmography. Tidal volume and minute volume showed significant changes during the initial 5-10 minutes of sedation, the changes being maximal during the first 5 minutes from the completion of injection of midazolam. The measurement of phase angle, an indicator of respiratory asynchrony, showed no significant change from normal, although a few patients showed some asynchrony of breathing, suggesting some amount of respiratory obstruction. A few patients showed a short period of apnoea and a small fall in the oxygen saturation. None of these changes caused any clinical concerns. It is suggested that the absence of stimulation after injection of midazolam, particularly in the initial few minutes, may contribute to the potential onset of respiratory problems. PMID:8910727

  10. 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

  11. 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

  12. Animal Model of Respiratory Syncytial Virus: CD8+ T Cells Cause a Cytokine Storm That Is Chemically Tractable by Sphingosine-1-Phosphate 1 Receptor Agonist Therapy

    PubMed Central

    Walsh, Kevin B.; Teijaro, John R.; Brock, Linda G.; Fremgen, Daniel M.; Collins, Peter L.

    2014-01-01

    ABSTRACT The cytokine storm is an intensified, dysregulated, tissue-injurious inflammatory response driven by cytokine and immune cell components. The cytokine storm during influenza virus infection, whereby the amplified innate immune response is primarily responsible for pulmonary damage, has been well characterized. Now we describe a novel event where virus-specific T cells induce a cytokine storm. The paramyxovirus pneumonia virus of mice (PVM) is a model of human respiratory syncytial virus (hRSV). Unexpectedly, when C57BL/6 mice were infected with PVM, the innate inflammatory response was undetectable until day 5 postinfection, at which time CD8+ T cells infiltrated into the lung, initiating a cytokine storm by their production of gamma interferon (IFN-?) and tumor necrosis factor alpha (TNF-?). Administration of an immunomodulatory sphingosine-1-phosphate (S1P) receptor 1 (S1P1R) agonist significantly inhibited PVM-elicited cytokine storm by blunting the PVM-specific CD8+ T cell response, resulting in diminished pulmonary disease and enhanced survival. IMPORTANCE A dysregulated overly exuberant immune response, termed a “cytokine storm,” accompanies virus-induced acute respiratory diseases (VARV), is primarily responsible for the accompanying high morbidity and mortality, and can be controlled therapeutically in influenza virus infection of mice and ferrets by administration of sphingosine-1-phosphate 1 receptor (S1P1R) agonists. Here, two novel findings are recorded. First, in contrast to influenza infection, where the cytokine storm is initiated early by the innate immune system, for pneumonia virus of mice (PVM), a model of RSV, the cytokine storm is initiated late in infection by the adaptive immune response: specifically, by virus-specific CD8 T cells via their release of IFN-? and TNF-?. Blockading these cytokines with neutralizing antibodies blunts the cytokine storm and protects the host. Second, PVM infection is controlled by administration of an S1P1R agonist. PMID:24672024

  13. Failure Analysis of Wire Bonds

    Microsoft Academic Search

    Harry A. Schafft

    1973-01-01

    Failure analysis of wire bonds has an important part to play in determining the causes of microelectronic device failure and ways for making and using devices to achieve greater reliability. Several tests and procedures used in the failure analysis of wire bonds are reviewed. Some of the inferences. about possible causes of permanent or intermittent failure that can be drawn

  14. Superior vena cava syndrome caused by embolisation of liquid Onyx

    Microsoft Academic Search

    Robbert Crusio; Kishan Ramachandran; Kavan Ramachandran; Yizhak Kupfer; Sidney Tessler

    2011-01-01

    Superior vena cava syndrome (SVCS) is usually caused by a malignancy or the presence of an intravascular device in a central vein. A 74-year-old male with a history of a superior vena cava (SVC) stent underwent embolisation of a brain arterio-venous malformation through the right meningeal artery with liquid Onyx. Two weeks later he presented with acute respiratory failure, upper

  15. [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

  16. Evaluation of efficacy of non-invasive ventilation in Non-COPD and non-trauma patients with acute hypoxemic respiratory failure: A systematic review and meta-analysis

    PubMed Central

    AlYami, Marja A.; AlAhmari, Mohammed D.; Alotaibi, Hajed; AlRabeeah, Saad; AlBalawi, Ibrahim; Mubasher, Mohamed

    2015-01-01

    Non-invasive ventilation (NIV) has been widely supported in the past two decades as an effective application in avoiding the need for endotracheal intubation (ETI) and reducing associated mortality in acute hypoxemic respiratory failure (AHRF) patients. However, the efficacy of NIV in AHRF patients, non-related to chronic obstructive pulmonary disease (COPD) and trauma is still controversial in the field of medical research. This retrospective study aimed to evaluate the efficacy of NIV as an adjunctive therapy in non-COPD and non-traumatic AHRF patients. Data of 11 randomized control trials (RCTs), which were conducted between 1990 and 2010 to determine the efficacy of NIV in non-COPD and non-traumatic AHRF patients, were reviewed from the PUBMED, MEDLINE, Cochrane Library, and EMBASE databases. Parameters monitored in this study included the ETI rate, fatal complications, mortality rate of patients, and their ICU and hospital duration of stay. Overall results showed a statistically significant decrease in the rate of ETI, mortality, and fatal complications along with reduced ICU and hospital length of stay in non-COPD and non-trauma AHRF patients of various etiologies. This systematic review suggests that non-COPD and non-trauma AHRF patients can potentially benefit from NIV as compared with conventional treatment methods. Observations from various cohort studies, observational studies, and previously published literature advocate on the efficacy of NIV for treating non-COPD and non-traumatic AHRF patients. However, considering the diversity of studied populations, further studies and more specific trials on less heterogeneous AHRF patient groups are needed to focus on this aspect. PMID:25593602

  17. 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.

  18. 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.

  19. RESPIRATORY/ LOUNGECONSULT

    E-print Network

    Goldman, Steven A.

    CLEAN SUPPLY PAT ROOM 15 PAT ROOM 14 PAT ROOM 16 PAT BAY 2 PAT BAY 1 TEAM ROOM ST TLT RESPIRATORY/ BLOODWORK AREA PAT ROOM 4 PAT ROOM 5 PAT ROOM 6 PAT ROOM 7 PAT ROOM 8 PAT ROOM 3 PAT ROOM 2 TWIN ROOM 1 GAS PAT BAY 7 PAT BAY 8 PAT BAY 5 PAT BAY 6 PAT BAY 3 PAT BAY 4 MEDS PAT ROOM 9 PAT ROOM 10 PAT ROOM

  20. Surfactant replacement therapy for preterm and term neonates with respiratory distress.

    PubMed

    Polin, Richard A; Carlo, Waldemar A

    2014-01-01

    Respiratory failure secondary to surfactant deficiency is a major cause of morbidity and mortality in preterm infants. Surfactant therapy substantially reduces mortality and respiratory morbidity for this population. Secondary surfactant deficiency also contributes to acute respiratory morbidity in late-preterm and term neonates with meconium aspiration syndrome, pneumonia/sepsis, and perhaps pulmonary hemorrhage; surfactant replacement may be beneficial for these infants. This statement summarizes the evidence regarding indications, administration, formulations, and outcomes for surfactant-replacement therapy. The clinical strategy of intubation, surfactant administration, and extubation to continuous positive airway pressure and the effect of continuous positive airway pressure on outcomes and surfactant use in preterm infants are also reviewed. PMID:24379227

  1. 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

  2. Colds and the Flu: Respiratory Infections during Pregnancy

    MedlinePLUS

    MENU Return to Web version Colds and the Flu | Respiratory Infections During Pregnancy What is a viral ... respiratory tract (breathing) and cause other symptoms. The flu and the common cold are examples of viral ...

  3. Survival and echocardiographic data in dogs with congestive heart failure caused by mitral valve disease and treated by multiple drugs: A retrospective study of 21 cases

    PubMed Central

    de Madron, Eric; King, Jonathan N.; Strehlau, Günther; White, Regina Valle

    2011-01-01

    This retrospective study reports the survival time [onset of congestive heart failure (CHF) to death from any cause] of 21 dogs with mitral regurgitation (MR) and CHF treated with a combination of furosemide, angiotensin-converting enzyme inhibitor (ACEI, benazepril, or enalapril), pimobendan, spironolactone, and amlodipine. Baseline echocardiographic data: end-systolic and end-diastolic volume indices (ESVI and EDVI), left atrium to aorta ratio (LA/Ao), and regurgitant fraction (RF) are reported. Median survival time (MST) was 430 d. Initial dosage of furosemide (P = 0.0081) and LA/Ao (P = 0.042) were negatively associated with survival. Baseline echocardiographic indices (mean ± standard deviation) were 40.24 ± 16.76 for ESVI, 161.48 ± 44.49 mL/m2 for EDVI, 2.11 ± 0.75 for LA/Ao, and 64.71 ± 16.85% for RF. Combining furosemide, ACEI, pimobendan, spironolactone, and amlodipine may result in long survival times in dogs with MR and CHF. Severity of MR at onset of CHF is at least moderate. PMID:22547843

  4. 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.

  5. Epidemiology of respiratory distress of newborns

    Microsoft Academic Search

    Alok Kumar; B. Vishnu Bhat

    1996-01-01

    The present prospective study was conducted to find out the incidence, etiology and outcome of respiratory distress (RD) in\\u000a newborns. All newborns (n=4505), delivered at this hospital over a period of 13 months, were observed for respiratory problems.\\u000a Relevant antenatal, intranatal and neonatal information was noted. Cases were investigated for the cause of respiratory distress\\u000a and followed up for the

  6. Altered respiratory physiology in obesity

    PubMed Central

    Parameswaran, Krishnan; Todd, David C; Soth, Mark

    2006-01-01

    The major respiratory complications of obesity include a heightened demand for ventilation, elevated work of breathing, respiratory muscle inefficiency and diminished respiratory compliance. The decreased functional residual capacity and expiratory reserve volume, with a high closing volume to functional residual capacity ratio of obesity, are associated with the closure of peripheral lung units, ventilation to perfusion ratio abnormalities and hypoxemia, especially in the supine position. Conventional respiratory function tests are only mildly affected by obesity except in extreme cases. The major circulatory complications are increased total and pulmonary blood volume, high cardiac output and elevated left ventricular end-diastolic pressure. Patients with obesity commonly develop hypoventilation and sleep apnea syndromes with attenuated hypoxic and hypercapnic ventilatory responsiveness. The final result is hypoxemia, pulmonary hypertension and progressively worsening disability. Obese patients have increased dyspnea and decreased exercise capacity, which are vital to quality of life. Decreased muscle, increased joint pain and skin friction are important determinants of decreased exercise capacity, in addition to the cardiopulmonary effects of obesity. The effects of obesity on mortality in heart failure and chronic obstructive pulmonary disease have not been definitively resolved. Whether obesity contributes to asthma and airway hyper-responsiveness is uncertain. Weight reduction and physical activity are effective means of reversing the respiratory complications of obesity. PMID:16779465

  7. Establishing Public Policy as a Primary Cause of Engineering Failure: Did Market Deregulation Lead to the North American `Blackout', August 14th 2003?

    E-print Network

    Williamson, John

    to the North American `Blackout', August 14th 2003? Christopher W. Johnson, Glasgow Accident Analysis Group an over-reliance on automated monitoring systems. The infrastructure failure also stemmed from of the failure, there was a net loss of 18.9 million work hours, and manufacturing shipments in Ontario were down

  8. Protocol for a systematic review and economic evaluation of the clinical and cost-effectiveness of non-hospital-based non-invasive ventilation (NIV) in patients with stable end-stage COPD with hypercapnic respiratory failure

    PubMed Central

    2014-01-01

    Background Chronic obstructive pulmonary disease (COPD) remains a significant public health burden. Non-invasive ventilation (NIV) is a method of supported breathing used as standard care for acutely unwell patients in hospital with COPD, but there is uncertainty around the potential benefits of using NIV in the treatment of stable patients in a non-hospital setting. This is a protocol for systematic reviews of the clinical and cost-effectiveness of NIV in this context, being undertaken in support of a model based economic evaluation. Methods/Design Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction for both the clinical and economic systematic reviews. Bibliographic databases (for example MEDLINE, EMBASE) and ongoing trials registers will be searched from 1980 onwards. The search strategy will combine terms for the population with those for the intervention. Studies will be selected for review if the population includes adult patients with COPD and hypercapnic respiratory failure, however defined. Systematic reviews, randomised controlled trials and observational studies (with n >1) will be included, and quality assessment will be tailored to the different study designs. The primary outcome measures of interest are survival, quality of life, and healthcare utilisations (hospitalisation and Accident and Emergency attendances). Meta-analyses will be undertaken where clinical and methodological homogeneity exists, supported by predefined subgroup analyses where appropriate. A systematic review of the evidence on the cost-effectiveness of non-hospital NIV will be completed, and a model-based cost-utility analysis undertaken to determine the cost-effectiveness of non-hospital-based NIV compared with standard care. Discussion These reviews will attempt to clarify the clinical effectiveness of non-hospital NIV in COPD patients as well as the cost-effectiveness. The findings may indicate whether NIV in a non-hospital setting should be considered more routinely in this patient group, and what the likely cost implications will be. PROSPERO registration 2012:CRD42012003286. PMID:24669937

  9. Respiratory Home Health Care

    MedlinePLUS

    Respiratory Home Health Care Respiratory care at home can contribute to improved quality of life and significant cost savings. Your respiratory care ... your family and home situation to help your health care provider plan for your care after you are ...

  10. Impact of gait speed and instrumental activities of daily living on all-cause mortality in adults ?65 years with heart failure.

    PubMed

    Lo, Alexander X; Donnelly, John P; McGwin, Gerald; Bittner, Vera; Ahmed, Ali; Brown, Cynthia J

    2015-03-15

    Mobility and function are important predictors of survival. However, their combined impact on mortality in adults ?65 years with heart failure (HF) is not well understood. This study examined the role of gait speed and instrumental activities of daily living (IADL) in all-cause mortality in a cohort of 1,119 community-dwelling Cardiovascular Health Study participants ?65 years with incident HF. Data on HF and mortality were collected through annual examinations or contact during the 10-year follow-up period. Slower gait speed (<0.8 m/s vs ?0.8 m/s) and IADL impairment (?1 vs 0 areas of dependence) were determined from baseline and follow-up assessments. A total of 740 (66%) of the 1,119 participants died during the follow-up period. Multivariate Cox proportional hazards models showed that impairments in either gait speed (hazard ratio 1.37, 95% confidence interval 1.10 to 1.70; p = 0.004) or IADL (hazard ratio 1.56, 95% confidence interval 1.29-1.89; p <0.001), measured within 1 year before the diagnosis of incident HF, were independently associated with mortality, adjusting for sociodemographic and clinical characteristics. The combined presence of slower gait speed and IADL impairment was associated with a greater risk of mortality and suggested an additive relation between gait speed and IADL. In conclusion, gait speed and IADL are important risk factors for mortality in adults ?65 years with HF, but the combined impairments of both gait speed and IADL can have an especially important impact on mortality. PMID:25655868

  11. Characterization of the Viral Microbiome in Patients with Severe Lower Respiratory Tract Infections, Using Metagenomic Sequencing

    Microsoft Academic Search

    Fredrik Lysholm; Anna Wetterbom; Cecilia Lindau; Hamid Darban; Annelie Bjerkner; Kristina Fahlander; A. Michael Lindberg; Bengt Persson; Tobias Allander; Björn Andersson

    2012-01-01

    The human respiratory tract is heavily exposed to microorganisms. Viral respiratory tract pathogens, like RSV, influenza and rhinoviruses cause major morbidity and mortality from respiratory tract disease. Furthermore, as viruses have limited means of transmission, viruses that cause pathogenicity in other tissues may be transmitted through the respiratory tract. It is therefore important to chart the human virome in this

  12. Elevated soluble ST2 and depression increased the risk of all-cause mortality and hospitalization in patients with heart failure.

    PubMed

    Xu, Su-Dan; Su, Guan-Hua; Lu, Yong-Xin; Shuai, Xin-Xin; Tao, Xiao-Fang; Meng, Yi-Di; Luo, Ping

    2014-01-01

    This study aimed to assess the predictive effect of soluble ST2 (sST2) and depressive symptoms in patients with heart failure (HF) and to determine whether the prognosis of HF patients with preserved ejection fraction (HFpEF) differs from those with reduced ejection fraction (HFrEF). A cohort of 233 HF patients was followed for 1 year. Depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale. The primary endpoint was all-cause mortality and HF-related hospitalization. For the analysis of survival, the left ventricular ejection fraction (LVEF) cut-offs for defining HFpEF were set at 50%, 45%, and 40%, respectively. With increasing LVEF, levels of sST2 were gradually decreased (45.2 ng/mL, 35.8 ng/mL, and 32.1 ng/mL in patients with LVEF ? 40%, 41% to 49%, and ? 50%, respectively, P for trend < 0.001), as well as the prevalence of depressive symptoms (35.4%, 33.3%, and 20.4%, respectively, P for trend = 0.022). After 1-year follow-up, 128 patients (54.9%) achieved the primary endpoint and 47 patients (20.2%) died. Depressive symptoms were independent risk factors of all-cause mortality and HF-related hospitalization. The combined presence of elevated sST2 (> 36.0 ng/mL) and depressive symptoms was associated with a 4.9-fold increased risk of the primary endpoint. Regardless of LVEF cut-offs, the associated risk of adverse outcomes in HFpEF was as high as in HFrEF after adjustment for significant risk factors including sST2 and N-terminal pro-brain natriuretic peptide. In conclusion, depressive symptoms provided additional prognostic information to that of sST2 in HF patients. The prognosis of HFpEF patients was similar to that of HFrEF patients. PMID:25070116

  13. 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., E-mail: pnguyen@LROC.harvard.edu [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA (United States); Chen, Ming-Hui [Department of Statistics, University of Connecticut, Storrs, CT (United States); Beckman, Joshua A. [Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (United States); Beard, Clair J.; Martin, Neil E. [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA (United States); Choueiri, Toni K. [Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); Hu, Jim C. [Division of Urologic Surgery, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, MA (United States); Hoffman, Karen E. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Dosoretz, Daniel E. [21st Century Oncology, Fort Myers, FL (United States); Moran, Brian J. [Chicago Prostate Center, Westmont, IL (United States); Salenius, Sharon A. [21st Century Oncology, Fort Myers, FL (United States); Braccioforte, Michelle H. [Chicago Prostate Center, Westmont, IL (United States); Kantoff, Philip W. [Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); D'Amico, Anthony V. [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA (United States); Ennis, Ronald D. [Department of Radiation Oncology, St. Luke's-Roosevelt and Beth Israel Hospitals, Continuum Cancer Centers of New York, Albert Einstein College of Medicine, New York, NY (Israel)

    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.

  14. 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...

  15. Nanotechnology in respiratory medicine.

    PubMed

    Omlor, Albert Joachim; Nguyen, Juliane; Bals, Robert; Dinh, Quoc Thai

    2015-01-01

    Like two sides of the same coin, nanotechnology can be both boon and bane for respiratory medicine. Nanomaterials open new ways in diagnostics and treatment of lung diseases. Nanoparticle based drug delivery systems can help against diseases such as lung cancer, tuberculosis, and pulmonary fibrosis. Moreover, nanoparticles can be loaded with DNA and act as vectors for gene therapy in diseases like cystic fibrosis. Even lung diagnostics with computer tomography (CT) or magnetic resonance imaging (MRI) profits from new nanoparticle based contrast agents. However, the risks of nanotechnology also have to be taken into consideration as engineered nanomaterials resemble natural fine dusts and fibers, which are known to be harmful for the respiratory system in many cases. Recent studies have shown that nanoparticles in the respiratory tract can influence the immune system, can create oxidative stress and even cause genotoxicity. Another important aspect to assess the safety of nanotechnology based products is the absorption of nanoparticles. It was demonstrated that the amount of pulmonary nanoparticle uptake not only depends on physical and chemical nanoparticle characteristics but also on the health status of the organism. The huge diversity in nanotechnology could revolutionize medicine but makes safety assessment a challenging task. PMID:26021823

  16. Bioterrorism for the respiratory physician.

    PubMed

    Waterer, Grant W; Robertson, Hannah

    2009-01-01

    Terrorist attacks by definition are designed to cause fear and panic. There is no question that a terrorist attack using biological agents would present a grave threat to stability of the society in which they were released. Early recognition of such a bioterrorist attack is crucial to containing the damage they could cause. As many of the most likely bioterrorism agents present with pulmonary disease, respiratory physicians may be crucial in the initial recognition and diagnosis phase, and certainly would be drawn into treatment of affected individuals. This review focuses on the biological agents thought most likely to be used by terrorists that have predominantly respiratory presentations. The primary focus of this review is on anthrax, plague, tularaemia, ricin, and Staphylococcal enterotoxin B. The pathogenesis, clinical manifestations and treatment of these agents will be discussed as well as historical examples of their use. Other potential bioterrorism agents with respiratory manifestations will also be discussed briefly. PMID:19144044

  17. 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.

  18. Rye grains and the soil derived from under the organic and conventional rye crops 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 Introduction: Due to the specific work environment, farmers are exposed to various biological occupational hazard. Among these factors significant are fungi present in the grain and also in the soil. The fungi may be the cause of human diseases including skin infections, asthma, allergic rhinitis and many others. Aim The aim of this study was to quantify and identify species of fungi colonizing rye grain samples and the soil under cultivation. Material and methods The material consisted of grain and soil samples from two agricultural systems: organic and conventional. To determine the concentration and composition of fungi in collected samples, two media: Malt Agar (MA, Becton, Dickinson and Company) and Potato Dextrose Agar (PDA, Becton, Dickinson and Company) were used. The composition of species in fungal flora was determined using macroscopic and microscopic methods. The isolates of fungi were ranked in the appropriate classes of biosafety BSL. Results The most frequently isolated fungi from organic rye grain, regardless of the media used, were species: Aureobasidium pullulans and Alternaria alternata. In conventional farms, most species isolated from rye grain were: Aureobasidium pullulans, Cladosporium oxysporum, Alternaria alternata and yeast-like fungi. Most often species isolated from the soil was Penicillium citreo-viride. Conclusions All the results of the research demonstrate the potential hazard to the health of people working in agriculture. Significant exposure of this professional group is associated with the presence of harmful biological agents present in the grain and soil from its cultivation. PMID:24494000

  19. Development of Neonatal Respiratory and Intensive Care: Chinese Perspectives

    Microsoft Academic Search

    Bo Sun; Li Ma; Xiaohong Liu; Xirong Gao; Liming Ni

    2012-01-01

    Recent economic improvements in China have allowed the development of perinatal-neonatal care in sub-provincial regions. However, variations in neonatal respiratory and intensive care exist, especially in regions with limited resources. We conducted a series of collaborative clinical investigations into neonatal hypoxemic respiratory failure (NRF). In the study period from 2004 to 2005, this nationwide study found an incidence of NRF

  20. Respiratory symptoms in elderly Chinese living in Hong Kong

    Microsoft Academic Search

    C. K. W. Lai; S. C. Ho; J. Lau; Y. K. Yuen; C. H. S Chan; J. Woo

    1995-01-01

    Respiratory diseases can cause considerable disability in the elderly because of their limited respiratory reserve as a result of ageing. We have investi- gated the prevalence of respiratory symptoms and diseases in elderly Chinese in Hong Kong and compared these data with those in elderly Caucasian populations. Two thousand and thirty two (999 male and 1,033 female) subjects, selected by

  1. Family cluster of Middle East respiratory syndrome coronavirus infections.

    PubMed

    Memish, Ziad A; Zumla, Alimuddin I; Al-Hakeem, Rafat F; Al-Rabeeah, Abdullah A; Stephens, Gwen M

    2013-06-27

    A human coronavirus, called the Middle East respiratory syndrome coronavirus (MERS-CoV), was first identified in September 2012 in samples obtained from a Saudi Arabian businessman who died from acute respiratory failure. Since then, 49 cases of infections caused by MERS-CoV (previously called a novel coronavirus) with 26 deaths have been reported to date. In this report, we describe a family case cluster of MERS-CoV infection, including the clinical presentation, treatment outcomes, and household relationships of three young men who became ill with MERS-CoV infection after the hospitalization of an elderly male relative, who died of the disease. Twenty-four other family members living in the same household and 124 attending staff members at the hospitals did not become ill. MERS-CoV infection may cause a spectrum of clinical illness. Although an animal reservoir is suspected, none has been discovered. Meanwhile, global concern rests on the ability of MERS-CoV to cause major illness in close contacts of patients. PMID:23718156

  2. 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.

  3. [Respiratory treatments in neuromuscular disease].

    PubMed

    Martínez Carrasco, C; Cols Roig, M; Salcedo Posadas, A; Sardon Prado, O; Asensio de la Cruz, O; Torrent Vernetta, A

    2014-10-01

    In a previous article, a review was presented of the respiratory pathophysiology of the patient with neuromuscular disease, as well as their clinical evaluation and the major complications causing pulmonary deterioration. This article presents the respiratory treatments required to preserve lung function in neuromuscular disease as long as possible, as well as in special situations (respiratory infections, spinal curvature surgery, etc.). Special emphasis is made on the use of non-invasive ventilation, which is changing the natural history of many of these diseases. The increase in survival and life expectancy of these children means that they can continue their clinical care in adult units. The transition from pediatric care must be an active, timely and progressive process. It may be slightly stressful for the patient before the adaptation to this new environment, with multidisciplinary care always being maintained. PMID:24890888

  4. Technical evaluation of the susceptibility of safety-related systems to flooding caused by the failure of non-category 1 systems for Indian Point, Unit 2

    Microsoft Academic Search

    V. R. Latorre; R. A. Victor

    1980-01-01

    Purpose of this evaluation was to determine whether the failure of any non-Class I (seismic) equipment could result in a condition, such as flooding, that might adversely affect the performance of the safety-related equipment required for the safe shutdown of the facility, or to mitigate the consequences of an accident. Criteria developed by the US Nuclear Regulatory Commission were used

  5. Respiratory muscle dysfunction in facioscapulohumeral muscular dystrophy.

    PubMed

    Santos, Dante Brasil; Boussaid, Ghilas; Stojkovic, Tanya; Orlikowski, David; Letilly, Nadege; Behin, Anthony; Butel, Sandrine; Lofaso, Frédéric; Prigent, Hélène

    2015-08-01

    Respiratory insufficiency in facioscapulohumeral muscular dystrophy has rarely been studied. We compared two age- and sex-matched groups of 29 patients, with and without respiratory dysfunction. Tests in the 29 patients with respiratory dysfunction suggested predominant expiratory muscle dysfunction, leading to ineffective cough in 17 patients. Supine and upright vital capacities were not different (P?=?0.76), suggesting absence of diaphragmatic dysfunction. By stepwise regression, only expiratory reserve volume correlated with the Walton and Gardner-Medwin score (R(2)?=?0.503; P?=?0.001). Compared to controls, patients with respiratory dysfunction had higher values for the Walton and Gardner-Medwin score (6.1?±?1.9 vs. 3.2?±?1.2; P?<0.0001) and body mass index (26.9?±?6.0 vs. 22.9?±?4.0 kg/m(2); P?=?0.003) and a smaller number of D4Z4 allele repeats (4.8?±?1.6 vs. 5.7?±?1.8; P?=?0.05). Mechanical ventilation was required eventually in 20 patients, including 14 who were wheelchair bound. Three patients had acute respiratory failure requiring mechanical ventilation; 16 patients had poor airway clearance, including 10 with sleep apnea syndrome, responsible in 7 for chronic hypercapnia. Two patients presented isolated severe sleep apnea syndrome. Respiratory dysfunction in facioscapulohumeral muscular dystrophy is predominantly related to expiratory muscle weakness. Respiratory function and cough effectiveness should especially be monitored in patients with severe motor impairment and high body mass index. PMID:26023000

  6. Seawater refrigerating system failure

    Microsoft Academic Search

    S. Simison; F. Gomez; A. Steckinger; S. R. de Sanchez

    1995-01-01

    The cause of failures of copper-nickel pipes in the seawater refrigerating systems of two ships was analyzed. Failure is attributed to poor design of the weldments aggravated by seawater contamination. Welds placed too close to each other promoted sensitization of the material. The alloy had been heated to the precipitation range of an iron-rich second phase, and a pronounced root

  7. Reported tailings dam failures

    Microsoft Academic Search

    M. Rico; G. Benito; A. R. Salgueiro; A. D ´ õez-Herrero; H. G. Pereira

    2008-01-01

    A detailed search and re-evaluation of the known historical cases of tailings dam failure was carried out. A corpus of 147 cases of worldwide tailings dam disasters, from which 26 located in Europe, was compiled in a database. This contains six sections, including dam location, its physical and constructive characteristics, actual and putative failure cause, sludge hydrodynamics, socio-economical consequences and

  8. Workshop on systems failures

    Microsoft Academic Search

    John Donaldson; John Jenkins

    2001-01-01

    Systems failures cause havoc everywhere. Failures may be total, partial or temporary; and examination of the subject has to consider: implemented systems, systems being enhanced and totally new projects. When failing situations arise, the aftermath is highly complicated because there are so many possible contributing factors. For many years, students of Computer Science and Software Engineering - and indeed software

  9. Advances in the management of acute liver failure.

    PubMed

    Wang, Da-Wei; Yin, Yi-Mei; Yao, Yong-Ming

    2013-11-01

    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

  10. 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

  11. 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 ...

  12. Technical evaluation of the susceptibility of safety-related systems to flooding caused by the failure of non-Category I systems for Surry Units 1 and 2

    Microsoft Academic Search

    V. R. Latorre; R. A. Victor

    1980-01-01

    This report documents the technical evaluation of Surry Power Station Units 1 and 2. The purpose of this evaluation was to determine whether the failure of any non-Class I (seismic) equipment\\/piping could result in a condition, such as flooding, that might adversely affect the performance of the safety-related equipment required for the safe shutdown of the facility, or to mitigate

  13. 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

  14. Elevations and discharges produced by a simulated flood wave on the lower Sabine River, Louisiana and Texas, caused by a theoretical dam failure

    USGS Publications Warehouse

    Neely, Braxtel L.; Stiltner, Gloria J.

    1979-01-01

    The Toledo Bend Reservoir is located on the lower Sabine River between Louisiana and Texas. Two mathematical models were coupled to calculate the flood wave that would result from the theoretical failure of 25 percent of Toledo Bend Dam and route the wave downstream to Orange, Tex. Computations assumed failure (1) at the peak of the 100-year flood when discharge of the Sabine River is 102,000 cubic feet per second and (2) when the average discharge is 10,000 cubic feet per second. Two techniques were used in the dam-break model. The method of characteristics was used to propagate the shock wave following dam failure. The linear implicit finite-difference solution was used to route the flood wave following shock wave dissipation. The magnitude of the flow was determined for Burkeville, Bon Wier, Ruliff, and Orange, Tex., along the lower Sabine River. For these sites, respectively, the following peak elevations were calculated: 119, 82, 31, and 13 feet for the 100-year flood and 110, 75, 27, and 9 feet for the average discharge. (Woodard-USGS)

  15. 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.

  16. Respiratory Mechanisms of Support

    E-print Network

    Kay, Mark A.

    Alkalosis: pCO2 pH *exaggerated ventilation (example ­ crying, fever) Treatment: reduce ventilation alkalosis (primary or secondary to respiratory acidosis). [7] Respiratory Support Lucile Packard Children

  17. Diseases of the respiratory tract of chelonians.

    PubMed

    Origgi, F C; Jacobson, E R

    2000-05-01

    Diseases of the respiratory tract commonly occur in captive chelonians, and several diseases also have occurred in wild chelonians. Infectious causes include viruses, bacteria, fungi, and parasites. Herpesviruses have surfaced as important pathogens of the oral cavity and respiratory tract in Hermann's tortoise (Testudo hermanii), spur-thighed tortoise (Testudo graeca), and other tortoises in Europe and the United States. Herpesvirus-associated respiratory diseases also have been reported in the green turtle, Chelonia mydas, in mariculture in the Cayman Islands. Of diseases caused by bacteria, an upper respiratory tract disease caused by Mycoplasma sp has been reported in free-hanging and captive gopher tortoises in the southeastern United States and in desert tortoises in the Mojave Desert of the southwestern United States. Mycotic pulmonary disease is commonly reported in captive chelonians, especially in those maintained at suboptimal temperatures. An intranuclear coccidia has been seen in several species of captive tortoises in the United States, and, in one case, a severe proliferative pneumonia was associated with organisms in the lung. The most common noninfectious cause of respiratory disease in chelonians results from trauma to the carapace. Although pulmonary fibromas commonly occur in green turtles with fibropapillomatosis, for the most part, tumors of the respiratory tract are uncommon in chelonians. PMID:11228895

  18. Respiratory Syncytial Virus Vaccine Development

    PubMed Central

    Murata, Yoshihiko

    2009-01-01

    Respiratory syncytial virus (RSV) is a clinically significant cause of respiratory tract disease, especially among high-risk infants and immunocompromised and elderly adults. Despite the burden of disease, there is no licensed prophylactic RSV vaccine. The initial efforts to develop an RSV vaccine involved formalin-inactivated virus preparations that unexpectedly caused vaccine-enhanced disease in clinical trials in RSV-naïve children. Over the last four decades, cautious and deliberate progress has been made towards RSV vaccine development using a variety of experimental approaches (Table 1), including live attenuated strains, vector-based, and viral protein subunit/DNA-based candidates. The scientific rationale, preclinical testing, and clinical development of each of these approaches are reviewed. PMID:19892231

  19. [Neuromuscular disorders - assessment of the respiratory muscles].

    PubMed

    Perez, T

    2006-04-01

    Involvement of respiratory muscles is a nearly constant feature of neuromuscular disorders, leading to respiratory failure. A careful respiratory follow up adapted to the variable time course of each disease is therefore mandatory. As the first step, a systematic clinical evaluation is essential to detect the subtle respiratory symptoms and signs related to respiratory muscle failure. Dyspnea and orthopnea are often late findings in patients with a usually severe functional impairment due to peripheral muscle weakness. Nocturnal respiratory events (obstructive sleep apnea syndrome and hypoventilation) are strongly suggested by daytime hypersomnolence and frequent morning headaches. Physical evaluation is essential to detect accessory muscle recruitment, supine abdominal paradox, and encumbrance of upper or lower airways. Vital capacity (VC) is the most classical lung function test. The major limitation of spirometry is its poor sensitivity to detect a moderate inspiratory muscle weakness. Supine VC may improve the detection of diaphragmatic involvement. Peak expiratory flow during cough (cough PEF) gives an overall evaluation of cough efficiency, values below 160 to 270 L/min suggesting poor airway clearance. Arterial blood gases are performed in case of clinical signs, significant deterioration of lung function tests, or sleep desaturations. Hypercapnia is weakly related to lung function results in patients with Steinert dystrophy and those with bulbar involvement. A specific evaluation of respiratory muscle strength is mandatory, as these tests are both sensitive and highly prognostic. Possible discrepancies (particularly in bulbar patients) between maximal inspiratory pressure (PImax) and sniff nasal inspiratory pressure (SNIP) justify to perform both measurements and to select the highest pressure. A maximal expiratory pressure (PEmax) below 45 cm H2O may indicate a compromised cough efficiency but the correlation with cough PEF may be poor. A screening nocturnal oxymetry is useful to detect sleep apneas and hypoventilation. Criteria defining significant desaturations remain however controversial. Suspicion of obstructive sleep apnea syndrome on clinical grounds or oxymetry findings should be confirmed by a conventional polysomnography. PMID:16585904

  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. Change in failure stress on the southern san andreas fault system caused by the 1992 magnitude = 7.4 landers earthquake.

    PubMed

    Stein, R S; King, G C; Lin, J

    1992-11-20

    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. PMID:17778356

  2. Diaphragm remodeling and compensatory respiratory mechanics in a canine model of Duchenne muscular dystrophy.

    PubMed

    Mead, A F; Petrov, M; Malik, A S; Mitchell, M A; Childers, M K; Bogan, J R; Seidner, G; Kornegay, J N; Stedman, H H

    2014-04-01

    Ventilatory insufficiency remains the leading cause of death and late stage morbidity in Duchenne muscular dystrophy (DMD). To address critical gaps in our knowledge of the pathobiology of respiratory functional decline, we used an integrative approach to study respiratory mechanics in a translational model of DMD. In studies of individual dogs with the Golden Retriever muscular dystrophy (GRMD) mutation, we found evidence of rapidly progressive loss of ventilatory capacity in association with dramatic morphometric remodeling of the diaphragm. Within the first year of life, the mechanics of breathing at rest, and especially during pharmacological stimulation of respiratory control pathways in the carotid bodies, shift such that the primary role of the diaphragm becomes the passive elastic storage of energy transferred from abdominal wall muscles, thereby permitting the expiratory musculature to share in the generation of inspiratory pressure and flow. In the diaphragm, this physiological shift is associated with the loss of sarcomeres in series (? 60%) and an increase in muscle stiffness (? 900%) compared with those of the nondystrophic diaphragm, as studied during perfusion ex vivo. In addition to providing much needed endpoint measures for assessing the efficacy of therapeutics, we expect these findings to be a starting point for a more precise understanding of respiratory failure in DMD. PMID:24408990

  3. Diaphragm remodeling and compensatory respiratory mechanics in a canine model of Duchenne muscular dystrophy

    PubMed Central

    Mead, A. F.; Petrov, M.; Malik, A. S.; Mitchell, M. A.; Childers, M. K.; Bogan, J. R.; Seidner, G.; Kornegay, J. N.

    2014-01-01

    Ventilatory insufficiency remains the leading cause of death and late stage morbidity in Duchenne muscular dystrophy (DMD). To address critical gaps in our knowledge of the pathobiology of respiratory functional decline, we used an integrative approach to study respiratory mechanics in a translational model of DMD. In studies of individual dogs with the Golden Retriever muscular dystrophy (GRMD) mutation, we found evidence of rapidly progressive loss of ventilatory capacity in association with dramatic morphometric remodeling of the diaphragm. Within the first year of life, the mechanics of breathing at rest, and especially during pharmacological stimulation of respiratory control pathways in the carotid bodies, shift such that the primary role of the diaphragm becomes the passive elastic storage of energy transferred from abdominal wall muscles, thereby permitting the expiratory musculature to share in the generation of inspiratory pressure and flow. In the diaphragm, this physiological shift is associated with the loss of sarcomeres in series (?60%) and an increase in muscle stiffness (?900%) compared with those of the nondystrophic diaphragm, as studied during perfusion ex vivo. In addition to providing much needed endpoint measures for assessing the efficacy of therapeutics, we expect these findings to be a starting point for a more precise understanding of respiratory failure in DMD. PMID:24408990

  4. Degeneracy as a substrate for respiratory regulation.

    PubMed

    Mellen, Nicholas M

    2010-06-30

    Recent studies in vivo and in vitro suggest that both respiratory rhythmogenesis and its central chemosensory modulation arise from multiple, mechanistically and/or anatomically distinct networks whose outputs are similar. These observations are consistent with degeneracy, defined as the ability of structurally distinct elements to generate similar function. This review argues that degeneracy is an essential feature of respiratory networks, ensuring the survival of the individual organism over the course of development, and accounting for the transformation of respiratory biomechanics over evolutionary time. At faster timescales, respiration must adapt continuously and rapidly to changes in metabolic demand and ambient conditions to maintain blood-gas homeostasis. Control theory, which formalizes homeostasis, states axiomatically that rapid responsiveness can only be achieved with high gain, but high gain comes at the cost of instability. Homeostatic systems displaying highly optimized tolerance (HOT) mitigate the instability accompanying high gain by incorporating regulatory mechanisms that provide protection against expected perturbations, yet these systems remain fragile to catastrophic failure in response to rare events. Because the multiple mechanisms that are conjectured to mediate respiratory rhythmogenesis and chemosensation have distinct ranges of activity and responses to modulatory input, they provide a richer substrate for respiratory regulation than those of any single mechanism. Respiration, though robust, remains fragile to rare perturbations, matching a key feature of HOT. These observations support the conclusion that degeneracy provides the substrate for respiratory regulation, and that the resulting regulatory system conforms to HOT. PMID:20412870

  5. Degeneracy as a Substrate for Respiratory Regulation

    PubMed Central

    Mellen, Nicholas M.

    2010-01-01

    Recent studies in vivo and in vitro suggest that both respiratory rhythmogenesis and its central chemosensory modulation arise from multiple, mechanistically and/or anatomically distinct networks whose outputs are similar. These observations are consistent with degeneracy, defined as the ability of structurally distinct elements to generate similar function. This review argues that degeneracy is an essential feature of respiratory networks, ensuring the survival of the individual organism over the course of development, and accounting for the transformation of respiratory biomechanics over evolutionary time. At faster timescales, respiration must adapt continuously and rapidly to changes in metabolic demand and ambient conditions to maintain blood-gas homeostasis. Control theory, which formalizes homeostasis, states axiomatically that rapid responsiveness can only be achieved with high gain, but high gain comes at the cost of instability. Homeostatic systems displaying highly optimized tolerance (HOT) mitigate the instability accompanying high gain by incorporating regulatory mechanisms that provide protection against expected perturbations, yet these systems remain fragile to catastrophic failure in response to rare events. Because the multiple mechanisms that are conjectured to mediate respiratory rhythmogenesis and chemosensation have distinct ranges of activity and responses to modulatory input, they provide a richer substrate for respiratory regulation than than those of any single mechanism. Respiration, though robust, remains fragile to rare perturbations, matching a key feature of HOT. These observations support the conclusion that degeneracy provides the substrate for respiratory regulation, and that the resulting regulatory system conforms to HOT. PMID:20412870

  6. What Causes Pericarditis?

    MedlinePLUS

    ... In many 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 infection. Bacterial, fungal, and other infections also can ...

  7. Mechanical properties of respiratory muscles.

    PubMed

    Sieck, Gary C; Ferreira, Leonardo F; Reid, Michael B; Mantilla, Carlos B

    2013-10-01

    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

  8. Occupational Respiratory Cancer in Korea

    PubMed Central

    Kim, Hyoung Ryoul

    2010-01-01

    Malignant mesothelioma and lung cancer are representative examples of occupational cancer. Lung cancer is the leading cause of cancer death, and the incidence of malignant mesothelioma is expected to increase sharply in the near future. Although information about lung carcinogen exposure is limited, it is estimated that the number of workers exposed to carcinogens has declined. The first official case of occupational cancer was malignant mesothelioma caused by asbestos exposure in the asbestos textile industry in 1992. Since then, compensation for occupational respiratory cancer has increased. The majority of compensated lung cancer was due to underlying pneumoconiosis. Other main causative agents of occupational lung cancer included asbestos, hexavalent chromium, and crystalline silica. Related jobs included welders, foundry workers, platers, plumbers, and vehicle maintenance workers. Compensated malignant mesotheliomas were associated with asbestos exposure. Epidemiologic studies conducted in Korea have indicated an elevated risk of lung cancer in pneumoconiosis patients, foundry workers, and asbestos textile workers. Occupational respiratory cancer has increased during the last 10 to 20 yr though carcinogen-exposed population has declined in the same period. More efforts to advance the systems for the investigation, prevention and management of occupational respiratory cancer are needed. PMID:21258597

  9. Respiratory consequences of preterm birth.

    PubMed

    Moss, Timothy J M

    2006-03-01

    Approximately 8% of Australia's 250,000 annual births occur preterm (before 37 weeks completed gestation). Preterm infants represent 75% of all neonatal deaths in Australia, with the vast majority of these deaths caused by pulmonary disease. 2. The respiratory consequences for survivors of preterm birth include the immediate challenges of breathing with underdeveloped lungs, usually manifest as respiratory distress syndrome (RDS), and, in the long term, with persisting pulmonary abnormalities. Therapies to prevent neonatal lung disease now permit survival of preterm infants born as early as 22 weeks gestational age, but not without consequences. 3. Preterm infants are at risk of developing chronic lung disease/bronchopulmonary dysplasia (BPD). The lungs of infants dying from BPD are inflamed and have fewer, larger alveoli than normal and exhibit abnormal pulmonary vascular development. There is now a growing appreciation of the contribution of intrauterine inflammation to the aetiology of BPD. 4. Impaired airway function is commonly reported in follow-up studies of children born preterm. Decreased expiratory flow rates have been associated with preterm birth per se, but airway function appears more affected in survivors of RDS and BPD. Observations in survivors of BPD suggest persisting abnormalities in the structure of the lung parenchyma and airways. 5. Follow-up studies of preterm infants into adulthood are lacking, as are experimental examinations of the long-term physiological and anatomical effects of preterm birth. Both are necessary to understand the causes of the long-term respiratory consequences of preterm birth. PMID:16487275

  10. 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 ...

  11. A major QTL associated with host response to Porcine Reproductive and Respiratory Syndrome virus challenge

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Porcine reproductive and respiratory syndrome (PRRS) causes severely decreased reproductive performance in breeding animals and increased respiratory problems and morbidity in growing animals, ultimately resulting in great economic losses in the swine industry. Vaccination has not generally been eff...

  12. Central respiratory and circulatory effects of Gymnodinium breve toxin in anaesthetized cats

    PubMed Central

    Borison, Herbert L.; Ellis, Sydney; McCarthy, Lawrence E.

    1980-01-01

    1 In cats anaesthetized with pentobarbitone, observations were made on respiration, spontaneous and evoked diaphragmatic electromyograms, blood pressure, heart rate, indirectly-induced contractions of the anterior tibialis muscle and nictitating membrane, and electrical excitability of the inspiratory centre in the medulla oblongata. 2 Gymnodinium breve toxin (GBTX) was administered intravenously, intra-arterially to the brain, and intracerebroventricularly. Physiological effects were recorded while alveolar PCO2 was controlled at a constant level except when changes in gas tension were made in order to measure CO2-ventilatory responsiveness. 3 Adequate doses of GBTX given intravenously by bolus injection elicited a non-tachyphylactic reflex response triad of apnoea, hypotension and bradycardia mediated by the vagus nerves independently of arterial baroreceptor and chemoreceptor innervation. 4 After vagotomy, additional amounts of GBTX (i.v.) resulted in apneustic breathing, hypertension and tachycardia. The cardiovascular effects were abolished by ganglionic blockade with hexamethonium. 5 Smaller doses of GBTX were required intra-arterially and intracerebroventricularly than by the intravenous route of injection to produce respiratory irregularity and cardiovascular hyperactivity. 6 Evoked motor responses, electrical excitability of the medulla oblongata and CO2-ventilatory responsiveness were largely spared even though GBTX caused marked disturbances in respiratory rhythmicity and cardiovascular functions. 7 It is concluded that GBTX acts reflexly on vagally innervated receptors to evoke a Bezold-Jarisch effect but that the toxin further acts centrally to cause irregular breathholding and hypertension with tachycardia, leading ultimately to respiratory and circulatory failure. PMID:7191740

  13. 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

  14. Meta-Analysis of the Associations of p-Cresyl Sulfate (PCS) and Indoxyl Sulfate (IS) with Cardiovascular Events and All-Cause Mortality in Patients with Chronic Renal Failure

    PubMed Central

    Lin, Cheng-Jui; Wu, Vincent; Wu, Pei-Chen; Wu, Chih-Jen

    2015-01-01

    Background Indoxyl sulfate (IS) and p-cresyl sulfate (PCS) are protein-bound uremic toxins that increase in the sera of patients with chronic kidney disease (CKD), and are not effectively removed by dialysis. The purpose of this meta-analysis was to investigate the relationships of PCS and IS with cardiovascular events and all-cause mortality in patients with CKD stage 3 and above. Methodology/Principle Findings Medline, Cochrane, and EMBASE databases were searched until January 1, 2014 with combinations of the following keywords: chronic renal failure, end-stage kidney disease, uremic toxin, uremic retention, indoxyl sulfate, p-cresyl sulfate. Inclusion criteria were: 1) Patients with stage 1 to 5 CKD; 2) Prospective study; 3) Randomized controlled trial; 4) English language publication. The associations between serum levels of PCS and IS and the risks of all-cause mortality and cardiovascular events were the primary outcome measures. Of 155 articles initially identified, 10 prospective and one cross-sectional study with a total 1,572 patients were included. Free PCS was significantly associated with all-cause mortality among patients with chronic renal failure (pooled OR = 1.16, 95% CI = 1.03 to 1.30, P = 0.013). An elevated free IS level was also significantly associated with increased risk of all-cause mortality (pooled OR = 1.10, 95% CI = 1.03 to 1.17, P = 0.003). An elevated free PCS level was significantly associated with an increased risk of cardiovascular events among patients with chronic renal failure (pooled OR = 1.28, 95% CI = 1.10 to 1.50, P = 0.002), while free IS was not significantly associated with risk of cardiovascular events (pooled OR = 1.05, 95% CI = 0.98 to 1.13, P = 0.196). Conclusions/Significance Elevated levels of PCS and IS are associated with increased mortality in patients with CKD, while PCS, but not IS, is associated with an increased risk of cardiovascular events. PMID:26173073

  15. Middle East respiratory syndrome: An emerging coronavirus infection tracked by the crowd.

    PubMed

    Mackay, Ian M; Arden, Katherine E

    2015-04-16

    In 2012 in Jordan, infection by a novel coronavirus (CoV) caused the first known cases of Middle East respiratory syndrome (MERS). MERS-CoV sequences have since been found in a bat and the virus appears to be enzootic among dromedary camels across the Arabian Peninsula and in parts of Africa. The majority of human cases have occurred in the Kingdom of Saudi Arabia (KSA). In humans, the etiologic agent, MERS-CoV, has been detected in severe, mild and influenza-like illness and in those without any obvious signs or symptoms of disease. MERS is often a lower respiratory tract disease associated with fever, cough, breathing difficulties, pneumonia that can progress to acute respiratory distress syndrome, multiorgan failure and death among more than a third of those infected. Severe disease is usually found in older males and comorbidities are frequently present in cases of MERS. Compared to SARS, MERS progresses more rapidly to respiratory failure and acute kidney injury, is more often observed as severe disease in patients with underlying illnesses and is more often fatal. MERS-CoV has a broader tropism than SARS-CoV, rapidly triggers cellular damage, employs a different receptor and induces a delayed proinflammatory response in cells. Most human cases have been linked to lapses in infection prevention and control in healthcare settings, with a fifth of virus detections reported among healthcare workers. This review sets out what is currently known about MERS and the MERS-CoV, summarises the new phenomenon of crowd-sourced epidemiology and lists some of the many questions that remain unanswered, nearly three years after the first reported case. PMID:25656066

  16. Left ventricular failure due to a rare variant of congenital adrenal hyperplasia.

    PubMed

    Bhatia, Sonal; Muranjan, Mamta N; Lahiri, Keya R

    2012-09-01

    "Hypertensive" variant of congenital adrenal hyperplasia is rare. The authors describe an interesting case of a 6-y-old boy who presented with an acute respiratory illness and progressive breathlessness since 1 y. Genital hyperpigmentation was noticed since 2 y of age; the onset of pubarche and increasing penile size at 4 y. He was admitted in congestive cardiac failure with a blood pressure of 150/100 mm Hg. Facial acne; slight facial, pubic hair and penile enlargement were additionally noted. Chest radiograph revealed cardiomegaly. Basal ACTH and 17-OHP levels were high. A diagnosis of congenital adrenal hyperplasia (11?-hydroxylase deficiency) was made due to hypertension with virilized genitalia. Cardiac failure was controlled with fluid restriction and diuretics; he was started on prednisolone, spironolactone and nifedipine. This case is presented for its rarity where hypertension can cause complication of cardiac failure, if diagnosis is delayed despite early features of pseudoprecocious puberty. PMID:22231770

  17. Calcium Channel Autoantibodies Predicted Sudden Cardiac Death and All-Cause Mortality in Patients with Ischemic and Nonischemic Chronic Heart Failure

    PubMed Central

    Yu, Haiyun; Pei, Juanhui; Liu, Xiaoyan; Chen, Jingzhou; Li, Xian; Zhang, Yinhui; Li, Ning; Wang, Zengwu; Zhang, Ping; Cao, Kejiang

    2014-01-01

    The purpose of this study was to evaluate whether CC-AAbs levels could predict prognosis in CHF patients. A total of 2096 patients with CHF (841 DCM patients and 1255 ICM patients) and 834 control subjects were recruited. CC-AAbs were detected and the relationship between CC-AAbs and patient prognosis was analyzed. During a median follow-up time of 52 months, there were 578 deaths. Of these, sudden cardiac death (SCD) occurred in 102 cases of DCM and 121 cases of ICM. The presence of CC-AAbs in patients was significantly higher than that of controls (both P < 0.001). Multivariate analysis revealed that positive CC-AAbs could predict SCD (HR 3.191, 95% CI 1.598–6.369 for DCM; HR 2.805, 95% CI 1.488–5.288 for ICM) and all-cause mortality (HR 1.733, 95% CI 1.042–2.883 for DCM; HR 2.219, 95% CI 1.461–3.371 for ICM) in CHF patients. A significant association between CC-AAbs and non-SCD (NSCD) was found in ICM patients (HR = 1.887, 95% CI 1.081–3.293). Our results demonstrated that the presence of CC-AAbs was higher in CHF patients versus controls and corresponds to a higher incidence of all-cause death and SCD. Positive CC-AAbs may serve as an independent predictor for SCD and all-cause death in these patients. PMID:24711674

  18. Dose-dependent Na and Ca in fluoride-rich drinking water--another major cause of chronic renal failure in tropical arid regions.

    PubMed

    Chandrajith, Rohana; Dissanayake, C B; Ariyarathna, Thivanka; Herath, H M J M K; Padmasiri, J P

    2011-01-15

    Endemic occurrence of chronic kidney disease with unknown etiology is reported in certain parts of the north central dry zone of Sri Lanka and has become a new and emerging health issue. The disease exclusively occurs in settlements where groundwater is the main source of drinking water and is more common among low socio-economic groups, particularly among the farming community. Due to its remarkable geographic distribution and histopathological evidence, the disease is believed to be an environmentally induced problem. This paper describes a detailed hydrogeochemical study that has been carried out covering endemic and non-endemic regions. Higher fluoride levels are common in drinking water from both affected and non-affected regions, whereas Ca-bicarbonate type water is more common in the affected regions. In terms of the geochemical composition of drinking water, affected households were rather similar to control regions, but there is a large variation in the Na/Ca ratio within each of the two groups. Fluoride as shown in this study causes renal tubular damage. However it does not act alone and in certain instances it is even cytoprotective. The fine dividing line between cytotoxicity and cytoprotectivity of fluoride appears to be the effect of Ca(2+) and Na(+) of the ingested water on the F(-) metabolism. This study illustrates a third major cause (the other two being hypertension and diabetes) of chronic kidney diseases notably in tropical arid regions such as the dry zone of Sri Lanka. PMID:21109289

  19. Stop sucker rod failures to save money

    SciTech Connect

    Moore, K.H.

    1981-07-01

    This study presents examples of frequent and common sucker rod failures, explains how failures occur, presents methods to recognize these failures, and discusses changes in conditions that cause failure. From early identification, corrective measures can be taken to prevent their recurrence, reducing downtime and lost production.

  20. [Examination of cause of failure to taxon-specific DNA was not detected from bifun (rice vermicelli) using processing model experiment].

    PubMed

    Takahashi, Kunihiko; Ishii, Rie; Matsumoto, Ryuji; Horie, Masakazu

    2010-01-01

    In the inspection of genetically modified rice, rice taxon-specific DNA could not be detected in processed rice food (bifun: rice vermicelli). The effects of using PCR the ratio of rice powder content and temperature of processing on the detection of taxon-specific DNA were examined by means of processing model experiments using cornstarch with 0, 2, 5, 10% rice powder by weight. Cornstarch and rice powder were blended with water and subjected to heating, steam-treatment, and autoclaving. The rice taxon-specific DNA was detectable in 2% rice powder following heat and steam treatments. After autoclaving, rice taxon-specific DNA was detected only in the 10% rice powder product. In the processing model experiment using rice powder, it was found that autoclaving caused severe DNA degradation. PMID:20208408

  1. Cardiovascular & Respiratory Modeling, Analysis & Control

    E-print Network

    Batzel, Jerry

    . . . . . . . . . . . . . . . . 36 1.7.3 Sensitivity analysis . . . . . . . . . . . . . . . . . . . 38 2 Respiratory Modeling 45 2Cardiovascular & Respiratory Systems: Modeling, Analysis & Control J. J. Batzel, F. Kappel, D.1 Respiratory Control Physiology . . . . . . . . . . . . . . . . . . 46 2.1.1 General features of respiration

  2. 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…

  3. Early Noninvasive Ventilation Averts Extubation Failure in Patients at Risk A Randomized Trial

    Microsoft Academic Search

    Miquel Ferrer; Mauricio Valencia; Josep Maria Nicolas; Oscar Bernadich; Joan Ramon Badia; Antoni Torres

    Rationale: Respiratory failure after extubation and reintubation is associated with increased morbidity and mortality. Objectives: To assess the efficacy of noninvasive ventilation in avert- ing respiratory failure after extubation in patients at increased risk. Methods: A prospective randomized controlled trial was conducted in 162 mechanically ventilated patients who tolerated a spontane- ous breathing trial after recovery from the acute episode

  4. Contact and respiratory sensitization by chemical allergens: Uneasy relationships

    Microsoft Academic Search

    Ian Kimber

    1995-01-01

    A variety of chemicals are able to cause allergic disease in susceptible individuals. Chemical-induced allergy may take several forms, chief among them being skin sensitization or allergic contact dermatitis and respiratory hypersensitivity. It has been found that contact and respiratory chemical allergens induce in mice qualitatively divergent immune responses consistent with the preferential activation of discrete Thelper (Th) cell subpopulations,

  5. Respiratory sensitization and allergy: Current research approaches and needs

    Microsoft Academic Search

    Darrell R. Boverhof; Richard Billington; B. Bhaskar Gollapudi; John A. Hotchkiss; Shannon M. Krieger; Alan Poole; Connie M. Wiescinski; Michael R. Woolhiser

    2008-01-01

    There are currently no accepted regulatory models for assessing the potential of a substance to cause respiratory sensitization and allergy. In contrast, a number of models exist for the assessment of contact sensitization and allergic contact dermatitis (ACD). Research indicates that respiratory sensitizers may be identified through contact sensitization assays such as the local lymph node assay, although only a

  6. Effects of Nasal or Pulmonary Delivered Treatments with an Adenovirus Vectored Interferon (mDEF201) on Respiratory and Systemic Infections in Mice Caused by Cowpox and Vaccinia Viruses

    PubMed Central

    Smee, Donald F.; Wong, Min-Hui; Hurst, Brett L.; Ennis, Jane; Turner, Jeffrey D.

    2013-01-01

    An adenovirus 5 vector encoding for mouse interferon alpha, subtype 5 (mDEF201) was evaluated for efficacy against lethal cowpox (Brighton strain) and vaccinia (WR strain) virus respiratory and systemic infections in mice. Two routes of mDEF201 administration were used, nasal sinus (5-µl) and pulmonary (50-µl), to compare differences in efficacy, since the preferred treatment of humans would be in a relatively small volume delivered intranasally. Lower respiratory infections (LRI), upper respiratory infections (URI), and systemic infections were induced by 50-µl intranasal, 10-µl intranasal, and 100-µl intraperitoneal virus challenges, respectively. mDEF201 treatments were given prophylactically either 24 h (short term) or 56d (long-term) prior to virus challenge. Single nasal sinus treatments of 106 and 107 PFU/mouse of mDEF201 protected all mice from vaccinia-induced LRI mortality (comparable to published studies with pulmonary delivered mDEF201). Systemic vaccinia infections responded significantly better to nasal sinus delivered mDEF201 than to pulmonary treatments. Cowpox LRI infections responded to 107 mDEF201 treatments, but a 106 dose was only weakly protective. Cowpox URI infections were equally treatable by nasal sinus and pulmonary delivered mDEF201 at 107 PFU/mouse. Dose-responsive prophylaxis with mDEF201, given one time only 56 d prior to initiating a vaccinia virus LRI infection, was 100% protective from 105 to 107 PFU/mouse. Improvements in lung hemorrhage score and lung weight were evident, as were decreases in liver, lung, and spleen virus titers. Thus, mDEF201 was able to treat different vaccinia and cowpox virus infections using both nasal sinus and pulmonary treatment regimens, supporting its development for humans. PMID:23874722

  7. 38 CFR 4.96 - Special provisions regarding evaluation of respiratory conditions.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...episodes of acute respiratory failure. (iv) When outpatient oxygen therapy is required. (2) If the DLCO (SB) (Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method) test is not of record, evaluate based on...

  8. Respiratory Physiology & Neurobiology Special Issue on Respiratory Biomechanics

    E-print Network

    Boyer, Edmond

    1 Respiratory Physiology & Neurobiology Special Issue on Respiratory Biomechanics Manuscript: Cell,version1-17Dec2008 Author manuscript, published in "Respiratory Physiology & Neurobiology / Respiratory Physiology & Neurobiology 2008;163 (1-3):3-16" DOI : 10.1016/j.resp.2008.04.018 #12;2 ABSTRACT Cell mechanics

  9. Climate change and respiratory disease: European Respiratory Society position statement

    Microsoft Academic Search

    J. G. Ayres; B. Forsberg; I. Annesi-Maesano; R. Dey; K. L. Ebi; P. J. Helms; M. Medina-Ramon; M. Windt; F. Forastiere

    2009-01-01

    Climate change will affect individuals with pre-existing respiratory disease, but the extent of the effect remains unclear. The present position statement was developed on behalf of the European Respiratory Society in order to identify areas of concern arising from climate change for individuals with respiratory disease, healthcare workers in the respiratory sector and policy makers. The statement was developed following

  10. 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

  11. Exposure to organic dust and respiratory disorders

    Microsoft Academic Search

    T. Smid

    1993-01-01

    Chapter 1 summarises the background of the study. Nonmalignant respiratory disorders account for a significant part of sick leave diagnoses (19%), disability pension (3.4%) and mortality (7%). The rate of chronic obstructive pulmonary diseases has risen substantially during the last 10 to 20 years. Allthough smoking is a major external cause for the increasing mortality and morbidity, other environmental factors

  12. Measurement of effective elastance of the total respiratory system in ventilated patients by a computed method

    Microsoft Academic Search

    C. Gillard; A. Flémale; J. P. Dierckx; G. Thémelin

    1990-01-01

    We have studied 28 patients mechanically ventilated for acute respiratory failure at different levels of externally applied positive end-expiratory pressure (PEEPe). We describe and compare a computed method of measuring “effective” elastance of the total respiratory system (Ers,eff) with the static values of elastance of the total respiratory system (Ers, st), obtained with the end-inflation occlusion technique. Ers, eff was

  13. Failure of anterior cruciate ligament reconstruction.

    PubMed

    Whitehead, Timothy S

    2013-01-01

    Failure after anterior cruciate ligament reconstruction is a potentially devastating event that affects a predominantly young and active population. This review article provides a comprehensive analysis of the potential causes of failure, including graft failure, loss of motion, extensor mechanism dysfunction, osteoarthritis, and infection. The etiology of graft failure is discussed in detail with a particular emphasis on failure after anatomic anterior cruciate ligament reconstruction. PMID:23177471

  14. Respiratory mechanics and ventilatory control in overlap syndrome and obesity hypoventilation

    PubMed Central

    2013-01-01

    The overlap syndrome of obstructive sleep apnoea (OSA) and chronic obstructive pulmonary disease (COPD), in addition to obesity hypoventilation syndrome, represents growing health concerns, owing to the worldwide COPD and obesity epidemics and related co-morbidities. These disorders constitute the end points of a spectrum with distinct yet interrelated mechanisms that lead to a considerable health burden. The coexistence OSA and COPD seems to occur by chance, but the combination can contribute to worsened symptoms and oxygen desaturation at night, leading to disrupted sleep architecture and decreased sleep quality. Alveolar hypoventilation, ventilation-perfusion mismatch and intermittent hypercapnic events resulting from apneas and hypopneas contribute to the final clinical picture, which is quite different from the “usual” COPD. Obesity hypoventilation has emerged as a relatively common cause of chronic hypercapnic respiratory failure. Its pathophysiology results from complex interactions, among which are respiratory mechanics, ventilatory control, sleep-disordered breathing and neurohormonal disturbances, such as leptin resistance, each of which contributes to varying degrees in individual patients to the development of obesity hypoventilation. This respiratory embarrassment takes place when compensatory mechanisms like increased drive cannot be maintained or become overwhelmed. Although a unifying concept for the pathogenesis of both disorders is lacking, it seems that these patients are in a vicious cycle. This review outlines the major pathophysiological mechanisms believed to contribute to the development of these specific clinical entities. Knowledge of shared mechanisms in the overlap syndrome and obesity hypoventilation may help to identify these patients and guide therapy. PMID:24256627

  15. Epidemiological and clinical evaluation of children with respiratory virus infections

    PubMed Central

    Shatizadeh, Somayeh; Yavarian, Jila; Rezaie, Farhad; Mahmoodi, Mahmood; Naseri, Maryam; Mokhtari Azad, Talat

    2014-01-01

    Background: Respiratory viruses are the leading cause of respiratory tract infections among children and are responsible for causing morbidity and mortality worldwide. This study was performed to detect viruses in children with respiratory infections and describe their epidemiology and clinical characteristics. Methods: In this descriptive cross sectional study, throat swabs and wash specimens from 202 children younger than six years of age with diagnosis of a respiratory tract infection from a total of 897 specimens were evaluated using multiplex PCR method. Results: Respiratory viruses were detected in 92 children: respiratory synsytial virus, 16.8%; influenza virus, 5.4%; parainfluenza virus, 8.4%; adenovirus, 14.4% and human metapneumo virus 0.49% with male predominance and higher distribution in children younger than 1 year of age with preference in the cold months of year. The clinical presentations of all detected viruses were almost similar. Conclusion: In the present study, nine different respiratory viruses were detected. RSV causes the great majority of respiratory virus infections in children. There was no significant difference in epidemiologic patterns of these viruses in comparison to other studies. PMID:25664303

  16. Chemical respiratory allergy: role of IgE antibody and relevance of route of exposure

    Microsoft Academic Search

    Ian Kimber; Rebecca J Dearman

    2002-01-01

    Chemicals are able to cause various forms of allergic disease in susceptible individuals. Among those of greatest importance in the context of occupational disease is chemical respiratory allergy, where allergic sensitization of the respiratory tract is associated with elicitation of rhinitis, asthma and\\/or other pulmonary symptoms following inhalation exposure to the inducing chemical allergen. Although for some chemical respiratory allergens

  17. Evidence of Recombination and Genetic Diversity in Human Rhinoviruses in Children with Acute Respiratory

    E-print Network

    Paris-Sud XI, Université de

    Background: Human rhinoviruses (HRVs) are a highly prevalent cause of acute respiratory infection in children diagnosis of HRV strains in a 2-year study of children with acute respiratory infection visiting one amongst 827 children with acute low respiratory tract infection. Two samples were co-infected with HRV

  18. The management of respiratory motion in radiation oncology report of AAPM Task Group 76

    Microsoft Academic Search

    Paul J. Keallb; Gig S. Mageras; James M. Balter; Richard S. Emery; Kenneth M. Forster; Steve B. Jiang; Jeffrey M. Kapatoes; Daniel A. Low; Martin J. Murphy; Brad R. Murray; Chester R. Ramsey; Marcel B. Van Herk; S. Sastry Vedam; John W. Wong; Ellen Yorke

    2006-01-01

    This document is the report of a task group of the AAPM and has been prepared primarily to advise medical physicists involved in the external-beam radiation therapy of patients with thoracic, abdominal, and pelvic tumors affected by respiratory motion. This report describes the magnitude of respiratory motion, discusses radiotherapy specific problems caused by respiratory motion, explains techniques that explicitly manage

  19. Preventing Early Learning Failure.

    ERIC Educational Resources Information Center

    Sornson, Bob, Ed.

    Noting that thousands of young children with the capacity to experience school success do not because they are unprepared for school learning activities, have experienced physical or emotional setbacks that cause them to be at risk for early learning failure, have never experienced limits on their behavior, or have mild sensory or motor deficits,…

  20. Acute Respiratory Infections in Children

    Microsoft Academic Search

    Eric A. F. Simoes; Thomas Cherian; Jeffrey Chow; Ramanan Laxminarayan; T. Jacob John

    Acute respiratory infections (ARIs) are classified as upper res- piratory tract infections (URIs) or lower respiratory tract infec- tions (LRIs). The upper respiratory tract consists of the airways from the nostrils to the vocal cords in the larynx, including the paranasal sinuses and the middle ear. The lower respiratory tract covers the continuation of the airways from the trachea and