Sample records for respiratory failure caused

  1. What Causes Respiratory Failure?

    MedlinePLUS

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

  2. Respiratory Failure

    MedlinePLUS

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

  3. 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

  4. An unusual cause of type 2 respiratory failure

    PubMed Central

    Rajagopala, Srinivas; Nathan, Balamurugan; Pillai, Vivekanandan

    2015-01-01

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

  5. [Acute respiratory failures caused by post-tracheotomy tracheomalacia].

    PubMed

    Igarashi, Ayuko; Sato, Masayoshi; Seino, Keiko

    2014-02-01

    A 77-year-old man underwent thoracic surgery. He had a history of two previous operations: parapharyngeal tumor removal with temporal tracheotomy 14 years ago and, two years later, a sinus surgery when, according to our anesthesia registry, intubation was extremely difficult due to stricture of the trachea underneath the tracheotomy scar. Pathology was not fully elucidated. Preoperative examinations including chest x-ray, spirogram and CT were not remarkable. The scar above the suprasternal notch was visibly sunken and retracted with respiration. Stridor was auscultated but breathing was not labored. The patient was anesthetized with propofol and intubation was smooth. During surgery anesthesia was maintained with sevoflurane, remifentanil and rocuronium. However, extubation was followed by desperate gasping and severe respiratory distress. The tracheotomy scar caved in and the airway collapsed. Continuous airway pressure via a facemask restored airway patency and improved breathing. After overnight respiratory support with non-invasive positive pressure ventilation (NPPV), patient was weaned from ventilator. Airway collapse and the two episodes of respiratory failures while under general anesthesia were attributed to post-tracheotomy tracheomalacia. PMID:24601110

  6. Successful Use of Extracorporeal Membrane Oxygenation for Respiratory Failure Caused by Mediastinal Precursor T Lymphoblastic Lymphoma

    PubMed Central

    Oto, Masafumi; Inadomi, Kyoko; Chosa, Toshiyuki; Uneda, Shima; Uekihara, Soichi; Yoshida, Minoru

    2014-01-01

    Precursor T lymphoblastic lymphoma (T-LBL) often manifests as a mediastinal mass sometimes compressing vital structures like vessels or large airways. This case was a 40-year-old male who developed T-LBL presenting as respiratory failure caused by mediastinal T-LBL. He presented with persistent life threatening hypoxia despite tracheal intubation. We successfully managed this respiratory failure using venovenous (VV) ECMO. Induction chemotherapy was started after stabilizing oxygenation and the mediastinal lesion shrank rapidly. Respiratory failure caused by compression of the central airway by tumor is an oncologic emergency. VV ECMO may be an effective way to manage this type of respiratory failure as a bridge to chemotherapy. PMID:25580133

  7. 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

  8. Empyema and Respiratory Failure Secondary to Nephropleural Fistula Caused by Chronic Urinary Tract Infection: A Case Report

    PubMed Central

    Jones, G. H.; Kalaher, H. R.; Misra, N.; Curtis, J.; Parker, R. J.

    2012-01-01

    We report a case of nephropleural fistula causing empyema and respiratory failure in a 68-year-old gentleman with a long history of urological problems including recurrent nephrolithiasis and urinary tract infections. He was admitted with sepsis, a productive cough, pyuria, and reduced breath sounds over the left hemithorax. Radiological imaging revealed a fistulous connection between a left-sided perinephric abscess and the pleural space. He was commenced on broad spectrum intravenous antibiotics but developed progressive respiratory failure requiring intensive care admission. Urinary and pleural aspirates cultured facultative anaerobic pathogens with identical resistance patterns. Drainage of thoracic and perinephric collections was carried out, allowing him to be extubated after 24 hours and discharged home after 18 days on an extended course of oral antibiotics. Left nephrectomy is now planned after a period of convalescence. Empyema developing in patients with known urolithiasis should alert the treating physician to the possibility that a pathological communication has formed especially if typical urinary tract pathogens are cultured from respiratory sampling. PMID:23198240

  9. 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

  10. Etiologies, diagnostic strategies, and outcomes of diffuse pulmonary infiltrates causing acute respiratory failure in cancer patients: a retrospective observational study

    PubMed Central

    2013-01-01

    Introduction Although previous studies have reported etiologies, diagnostic strategies, and outcomes of acute respiratory failure (ARF) in cancer patients, few studies investigated ARF in cancer patients presenting with diffuse pulmonary infiltrates. Methods This was a retrospective observational study of 214 consecutive cancer patients with diffuse pulmonary infiltrates on chest radiography admitted to the oncology medical intensive care unit for acute respiratory failure between July 2009 and June 2011. Results After diagnostic investigations including bronchoalveolar lavage in 160 (75%) patients, transbronchial lung biopsy in 75 (35%), and surgical lung biopsy in 6 (3%), the etiologies of diffuse pulmonary infiltrates causing ARF were identified in 187 (87%) patients. The most common etiology was infection (138, 64%), followed by drug-induced pneumonitis (13, 6%) and metastasis (12, 6%). Based on the etiologic diagnoses, therapies for diffuse pulmonary infiltrates were subsequently modified in 99 (46%) patients. Diagnostic yield (46%, 62%, 85%, and 100%; P for trend < 0.001) and frequency of therapeutic modifications (14%, 37%, 52%, and 100%; P for trend < 0.001) were significantly increased with additional invasive tests. Patients with therapeutic modification had a 34% lower in-hospital mortality rate than patients without therapeutic modification (38% versus 58%, P = 0.004) and a similar difference in mortality rate was observed up to 90 days (55% versus 73%, Log-rank P = 0.004). After adjusting for potential confounding factors, therapeutic modification was still significantly associated with reduced in-hospital mortality (adjusted OR 0.509, 95% CI 0.281-0.920). Conclusions Invasive diagnostic tests, including lung biopsy, increased diagnostic yield and caused therapeutic modification that was significantly associated with better outcomes for diffuse pulmonary infiltrates causing ARF in cancer patients. PMID:23880212

  11. What Causes Heart Failure?

    MedlinePLUS

    ... page from the NHLBI on Twitter. What Causes Heart Failure? Conditions that damage or overwork the heart muscle ... and they worsen heart failure. Common Causes of Heart Failure The most common causes of heart failure are ...

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

    Microsoft Academic Search

    Jordi Rello; Alejandro Rodríguez; Pedro Ibańez; Lorenzo Socias; Javier Cebrian; Asunción Marques; José Guerrero; Sergio Ruiz-Santana; Enrique Marquez; Frutos Del Nogal-Saez; Francisco Alvarez-Lerma; Sergio Martínez; Miquel Ferrer; Manuel Avellanas; Rosa Granada; Enrique Maraví-Poma; Patricia Albert; Rafael Sierra; Loreto Vidaur; Patricia Ortiz; Isidro Prieto del Portillo; Beatriz Galván; Cristóbal León-Gil

    2009-01-01

    INTRODUCTION: Patients with influenza A (H1N1)v infection have developed rapidly progressive lower respiratory tract disease resulting in respiratory failure. We describe the clinical and epidemiologic characteristics of the first 32 persons reported to be admitted to the intensive care unit (ICU) due to influenza A (H1N1)v infection in Spain. METHODS: We used medical chart reviews to collect data on ICU

  13. Respiratory failure due to tracheobronchomalacia

    Microsoft Academic Search

    P. Collard; L. Freitag; M. S. Reynaert; D. O. Rodenstein; C. Francis

    1996-01-01

    A case is described of tracheobronchomegaly progressing to extensive tracheomalacia, complicated by episodic choking, recurrent pulmonary infections, and irreversible hypercapnic respiratory failure. A Y-shaped tracheobronchial stent was placed endoscopically to splint the trachea open, with excellent clinical and physiological improvement. New stent designs may provide long term palliation in selected cases of diffuse tracheal collapse or stenosis, and offer an

  14. Disruption of Sorting Nexin 5 Causes Respiratory Failure Associated with Undifferentiated Alveolar Epithelial Type I Cells in Mice

    PubMed Central

    Im, Sun-Kyoung; Jeong, HyoBin; Jeong, Hyun-Woo; Kim, Kyong-Tai; Hwang, Daehee; Ikegami, Machiko; Kong, Young-Yun

    2013-01-01

    Sorting nexin 5 (Snx5) has been posited to regulate the degradation of epidermal growth factor receptor and the retrograde trafficking of cation-independent mannose 6-phosphate receptor/insulin-like growth factor II receptor. Snx5 has also been suggested to interact with Mind bomb-1, an E3 ubiquitin ligase that regulates the activation of Notch signaling. However, the in vivo functions of Snx5 are largely unknown. Here, we report that disruption of the Snx5 gene in mice (Snx5-/- mice) resulted in partial perinatal lethality; 40% of Snx5-/- mice died shortly after birth due to cyanosis, reduced air space in the lungs, and respiratory failure. Histological analysis revealed that Snx5-/- mice exhibited thickened alveolar walls associated with undifferentiated alveolar epithelial type I cells. In contrast, alveolar epithelial type II cells were intact, exhibiting normal surfactant synthesis and secretion. Although the expression levels of surfactant proteins and saturated phosphatidylcholine in the lungs of Snx5-/- mice were comparable to those of Snx5+/+ mice, the expression levels of T1?, Aqp5, and Rage, markers for distal alveolar epithelial type I cells, were significantly decreased in Snx5-/- mice. These results demonstrate that Snx5 is necessary for the differentiation of alveolar epithelial type I cells, which may underlie the adaptation to air breathing at birth. PMID:23526992

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

    PubMed

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

    2014-09-01

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

  16. 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.

  17. 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

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

    MedlinePLUS

    ... Genetic disorder catalog Conditions > Hereditary myopathy with early respiratory failure (often shortened to HMERF ) On this page: ... 2012 What is HMERF? Hereditary myopathy with early respiratory failure (HMERF) is an inherited muscle disease that ...

  19. 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

  20. Acute respiratory failure due to Nicotiana glauca ingestion

    PubMed Central

    Ntelios, D; Kargakis, M; Topalis, T; Drouzas, A; Potolidis, E

    2013-01-01

    Background: A variety of organisms produce potent toxins that impact human health through compromising respiratory function. Case report: We describe a rare case of abrupt respiratory failure afterNicotiana glaucaingestion in a previously healthy sixty years old female patient. She presented complaining for gait instability and malaise after ingestion of cooked leaves of the wild plant and two hours after the onset she developed respiratory failurefor which she was intubated and mechanically ventilated for two days. The patient fully recovered and was discharged from the hospital. Conclusion: Anabasine, the plant’s main active ingredient, can cause severe systemic intoxication due to its nicotinic receptor agonist action with respiratory muscle paralysis being the main effect. PMID:24376330

  1. Rhinovirus Associated Severe Respiratory Failure in Immunocompetent Adult Patient

    PubMed Central

    Kim, Kiwook; Song, Yeon Han; Park, Joo-Hyun; Park, Hye Kyeong; Kim, Su Young; Jung, Hun; Lee, Sung-Soon

    2014-01-01

    Rhinovirus infection is typically associated with the common cold and has rarely been reported as a cause of severe pneumonia in immunocompetent adults. A 55-year-old previous healthy woman, who consumed half a bottle of alcohol daily, presented with respiratory failure after one week of upper respiratory infection symptoms. Radiography revealed bilateral, diffuse ground glass opacity with patchy consolidation in the whole lung field; bronchoalveolar lavage fluid analysis indicated that rhinovirus was the causative organism. After five days of conservative support, the symptoms and radiographic findings began to improve. We report this rare case of rhinovirus pneumonia in an otherwise healthy host along with a review of references. PMID:25309608

  2. Diagnosis of muscle diseases presenting with early respiratory failure.

    PubMed

    Pfeffer, Gerald; Povitz, Marcus; Gibson, G John; Chinnery, Patrick F

    2014-11-01

    Here we describe a clinical approach and differential diagnosis for chronic muscle diseases which include early respiratory failure as a prominent feature in their presentation (i.e. respiratory failure whilst still ambulant). These patients typically present to neurology or respiratory medicine out-patient clinics and a distinct differential diagnosis of neuromuscular aetiologies should be considered. Amyotrophic lateral sclerosis and myasthenia gravis are the important non-muscle diseases to consider, but once these have been excluded there remains a challenging differential diagnosis of muscle conditions, which will be the focus of this review. The key points in the diagnosis of these disorders are being aware of relevant symptoms, which are initially caused by nocturnal hypoventilation or diaphragmatic weakness; and identifying other features which direct further investigation. Important muscle diseases to identify, because their diagnosis has disease-specific management implications, include adult-onset Pompe disease, inflammatory myopathy, and sporadic adult-onset nemaline myopathy. Cases which are due to metabolic myopathy or muscular dystrophy are important to diagnose because of their implications for genetic counselling. Myopathy from sarcoidosis and colchicine each has a single reported case with this presentation, but should be considered because they are treatable. Disorders which have recently had their genetic aetiologies identified include hereditary myopathy with early respiratory failure (due to TTN mutations), the FHL1-related syndromes, and myofibrillar myopathy due to BAG3 mutation. Recently described syndromes include oculopharyngodistal muscular dystrophy that awaits genetic characterisation. PMID:25377282

  3. 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

  4. Occupational respiratory disease caused by acrylates.

    PubMed

    Savonius, B; Keskinen, H; Tuppurainen, M; Kanerva, L

    1993-05-01

    Acrylates are compounds used in a variety of industrial fields and their use is increasing. They have many features which make them superior to formerly used chemicals, regarding both their industrial use and their possible health effects. Contact sensitization is, however, one of their well known adverse health effects but they may also cause respiratory symptoms. We report on 18 cases of respiratory disease, mainly asthma, caused by different acrylates, 10 cases caused by cyanoacrylates, four by methacrylates and two cases by other acrylates. PMID:8334539

  5. Urinothorax: A rare cause of severe respiratory distress

    PubMed Central

    Chandra, Alka; Pathak, Amrendra; Kapur, Anu; Russia, Neha; Bhasin, Nikhil

    2014-01-01

    A case of massive right pleural effusion in a postoperative patient of percutaneous nephrolithotomy leading to severe respiratory distress is reported. A high degree of clinical suspicion and prompt intervention by insertion of an intercostal drainage tube prevented the patient from going in to respiratory failure. The development of arrhythmias confused the picture increasing the morbidity of the patient. However, the patient was managed in an intensive care unit with intercostal chest tube insertion and antiarrhythmic agents. After correction of the specific cause of the effusion the intercostal tube was removed on the 4th day without further recurrence of the effusion. PMID:24914262

  6. [Update on current care guidelines: acute respiratory failure].

    PubMed

    2014-01-01

    Acute respiratory failure is the most common organ failure leading to need of intensive care. The incidence of acute respiratory failure in adult population is 78-89/100000/year and mortality is 35-40 %. The preferred treatment modality in acute respiratory failure related to exacerbation of COPD is noninvasive ventilation. NIV reduces mortality of COPD and pulmonary oedema patients compared to plain oxygen therapy. However, the evidence of NIV's effect on mortality in more heterogenous group of hypoxemic patients is scarce. Key recommendations conserning invasive ventilation is to avoid tidal volumes over 7 ml/bodyweight and to use at least 5 cm H2O of PEEP. PMID:25158586

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

    PubMed Central

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

    2014-01-01

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

  8. Acute respiratory distress caused by Neosartorya udagawae

    PubMed Central

    Farrell, John J.; Kasper, Douglas J.; Taneja, Deepak; Baman, Sudhakar; O?Rourke, Lindsay M.; Lowery, Kristin S.; Sampath, Rangarajan; Bonomo, Robert A.; Peterson, Stephen W.

    2014-01-01

    We describe the first reported case of acute respiratory distress syndrome (ARDS) attributed to Neosartorya udagawae infection. This mold grew rapidly in cultures of multiple respiratory specimens from a previously healthy 43-year-old woman. Neosartorya spp. are a recently recognized cause of invasive disease in immunocompromised patients that can be mistaken for their sexual teleomorph, Aspergillus fumigatus. Because the cultures were sterile, phenotypic identification was not possible. DNA sequencing of ITS, calmodulin and ?-tubulin genes supported identification of Neosartorya udagawae. Our case is the first report of ARDS associated with Neosartorya sp. infection and defines a new clinical entity. PMID:25379388

  9. MODELING CARDIOVASCULAR AND RESPIRATORY DYNAMICS IN CONGESTIVE HEART FAILURE

    E-print Network

    Olufsen, Mette Sofie

    MODELING CARDIOVASCULAR AND RESPIRATORY DYNAMICS IN CONGESTIVE HEART FAILURE LAURA M. ELLWEIN1 heart failure. The model is a lumped parameter model giving rise to a system of ordinary differential physiologically reasonable for a patient with congestive heart failure. 1. Introduction. The strong

  10. 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,

  11. The causes of project failure

    Microsoft Academic Search

    JEFFREY K. PINTO

    1990-01-01

    A study was conducted of 97 projects identified as failures by the projects' managers or parent organizations. Using the project implementation profile, a set of managerially controllable factors is identified as associated with project failure. The factors differed according to three contingency variables: the precise way in which failure was defined; the type of project, and the stage of the

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

    PubMed Central

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

    2014-01-01

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

  13. Care For Patients With Severe Chronic Airflow Obstruction And Respiratory Failure

    PubMed Central

    Pugsley, S. O.; Robinson, L. A.

    1979-01-01

    The successful care of patients with disorders causing chronic airflow obstruction (CAO) and potential chronic respiratory failure and pulmonary heart disease (cor pulmonale) requires the following: 1. Recognize CAO as the cause of a patient's problem. 2. Describe and measure airflow obstruction and the individual's response to it. 3. Undertake therapeutic trials to maximize airflow. 4. Teach patients monitoring skills and interventions in order to prevent acute respiratory failure and hospital admission. 5. Maintain optimism and interest in the patient's chronic illness, appreciating its impact on the total person and his daily life. PMID:21297794

  14. Large thymolipoma causing primarily respiratory distress.

    PubMed

    Abi Ghanem, Moussa; Habambo, Georges; Bahous, Joudy; Chouairy, Camil; Abu Khalil, Bassam

    2012-01-01

    Thymolipoma, is an anterior mediastinal tumor that is benign in origin. It is often asymptomatic, but can enlarge significantly prior to diagnosis. It consists of thymic and fatty tissue and is surrounded by a capsule. Less than a hundred cases have been reported worldwide. Although rare, it should be considered in the differential diagnosis of mediastinal tumors. In this paper, we report the case of a 44-year-old woman presenting with a giant thymolipoma causing symptoms of severe respiratory distress. The patient underwent surgical resection, which is the main treatment, and remains free of disease. PMID:22919867

  15. 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

  16. 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.

  17. Genetic causes of human heart failure

    PubMed Central

    Morita, Hiroyuki; Seidman, Jonathan; Seidman, Christine E.

    2005-01-01

    Factors that render patients with cardiovascular disease at high risk for heart failure remain incompletely defined. Recent insights into molecular genetic causes of myocardial diseases have highlighted the importance of single-gene defects in the pathogenesis of heart failure. Through analyses of the mechanisms by which a mutation selectively perturbs one component of cardiac physiology and triggers cell and molecular responses, studies of human gene mutations provide a window into the complex processes of cardiac remodeling and heart failure. Knowledge gleaned from these studies shows promise for defining novel therapeutic targets for genetic and acquired causes of heart failure. PMID:15765133

  18. Risk factors for respiratory failure in pneumococcal pneumonia: the importance of pneumococcal serotypes.

    PubMed

    Burgos, Joaquín; Luján, Manel; Larrosa, Maria Nieves; Fontanals, Dionísia; Bermudo, Guadalupe; Planes, Ana Maria; Puig, Mireia; Rello, Jordi; Falcó, Vicenç; Pahissa, Albert

    2014-02-01

    Pneumococcal serotypes are one of the main determinants of pneumococcal disease severity; however, data about their implication in respiratory failure are scarce. We conducted an observational study of adults hospitalised with invasive pneumococcal pneumonia to describe the host- and pathogen-related factors associated with respiratory failure. Of 1258 adults with invasive pneumococcal disease, 615 (48.9%) had respiratory failure at presentation. Patients with respiratory failure were older (62.1 years versus 55.4 years, p<0.001) and had a greater proportion of comorbid conditions. They also had a greater proportion of septic shock (41.7% versus 6.1%, p<0.001), required admission to the intensive care unit more often (38.4% versus 4.2%, p<0.001) and had a higher mortality (25.5% versus 3.5%, p<0.001). After adjustment, independent risk factors for respiratory failure were: age >50 years (OR 1.63, 95% CI 1.15-2.3), chronic lung disease (OR 1.54, 95% CI 1.1-2.15), chronic heart disease (OR 1.49, 95% CI 1.01-2.22) and infection caused by serotypes 3 (OR 1.97, 95% CI 1.23-3.16), 19A (OR 2.34, 95% CI 1.14-4.42) and 19F (OR 3.55, 95% CI 1.22-10.28). In conclusion, respiratory failure is a frequent complication of pneumococcal pneumonia and causes high morbidity and mortality. Pneumococcal serotypes 3, 19A and 19F are the main risk factors for this complication. PMID:23845720

  19. Causes of respiratory ailments in pregnancy

    PubMed Central

    2010-01-01

    Objective During pregnancy, especially during its third trimester, most pregnant women reported respiratory discomfort (dyspnea), despite the absence of previously coexisting respiratory illnesses. The aim of this study was to determine the reason for this discomfort. Materials and methods The study included 24 women examined before and after childbirth. Evaluation of respiratory complains was made on the basis of the respiratory questionnaire of St. George's Hospital. The data were correlated with the results of static and dynamic spirometric tests performed before and after childbirth. Results Pregnancy did not affect vital capacity (VC). Frequency of perceived symptoms correlated positively with IRV and the ratio IC/VC. A negative correlation was found between ERV and its derivative ERV/VC. There was no relationship between perceived discomfort and parameters of the flow-volume loop. Conclusions The extent of perceived respiratory discomfort (dyspnea) during pregnancy was primarily associated with a reduction in expiratory reserve (ERV). PMID:21147649

  20. Genetic causes of spermatogenic failure

    PubMed Central

    Massart, Annelien; Lissens, Willy; Tournaye, Herman; Stouffs, Katrien

    2012-01-01

    Approximately 10%–15% of couples are infertile, and a male factor is involved in almost half of these cases. This observation is due in part to defects in spermatogenesis, and the underlying causes, including genetic abnormalities, remain largely unknown. Until recently, the only genetic tests used in the diagnosis of male infertility were aimed at detecting the presence of microdeletions of the long arm of the Y chromosome and/or chromosomal abnormalities. Various other single-gene or polygenic defects have been proposed to be involved in male fertility. However, their causative effects often remain unproven. The recent evolution in the development of whole-genome-based techniques and the large-scale analysis of mouse models might help in this process. Through knockout mouse models, at least 388 genes have been shown to be associated with spermatogenesis in mice. However, problems often arise when translating this information from mice to humans. PMID:22138898

  1. 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

  2. Non-invasive ventilation in acute respiratory failure in children

    PubMed Central

    Abadesso, Clara; Nunes, Pedro; Silvestre, Catarina; Matias, Ester; Loureiro, Helena; Almeida, Helena

    2012-01-01

    The aim of this paper is to assess the clinical efficacy of non-invasive ventilation (NIV) in avoiding endotracheal intubation (ETI), to demonstrate clinical and gasometric improvement and to identify predictive risk factors associated with NIV failure. An observational prospective clinical study was carried out. Included Patients with acute respiratory disease (ARD) treated with NIV, from November 2006 to January 2010 in a Pediatric Intensive Care Unit (PICU). NIV was used in 151 patients with acute respiratory failure (ARF). Patients were divided in two groups: NIV success and NIV failure, if ETI was required. Mean age was 7.2±20.3 months (median: 1 min: 0,3 max.: 156). Main diagnoses were bronchiolitis in 102 (67.5%), and pneumonia in 44 (29%) patients. There was a significant improvement in respiratory rate (RR), heart rate (HR), pH, and pCO2 at 2, 6, 12 and 24 hours after NIV onset (P<0.05) in both groups. Improvement in pulse oximetric saturation/fraction of inspired oxygen (SpO2/FiO2) was verified at 2, 4, 6, 12 and 24 hours after NIV onset in the success group (P<0.001). In the failure group, significant SpO2/FiO2 improvement was only observed in the first 4 hours. NIV failure occurred in 34 patients (22.5%). Risk factors for NIV failure were apnea, prematurity, pneumonia, and bacterial co-infection (P<0.05). Independent risk factors for NIV failure were apneia (P<0.001; odds ratio 15.8; 95% confidence interval: 3.42–71.4) and pneumonia (P<0.001, odds ratio 31.25; 95% confidence interval: 8.33–111.11). There were no major complications related with NIV. In conclusion this study demonstrates the efficacy of NIV as a form of respiratory support for children and infants with ARF, preventing clinical deterioration and avoiding ETI in most of the patients. Risk factors for failure were related with immaturity and severe infection. PMID:22802994

  3. 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.

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

    PubMed Central

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

    2009-01-01

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

  5. Acute respiratory distress caused by Neosartorya udagawae

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  6. 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

  7. Brainstem respiratory control: substrates of respiratory failure of multiple system atrophy.

    PubMed

    Benarroch, Eduardo E

    2007-01-15

    Multiple system atrophy may manifest with severe respiratory disorders, including sleep apnea and laryngeal stridor, which reflect a failure of automatic control of respiration. This function depends on a pontomedullary network of interconnected neurons located in the parabrachial/Kölliker Fuse nucleus in the pons, nucleus of the solitary tract, and ventrolateral medulla. Neurons in the preBötzinger complex expressing neurokinin-1 receptors are critically involved in respiratory rhythmogenesis, whereas serotonergic neurons in the medullary raphe and glutamatergic neurons located close to the ventral medullary surface are involved in central chemosensitivity to hypercapnia, hypoxia, or both. Pathological studies using selective neurochemical markers indicate that these neuronal groups are affected in multiple system atrophy. This finding may provide potential anatomical substrates for the respiratory manifestations of the disease. PMID:17133520

  8. Acute renal failure caused by nephrotoxins.

    PubMed

    Oken, D E

    1976-06-01

    Renal micropuncture studies have greatly changed our views on the pathophysiology of acute renal failure caused by nephrotoxins. Formerly, this type of renal insufficiency was attributed to a direct effect of the nephrotoxins on tubule epithelial permeability. According to that theory, glomerular filtration was not greatly diminished, the filtrate formed being absorbed almost quantitatively and nonselectively across damaged tubule epithelium. Studies in a wide variety of rat models have now shown glomerular filtration to be reduced to a level which will inevitably cause renal failure in and of itself. Passive backflow of filtrate across tubular epithelium is either of minor degree or nonexistent even in models where frank tubular necrosis has occurred. This failure of filtration cannot be attributed to tubular obstruction since proximal tubule pressure is distinctly subnormal in most models studied. Instead, filtration failure appears best attributed to intrarenal hemodynamic alterations. While certain facts tend to incriminate the renin-angiotensin system as the cause of the hemodynamic aberrations, others argue to the contrary. The issue is underactive investigation. PMID:1001287

  9. 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.

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

    PubMed

    Pickles, Raymond J; DeVincenzo, John P

    2015-01-01

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

  11. Hereditary myopathy with early respiratory failure associated with a mutation in A-band titin.

    PubMed

    Ohlsson, Monica; Hedberg, Carola; Brĺdvik, Björn; Lindberg, Christopher; Tajsharghi, Homa; Danielsson, Olof; Melberg, Atle; Udd, Bjarne; Martinsson, Tommy; Oldfors, Anders

    2012-06-01

    Hereditary myopathy with early respiratory failure and extensive myofibrillar lesions has been described in sporadic and familial cases and linked to various chromosomal regions. The mutated gene is unknown in most cases. We studied eight individuals, from three apparently unrelated families, with clinical and pathological features of hereditary myopathy with early respiratory failure. The investigations included clinical examination, muscle histopathology and genetic analysis by whole exome sequencing and single nucleotide polymorphism arrays. All patients had adult onset muscle weakness in the pelvic girdle, neck flexors, respiratory and trunk muscles, and the majority had prominent calf hypertrophy. Examination of pulmonary function showed decreased vital capacity. No signs of cardiac muscle involvement were found. Muscle histopathological features included marked muscle fibre size variation, fibre splitting, numerous internal nuclei and fatty infiltration. Frequent groups of fibres showed eosinophilic inclusions and deposits. At the ultrastructural level, there were extensive myofibrillar lesions with marked Z-disc alterations. Whole exome sequencing in four individuals from one family revealed a missense mutation, g.274375T>C; p.Cys30071Arg, in the titin gene (TTN). The mutation, which changes a highly conserved residue in the myosin binding A-band titin, was demonstrated to segregate with the disease in all three families. High density single nucleotide polymorphism arrays covering the entire genome demonstrated sharing of a 6.99?Mb haplotype, located in chromosome region 2q31 including TTN, indicating common ancestry. Our results demonstrate a novel and the first disease-causing mutation in A-band titin associated with hereditary myopathy with early respiratory failure. The typical histopathological features with prominent myofibrillar lesions and inclusions in muscle and respiratory failure early in the clinical course should be incentives for analysis of TTN mutations. PMID:22577218

  12. Pyrotechnic system failures: Causes and prevention

    NASA Technical Reports Server (NTRS)

    Bement, Laurence J.

    1988-01-01

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

  13. 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

  14. An unusual cause of respiratory distress in an infant.

    PubMed

    Rusciolelli, Colleen H; Hageman, Joseph R; Groner, Abraham

    2014-05-01

    Partial anomalous venous connection (PAPVC) is a congenital cardiovascular defect where one or more (but not all) of the pulmonary veins return anomalously back to the right atrium, either via a direct or indirect connection. It often occurs with other cardiac defects, most commonly a secundum atrial septal defect. Individuals with a large degree of shunting will present with dyspnea, fatigue, and, in some cases, heart failure. Clinical associations and variants of PAPVC include scimitar syndrome, pseudo-scimitar or meandering right pulmonary vein, sinous venosus defects, malposition of the septum primum, and Turner syndrome. The patient in this case, a previously healthy, 6-month-old, full-term male, presented to the emergency department for evaluation of respiratory distress and wheezing. The infant was first seen in his pediatrician's office, where he was noted to be tachypneic and wheezing. He was feeding without difficulty, voiding well, and was active and playful. The patient had passed critical congenital heart disease screening after his birth and prior to discharge, and the family history was negative for any respiratory or cardiac conditions. Cardiac magnetic resonance imaging is becoming the mode of choice for diagnosis of PAPVC. The definitive treatment is surgical correction, but surgery is not indicated in all cases, especially if the patient is asymptomatic and the degree of shunting is small. Patients with isolated PAPVC who undergo surgical correction have good long-term outcomes. In this case, the patient underwent the Warden procedure, which causes an increased risk of superior vena cava stenosis or obstruction to the right atrium. This patient will require lifelong follow-up to assess for new onset pulmonary venous obstruction. PMID:24877494

  15. Predictors of Non-Invasive Ventilation Failure in Severe Respiratory Failure Due to Community Acquired Pneumonia

    PubMed Central

    Piroddi, Ines Maria Grazia; Barlascini, Cornelius; Senarega, Renata

    2014-01-01

    Background Non-invasive ventilation (NIV) has been used for acute respiratory failure to avoid endotracheal intubation and intensive care admission. Few studies have assessed the usefulness of NIV in patients with severe community acquired pneumonia (CAP). The use of NIV in severe CAP is controversial because there is a greater variability in success compared to other pulmonary conditions. Materials and Methods We retrospectively followed 130 patients with CAP and severe acute respiratory failure (PaO2/FiO2 < 250) admitted to a Respiratory Monitoring Unit (RMU) and underwent NIV. We assessed predictors of NIV failure and hospital mortality using univariate and multivariate analyses. Results NIV failed in 26 patients (20.0%). Higher chest X-ray score at admission, higher heart rate after 1 hour of NIV, and a higher alveolar-arteriolar gradient (A-aDO2) after 24 hours of NIV each independently predicted NIV failure. Higher chest X ray score, higher LDH at admission, higher heart rate after 24 hours of NIV and higher A-aDO2 after 24 hours of NIV were directly related to hospital mortality. Conclusion NIV treatment had high rate of success. Successful treatment is related to less lung involvement and to early good response to NIV and continuous improvement in clinical response.

  16. Respiratory failure and mechanical ventilation: Pathophysiology and methods of promoting weaning

    Microsoft Academic Search

    Jill P. Karpel; Thomas K. Aldrich

    1986-01-01

    Respiratory failure may be manifested either by impaired gas exchange or by impaired ventilatory function. The latter results\\u000a in more severe problems in weaning patients from mechanical ventilation. Ventilatory failure may result from inadequate respiratory\\u000a drive, excessive respiratory workload, inadequate respiratory muscle endurance, or a combination of these factors.\\u000a \\u000a Simple bedside tests of ventilatory function are useful for evaluating the

  17. An undiagnosed myasthenia gravis presenting as isolated recurrent acute respiratory failure

    PubMed Central

    Sharma, Shri Ram; Sharma, Nalini; Yeolekar, ME

    2012-01-01

    Acute respiratory failure is an uncommon initial presentation of myasthenia gravis (MG). In our case a 22-year-old woman of unrecognized MG presented to the emergency department with isolated respiratory failure as the first presenting symptom. Initially she presented with dysphonia and was managed by speech therapist and ENT surgeons for 3 months. Subsequently, she presented with signs and symptoms of sepsis and went into acute respiratory failure. This case highlights the need to consider MG in the differential diagnosis of an otherwise unexplained respiratory failure in the critical care setting. PMID:22346203

  18. 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

  19. 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

  20. 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

  1. Respiratory failure due to a displaced fracture of the odontoid.

    PubMed

    Clarke, A; Hutton, M J; Chan, D

    2010-07-01

    Fractures of the odontoid peg are relatively common in elderly people. Often they are minimally displaced and can be treated with a collar. However, a fracture which is displaced significantly may be difficult to manage. We describe the case of an 80-year-old man with a fracture of the odontoid peg which was completely displaced and caused respiratory distress. After initial closed reduction and application of a halo jacket, open and internal fixation was undertaken and relieved his symptoms. It is a safe and effective way to manage this injury. PMID:20595126

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

    SciTech Connect

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

    1987-09-01

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

  3. Causes of death in asthma, COPD and non-respiratory hospitalized patients: a multicentric study”

    PubMed Central

    2013-01-01

    Background There is limited information on the causes of death in asthma patients. To determine the causes of death in hospitalized asthmatic patients and to compare with those observed in COPD patients and non-respiratory individuals, with a particular interest in associations with previous cardiovascular disease. Methods Retrospective case–control study which analyzed the deaths of all hospitalized patients admitted for any reason during January, April, July and October of 2008 in 13 Spanish centers. Medical records of deceased patients were reviewed, and demographic and clinical data were collected. Results A total of 2,826 deaths (mean age 75 years, 56% men) were included in the analysis, of which 82 (2.9%) were of patients with asthma and 283 (10%) with COPD. The most common causes of death in asthma patients were cardiovascular diseases (29.3%), malignancies (20.7%) and infections (14.6%); in COPD patients they were malignancies (26.5%), acute respiratory failure (25.8%) and cardiovascular diseases (21.6%). Asthma, compared to COPD patients, died significantly less frequently from acute respiratory failure and lung cancer. A multivariate logistic regression analysis failed to associate asthma with cardiovascular deaths. Conclusions Cardiovascular disease is the most frequent cause of death among hospitalized asthma patients. The specific causes of death differ between asthma and COPD patients. PMID:24321217

  4. Symptomatic palatal myoclonus: an unusual cause of respiratory difficulty.

    PubMed

    Sumer, M

    2001-06-01

    A 67-year-old man presented with dysphagia and difficulty breathing. Physical examination revealed palatal myoclonus. In this patient, the respiratory difficulty was caused by the fragmentation of breathing. Electromyographic examination of the cricothyroid muscle demonstrated rhythmic myoclonic jerks. Magnetic Resonance Imaging (MRI) yielded a pontine midline and right sided tegmental infarct. The patient responded to sodium valproate. PMID:11486557

  5. Non-invasive positive pressure ventilation for acute respiratory failure: justified or just hot air?

    PubMed

    Crummy, F; Naughton, M T

    2007-02-01

    Non-invasive positive pressure ventilation (NIV) is the provision of mechanical positive airway pressure ventilatory support through the patient's upper airway through mask interface. Conditions in which it has been shown to be effective are acute cardiogenic pulmonary oedema and acute hypercapnic exacerbations of chronic obstructive pulmonary disease. In such conditions, NIV is associated with reduced intensive care unit demands, a reduction in intubation rates, reduced health-care expenditure and improved survival. Other conditions, such as hypercapnia of other cause, hypoxaemic respiratory failure and acute asthma, have supportive, but less conclusive data. Indications, contraindications and guidelines for the use of NIV are discussed. PMID:17229254

  6. Pathogenesis of acute respiratory illness caused by human parainfluenza viruses

    PubMed Central

    Schomacker, Henrick; Schaap-Nutt, Anne; Collins, Peter L.; Schmidt, Alexander C.

    2012-01-01

    Human parainfluenza viruses (HPIVs) are a common cause of acute respiratory illness throughout life. Infants, children, and the immunocompromised are the most likely to develop severe disease. HPIV1 and HPIV2 are best known to cause croup while HPIV3 is a common cause of bronchiolitis and pneumonia. HPIVs replicate productively in respiratory epithelial cells and do not spread systemically unless the host is severely immunocompromised. Molecular studies have delineated how HPIVs evade and block cellular innate immune responses to permit efficient replication, local spread, and host-to-host transmission. Studies using ex vivo human airway epithelium have focused on virus tropism, cellular pathology and the epithelial inflammatory response, elucidating how events early in infection shape the adaptive immune response and disease outcome. PMID:22709516

  7. Efficacy of Veno-Venous Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Failure

    PubMed Central

    Lee, Jae Jun; Hwang, Sung Mi; Ko, Jae Houn; Hong, Kyung Soon; Choi, Hyun Hee; Lee, Myung Goo; Lee, Chang Youl; Lee, Won Ki; Soun, Eun Jin; Lee, Tae Hun; Seo, Jeong Yeol

    2015-01-01

    Purpose The objective of this study was to evaluate our institutional experience with veno-venous (VV) extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory failure (ARF). Materials and Methods From January 2007 to August 2013, 31 patients with severe ARF that was due to various causes and refractory to mechanical ventilation with conventional therapy were supported with VV ECMO. A partial pressure of arterial oxygen (PaO2)/inspired fraction of oxygen (FiO2) <100 mm Hg at an FiO2 of 1.0 or a pH <7.25 due to CO2 retention were set as criteria for VV ECMO. Results Overall, 68% of patients survived among those who had received VV ECMO with a mean PaO2/FiO2 of 56.8 mm Hg. Furthermore, in trauma patients, early use of ECMO had the best outcome with a 94% survival rate. Conclusion VV ECMO is an excellent, life-saving treatment option in patients suffering from acute and life-threatening respiratory failure due to various causes, especially trauma, and early use of VV ECMO therapy improved outcomes in these patients. PMID:25510767

  8. Does the Mean Arterial Pressure Influence Mortality Rate in Patients with Acute Hypoxemic Respiratory Failure under Mechanical Ventilation?

    PubMed Central

    Gjonbrataj, Juarda; Kim, Hyun Jung; Jung, Hye In

    2015-01-01

    Background In sepsis patients, target mean arterial pressures (MAPs) greater than 65 mm Hg are recommended. However, there is no such recommendation for patients receiving mechanical ventilation. We aimed to evaluate the influence of MAP over the first 24 hours after intensive care unit (ICU) admission on the mortality rate at 60 days post-admission in patients showing acute hypoxemic respiratory failure under mechanical ventilation. Methods This prospective, multicenter study included 22 ICUs and compared the mortality and clinical outcomes in patients showing acute hypoxemic respiratory failure with high (75-90 mm Hg) and low (65-74.9 mm Hg) MAPs over the first 24 hours of admission to the ICU. Results Of the 844 patients with acute hypoxemic respiratory failure, 338 had a sustained MAP of 65-90 mm Hg over the first 24 hours of admission to the ICU. At 60 days, the mortality rates in the low (26.2%) and high (24.5%) MAP groups were not significantly different. The ICU days, hospital days, and 60-day mortality rate did not differ between the groups. Conclusion In the first 24 hours of ICU admission, MAP range between 65 and 90 mm Hg in patients with acute hypoxemic respiratory failure under mechanical ventilation may not cause significantly differences in 60-day mortality. PMID:25861341

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

    PubMed

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

    2015-01-01

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

  10. Early Physical Medicine and Rehabilitation for Patients With Acute Respiratory Failure: A Quality Improvement Project

    Microsoft Academic Search

    Dale M. Needham; Radha Korupolu; Jennifer M. Zanni; Pranoti Pradhan; Elizabeth Colantuoni; Jeffrey B. Palmer; Roy G. Brower; Eddy Fan

    2010-01-01

    Needham DM, Korupolu R, Zanni JM, Pradhan P, Colantuoni E, Palmer JB, Brower RG, Fan E. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project.

  11. Respiratory failure associated with hypoventilation in a patient with severe hypothyroidism

    PubMed Central

    Fukusumi, Munehisa; Iidaka, Toshiko; Mouri, Atsuto; Hamamoto, Yoichiro; Kamimura, Mitsuhiro

    2014-01-01

    A 70-year-old Japanese man was admitted to hospital because of decreased consciousness due to type II respiratory failure. Severe hypothyroidism was diagnosed and considered to be associated with hypoventilation due to respiratory muscle dysfunction and sleep apnea syndrome. His status was improved partially by replacement of thyroid hormone. Despite maintaining a euthyroid state, improvement of respiratory muscle dysfunction was incomplete. PMID:25473574

  12. Exercise Endurance before and after Long-Term Noninvasive Ventilation in Patients with Chronic Respiratory Failure

    Microsoft Academic Search

    Bernd Schönhofer; Dominic Dellweg; Stefan Suchi; Dieter Köhler

    2008-01-01

    Background: Noninvasive mechanical ventilation (NIV) is known to reduce hypoventilation and improves respiratory and peripheral muscle endurance in patients with chronic respiratory failure (CRF) due to thoracic restriction. Objectives: To compare the effect of short-term NIV on endurance in patients with CRF due to thoracorestriction and chronic obstructive pulmonary disease (COPD) and to evaluate differences in spiroergometric data during exercise

  13. Acute respiratory failure associated with polymethyl methacrylate pulmonary emboli after percutaneous vertebroplasty.

    PubMed

    Zaccheo, Matthew V; Rowane, Joseph E; Costello, Erin M

    2008-06-01

    We report a case of symptomatic polymethyl methacrylate pulmonary emboli after percutaneous vertebroplasty to alert clinicians to this potential cause of pulmonary emboli. A 77-year-old woman developed acute respiratory failure after multilevel percutaneous vertebroplasty. She received mechanical ventilatory support and anticoagulation with low-molecular-weight heparin and warfarin. Multiple pulmonary polymethyl methacrylate cement emboli were identified by computed tomography angiogram. Polymethyl methacrylate cement extravasation into the vertebral venous circulation is common during vertebroplasty. Pulmonary embolism caused by cement migration after this procedure is extremely rare, as reported in the literature to date. However, the frequency of this complication may increase secondary to the widespread use of percutaneous vertebroplasty and kyphoplasty for osteoporotic compression fractures. PMID:18534316

  14. Negative extrathoracic pressure in treatment of respiratory failure in infants and young children

    Microsoft Academic Search

    M. P. Samuels; D. P. Southall

    1989-01-01

    OBJECTIVE--To assess the efficacy of a newly developed system for applying continuous or intermittent negative (subatmospheric) extrathoracic pressure in respiratory failure. DESIGN--Uncontrolled clinical trials in infants deteriorating or failing to improve despite standard medical treatment. SETTING--Paediatric and neonatal intensive care units and paediatric wards. PATIENTS--88 Infants and young children aged 1 day to 2 years with respiratory failure due to

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

    PubMed Central

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

    2014-01-01

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

  16. RESPIRATORY SYNCYTIAL VIRUS: AN IMPORTANT CAUSE OF ACUTE RESPIRATORY ILLNESS AMONG YOUNG ADULTS UNDERGOING MILITARY TRAINING

    PubMed Central

    O’Shea, Matthew K.; Pipkin, Christopher; Cane, Patricia A.; Gray, Gregory C.

    2008-01-01

    SUMMARY Background Military recruits receiving training are vulnerable to acute respiratory disease and a significant proportion of illness is due to unidentified pathogens. While some countries use surveillance programs to monitor such illness, few data exist for recruits of the British Armed Forces. Objectives Through active surveillance of approximately 1000 Royal Navy trainees during 2001, we sought to describe and determine the aetiology of acute respiratory illness. Methods Standard viral culture was used together with serology and a novel highly sensitive real-time PCR and molecular beacon probe assay for RSV detection. Results Among 54 Royal Navy recruits with respiratory symptoms adenovirus was identified in 35%, influenza viruses in 19% and RSV in 14% of this group. All of the recruits were absent from training for almost a week, most of whom were confined to the sickbay. Conclusions This study is the first to document adenovirus and RSV as important causes of acute respiratory illness among Royal Navy trainees. The study findings demonstrate the clinical significance and challenges of diagnosing RSV infection in young adults. PMID:18846262

  17. 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

  18. An unexpected cause of acute liver failure

    PubMed Central

    Lacey, Brent

    2014-01-01

    A 66-year-old man presented with decompensated acute liver failure with no clear etiology. Eventually, a bone marrow biopsy revealed hemophagocytic cells, and he was diagnosed with hemophagocytic lymphohistiocytosis. This is an uncommon condition in adults, with high morbidity and mortality, and it is often indistinguishable from other forms of acute liver failure. Early clinical suspicion is critical to making the diagnosis, based on meeting at least four of nine specified criteria. PMID:24759344

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

    PubMed

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

    2009-06-01

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

  20. 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

  1. Common-Cause Failure Analysis in Event Assessment

    SciTech Connect

    Dana L. Kelly; Dale M. Rasmuson

    2008-09-01

    This paper describes the approach taken by the U. S. Nuclear Regulatory Commission to the treatment of common-cause failure in probabilistic risk assessment of operational events. The approach is based upon the Basic Parameter Model for common-cause failure, and examples are illustrated using the alpha-factor parameterization, the approach adopted by the NRC in their Standardized Plant Analysis Risk (SPAR) models. The cases of a failed component (with and without shared common-cause failure potential) and a component being unavailable due to preventive maintenance or testing are addressed. The treatment of two related failure modes (e.g., failure to start and failure to run) is a new feature of this paper. These methods are being applied by the NRC in assessing the risk significance of operational events for the Significance Determination Process (SDP) and the Accident Sequence Precursor (ASP) program.

  2. 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.

  3. Intravascular foscarnet crystal precipitation causing multiorgan failure.

    PubMed

    Philipponnet, Carole; Michel, Pierre-Antoine; Daudon, Michel; Brocheriou, Isabelle; Boffa, Jean-Jacques

    2015-01-01

    We report a case of multiorgan failure resulting from treatment with the antiviral foscarnet in a kidney transplant recipient. Precipitation of foscarnet crystals was confirmed histologically from a biopsy of the transplant using optical and infrared microscopy. In addition to kidney damage resulting from foscarnet crystal precipitation in the tubular lumen and glomerular capillaries, the patient presented with pancreatitis, pancolitis, and myocarditis with shock. Interruption of the treatment led to rapid improvement in her general condition, but did not prevent permanent loss of the kidney transplant. When faced with unexplained multiorgan failure in a patient treated with foscarnet, one should assume this substance to be toxic. A kidney biopsy can confirm this diagnosis. PMID:25301103

  4. The Role of Corticosteroids in Adult Respiratory Distress Syndrome caused by Viridans Group Streptococci Bacteremia in Neutropenic Patients

    PubMed Central

    Yacoub, Abraham T.; Mojica, Lysenia; Jones, Lily; Knab, Andrea; Alrabaa, Sally; Greene, John

    2014-01-01

    In the past decades, viridans group Streptococci (VGS) have emerged as an important cause of bacteremia in neutropenic patients with cancer. The clinical course of VGS bacteremia can be devastating including septic shock and adult respiratory distress syndrome (ARDS). It has been suggested that septicemia with VGS triggers the development of noncardiogenic pulmonary edema in patients with pre-existing damage of the lungs due to aggressive cytotoxic treatment. Thus, the preemptive administration of corticosteroid to patients diagnosed with VGS bacteremia with early onset of respiratory failure has been employed to prevent ARDS. While this management strategy has been suggested in the literature, little published data are available to validate this practice. In this study, we sought to review the benefit of early administration of corticosteroid to patients who developed symptom or early signs of respiratory failure while being neutropenic with VGS bacteremia. PMID:25237468

  5. 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

  6. Home Ventilation for Children with Chronic Respiratory Failure in Istanbul

    Microsoft Academic Search

    S. Oktem; R. Ersu; Z. S. Uyan; E. Cakir; F. Karakoc; B. Karadag; G. Kiyan; E. Dagli

    2008-01-01

    Background: The number of children on home mechanical ventilation (HMV) has increased markedly in Europe and North America but little is known about the HMV use and outcomes in children in Turkey. Objective: To review clinical conditions and outcome of children who were discharged from the hospital on respiratory support. Methods: Thirty-four patients assessed at the Marmara University Hospital in

  7. Bayesian analysis for causes of failure at a water utility

    Microsoft Academic Search

    Amarjit Singh

    2011-01-01

    Purpose – The purpose of this paper is to inform facility managers of the type of failure affecting certain pipe types more than others. This is useful in asset management as preventive maintenance can be undertaken for those pipe types that experience high probabilities of failure. Design\\/methodology\\/approach – The probability of a specific pipe type failing given the cause of

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

    PubMed Central

    2014-01-01

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

  9. Telomere dysfunction causes alveolar stem cell failure.

    PubMed

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

    2015-04-21

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

  10. Central nervous system alterations caused by infection with the human respiratory syncytial virus.

    PubMed

    Bohmwald, Karen; Espinoza, Janyra A; González, Pablo A; Bueno, Susan M; Riedel, Claudia A; Kalergis, Alexis M

    2014-11-01

    Worldwide, the human respiratory syncytial virus (hRSV) is the leading cause of infant hospitalization because of acute respiratory tract infections, including severe bronchiolitis and pneumonia. Despite intense research, to date there is neither vaccine nor treatment available to control hRSV disease burden globally. After infection, an incubation period of 3-5?days is usually followed by symptoms, such as cough and low-grade fever. However, hRSV infection can also produce a larger variety of symptoms, some of which relate to the individual's age at infection. Indeed, infants can display severe symptoms, such as dyspnea and chest wall retractions. Upon examination, crackles and wheezes are also common features that suggest infection by hRSV. Additionally, infection in infants younger than 1?year is associated with several non-specific symptoms, such as failure to thrive, periodic breathing or apnea, and feeding difficulties that usually require hospitalization. Recently, neurological symptoms have also been associated with hRSV respiratory infection and include seizures, central apnea, lethargy, feeding or swallowing difficulties, abnormalities in muscle tone, strabismus, abnormalities in the CSF, and encephalopathy. Here, we discuss recent findings linking the neurological, extrapulmonary effects of hRSV with infection and functional impairment of the CNS. PMID:25316031

  11. Noninvasive ventilation for patients presenting with acute respiratory failure: the randomized controlled trials.

    PubMed

    Keenan, Sean P; Mehta, Sangeeta

    2009-01-01

    Noninvasive ventilation (NIV) in patients with acute respiratory failure (ARF), which was originally described decades ago, underwent a rebirth after reports of successful use in 1989. Over the following 18 years the literature on NIV has grown substantially. This paper summarizes the randomized controlled trials (RCTs) on NIV for acute respiratory failure. We conducted an extensive literature search and selected RCTs from that search. The results are presented primarily by etiology of respiratory failure, but we also include a short section on NIV for ARF in immunocompromised patients. The latter studies included patients with various etiologies of respiratory failure but with the common comorbidity of immunocompromise. Most of the RCTs have studied NIV for exacerbation of chronic obstructive pulmonary disease (COPD) or cardiogenic pulmonary edema. In general the RCTs have been small and used endotracheal intubation or NIV failure rate as primary outcomes. We conclude that NIV for ARF is supported by strong evidence from patients with COPD, but there is only weak support for NIV in other patient groups, such as immunocompromised patients. For other groups, such as patients with asthma, pneumonia, or acute lung injury, RCT-level evidence is lacking or does not suggest benefit. Clearly, major gaps remain in our evidence base. PMID:19111111

  12. Noninvasive Positive-Pressure Ventilation for Respiratory Failure after Extubation

    Microsoft Academic Search

    Andrés Esteban; Fernando Frutos-Vivar; Niall D. Ferguson; Yaseen Arabi; Carlos Apezteguía; Marco González; Scott K. Epstein; Nicholas S. Hill; Stefano Nava; Marco-Antonio Soares; Gabriel D'Empaire; Inmaculada Alía; Antonio Anzueto

    2004-01-01

    background The need for reintubation after extubation and discontinuation of mechanical ventilation is not uncommon and is associated with increased mortality. Noninvasive positive- pressure ventilation has been suggested as a promising therapy for patients with respi- ratory failure after extubation, but a single-center, randomized trial recently found no benefit. We conducted a multicenter, randomized trial to evaluate the effect of

  13. The use of high-flow nasal oxygen therapy in the management of hypercarbic respiratory failure.

    PubMed

    Millar, Jonathan; Lutton, Stuart; O'Connor, Philip

    2014-04-01

    Hypercarbic respiratory failure, occurring secondary to chronic lung disease, is a frequently encountered problem. These patients present a significant challenge to respiratory and critical care services, as many are unsuitable for mechanical ventilation and most have multiple comorbidities. Recently, noninvasive ventilation (NIV) has become established as the primary modality for respiratory support in this group of patients. Several factors limit patient compliance with NIV, not least comfort and tolerability. A recent innovation in adult critical care is the use of high-flow nasal oxygen (HFNO) devices. These systems are capable of delivering high gas flows via nasal cannulae, with the ability to blend air and oxygen to give a controlled FiO2. Few clinical studies have been conducted in adults, although several are planned. To date the majority of available evidence addresses the use of HFNO in hypoxemic respiratory failure. Here we present a case in which a HFNO system was used to successfully manage hypercarbic respiratory failure in a patient unable to tolerate conventional NIV. PMID:24670392

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

    MedlinePLUS

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

  15. CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure

    Microsoft Academic Search

    Giles J Peek; Felicity Clemens; Diana Elbourne; Richard Firmin; Pollyanna Hardy; Clare Hibbert; Hilliary Killer; Miranda Mugford; Mariamma Thalanany; Ravin Tiruvoipati; Ann Truesdale; Andrew Wilson

    2006-01-01

    BACKGROUND: An estimated 350 adults develop severe, but potentially reversible respiratory failure in the UK annually. Current management uses intermittent positive pressure ventilation, but barotrauma, volutrauma and oxygen toxicity can prevent lung recovery. An alternative treatment, extracorporeal membrane oxygenation, uses cardio-pulmonary bypass technology to temporarily provide gas exchange, allowing ventilator settings to be reduced. While extracorporeal membrane oxygenation is proven

  16. Plasma Orexin-A Levels in COPD Patients with Hypercapnic Respiratory Failure

    PubMed Central

    Zhu, Lin-Yun; Summah, Hanssa; Jiang, Hong-Ni; Qu, Jie-Ming

    2011-01-01

    Orexins have previously been shown to promote wakefulness, regulate lipid metabolism and participate in energy homeostasis. The aim of the study was to determine the relationship between plasma orexin-A and body composition in COPD in-patients with hypercapnic respiratory failure. 40 patients with hypercapnic respiratory failure and 22 healthy individuals were enrolled prospectively in this study. Plasma orexin-A levels, BMI, SaO2, PaCO2 and PaO2 were noted for all the patients. Plasma orexin-A levels were higher in the underweight (UW) group, normal weight (NW) group and overweight (OW) group of COPD patients as compared with UW, NW and OW group of the control group (P < .05). Plasma orexin-A in COPD patients were higher in the OW group than in the NW group and the UW group. Plasma orexin-A levels showed significant correlation with body mass index (BMI), independent of PaO2 (r = 0.576; P < .05) and %fat (r = 0.367; P < .05); a negative correlation was noted between plasma orexin-A levels and PaO2 (r = ?0.738; P < .05) and SaO2 (r = ?0.616; P < .05). Our results suggest that orexin-A levels are high in COPD patients with hypercapnic respiratory failure, and vary according to BMI and body composition. Orexin-A may be associated with the severity of hypoxemia in COPD patients with hypercapnic respiratory failure. PMID:21765621

  17. Acute respiratory failure as primary manifestation of antineutrophil cytoplasmic antibodies-associated vasculitis.

    PubMed

    Sourla, Evdokia; Bagalas, Vasilis; Tsioulis, Helias; Paspala, Asimina; Akritidou, Sofia; Pataka, Athanasia; Fekete, Katalin; Kioumis, Ioannis P; Stanopoulos, Ioannis; Pitsiou, Georgia

    2014-06-18

    The systemic vasculitides are multifocal diseases characterized by the presence of blood vessel inflammation in multiple organ systems. Their clinical presentation is variable extending from self-limited illness to critical complications including diffuse alveolar hemorrhage and glomerulonephritis. Alveolar hemorrhage is a life-threatening manifestation of pulmonary vasculitis that can rapidly progress into acute respiratory failure requiring ventilatory support. We present the case of a 74-year-old patient admitted to the Intensive Care Unit with severe hypoxic respiratory failure and diffuse alveolar infiltrates in chest imaging that was later diagnosed as antineutrophil cytoplasmic antibodies-associated vasculitis. The report highlights the importance of differentiate between alveolar hemorrhage and acute respiratory distress syndrome of other etiology because alveolar hemorrhage is reversible with prompt initiation of treatment. PMID:25332763

  18. A Complication of Tracheobronchopathia Osteochondroplastica Presenting as Acute Hypercapnic Respiratory Failure

    PubMed Central

    Danckers, Mauricio; Raad, Roy A.; Zamuco, Ronaldo; Pollack, Aron; Rickert, Scott; Caplan-Shaw, Caralee

    2015-01-01

    Patient: Male, 27 Final Diagnosis: Tracheobronchopathia osteochondroplastica Symptoms: Shortness of breath • stridor Medication: — Clinical Procedure: Neck computer tomography • pulmonary function test • neck surgical exploration • tracheostomy placement Specialty: Critical Care Medicine Objective: Unusual clinical course Background: Tracheobronchopathia osteochondroplastica is a rare benign and often indolent disease. We report the first case of tracheobronchopathia osteochondroplastica (TBO) presenting as acute hypercarbic respiratory failure due to superimposed subglottic submucosal abscess. Case Report: A 27-year-old man presented to the emergency department in respiratory distress that required mechanical ventilation for acute hypercarbic respiratory failure. Upon extubation the next day, stridor was elicited with ambulation. Spirometry revealed fixed upper airway obstruction. Neck imaging showed a 2.8×2.0×4.0 cm partially calcified subglottic mass with cystic and solid component obstructing 75% of the airway. Surgical exploration revealed purulent drainage upon elevation of the thyroid isthmus and an anterolateral cricoid wall defect in communication with a subglottic submucosal cavity. Microbiology was negative for bacteria or fungi. Pathology showed chondro-osseous metaplasia compatible with tracheobronchopathia osteochondroplastica (TBO). The patient received a course of antibiotics and prophylactic tracheostomy. Since tracheostomy removal 3 days later, the patient remains asymptomatic. Conclusions: Tracheobronchopathia osteochondroplastica is a rare disease with usually benign clinical course and incidental diagnosis. It may present as acute hypercarbic respiratory failure when subglottic infection is superimposed. PMID:25629203

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  20. Extracorporeal life support for 100 adult patients with severe respiratory failure.

    PubMed Central

    Kolla, S; Awad, S S; Rich, P B; Schreiner, R J; Hirschl, R B; Bartlett, R H

    1997-01-01

    OBJECTIVE: The authors retrospectively reviewed their experience with extracorporeal life support (ECLS) in 100 adult patients with severe respiratory failure (ARF) to define techniques, characterize its efficacy and utilization, and determine predictors of outcome. SUMMARY BACKGROUND DATA: Extracorporeal life support maintains gas exchange during ARF, providing diseased lungs an optimal environment in which to heal. Extracorporeal life support has been successful in the treatment of respiratory failure in infants and children. In 1990, the authors instituted a standardized protocol for treatment of severe ARF in adults, which included ECLS when less invasive methods failed. METHODS: From January 1990 to July 1996, the authors used ECLS for 100 adults with severe acute hypoxemic respiratory failure (n = 94): paO2/FiO2 ratio of 55.7+/-15.9, transpulmonary shunt (Qs/Qt) of 52+/-22%, or acute hypercarbic respiratory failure (n = 6): paCO2 84.0+/-31.5 mmHg, despite and after maximal conventional ventilation. The technique included venovenous percutaneous access, lung "rest," transport on ECLS, minimal anticoagulation, hemofiltration, and optimal systemic oxygen delivery. RESULTS: Overall hospital survival was 54%. The duration of ECLS was 271.9+/-248.6 hours. Primary diagnoses included pneumonia (49 cases, 53% survived), adult respiratory distress syndrome (45 cases, 51 % survived), and airway support (6 cases, 83% survived). Multivariate logistic regression modeling identified the following pre-ECLS variables significant independent predictors of outcome: 1) pre-ECLS days of mechanical ventilation (p = 0.0003), 2) pre-ECLS paO2/FiO2 ratio (p = 0.002), and 3) age (years) (p = 0.005). Modeling of variables during ECLS showed that no mechanical complications were independent predictors of outcome, and the only patient-related complications associated with outcome were the presence of renal failure (p < 0.0001) and significant surgical site bleeding (p = 0.0005). CONCLUSIONS: Extracorporeal life support provides life support for ARF in adults, allowing time for injured lungs to recover. In 100 patients selected for high mortality risk despite and after optimal conventional treatment, 54% survived. Extracorporeal life support is extraordinary but reasonable treatment in severe adult respiratory failure. Predictors of survival exist that may be useful for patient prognostication and design of future prospective studies. Images Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. PMID:9351722

  1. Noninvasive radiographic assessment of cardiovascular function in acute and chronic respiratory failure

    SciTech Connect

    Berger, H.J.; Matthay, R.A.

    1981-04-01

    Noninvasive radiographic techniques have provided a means of studying the natural history and pathogenesis of cardiovascular performance in acute and chronic respiratory failure. Chest radiography, radionuclide angiocardiography and thallium-201 imaging, and M mode and cross-sectional echocardiography have been employed. Each of these techniques has specific uses, attributes and limitations. For example, measurement of descending pulmonary arterial diameters on the plain chest radiograph allows determination of the presence or absence of pulmonary arterial hypertension. Right and left ventricular performance can be evaluated at rest and during exercise using radionuclide angiocardiography. The biventricular response to exercise and to therapeutic interventions also can be assessed with this approach. Evaluation of the pulmonary valve echogram and echocardiographic right ventricular dimensions have been shown to reflect right ventricular hemodynamics and size. Each of these noninvasive techniques has been applied to the study of patients with respiratory failure and has provided important physiologic data.

  2. Subglosso-palatal membrane a rare cause of neonatal respiratory distress: A case report

    PubMed Central

    Pandey, Vaibhav; Tiwari, Preeti; Tapadar, Jayanto; Gangopadhyay, Ajay Narayan

    2014-01-01

    Subglosso-palatal membrane is a rare cause of acute respiratory distress in newborn. Contrary to the earlier reported cases in which immediate splitting or excision of membrane has been described as measure to relief respiratory distress, we managed our case successfully without any emergency surgical procedure. PMID:24741217

  3. Correntropy-based spectral characterization of respiratory patterns in patients with chronic heart failure.

    PubMed

    Garde, Ainara; Sörnmo, Leif; Jané, Raimon; Giraldo, Beatriz F

    2010-08-01

    A correntropy-based technique is proposed for the characterization and classification of respiratory flow signals in chronic heart failure (CHF) patients with periodic or nonperiodic breathing (PB or nPB, respectively) and healthy subjects. The correntropy is a recently introduced, generalized correlation measure whose properties lend themselves to the definition of a correntropy-based spectral density (CSD). Using this technique, both respiratory and modulation frequencies can be reliably detected at their original positions in the spectrum without prior demodulation of the flow signal. Single-parameter classification of respiratory patterns is investigated for three different parameters extracted from the respiratory and modulation frequency bands of the CSD, and one parameter defined by the correntropy mean. The results show that the ratio between the powers in the modulation and respiratory frequency bands provides the best result when classifying CHF patients with either PB or nPB, yielding an accuracy of 88.9%. The correntropy mean offers excellent performance when classifying CHF patients versus healthy subjects, yielding an accuracy of 95.2% and discriminating nPB patients from healthy subjects with an accuracy of 94.4%. PMID:20211799

  4. 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.

  5. 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

  6. CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure

    PubMed Central

    Peek, Giles J; Clemens, Felicity; Elbourne, Diana; Firmin, Richard; Hardy, Pollyanna; Hibbert, Clare; Killer, Hilliary; Mugford, Miranda; Thalanany, Mariamma; Tiruvoipati, Ravin; Truesdale, Ann; Wilson, Andrew

    2006-01-01

    Background An estimated 350 adults develop severe, but potentially reversible respiratory failure in the UK annually. Current management uses intermittent positive pressure ventilation, but barotrauma, volutrauma and oxygen toxicity can prevent lung recovery. An alternative treatment, extracorporeal membrane oxygenation, uses cardio-pulmonary bypass technology to temporarily provide gas exchange, allowing ventilator settings to be reduced. While extracorporeal membrane oxygenation is proven to result in improved outcome when compared to conventional ventilation in neonates with severe respiratory failure, there is currently no good evidence from randomised controlled trials to compare these managements for important clinical outcomes in adults, although evidence from case series is promising. Methods/Design The aim of the randomised controlled trial of Conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR) is to assess whether, for patients with severe, but potentially reversible, respiratory failure, extracorporeal membrane oxygenation will increase the rate of survival without severe disability ('confined to bed' and 'unable to wash or dress') by six months post-randomisation, and be cost effective from the viewpoints of the NHS and society, compared to conventional ventilatory support. Following assent from a relative, adults (18–65 years) with severe, but potentially reversible, respiratory failure (Murray score ? 3.0 or hypercapnea with pH < 7.2) will be randomised for consideration of extracorporeal membrane oxygenation at Glenfield Hospital, Leicester or continuing conventional care in a centre providing a high standard of conventional treatment. The central randomisation service will minimise by type of conventional treatment centre, age, duration of high pressure ventilation, hypoxia/hypercapnea, diagnosis and number of organs failed, to ensure balance in key prognostic variables. Extracorporeal membrane oxygenation will not be available for patients meeting entry criteria outside the trial. 180 patients will be recruited to have 80% power to be able to detect a one third reduction in the primary outcome from 65% at 5% level of statistical significance (2-sided test). Secondary outcomes include patient morbidity and health status at 6 months. Discussion Analysis will be based on intention to treat. A concurrent economic evaluation will also be performed to compare the costs and outcomes of both treatments. PMID:17187683

  7. Non-Invasive Pressure Support Ventilation in Patients with Respiratory Failure due to Severe Acute Cardiogenic Pulmonary Edema

    Microsoft Academic Search

    Arschang Valipour; Wolfgang Cozzarini; Otto C. Burghuber

    2004-01-01

    Background: Recent studies suggest the use of non-invasive pressure support ventilation (NIPSV) in patients with acute cardiogenic pulmonary edema (ACPE). However, it remains unclear whether all patients with ACPE benefit from NIPSV. Objectives: To investigate short-term effects of NIPSV on respiratory, hemodynamic and oxygenation parameters in patients with respiratory failure due to severe ACPE and to identify factors predicting the

  8. Insights About Emergency Diesel Generator Failures from the USNRC's Common Cause Failure Database

    SciTech Connect

    Mosleh, A. [Univ. of Maryland, MD (US); Rasmuson, D. [USNRC (US); Marshall, F.; Wierman, T. [INEEL (US)

    1999-08-01

    The US Nuclear Regulatory Commission has sponsored development of a database of common cause failure events for use in commercial nuclear power plant risk and reliability analyses. This paper presents a summary of the results from analysis of the emergency diesel generator data from the database. The presentation is limited to the overall insights, the design and manufacturing cause and the instrumentation and control sub-system.

  9. Description: Swine influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that cause regular

    E-print Network

    Blows, Mark

    Description: Swine influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that cause regular outbreaks in pigs. People do not usually get swine flu, but human infections can and do happen. Swine flu viruses have been reported to spread from person to person

  10. Respiratory Failure

    MedlinePLUS

    ... Examples include COPD (chronic obstructive pulmonary disease) and spinal cord injuries. COPD prevents enough air from flowing in and out of the airways. Spinal cord injuries can damage the nerves that control breathing. Overview ...

  11. 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.

  12. Correntropy-based analysis of respiratory patterns in patients with chronic heart failure.

    PubMed

    Garde, Ainara; Sörnmo, Leif; Jané, Raimon; Giraldo, Beatriz F

    2009-01-01

    A correntropy-based technique is proposed for the analysis and characterization of respiratory flow signals in chronic heart failure (CHF) patients with both periodic and nonperiodic breathing (PB and nPB), and healthy subjects. Correntropy is a novel similarity measure which provides information on temporal structure and statistical distribution simultaneously. Its properties lend itself to the definition of the correntropy spectral density (CSD). An interesting result from CSD-based spectral analysis is that both the respiratory frequency and modulation frequency can be detected at their original positions in the spectrum without prior demodulation of the flow signal. The respiratory pattern is characterized by a number of spectral parameters extracted from the respiratory and modulation frequency bands. The results show that the power of the modulation frequency band offers excellent performance when classifying CHF patients versus healthy subjects, with an accuracy of 95.3%, and nPB patients versus healthy subjects with 90.7%. The ratio between the power in the modulation and respiration frequency bands provides the best results classifying CHF patients into PB and nPB, with an accuracy of 88.9%. PMID:19964830

  13. Are you protected against Pertussis? Pertussis, or whooping cough, is a highly contagious respiratory infection caused by the bacterium

    E-print Network

    Are you protected against Pertussis? Pertussis, or whooping cough, is a highly contagious respiratory infection caused by the bacterium Bordetella pertussis. It causes severe coughing spells, vomiting

  14. Respiratory illness caused by overheating of polyvinyl chloride.

    PubMed Central

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

    1982-01-01

    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

  15. Geographic Access to High Capability Severe Acute Respiratory Failure Centers in the United States

    PubMed Central

    Wallace, David J.; Angus, Derek C.; Seymour, Christopher W.; Yealy, Donald M.; Carr, Brendan G.; Kurland, Kristen; Boujoukos, Arthur; Kahn, Jeremy M.

    2014-01-01

    Objective Optimal care of adults with severe acute respiratory failure requires specific resources and expertise. We sought to measure geographic access to these centers in the United States. Design Cross-sectional analysis of geographic access to high capability severe acute respiratory failure centers in the United States. We defined high capability centers using two criteria: (1) provision of adult extracorporeal membrane oxygenation (ECMO), based on either 2008–2013 Extracorporeal Life Support Organization reporting or provision of ECMO to 2010 Medicare beneficiaries; or (2) high annual hospital mechanical ventilation volume, based 2010 Medicare claims. Setting Nonfederal acute care hospitals in the United States. Measurements and Main Results We defined geographic access as the percentage of the state, region and national population with either direct or hospital-transferred access within one or two hours by air or ground transport. Of 4,822 acute care hospitals, 148 hospitals met our ECMO criteria and 447 hospitals met our mechanical ventilation criteria. Geographic access varied substantially across states and regions in the United States, depending on center criteria. Without interhospital transfer, an estimated 58.5% of the national adult population had geographic access to hospitals performing ECMO and 79.0% had geographic access to hospitals performing a high annual volume of mechanical ventilation. With interhospital transfer and under ideal circumstances, an estimated 96.4% of the national adult population had geographic access to hospitals performing ECMO and 98.6% had geographic access to hospitals performing a high annual volume of mechanical ventilation. However, this degree of geographic access required substantial interhospital transfer of patients, including up to two hours by air. Conclusions Geographic access to high capability severe acute respiratory failure centers varies widely across states and regions in the United States. Adequate referral center access in the case of disasters and pandemics will depend highly on local and regional care coordination across political boundaries. PMID:24705417

  16. Severe acute respiratory failure secondary to acute fibrinous and organizing pneumonia requiring mechanical ventilation: a case report and literature review.

    PubMed

    López-Cuenca, Sonia; Morales-García, Silvia; Martín-Hita, Ana; Frutos-Vivar, Fernando; Fernández-Segoviano, Pilar; Esteban, Andrés

    2012-08-01

    A 27-year-old woman was admitted to our ICU with acute hypoxemic respiratory failure and criteria for ARDS. Despite an F(IO(2)) of 1.0 and a lung protective strategy, the patient died on day 15 without any improvement. The relatives gave consent for post-mortem analysis. The histopathologic study of the lung showed findings typical of an acute fibrinous and organizing pneumonia. Apropos of this case we performed a PubMed search. We found 13 articles, including a total of 29 patients. Acute fibrinous and organizing pneumonia is an unusual cause of acute lung injury. The diagnostic criterion is histopathologic. There is little information regarding the pathophysiology of this illness. Important questions remain regarding this disease, including predisposing factors and management. Patients who require mechanical ventilation have poor outcomes. PMID:22348347

  17. Phrenic nerve palsy: A rare cause of respiratory distress in newborn

    PubMed Central

    Murty, V. S. S. Yerramilli; Ram, K. Dinedra

    2012-01-01

    Birth injury is defined as an impairment of a newborn's body function or structure due to adverse influences that occurred at birth. Phrenic nerve palsy may result from birth trauma during a traumatic neonatal delivery from a stretch injury due to lateral hyperextension of the neck at birth. This could be a rare cause of respiratory distress in the newborn period with irregular respiration. Respiratory distress due to phrenic nerve damage leading to paralysis of the ipsilateral diaphragm may require continuous positive airway pressure or mechanical ventilation and if unresponsive, surgical plication of diaphragm. Herein, we report a case of phrenic nerve palsy in a newborn presenting with respiratory distress. PMID:23560016

  18. Bedside pleuroscopy in the management of undiagnosed exudative pleural effusion with acute respiratory failure.

    PubMed

    Hean, O; Shang-Miao, C; Chien-Ming, L; Ku-Liang, C; Jeng-Yuan, W; Nan-Yung, H; Bor-Tsung, H

    2013-07-01

    Pleuroscopy is indicated in patients with acute respiratory failure due to an unresolved exudative pleural effusion but it may not be possible to move such patients to the operating theatre or endoscopy room for pleuroscopy due to their critical condition. We report our experience of using flexible bronchoscopy for pleuroscopy to diagnose pleural effusion in patients with acute respiratory failure at the bedside in the intensive care unit. Before pleuroscopy, patients were placed in the lateral decubitus position. We used bedside chest sonography to guide safe entry of the trocar. The skin was sterilised with povidone-iodine and local analgesia was with 2% lignocaine. Incisions were made using a knife with a width of 5 mm. A trocar 5.5 mm in diameter was inserted and a bronchoscope was inserted. The pleural cavity was inspected and biopsies were performed under direct vision in all suspected areas. A 16 Fr pigtail catheter was inserted for drainage after the pleuroscopy. Chest radiographs were routinely obtained after the procedure. In summary, this modified pleuroscopy technique can be performed at the bedside in an intensive care unit. PMID:23808505

  19. 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

  20. Causes and Outcomes of Acute Liver Failure in China

    PubMed Central

    Zhao, Pan; Wang, Chunya; Liu, Weiwei; Chen, Gang; Liu, Xinying; Wang, Xi; Wang, Bao; Yu, Liming; Sun, Yanrong; Liang, Xiaoming; Yang, Haozhen; Zhang, Fei

    2013-01-01

    Objectives No extensive investigation has been performed and thus no representative data are available regarding acute liver failure (ALF) in China. This study aims to investigate the causes and outcomes of ALF in China and establish a prognostic model. Methods Patients diagnosed as ALF in seven hospitals in different areas of China from January 2007 to December 2012 were retrospectively selected. Results Of the 177 patients included in this study, 112 (63.28%) eventually died. The common causes of ALF were drug toxicity (43.50%), indeterminate etiology (29.38%) and acute viral hepatitis (11.30%). Additionally, traditional Chinese herbs predominated in the causes of drug-induced ALF (30/77). No patients in this study received liver transplantation. In the established model for predicting death in ALF, four variables were finally selected out, including age (P=0.01), the entry hepatic encephalopathy grade (P=0.04), international normalized ratio (P<0.01) and arterial blood ammonia (P=0.02). Using a threshold value of 0.5683, this model had a sensitivity of 95.24% and a specificity of 91.30%. Conclusions Traditional Chinese medicine was a major cause of ALF in China. The spontaneous mortality of ALF was high, whereas the rate of liver transplantation was significantly low. The established prognostic model of ALF had superior sensitivity and specificity. PMID:24278360

  1. Noninvasive Positive Pressure Ventilation for Acute Respiratory Failure Patients With Chronic Obstructive Pulmonary Disease (COPD)

    PubMed Central

    McCurdy, BR

    2012-01-01

    Executive Summary In July 2010, the Medical Advisory Secretariat (MAS) began work on a Chronic Obstructive Pulmonary Disease (COPD) evidentiary framework, an evidence-based review of the literature surrounding treatment strategies for patients with COPD. This project emerged from a request by the Health System Strategy Division of the Ministry of Health and Long-Term Care that MAS provide them with an evidentiary platform on the effectiveness and cost-effectiveness of COPD interventions. After an initial review of health technology assessments and systematic reviews of COPD literature, and consultation with experts, MAS identified the following topics for analysis: vaccinations (influenza and pneumococcal), smoking cessation, multidisciplinary care, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation for acute and chronic respiratory failure, hospital-at-home for acute exacerbations of COPD, and telehealth (including telemonitoring and telephone support). Evidence-based analyses were prepared for each of these topics. For each technology, an economic analysis was also completed where appropriate. In addition, a review of the qualitative literature on patient, caregiver, and provider perspectives on living and dying with COPD was conducted, as were reviews of the qualitative literature on each of the technologies included in these analyses. The Chronic Obstructive Pulmonary Disease Mega-Analysis series is made up of the following reports, which can be publicly accessed at the MAS website at: http://www.hqontario.ca/en/mas/mas_ohtas_mn.html. Chronic Obstructive Pulmonary Disease (COPD) Evidentiary Framework Influenza and Pneumococcal Vaccinations for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Smoking Cessation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Community-Based Multidisciplinary Care for Patients With Stable Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Pulmonary Rehabilitation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Long-term Oxygen Therapy for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Noninvasive Positive Pressure Ventilation for Acute Respiratory Failure Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Noninvasive Positive Pressure Ventilation for Chronic Respiratory Failure Patients With Stable Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Hospital-at-Home Programs for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Home Telehealth for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Cost-Effectiveness of Interventions for Chronic Obstructive Pulmonary Disease Using an Ontario Policy Model Experiences of Living and Dying With COPD: A Systematic Review and Synthesis of the Qualitative Empirical Literature For more information on the qualitative review, please contact Mita Giacomini at: http://fhs.mcmaster.ca/ceb/faculty_member_giacomini.htm. For more information on the economic analysis, please visit the PATH website: http://www.path-hta.ca/About-Us/Contact-Us.aspx. The Toronto Health Economics and Technology Assessment (THETA) collaborative has produced an associated report on patient preference for mechanical ventilation. For more information, please visit the THETA website: http://theta.utoronto.ca/static/contact. Objective The objective of this evidence-based analysis was to examine the effectiveness, safety, and cost-effectiveness of noninvasive positive pressure ventilation (NPPV) in the following patient populations: patients with acute respiratory failure (ARF) due to acute exacerbations of chronic obstructive pulmonary disease (COPD); weaning of COPD patients from invasive mechanical ventilation (IMV); and prevention of or treatment of recurrent respiratory failure in COPD patients after ex

  2. Ventilator management for hypoxemic respiratory failure attributable to H1N1 novel swine origin influenza virus.

    PubMed

    Ramsey, Clare D; Funk, Duane; Miller, Russell R; Kumar, Anand

    2010-04-01

    Novel H1N1 swine origin influenza virus has led to a worldwide pandemic. During the pandemic, a significant number of patients became critically ill primarily because of respiratory failure. Most of these patients required intubation and mechanical ventilation and were treated with conventional modes of mechanical ventilation using a lung-protective strategy with low tidal volumes, plateau pressures <30 to 35 cm H2O, and optimal positive end-expiratory pressure. In some patients with persistent hypoxemia, alternative modes of ventilation, such as high-frequency oscillatory ventilation and airway pressure release ventilation, were used. We review the ventilatory management, recruitment maneuvers, prone positioning, and goals of ventilatory therapy for hypoxemic respiratory failure in general, as well as lessons learned in the management of H1N1-related respiratory failure. PMID:20042855

  3. Epidemiology of noninvasive mechanical ventilation in acute respiratory failure - a retrospective population-based study

    PubMed Central

    2013-01-01

    Background Noninvasive mechanical ventilation (NIV) is a front-line therapy for the management of acute respiratory failure (ARF) in the intensive care units. However, the data on factors and outcomes associated with the use of NIV in ARF patients is lacking. Therefore, we aimed to determine the utilization of NIV for ARF in a population-based study. Methods We conducted a populated-based retrospective cohort study, where in all consecutively admitted adults (?18?years) with ARF from Olmsted County, Rochester, MN, at the Mayo Clinic medical and surgical ICUs, during 2006 were included. Patients without research authorization or on chronic NIV use for sleep apnea were excluded. Results Out of 1461 Olmsted County adult residents admitted to the ICUs in 2006, 364 patients developed ARF, of which 146 patients were initiated on NIV. The median age in years was 75 (interquartile range, 60–84), 48% females and 88.7% Caucasians. Eighteen patients (12%) were on Continuous Positive Airway Pressure (CPAP) mode and 128 (88%) were on noninvasive intermittent positive-pressure ventilation (NIPPV) mode. Forty-six (10%) ARF patients were put on NIV for palliative strategy to alleviate dyspnea. Seventy-six ARF patients without treatment limitation were given a trial of NIV and 49 patients succeeded, while 27 had to be intubated. Mortality was similar between the patients initially supported with NIV versus invasive mechanical ventilation (33% vs 22%, P=0.289). In the multivariate analysis, the development of acute respiratory distress syndrome (ARDS) and higher APACHE III scores were associated with the failure of initial NIV treatment. Conclusions Our results have important implications for a future planning of NIV in a suburban US community with high access to critical care services. The higher APACHE III scores and the development of ARDS are associated with the failure of initial NIV treatment. PMID:23570601

  4. Diversity Strategies to Mitigate Postulated Common Cause Failure Vulnerabilities

    SciTech Connect

    Wood, Richard Thomas [ORNL] [ORNL

    2010-01-01

    This paper describes an approach to establish effective mitigating strategies that can resolve potential common-cause failure (CCF) vulnerabilities in instrumentation and control (I&C) systems at nuclear power plants. A particular objective in the development of these strategies, which consist of combinations of diversity attributes and their associated criteria, is to address the unique characteristics of digital technology that can contribute to CCF concerns. The research approach employed to establish diversity strategies involves investigation of available documentation on diversity usage and experience from nuclear power and non-nuclear industries, capture of expert knowledge and lessons learned, determination of common practices, and assessment of the nature of CCFs and compensating diversity attributes. The resulting diversity strategies address considerations such as the effect of technology choices, the nature of CCF vulnerabilities, and the prospective impact of each diversity type. In particular, the impact of each attribute and criterion on the purpose, process, product, and performance aspects of diverse systems are considered.

  5. Negative Pressure Artificial Respiration: Use in Treatment of Respiratory Failure of the Newborn

    PubMed Central

    Stern, Leo; Ramos, Angeles D.; Outerbridge, Eugene W.; Beaudry, Pierre H.

    1970-01-01

    Ninety-one infants with respiratory failure secondary to primary pulmonary disease and with a birth weight of 1000 g. or over have been managed in a negative-pressure respirator (Air-Shields) over a three-year period. Of these the failure in 87 was due to respiratory distress syndrome (RDS) and in four it resulted from massive meconium aspiration. Respiratory failure was indicated initially by arterial blood gas tensions (while breathing 100% O2) of Po2 <40 mm. Hg, pH <7.10 and Pco2 >75 mm. Hg in the initial 47 cases; these levels were subsequently raised to Po2 < 50 mm. Hg, pH <7.20 and Pco2 >70 mm. Hg for the remainder. Fifty-four (59.3%) of the infants survived the use of the respirator and 47 of these (51.6%) were subsequently discharged alive and well. Mean time in hours to normalization of blood gas values while on the respirator were as follows: for Po2, 10.5; for pH, 11.6; and for Pco2, 22.6. These values indicate that the respirator is more efficient in promoting oxygenation (raising Po2) than ventilation (lowering Pco2). They also suggest that the observed acidosis is in large part secondary to the hypoxia rather than the result of co2 retention. For the survivors the average time of total respirator dependency before commencement of weaning was 53.7 hours. All the infants were managed without the use of endotracheal tubes although the use of the respirator and/or administration of 100% oxygen were either continuous or intermittent for periods of up to two weeks. There have been no instances of so-called respirator lung disease in the survivors or in those who died, which suggests that the use of high oxygen concentration by itself is not the major factor in the pathogenesis of this complication. ImagesFIG. 1FIG. 3FIG. 4 PMID:5265797

  6. 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

  7. Bronchiectasis: a neglected cause of respiratory morbidity and mortality.

    PubMed

    Kolbe, J; Wells, A U

    1996-12-01

    Bronchiectasis is a progressive condition characterized by irreversible destruction and dilation of airways generally associated with chronic bacterial infections. Although in Western countries, the morbidity and mortality from bronchiectasis is considered to have declined markedly in the modern era, the condition continues to cause significant morbidity and mortality in the south-west Pacific and probably also in South-East Asia. There is a high prevalence in indigenous populations in the region and factors such as poverty, substandard housing, malnutrition, barriers to medical care and inadequate education are all likely to have a major impact on prevalence and outcome of bronchiectasis. Although bronchiectasis has been viewed as a disease of medium and large airways, there is now increasing evidence of the importance of small airways disease in bronchiectasis and that it may play an integral role in pathogenesis. Chronic inflammation of the bronchial wall by mononuclear cells is common to all types of bronchiectasis. A vicious cycle of bacteria (mediated lung toxicity and bacteria) provoked, host-mediated inflammatory lung damage has been described. If progressive lung damage with its attendant morbidity and mortality is to be prevented, this vicious cycle needs to be broken. The two distinct therapeutic goals in bronchiectasis are to reduce morbidity and to prevent progression of underlying disease. It may be possible to modulate the host response directly and thus reduce tissue damage, but the precise role of immuno-modulatory therapy in bronchiectasis is still unclear. The management of this hitherto neglected disease, which reaches almost epidemic proportions in some ethnic groups and is an ongoing source of considerable morbidity and mortality, requires a comprehensive, multidisciplinary approach, which can be modelled on the successful management of chronic asthma in New Zealand. PMID:9441110

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

    EPA Science Inventory

    World Trade Center Fine Particulate Matter Causes Respiratory Tract Hyperresponsiveness in Mice Stephen H. Gavett1, Najwa Haykal-Coates1, Jerry W. Highfill1, Allen D. Ledbetter1, Lung Chi Chen2, Mitchell D. Cohen2, Jack R. Harkema3, James G. Wagner3, and Daniel L. Costa1....

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

    PubMed

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

    2014-09-01

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

  10. Tacrolimus rescue therapy for severe respiratory failure in the anti-synthetase syndrome

    PubMed Central

    Rigby, Amy L; Plit, Marshall; Glanville, Allan R

    2014-01-01

    Interstitial lung disease (ILD) is the major determinant of morbidity and mortality in the anti-synthetase syndrome (ASS). The therapeutic efficacy of corticosteroids for the ILD component is limited; hence, additional immunosuppressive and immunomodulatory therapies have been tried with a modicum of success in recent years. Tacrolimus, a calcineurin inhibitor, is one potential therapy. We describe four consecutive patients with ASS whom we treated with tacrolimus at a quaternary referral hospital in 2009–2013. All four patients had significant ILD, three had severe and progressive ILD, and two had been referred for consideration of lung transplantation. Tacrolimus use was associated with improvement in ILD in all four patients with a mean follow-up of 3 years. Our case series adds further evidence to support the use of tacrolimus as salvage therapy for severe respiratory failure due to ILD in ASS, which may be associated with a dramatic and enduring response. PMID:25473571

  11. Role of noninvasive ventilation in elderly patients with hypercapnic respiratory failure.

    PubMed

    Riario-Sforza, G G; Scarpazza, P; Incorvaia, C; Casali, W

    2012-01-01

    The effectiveness of non-invasive ventilation (NIV) in treating patients with acute respiratory failure (ARF) is showed by its ability to diminish the recurrence to endotracheal intubation (ETI), the occurrence of ETI-associated lung infections as well as related mortality. A specific issue is the outcome of NIV in patients referring to Emergency Department for ARF who receive a do-not-intubate (DNI) order because of too critical conditions or advanced age. Recent data show that elderly patients (mean age 81 years) with ARF who have a DNI order can be successfully treated by NIV, as demonstrated by a survival rate of 83%. The positive outcome was confirmed by a subsequent 3-year observation, that demonstrated an overall survival rate of 54%. These findings clearly suggest to treat by NIV elderly patients also in presence of a DNI order. PMID:22362244

  12. Acute respiratory failure from Surgifoam expansion after anterior cervical surgery: case report.

    PubMed

    Skovrlj, Branko; Mascitelli, Justin R; Camins, Martin B; Doshi, Amish H; Qureshi, Sheeraz A

    2013-10-01

    A 65-year-old woman underwent an uneventful C3-4 anterior cervical discectomy and fusion for a large, symptomatic disc herniation. On postoperative Day 1 the patient suffered a sudden, acute respiratory compromise. Emergency fiberoptic intubation revealed significant anterior neck swelling with concern for physical obstruction of the airway. Computed tomography of the neck did not demonstrate an expanding hematoma. The patient was managed with surgical wound exploration and washout. Examination of the anterior neck after incision of the prior surgical site revealed a large volume of Surgifoam under high pressure, which was greater than the amount used during the initial surgery. Thorough washout of the surgical site did not reveal any swelling of the prevertebral soft tissues or hematoma, and the Hemovac drain did not appear to be occluded. The patient was extubated on the 2nd postoperative day and is symptom free 12 months after surgery. To the authors' knowledge, this report represents the first reported complication of acute respiratory failure from Surgifoam overexpansion after anterior cervical surgery. PMID:23971761

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

    PubMed Central

    2009-01-01

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

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

    PubMed

    Maslach-Hubbard, Anna; Bratton, Susan L

    2013-11-01

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

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

    PubMed Central

    Maslach-Hubbard, Anna; Bratton, Susan L

    2013-01-01

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

  16. Aquatic leech as a rare cause of respiratory distress and hemoptysis.

    PubMed

    Rahimi-Rad, Mohammad Hossein; Alizadeh, Effat; Samarei, Reza

    2011-01-01

    This paper presents a 73 years old male with three weeks history of intermittent hemoptysis, dysphagia, dyspnea, stridor, and suffocations sensation. By means of fibrotic bronchoscopic examination, the cause was found to be a leech in the glottis. It was removed by injection of 4 ml lidocaine 2%. Infestation into the respiratory tract by a leech may become lethal because of hypoxia and death secondary to airway obstruction. A high index of suspicion of leech infestation sould be considered in patients presenting with hemoptysis, hoarseness and respiratory distress and a history of recent contact with fresh water streams. PMID:21823359

  17. High Prevalence of Respiratory Muscle Weakness in Hospitalized Acute Heart Failure Elderly Patients

    PubMed Central

    Verissimo, Pedro; Timenetsky, Karina T.; Casalaspo, Thaisa Juliana André; Gonçalves, Louise Helena Rodrigues; Yang, Angela Shu Yun; Eid, Raquel Caserta

    2015-01-01

    Introduction Respiratory Muscle Weakness (RMW) has been defined when the maximum inspiratory pressure (MIP) is lower than 70% of the predictive value. The prevalence of RMW in chronic heart failure patients is 30 to 50%. So far there are no studies on the prevalence of RMW in acute heart failure (AHF) patients. Objectives Evaluate the prevalence of RMW in patients admitted because of AHF and the condition of respiratory muscle strength on discharge from the hospital. Methods Sixty-three patients had their MIP measured on two occasions: at the beginning of the hospital stay, after they had reached respiratory, hemodynamic and clinical stability and before discharge from the hospital. The apparatus and technique to measure MIP were adapted because of age-related limitations of the patients. Data on cardiac ejection fraction, ECG, brain natriuretic peptide (BNP) levels and on the use of noninvasive ventilation (NIV) were collected. Results The mean age of the 63 patients under study was 75 years. On admission the mean ejection fraction was 33% (95% CI: 31–35) and the BNP hormone median value was 726.5 pg/ml (range: 217 to 2283 pg/ml); 65% of the patients used NIV. The median value of MIP measured after clinical stabilization was -52.7 cmH2O (range: -20 to -120 cmH2O); 76% of the patients had MIP values below 70% of the predictive value. On discharge, after a median hospital stay of 11 days, the median MIP was -53.5 cmH2O (range:-20 to -150 cmH2O); 71% of the patients maintained their MIP values below 70% of the predictive value. The differences found were not statistically significant. Conclusion Elderly patients admitted with AHF may present a high prevalence of RMW on admission; this condition may be maintained at similar levels on discharge in a large percentage of these patients, even after clinical stabilization of the heart condition. PMID:25671566

  18. Relation between Respiratory Changes in Arterial Pulse Pressure and Fluid Responsiveness in Septic Patients with Acute Circulatory Failure

    Microsoft Academic Search

    FRÉDÉRIC MICHARD; SANDRINE BOUSSAT; DENIS CHEMLA; NADIA ANGUEL; ALAIN MERCAT; YVES LECARPENTIER; CHRISTIAN RICHARD; MICHAEL R. PINSKY; JEAN-LOUIS TEBOUL

    2000-01-01

    In mechanically ventilated patients with acute circulatory failure related to sepsis, we investigated whether the respiratory changes in arterial pressure could be related to the effects of volume ex- pansion (VE) on cardiac index (CI). Forty patients instrumented with indwelling systemic and pulmonary artery catheters were studied before and after VE. Maximal and minimal values of pulse pressure (Pp max

  19. Epidemiology of respiratory infections caused by atypical bacteria in two Kenyan refugee camps.

    PubMed

    Kim, Curi; Nyoka, Raymond; Ahmed, Jamal A; Winchell, Jonas M; Mitchell, Stephanie L; Kariuki Njenga, M; Auko, Erick; Burton, Wagacha; Breiman, Robert F; Eidex, Rachel B

    2012-02-01

    Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella spp. are common causes of atypical pneumonia; however, data about these atypical pathogens are limited in the refugee setting. Paired nasopharyngeal and oropharyngeal specimens were collected from patients with respiratory illness presenting to healthcare centers in two refugee camps in Kenya. The specimens were tested for C. pneumoniae, M. pneumoniae, and Legionella spp. as well as eight respiratory viruses. Atypical pathogens were detected in 5.5% of the specimens of which 54% were co-infected with at least one of the eight viruses tested. Patients positive for atypical bacteria co-infected with virus were significantly more likely to have severe acute respiratory illness than patients infected with only atypical bacteria (P = 0.04). While the percentage of atypical pathogens identified was lower than expected, we found a significant relationship between atypical bacterial-viral co-infection and severity of disease in this refugee population. PMID:21701900

  20. Primary Cutaneous Blastomycosis as a Cause of Acute Respiratory Distress Syndrom

    PubMed Central

    Spear, Joel B.

    2009-01-01

    Blastomycosis is a fungal infection caused by Blastomyces dermatitidis. Exposure in endemic regions frequently occurs when spores in soil are disturbed and subsequently inhaled. Less commonly, primary cutaneous blastomycosis may follow after traumatic inoculation of the fungus into the skin. Most patients infected with blastomycosis are asymptomatic, but an unfortunate small number present with fulminant disease. Rarely, the infection can affect organs, such as the skin, bone, or genitourinary system. In a small percentage of cases, blastomycosis may cause acute respiratory distress syndrome, which is associated with a very high mortality rate. Increased survival rates have been shown when the clinician has a high index of suspicion and facilitates rapid evaluation and initiation of the appropriate therapy. We present a rare case of a patient presenting with primary cutaneous blastomycosis that progressed to disseminated disease causing acute respiratory distress syndrome. High clinical suspicion, prompt diagnostic testing, and therapy with amphotericin B, confirmed the diagnosis and resulted in a swift recovery. PMID:20729940

  1. Respiratory failure due to upper airway obstruction in children: use of the helmet as bridge interface.

    PubMed

    Racca, F; Cutrera, R; Robba, C; Caldarelli, V; Paglietti, M; De Angelis, M C; Sekhon, M S; Gualino, J; Bella, C; Passoni, N; Ranieri, V M

    2015-02-01

    Upper airway obstruction (UAO) can cause severe respiratory distress in young children by increasing inspiratory muscle load and decreasing alveolar ventilation, ultimately resulting in hypercapnia and hypoxemia which have long term negative cardiovascular effects. Although non-invasive continuous positive airway pressure (CPAP) improves gas exchange in these patients, use of conventional interfaces (nasal mask, nasal pillow and facial mask) may cause significant discomfort and lead to CPAP intolerance. We report five cases of children affected by UAO who experienced CPAP intolerance via application of conventional interfaces. Alternatively, we acutely applied helmet-CPAP which resulted in improved breathing pattern and gas exchange. Thereafter, patients received training with respect to a nasal CPAP interface, allowing successful long term treatment. In conclusion, these five clinical cases demonstrate that helmet-CPAP can be used acutely in children with UAO if compliance to conventional modalities is problematic, allowing for sufficient time to achieve compliance to nasal-CPAP. PMID:24918190

  2. Six minute walking distance in kyphoscoliosis patients with chronic respiratory failure

    PubMed Central

    2010-01-01

    Aim To evaluate kyphoscoliosis patients with chronic hypercapnic respiratory failure (CHRF) using the six minute walk test (6MWT) distance (6MWD) and cardio-pulmonary function tests. Method This prospective cross-sectional study was carried out in a tertiary training and research hospital in Turkey. Kyphoscoliosis patients with CHRF on home mechanical ventilation (HMV) followed in a respiratory intensive care unit (RICU) out-patient clinic were enrolled. Patients' demographics were recorded as well as transthoracic echocardiography (ECHO), 6MWD, spirometry, arterial blood gas (ABG) values and high resolution chest computed tomography. 6MWT results were compared with other parameters. Results Thirty four patients with kyphoscoliosis and chronic respiratory insufficiency admitted to our outpatient clinic were included in the study but 25 (17 M) patients underwent 6MWT (8 patients walked with oxygen supplement due to PaO2 < 60 mm Hg). The mean 6MWD was 274.4 ± 76.2 (median 270) m and median 6MWD predicted rate was 43.7% (inter quartile ratio, IQR, 37.6% to 47.7%). Median HMV use was 3 years (IQR 2-4). 6MWD predicted rate, body mass index (BMI), HMV duration were similar in male and female patients. 6MWD correlated well with age, BMI, dyspnea score for baseline 6MWT (r: - 0.59, p < 0.002, r: - 0.58, p < 0.003, r: - 0.55, p < 0.005 respectively) but modestly with forced expiratory volume in one second, pulse rate for baseline 6MWT, pulse saturation rate, fatigue and dyspnea score at end of 6MWT (r: - 0.44, p < 0.048; r: 0.44, p < 0.027; r: - 0.43, p < 0.031; r: - 0.42, p < 0.036; r: - 0.42, p < 0.034 respectively). 6MWD predicted rate was only correlated with dyspnea score at baseline (r: - 0.46, p < 0.022). The systolic pulmonary arterial pressure (PAPs) in 6 (24%) cases was more than 40 mmHg, in whom mean PaO2/FiO2 was 301.4 ± 55.4 compared to 280.9 ± 50.2 in those with normal PAPs (p > 0.40). Conclusion The 6MWT is an easy way to evaluate physical performance limitation in kyphoscoliosis patients with chronic hypercapnic respiratory failure using home mechanical ventilation. Nearly 275 m was the mean distance walked in the 6MWT, but rather than distance in meters, the 6MWD predicted rate according to gender and body mass index equation might be a better way for deciding about physical performance of these patients. Dyspnea score at baseline before the 6MWT may be the most important point that affects 6MWD in this patient population. PMID:22958538

  3. 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

  4. Extracorporeal membrane oxygenation in adult patients with hematologic malignancies and severe acute respiratory failure

    PubMed Central

    2014-01-01

    Introduction Acute respiratory failure (ARF) is the main reason for intensive care unit (ICU) admissions in patients with hematologic malignancies (HMs). We report the first series of adult patients with ARF and HMs treated with extracorporeal membrane oxygenation (ECMO). Methods This is a retrospective cohort study of 14 patients with HMs (aggressive non-Hodgkin lymphoma (NHL) n?=?5; highly aggressive NHL, that is acute lymphoblastic leukemia or Burkitt lymphoma, n?=?5; Hodgkin lymphoma, n?=?2; acute myeloid leukemia, n?=?1; multiple myeloma, n?=?1) receiving ECMO support because of ARF (all data as medians and interquartile ranges; age, 32 years (22 to 51 years); simplified acute physiology score II (SAPS II): 51 (42 to 65)). Etiology of ARF was pneumonia (n?=?10), thoracic manifestation of NHL (n?=?2), sepsis of nonpulmonary origin (n?=?1), and transfusion-related acute lung injury (n?=?1). Diagnosis of HM was established during ECMO in four patients, and five first received (immuno-) chemotherapy on ECMO. Results Before ECMO, the PaO2/FiO2 ratio was 60 (53 to 65), (3.3 to 3.7). Three patients received venoarterial ECMO because of acute circulatory failure in addition to ARF; all other patients received venovenous ECMO. All patients needed vasopressors, and five needed hemofiltration. Thrombocytopenia occurred in all patients (lowest platelet count was 20 (11 to 21) G/L). Five major bleeding events were noted. ECMO duration was 8.5 (4 to 16) days. ICU and hospital survival was 50%. All survivors were alive at follow-up (36 (10 to 58) months); five patients were in complete remission, one in partial remission, and one had relapsed. Conclusions ECMO therapy is feasible in selected patients with HMs and ARF and can be associated with long-term disease-free survival. PMID:24443905

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

    PubMed Central

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

    2013-01-01

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

  6. 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

  7. Cardiorenal Syndrome Caused by Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Lazzeri, Chiara; Valente, Serafina; Tarquini, Roberto; Gensini, Gian Franco

    2011-01-01

    Since cardiorenal dysfunction is usually secondary to multiple factors acting in concert (and not only reduced cardiac output) in the present paper we are going to focus on the interrelationship between heart failure with normal ejection fraction and the development of cardiorenal syndrome. The coexistence of renal impairment in heart failure with preserved ejection fraction (CRS type 2 and 4) is common especially in older females with hypertension and/or diabetes. It can be hypothesized that the incidence of this disease association is growing, while clinical trials enrolling these patients are still lacking. The main mechanisms thought to be involved in the pathophysiology of this condition are represented by the increase of intra-abdominal and central venous pressure and the activation of the renin-angiotensin system. Differently from CRS in heart failure with reduced ejection fraction, the involvement of the kidney may be under-diagnosed in patients with heart failure and preserved ejection fraction and the optimal therapeutic strategy in this condition, though challenging, is far to be completely elucidated. Further studies are needed to assess the best therapeutic regimen in patients with renal dysfunction (and worsening) and heart failure and preserved ejection fraction. PMID:21331316

  8. Mixed Acid-Base Disorders, Hydroelectrolyte Imbalance and Lactate Production in Hypercapnic Respiratory Failure: The Role of Noninvasive Ventilation

    PubMed Central

    Terzano, Claudio; Di Stefano, Fabio; Conti, Vittoria; Di Nicola, Marta; Paone, Gregorino; Petroianni, Angelo; Ricci, Alberto

    2012-01-01

    Background Hypercapnic Chronic Obstructive Pulmonary Disease (COPD) exacerbation in patients with comorbidities and multidrug therapy is complicated by mixed acid-base, hydro-electrolyte and lactate disorders. Aim of this study was to determine the relationships of these disorders with the requirement for and duration of noninvasive ventilation (NIV) when treating hypercapnic respiratory failure. Methods Sixty-seven consecutive patients who were hospitalized for hypercapnic COPD exacerbation had their clinical condition, respiratory function, blood chemistry, arterial blood gases, blood lactate and volemic state assessed. Heart and respiratory rates, pH, PaO2 and PaCO2 and blood lactate were checked at the 1st, 2nd, 6th and 24th hours after starting NIV. Results Nine patients were transferred to the intensive care unit. NIV was performed in 11/17 (64.7%) mixed respiratory acidosis–metabolic alkalosis, 10/36 (27.8%) respiratory acidosis and 3/5 (60%) mixed respiratory-metabolic acidosis patients (p?=?0.026), with durations of 45.1±9.8, 36.2±8.9 and 53.3±4.1 hours, respectively (p?=?0.016). The duration of ventilation was associated with higher blood lactate (p<0.001), lower pH (p?=?0.016), lower serum sodium (p?=?0.014) and lower chloride (p?=?0.038). Hyponatremia without hypervolemic hypochloremia occurred in 11 respiratory acidosis patients. Hypovolemic hyponatremia with hypochloremia and hypokalemia occurred in 10 mixed respiratory acidosis–metabolic alkalosis patients, and euvolemic hypochloremia occurred in the other 7 patients with this mixed acid-base disorder. Conclusions Mixed acid-base and lactate disorders during hypercapnic COPD exacerbations predict the need for and longer duration of NIV. The combination of mixed acid-base disorders and hydro-electrolyte disturbances should be further investigated. PMID:22539963

  9. Fatal renal failure caused by diethylene glycol in paracetamol elixir: the Bangladesh epidemic

    Microsoft Academic Search

    Mohammed Hanif; M Reaz Mobarak; Anne Ronan; Dilruba Rahman; John J Donovan; Michael L Bennish

    1995-01-01

    AbstractObjective: To determine the cause of a large increase in the number of children with unexplained renal failure.Design: Case-control study.Setting: Children's hospital in Dhaka, Bangladesh.Subjects: Cases were all 339 children with initially unexplained renal failure; controls were 90 children with cause of renal failure identified; all were admitted to hospital during 35 months after January 1990.Main outcome measures: Differences between

  10. CT Arterial Portography: Causes of Technical Failure and Variable Liver Enhancement

    Microsoft Academic Search

    Erik K. Paulson; Mark E. Baker; David J. Hilleren; William P. Jones; Mark H. Knelson; Scott N. NadeF; Richard A. Leder; William C. Meyers

    OBJECTIVE. We studied the causes of technical failure and enhancement variability encountered during CT arterial portography. MATERIALS AND METHODS. CT arterial portograms and digital artenograms were obtained via the superior mesenteric artery before partial liver resection in 43 patients with malignant tumors. These studies were reviewed for causes of technical failure and variable enhancement. RESULTS. Eleven (26%) of 43 procedures

  11. The Impact of Vaccination on Influenza-Related Respiratory Failure and Mortality in Hospitalized Elderly Patients Over the 2013-2014 Season

    PubMed Central

    Joshi, Manish; Chandra, Deepak; Mittadodla, Penchala; Bartter, Thaddeus

    2015-01-01

    Background : Seasonal Influenza (“the flu”) is a respiratory illness caused by influenza viruses. Yearly influenza vaccination is considered to be protective against illness and/or severity of illness and is recommended by CDC for all individuals > 6 months of age. However, the effectiveness of influenza vaccine in older individuals has come under question. Objectives : To describe the clinical characteristics and treatment outcomes of patients admitted to an academic tertiary care Veterans Administration hospital with influenza during the 2013-2014 influenza season and determine the impact, if any, of prior influenza vaccination upon patient outcomes. Methods : Medical electronic records were searched for all patients admitted to the Little Rock Veterans Administration Hospital with proven influenza during the 2013-2014 influenza season. Cohorts of vaccinated and non-vaccinated patients were then compared to determine the impact of prior influenza vaccination upon respiratory-failure and mortality. Results : Seventy patients met selection criteria. Mean age was 66 years. Sixty-four (91%) patients had at least one underlying co-morbid condition; these conditions included COPD, congestive heart failure, diabetes, and cancer. 60/70 (85%) tested positive for Influenza A, and 43 tested positive for H1N1. Oseltamivir was initiated in 55 (78%) patients. Forty-four percent of the patients had been vaccinated. When separated by vaccination status, those who had been vaccinated had higher rates of ICU admission, need for mechanical or non-invasive ventilation, and mortality. All but mortality reached statistical significance. Conclusion : The data suggest that there was no protective effect from prior vaccination in preventing hospital admission, respiratory failure, and mortality in this population of older men admitted to the hospital with influenza.

  12. Rectal atresia: a rare cause of failure to pass meconium

    PubMed Central

    Laamrani, Fatima Zahrae; Dafiri, Rachida

    2014-01-01

    Rectal atresia or stenosis is an extremely rare anorectal malformation associating a normal anal canal with a stricture or a complete rectal atresia. We describe a case of rectal atresia in a newborn female presenting with an abdominal distension and failure of passing meconium.

  13. Tests find hammering, fluid cutting, erosion cause float shoe failures

    Microsoft Academic Search

    Stringfellow

    1985-01-01

    The results of a systematic test program to evaluate float equipment performance are presented. The testing has destroyed, over an eightmonth period, 160 float valves, float shoes and float collars. A new float valve design with greater resistance to failure has been developed as a result of the testing. New float collars and float shoes are expected to provide the

  14. Clostridium difficile causing acute renal failure: Case presentation and review

    Microsoft Academic Search

    Jasmin Arrich; Gottfried H. Sodeck; Gürkan Sengölge; Christoforos Konnaris; Marcus Müllner; Anton N. Laggner; Hans Domanovits

    Abstract Abstract Abstract Abstract AIM: Clostridium difficile infection is primarily a nosocomial infection but asymptomatic carriers of Clostridium difficile can be found in up to 5% of the general population. Ampicillin, cephalosporins and clindamycin are the antibiotics that are most frequently associated with Clostridium difficile-associated diarrhea or colitis. Little is known about acute renal failure as a consequence of Clostridium

  15. Renal Failure Caused by Malakoplakia Lesions of the Urinary Bladder

    PubMed Central

    Stamatiou, Konstantinos; Chelioti, Eleni; Tsavari, Aikaterini; Koulia, Kalliroi; Papalexandrou, Alexia; Efthymiou, Evdokia; Tsilivigkou, Maria; Vasilakaki, Thivi

    2014-01-01

    ?alakoplakia is a rare inflammatory condition of the urogenital tract. The most frequently affected organ is urinary bladder. This condition has features of a granulomatous inflammation, the pathogenesis of which is not well understood. In this study, we presented a case of urinary bladder malakoplakia associated with advanced obstructive uropathy and renal failure. PMID:25695020

  16. Catastrophic Failures in Power Systems: Causes, Analyses, and Countermeasures

    Microsoft Academic Search

    JAIME DE LA REE; Yilu Liu; LAMINE MILI; ARUN G. PHADKE; LUIZ DASILVA

    2005-01-01

    Catastrophic failures of power systems are phenomena which occur with some regularity throughout the world. It is recognized that these cannot be prevented, although with the use of newer developments in power engineering, in communication systems, and in computer engineering it would be possible to reduce their frequency and their impact on society. Analyses of many blackouts point to some

  17. Effect of Selected Antiasthmatic Plant Constituents Against Micro Organism Causing Upper Respiratory Tract Infection

    PubMed Central

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

    2010-01-01

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

  18. Inhaled nitric oxide therapy during the transport of neonates with persistent pulmonary hypertension or severe hypoxic respiratory failure

    Microsoft Academic Search

    Calvin G. Lowe; Johnn G. Trautwein

    2007-01-01

    Our aim was to determine whether starting inhaled nitric oxide (iNO) on critically ill neonates with severe hypoxemic respiratory\\u000a failure and\\/or persistent pulmonary hypertension (PPH), at a referring hospital at the start of transport, decreases the need\\u000a for extracorporeal membrane oxygenation (ECMO), lessens the number of hospital days and improves survival in comparison with\\u000a those patients who were started on

  19. 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.

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

    PubMed Central

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

    2015-01-01

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

  1. Visual failure caused by raised intracranial pressure in craniosynostosis

    Microsoft Academic Search

    P. Stavrou; S. Sgouros; H. E. Willshaw; J. H. Goldin; A. D. Hockley; M. J. C. Wake

    1997-01-01

    Craniosynostosis, the premature fusion of one or multiple cranial sutures, can be complicated by visual failure resulting\\u000a from raised intracranial pressure (ICP). Of the 290 children operated on at the Birmingham Children's Hospital between 1978\\u000a and 1995 for craniosynostosis, 9 were found to have defective visual acuity attributable to raised ICP. Mean age at presentation\\u000a was 3.11 years (range: 1–6

  2. 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

  3. Middle East respiratory syndrome coronavirus: another zoonotic betacoronavirus causing SARS-like disease.

    PubMed

    Chan, Jasper F W; Lau, Susanna K P; To, Kelvin K W; Cheng, Vincent C C; Woo, Patrick C Y; Yuen, Kwok-Yung

    2015-04-01

    The source of the severe acute respiratory syndrome (SARS) epidemic was traced to wildlife market civets and ultimately to bats. Subsequent hunting for novel coronaviruses (CoVs) led to the discovery of two additional human and over 40 animal CoVs, including the prototype lineage C betacoronaviruses, Tylonycteris bat CoV HKU4 and Pipistrellus bat CoV HKU5; these are phylogenetically closely related to the Middle East respiratory syndrome (MERS) CoV, which has affected more than 1,000 patients with over 35% fatality since its emergence in 2012. All primary cases of MERS are epidemiologically linked to the Middle East. Some of these patients had contacted camels which shed virus and/or had positive serology. Most secondary cases are related to health care-associated clusters. The disease is especially severe in elderly men with comorbidities. Clinical severity may be related to MERS-CoV's ability to infect a broad range of cells with DPP4 expression, evade the host innate immune response, and induce cytokine dysregulation. Reverse transcription-PCR on respiratory and/or extrapulmonary specimens rapidly establishes diagnosis. Supportive treatment with extracorporeal membrane oxygenation and dialysis is often required in patients with organ failure. Antivirals with potent in vitro activities include neutralizing monoclonal antibodies, antiviral peptides, interferons, mycophenolic acid, and lopinavir. They should be evaluated in suitable animal models before clinical trials. Developing an effective camel MERS-CoV vaccine and implementing appropriate infection control measures may control the continuing epidemic. PMID:25810418

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

    PubMed Central

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

    2015-01-01

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

  5. Epidemiology and Outcomes of Acute Respiratory Failure in the United States, 2001 – 2009: A National Survey

    PubMed Central

    Stefan, Mihaela S.; Shieh, Meng-Shiou; Pekow, Penelope S.; Rothberg, Michael B.; Steingrub, Jay S.; Lagu, Tara; Lindenauer, Peter K.

    2012-01-01

    Background The objective of this study was to evaluate trends in hospitalization, cost, and short-term outcomes in acute respiratory failure (ARF) between 2001 and 2009 in the United States. Methods Using the Nationwide Inpatient Sample we identified cases of ARF based on International Classification for Diseases, Ninth Revision, Clinical Modification codes. We calculated weighted frequencies of ARF hospitalizations by year and estimated population adjusted incidence and mortality rates. We used logistic regression to examine hospital mortality rates over time while adjusting for changes in demographic characteristics and comorbidities of patients. Results The number of hospitalizations with a diagnosis of ARF rose from 1,007,549 in 2001 to 1,917,910 in 2009 with an associated increase in total hospital costs from 30.1 billion to 54.3 billion. During the same period we observed a decrease in hospital mortality from 27.6% in 2001 to 20.6% in 2009, a slight decline in average length of stay from 7.8 days to 7.1 days, and no significant change in the mean cost per case ($ 15, 900). Rates of mechanical ventilation (noninvasive, NIV or invasive mechanical ventilation, IMV) remained stable over the nine-year period and the use of NIV increased from 4% in 2001 to 10% in 2009. Conclusions Over the period of 2001–2009 there was a steady increase in the number of hospitalizations with a discharge diagnosis of ARF, with a decrease in inpatient mortality. There was a significant shift during this time toward the use of NIV, with a decrease in the rates of IMV use. PMID:23335231

  6. 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

  7. Etiological factors causing lower respiratory tract infections isolated from hospitalized patients.

    PubMed

    Guzek, A; Rybicki, Z; Korzeniewski, K; Mackiewicz, K; Saks, E; Chcia?owski, A; Zwoli?ska, E

    2015-01-01

    Lower respiratory tract infections (LRTI) account for 20-30 % of all hospital-acquired contagions. They are characterized by high mortality of hospitalized patients. The most serious form of LRTI is pneumonia, and the most common etiological factors in such cases are bacteria. The article gives the analysis of bacterial flora samples obtained from lower respiratory tract of hospitalized patients. In vitro susceptibility of pathogens to selected antibiotics has also been assessed. We carried out a retrospective analysis of 1,171 bacterial strains isolated from 1,171 patients treated in clinics of the Military Institute of Medicine in Warsaw, Poland. In most cases the samples were collected from an endotracheal or tracheostomic tube (71.5 %) and from bronchoalveolar lavage (21.7 %). The most commonly isolated pathogens included Acinetobacter baumannii (35.8 %), Staphylococcus aureus (27.6 %), Klebsiella pneumoniae (19.4 %), and Pseudomonas aeruginosa (16.2 %). Multidrug-resistant gram-negative bacteria exhibited 100 % susceptibility to colistin only. Klebsiella pneumoniae ESBL+ and Acinetobacter baumannii were most susceptible to carbapenems, while Pseudomonas aeruginosa strains to ceftazidime. Methicillin-resistant Staphylococcus aureus were 100 % susceptible to vancomycin, linezolid, and tigecycline. In conclusion, identifying the etiological factors causing infections of the lower respiratory tract and determining their drug-susceptibility is of key importance in empirical treatment. PMID:25310945

  8. Inference for the Dependent Competing Risks Model with Masked Causes of Failure

    Microsoft Academic Search

    Radu V. Craiu; Benjamin Reiser

    2006-01-01

    The competing risks model is useful in settings in which individuals\\/units may die\\/fail for different reasons. The cause specific\\u000a hazard rates are taken to be piecewise constant functions. A complication arises when some of the failures are masked within\\u000a a group of possible causes. Traditionally, statistical inference is performed under the assumption that the failure causes\\u000a act independently on each

  9. Efficacy of high-flow oxygen by nasal cannula with active humidification in a patient with acute respiratory failure of neuromuscular origin.

    PubMed

    Díaz-Lobato, Salvador; Folgado, Miguel Angel; Chapa, Angel; Mayoralas Alises, Sagrario

    2013-12-01

    The treatment of choice for patients with respiratory failure of neuromuscular origin, especially in patients with hypercapnic respiratory acidosis, is noninvasive ventilation (NIV). Endotracheal intubation and invasive ventilation are indicated for patients with severe respiratory compromise or failure of NIV. In recent years, high-flow oxygen therapy and active humidification devices have been introduced, and emerging evidence suggests that high-flow oxygen may be effective in various clinical settings, such as acute respiratory failure, after cardiac surgery, during sedation and analgesia, in acute heart failure, in hypoxemic respiratory distress, in do-not-intubate patients, in patients with chronic cough and copious secretions, pulmonary fibrosis, or cancer, in critical areas and the emergency department. We report on a patient with amyotrophic lateral sclerosis who arrived at the emergency department with acute hypercapnic respiratory failure. She did not tolerate NIV and refused intubation, but was treated successfully with heated, humidified oxygen via high-flow nasal cannula. Arterial blood analysis after an hour on high-flow nasal cannula showed improved pH, P(aCO2), and awareness. The respiratory acidosis was corrected, and she was discharged after 5 days of hospitalization. Her response to high-flow nasal cannula was similar to that expected with NIV. We discuss the mechanisms of action of heated, humidified high-flow oxygen therapy. PMID:23650430

  10. Bilateral botryoid nephroblastoma: a rare cause of renal failure

    PubMed Central

    Conlon, Niamh; Teoh, Chia Wei; Pears, Jane; O’Sullivan, Maureen

    2012-01-01

    The authors describe the case of a 16-month-old girl who presented with bilateral hydronephrosis and renal failure secondary to bilateral renal pelvic botryoid Wilms’ tumour (nephroblastoma). The term ‘botryoid’ describes an intrapelvic polypoid renal Wilms tumour, either extending from the renal parenchyma or primarily pelvis-based tumour. Both tumours filled the renal pelvis and extended down the proximal ureter, with no intraparenchymal tumour seen. Bilateral intralobar nephrogenic rests were present. Histological examination demonstrated triphasic nephroblastoma, with focal rhabdomyomatous differentiation of the stromal element bilaterally. Postchemotherapy, the patient underwent bilateral nephrectomy. Post complete resection of her bilateral disease, this patient has had an excellent outcome. This is only the third reported case of bilateral botryoid Wilms’ tumour. While the condition is extremely rare, it should be included in the differential diagnosis of a young child with bilateral renal pelvic masses. PMID:22962373

  11. Respiratory Viral Infections in Infants: Causes, Clinical Symptoms, Virology, and Immunology

    PubMed Central

    Tregoning, John S.; Schwarze, Jürgen

    2010-01-01

    Summary: In global terms, respiratory viral infection is a major cause of morbidity and mortality. Infancy, in particular, is a time of increased disease susceptibility and severity. Early-life viral infection causes acute illness and can be associated with the development of wheezing and asthma in later life. The most commonly detected viruses are respiratory syncytial virus (RSV), rhinovirus (RV), and influenza virus. In this review we explore the complete picture from epidemiology and virology to clinical impact and immunology. Three striking aspects emerge. The first is the degree of similarity: although the infecting viruses are all different, the clinical outcome, viral evasion strategies, immune response, and long-term sequelae share many common features. The second is the interplay between the infant immune system and viral infection: the immaturity of the infant immune system alters the outcome of viral infection, but at the same time, viral infection shapes the development of the infant immune system and its future responses. Finally, both the virus and the immune response contribute to damage to the lungs and subsequent disease, and therefore, any prevention or treatment needs to address both of these factors. PMID:20065326

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

    E-print Network

    Zand, Robert

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

  13. Acute respiratory failure onset in a patient with Guillain-Barré syndrome after Legionella-associated pneumonia: a case report.

    PubMed

    Vigneri, Simone; Spadaro, Savino; Farinelli, Ilaria; Ragazzi, Riccardo; Volta, Carlo A; Capone, Jay G; Sette, Elisabetta; Tugnoli, Valeria

    2014-12-01

    A 69-year-old white man was admitted because of a clinical history of persistent cough and fever. Chest x-rays showed bilateral lung infiltrates with air bronchograms, whereas the urine antigen test resulted positive for Legionella pneumophila. The next day, he was transferred to the intensive care unit and intubated because of severe renal and respiratory distress. Neurological examination revealed distal weakness and loss of deep tendon reflexes in lower extremities. Nerve conduction studies displayed severe demyelinating sensorimotor polyneuropathy, and plasmapheresis was therefore applied with mild improvement. Few weeks after, dysphagia occurred and electrophysiologic tests showed progressive axonal involvement with spread of demyelination to the cranial nerves. The patient underwent a new plasmapheresis course and slowly reached stable clinical improvement of neurological status, which allowed him to be safely discharged. This case showed a critical onset with respiratory failure and kidney functional impairment due to L. pneumophila, subsequently disclosing Guillain-Barré syndrome. PMID:25415518

  14. Causes for the failure of water-heater pipes in ammonia production

    Microsoft Academic Search

    M. B. Shapiro; Yu. P. Surkov; M. B. Chizhmakov; A. L. Belinkii; O. M. Sokolova; V. G. Rybalko

    1987-01-01

    The causes for the failure of subassemblies and components of apparatus used for chemical production should be diagnosed using modern methods of investigation for the complex study of the properties of the damaged metal and the character of the fracture. We investigated the character and causes of the failure of type 12KhlSNIOT steel pipes 21.7 Ť 3.5 mm in diameter,

  15. A cohort study to identify simple clinical tests for chronic respiratory failure in obese patients with sleep-disordered breathing

    PubMed Central

    Mandal, S; Suh, E S; Boleat, E; Asher, W; Kamalanathan, M; Lee, K; Douiri, A; Murphy, P B; Steier, J; Hart, N

    2014-01-01

    Background Chronic respiratory failure complicating sleep-disordered breathing in obese patients has important adverse clinical implications in terms of morbidity, mortality and healthcare utilisation. Screening strategies are essential to identify obese patients with chronic respiratory failure. Method Prospective data were collected from patients with obesity-related sleep-disordered breathing admitted for respiratory assessment at a UK national sleep and ventilation centre. Hypercapnia was defined as an arterial partial pressure of carbon dioxide of >6kPa. Results 245 obese patients (56±13?years) with a body mass index of 48±12?kg/m2, forced vital capacity (FVC) of 2.1±1.1?L, daytime oximetry (SpO2) of 91±6% and abnormal overnight oximetry were included in the analysis. Receiver operator curve analysis for the whole group showed that an FVC ?3?L had a sensitivity of 90% and a specificity of 41% in predicting hypercapnia, and an SpO2 ?95% had a sensitivity of 83% and a specificity of 63% in predicting hypercapnia. Gender differences were observed and receiver operator curve analysis demonstrated ‘cut-offs’ for (1) SpO2 of ?95% for men and ?93% for women and (2) FVC of ?3.5?L for men and ?2.3?L for women, in predicting hypercapnia. Conclusions The measurement of FVC and clinic SpO2 in obese patients with abnormal overnight limited respiratory studies predicted hypercapnia. This may have clinical utility in stratifying patients attending sleep clinics. PMID:25478174

  16. Effects of Glycinergic Inhibition Failure on Respiratory Rhythm and Pattern Generation

    PubMed Central

    Shevtsova, Natalia A.; Büsselberg, Dietrich; Molkov, Yaroslav I.; Bischoff, Anne M.; Smith, Jeffrey C.; Richter, Diethelm W.; Rybak, Ilya A.

    2014-01-01

    Inhibitory interactions between neurons of the respiratory network are involved in rhythm generation and pattern formation. Using a computational model of brainstem respiratory networks, we investigated the possible effects of suppressing glycinergic inhibition on the activity of different respiratory neuron types. Our study revealed that progressive suppression of glycinergic inhibition affected all neurons of the network and disturbed neural circuits involved in termination of inspiration. Causal was a dysfunction of postinspiratory inhibition targeting inspiratory neurons, which often led to irregular preterm reactivation of these neurons, producing double or multiple short-duration inspiratory bursts. An increasing blockade of glycinergic inhibition led to apneustic inspiratory activity. Similar disturbances of glycinergic inhibition also occur during hypoxia. A clear difference in prolonged hypoxia, however, is that the rhythm terminates in expiratory apnea. The critical function of glycinergic inhibition for normal respiratory rhythm generation and the consequences of its reduction, including in pathological conditions, are discussed. PMID:24746041

  17. 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

  18. Hypercapnic respiratory failure and partial upper airway obstruction during high frequency oscillatory ventilation in an adult burn patient

    Microsoft Academic Search

    Andrew B. Cooper; Avinash Islur; Manuel Gomez; Gordon L. Goldenson; Robert C. Cartotto

    2002-01-01

    Purpose  To present a case of severe hypercapnic respiratory failure in an adult burn patient and to describe our clinical problem\\u000a solving approach during support with an unconventional mode of mechanical ventilation.\\u000a \\u000a \\u000a \\u000a Clinical features  A 19-yr-old male with smoke inhalation and flame burns to 50% total body surface area was admitted to the Ross Tilley Burn\\u000a Centre. High frequency oscillatory ventilation (HFOV)

  19. Spontaneous Pneumomediastinum, Pneumopericardium, and Pneumothorax with Respiratory Failure in a Patient with AIDS and Pneumocystis jirovecii Pneumonia.

    PubMed

    Park, Yun Kyung; Jung, Hee Chan; Kim, Shin Young; Kim, Min Young; Jo, Kwanhoon; Kim, Se Young; Kang, Borami; Woo, Gihyeon; Choi, Hyun Joo; Wie, Seong-Heon

    2014-09-01

    Spontaneous pneumothorax occurs in up to 35% of patients with Pneumocystis jirovecii pneumonia. However, spontaneous pneumomediastinum and pneumopericardium are uncommon complications in patients infected with human immunodeficiency virus, with no reported incidence rates, even among patients with acquired immunodeficiency syndrome (AIDS) and P. jirovecii pneumonia. We report a case of spontaneous pneumomediastinum, pneumopericardium, and pneumothorax with respiratory failure during treatment of P. jirovecii pneumonia in a patient with AIDS; the P. jirovecii infection was confirmed by performing methenamine silver staining of bronchoalveolar lavage specimens. This case suggests that spontaneous pneumomediastinum and pneumopericardium should be considered in patients with AIDS and P. jirovecii pneumonia. PMID:25298911

  20. Spontaneous Pneumomediastinum, Pneumopericardium, and Pneumothorax with Respiratory Failure in a Patient with AIDS and Pneumocystis jirovecii Pneumonia

    PubMed Central

    Park, Yun Kyung; Jung, Hee Chan; Kim, Shin Young; Kim, Min Young; Jo, Kwanhoon; Kim, Se Young; Kang, Borami; Woo, Gihyeon; Choi, Hyun Joo

    2014-01-01

    Spontaneous pneumothorax occurs in up to 35% of patients with Pneumocystis jirovecii pneumonia. However, spontaneous pneumomediastinum and pneumopericardium are uncommon complications in patients infected with human immunodeficiency virus, with no reported incidence rates, even among patients with acquired immunodeficiency syndrome (AIDS) and P. jirovecii pneumonia. We report a case of spontaneous pneumomediastinum, pneumopericardium, and pneumothorax with respiratory failure during treatment of P. jirovecii pneumonia in a patient with AIDS; the P. jirovecii infection was confirmed by performing methenamine silver staining of bronchoalveolar lavage specimens. This case suggests that spontaneous pneumomediastinum and pneumopericardium should be considered in patients with AIDS and P. jirovecii pneumonia. PMID:25298911

  1. 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.

  2. Ocular Tropism of Respiratory Viruses

    PubMed Central

    Rota, Paul A.; Tumpey, Terrence M.

    2013-01-01

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

  3. Induction of protective effector immunity to prevent pathogenesis caused by the respiratory syncytial virus. Implications on therapy and vaccine design.

    PubMed

    Espinoza, Janyra A; Bueno, Susan M; Riedel, Claudia A; Kalergis, Alexis M

    2014-09-01

    Human respiratory syncytial virus (hRSV) is the leading cause of respiratory illness in infants and young children around the globe. This pathogen, which was discovered in 1956, continues to cause a huge number of hospitalizations due to respiratory disease and it is considered a health and economic burden worldwide, especially in developing countries. The immune response elicited by hRSV infection leads to lung and systemic inflammation, which results in lung damage but is not efficient at preventing viral replication. Indeed, natural hRSV infection induces a poor immune memory that allows recurrent infections. Here, we review the most recent knowledge about the lifecycle of hRSV, the immune response elicited by this virus and the subsequent pathology induced in response to infection in the airways. Novel findings about the alterations that this virus causes in the central nervous system and potential therapies and vaccines designed to treat or prevent hRSV infection are discussed. PMID:24801878

  4. Mitochondrial reactive oxygen species production and respiratory complex activity in rats with pressure overload-induced heart failure.

    PubMed

    Schwarzer, Michael; Osterholt, Moritz; Lunkenbein, Anne; Schrepper, Andrea; Amorim, Paulo; Doenst, Torsten

    2014-09-01

    We investigated the impact of cardiac reactive oxygen species (ROS) during the development of pressure overload-induced heart failure. We used our previously described rat model where transverse aortic constriction (TAC) induces compensated hypertrophy after 2 weeks, heart failure with preserved ejection fraction at 6 and 10 weeks, and heart failure with systolic dysfunction after 20 weeks. We measured mitochondrial ROS production rates, ROS damage and assessed the therapeutic potential of in vivo antioxidant therapies. In compensated hypertrophy (2 weeks of TAC) ROS production rates were normal at both mitochondrial ROS production sites (complexes I and III). Complex I ROS production rates increased with the appearance of diastolic dysfunction (6 weeks of TAC) and remained high thereafter. Surprisingly, maximal ROS production at complex III peaked at 6 weeks of pressure overload. Mitochondrial respiratory capacity (state 3 respiration) was elevated 2 and 6 weeks after TAC, decreased after this point and was significantly impaired at 20 weeks, when contractile function was also impaired and ROS damage was found with increased hydroxynonenal. Treatment with the ROS scavenger ?-phenyl-N-tert-butyl nitrone or the uncoupling agent dinitrophenol significantly reduced ROS production rates at 6 weeks. Despite the decline in ROS production capacity, no differences in contractile function between treated and untreated animals were observed. Increased ROS production occurs early in the development of heart failure with a peak at the onset of diastolic dysfunction. However, ROS production may not be related to the onset of contractile dysfunction. PMID:24951621

  5. Oscillatory behavior of ventricular action potential duration in heart failure patients at respiratory rate and low frequency.

    PubMed

    Hanson, Ben; Child, Nick; Van Duijvenboden, Stefan; Orini, Michele; Chen, Zhong; Coronel, Ruben; Rinaldi, Christopher A; Gill, Jaspal S; Gill, Jaswinder S; Taggart, Peter

    2014-01-01

    Oscillations of arterial pressure occur spontaneously at a frequency of approximately 0.1 Hz coupled with synchronous oscillations of sympathetic nerve activity ("Mayer waves"). This study investigated the extent to which corresponding oscillations may occur in ventricular action potential duration (APD). Fourteen ambulatory (outpatient) heart failure patients with biventricular pacing devices were studied while seated upright watching movie clips to maintain arousal. Activation recovery intervals (ARI) as a measure of ventricular APD were obtained from unipolar electrograms recorded from the LV epicardial pacing lead during steady state RV pacing from the device. Arterial blood pressure was measured non-invasively (Finapress) and respiration monitored. Oscillations were quantified using time frequency and coherence analysis. Oscillatory behavior of ARI at the respiratory frequency was observed in all subjects. The magnitude of the ARI variation ranged from 2.2 to 6.9 ms (mean 5.0 ms). Coherence analysis showed a correlation with respiratory oscillation for an average of 43% of the recording time at a significance level of p < 0.05. Oscillations in systolic blood pressure in the Mayer wave frequency range were observed in all subjects for whom blood pressure was recorded (n = 13). ARI oscillation in the Mayer wave frequency range was observed in 6/13 subjects (46%) over a range of 2.9 to 9.2 ms. Coherence with Mayer waves at the p < 0.05 significance level was present for an average of 29% of the recording time. In ambulatory patients with heart failure during enhanced mental arousal, left ventricular epicardial APD (ARI) oscillated at the respiratory frequency (approximately 0.25 Hz). In 6 patients (46%) APD oscillated at the slower Mayer wave frequency (approximately 0.1 Hz). These findings may be important in understanding sympathetic activity-related arrhythmogenesis. PMID:25389408

  6. Multiple, Bilateral Fibroepithelial Polyps Causing Acute Renal Failure in a Gastric Cancer Patient

    PubMed Central

    Kim, Sun-Ouck; Youn, Chul Woong; Im, Chang Min; Jung, Sung Il; Oh, Kyung Jin; Kwon, Dongdeuk; Park, Kwangsung; Ryu, Soo Bang

    2010-01-01

    We report a case of primary fibroepithelial polyps (FEPs) in the middle of both ureters in a patient with advanced gastric cancer and acute renal failure. Ureteral FEPs are rare benign lesions, and multiple, bilateral lesions are extremely rare. To our knowledge, this report is the seventh case of bilateral FEPs in the literature. Our case has clinical implications because FEPs should be considered as a cause of ureteral obstruction inducing acute renal failure in advanced gastric cancer. PMID:20358014

  7. Multiple, bilateral fibroepithelial polyps causing acute renal failure in a gastric cancer patient.

    PubMed

    Kim, Sun-Ouck; Youn, Chul Woong; Kang, Taek Won; Im, Chang Min; Jung, Sung Il; Oh, Kyung Jin; Kwon, Dongdeuk; Park, Kwangsung; Ryu, Soo Bang

    2010-04-01

    We report a case of primary fibroepithelial polyps (FEPs) in the middle of both ureters in a patient with advanced gastric cancer and acute renal failure. Ureteral FEPs are rare benign lesions, and multiple, bilateral lesions are extremely rare. To our knowledge, this report is the seventh case of bilateral FEPs in the literature. Our case has clinical implications because FEPs should be considered as a cause of ureteral obstruction inducing acute renal failure in advanced gastric cancer. PMID:20358014

  8. Altered distribution of digoxin in renal failure—a cause of digoxin toxicity?

    PubMed Central

    Aronson, J. K.; Grahame-Smith, D. G.

    1976-01-01

    1 Three cases are described in which renal failure was accompanied by a lowered apparent volume of distribution of digoxin. In two cases this resulted in frank digoxin toxicity and in one equivocal toxicity. In all three cases digoxin plasma levels were greater than 2 ng/ml. 2 The possible causes of the abnormal distribution of digoxin in renal failure are discussed. 3 Recommendations are outlined for the use of digoxin in patients with renal failure aimed at circumventing the problem raised by a lowered apparent volume of distribution of the drug. PMID:22216528

  9. Acute Respiratory Failure and Active Bleeding Are the Important Fatality Predictive Factors for Severe Dengue Viral Infection

    PubMed Central

    Laoprasopwattana, Kamolwish; Chaimongkol, Wanwipa; Pruekprasert, Pornpimol; Geater, Alan

    2014-01-01

    Objective To determine the outcome of severe dengue viral infection (DVI) and the main dengue fatality risk factors. Study design The medical records of patients aged <15 years admitted to Songklanagarind Hospital in southern Thailand during 1989–2011 were reviewed. Patients who had dengue hemorrhagic fever (DHF) grades III–IV, organ failure (cardiovascular, respiratory, liver, renal or hematologic), impaired consciousness, or aspartate aminotransferase more than 1,000 units/L, were classified as having severe DVI. To determine the fatality risk factors of severe DVI, the classification trees were constructed based on manual recursive partitioning. Results Of the 238 children with severe DVI, 30 (12.6%) died. Compared to the non-fatal DVI cases, the fatal cases had higher rates of DHF grade IV (96.7% vs 24.5%), repeated shock (93.3% vs 27.9%), acute respiratory failure (ARF) (100% vs 6.7%), acute liver failure (ALF) (96.6% vs 6.3%), acute kidney injury (AKI) (79.3% vs 4.5%), and active bleeding requiring blood transfusion (93.3% vs 5.4%), all p<0.01. The combined risk factors of ARF and active bleeding considered together predicted fatal outcome with sensitivity, specificity, and negative and positive predictive values of 0.93 (0.78–0.99), 0.97 (0.93–0.99), 0.99 (0.97–1.00), and 0.82 (0.65–0.93), respectively. The likelihood ratios for a fatal outcome in the patients who had and did not have this risk combination were 32.4 (14.6–71.7) and 0.07 (0.02–0.26), respectively. Conclusion Severe DVI patients who have ARF and active bleeding are at a high risk of death, while patients without these things together should survive. PMID:25460594

  10. Noninvasive ventilatory support does not facilitate recovery from acute respiratory failure in chronic obstructive pulmonary disease

    Microsoft Academic Search

    F. Barbé; B. Togores; M. Rubí; S. Pons; A. Maimó; A. G. N. Agustí

    1996-01-01

    Noninvasive ventilatory support does not facilitate recovery from acute respiratory fail- ure in chronic obstructive pulmonary disease. F. Barbé, B. Togores, M. Rubí, S. Pons, A. Maimó, A.G.N. Agustí. ©ERS Journals Ltd 1996. ABSTRACT: This investigation evaluates, in a prospective, randomized and con- trolled manner, whether noninvasive ventilatory support (NIVS) with bilevel posi- tive airway pressure (BiPAP) facilitates recovery from

  11. What is Measles? Measles, also known as Rubeola, is a highly contagious respiratory infection caused by a virus.

    E-print Network

    respiratory infection caused by a virus. Measles can lead to permanent disability and even death of infants infected with the measles virus, symptoms typically begin 7 to 14 days later. Some common early symptoms birth, or a low-birth-weight baby. How do I treat it? Measles is a virus, so it needs to run its course

  12. 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 ...

  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. 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

  15. The increasing racial disparity in infant mortality: respiratory distress syndrome and other causes.

    PubMed

    Frisbie, W Parker; Song, Seung-Eun; Powers, Daniel A; Street, Julie A

    2004-11-01

    Although substantial declines in infant mortality rates have occurred across racial/ethnic groups, there has been a marked increase in relative black-white disparity in the risk of infant death over the past two decades. The objective of our analysis was to gain insight into the reasons for this growing inequality on the basis of data from linked cohort files for 1989-1990 and 1995-1998. We found a nationwide reversal from a survival advantage to a survival disadvantage for blacks with respect to respiratory distress syndrome over this period. The results are consistent with the view that the potential for a widening of the relative racial gap in infant mortality is high when innovations in health care occur in a continuing context of social inequality. As expected, the results for other causes of infant mortality, although similar, are less striking. Models of absolute change demonstrate that among low-weight births, absolute declines in mortality were greater for white infants than for black infants. PMID:15622954

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

    NASA Astrophysics Data System (ADS)

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

    2014-07-01

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

  17. Anemia and performance status as prognostic markers in acute hypercapnic respiratory failure due to chronic obstructive pulmonary disease

    PubMed Central

    Mydin, Helmy Haja; Murphy, Stephen; Clague, Howell; Sridharan, Kishore; Taylor, Ian K

    2013-01-01

    Background In patients with acute hypercapnic respiratory failure (AHRF) during exacerbations of COPD, mortality can be high despite noninvasive ventilation (NIV). For some, AHRF is terminal and NIV is inappropriate. However there is no definitive method of identifying patients who are unlikely to survive. The aim of this study was to identify factors associated with inpatient mortality from AHRF with respiratory acidosis due to COPD. Methods COPD patients presenting with AHRF and who were treated with NIV were studied prospectively. The forced expiratory volume in 1 second (FEV1), World Health Organization performance status (WHO-PS), clinical observations, a composite physiological score (Early Warning Score), routine hematology and biochemistry, and arterial blood gases prior to commencing NIV, were recorded. Results In total, 65 patients were included for study, 29 males and 36 females, with a mean age of 71 ± 10.5 years. Inpatient mortality in the group was 33.8%. Mortality at 30 days and 12 months after admission were 38.5% and 58.5%, respectively. On univariate analysis, the variables associated with inpatient death were: WHO-PS ? 3, long-term oxygen therapy, anemia, diastolic blood pressure < 70 mmHg, Early Warning Score ? 3, severe acidosis (pH < 7.20), and serum albumin < 35 g/L. On multivariate analysis, only anemia and WHO-PS ? 3 were significant. The presence of both predicted 68% of inpatient deaths, with a specificity of 98%. Conclusion WHO-PS ? 3 and anemia are prognostic factors in AHRF with respiratory acidosis due to COPD. A combination of the two provides a simple method of identifying patients unlikely to benefit from NIV. PMID:23658480

  18. Volume-assured pressure support ventilation (VAPSV). A new approach for reducing muscle workload during acute respiratory failure.

    PubMed

    Amato, M B; Barbas, C S; Bonassa, J; Saldiva, P H; Zin, W A; de Carvalho, C R

    1992-10-01

    This study reports the preliminary clinical evaluation of a new mode of ventilation--volume-assured pressure support ventilation (VAPSV)--which incorporates inspiratory pressure support (PSV) with conventional volume-assisted cycles (VAV). This combination optimizes the inspiratory flow during assisted/controlled cycles, reducing the patient's respiratory burden commonly observed during VAV. Different from conventional PSV, VAPSV assures precise control of tidal volume (VT) in unstable patients. Eight patients with acute respiratory failure (ARF) were submitted to assisted ventilation under VAV and VAPSV. Patient's ventilatory workload (evaluated through the pressure-time product, mechanical work per liter of ventilation, and work per minute) and patient's ventilatory drive (occlusion pressure--P0.1) were significantly reduced during VAPSV. This "relief" was more evident among the most distressed patients (p < 0.001), allowing a reduction of more than 60 percent in muscle load, without the need of increasing peak tracheal pressure. Mean inspiratory flow (VT/TI), VT, and effective dynamic compliance were significantly increased during VAPSV, whereas the effective inspiratory impedance decreased. These mechanical advantages of VAPSV allowed a reduction of intrinsic PEEP, whenever it was present. Blood gas values were similar in both periods. We concluded that VAPSV is a promising form of ventilatory support. At the same time that it was able to safely assure a minimum preset VT, VAPSV reduced patient workload and improved synchrony between the patient and the ventilator during ARF. PMID:1395773

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

    PubMed Central

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

    2014-01-01

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

  20. Cyclic Loading of Transosseous Rotator Cuff Repairs" Tension Overload as a Possible Cause of Failure

    E-print Network

    Athanasiou, Kyriacos

    failed first and by the largest magnitude. This study suggests that rotator cuff tears that are repairedCyclic Loading of Transosseous Rotator Cuff Repairs" Tension Overload as a Possible Cause. Athanasiou, Ph.D. Summary: Previous experimental studies of failure of rotator cuff repair have involved

  1. Professional accounting bodies' perceptions of ethical issues, causes of ethical failure and ethics education

    Microsoft Academic Search

    Beverley Jackling; Barry J. Cooper; Philomena Leung; Steven Dellaportas

    2007-01-01

    Purpose – Given the calls for increased ethics education following recent corporate collapses, this paper aims to examine the significance of ethical issues that challenge the profession and, more specifically, professional accounting bodies. Design\\/methodology\\/approach – The study assesses the perceptions via an online survey of 66 professional accounting bodies worldwide in respect of ethical issues, potential causes of ethical failure

  2. Lung Donation and Causes Behind Its Failure: A Single-Center Experience

    Microsoft Academic Search

    K. Najafizadeh; M. B. Shadmehr; A. Daneshvar; M. Malekmohammad; M. Arab; Z. H. Ahmadi; Sh. Shafaghi; F. Ghorbani; S. Assari; M. Moghani-Lankarani

    2009-01-01

    IntroductionBrain-dead patients are almost the only source of organs for lung transplantation, and lungs fall within the area of the least harvested organs. As a result, maintaining the highest possible harvest rate is a must for the lung transplantation system. In the present study, the harvest rate of lungs and also the causes of failure to donate the lungs is

  3. Overview of the Electric Power Research Institute research program on common-cause failures

    Microsoft Academic Search

    D. H. Worledge; I. B. Wall

    1989-01-01

    The Electric Power Research Institute research project on common cause failures (CCFS) is the main vehicle for presenting a survey of developments in the field over the last 5 yr. The roles of other organizations worldwide are highlighted to show the international and synergistic character of the work accomplished. Included are aspects of data analysis, modeling approaches, and defensive strategies

  4. Failure of a mine waste dump in Zimbabwe: Causes and consequences

    Microsoft Academic Search

    Richard A. Shakesby; J. Richard Whitlow

    1991-01-01

    A combination of factors are considered important in causing the failure and subsequent development of a flowslide of a gold mine waste dump (or tailings dam) at Arcturus, near Harare, Zimbabwe. These factors comprise poor basal drainage, steep perimeter walls, saturation of the walls and basal sediments through continued spigoting of slurry during a period of heavy rainfall, and the

  5. [Extracorporeal lung assist in severe respiratory failure and ARDS. Current situation and clinical applications].

    PubMed

    Gómez-Caro, Abel; Badia, Joan Ramon; Ausin, Pilar

    2010-10-01

    Despite improvements in ventilation support techniques, lung protection strategies, and the application of new support treatment, acute respiratory distress syndrome continues to have a high mortality rate. Many strategies and treatments for this syndrome have been investigated over the last few year. However, the only therapeutic measure that has systematically shown to be able to improve survival is that of low volume lung protective ventilation. Thus, using a low tidal volume prevents added lung damage by the same mechanical ventilation that is essential for life support. In this context, the use of extracorporeal lung assist systems is considered an exceptional use rescue treatment in extreme cases. On the other hand, it could be a potentially useful complementary method for an ultra-protective ventilation strategy, that is, by using even lower tidal volumes. The currently available extracorporeal lung assist systems are described in this article, including high flow systems such as traditional extracorporeal membrane oxygenation, CO? removal systems (interventional lung assist or iLA, with or without associated centrifugal pumps), and the new low flow and less invasive systems under development. The aim of this review is to update the latest available clinical and experimental data, the indications for these devices in adult respiratory distress syndrome (ARDS), and their potential indications in other clinical situations, such as the bridge to lung transplantation, multiple organ dysfunction syndrome, or COPD. PMID:20937437

  6. A giant inguinoscrotal bladder hernia as a cause of chronic renal failure: A rare case

    PubMed Central

    Karatzas, Anastasios; Christodoulidis, Gregory; Spyridakis, Michael; Stavaras, Christos; Aravantinos, Evangelos; Melekos, Michael

    2013-01-01

    INTRODUCTION Giant inguinoscrotal bladder hernias are very rare and require surgical intervention. They usually do not cause any specific symptoms and thus, they are often misdiagnosed. If left untreated though, they might lead to severe medical conditions, such as renal failure. PRESENTATION OF CASE We present the case of a 71-year-old male patient suffering from a giant inguinoscrotal mass, accompanied by symptoms of the lower urinary track (LUTS) and chronic renal failure. DISCUSSION In our case, the patient presented with bladder hernia causing non specific symptoms of renal failure. In contrast to acute renal failure, a chronic renal impairment most often comes with no specific symptoms and thus, it can be present for many years before the diagnosis is made. It is evident that such serious conditions should be suspected and treated. CONCLUSION Inguinoscrotal bladder hernias may be associated with severe medical conditions, such as renal deterioration, and should be considered in the differential diagnosis of renal failure, when accompanied by any inguinal, scrotal, or low abdominal wall hernia. PMID:23416505

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

    PubMed

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

    2013-01-01

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

  8. Lifesaving liver transplantation for multi-organ failure caused by Bacillus cereus food poisoning.

    PubMed

    Tschiedel, Eva; Rath, Peter-Michael; Steinmann, Jörg; Becker, Heinz; Dietrich, Rudolf; Paul, Andreas; Felderhoff-Müser, Ursula; Dohna-Schwake, Christian

    2015-02-01

    Bacillus cereus is a spore-forming, gram-positive bacterium that causes food poisoning presenting with either emesis or diarrhea. Diarrhea is caused by proteinaceous enterotoxin complexes, mainly hemolysin BL, non-hemolytic enterotoxin (NHE), and cytotoxin K. In contrast, emesis is caused by the ingestion of the depsipeptide toxin cereulide, which is produced in B. cereus contaminated food, particularly in pasta or rice. In general, the illness is mild and self-limiting. However, due to cereulide intoxication, nine severe cases with rhabdomyolysis and/or liver failure, five of them lethal, are reported in literature. Here we report the first case of life-threatening liver failure and severe rhabdomyolysis in this context that could not be survived without emergency hepatectomy and consecutive liver transplantation. PMID:25323120

  9. 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

  10. Chronic respiratory failure after lung resection: the role of pulmonary rehabilitation.

    PubMed

    Celli, Bartolome R

    2004-08-01

    Pulmonary rehabilitation gradually has become the gold standard treatment for patients with severe lung disease, especially COPD. By definition, rehabilitation services are provided to patients with symptoms, most of whom have moderate-to-advanced lung disease. Because new therapeutic strategies, such as lung volume-reduction surgery and lung transplantation, require well-conditioned patients, pulmonary rehabilitation is becoming a crucial component of the overall treating strategy of many patients who heretofore were deemed untreatable. The positive results in several randomized trials have documented the effectiveness of pulmonary rehabilitation. Currently, pulmonary rehabilitation should be made available to all patients with symptomatic respiratory disease and be an integral part of any program considering high-risk surgery. PMID:15382772

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

    E-print Network

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

    2008-08-05

    impairment. Although not the first of its kind, we present an unusual case of pulmonary siderosis with symptomatic respiratory disease, most likely secondary to associated fibrosis. Case presentation A 66-year-old Caucasian man was referred to the outpatient...

  12. 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.

  13. 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

  14. Respiratory Failure Caused by Intratracheal Saline: Additive Effect of Xanthine Oxidase

    Microsoft Academic Search

    Ola Didrik Saugstad; Mikko Hallman; Günther Becher; Arno Oddoy; Björn Lium; Burkhard Lachmann

    1988-01-01

    Administration of physiological saline or drugs together with saline into the airways is becoming common clinical practice. However, there are few studies on possible side effects. We have studied the effects of saline, saline plus xanthine oxidase, and saline plus xanthine oxidase plus superoxidase dismutase on lung-thorax compliance and on arterial blood gases in anesthetized, paralyzed guinea pigs, ventilated for

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

    PubMed Central

    2013-01-01

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

  16. 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

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

    NASA Technical Reports Server (NTRS)

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

    2012-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2012-01-01

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

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

    USGS Publications Warehouse

    Schwab, William C.; Lee, Homa J.

    1988-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2006-01-01

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

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

    PubMed

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

    2003-10-01

    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 from Mafb(-/-) mice are insensitive to preBötC electrolytic lesion or stimulation and modulation of rhythmogenesis by hypoxia or peptidergic input. Furthermore, in Mafb(-/-) mice the preBötC, but not major neuromodulatory groups, presents severe anatomical defects with loss of cellularity. Our results show an essential role of MafB in central respiratory control, possibly involving the specification of rhythmogenic preBötC neurons. PMID:14513037

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

    PubMed Central

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

    1999-01-01

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

  3. Acute management of neonatal respiratory failure due to crossed ectopic obstructed megaureter in a duplicated pelvic kidney.

    PubMed

    Leocádio, D E; Coutu, F H; Gagnon, A I; Mingin, G

    2011-02-01

    Respiratory distress due to urinary tract obstruction can be a urologic emergency. We describe the diagnostic and surgical management of severe respiratory distress in a neonate due to a crossed ectopic obstructed megaureter in a duplicated pelvic kidney. PMID:21050823

  4. 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

  5. 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

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

    PubMed

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

    2014-01-01

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

  7. 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

  8. 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

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

    PubMed

    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

    2015-03-01

    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

  10. Classic Bartter syndrome: a rare cause of failure to thrive in a child.

    PubMed

    Vieira, Helena; Mendes, Leonor; Mendes, Patricia; da Silva, José Esteves

    2012-01-01

    Bartter syndrome is a group of rare autosomal-recessive disorders caused by a defect in distal tubule transport of sodium and chloride. Blood gases and plasma electrolytes raise suspicion of this diagnosis and the definitive diagnosis is made by genetic study. Early treatment improves prognosis. The authors present the case of an 11-month-old child with early failure to thrive and severe regurgitation. Blood gases revealed hypochloraemic metabolic alkalosis, hyponatraemia and hypokalaemia. Blood pressure was normal and polyuria was documented. She began therapy with potassium chloride supplementation and indomethacin. There was clinical improvement and plasma potassium and bicarbonate normalised. The molecular study confirmed it was the classic form of Bartter syndrome. Despite being rare in clinical practice, which may lead to unnecessary medical investigation and diagnosis delay, in a child with failure to thrive, hypochloraemic metabolic alkalosis and hypokalaemia, this diagnosis must be considered. PMID:22744244

  11. Acute respiratory distress syndrome caused by leukemic infiltration of the lung.

    PubMed

    Wu, Yao-Kuang; Huang, Yi-Chih; Huang, Shiu-Feng; Huang, Chung-Chi; Tsai, Ying-Huang

    2008-05-01

    Respiratory distress syndrome resulting from leukemic pulmonary infiltrates is seldom diagnosed antemortem. Two 60- and 80-year-old women presented with general malaise, progressive shortness of breath, and hyperleukocytosis, which progressed to acute respiratory distress syndrome (ARDS) after admission. Acute leukemia with pulmonary infection was initially diagnosed, but subsequent examinations including open lung biopsy revealed leukemic pulmonary infiltrates without infection. In one case, the clinical condition and chest radiography improved initially after combination therapy with chemotherapy for leukemia and aggressive pulmonary support. However, new pulmonary infiltration on chest radiography and hypoxemia recurred, which was consistent with acute lysis pneumopathy. Despite aggressive treatment, both patients died due to rapidly deteriorating condition. Leukemic pulmonary involvement should be considered in acute leukemia patients with non-infectious diffusive lung infiltration, especially in acute leukemia with a high blast count. PMID:18492627

  12. 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

  13. ECHS1 mutations cause combined respiratory chain deficiency resulting in Leigh syndrome.

    PubMed

    Sakai, Chika; Yamaguchi, Seiji; Sasaki, Masayuki; Miyamoto, Yusaku; Matsushima, Yuichi; Goto, Yu-ichi

    2015-02-01

    The human ECHS1 gene encodes the short-chain enoyl coenzyme A hydratase, the enzyme that catalyzes the second step of ?-oxidation of fatty acids in the mitochondrial matrix. We report on a boy with ECHS1 deficiency who was diagnosed with Leigh syndrome at 21 months of age. The patient presented with hypotonia, metabolic acidosis, and developmental delay. A combined respiratory chain deficiency was also observed. Targeted exome sequencing of 776 mitochondria-associated genes encoded by nuclear DNA identified compound heterozygous mutations in ECHS1. ECHS1 protein expression was severely depleted in the patient's skeletal muscle and patient-derived myoblasts; a marked decrease in enzyme activity was also evident in patient-derived myoblasts. Immortalized patient-derived myoblasts that expressed exogenous wild-type ECHS1 exhibited the recovery of the ECHS1 activity, indicating that the gene defect was pathogenic. Mitochondrial respiratory complex activity was also mostly restored in these cells, suggesting that there was an unidentified link between deficiency of ECHS1 and respiratory chain. Here, we describe the patient with ECHS1 deficiency; these findings will advance our understanding not only the pathology of mitochondrial fatty acid ?-oxidation disorders, but also the regulation of mitochondrial metabolism. PMID:25393721

  14. Lymphangitic metastasis of recurrent renal cell carcinoma to the contralateral lung causing lymphangitic carcinomatosis and respiratory symptoms.

    PubMed

    Wallach, J B; McGarry, T; Torres, J

    2011-01-01

    Renal cell carcinoma comprises 80%-85% of kidney malignancies. For early presentations, nephrectomy provides a high cure rate, but patients usually present at advanced stages, leading to poor outcomes. Even for patients without metastatic spread who undergo nephrectomy, metastatic recurrence is frequent. We report the case of a patient who underwent nephrectomy for stage iii renal cell carcinoma and who presented 20 months later with respiratory symptoms consistent with pneumonia, influenza, or (less likely) congestive heart failure or a cardiac event. Persistent right pleural effusion on serial chest radiographs despite treatment prompted computed tomography evaluation, which revealed lymphangitic carcinomatosis, a very rare form of renal cell carcinoma metastasis to the lung. This preliminary finding was confirmed by right middle lobe tissue biopsy through bronchoscopy and cytopathology examination. PMID:21331270

  15. Health-related quality of life and long-term prognosis in chronic hypercapnic respiratory failure: a prospective survival analysis

    PubMed Central

    Budweiser, Stephan; Hitzl, Andre P; Jörres, Rudolf A; Schmidbauer, Kathrin; Heinemann, Frank; Pfeifer, Michael

    2007-01-01

    Background Health-related quality of life (HRQL) is considered as an important outcome parameter in patients with chronic diseases. This study aimed to assess the role of disease-specific HRQL for long-term survival in patients of different diagnoses with chronic hypercapnic respiratory failure (CHRF). Methods In a cohort of 231 stable patients (chronic obstructive pulmonary disease (COPD), n = 98; non-COPD (obesity-hypoventilation syndrome, restrictive disorders, neuromuscular disorders), n = 133) with CHRF and current home mechanical ventilation (HMV), HRQL was assessed by the disease-specific Severe Respiratory Insufficiency (SRI) questionnaire and its prognostic value was prospectively evaluated during a follow-up of 2–4 years, using univariate and multivariate regression analysis. Results HRQL was more impaired in COPD (mean ± SD SRI-summary score (SRI-SS) 52.5 ± 15.6) than non-COPD patients (67.6 ± 16.4; p < 0.001). Overall mortality during 28.9 ± 8.8 months of follow-up was 19.1% (31.6% in COPD, 9.8% in non-COPD). To identify the overall role of SRI, we first evaluated the total study population. SRI-SS and its subdomains (except attendance symptoms and sleep), as well as body mass index (BMI), leukocyte number and spirometric indices were associated with long-term survival (p < 0.01 each). Of these, SRI-SS, leukocytes and forced expiratory volume in 1 s (FEV1) turned out to be independent predictors (p < 0.05 each). More specifically, in non-COPD patients SRI-SS and most of its subdomains, as well as leukocyte number, were related to survival (p < 0.05), whereas in patients with COPD only BMI and lung function but not SRI were predictive. Conclusion In patients with CHRF and HMV, the disease-specific SRI was an overall predictor of long-term survival in addition to established risk factors. However, the SRI predominantly beared information regarding long-term survival in non-COPD patients, while in COPD patients objective measures of the disease state were superior. This on one hand highlights the significance of HRQL in the long-term course of patients with CHRF, on the other hand it suggests that the predictive value of HRQL depends on the underlying disease. PMID:18086309

  16. 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

  17. FAILURE MECHANISM OF RAILWAY EMBANKMENT DUE TO INUNDATION FLOW CAUSED BY HEAVY RAINFALL

    NASA Astrophysics Data System (ADS)

    Tsubaki, Ryota; Kawahara, Yoshihisa; Sayama, Takahiro; Fujita, Ichiro

    Railway and road embankments on a flood plain affect the propagation of inundation flow. In inundation simulation, the embankment in the flooded area is treated as the solid wall that inundation flow is able to overflow. However, the embankment involves the potential to be damaged during a severe flood event, and the breakage of the embankments causes not only physical damage but also a reduction of transportation function. In this study, the damage to the embankment of the Kishin line during the flood event in August 2009 is analyzed. The topographic and hydraulic conditions of the embankment failure are discussed.

  18. Cladribine underdosing in hairy-cell leukemia: a cause for apparent response failure.

    PubMed

    Golde, David W; Jakubowiak, Andrzej; Caggiano, Janine; Heaney, Mark L

    2002-02-01

    While chemotherapy overdose is often readily discovered, underdosing errors are seldom appreciated. We report two patients with hairy-cell leukemia who apparently failed to respond to cladribine administered by continuous portable pump infusion. It was determined that both patients received one-seventh of the prescribed dose, although the orders were written correctly. The errors resulted in the administration of 1 day's dose over 1 week. The use of 7-day portable pump infusion therapy for cladribine can be associated with misdosing, and is an occult cause of apparent failure to respond in hairy-cell leukemia. PMID:11999571

  19. The causes, consequences, and treatment of left or right heart failure

    PubMed Central

    Pazos-López, Pablo; Peteiro-Vázquez, Jesús; Carcía-Campos, Ana; García-Bueno, Lourdes; de Torres, Juan Pablo Abugattas; Castro-Beiras, Alfonso

    2011-01-01

    Chronic heart failure (HF) is a cardiovascular disease of cardinal importance because of several factors: a) an increasing occurrence due to the aging of the population, primary and secondary prevention of cardiovascular events, and modern advances in therapy, b) a bad prognosis: around 65% of patients are dead within 5 years of diagnosis, c) a high economic cost: HF accounts for 1% to 2% of total health care expenditure. This review focuses on the main causes, consequences in terms of morbidity, mortality and costs and treatment of HF. PMID:21603593

  20. Living with intestinal failure caused by Crohn disease: not letting the disease conquer life.

    PubMed

    Carlsson, Eva; Persson, Eva

    2015-01-01

    This article reports the findings of what it means to live with intestinal failure caused by Crohn disease and how it influences daily life. Ten patients, 7 with an ostomy and 7 on home parenteral nutrition followed up at an outpatient clinic for patients with intestinal failure, were interviewed using a qualitative, phenomenological-hermeneutic method. The analysis of the transcribed data is described thematically and resulted in 3 main themes; (a) struggling to not be controlled by the disease, (b) walking on a thin thread, and (c) being seen as a person, not just as a patient. These themes led to the comprehensive understanding that living with intestinal failure was interpreted as the criticality of maintaining control over one's life and body while maintaining autonomy and not letting the disease conquer life. Life entails a constant struggle with much planning to live as normally as possible and get the most out of life. It was of great importance to be seen as a person and not just as a disease, affirm that life as it is has meaning, there is a state of suffering related to the disease, there are existential issues, and suffering is related to care. PMID:25636009

  1. 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

  2. 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

  3. Nasal high–flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV)

    PubMed Central

    2014-01-01

    Background Aim of the study was to compare the short-term effects of oxygen therapy via a high-flow nasal cannula (HFNC) on functional and subjective respiratory parameters in patients with acute hypoxic respiratory failure in comparison to non-invasive ventilation (NIV) and standard treatment via a Venturi mask. Methods Fourteen patients with acute hypoxic respiratory failure were treated with HFNC (FiO2 0.6, gas flow 55 l/min), NIV (FiO2 0.6, PEEP 5 cm H2O Hg, tidal volume 6–8 ml/kg ideal body weight,) and Venturi mask (FiO2 0.6, oxygen flow 15 l/min,) in a randomized order for 30 min each. Data collection included objective respiratory and circulatory parameters as well as a subjective rating of dyspnea and discomfort by the patients on a 10-point scale. In a final interview, all three methods were comparatively evaluated by each patient using a scale from 1 (=very good) to 6 (=failed) and the patients were asked to choose one method for further treatment. Results PaO2 was highest under NIV (129 ± 38 mmHg) compared to HFNC (101 ± 34 mmHg, p <0.01 vs. NIV) and VM (85 ± 21 mmHg, p <0.001 vs. NIV, p <0.01 vs. HFNC, ANOVA). All other functional parameters showed no relevant differences. In contrast, dyspnea was significantly better using a HFNC (2.9 ± 2.1, 10-point Borg scale) compared to NIV (5.0 ± 3.3, p <0.05), whereas dyspnea rating under HFNC and VM (3.3 ± 2.3) was not significantly different. A similar pattern was found when patients rated their overall discomfort on the 10 point scale: HFNC 2.7 ± 1.8, VM 3.1 ± 2.8 (ns vs. HFNC), NIV 5.4 ± 3.1 (p <0.05 vs. HFNC). In the final evaluation patients gave the best ratings to HFNC 2.3 ± 1.4, followed by VM 3.2 ± 1.7 (ns vs. HFNC) and NIV 4.5 ± 1.7 (p <0.01 vs. HFNC and p <0.05 vs. VM). For further treatment 10 patients chose HFNC, three VM and one NIV. Conclusions In hypoxic respiratory failure HFNC offers a good balance between oxygenation and comfort compared to NIV and Venturi mask and seems to be well tolerated by patients. Trial registration German clinical trials register: DRKS00005132. PMID:25110463

  4. 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, Nc; Hirose, H

    2014-09-19

    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

  5. 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.

  6. Acute Lung Failure

    PubMed Central

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

    2013-01-01

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

  7. Assessment of filter dust characteristics that cause filter failure during hot-gas filtration

    SciTech Connect

    John P. Hurley; Biplab Mukherjee; Michael D. Mann [University of North Dakota, Grand Forks, ND (United States). Energy & Environmental Research Center

    2006-08-15

    The high-temperature filtration of particulates from gases is greatly limited because of the development of dust cakes that are difficult to remove and can bridge between candle filters, causing them to break. Understanding the conditions leading to the formation of cohesive dust can prevent costly filter failures and ensure higher efficiency of solid fuel, direct-fired turbine power generation systems. The University of North Dakota Energy & Environmental Research Center is working with the New Energy and Industrial Technology Development Organization and the U.S. Department of Energy to perform research to characterize and determine the factors that cause the development of such dust cakes. Changes in the tensile strength, bridging propensity, and plasticity of filter dust cakes were measured as a function of the temperature and a filter pressure drop for a coal and a biomass filter dust. The biomass filter dust indicated that potential filtering problems can exist at temperatures as low as 400{sup o}C, while the coal filter dust showed good filtering characteristics up to 750{sup o}C. A statistically valid model that can indicate the propensity of filters to fail with system operating conditions was developed. A detailed analysis of the chemical aspect of dusts is also presented in order to explore the causes of such stickiness. 16 refs., 10 figs., 3 tabs.

  8. 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.

  9. Plastination with silicone method S 10--monitoring and analysis causes of failure.

    PubMed

    Miklosová, Mária; Miklos, Vojtech

    2004-12-01

    Plastination is in some cases unsuccessful. The goal of this work was to monitor, to describe and to analyse the reasons of S10 plastination method failure. We prepared the silicone-impregnated specimens using the standard silicone method S 10. The causes of bad preparation are numerous. Usual defects produced during plastination process are the changes in the bulk, the changes in the colour and other visible defects (e.g. deformations, spots on the organs surface). The frequent reasons for these defects are: unsuitable temperature, using of old bad fixed formaldehyde specimens and too long gas-curing procedure. The knowledge of reasons of unsuccessful plastination is important condition for achievement the good results. PMID:15744385

  10. Effect of non-invasive mechanical ventilation on sleep and nocturnal ventilation in patients with chronic respiratory failure

    PubMed Central

    Schonhofer, B.; Kohler, D.

    2000-01-01

    BACKGROUND—Chronic respiratory failure (CRF) is associated with nocturnal hypoventilation. Due to the interaction of sleep and breathing, sleep quality is reduced during nocturnal hypoventilation. Non-invasive mechanical ventilation (NMV), usually performed overnight, relieves symptoms of hypoventilation and improves daytime blood gas tensions in patients with CRF. The time course of the long term effect of NMV on sleep and breathing during both spontaneous ventilation (withdrawing the intervention) and NMV was investigated in patients with CRF due to thoracic restriction.?METHODS—Fifteen consecutive patients (13 women) of mean (SD) age 57.9 (12.0) years with CRF due to thoracic restriction were included in the study. During the one year observation period four polysomnographic studies were performed: three during spontaneous breathing without NMV—before initiation of NMV (T0) and after withdrawing NMV for one night at six months (T6) and 12 months (T12-)—and the fourth during NMV after 12 months (T12+). Daytime blood gas tensions and lung function were also measured.?RESULTS—Spontaneous ventilation (in terms of mean oxygen saturation) progressively improved (from T0 to T12-) during both REM sleep (24.8%, 95% CI 12.9 to 36.9) and NREM sleep (21.5%, 95% CI 12.4to 30.6). Sleep quality during spontaneous ventilation also improved in terms of increased total sleep time (26.8%, 95% CI 11.6 to 42.0) and sleep efficiency (17.5%, 95% CI 5.4 to 29.6) and decreased awakenings (54.0%, 95% CI 70.3 to 37.7). Accordingly, REM and NREM sleep stages 3 and 4 significantly improved. However, the most significant improvements in both nocturnal ventilation and sleep quality were seen during NMV at 12months.?CONCLUSIONS—After long term NMV both spontaneous ventilation during sleep and sleep quality in patients with CRF due to thoracic restriction showed evidence of progressive improvement compared with baseline after withdrawal of NMV for a single night at six and 12 months. However, the greatest improvements in nocturnal ventilation and sleep were achieved during NMV at 12months.?? PMID:10722771

  11. Intracellular cystine loading causes proximal tubule respiratory dysfunction: effect of glycine.

    PubMed

    Sakarcan, A; Aricheta, R; Baum, M

    1992-12-01

    The present study examined proximal tubular respiration in control proximal tubules and proximal tubules loaded with cystine using 2 mmol/L cystine dimethyl ester. Basal oxygen consumption was significantly less in cystine-loaded tubules (20.6 +/- 0.5 versus 12.1 +/- 0.6 nmol O2.min-1.mg protein-1, p < 0.001). In the presence of 10(-4) mol/L ouabain, an inhibitor of the NaK ATPase, oxygen consumption was 10.2 +/- 0.7 nmol O2.min-1.mg protein-1 in control tubules and 11.4 +/- 1.0 nmol O2.min-1.mg protein-1 in cystine-loaded tubules. Thus, proximal tubular intracellular cystine loading specifically inhibits oxygen metabolism directed toward transport. Compared with control proximal tubules, cystine-loaded proximal tubules also had a lower rate of O2 consumption when the cells were permeabilized to sodium with nystatin and when mitochondrial respiration was uncoupled. Glycine, an amino acid that is cytoprotective to hypoxic proximal tubule injury, ameliorated the respiratory dysfunction observed in cystine-loaded tubules. PMID:1337587

  12. Individual Differences in Self-Regulatory Failure and Menstrual Dysfunction Predict Upper Respiratory Infection Symptoms and Antibody Response to Flu Immunization

    PubMed Central

    Strauman, Timothy J.; Coe, Christopher L.; McCrudden, Megan C.; Vieth, Angela Z.; Kwapil, Lori

    2008-01-01

    Prior research indicates that cognitive priming manipulations that activate personal goals acutely increase or decrease natural killer cell cytotoxicity depending on whether individuals see themselves as making or failing to make progress toward their goals. Those findings in a laboratory setting revealed a psychobiological pathway whereby experiences of failure can influence health, but did not assess the impact of chronic perceived success/failure in goal pursuit on actual health outcomes. Three new studies investigated whether individual differences in perceived failure to attain personal goals influenced the self-reported symptoms of upper respiratory infections (URIs) as well as antibody response to flu immunization. Based on pilot data in young women, it also was hypothesized that the occurrence of menstrual dysfunction might interact with goal pursuit failure to more specifically predict cold and flu symptoms and optimal responses to vaccination. Perceived failure to attain goals did predict the reporting of URI symptoms as well as antibody levels post-immunization, both alone and in combination with menstrual dysfunction. PMID:18294813

  13. Acute respiratory failure due to hemothorax after posterior correction surgery for adolescent idiopathic scoliosis: a case report

    PubMed Central

    2013-01-01

    Background Although posterior correction and fusion surgery using pedicle screws carries the risk of vascular injury, a massive postoperative hemothorax in a patient with adolescent idiopathic scoliosis (AIS) is quite rare. We here report a case of a 12-year-old girl with AIS who developed a massive postoperative hemothorax. Case presentation The patient had a double thoracic curve with Cobb angles of 63° at T2-7 and 54° at T7-12. Posterior correction and fusion surgery was performed using a segmental pedicle screw construct placed between T2 and T12. Although the patient's respiration was stable during the surgery, 20 minutes after removing the trachea tube, the patient’s pulse oximetry oxygen saturation suddenly decreased to 80%. A contrast CT scan showed a massive left hemothorax, and a drainage tube was quickly inserted into the chest. The patient was re-intubated and a positive end-expiratory pressure of 5 cmH2O applied, which successfully stopped the bleeding. The patient was extubated 4 days after surgery without incident. Based on contrast CT scans, it was suspected that the hemothorax was caused by damage to the intercostal arteries or branches during pedicle probing on the concave side of the upper thoracic curve. Extensive post-surgical blood tests, echograms, and CT and MRI radiographs did not detect coagulopathy, pulmonary or vascular malformation, or any other possible causative factors. Conclusion This case underscores the potential risk of massive hemothorax related to thoracic pedicle screw placement, and illustrates that for this serious complication, respiratory management with positive airway pressure, along with a chest drainage tube, can be an effective treatment option. PMID:23577922

  14. 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.

  15. 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

  16. 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

  17. 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.

  18. Heart failure causes cholinergic transdifferentiation of cardiac sympathetic nerves via gp130-signaling cytokines in rodents

    PubMed Central

    Kanazawa, Hideaki; Ieda, Masaki; Kimura, Kensuke; Arai, Takahide; Kawaguchi-Manabe, Haruko; Matsuhashi, Tomohiro; Endo, Jin; Sano, Motoaki; Kawakami, Takashi; Kimura, Tokuhiro; Monkawa, Toshiaki; Hayashi, Matsuhiko; Iwanami, Akio; Okano, Hideyuki; Okada, Yasunori; Ishibashi-Ueda, Hatsue; Ogawa, Satoshi; Fukuda, Keiichi

    2010-01-01

    Although several cytokines and neurotrophic factors induce sympathetic neurons to transdifferentiate into cholinergic neurons in vitro, the physiological and pathophysiological roles of this remain unknown. During congestive heart failure (CHF), sympathetic neural tone is upregulated, but there is a paradoxical reduction in norepinephrine synthesis and reuptake in the cardiac sympathetic nervous system (SNS). Here we examined whether cholinergic transdifferentiation can occur in the cardiac SNS in rodent models of CHF and investigated the underlying molecular mechanism(s) using genetically modified mice. We used Dahl salt-sensitive rats to model CHF and found that, upon CHF induction, the cardiac SNS clearly acquired cholinergic characteristics. Of the various cholinergic differentiation factors, leukemia inhibitory factor (LIF) and cardiotrophin-1 were strongly upregulated in the ventricles of rats with CHF. Further, LIF and cardiotrophin-1 secreted from cultured failing rat cardiomyocytes induced cholinergic transdifferentiation in cultured sympathetic neurons, and this process was reversed by siRNAs targeting Lif and cardiotrophin-1. Consistent with the data in rats, heart-specific overexpression of LIF in mice caused cholinergic transdifferentiation in the cardiac SNS. Further, SNS-specific targeting of the gene encoding the gp130 subunit of the receptor for LIF and cardiotrophin-1 in mice prevented CHF-induced cholinergic transdifferentiation. Cholinergic transdifferentiation was also observed in the cardiac SNS of autopsied patients with CHF. Thus, CHF causes target-dependent cholinergic transdifferentiation of the cardiac SNS via gp130-signaling cytokines secreted from the failing myocardium. PMID:20051627

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

    PubMed

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

    2013-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  1. 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).

  2. Failure to maintain luteal function: a possible cause of early embryonic loss in a cow.

    PubMed Central

    Lafrance, M; Goff, A K; Guay, P; Harvey, D

    1989-01-01

    The effect of early pregnancy failure on the release of prostaglandin F2 alpha (PGF2 alpha) in response to oxytocin (Ot) was examined in an abnormal breeder (AB) heifer that was not able to maintain a pregnancy beyond 21 days. This animal was used in three experiments: 1) She received one intravenous injection of 100 IU Ot 17 days after the onset of oestrus (Day 0). Frequent blood samples were taken for the measurement of 15-keto-13,14-dihydro-PGF2 alpha (PGFM) by radioimmunoassay. Daily samples for progesterone (P4) determinations were taken to monitor luteal function. This was then repeated using the same animal at either day 17 or 18 or 19 (day 17-19) of pregnancy. 2) Embryos from superovulated normal breeder (NB) donors were transferred at day 7 to the AB heifer as well as to NB control animals. 3) Seven day old embryos from the superovulated AB heifer were transferred to NB recipient animals. At day 17-19 of pregnancy all the recipient heifers (experiments 2 and 3) were subjected to the same protocol as in experiment 1. The results showed that the ability of Ot to stimulate PGF2 alpha release was reduced in the NB recipients bearing viable embryos when compared to cyclic animals. However, for the AB heifer, Ot stimulated PGF2 alpha release to the same extent whether the animal was cyclic or pregnant. Furthermore, the AB animal did not have the extended luteal function associated with removal of viable embryos on day 17-19. The data suggest that the embryonic loss might have been caused by failure of the embryos to prevent the luteolytic release of PGF2 alpha. PMID:2766148

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

    PubMed

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

  5. Genetic disorders of neonatal respiratory function.

    PubMed

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

    2001-08-01

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

  6. N-Acylphosphatidylethanolamine accumulation in potato cells upon energy shortage caused by anoxia or respiratory inhibitors.

    PubMed

    Rawyler, A J; Braendle, R A

    2001-09-01

    A minor phospholipid was isolated from potato (Solanum tuberosum L. cv Bintje) cells, chromatographically purified, and identified by electrospray ionization mass spectrometry as N-acylphosphatidylethanolamine (NAPE). The NAPE level was low in unstressed cells (13 +/- 4 nmol g fresh weight(-1)). According to acyl chain length, only 16/18/18 species (group II) and 18/18/18 species (group III) were present. NAPE increased up to 13-fold in anoxia-stressed cells, but only when free fatty acids (FFAs) started being released, after about 10 h of treatment. The level of groups II and III was increased by unspecific N-acylation of phosphatidylethanolamine, and new 16/16/18 species (group I) appeared via N-palmitoylation. NAPE also accumulated in aerated cells treated with NaN(3) plus salicylhydroxamate. N-acyl patterns of NAPE were dominated by 18:1, 18:2, and 16:0, but never reflected the FFA composition. Moreover, they did not change greatly after the treatments, in contrast with O-acyl patterns. Anoxia-induced NAPE accumulation is rooted in the metabolic homeostasis failure due to energy deprivation, but not in the absence of O(2), and is part of an oncotic death process. The acyl composition of basal and stress-induced NAPE suggests the existence of spatially distinct FFA and phosphatidylethanolamine pools. It reflects the specificity of NAPE synthase, the acyl composition, localization and availability of substrates, which are intrinsic cell properties, but has no predictive value as to the type of stress imposed. Whether NAPE has a physiological role depends on the cell being still alive and its compartmentation maintained during the stress period. PMID:11553752

  7. Molecular characterization of penicillin-resistant Streptococcus pneumoniae isolates causing respiratory disease in the United States.

    PubMed

    Corso, A; Severina, E P; Petruk, V F; Mauriz, Y R; Tomasz, A

    1998-01-01

    Three hundred twenty-eight (328) penicillin-resistant Streptococcus pneumoniae isolates collected in 39 states of the United States between October, 1996, and March, 1997, from (mostly adult) patients with respiratory disease were characterized by microbiological, serological, and molecular fingerprinting techniques, including determination of chromosomal macrorestriction pattern with pulsed-field gel electrophoresis (PFGE) and hybridization with DNA probes specific for various antibiotic resistance genes. The overwhelming majority of the isolates were in five serogroups (23, 6, 19, 9, 14). All isolates had penicillin MIC values of at least 2 microg/ml, but the collection also included isolates with MIC values as high as 16 microg/ml. Virtually all isolates (96.6%) were resistant to trimethoprim/sulfamethoxazole (SXT) and many isolates were also resistant to chloramphenicol (43%), tetracycline (55%), and erythromycin (65%). Resistance to levofloxacin was extremely rare. The molecular fingerprinting methods showed that a surprisingly large proportion (167 out of 328, or 50.9%) of the isolates belonged to two international epidemic clones of S. pneumoniae: clone A (127, or 38.7%) with properties indistinguishable from that of the 23F multiresistant "Spanish/USA" clone widely spread in Europe, Asia, Latin America, and South Africa, and clone B (40, or 12.2%) belonging to the "French" serogroup 9/14 clone widely spread in Europe and South America. Virtually all members of clone A were also resistant to chloramphenicol (cat+), tetracycline (tetM+), and SXT, and about 75% were also resistant to erythromycin (mefE+ or ermB+). Close to 30% (39 out of 127) of the clone A isolates expressed anomalous serotypes (primarily serotypes 19 and 14, and nontypable) and most likely represented spontaneous capsular transformants. Most of the 40 isolates (35/40) belonging to clone B expressed serotype 9, with five of the isolates expressing serotypes 14 or 19, or were nontypable. All members of this clone were resistant to penicillin and SXT with only occasional isolates showing resistance to macrolides, tetracycline, and chloramphenicol. The combination of microbiological tests and DNA hybridizations also allowed the identification of unusual strains, for instance, isolates that reacted with the tetM or mefE DNA probes without showing phenotypic antibiotic resistance, an isolate showing phenotypic macrolide resistance without hybridizing with either the ermB or mefE DNA probes, or isolates that hybridized with both of these DNA probes. In addition to clones A and B, another large portion of the S. pneumoniae isolates (112 of 328, or 34.1%) was represented by eight clusters, each with a unique PFGE type. These clusters, together with the clone A and clone B isolates, made up 85% of all the penicillin-resistant isolates identified in this survey in the United States. Both international clones and the unique clusters showed wide geographic dispersal: Clone A was present in 30 of the 39 states and clone B in 18. The data suggest that the major mode of spread of penicillin-resistant pneumococci in the United States is by clonal expansion and that the most significant components (clones A and B) have been imported into the United States from abroad. PMID:9988052

  8. Primary Respiratory Chain Disease Causes Tissue-Specific Dysregulation of the Global Transcriptome and Nutrient-Sensing Signaling Network

    PubMed Central

    Zhang, Zhe; Tsukikawa, Mai; Peng, Min; Polyak, Erzsebet; Nakamaru-Ogiso, Eiko; Ostrovsky, Julian; McCormack, Shana; Place, Emily; Clarke, Colleen; Reiner, Gail; McCormick, Elizabeth; Rappaport, Eric; Haas, Richard; Baur, Joseph A.; Falk, Marni J.

    2013-01-01

    Primary mitochondrial respiratory chain (RC) diseases are heterogeneous in etiology and manifestations but collectively impair cellular energy metabolism. Mechanism(s) by which RC dysfunction causes global cellular sequelae are poorly understood. To identify a common cellular response to RC disease, integrated gene, pathway, and systems biology analyses were performed in human primary RC disease skeletal muscle and fibroblast transcriptomes. Significant changes were evident in muscle across diverse RC complex and genetic etiologies that were consistent with prior reports in other primary RC disease models and involved dysregulation of genes involved in RNA processing, protein translation, transport, and degradation, and muscle structure. Global transcriptional and post-transcriptional dysregulation was also found to occur in a highly tissue-specific fashion. In particular, RC disease muscle had decreased transcription of cytosolic ribosomal proteins suggestive of reduced anabolic processes, increased transcription of mitochondrial ribosomal proteins, shorter 5?-UTRs that likely improve translational efficiency, and stabilization of 3?-UTRs containing AU-rich elements. RC disease fibroblasts showed a strikingly similar pattern of global transcriptome dysregulation in a reverse direction. In parallel with these transcriptional effects, RC disease dysregulated the integrated nutrient-sensing signaling network involving FOXO, PPAR, sirtuins, AMPK, and mTORC1, which collectively sense nutrient availability and regulate cellular growth. Altered activities of central nodes in the nutrient-sensing signaling network were validated by phosphokinase immunoblot analysis in RC inhibited cells. Remarkably, treating RC mutant fibroblasts with nicotinic acid to enhance sirtuin and PPAR activity also normalized mTORC1 and AMPK signaling, restored NADH/NAD+ redox balance, and improved cellular respiratory capacity. These data specifically highlight a common pathogenesis extending across different molecular and biochemical etiologies of individual RC disorders that involves global transcriptome modifications. We further identify the integrated nutrient-sensing signaling network as a common cellular response that mediates, and may be amenable to targeted therapies for, tissue-specific sequelae of primary mitochondrial RC disease. PMID:23894440

  9. Cardiomyocyte aldose reductase causes heart failure and impairs recovery from ischemia.

    PubMed

    Son, Ni-Huiping; Ananthakrishnan, Radha; Yu, Shuiqing; Khan, Raffay S; Jiang, Hongfeng; Ji, Ruiping; Akashi, Hirokazu; Li, Qing; O'Shea, Karen; Homma, Shunichi; Goldberg, Ira J; Ramasamy, Ravichandran

    2012-01-01

    Aldose reductase (AR), an enzyme mediating the first step in the polyol pathway of glucose metabolism, is associated with complications of diabetes mellitus and increased cardiac ischemic injury. We investigated whether deleterious effects of AR are due to its actions specifically in cardiomyocytes. We created mice with cardiac specific expression of human AR (hAR) using the ?-myosin heavy chain (MHC) promoter and studied these animals during aging and with reduced fatty acid (FA) oxidation. hAR transgenic expression did not alter cardiac function or glucose and FA oxidation gene expression in young mice. However, cardiac overexpression of hAR caused cardiac dysfunction in older mice. We then assessed whether hAR altered heart function during ischemia reperfusion. hAR transgenic mice had greater infarct area and reduced functional recovery than non-transgenic littermates. When the hAR transgene was crossed onto the PPAR alpha knockout background, another example of greater heart glucose oxidation, hAR expressing mice had increased heart fructose content, cardiac fibrosis, ROS, and apoptosis. In conclusion, overexpression of hAR in cardiomyocytes leads to cardiac dysfunction with aging and in the setting of reduced FA and increased glucose metabolism. These results suggest that pharmacological inhibition of AR will be beneficial during ischemia and in some forms of heart failure. PMID:23029549

  10. Diencephalic syndrome: a cause of failure to thrive and a model of partial growth hormone resistance.

    PubMed

    Fleischman, Amy; Brue, Catherine; Poussaint, Tina Young; Kieran, Mark; Pomeroy, Scott L; Goumnerova, Liliana; Scott, R Michael; Cohen, Laurie E

    2005-06-01

    Diencephalic syndrome is a rare but potentially lethal cause of failure to thrive in infants and young children. The diencephalic syndrome includes clinical characteristics of severe emaciation, normal linear growth, and normal or precocious intellectual development in association with central nervous system tumors. Our group initially described a series of 9 patients with diencephalic syndrome and found a reduced prevalence of emesis, hyperalertness, or hyperactivity compared with previous reports. Also, the tumors were found to be larger, occur at a younger age, and behave more aggressively than similarly located tumors without diencephalic syndrome. We have been able to extend our follow-up of the original patients, as well as describe 2 additional cases. Because the mechanism of the growth and endocrinologic findings in diencephalic syndrome has not been explained, we report on these patients in light of current research on hypothalamic factors that affect growth and weight. This study emphasizes diencephalic syndrome as a model for additional study of growth hormone resistance and metabolic regulation of adiposity. PMID:15930202

  11. Reliability enhancement of APR + diverse protection system regarding common cause failures

    SciTech Connect

    Oh, Y. G.; Kim, Y. M.; Yim, H. S. [KEPCO Engineering and Construction Company, Inc., 1045 Daedeok-Daero, Yuseong-gu, Daejeon 305-353 (Korea, Republic of); Lee, S. J. [Chungnam National Univ., 99 Daehak-ro, Yuseong-gu, Daejeon 305-764 (Korea, Republic of)

    2012-07-01

    The Advanced Power Reactor Plus (APR +) nuclear power plant design has been developed on the basis of the APR1400 (Advanced Power Reactor 1400 MWe) to further enhance safety and economics. For the mitigation of Anticipated Transients Without Scram (ATWS) as well as Common Cause Failures (CCF) within the Plant Protection System (PPS) and the Emergency Safety Feature - Component Control System (ESF-CCS), several design improvement features have been implemented for the Diverse Protection System (DPS) of the APR + plant. As compared to the APR1400 DPS design, the APR + DPS has been designed to provide the Safety Injection Actuation Signal (SIAS) considering a large break LOCA accident concurrent with the CCF. Additionally several design improvement features, such as channel structure with redundant processing modules, and changes of system communication methods and auto-system test methods, are introduced to enhance the functional reliability of the DPS. Therefore, it is expected that the APR + DPS can provide an enhanced safety and reliability regarding possible CCF in the safety-grade I and C systems as well as the DPS itself. (authors)

  12. Mutation of BSND causes Bartter syndrome with sensorineural deafness and kidney failure.

    PubMed

    Birkenhäger, R; Otto, E; Schürmann, M J; Vollmer, M; Ruf, E M; Maier-Lutz, I; Beekmann, F; Fekete, A; Omran, H; Feldmann, D; Milford, D V; Jeck, N; Konrad, M; Landau, D; Knoers, N V; Antignac, C; Sudbrak, R; Kispert, A; Hildebrandt, F

    2001-11-01

    Antenatal Bartter syndrome (aBS) comprises a heterogeneous group of autosomal recessive salt-losing nephropathies. Identification of three genes that code for renal transporters and channels as responsible for aBS has resulted in new insights into renal salt handling, diuretic action and blood-pressure regulation. A gene locus of a fourth variant of aBS called BSND, which in contrast to the other forms is associated with sensorineural deafness (SND) and renal failure, has been mapped to chromosome 1p. We report here the identification by positional cloning, in a region not covered by the human genome sequencing projects, of a new gene, BSND, as the cause of BSND. We examined ten families with BSND and detected seven different mutations in BSND that probably result in loss of function. In accordance with the phenotype, BSND is expressed in the thin limb and the thick ascending limb of the loop of Henle in the kidney and in the dark cells of the inner ear. The gene encodes a hitherto unknown protein with two putative transmembrane alpha-helices and thus might function as a regulator for ion-transport proteins involved in aBS, or else as a new transporter or channel itself. PMID:11687798

  13. Sex differences in the causes and natural history of heart failure

    Microsoft Academic Search

    Bobbi L. Hoppe; Denise D. Hermann

    2003-01-01

    Heart failure is a clinical syndrome of increasing prevalence in the United States, with significant morbidity and mortality.\\u000a Although men have a higher annual mortality rate, more women than men die from heart failure each year. Optimal disease management\\u000a is critical in limiting the impact of heart failure on life quality, quantity, and health care expenditures. Women have a\\u000a unique

  14. 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

  15. Simultaneous Detection and High-Throughput Identification of a Panel of RNA Viruses Causing Respiratory Tract Infections

    Microsoft Academic Search

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

    2007-01-01

    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)

  16. Heparin binding protein in patients with acute respiratory failure treated with granulocyte colony-stimulating factor (filgrastim) – a prospective, placebo-controlled, double-blind study

    PubMed Central

    2013-01-01

    Background Heparin Binding Protein (HBP) is released to blood circulation from activated neutrophils in bacterial infections. It is a potential inducer of vascular leakage and precludes the development of septic shock. Filgrastim induces the production of new neutrophils and modulates their bacterial-killing activity. We evaluated the effect of filgrastim on HBP –concentrations in critically ill patients with acute respiratory failure. Methods 59 critically ill patients with acute respiratory failure were included in this randomised, double-blind, placebo-controlled study of filgrastim 300 micrograms/day or corresponding placebo for 7 days. Plasma samples were drawn on baseline, day 4 and day 7. HBP –concentrations, absolute leukocyte and neutrophil counts were measured. Results The median [IQR] HBP concentrations were 23.6 ng/ml [13.9-43.0 ng/ml], 25.1 ng/ml [17.7-35.5 ng/ml] and 15.9 ng/ml [12.6-20.7 ng/ml] in patients receiving filgrastim on baseline, day 4 and day 7, respectively. The HBP concentrations in placebo group were 21.6 ng/ml [16.9-28.7 ng/ml], 13.9 ng/ml [12.0-19.5 ng/ml] and 17.8 ng/ml [13.6-20.9 ng/ml]. At day 4, the filgrastim group had significantly higher HBP –concentrations when compared to placebo group (p?failure did not correlate with the observed plasma HBP –concentrations. Trial registration Clinicaltrials.gov NCT01713309 PMID:23363492

  17. Causes of developmental failure of in-vitro matured rhesus monkey oocytes: impairments in embryonic genome activation

    Microsoft Academic Search

    R. Dee Schramm; Ann Marie Paprocki; Catherine A. VandeVoort

    2003-01-01

    BACKGROUND: Understanding the causes of developmental failure of in-vitro matured primate oocytes may lead to viable strategies for improving their developmental competence. The aims of this study were to determine whether the timely onset of embryonic genome activation among individual blastomeres of preimplantation maca- que embryos is impaired by in-vitro maturation (IVM) of oocytes and whether these impairments are associated

  18. Incidence and Causes of Physical Failure of Artificial Habitat Structures in Streams of Western Oregon and Washington

    Microsoft Academic Search

    CHRISTOPHER A. FRISSELL; RICHARD K. NAWA

    1992-01-01

    In recent years an increasing share of fishery management resources has been com- mitted to alteration of fish habitat with artificial stream structures. We evaluated rates and causes of physical impairment or failure for 161 fish habitat structures in 15 streams in southwest Oregon and southwest Washington, following a flood of a magnitude that recurs every 2-10 years. The incidence

  19. Massive Infiltration of Liver by Metastatic Adenocarcinoma: A Rare Cause of Acute Hepatic Failure

    PubMed Central

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

    2012-01-01

    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.

  20. HIBCH mutations can cause Leigh-like disease with combined deficiency of multiple mitochondrial respiratory chain enzymes and pyruvate dehydrogenase

    PubMed Central

    2013-01-01

    Background Deficiency of 3-hydroxy-isobutyryl-CoA hydrolase (HIBCH) caused by HIBCH mutations is a rare cerebral organic aciduria caused by disturbance of valine catabolism. Multiple mitochondrial respiratory chain (RC) enzyme deficiencies can arise from a number of mechanisms, including defective maintenance or expression of mitochondrial DNA. Impaired biosynthesis of iron-sulphur clusters and lipoic acid can lead to pyruvate dehydrogenase complex (PDHc) deficiency in addition to multiple RC deficiencies, known as the multiple mitochondrial dysfunctions syndrome. Methods Two brothers born to distantly related Pakistani parents presenting in early infancy with a progressive neurodegenerative disorder, associated with basal ganglia changes on brain magnetic resonance imaging, were investigated for suspected Leigh-like mitochondrial disease. The index case had deficiencies of multiple RC enzymes and PDHc in skeletal muscle and fibroblasts respectively, but these were normal in his younger brother. The observation of persistently elevated hydroxy-C4-carnitine levels in the younger brother led to suspicion of HIBCH deficiency, which was investigated by biochemical assay in cultured skin fibroblasts and molecular genetic analysis. Results Specific spectrophotometric enzyme assay revealed HIBCH activity to be below detectable limits in cultured skin fibroblasts from both brothers. Direct Sanger sequence analysis demonstrated a novel homozygous pathogenic missense mutation c.950G cause of the multiple mitochondrial dysfunctions syndrome, and should be considered in the differential diagnosis of patients presenting with multiple RC deficiencies and/or pyruvate dehydrogenase deficiency. PMID:24299452

  1. Bronchiolitis caused by respiratory syncytial virus in an area of portugal: epidemiology, clinical features, and risk factors.

    PubMed

    Flores, P; Rebelo-de-Andrade, H; Gonçalves, P; Guiomar, R; Carvalho, C; Sousa, E N; Noronha, F T; Palminha, J M

    2004-01-01

    The aim of the present study was to analyse the clinical and epidemiological characteristics of bronchiolitis caused by respiratory syncytial virus (RSV) in 225 children observed in a paediatric hospital in Lisbon, Portugal, and to determine the clinical, epidemiological, or laboratory parameters that correlate with greater severity of the disease. This prospective study included hospitalised and ambulatory children younger than 36 months of age with a diagnosis of bronchiolitis and was conducted during two consecutive RSV epidemiological seasons (November-March 2000/01 and 2001/02). The median age of the patients was 5 months, and the male-to-female ratio was 1.6:1. RSV was isolated in 60.9% of patients, predominantly in the hospitalised group. The subtype A:B ratio was 7.4:1 and was similar in both seasons. RSV-positive patients were younger, had more severe clinical forms of bronchiolitis, and fewer changes in leucocyte total and differential counts. Among infected patients, higher clinical severity scores occurred in association with first wheezing episodes, overcrowded households, attendance at day-care centres, or prematurity (<36 weeks). This first prospective study of RSV epidemiology in Portugal provides a foundation for appropriate surveillance programmes of RSV infection in this country. A multicentre study is desirable in order to delineate optimal prophylactic and therapeutic guidelines for RSV infection in Portugal. PMID:14615937

  2. Hyperbilirubinemia and rapid fatal hepatic failure in severe combined immunodeficiency caused by adenosine deaminase deficiency (ADA-SCID).

    PubMed

    Kühl, J S; Schwarz, K; Münch, A; Schmugge, M; Pekrun, A; Meisel, C; Wahn, V; Ebell, W; von Bernuth, H

    2011-03-01

    Adenosin deaminase (ADA) deficiency is the cause for Severe Combined Immunodeficiency (SCID) in about 15% of patients with SCID, often presenting as T (-)B (-)NK (-)SCID. Treatment options for ADA-SCID are enzyme replacement, bone marrow transplantation or gene therapy. We here describe the first patient with ADA-SCID and fatal hepatic failure despite bone marrow transplantation from a 10/10 HLA identical related donor. As patients with ADA-SCID may be at yet underestimated increased risk for rapid hepatic failure we speculate whether hepatitis in ADA-SCID should lead to the immediate treatment with enzyme replacement by pegylated ADA. PMID:21271505

  3. Heart Failure Caused by Atrial Fibrillation in a Patient with Isolated Adrenocorticotropic Hormone Deficiency and Hashimoto's Thyroiditis

    PubMed Central

    Maemura, Ryo; Kajiya, Takashi; Koriyama, Nobuyuki; Lee, Souki

    2014-01-01

    We report the case of a 75-year-old female patient with a history of Hashimoto's thyroiditis who presented with congestive heart failure caused by atrial fibrillation associated with isolated adrenocorticotropic hormone (ACTH) deficiency. This is the first case of the combination of these complex conditions. Clinical conditions in a patient with isolated ACTH deficiency and Hashimoto's thyroiditis can be variable. Thus, it is sometimes difficult to establish a diagnosis. The mechanism underlying heart failure may be complex in some cases. Various conditions can affect patients simultaneously. Therefore, making a proper diagnosis is necessary to improve the patient's prognosis.

  4. 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 ...

  5. Investigation into the cause of pneumatic actuator failure on the HypoSurface

    E-print Network

    Chun, Darren M. K. (Darren Masayasu Kekoa)

    2007-01-01

    An investigation into the failure of pneumatic actuators on the HypoSurface was conducted to provide information on the current HypoSurface prototype. Using a systematic approach throughout testing, piston components were ...

  6. The dilemma, causes and approaches to avoid recurrent hospital readmissions for patients with chronic heart failure

    Microsoft Academic Search

    Melody Zaya; Anita Phan; Ernst R. Schwarz

    Heart failure is a progressive illness that carries significant morbidity and mortality. This highly prevalent illness leads\\u000a to frequent, costly hospitalizations with approximately 50% of patients being readmitted within 6 months of initial hospitalization.\\u000a While rehospitalization has been extensively studied in the past, little progress has been made in terms of reducing readmission\\u000a rates of heart failure patients in the last

  7. Does symptom-limited cycle exercise cause low frequency diaphragm fatigue in patients with heart failure?

    Microsoft Academic Search

    Mark J. Dayer; Nicholas S. Hopkinson; Ewen T. Ross; Sophie Jonville; Tarek Sharshar; Mark Kearney; John Moxham; Michael I. Polkey

    Abstract Background: Reduced,diaphragm,contractility occurs in some,healthy subjects when,they exercise to exhaustion. This indicates low frequency fatigue, which may contribute to task failure. We hypothesised that patients with congestive heart failure (CHF) might be especially vulnerable to the development,of low frequency diaphragm,fatigue after exhaustive exercise. Aims: To study the effect of exhaustive incremental cycle exercise on diaphragm,contractility in patients with CHF.

  8. Respiratory Syncytial Virus

    MedlinePLUS

    ... JavaScript on. Read more information on enabling JavaScript. Respiratory Syncytial Virus (RSV) Skip Content Marketing Share this: ... common. The infection can progress to the lower respiratory tract to cause more severe illness such as ...

  9. 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

  10. 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…

  11. [Respiratory symptoms caused by the use of electrocautery in physicians being trained in surgery in a Mexican hospital].

    PubMed

    Navarro-Meza, María Cristina; González-Baltazar, Raquel; Aldrete-Rodríguez, María Guadalupe; Carmona-Navarro, David Enrique; López-Cardona, María Guadalupe

    2013-03-01

    In order to determine the frequency of respiratory symptoms among residents from surgical specialties dures exposed to the electrocautery smoke, a cross-sectional study was conducted in February 2012. 50 third-year residents from different surgical specialties coming from a third-level hospital belonging to the Institute of Security and Social Services of the State Workers in Jalisco, Mexico, were included. The subject selection was non-probabilistic. A questionnaire on respiratory symptoms developed in Cuba was used for data collection. The most common symptoms were sensation of a lump in the throat (58%), and a sore throat (22%). The specialty with the highest rate of exposure was neurosurgery (24.1 min/surgical procedure). All, the physicians from this specialty had respiratory symptoms. We conclude that the cauterization smoke may be considered a risk for developing respiratory symptoms among physicians with surgical specialties. PMID:23612810

  12. [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; Peńa 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

  13. Assessment of Some Inflammatory Biomarkers as Predictors of Outcome of Acute Respiratory Failure on Top of Chronic Obstructive Pulmonary Disease and Evaluation of the Role of Bacteria

    PubMed Central

    Shafiek, Hanaa Ahmed; Abd-Elwahab, Nashwa Hassan; Baddour, Manal Mohammad; El-Hoffy, Mohamed Mabrouk; Degady, Akram Abd-Elmoneim; Khalil, Yehia Mohamed

    2012-01-01

    Objective. To study the value of the inflammatory markers (interleukin-6 (IL-6), interleukin-8 (IL-8), and C-reactive protein (CRP)) in predicting the outcome of noninvasive ventilation (NIV) in the management of acute respiratory failure (ARF) on top of chronic obstructive pulmonary disease (COPD) and the role of bacteria in the systemic inflammation. Methods. Thirty three patients were subjected to standard treatment plus NIV, and accordingly, they were classified into responders and nonresponders. Serum samples were collected for IL-6, IL-8, and CRP analysis. Sputum samples were taken for microbiological evaluation. Results. A wide spectrum of bacteria was revealed; Gram-negative and atypical bacteria were the most common (31% and 28% resp.; single or copathogen). IL-8 and dyspnea grade was significantly higher in the non-responder group (P = 0.01 and 0.023 resp.). IL-6 correlated positivity with the presence of infection and type of pathogen (P = 0.038 and 0.034 resp.). Gram-negative bacteria were associated with higher significant IL-6 in comparison between others (196.4 ± 239.1?pg/dL; P = 0.011) but insignificantly affected NIV outcome (P > 0.05). Conclusions. High systemic inflammation could predict failure of NIV. G-ve bacteria correlated with high IL-6 but did not affect the response to NIV. PMID:23724320

  14. 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

  15. Renal infections and pyelonephritis as the main cause of renal failure and the associated glomerulopathy

    Microsoft Academic Search

    W. El-Said

    1973-01-01

    In a retrospective study of 113 patients with chronic renal failure, including 39 dialysis patients, evidence of urinary infection and pyelonephritis was found in 72% of cases. Even in the majority of the cases diagnosed by renal biopsy as chronic glomerulonephritis, the clinical and laboratory data pointed clearly to the presence of pyelonephritis. Traditionally, the pyelonephritis in such cases is

  16. 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

  17. Causes and Cures of Reading Failure in the Culturally Different: A Minority View.

    ERIC Educational Resources Information Center

    Karlin, Robert

    Research studies have attributed the reading failure of children from low socioeconomic groups to factors such as hunger, poor physical health, substandard living conditions, and the language mismatch that results from the difference between spoken nonstandard dialect and printed standard English. While each of these does influence reading…

  18. What Causes a Broken Heart—Molecular Insights into Heart Failure

    Microsoft Academic Search

    Seán P. Barry; Paul A. Townsend

    2010-01-01

    Our understanding of the molecular processes which regulate cardiac function has grown immeasurably in recent years. Even with the advent of ?-blockers, angiotensin inhibitors and calcium modulating agents, heart failure (HF) still remains a seriously debilitating and life-threatening condition. Here, we review the molecular changes which occur in the heart in response to increased load and the pathways which control

  19. California Fault Lines: Understanding the Causes and Impact of Network Failures

    E-print Network

    . INTRODUCTION Today's network-centric enterprises are built on the promise of uninterrupted service availability factors affecting end-to-end service availability, net- work component failure is perhaps the least well "low-quality" data sources that are already available in modern net- work environments. We describe

  20. [Rare cause of heart failure in an elderly woman in Djibouti: left ventricular non compaction].

    PubMed

    Massoure, P L; Lamblin, G; Bertani, A; Eve, O; Kaiser, E

    2011-10-01

    The purpose of this report is to describe the first case of left ventricular non compaction diagnosed in Djibouti. The patient was a 74-year-old Djiboutian woman with symptomatic heart failure. Echocardiography is the key tool for assessment of left ventricular non compaction. This rare cardiomyopathy is probably underdiagnosed in Africa. PMID:22235629

  1. [Hemoptysis and the adult respiratory distress syndrome as the causes of death in leptospirosis. Changes in the clinical and anatomicopathological patterns].

    PubMed

    Gonçalves, A J; de Carvalho, J E; Guedes e Silva, J B; Rozembaum, R; Vieira, A R

    1992-01-01

    Human leptospirosis, one of the main urban endemics/epidemics in Brazil, has dramatically grown in the last three decades, especially after floods caused by summer rains. This presentation describes recent changes in the clinical patterns of this pathology in our region, expressed by the emergence of massive haemoptysis and acute respiratory distress syndrome, or both conditions associated. The evident changes in the respiratory structures emerged as a serious life threat and death mechanisms, becoming the main cause of death in leptospirosis among us because of their high incidence. This new face of the disease demands a revision of current concepts about its seriousness and raises speculations about the pathogenesis of such alterations. PMID:1340542

  2. Short-term effect of dust storms on the risk of mortality due to respiratory, cardiovascular and all-causes in Kuwait.

    PubMed

    Al-Taiar, Abdullah; Thalib, Lukman

    2014-01-01

    This study aimed to investigate the impact of dust storms on short-term mortality in Kuwait. We analyzed respiratory and cardiovascular mortality as well as all-cause mortality in relation to dust storm events over a 5-year study period, using data obtained through a population-based retrospective ecological time series study. Dust storm days were identified when the national daily average of PM10 exceeded 200 ?g/m(3). Generalized additive models with Poisson link were used to estimate the relative risk (RR) of age-stratified daily mortality associated with dust events, after adjusting for potential confounders including weather variables and long-term trends. There was no significant association between dust storm events and same-day respiratory mortality (RR = 0.96; 95%CI 0.88-1.04), cardiovascular mortality (RR = 0.98; 95%CI 0.96-1.012) or all-cause mortality (RR = 0.99; 95%CI 0.97-1.00). Overall our findings suggest that local dust, that most likely originates from crustal materials, has little impact on short-term respiratory, cardiovascular or all-cause mortality. PMID:23329278

  3. Short-term effect of dust storms on the risk of mortality due to respiratory, cardiovascular and all-causes in Kuwait

    NASA Astrophysics Data System (ADS)

    Al-Taiar, Abdullah; Thalib, Lukman

    2014-01-01

    This study aimed to investigate the impact of dust storms on short-term mortality in Kuwait. We analyzed respiratory and cardiovascular mortality as well as all-cause mortality in relation to dust storm events over a 5-year study period, using data obtained through a population-based retrospective ecological time series study. Dust storm days were identified when the national daily average of PM10 exceeded 200 ?g/m3. Generalized additive models with Poisson link were used to estimate the relative risk (RR) of age-stratified daily mortality associated with dust events, after adjusting for potential confounders including weather variables and long-term trends. There was no significant association between dust storm events and same-day respiratory mortality (RR = 0.96; 95 %CI 0.88-1.04), cardiovascular mortality (RR = 0.98; 95 %CI 0.96-1.012) or all-cause mortality (RR = 0.99; 95 %CI 0.97-1.00). Overall our findings suggest that local dust, that most likely originates from crustal materials, has little impact on short-term respiratory, cardiovascular or all-cause mortality.

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

    NASA Astrophysics Data System (ADS)

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

    2014-05-01

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

  5. Causes of recruitment failure in freshwater mussel populations in southeastern New York.

    PubMed

    Strayer, David L; Malcom, Heather M

    2012-09-01

    Populations of freshwater mussels (Unionoida) are declining or disappearing from many waters around the world. In many declining populations, recruitment fails before adult mortality occurs, resulting in relict populations that can persist for decades. We tested whether recruitment failure in populations of the freshwater mussel Elliptio complanata was associated with invasion of nonnative crayfish, loss of a primary fish host (American eel Anguilla rostrata), excessive inputs of fine sediments, or unfavorable interstitial water chemistry (too little dissolved oxygen or too much un-ionized ammonia). We sampled mussel populations, crayfish populations, and environmental conditions at 14 sites on wadeable streams in southeastern New York. Five of the mussel populations had little or no recent recruitment. We found no association between recruitment failure and crayfish, American eels, fine sediments, or interstitial dissolved oxygen. In contrast, recruitment failure was strongly associated with high concentrations (>0.2 microg N/L) of un-ionized ammonia. This threshold is much lower than thresholds for acute ammonia toxicity identified in laboratory studies. We suggest that excessive concentrations of interstitial un-ionized ammonia may be responsible for widespread declines of freshwater mussel populations, especially in agricultural areas. PMID:23092015

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

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  8. Cardio-respiratory failure secondary to ectopic Cushing's syndrome as the index presentation of small-cell lung cancer.

    PubMed

    von Stempel, Conrad; Perks, Clarissa; Corcoran, John; Grayez, Jamal

    2013-01-01

    A 79-year-old woman, a smoker, presented to the emergency department with a 2-week history of progressive dyspnoea and peripheral oedema, preceded by flu-like symptoms that had failed to improve despite antibiotics. Examination identified severe hypertension and signs consistent with severe fluid overload. Baseline chest X ray showed a right-sided abnormality. In the context of an extensive smoking history CT thorax was indicated which demonstrated a right-sided hilar mass and lymphadenopathy. Blood tests showed an unexplained metabolic alkalosis with partial respiratory compensation and hypokalaemia prompting endocrinological tests investigating Cushing's syndrome. Urinary cortisol was measured at 3174 nmol/L/24 h (normal<560), serum adrenocorticotropic hormone (ACTH) of 215 ng/L (normal<46). Pleural fluid cytology confirmed a diagnosis of small-cell lung cancer (SCLC). The patient's condition deteriorated despite intravenous diuretics and nitrates, metyrapone and non-invasive ventilation. Treatment was withdrawn 1 week after admission. The clinical course in the presence of biochemical derangement and SCLC is highly suggestive of paraneoplastic ectopic ACTH secretion. PMID:23946525

  9. Impaired S-nitrosylation of the ryanodine receptor caused by xanthine oxidase activity contributes to calcium leak in heart failure.

    PubMed

    Gonzalez, Daniel R; Treuer, Adriana V; Castellanos, Jorge; Dulce, Raul A; Hare, Joshua M

    2010-09-10

    S-Nitrosylation is a ubiquitous post-translational modification that regulates diverse biologic processes. In skeletal muscle, hypernitrosylation of the ryanodine receptor (RyR) causes sarcoplasmic reticulum (SR) calcium leak, but whether abnormalities of cardiac RyR nitrosylation contribute to dysfunction of cardiac excitation-contraction coupling remains controversial. In this study, we tested the hypothesis that cardiac RyR2 is hyponitrosylated in heart failure, because of nitroso-redox imbalance. We evaluated excitation-contraction coupling and nitroso-redox balance in spontaneously hypertensive heart failure rats with dilated cardiomyopathy and age-matched Wistar-Kyoto rats. Spontaneously hypertensive heart failure myocytes were characterized by depressed contractility, increased diastolic Ca(2+) leak, hyponitrosylation of RyR2, and enhanced xanthine oxidase derived superoxide. Global S-nitrosylation was decreased in failing hearts compared with nonfailing. Xanthine oxidase inhibition restored global and RyR2 nitrosylation and reversed the diastolic SR Ca(2+) leak, improving Ca(2+) handling and contractility. Together these findings demonstrate that nitroso-redox imbalance causes RyR2 oxidation, hyponitrosylation, and SR Ca(2+) leak, a hallmark of cardiac dysfunction. The reversal of this phenotype by inhibition of xanthine oxidase has important pathophysiologic and therapeutic implications. PMID:20643651

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

    NASA Astrophysics Data System (ADS)

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

    2014-10-01

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

  11. Causes, mechanisms, and rates of failing of Mark II fuel elements (failures 39, 40, and 41)

    Microsoft Academic Search

    Guay

    1968-01-01

    It is concluded from radiometallurgy investigations that the three n-reactor Mark II driver elements (numbers 39, 40, and 41) have failed by cause of very localized and severe overheating of the inner cladding and that localized corrosion has been the mechanism by which the cladding has failed and coolant has been admitted. The fundamental cause resulted from impaired heat transfer

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

    PubMed

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

    2009-12-01

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

  13. 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

  14. 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

  15. “Knot Stent”: An Unusual Cause of Acute Renal Failure in Solitary Kidney

    PubMed Central

    Moufid, Kamal; Touiti, Driss; Mohamed, Lezrek

    2012-01-01

    The insertion of indwelling ureteric stents is a routine procedure in urology practice. Complications secondary to the insertion of these stents have also increased, such as stent encrustation, stent fragmentation, stone formation, and recurrent urinary tract infections. Knot formation within the renal pelvis or in the coiled portion of the ureteral stent is an extremely rare condition, with less than 15 cases reported in literature. The authors report a rare case of knotted stent, complicated by an obstructive acute renal failure and urosepsis, in a patient with a solitary functioning kidney. PMID:22919550

  16. Microbiologically influenced corrosion causes failure of type 304 water well screens

    SciTech Connect

    Elshawesh, F.; Elmendelsi, T.; Elhoud, A.; Abuan, E.; Elagdel, E. [Petroleum Research Center, Tripoli (Libyan Arab Jamahiriya)

    1997-06-01

    Austenitic stainless steel (SS) type 304 (UNS S30400) wire and rod screens installed in fresh water wells (500 m depth) failed after {approximately} 2 years of service. The failed screens from different wells showed severe localized corrosion attack and were covered by black and reddish-brown deposits. These findings indicated the contribution of bacteria in the screen failure. The bacteria might have developed from the external contamination of fluids during well drilling and/or other sources. Water treatment to minimize the bacterial activity, such as chlorination, was not applied during well-drilling, development, and operation.

  17. MCM4 mutation causes adrenal failure, short stature, and natural killer cell deficiency in humans

    PubMed Central

    Hughes, Claire R.; Guasti, Leonardo; Meimaridou, Eirini; Chuang, Chen-Hua; Schimenti, John C.; King, Peter J.; Costigan, Colm; Clark, Adrian J.L.; Metherell, Louise A.

    2012-01-01

    An interesting variant of familial glucocorticoid deficiency (FGD), an autosomal recessive form of adrenal failure, exists in a genetically isolated Irish population. In addition to hypocortisolemia, affected children show signs of growth failure, increased chromosomal breakage, and NK cell deficiency. Targeted exome sequencing in 8 patients identified a variant (c.71-1insG) in minichromosome maintenance–deficient 4 (MCM4) that was predicted to result in a severely truncated protein (p.Pro24ArgfsX4). Western blotting of patient samples revealed that the major 96-kDa isoform present in unaffected human controls was absent, while the presence of the minor 85-kDa isoform was preserved. Interestingly, histological studies with Mcm4-depleted mice showed grossly abnormal adrenal morphology that was characterized by non-steroidogenic GATA4- and Gli1-positive cells within the steroidogenic cortex, which reduced the number of steroidogenic cells in the zona fasciculata of the adrenal cortex. Since MCM4 is one part of a MCM2-7 complex recently confirmed as the replicative helicase essential for normal DNA replication and genome stability in all eukaryotes, it is possible that our patients may have an increased risk of neoplastic change. In summary, we have identified what we believe to be the first human mutation in MCM4 and have shown that it is associated with adrenal insufficiency, short stature, and NK cell deficiency. PMID:22354170

  18. Failure of customary treatment in chronic active liver disease: causes and management.

    PubMed

    Schalm, S W; Ammon, H V; Summerskill, W H

    1976-06-01

    Among 134 patients with chronic active liver disease, selected by identical clinical, biochemical and morphologic criteria, assigned to standard treatment programs and followed at regular intervals, 21 of 105 failed treatment with standard regimens containing steroids. Treatment failure was more common in patients whose serum contained hepatitis B surface antigen, those with more severe liver disease as judged by liver function tests (prothrombin time) and hepatic morphology (subacute hepatitis or cirrhosis). Early diagnosis of treatment failure, based on changes in liver function tests rather than on clinical features of deterioration, coupled with the immediate administration of higher doses of prednisone with or without higher doses of azathioprine, resulted in disappearance of clinical and biochemical features of disease activity in the majority of patients. These results were greatly superior to those earlier reported by us from patients chosen by identical criteria but treated by conventional measures. However, when endogenous encephalopathy developed the outlook was grave, regardless of previous or subsequent therapy. We recommend that patients at risk for failing conventional treatment be identified early, followed carefully with serial liver function tests, and be treated promptly with higher doses of medication when deterioration occurs. PMID:793499

  19. 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

  20. 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

  1. 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

  2. Hyperglycaemia results from beta-cell dysfunction in critically ill children with respiratory and cardiovascular failure: a prospective observational study

    Microsoft Academic Search

    Catherine M Preissig; Mark R Rigby

    2009-01-01

    INTRODUCTION: Hyperglycaemia is common in critical illness and associated with poor outcome. Glycaemic control using insulin may decrease morbidity and mortality. Many questions remain about the cause of critical illness hyperglycaemia (CIH). Our objective was to investigate the endocrinological basis of paediatric CIH. METHODS: C-peptide and blood glucose (BG) levels were assessed in 41 children aged 2 to 18 years

  3. Phase I/II Trial of Adeno-Associated Virus–Mediated Alpha-Glucosidase Gene Therapy to the Diaphragm for Chronic Respiratory Failure in Pompe Disease: Initial Safety and Ventilatory Outcomes

    PubMed Central

    Smith, Barbara K.; Collins, Shelley W.; Conlon, Thomas J.; Mah, Cathryn S.; Lawson, Lee Ann; Martin, Anatole D.; Fuller, David D.; Cleaver, Brian D.; Clément, Nathalie; Phillips, Dawn; Islam, Saleem; Dobjia, Nicole

    2013-01-01

    Abstract Pompe disease is an inherited neuromuscular disease caused by deficiency of lysosomal acid alpha-glucosidase (GAA) leading to glycogen accumulation in muscle and motoneurons. Cardiopulmonary failure in infancy leads to early mortality, and GAA enzyme replacement therapy (ERT) results in improved survival, reduction of cardiac hypertrophy, and developmental gains. However, many children have progressive ventilatory insufficiency and need additional support. Preclinical work shows that gene transfer restores phrenic neural activity and corrects ventilatory deficits. Here we present 180-day safety and ventilatory outcomes for five ventilator-dependent children in a phase I/II clinical trial of AAV-mediated GAA gene therapy (rAAV1-hGAA) following intradiaphragmatic delivery. We assessed whether rAAV1-hGAA results in acceptable safety outcomes and detectable functional changes, using general safety measures, immunological studies, and pulmonary functional testing. All subjects required chronic, full-time mechanical ventilation because of respiratory failure that was unresponsive to both ERT and preoperative muscle-conditioning exercises. After receiving a dose of either 1×1012 vg (n=3) or 5×1012 vg (n=2) of rAAV1-hGAA, the subjects' unassisted tidal volume was significantly larger (median [interquartile range] 28.8% increase [15.2–35.2], p<0.05). Further, most patients tolerated appreciably longer periods of unassisted breathing (425% increase [103–851], p=0.08). Gene transfer did not improve maximal inspiratory pressure. Expected levels of circulating antibodies and no T-cell-mediated immune responses to the vector (capsids) were observed. One subject demonstrated a slight increase in anti-GAA antibody that was not considered clinically significant. These results indicate that rAAV1-hGAA was safe and may lead to modest improvements in volitional ventilatory performance measures. Evaluation of the next five patients will determine whether earlier intervention can further enhance the functional benefit. PMID:23570273

  4. Phase I/II trial of adeno-associated virus-mediated alpha-glucosidase gene therapy to the diaphragm for chronic respiratory failure in Pompe disease: initial safety and ventilatory outcomes.

    PubMed

    Smith, Barbara K; Collins, Shelley W; Conlon, Thomas J; Mah, Cathryn S; Lawson, Lee Ann; Martin, Anatole D; Fuller, David D; Cleaver, Brian D; Clément, Nathalie; Phillips, Dawn; Islam, Saleem; Dobjia, Nicole; Byrne, Barry J

    2013-06-01

    Pompe disease is an inherited neuromuscular disease caused by deficiency of lysosomal acid alpha-glucosidase (GAA) leading to glycogen accumulation in muscle and motoneurons. Cardiopulmonary failure in infancy leads to early mortality, and GAA enzyme replacement therapy (ERT) results in improved survival, reduction of cardiac hypertrophy, and developmental gains. However, many children have progressive ventilatory insufficiency and need additional support. Preclinical work shows that gene transfer restores phrenic neural activity and corrects ventilatory deficits. Here we present 180-day safety and ventilatory outcomes for five ventilator-dependent children in a phase I/II clinical trial of AAV-mediated GAA gene therapy (rAAV1-hGAA) following intradiaphragmatic delivery. We assessed whether rAAV1-hGAA results in acceptable safety outcomes and detectable functional changes, using general safety measures, immunological studies, and pulmonary functional testing. All subjects required chronic, full-time mechanical ventilation because of respiratory failure that was unresponsive to both ERT and preoperative muscle-conditioning exercises. After receiving a dose of either 1×10(12) vg (n=3) or 5×10(12) vg (n=2) of rAAV1-hGAA, the subjects' unassisted tidal volume was significantly larger (median [interquartile range] 28.8% increase [15.2-35.2], p<0.05). Further, most patients tolerated appreciably longer periods of unassisted breathing (425% increase [103-851], p=0.08). Gene transfer did not improve maximal inspiratory pressure. Expected levels of circulating antibodies and no T-cell-mediated immune responses to the vector (capsids) were observed. One subject demonstrated a slight increase in anti-GAA antibody that was not considered clinically significant. These results indicate that rAAV1-hGAA was safe and may lead to modest improvements in volitional ventilatory performance measures. Evaluation of the next five patients will determine whether earlier intervention can further enhance the functional benefit. PMID:23570273

  5. Prediction of extubation failure for neonates with respiratory distress syndrome using the MIMIC-II clinical database.

    PubMed

    Mikhno, Arthur; Ennett, Colleen M

    2012-01-01

    Extubation failure (EF) is an ongoing problem in the neonatal intensive care unit (NICU). Nearly 25% of neonates fail their first extubation attempt, requiring re-intubations that are associated with risk factors and financial costs. We identified 179 mechanically ventilated neonatal patients that were intubated within 24 hours of birth in the MIMIC-II intensive care database. We analyzed data from the patients 2 hours prior to their first extubation attempt, and developed a prediction algorithm to distinguish patients whose extubation attempt was successful from those that had EF. From an initial list of 57 candidate features, our machine learning approach narrowed down to six features useful for building an EF prediction model: monocyte cell count, rapid shallow breathing index, fraction of inspired oxygen (FiO(2)), heart rate, PaO(2)/FiO(2) ratio where PaO(2) is the partial pressure of oxygen in arterial blood, and work of breathing index. Algorithm performance had an area under the receiver operating characteristic curve (AUC) of 0.871 and sensitivity of 70.1% at 90% specificity. PMID:23367074

  6. Acute renal failure in a patient with acute lymphoblastic leukemia: a rare cause.

    PubMed

    Sharma, Alok; Gupta, Ruchika; Rizvi, Yasir; Rathi, Shyam; Mahapatra, Manoranjan; Bhowmik, Dipankar; Dinda, Amit K

    2013-01-01

    A young adult was diagnosed to have acute lymphoblastic leukemia, T-cell immunophenotype and was initiated on chemotherapy. He presented with acute renal failure two days after the completion of his induction regimen. A renal biopsy showed features of necrotizing crescentic glomerulonephritis (GN). Serology for c-anti-neutrophil cytoplasmic antibody (ANCA) was positive and a final diagnosis of ANCA-associated necrotizing crescentic GN was made. Aggressive immunosuppression could not be used due to the presence of nosocomial pneumonia and the patient expired 26 days after the renal biopsy diagnosis. We report for the first time the association of acute lymphoblastic leukemia with crescentic GN and, hence, expand the list of malignancy-related ANCA-positive GN. PMID:23354200

  7. VIP Gene Deletion in Mice Causes Cardiomyopathy Associated with Upregulation of Heart Failure Genes

    PubMed Central

    Szema, Anthony M.; Hamidi, Sayyed A.; Smith, S. David; Benveniste, Helene

    2013-01-01

    Rationale Vasoactive Intestinal Peptide (VIP), a pulmonary vasodilator and inhibitor of vascular smooth muscle proliferation, is absent in pulmonary arteries of patients with idiopathic pulmonary arterial hypertension (PAH). We previously determined that targeted deletion of the VIP gene in mice leads to PAH with pulmonary vascular remodeling and right ventricular (RV) dilatation. Whether the left ventricle is also affected by VIP gene deletion is unknown. In the current study, we examined if VIP knockout mice (VIP?/?) develop both right (RV) and left ventricular (LV) cardiomyopathy, manifested by LV dilatation and systolic dysfunction, as well as overexpression of genes conducive to heart failure. Methods We examined VIP?/?and wild type (WT) mice using Magnetic Resonance Imaging (MRI) for evidence of cardiomyopathy associated with biventricular dilation and wall thickness changes. Lung tissue from VIP?/? and WT mice was subjected to whole-genome gene microarray analysis. Results Lungs from VIP?/? mice showed overexpression of cardiomyopathy genes: Myh1 was upregulated 224 times over WT, and Mylpf was increased 72 fold. Tnnt3 was increased 105 times and tnnc2 181 fold. Hearts were dilated in VIP?/? mice, with thinning of LV wall and increase in RV and LV chamber size, though RV enlargement varied. Weights of VIP?/? mice were consistently lower. Conclusions Critically-important heart failure-related genes are upregulated in VIP?/? mice associated with the spontaneous cardiomyopathy phenotype, involving both left and right ventricles, suggesting that loss of the VIP gene orchestrates a panoply of pathogenic genes which are detrimental to both left and right cardiac homeostasis. PMID:23700405

  8. Respiratory infection caused by chlamydophila pneumoniae in children and adolescents in the lower silesia region of poland

    PubMed Central

    2010-01-01

    Objective To assess the incidence of Chlamydia pneumoniae respiratory tract infection in children and adolescents in the Lower Silesia Region in Poland in 2009. Materials and methods 641 throat swabs obtained from 326 girls and 315 boys, aged 11 months to 18 years, were assessed diagnostically. The patients enrolled into the study were treated on an outpatient basis due to various, non-specific respiratory ailments. The most common presenting clinical symptom of a respiratory problem was dry cough, which occurred in 295 studied subjects, followed by runny nose and cough with discharge in 176 subjects, and other minor symptoms in 35 subjects. The assessment was conducted by an indirect immunofluorescence antibody (IFA) Chlamydia Testing kit (Cellabs, Sydney, Australia). Results Overall, Chlamydia infection was detected in the respiratory tract in 43.1% (276/641) of the children, with no clear gender differences. Of the 295 subjects presenting with dry cough, 122 (41.4%) had positive tests for Chlamydia. Of the 176 subjects with runny nose and cough and the 35 subjects with other symptoms, 83 (47.2%) and 8 (22.9%) had positive tests for Chlamydia, respectively. In the asymptomatic children who had direct contact with a Chlamydia infected person, there were 29.6% (8/27) positively tested cases, whereas in the children presenting symptoms, the percentage of positive tests was 48.3% (29/60). Conclusions In children living in the Lower Silesia Region of Poland, there is a substantial ~50% rate of Chlamydia infection, transmitted via airborne droplets. The finding of Chlamydia infection should be the signal for testing other subjects from the child's closest environment. PMID:21147636

  9. BulletinoftheSeismologicalSocietyofAmerica,Vol.73,No.4,pp. 1161-117l,August1983 GROUND FAILURE ALONG THE NEW RIVER CAUSED BY THE

    E-print Network

    Greer, Julia R.

    ALONG THE NEW RIVER CAUSED BY THE OCTOBER 1979 IMPERIAL VALLEY EARTHQUAKE SEQUENCE BY THOMAS H. HEATON the south bank of the New River north of Brawley, California, following the 15 October 1979 Imperial Valley by liquefaction, near the Del Rio Country Club. These ground failures, together with failures at the New River

  10. 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.

  11. Stingray barb injury: a cause of late coronary occlusion and stent failure.

    PubMed

    Saunders, Craig R; Saro, Enrique; Patel, Parag; Swidryk, John; Bacani, Victor O; Russo, Mark J; Stone, Jay H

    2013-11-01

    Stingray injuries to the heart are rare, and survivors of this injury are even rarer. To date, there are only three reported survivors of this mode of penetrating cardiac injury, all inflicted by the living animal itself. The following is a report of a stingray injury, inflicted by a human, causing coronary complications 17 years after the injury was sustained. PMID:24182483

  12. Destructive Interactions Between Mitigation Strategies and the Causes of Unexpected Failures in Natural Hazard Mitigation Systems

    NASA Astrophysics Data System (ADS)

    Day, S. J.; Fearnley, C. J.

    2013-12-01

    Large investments in the mitigation of natural hazards, using a variety of technology-based mitigation strategies, have proven to be surprisingly ineffective in some recent natural disasters. These failures reveal a need for a systematic classification of mitigation strategies; an understanding of the scientific uncertainties that affect the effectiveness of such strategies; and an understanding of how the different types of strategy within an overall mitigation system interact destructively to reduce the effectiveness of the overall mitigation system. We classify mitigation strategies into permanent, responsive and anticipatory. Permanent mitigation strategies such as flood and tsunami defenses or land use restrictions, are both costly and 'brittle': when they malfunction they can increase mortality. Such strategies critically depend on the accuracy of the estimates of expected hazard intensity in the hazard assessments that underpin their design. Responsive mitigation strategies such as tsunami and lahar warning systems rely on capacities to detect and quantify the hazard source events and to transmit warnings fast enough to enable at risk populations to decide and act effectively. Self-warning and voluntary evacuation is also usually a responsive mitigation strategy. Uncertainty in the nature and magnitude of the detected hazard source event is often the key scientific obstacle to responsive mitigation; public understanding of both the hazard and the warnings, to enable decision making, can also be a critical obstacle. Anticipatory mitigation strategies use interpretation of precursors to hazard source events and are used widely in mitigation of volcanic hazards. Their critical limitations are due to uncertainties in time, space and magnitude relationships between precursors and hazard events. Examples of destructive interaction between different mitigation strategies are provided by the Tohoku 2011 earthquake and tsunami; recent earthquakes that have impacted population centers with poor enforcement of building codes, unrealistic expectations of warning systems or failures to understand local seismic damage mechanisms; and the interaction of land use restriction strategies and responsive warning strategies around lahar-prone volcanoes. A more complete understanding of the interactions between these different types of mitigation strategy, especially the consequences for the expectations and behaviors of the populations at risk, requires models of decision-making under high levels of both uncertainty and danger. The Observation-Orientation-Decision-Action (OODA) loop model (Boyd, 1987) may be a particularly useful model. It emphasizes the importance of 'orientation' (the interpretation of observations and assessment of their significance for the observer and decision-maker), the feedback between decisions and subsequent observations and orientations, and the importance of developing mitigation strategies that are flexible and so able to respond to the occurrence of the unexpected. REFERENCE: Boyd, J.R. A Discourse on Winning and Losing [http://dnipogo.org/john-r-boyd/

  13. Prevalence of potentially preventable unplanned hospitalizations caused by therapeutic failures and adverse drug withdrawal events among older veterans.

    PubMed

    Marcum, Zachary A; Pugh, Mary Jo V; Amuan, Megan E; Aspinall, Sherrie L; Handler, Steven M; Ruby, Christine M; Hanlon, Joseph T

    2012-08-01

    Background. Studies of drug-related hospitalizations have focused on adverse drug reactions, but few data are available on therapeutic failures (TFs) and adverse drug withdrawal events (ADWEs) leading to hospitalization among community-dwelling older adults. Thus, we sought to describe the prevalence of unplanned hospitalizations caused by TFs and ADWEs. In addition, we evaluated factors associated with these events in a nationally representative sample of older Veterans. Methods. This study included 678 randomly selected unplanned hospitalizations of older (age ? 65 years) Veterans between December 1, 2003, and November 9, 2006. The main outcomes were hospitalizations caused by a TF and/or an ADWE as determined by a pair of health professionals from review of medication charts and application of the Therapeutic Failure Questionnaire and/or Naranjo ADWE algorithm, respectively. Preventability (ie, medication error) of the admission was also assessed. Results. Thirty-four TFs and eight ADWEs involving 54 drugs were associated with 40 (5.9%) Veterans' hospitalizations; of these admissions, 90.0% (36/40) were rated as potentially preventable mostly due to medication nonadherence and suboptimal prescribing. The most common TFs that occurred were heart failure exacerbations (n = 8), coronary heart disease symptoms (n = 6), tachyarrhythmias (n = 3), and chronic obstructive pulmonary disease exacerbations (n = 3). Half (4/8) of the ADWEs that occurred were cardiovascular in nature. Multivariable logistic regression modeling indicated that black Veterans (adjusted odds ratio 2.92, 95% CI 1.25-6.80) were significantly more likely to experience a TF-related admission compared with white Veterans. Conclusions. TF-related unplanned hospitalizations occur more frequently than ADWE-related admissions among older Veterans. Almost all TFs and/or ADWEs are potentially preventable. PMID:22389461

  14. Prevalence of Potentially Preventable Unplanned Hospitalizations Caused by Therapeutic Failures and Adverse Drug Withdrawal Events Among Older Veterans

    PubMed Central

    Pugh, Mary Jo V.; Amuan, Megan E.; Aspinall, Sherrie L.; Handler, Steven M.; Ruby, Christine M.; Hanlon, Joseph T.

    2012-01-01

    Background. Studies of drug-related hospitalizations have focused on adverse drug reactions, but few data are available on therapeutic failures (TFs) and adverse drug withdrawal events (ADWEs) leading to hospitalization among community-dwelling older adults. Thus, we sought to describe the prevalence of unplanned hospitalizations caused by TFs and ADWEs. In addition, we evaluated factors associated with these events in a nationally representative sample of older Veterans. Methods. This study included 678 randomly selected unplanned hospitalizations of older (age ? 65 years) Veterans between December 1, 2003, and November 9, 2006. The main outcomes were hospitalizations caused by a TF and/or an ADWE as determined by a pair of health professionals from review of medication charts and application of the Therapeutic Failure Questionnaire and/or Naranjo ADWE algorithm, respectively. Preventability (ie, medication error) of the admission was also assessed. Results. Thirty-four TFs and eight ADWEs involving 54 drugs were associated with 40 (5.9%) Veterans’ hospitalizations; of these admissions, 90.0% (36/40) were rated as potentially preventable mostly due to medication nonadherence and suboptimal prescribing. The most common TFs that occurred were heart failure exacerbations (n = 8), coronary heart disease symptoms (n = 6), tachyarrhythmias (n = 3), and chronic obstructive pulmonary disease exacerbations (n = 3). Half (4/8) of the ADWEs that occurred were cardiovascular in nature. Multivariable logistic regression modeling indicated that black Veterans (adjusted odds ratio 2.92, 95% CI 1.25–6.80) were significantly more likely to experience a TF-related admission compared with white Veterans. Conclusions. TF-related unplanned hospitalizations occur more frequently than ADWE-related admissions among older Veterans. Almost all TFs and/or ADWEs are potentially preventable. PMID:22389461

  15. Dihydrolipoamide dehydrogenase deficiency: a still overlooked cause of recurrent acute liver failure and Reye-like syndrome.

    PubMed

    Brassier, Anaďs; Ottolenghi, Chris; Boutron, Audrey; Bertrand, Anne-Marie; Valmary-Degano, Séverine; Cervoni, Jean-Paul; Chrétien, Dominique; Arnoux, Jean-Baptiste; Hubert, Laurence; Rabier, Daniel; Lacaille, Florence; de Keyzer, Yves; Di Martino, Vincent; de Lonlay, Pascale

    2013-05-01

    The causes of Reye-like syndrome are not completely understood. Dihydrolipoamide dehydrogenase (DLD or E3) deficiency is a rare metabolic disorder causing neurological or liver impairment. Specific changes in the levels of urinary and plasma metabolites are the hallmark of the classical form of the disease. Here, we report a consanguineous family of Algerian origin with DLD deficiency presenting without suggestive clinical laboratory and anatomopathological findings. Two children died at birth from hepatic failure and three currently adult siblings had recurrent episodes of hepatic cytolysis associated with liver failure or Reye-like syndrome from infancy. Biochemical investigation (lactate, pyruvate, aminoacids in plasma, organic acids in urine) was normal. Histologic examination of liver and muscle showed mild lipid inclusions that were only visible by electron microscopy. The diagnosis of DLD deficiency was possible only after genome-wide linkage analysis, confirmed by a homozygous mutation (p.G229C) in the DLD gene, previously reported in patients with the same geographic origin. DLD and pyruvate dehydrogenase activities were respectively reduced to 25% and 70% in skin fibroblasts of patients and were unresponsive to riboflavin supplementation. In conclusion, this observation clearly supports the view that DLD deficiency should be considered in patients with Reye-like syndrome or liver failure even in the absence of suggestive biochemical findings, with the p.G229C mutation screening as a valuable test in the Arab patients because of its high frequency. It also highlights the usefulness of genome-wide linkage analysis for decisive diagnosis advance in inherited metabolic disorders. PMID:23478190

  16. Increased expression of ERp57/GRP58 is protective against pancreatic beta cell death caused by autophagic failure.

    PubMed

    Yamamoto, Eriko; Uchida, Toyoyoshi; Abe, Hiroko; Taka, Hikari; Fujimura, Tsutomu; Komiya, Koji; Hara, Akemi; Ogihara, Takeshi; Fujitani, Yoshio; Ueno, Takashi; Takeda, Satoru; Watada, Hirotaka

    2014-10-10

    Autophagy is a tightly regulated self-digestion system. As in other cell types, autophagy plays an essential role in the homeostasis of pancreatic beta cells. However, the mechanisms involved in the deterioration of beta cell function caused by autophagic failure have not yet been fully elucidated. To gain insight into its mechanisms, we compared the protein expression of islets from beta cell-specific Atg7-deficient mice (Atg7(??-cell) mice) and their controls (Atg7(f/f) mice). Liquid chromatography/mass spectrometry after 1-dimensional electrophoresis identified the increased expression of ERp57/GRP58 in islets isolated from Atg7(??-cell) mice compared with those from Atg7(f/f) mice. The expression level of ERp57 was also elevated in rat insulinoma INS-1 cells by inducible knock-down of the atg7-gene. In Atg7 knock-down INS-1 cells, the suppression of ERp57 expression by siRNA resulted in an increase in the level of cleaved Caspase-3 protein and a decrease in the number of live cells. Furthermore, cell cycle analyses demonstrated that the suppressed expression of ERp57 increased the sub-G1 population. These data reveal that increased expression of ERp57 may contribute to the protection from beta cell death caused by autophagic failure. PMID:25241190

  17. Pacemaker-associated thrombotic occlusion of the inferior vena cava causing liver failure.

    PubMed

    Schroeter, T; Dähnert, I; Doll, N; Mohr, F W; Borger, M A

    2010-10-01

    Pacemaker implantation using endocardial leads can give rise to thrombotic venous occlusion. We report the case of a 23-year-old male with transposition of the great arteries, who had previously undergone a Senning repair at the age of one year. A sick sinus syndrome required pacemaker implantation with subsequent multiple lead revisions. Following the implantation of the last lead, the patient developed complete occlusion of the inferior vena cava (IVC) with stenosis of the superior vena cava (SVC) with pacemaker leads in both lesions. Liver failure, ascites and esophageal varices developed. Thrombolytic treatment was ineffective; finally the patient was listed for liver transplantation. We explanted the lead embedding the thrombosis, together with some lead remnants. The stenosis of the SVC and the occlusion of the IVC were dilatated and stabilized with four stents. Over a follow-up period of 4 months, NYHA class improved from NYHA III to NYHA I-II, the hepatic function showed complete remission, and a liver transplantation was not necessary. PMID:20922629

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

    PubMed Central

    Pall, Martin L.

    2013-01-01

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

  19. 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

  20. What is the Role of Respiratory Viruses in Community Acquired Pneumonia; What is the Best Therapy for Influenza and Other Viral Causes of CAP?

    PubMed Central

    Pavia, Andrew T

    2012-01-01

    Synopsis Respiratory viruses including influenza have long been appreciated as a cause of community acquired pneumonia (CAP), particularly among children, people with serious medical co-morbidities and military recruits. They are increasingly recognized as a cause of CAP among adults, particularly older adults. Polymerase chain reaction-based testing has allowed detection of newer agents (e.g. human metapneumovirus, coronavirus HKU1 and NL63) as well as improved the ability to detect “old” viral infections such as influenza virus and rhinovirus. When PCR is used, viruses have been detected in 45–75% of children and 15–54% of adults with CAP. Co-infection with viruses and bacteria is common and it remains challenging to determine which patients have only viral infection as the cause of CAP. Treatment for influenza with neuraminidase inhibitors should be started promptly for patients with CAP when influenza is suspected or documented, regardless of evidence of bacterial co-infection. Better ways to diagnose viral CAP and to integrate detection into management are urgently needed, as well as better treatment options for non-influenza respiratory viral infections. PMID:23398872

  1. Airway obstruction due to tracheomalacia caused by innominate artery compression and a kyphotic cervical spine.

    PubMed

    Liu, Chia-Hsin; Huang, Wen-Sheng; Wang, Hong-Hau; Wu, Chin-Pyng; Chian, Chih-Feng; Perng, Wann-Cherng; Tsai, Chen-Liang

    2015-02-01

    Tracheomalacia can cause variable degrees of intrathoracic airway obstruction and is an easily overlooked cause of respiratory distress in adults. Here, we report a case of acute respiratory failure in which subglottic stenosis was accidentally identified during endotracheal intubation. Subsequent bronchoscopy and computed tomography of the thorax and neck revealed tracheal compression with tracheomalacia caused by a tortuous innominate artery and a kyphotic cervical spine. The patient underwent rigid bronchoscopy with metal stent implantation, and her symptoms were alleviated. These findings outline the importance of precise diagnosis and interventions for preventing recurrent life-threatening respiratory failure in such cases. PMID:25639407

  2. FAN1 mutations cause karyomegalic interstitial nephritis, linking chronic kidney failure to defective DNA damage repair.

    PubMed

    Zhou, Weibin; Otto, Edgar A; Cluckey, Andrew; Airik, Rannar; Hurd, Toby W; Chaki, Moumita; Diaz, Katrina; Lach, Francis P; Bennett, Geoffrey R; Gee, Heon Yung; Ghosh, Amiya K; Natarajan, Sivakumar; Thongthip, Supawat; Veturi, Uma; Allen, Susan J; Janssen, Sabine; Ramaswami, Gokul; Dixon, Joanne; Burkhalter, Felix; Spoendlin, Martin; Moch, Holger; Mihatsch, Michael J; Verine, Jerome; Reade, Richard; Soliman, Hany; Godin, Michel; Kiss, Denes; Monga, Guido; Mazzucco, Gianna; Amann, Kerstin; Artunc, Ferruh; Newland, Ronald C; Wiech, Thorsten; Zschiedrich, Stefan; Huber, Tobias B; Friedl, Andreas; Slaats, Gisela G; Joles, Jaap A; Goldschmeding, Roel; Washburn, Joseph; Giles, Rachel H; Levy, Shawn; Smogorzewska, Agata; Hildebrandt, Friedhelm

    2012-08-01

    Chronic kidney disease (CKD) represents a major health burden. Its central feature of renal fibrosis is not well understood. By exome sequencing, we identified mutations in FAN1 as a cause of karyomegalic interstitial nephritis (KIN), a disorder that serves as a model for renal fibrosis. Renal histology in KIN is indistinguishable from that of nephronophthisis, except for the presence of karyomegaly. The FAN1 protein has nuclease activity and acts in DNA interstrand cross-link (ICL) repair within the Fanconi anemia DNA damage response (DDR) pathway. We show that cells from individuals with FAN1 mutations have sensitivity to the ICL-inducing agent mitomycin C but do not exhibit chromosome breakage or cell cycle arrest after diepoxybutane treatment, unlike cells from individuals with Fanconi anemia. We complemented ICL sensitivity with wild-type FAN1 but not with cDNA having mutations found in individuals with KIN. Depletion of fan1 in zebrafish caused increased DDR, apoptosis and kidney cysts. Our findings implicate susceptibility to environmental genotoxins and inadequate DNA repair as novel mechanisms contributing to renal fibrosis and CKD. PMID:22772369

  3. 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.

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

    PubMed Central

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

    2013-01-01

    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, were instilled into the trachea. Arterial O2 saturation was monitored using pulse oximetry. Twelve hours after exposure, animals were euthanized and bronchoalveolar lavage fluid (BALF) and plasma 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 were 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. PMID:23727623

  5. Practical applications of monitoring respiratory mechanics in newborn.

    PubMed

    Migliori, C; Gallina, M R; Bona, G

    1999-03-01

    The authors evaluate the use of data supplied by common systems used to calculate respiratory mechanics in newborns in order to analyse the impact on the management of patients requiring assisted ventilation. Over the past few years, the sale of respiratory monitors that are easier to use and less complicated to manage, as well as being less expensive, has meant that nearly every Neonatal ICU can now determine, in real time, both the causes of respiratory insufficiency and the conditions of the newborn lung during mechanical ventilation to ensure improved adaptation of ventilatory support. Leaving aside a discussion of respiratory physiopathology and the principles regulating pulmonary ventilation, the authors focus on the practical effect that data normally supplied by this type of apparatus (airway pressure, inspiration and expiration airflow, expiration minute volume calculated for each respiratory act, tidal volume, system leaks and dynamic compliance) have on the ventilatory "setting" chosen by the clinician or on the diagnosis of some commonly found situations during neonatal mechanical ventilation. The experience described concerns the impression of clinicians, skilled in the management of patients receiving conventional artificial ventilation but not so attracted by respiratory physiopathology, regarding the value of such instruments. The unanimous positive opinion confirms the thesis whereby respiratory monitoring can certainly help the neonatologist make a real time evaluation of both the causes leading to respiratory failure and the effect on the lung of any therapeutic decisions. PMID:10368568

  6. Respiratory Syncytial Virus Infections

    MedlinePLUS

    Respiratory syncytial virus (RSV) causes mild, cold-like symptoms in adults and older healthy children. It can cause serious problems in ... tests can tell if your child has the virus. There is no specific treatment. You should give ...

  7. MARS OBSERVER Mission Failure

    E-print Network

    Rhoads, James

    : Pressure Regulator Failure....................... D-28 c. Potential Cause: Failure of a Pyro Valve Charge Check Valves .................................................................. D-14 b. Potential Cause

  8. Exploitation of Diagnostic Computed Tomography Scans to Assess the Impact of Nutritional Support on Body Composition Changes in Respiratory Failure Patients

    PubMed Central

    Braunschweig, Carol A.; Sheean, Patricia M.; Peterson, Sarah J.; Perez, Sandra Gomez; Freels, Sally; Troy, Karen L.; Ajanaku, Folabomi C.; Patel, Ankur; Sclamberg, Joy S.; Wang, Zebin

    2014-01-01

    Background Assessment of nutritional status in intensive care unit (ICU) patients is limited. Computed tomography (CT) scans that include the first to fifth lumbar region completed for diagnostic purposes measures fat and lean body mass (LBM) depots and are frequently done in ICU populations and can be used to quantify fat and LBM depots. The purpose of this study was to assess if these scans could measure change in skeletal muscle (SKT), visceral adipose (VAT), and intermuscular adipose (IMAT) tissue and to examine the association between the amount of energy and protein received and changes in these depots. Methods Cross-sectional area of SKT, VAT, and IMAT from CT scans at the third lumbar region was quantified at 2 time points (CT1 and CT2). Change scores between CT1 and CT2 for each of these depots and the percentage of estimated energy/protein needs received were determined in 33 adults that with acute respiratory failure. Descriptive statistics and multiple regression was used to evaluate the influence of baseline characteristics and the percentage energy/protein needs received between CT1 and CT2 on percentage change/day between CT1 and CT2 on SKM, IMAT, and VAT. Results Participants were on average (SD) 59.7 (16) years old, received 41% of energy and 57% of protein needs. The average time between CT1 and CT2 was 10 (5) days. SKM declined 0.49%/day (men P = .07, women P = .09) and percentage of energy needs received reduced loss (? = 0.024, P = .03). No change in VAT or IMAT occurred. Conclusions CT scans can be exploited to assess change in body composition in ICU patients and may assist in detecting the causal link between nutritional support and outcomes in future clinical trials. PMID:23976767

  9. 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

  10. Respiratory disease caused by Mycoplasma bovis is enhanced by exposure to bovine herpes virus 1 (BHV-1) but not to bovine viral diarrhea virus (BVDV) type 2

    PubMed Central

    Prysliak, Tracy; van der Merwe, Jacques; Lawman, Zoe; Wilson, Donald; Townsend, Hugh; van Drunen Littel-van den Hurk, Sylvia; Perez-Casal, José

    2011-01-01

    To determine if previous exposure to bovine viral diarrhea virus (BVDV) and bovine herpes virus 1 (BHV-1) type 2 affects the onset of disease caused by Mycoplasma bovis, 6- to 8-month-old beef calves were exposed to BVDV or BHV-1 4 d prior to challenge with a suspension of 3 clinical isolates of M. bovis. Animals were observed for clinical signs of disease and at necropsy, percent abnormal lung tissue and presence of M. bovis were determined. Most animals pre-exposed to BHV-1 type 2 but not BVDV developed M. bovis-related respiratory illness. In a second trial, we determined that a 100-fold reduction in the number of M. bovis bacteria administered to BHV-1 exposed animals reduced the percentage of abnormal lung tissue but not the severity of clinical signs. We conclude that previous exposure to BHV-1 but not BVDV type 2 was a necessary cause of M. bovis-related respiratory diseases in our disease model. PMID:22547839

  11. FAN1 mutations cause karyomegalic interstitial nephritis, linking chronic kidney failure to defective DNA damage repair

    PubMed Central

    Zhou, Weibin; Otto, Edgar A.; Cluckey, Andrew; Airik, Rannar; Hurd, Toby W.; Chaki, Moumita; Diaz, Katrina; Lach, Francis P.; Bennett, Geoffrey R.; Gee, Heon Y.; Ghosh, Amiya K.; Natarajan, Sivakumar; Thongthip, Supawat; Veturi, Uma; Allen, Susan J.; Janssen, Sabine; Ramaswami, Gokul; Dixon, Joanne; Burkhalter, Felix; Spoendlin, Martin; Moch, Holger; Mihatsch, Michael J.; Verine, Jerome; Reade, Richard; Soliman, Hany; Godin, Michel; Kiss, Denes; Monga, Guido; Mazzucco, Gianna; Amann, Kerstin; Artunc, Ferruh; Newland, Ronald C.; Wiech, Thorsten; Zschiedrich, Stefan; Huber, Tobias B.; Friedl, Andreas; Slaats, Gisela G.; Joles, Jaap A.; Goldschmeding, Roel; Washburn, Joseph; Giles, Rachel H.; Levy, Shawn; Smogorzewska, Agata; Hildebrandt, Friedhelm

    2012-01-01

    SUMMARY Chronic kidney disease (CKD) represents a major health burden1. Its central feature of renal fibrosis is not well understood. By whole exome resequencing in a model disorder for renal fibrosis, nephronophthisis (NPHP), we identified mutations of Fanconi anemia-associated nuclease 1 (FAN1) as causing karyomegalic interstitial nephritis (KIN). Renal histology of KIN is indistinguishable from NPHP except for the presence of karyomegaly2. FAN1 has nuclease activity, acting in DNA interstrand crosslinking (ICL) repair within the Fanconi anemia pathway of DNA damage response (DDR)3–6. We demonstrate that cells from individuals with FAN1 mutations exhibit sensitivity to the ICL agent mitomycin C. However, they do not exhibit chromosome breakage or cell cycle arrest after diepoxybutane treatment, unlike cells from patients with Fanconi anemia. We complement ICL sensitivity with wild type FAN1 but not mutant cDNA from individuals with KIN. Depletion of fan1 in zebrafish revealed increased DDR, apoptosis, and kidney cysts akin to NPHP. Our findings implicate susceptibility to environmental genotoxins and inadequate DNA repair as novel mechanisms of renal fibrosis and CKD. PMID:22772369

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

    SciTech Connect

    Faux, D. R., LLNL

    1997-12-01

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

  13. How Is Respiratory Failure Treated?

    MedlinePLUS

    ... and your diaphragm slide down, helping you inhale. Fluids You may be given fluids to improve blood flow throughout your body and ... make sure you get the right amount of fluids. Too much fluid can fill the lungs and ...

  14. How Is Respiratory Failure Diagnosed?

    MedlinePLUS

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

  15. 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 ...

  16. 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

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

    PubMed Central

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

    2015-01-01

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

  18. Off-axis loads cause failure of the distal radius at lower magnitudes than axial loads: A finite element analysis

    PubMed Central

    Troy, Karen L.; Grabiner, Mark D.

    2014-01-01

    Distal radius (Colles’) fractures are a common fall-related injury in older adults and frequently result in long-term pain and reduced ability to perform activities of daily living. Because the occurrence of a fracture during a fall depends on both the strength of the bone and upon the kinematics and kinetics of the impact itself, we sought to understand how changes in bone mineral density (BMD) and loading direction affect the fracture strength and fracture initiation location in the distal radius. A three-dimensional finite element model of the radius, scaphoid, and lunate was used to examine changes of ±2% and ±4% BMD, and both axial and physiologically relevant off-axis loads on the radius. Changes in BMD resulted in similar percent changes in fracture strength. However, modifying the applied load to include dorsal and lateral components (assuming a dorsal view of the wrist, rather than an anatomic view) resulted in a 47% decrease in fracture strength (axial failure load: 2752 N, off-axis: 1448 N). Loading direction also influenced the fracture initiation site. Axially loaded radii failed on the medial surface immediately proximal to the styloid process. In contrast, off-axis loads, containing dorsal and lateral components, caused failure on the dorsal–lateral surface. Because the radius appears to be very sensitive to loading direction, the results suggest that much of the variability in fracture strength seen in cadaver studies may be attributed to varying boundary conditions. The results further suggest that interventions focused on reducing the incidence of Colles’ fractures when falls onto the upper extremities are unavoidable may benefit from increasing the extent to which the radius is loaded along its axis. PMID:17368466

  19. Living donor liver transplantation for acute liver failure in pediatric patients caused by the ingestion of fireworks containing yellow phosphorus.

    PubMed

    Ates, Mustafa; Dirican, Abuzer; Ozgor, Dincer; Aydin, Cemalettin; Isik, Burak; Ara, Cengiz; Yilmaz, Mehmet; Ayse Selimoglu, M; Kayaalp, Cuneyt; Yilmaz, Sezai

    2011-11-01

    Yellow phosphorus is a protoplasmic toxicant that targets the liver. The ingestion of fireworks containing yellow phosphorus, either by children who accidentally consume them or by adults who are attempting suicide, often results in death due to acute liver failure (ALF). We present the outcomes of 10 children who ingested fireworks containing yellow phosphorus. There were 6 boys and 4 girls, and their ages ranged from 21 to 60 months. One patient remained stable without liver complications and was discharged. Three patients died of hepatorenal failure and cardiovascular collapse, and living donor liver transplantation (LDLT) was performed for 6 patients. The patients had grade II or III encephalopathy, a mean alanine aminotransferase level of 1148.2 IU/L, a mean aspartate aminotransferase level of 1437.5 IU/L, a mean total bilirubin level of 6.9 mg/dL, a mean international normalized ratio of 6.6, a mean Pediatric End-Stage Liver Disease score of 33.7, and a mean Child-Pugh score of 11.3. Postoperatively, 2 patients had persistent encephalopathy and died on the second or third postoperative day, and 1 patient died of cardiac arrest on the first postoperative day despite a well-functioning graft. The other 3 patients were still alive at a mean of 204 days. In conclusion, the ingestion of fireworks containing yellow phosphorus causes ALF with a high mortality rate. When signs of irreversible ALF are detected, emergency LDLT should be considered as a lifesaving procedure; however, if yellow phosphorus toxicity affects both the brain and the heart in addition to the liver, the mortality rate remains very high despite liver transplantation. PMID:21761550

  20. 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

  1. Mucolipin Co-deficiency Causes Accelerated Endolysosomal Vacuolation of Enterocytes and Failure-to-Thrive from Birth to Weaning

    PubMed Central

    Castiglioni, Andrew J.; Flores, Emma N.; Cantú, Jorge A.; García-Ańoveros, Jaime

    2014-01-01

    During the suckling period, intestinal enterocytes are richly endowed with endosomes and lysosomes, which they presumably utilize for the uptake and intracellular digestion of milk proteins. By weaning, mature intestinal enterocytes replace those rich in lysosomes. We found that mouse enterocytes before weaning express high levels of two endolysosomal cation channels, mucolipins 3 and 1 -products of Trpml3 and Trpml1 genes; moreover neonatal enterocytes of mice lacking both mucolipins (Trpml3?/?;Trpml1?/?) vacuolated pathologically within hours of birth and remained so until weaning. Ultrastructurally and chemically these fast-forming vacuoles resembled those that systemically appear in epithelial cells of mucolipidosis type IV (MLIV) patients, which bear mutations in Trpml1. Hence, lack of both mucolipins 1 and 3 causes an accelerated MLIV-type of vacuolation in enterocytes. The vacuoles were aberrant hybrid organelles with both endosomal and lysosomal components, and were not generated by alterations in endocytosis or exocytosis, but likely by an imbalance between fusion of lysosomes and endosomes and their subsequent scission. However, upon extensive vacuolation enterocytes displayed reduced endocytosis from the intestinal lumen, a defect expected to compromise nutrient uptake. Mice lacking both mucolipins suffered a growth delay that began after birth and continued through the suckling period but recovered after weaning, coinciding with the developmental period of enterocyte vacuolation. Our results demonstrate genetic redundancy between lysosomal mucolipins 3 and 1 in neonatal enterocytes. Furthermore, our Trpml3?/?;Trpml1?/? mice represent a polygenic animal model of the poorly-understood, and often intractable, neonatal failure-to-thrive with intestinal pathology. Our results implicate lysosomes in neonatal intestinal pathologies, a major cause of infant mortality worldwide, and suggest transient intestinal dysfunction might affect newborns with lysosomal storage disorders. Finally, we conclude that mucolipin-endowed lysosomes in the young play an evolutionarily-conserved role in the intracellular digestion of maternally-provided nutrients, whether milk in mammals or yolk in oviparous species. PMID:25521295

  2. 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.

  3. Rictor/mTORC2 Pathway in Oocytes Regulates Folliculogenesis, and Its Inactivation Causes Premature Ovarian Failure.

    PubMed

    Chen, Zhenguo; Kang, Xiangjin; Wang, Liping; Dong, Heling; Wang, Caixia; Xiong, Zhi; Zhao, Wanlu; Jia, Chunhong; Lin, Jun; Zhang, Wen; Yuan, Weiping; Zhong, Mei; Du, Hongzi; Bai, Xiaochun

    2015-03-01

    Molecular basis of ovarian folliculogenesis and etiopathogenesis of premature ovarian failure (POF), a common cause of infertility in women, are not fully understood. Mechanistic target of rapamycin complex 2 (mTORC2) is emerging as a central regulator of cell metabolism, proliferation, and survival. However, its role in folliculogenesis and POF has not been reported. Here, we showed that the signaling activity of mTORC2 is inhibited in a 4-vinylcyclohexene diepoxide (VCD)-induced POF mouse model. Notably, mice with oocyte-specific ablation of Rictor, a key component of mTORC2, demonstrated POF phenotypes, including massive follicular death, excessive loss of functional ovarian follicles, abnormal gonadal hormone secretion, and consequently, secondary subfertility in conditional knock-out (cKO) mice. Furthermore, reduced levels of Ser-473-phosphorylated Akt and Ser-253-phosphorylated Foxo3a and elevated pro-apoptotic proteins, Bad, Bax, and cleaved poly ADP-ribose polymerase (PARP), were observed in cKO mice, replicating the signaling alterations in 4-VCD-treated ovaries. These results indicate a critical role of the Rictor/mTORC2/Akt/Foxo3a pro-survival signaling axis in folliculogenesis. Interestingly, loss of maternal Rictor did not cause obvious developmental defects in embryos or placentas from cKO mice, suggesting that maternal Rictor is dispensable for preimplantation embryonic development. Our results collectively indicate key roles of Rictor/mTORC2 in folliculogenesis, follicle survival, and female fertility and support the utility of oocyte-specific Rictor knock-out mice as a novel model for POF. PMID:25564616

  4. Deregulation of the serum- and glucocorticoid-inducible kinase SGK1 in the endometrium causes reproductive failure.

    PubMed

    Salker, Madhuri S; Christian, Mark; Steel, Jennifer H; Nautiyal, Jaya; Lavery, Stuart; Trew, Geoffrey; Webster, Zoe; Al-Sabbagh, Marwa; Puchchakayala, Goverdhan; Föller, Michael; Landles, Christian; Sharkey, Andrew M; Quenby, Siobhan; Aplin, John D; Regan, Lesley; Lang, Florian; Brosens, Jan J

    2011-01-01

    Infertility and recurrent pregnancy loss (RPL) are prevalent but distinct causes of reproductive failure that often remain unexplained despite extensive investigations. Analysis of midsecretory endometrial samples revealed that SGK1, a kinase involved in epithelial ion transport and cell survival, is upregulated in unexplained infertility, most prominently in the luminal epithelium, but downregulated in the endometrium of women suffering from RPL. To determine the functional importance of these observations, we first expressed a constitutively active SGK1 mutant in the luminal epithelium of the mouse uterus. This prevented expression of certain endometrial receptivity genes, perturbed uterine fluid handling and abolished embryo implantation. By contrast, implantation was unhindered in Sgk1-/- mice, but pregnancy was often complicated by bleeding at the decidual-placental interface and fetal growth retardation and subsequent demise. Compared to wild-type mice, Sgk1-/- mice had gross impairment of pregnancy-dependent induction of genes involved in oxidative stress defenses. Relative SGK1 deficiency was also a hallmark of decidualizing stromal cells from human subjects with RPL and sensitized these cells to oxidative cell death. Thus, depending on the cellular compartment, deregulated SGK1 activity in cycling endometrium interferes with embryo implantation, leading to infertility, or predisposes to pregnancy complications by rendering the feto-maternal interface vulnerable to oxidative damage. PMID:22001908

  5. Loss of desmoplakin isoform I causes early onset cardiomyopathy and heart failure in a Naxos?like syndrome

    PubMed Central

    Uzumcu, A; Norgett, E E; Dindar, A; Uyguner, O; Nisli, K; Kayserili, H; Sahin, S E; Dupont, E; Severs, N J; Leigh, I M; Yuksel?Apak, M; Kelsell, D P; Wollnik, B

    2006-01-01

    Background Desmosomes are cellular junctions important for intercellular adhesion and anchoring the intermediate filament (IF) cytoskeleton to the cell membrane. Desmoplakin (DSP) is the most abundant desmosomal protein with 2 isoforms produced by alternative splicing. Methods We describe a patient with a recessively inherited arrhythmogenic dilated cardiomyopathy with left and right ventricular involvement, epidermolytic palmoplantar keratoderma, and woolly hair. The patient showed a severe heart phenotype with an early onset and rapid progression to heart failure at 4?years of age. Results A homozygous nonsense mutation, R1267X, was found in exon 23 of the desmoplakin gene, which results in an isoform specific truncation of the larger DSPI isoform. The loss of most of the DSPI specific rod domain and C?terminal area was confirmed by Western blotting and immunofluorescence. We further showed that the truncated DSPI transcript is unstable, leading to a loss of DSPI. DSPI is reported to be an obligate constituent of desmosomes and the only isoform present in cardiac tissue. To address this, we reviewed the expression of DSP isoforms in the heart. Our data suggest that DSPI is the major cardiac isoform but we also show that specific compartments of the heart have detectable DSPII expression. Conclusions This is the first description of a phenotype caused by a mutation affecting only one DSP isoform. Our findings emphasise the importance of desmoplakin and desmosomes in epidermal and cardiac function and additionally highlight the possibility that the different isoforms of desmoplakin may have distinct functional properties within the desmosome. PMID:16467215

  6. N-Acylphosphatidylethanolamine Accumulation in Potato Cells upon Energy Shortage Caused by Anoxia or Respiratory Inhibitors1

    PubMed Central

    Rawyler, André J.; Braendle, Roland A.

    2001-01-01

    A minor phospholipid was isolated from potato (Solanum tuberosum L. cv Bintje) cells, chromatographically purified, and identified by electrospray ionization mass spectrometry as N-acylphosphatidylethanolamine (NAPE). The NAPE level was low in unstressed cells (13 ± 4 nmol g fresh weight?1). According to acyl chain length, only 16/18/18 species (group II) and 18/18/18 species (group III) were present. NAPE increased up to 13-fold in anoxia-stressed cells, but only when free fatty acids (FFAs) started being released, after about 10 h of treatment. The level of groups II and III was increased by unspecific N-acylation of phosphatidylethanolamine, and new 16/16/18 species (group I) appeared via N-palmitoylation. NAPE also accumulated in aerated cells treated with NaN3 plus salicylhydroxamate. N-acyl patterns of NAPE were dominated by 18:1, 18:2, and 16:0, but never reflected the FFA composition. Moreover, they did not change greatly after the treatments, in contrast with O-acyl patterns. Anoxia-induced NAPE accumulation is rooted in the metabolic homeostasis failure due to energy deprivation, but not in the absence of O2, and is part of an oncotic death process. The acyl composition of basal and stress-induced NAPE suggests the existence of spatially distinct FFA and phosphatidylethanolamine pools. It reflects the specificity of NAPE synthase, the acyl composition, localization and availability of substrates, which are intrinsic cell properties, but has no predictive value as to the type of stress imposed. Whether NAPE has a physiological role depends on the cell being still alive and its compartmentation maintained during the stress period. PMID:11553752

  7. Bacterial Respiratory Diseases of Poultry

    Microsoft Academic Search

    JOHN R. GLISSON

    Bacterial pathogens play an important role in causing respiratory disease in domestic poultry species. In many cases, the bacterial component of a respiratory disease colonizes the respiratory system only after a primary viral or environmental insult. Coloniza- tion of the airsacs of a chicken by Escherichia coli following an infectious bronchitis virus infection is an example of secondary bacterial invasion.

  8. Invasive Fungal Sinusitis Caused by Scytalidium dimidiatum in a Lung Transplant Recipient

    PubMed Central

    Dunn, James J.; Wolfe, Michael J.; Trachtenberg, Joel; Kriesel, John D.; Orlandi, Richard R.; Carroll, Karen C.

    2003-01-01

    We describe a case of invasive fungal sinusitis caused by Scytalidium dimidiatum in a lung transplant recipient. Treatment was complicated by renal failure with amphotericin B therapies. Following 6 months of voriconazole treatment, the patient remained radiographically and clinically stable for a short time before dying of respiratory failure precipitated by graft rejection. PMID:14662991

  9. 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

  10. Re-emergent Human Adenovirus Genome Type 7d Caused an Acute Respiratory Disease Outbreak in Southern China After a Twenty-one Year Absence

    PubMed Central

    Zhao, Suhui; Wan, Chengsong; Ke, Changwen; Seto, Jason; Dehghan, Shoaleh; Zou, Lirong; Zhou, Jie; Cheng, Zetao; Jing, Shuping; Zeng, Zhiwei; Zhang, Jing; Wan, Xuan; Wu, Xianbo; Zhao, Wei; Zhu, Li; Seto, Donald; Zhang, Qiwei

    2014-01-01

    Human adenoviruses (HAdVs) are highly contagious pathogens causing acute respiratory disease (ARD), among other illnesses. Of the ARD genotypes, HAdV-7 presents with more severe morbidity and higher mortality than the others. We report the isolation and identification of a genome type HAdV-7d (DG01_2011) from a recent outbreak in Southern China. Genome sequencing, phylogenetic analysis, and restriction endonuclease analysis (REA) comparisons with past pathogens indicate HAdV-7d has re-emerged in Southern China after an absence of twenty-one years. Recombination analysis reveals this genome differs from the 1950s-era prototype and vaccine strains by a lateral gene transfer, substituting the coding region for the L1 52/55?kDa DNA packaging protein from HAdV-16. DG01_2011 descends from both a strain circulating in Southwestern China (2010) and a strain from Shaanxi causing a fatality and outbreak (Northwestern China; 2009). Due to the higher morbidity and mortality rates associated with HAdV-7, the surveillance, identification, and characterization of these strains in population-dense China by REA and/or whole genome sequencing are strongly indicated. With these accurate identifications of specific HAdV types and an epidemiological database of regional HAdV pathogens, along with the HAdV genome stability noted across time and space, the development, availability, and deployment of appropriate vaccines are needed. PMID:25482188

  11. Bacterial respiratory disease of poultry.

    PubMed

    Glisson, J R

    1998-08-01

    Bacterial pathogens play an important role in causing respiratory disease in domestic poultry species. In many cases, the bacterial component of a respiratory disease colonizes the respiratory system only after a primary viral or environmental insult. Colonization of the airsacs of a chicken by Escherichia coli following an infectious bronchitis virus infection is an example of secondary bacterial invasion. In other cases, the bacterial component of the respiratory disease is the primary initiating cause of the disease. Examples of primary bacterial respiratory disease are infectious coryza in chickens and fowl cholera in chickens and turkeys. PMID:9706078

  12. Experimental heart failure causes depression-like behavior together with differential regulation of inflammatory and structural genes in the brain

    PubMed Central

    Frey, Anna; Popp, Sandy; Post, Antonia; Langer, Simon; Lehmann, Marc; Hofmann, Ulrich; Sirén, Anna-Leena; Hommers, Leif; Schmitt, Angelika; Strekalova, Tatyana; Ertl, Georg; Lesch, Klaus-Peter; Frantz, Stefan

    2014-01-01

    Background: Depression and anxiety are common and independent outcome predictors in patients with chronic heart failure (CHF). However, it is unclear whether CHF causes depression. Thus, we investigated whether mice develop anxiety- and depression-like behavior after induction of ischemic CHF by myocardial infarction (MI). Methods and Results: In order to assess depression-like behavior, anhedonia was investigated by repeatedly testing sucrose preference for 8 weeks after coronary artery ligation or sham operation. Mice with large MI and increased left ventricular dimensions on echocardiography (termed CHF mice) showed reduced preference for sucrose, indicating depression-like behavior. 6 weeks after MI, mice were tested for exploratory activity, anxiety-like behavior and cognitive function using the elevated plus maze (EPM), light-dark box (LDB), open field (OF), and object recognition (OR) tests. In the EPM and OF, CHF mice exhibited diminished exploratory behavior and motivation despite similar movement capability. In the OR, CHF mice had reduced preference for novelty and impaired short-term memory. On histology, CHF mice had unaltered overall cerebral morphology. However, analysis of gene expression by RNA-sequencing in prefrontal cortical, hippocampal, and left ventricular tissue revealed changes in genes related to inflammation and cofactors of neuronal signal transduction in CHF mice, with Nr4a1 being dysregulated both in prefrontal cortex and myocardium after MI. Conclusions: After induction of ischemic CHF, mice exhibited anhedonic behavior, decreased exploratory activity and interest in novelty, and cognitive impairment. Thus, ischemic CHF leads to distinct behavioral changes in mice analogous to symptoms observed in humans with CHF and comorbid depression. PMID:25400562

  13. 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.

  14. 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

  15. Grain dust originating from organic and conventional farming as a potential source of biological agents causing respiratory diseases in farmers

    PubMed Central

    Cholewa, Gra?yna; Krasowska, Ewelina; Chmielewska-Badora, Jolanta; Zwoli?ski, Jacek; Sobczak, Pawe?

    2013-01-01

    Introduction Agricultural producers are exposed to a number of different health risks associated with their work environment. Aim The objective of the study was to assess the degree of colonization by fungi in terms of quantity and in terms of variety of species the samples taken from the settled dust from combine threshing of rye cultivation from organic and conventional farms in the Province of Lublin. Material and methods This paper is a preliminary quantitative assessment of the species of fungi colonizing the samples of settled dust collected during combine threshing from organic and conventional farms in the Province of Lublin. One of the stages of the project was the classification of biosafety BSL (biosafety level) of selected isolates and API ZYM tests to evaluate the potential ability of isolates to cause adverse health effects. To determine the concentration and composition of fungi in collected samples plate dilution method was used with two media: Malt Agar and Potato Dextrose Agar. Results Most commonly isolated fungi in settled dust samples collected during combine threshing from organic farms, on PDA medium were: Alternaria alternata and Aureobasidium pullulans. Cultures on MA medium were dominated by Alternaria alternata, Mycelia sterilia and Fusarium poae. In samples of dust from conventional crops, the predominant species was Alternaria alternata on PDA medium and on MA medium. Conclusions The obtained results show a potential risk of people involved in agricultural work. PMID:24493998

  16. Respiratory control and arousal in sleeping infants

    Microsoft Academic Search

    Rosemary S. C Horne; Peter M Parslow; Richard Harding

    2004-01-01

    Control of the cardiovascular and respiratory systems undergoes rapid maturation during infancy. Sleep is at a lifetime maximum during this period and has a marked influence on cardiorespiratory function. The mechanisms leading to sudden infant death syndrome (SIDS) may include a failure in the neural integration of the cardiovascular and respiratory systems, with a concomitant failure to arouse from sleep.

  17. PASSIVE TRANSFER OF VIRUS-SPECIFIC NEUTRALIZING ANTIBODIES CONFERS PROTECTION AGAINST REPRODUCTIVE FAILURE INDUCED BY A VIRULENT STRAIN OF PORCINE REPRODUCTIVE AND RESPIRATORY SYNDROME VIRUS & ESTABLISHES STERILIZING IMMUNITY

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Immune mechanisms mediating protective immunity against Porcine Reproductive and Respiratory Syndrome Virus (PRRSV) are not well understood. The PRRSV-specific humoral immune response has been dismissed as being ineffective and perhaps deleterious for the host. The function of PRRSV-neutralizing a...

  18. Respiratory mechanics and survival in patients with acute cardiogenic pulmonary edema

    Microsoft Academic Search

    A Gil Cano; J M San Pedro; J Hernández; F Carrizosa; A Herrero; J Martin

    1996-01-01

    Conclusions 1) Chest inflation impedance (Wi) was higher in patients with CPE. 2) Patients with CPE and higher Wi had better prognostic. 3) Patients with CPE who died had higher incidence of shock (83% vs 23%) and lower Wi; the cause of respiratory failure in these patients was probably due to pulmonary edema and perhaps to some component of muscular

  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. A mid-layer model for human reliability analysis : understanding the cognitive causes of human failure events.

    SciTech Connect

    Shen, Song-Hua (US Nuclear Regulatory Commission, Washington, DC); Chang, James Y. H. (US Nuclear Regulatory Commission, Washington, DC); Boring,Ronald L. (Idaho National Laboratory, Idaho Falls, ID); Whaley, April M. (Idaho National Laboratory, Idaho Falls, ID); Lois, Erasmia (US Nuclear Regulatory Commission, Washington, DC); Hendrickson, Stacey M. Langfitt; Oxstrand, Johanna H. (Vattenfall Ringhals AB, Varobacka, Sweden); Forester, John Alan; Kelly, Dana L. (Idaho National Laboratory, Idaho Falls, ID); Mosleh, Ali (University of Maryland, College Park, MD)

    2010-03-01

    The Office of Nuclear Regulatory Research (RES) at the US Nuclear Regulatory Commission (USNRC) 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.

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

    NASA Astrophysics Data System (ADS)

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

    2010-05-01

    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 and debris avalanches. Moreover, volcanoes located in coastal areas or islands, may experience lateral collapses with the potential to generate large tsunamis. Although there is very little literature on the relationships among caldera resurgence, volcanism and slope instability, recently also the caldera resurgence has been suggested as a possible cause of slope failure, as for the southern flank of the island of Ischia in the Southern Tyrrhenian sea (Italy). Ischia island gives a good opportunity to investigate such phenomena and related effects, as it is the only documented example of resurgent caldera in which, during uplift, volcanism and generation of mass movements have been very active and linked to each other in a sort of cyclical behaviour. The island of Ischia is one of the most impressive examples of resurgent calderas in the world. This caldera formed in response to a complex explosive eruption that, about 55 ka B.P., produced the Mt. Epomeo Green Tuff ignimbritic deposit. Starting from at least 30 ka B.P. the caldera floor has been uplifted of about 900 m, due to a resurgent phenomenon, which occurred through intermittent uplifting, likely triggered by the intrusion of new magma into the system, and tectonic quietness phases. During uplift, volcanism and generation of mass movements were very active. The resurgent area is composed of differentially displaced blocks and has a poligonal shape, resulting from reactivation of regional faults and activation of faults directly related to volcano-tectonism. The western sector is bordered by inward-dipping, high-angle reverse faults, cut by late outward-dipping normal faults due to gravitational readjustment of the slopes. The north-eastern and the south-western sides are bordered by vertical faults with right transtensive and left transpressive movements, respectively. The area located to the east of the most uplifted block is displaced by outward-dipping normal faults. Some giant landslides and their relationships with volcano-tectonism have been recognized at Ischia. Their deposits are intercalated with primary volcanics and minor landslide deposits in the eastern sector of the island. Within the northern and western sectors, historical earthquake-triggered landslides are well exposed, also due to lack of recent volcanic rocks. The largest landslide bodies seem to have a submarine counterpart, as evidenced by the hummocky topography of the seafloor in the offshore of the island. The recognized landslides vary from small lahars to large debris-avalanche, whose detachment areas are clearly conditioned by the geometry of the same structures that drove resurgence and fed volcanism. In conclusion, the results of a detailed stratigraphical, sedimentological and structural study carried out at Ischia, emphasize the intimate interplay among slope instability, resurgence dynamics, fault generation, seismicity and volcanism on the island.

  2. UCSD Respiratory Protection Program Administered by Environment, Health and Safety

    E-print Network

    Fainman, Yeshaiahu

    . II. The Respiratory Protection Program A. Hazards to the Respiratory System Your body's respiratory are breathed in, they become trapped in the respiratory system causing irritation. Short ­ or long-term health or vapors irritates the respiratory system, causing either short-or long-term health problems, or even death

  3. Respiratory system

    NASA Technical Reports Server (NTRS)

    Bartlett, R. G., Jr.

    1973-01-01

    The general anatomy and function of the human respiratory system is summarized. Breathing movements, control of breathing, lung volumes and capacities, mechanical relations, and factors relevant to respiratory support and equipment design are discussed.

  4. Respiratory acidosis

    MedlinePLUS

    ... 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, ... of Respiratory Medicine . 5th ed. Philadelphia, PA: Elsevier ...

  5. Acute kidney failure

    MedlinePLUS

    Kidney failure; Renal failure; Renal failure - acute; ARF; Kidney injury - acute ... There are many possible causes of kidney damage. They include: ... cholesterol (cholesterol emboli) Decreased blood flow due to very ...

  6. 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

  7. 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.

  8. Investigation of occupational and environmental causes of respiratory cancers (ICARE): a multicenter, population-based case-control study in France

    PubMed Central

    2011-01-01

    Background Occupational causes of respiratory cancers need to be further investigated: the role of occupational exposures in the aetiology of head and neck cancers remains largely unknown, and there are still substantial uncertainties for a number of suspected lung carcinogens. The main objective of the study is to examine occupational risk factors for lung and head and neck cancers. Methods/design ICARE is a multi-center, population-based case-control study, which included a group of 2926 lung cancer cases, a group of 2415 head and neck cancer cases, and a common control group of 3555 subjects. Incident cases were identified in collaboration with cancer registries, in 10 geographical areas. The control group was a random sample of the population of these areas, with a distribution by sex and age comparable to that of the cases, and a distribution by socioeconomic status comparable to that of the population. Subjects were interviewed face to face, using a standardized questionnaire collecting particularly information on tobacco and alcohol consumption, residential history and a detailed description of occupational history. Biological samples were also collected from study subjects. The main occupational exposures of interest are asbestos, man-made mineral fibers, formaldehyde, polycyclic aromatic hydrocarbons, chromium and nickel compounds, arsenic, wood dust, textile dust, solvents, strong acids, cutting fluids, silica, diesel fumes, welding fumes. The complete list of exposures of interest includes more than 60 substances. Occupational exposure assessment will use several complementary methods: case-by-case evaluation of exposure by experts; development and use of algorithms to assess exposure from the questionnaires; application of job-exposure matrices. Discussion The large number of subjects should allow to uncover exposures associated with moderate increase in risks, and to evaluate risks associated with infrequent or widely dispersed exposures. It will be possible to study joint effects of exposure to different occupational risk factors, to examine the interactions between occupational exposures, tobacco smoking, alcohol drinking, and genetic risk factors, and to estimate the proportion of respiratory cancers attributable to occupational exposures in France. In addition, information on many non-occupational risk factors is available, and the study will provide an excellent framework for numerous studies in various fields. PMID:22171573

  9. Heart Failure

    MedlinePLUS

    ... report any unexplained changes to your doctor. Other Organizations ... What is the likely cause of my congestive heart failure? How serious is my condition? How will my life change now that we know I have heart ...

  10. Achromobacter respiratory infections.

    PubMed

    Swenson, Colin E; Sadikot, Ruxana T

    2015-02-01

    Achromobacteria are ubiquitous environmental organisms that may also become opportunistic pathogens in certain conditions, such as cystic fibrosis, hematologic and solid organ malignancies, renal failure, and certain immune deficiencies. Some members of this genus, such as xylosoxidans, cause primarily nosocomially acquired infections affecting multiple organ systems, including the respiratory tract, urinary tract, and, less commonly, the cardiovascular and central nervous systems. Despite an increasing number of published case reports and literature reviews suggesting a global increase in achromobacterial disease, most clinicians remain uncertain of the organism's significance when clinically isolated. Moreover, effective treatment can be challenging due to the organism's inherent and acquired multidrug resistance patterns. We reviewed all published cases to date of non-cystic fibrosis achromobacterial lung infections to better understand the organism's pathogenic potential and drug susceptibilities. We found that the majority of these cases were community acquired, typically presenting as pneumonias (88%), and were most frequent in individuals with hematologic and solid organ malignancies. Our findings also suggest that achromobacterial lung infections are difficult to treat, but respond well to extended-spectrum penicillins and cephalosporins, such as ticarcillin, piperacillin, and cefoperazone. PMID:25706494

  11. Retroperitoneal abscess with consecutive acute renal failure caused by a lost gallstone 2 years after laparoscopic cholecystectomy.

    PubMed

    Justinger, Christoph; Sperling, Jens; Katoh, Marcus; Kollmar, Otto; Schilling, Martin K; Schuld, Jochen

    2010-03-01

    A 70-year-old male patient presented with abdominal pain, acute renal failure, and fever 2 years after laparoscopic cholecystectomy. During the surgical drainage of the abscess formation on the patient's right flank, a huge gallstone was found in the retroperitoneum. The patient was dismissed from the hospital 11 days after admission with normal lab panel and restored renal function. PMID:20082093

  12. 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

  13. The effects of mechanical ventilation on the development of Acute Respiratory Distress Syndrome

    E-print Network

    Jia, Xiaoming, M. Eng. Massachusetts Institute of Technology

    2007-01-01

    Acute Respiratory Distress Syndrome (ARDS) is a severe lung illness characterized by inflammation and fluid accumulation in the respiratory system. Historically, ARDS and other forms of respiratory failure have been treated ...

  14. 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

  15. Methods of data collection and analysis for the economic evaluation alongside a national, multi-centre trial in the UK: Conventional ventilation or ECMO for Severe Adult Respiratory Failure (CESAR)

    PubMed Central

    Thalanany, Mariamma M; Mugford, Miranda; Hibbert, Clare; Cooper, Nicola J; Truesdale, Ann; Robinson, Steven; Tiruvoipati, Ravindranath; Elbourne, Diana R; Peek, Giles J; Clemens, Felicity; Hardy, Polly; Wilson, Andrew

    2008-01-01

    Background Extracorporeal Membrane Oxygenation (ECMO) is a technology used in treatment of patients with severe but potentially reversible respiratory failure. A multi-centre randomised controlled trial (CESAR) was funded in the UK to compare care including ECMO with conventional intensive care management. The protocol and funding for the CESAR trial included plans for economic data collection and analysis. Given the high cost of treatment, ECMO is considered an expensive technology for many funding systems. However, conventional treatment for severe respiratory failure is also one of the more costly forms of care in any health system. Methods/Design The objectives of the economic evaluation are to compare the costs of a policy of referral for ECMO with those of conventional treatment; to assess cost-effectiveness and the cost-utility at 6 months follow-up; and to assess the cost-utility over a predicted lifetime. Resources used by patients in the trial are identified. Resource use data are collected from clinical report forms and through follow up interviews with patients. Unit costs of hospital intensive care resources are based on parallel research on cost functions in UK NHS intensive care units. Other unit costs are based on published NHS tariffs. Cost effectiveness analysis uses the outcome: survival without severe disability. Cost utility analysis is based on quality adjusted life years gained based on the Euroqol EQ-5D at 6 months. Sensitivity analysis is planned to vary assumptions about transport costs and method of costing intensive care. Uncertainty will also be expressed in analysis of individual patient data. Probabilities of cost effectiveness given different funding thresholds will be estimated. Discussion In our view it is important to record our methods in detail and present them before publication of the results of the trial so that a record of detail not normally found in the final trial reports can be made available in the public domain. Trial Registrations The CESAR trial registration number is ISRCTN47279827. PMID:18447931

  16. Managing Feelings about Heart Failure

    MedlinePLUS

    ... About Heart Failure Module 6: Managing Feelings About Heart Failure Download Module Order Hardcopy Heart failure can cause ... professional help for emotional problems. Common Feelings About Heart Failure It is common for people to feel depressed ...

  17. 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...

  18. Proteinuria, hypertension and chronic renal failure in X-linked Kallmann's syndrome, a defined genetic cause of solitary functioning kidney

    Microsoft Academic Search

    Veronique Duke; Richard Quinton; Isky Gordon; Pierre M. G. Bouloux; Adrian S. Woolf

    type, renal agenesis, the kidney is absent (2). In an Background. Anosmia and hypogonadotrophic hypo- autopsy study of 9200 individuals dying of incidental gonadism are the classic features of X-linked causes, unilateral agenesis was noted in seven (3), Kallmann's syndrome, a disorder caused by mutations whereas another, radiological, series identified no renal of KAL, a gene expressed during kidney and

  19. The Acute Respiratory Distress Syndrome

    NSDL National Science Digital Library

    Claude A. Piantadosi (Duke University Medical Center)

    2004-09-22

    Physiology in Medicine review article. This review describes the clinical, etiologic, and physiologic basis of ARDS and summarizes our understanding of how its molecular pathogenesis leads to the physiologic alterations of respiratory failure, emphasizing factors known to be involved in the formation and resolution of permeability pulmonary edema. It also provides a physiologic basis for understanding and implementing modern strategies for the respiratory management of patients with ARDS.

  20. Association of Weekend Admission With Hospital Length of Stay, Time to Chemotherapy, and Risk for Respiratory Failure in Pediatric Patients With Newly Diagnosed Leukemia at Freestanding US Children's Hospitals

    PubMed Central

    Goodman, Elizabeth K.; Reilly, Anne F.; Fisher, Brian T.; Fitzgerald, Julie; Li, Yimei; Seif, Alix E.; Huang, Yuan-Shung; Bagatell, Rochelle; Aplenc, Richard

    2015-01-01

    IMPORTANCE In adult patients with leukemia, weekend admission is associated with increased inpatient mortality. It is unknown whether weekend diagnostic admissions in pediatric patients with leukemia demonstrate similar adverse outcomes. OBJECTIVE To estimate adverse clinical outcomes associated with weekend admission in the first hospitalization of pediatric patients with newly diagnosed leukemia. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study from 1999 to 2011 featured index hospital admissions identified from the Pediatric Health Information System database. Participants were children with newly diagnosed acute lymphoid leukemia or acute myeloid leukemia. EXPOSURES Weekend (Saturday and Sunday) or weekday index admission. MAIN OUTCOMES AND MEASURES Inpatient mortality, length of inpatient stay, time to chemotherapy, and organ-system failure in index admission. RESULTS A total of 10 720 patients with acute lymphoid leukemia and 1323 patients with acute myeloid leukemia were identified; 2009 patients (16.7%) were admitted on the weekend. While the total daily number of patients receiving intensive care unit–level care was constant regardless of the day of admission, these patients represented a larger percentage of total admissions on weekends. In adjusted analyses, patients admitted on the weekend did not have an increased rate of mortality during the first admission (odds ratio, 1.0; 95% CI, 0.8–1.6). Patients whose initial admission for leukemia occurred during a weekend had a significantly increased length of stay (1.4-day increase; 95% CI, 0.7–2.1), time to initiation of chemotherapy (0.36-day increase; 95% CI, 0.3–0.5), and risk for respiratory failure (odds ratio, 1.5; 95% CI, 1.2–1.7) after adjusting for demographics, severity of illness, and hospital-level factors. CONCLUSIONS AND RELEVANCE While pediatric patients with newly diagnosed leukemia admitted on weekends do not have higher mortality rates, they have a prolonged length of stay, increased time to chemotherapy, and higher risk for respiratory failure. Patients who are severely ill at presentation represent a higher proportion of weekend index admissions. Optimizing weekend resources by increasing staffing and access to diagnostic and therapeutic resources may help to reduce hospital length of stay across all weekend admissions and may also ensure the availability of comprehensive care for those weekend admissions with higher acuity. PMID:25155012

  1. Acute liver failure caused by concurrent autoimmune hepatitis and hepatitis B in a 16-year old girl.

    PubMed

    Paw?owska, Ma?gorzata; Halota, Waldemar

    2010-10-27

    A 16 year-old girl was admitted to hospital because of fatigue and somnolence, nausea, epistaxis and jaundice. Physical examination revealed jaundice, an enlarged liver and tenderness of upper right abdomen. Laboratory tests revealed an increased level of acute liver failure, bilirubin, bile acids, GGTP and a decreased prothrombin ratio, with elevated gamma-globulin and IgG levels, and the presence of anti-mitochondrial M2 antibodies and HBV infection markers. The patient was diagnosed with liver failure resulting from chronic hepatitis B with an autoimmune component. The treatment consisted of steroids, azathioprine, vitamin K, low-protein diet and lactulose enemas. After undergoing a molecular test (HBV DNA 3.23 × 10(5) IU/mL and mutations I 204 and I 80), the treatment was modified by adding entecavir. After one month the patient was discharged in good clinical condition, with the recommendation of continued entecavir, prednisone and azathioprine. In subsequent months, no clinical deterioration or abnormal biochemical liver function test results were found, despite the discontinuation of immunosuppressive therapy after 10 mo. The patient continues entecavir therapy. PMID:21160949

  2. Stress Analysis and Testing at the Marshall Space Flight Center to Study Cause and Corrective Action of Space Shuttle External Tank Stringer Failures

    NASA Technical Reports Server (NTRS)

    Wingate, Robert J.

    2012-01-01

    After the launch scrub of Space Shuttle mission STS-133 on November 5, 2010, large cracks were discovered in two of the External Tank intertank stringers. The NASA Marshall Space Flight Center, as managing center for the External Tank Project, coordinated the ensuing failure investigation and repair activities with several organizations, including the manufacturer, Lockheed Martin. To support the investigation, the Marshall Space Flight Center formed an ad-hoc stress analysis team to complement the efforts of Lockheed Martin. The team undertook six major efforts to analyze or test the structural behavior of the stringers. Extensive finite element modeling was performed to characterize the local stresses in the stringers near the region of failure. Data from a full-scale tanking test and from several subcomponent static load tests were used to confirm the analytical conclusions. The analysis and test activities of the team are summarized. The root cause of the stringer failures and the flight readiness rationale for the repairs that were implemented are discussed.

  3. Effect of aging on respiratory system physiology and immunology

    PubMed Central

    Sharma, Gulshan; Goodwin, James

    2006-01-01

    With the looming expansion of the elderly population of the US, a thorough understanding of “normal” aging-related changes on the respiratory system is paramount. The respiratory system undergoes various anatomical, physiological and immunological changes with age. The structural changes include chest wall and thoracic spine deformities which impairs the total respiratory system compliance leading to increase work of breathing. The lung parenchyma loses its supporting structure causing dilation of air spaces: “senile emphysema”. Respiratory muscle strength decreases with age and can impair effective cough, which is important for airway clearance. The lung matures by age 20–25 years, and thereafter aging is associated with progressive decline in lung function. The alveolar dead space increases with age, affecting arterial oxygen without impairing the carbon dioxide elimination. The airways receptors undergo functional changes with age and are less likely to respond to drugs used in younger counterparts to treat the same disorders. Older adults have decreased sensation of dyspnea and diminished ventilatory response to hypoxia and hypercapnia, making them more vulnerable to ventilatory failure during high demand states (ie, heart failure, pneumonia, etc) and possible poor outcomes. PMID:18046878

  4. Novel Receptor-Derived Cyclopeptides to Treat Heart Failure Caused by Anti-?1-Adrenoceptor Antibodies in a Human-Analogous Rat Model.

    PubMed

    Boivin, Valérie; Beyersdorf, Niklas; Palm, Dieter; Nikolaev, Viacheslav O; Schlipp, Angela; Müller, Justus; Schmidt, Doris; Kocoski, Vladimir; Kerkau, Thomas; Hünig, Thomas; Ertl, Georg; Lohse, Martin J; Jahns, Roland

    2015-01-01

    Despite recent therapeutic advances the prognosis of heart failure remains poor. Recent research suggests that heart failure is a heterogeneous syndrome and that many patients have stimulating auto-antibodies directed against the second extracellular loop of the ?1 adrenergic receptor (?1EC2). In a human-analogous rat model such antibodies cause myocyte damage and heart failure. Here we used this model to test a novel antibody-directed strategy aiming to prevent and/or treat antibody-induced cardiomyopathy. To generate heart failure, we immunised n = 76/114 rats with a fusion protein containing the human ?1EC2 (amino-acids 195-225) every 4 weeks; n = 38/114 rats were control-injected with 0.9% NaCl. Intravenous application of a novel cyclic peptide mimicking ?1EC2 (?1EC2-CP, 1.0 mg/kg every 4 weeks) or administration of the ?1-blocker bisoprolol (15 mg/kg/day orally) was initiated either 6 weeks (cardiac function still normal, prevention-study, n = 24 (16 treated vs. 8 untreated)) or 8.5 months after the 1st immunisation (onset of cardiomyopathy, therapy-study, n = 52 (40 treated vs. 12 untreated)); n = 8/52 rats from the therapy-study received ?1EC2-CP/bisoprolol co-treatment. We found that ?1EC2-CP prevented and (alone or as add-on drug) treated antibody-induced cardiac damage in the rat, and that its efficacy was superior to mono-treatment with bisoprolol, a standard drug in heart failure. While bisoprolol mono-therapy was able to stop disease-progression, ?1EC2-CP mono-therapy -or as an add-on to bisoprolol- almost fully reversed antibody-induced cardiac damage. The cyclo¬peptide acted both by scavenging free anti-?1EC2-antibodies and by targeting ?1EC2-specific memory B-cells involved in antibody-production. Our model provides the basis for the clinical translation of a novel double-acting therapeutic strategy that scavenges harmful anti-?1EC2-antibodies and also selectively depletes memory B-cells involved in the production of such antibodies. Treatment with immuno-modulating cyclopeptides alone or as an add-on to ?1-blockade represents a promising new therapeutic option in immune-mediated heart failure. PMID:25700031

  5. Application of ISO22000, failure mode, and effect analysis (FMEA) cause and effect diagrams and pareto in conjunction with HACCP and risk assessment for processing of pastry products.

    PubMed

    Varzakas, Theodoros H

    2011-09-01

    The Failure Mode and Effect Analysis (FMEA) model has been applied for the risk assessment of pastry processing. A tentative approach of FMEA application to the pastry industry was attempted in conjunction with ISO22000. Preliminary Hazard Analysis was used to analyze and predict the occurring failure modes in a food chain system (pastry 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 pastry processing and packaging. However, the main emphasis was put on the quantification of risk assessment by determining the Risk Priority Number (RPN) per identified processing hazard. Storage of raw materials and storage of final products at -18°C followed by freezing were the processes identified as the ones with the highest RPN (225, 225, and 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 pastry processing industry is considered imperative. PMID:21838557

  6. Severe respiratory phenotype caused by a de novo Arg528Gly mutation in the CACNA1S gene in a patient with hypokalemic periodic paralysis

    Microsoft Academic Search

    Tae-Hwan Kil; June-Bum Kim

    2010-01-01

    Hypokalemic periodic paralysis (HOKPP) is a rare disorder characterized by episodic muscle weakness with hypokalemia. Mutations in the CACNA1S gene, which encodes the alpha 1-subunit of the skeletal muscle L-type voltage-dependent calcium channel, have been reported to be mainly responsible for HOKPP. The paralytic attacks generally spare the respiratory muscles and the heart. Here, we report the case of a

  7. 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.

  8. Severe respiratory phenotype caused by a de novo Arg528Gly mutation in the CACNA1S gene in a patient with hypokalemic periodic paralysis.

    PubMed

    Kil, Tae-Hwan; Kim, June-Bum

    2010-05-01

    Hypokalemic periodic paralysis (HOKPP) is a rare disorder characterized by episodic muscle weakness with hypokalemia. Mutations in the CACNA1S gene, which encodes the alpha 1-subunit of the skeletal muscle L-type voltage-dependent calcium channel, have been reported to be mainly responsible for HOKPP. The paralytic attacks generally spare the respiratory muscles and the heart. Here, we report the case of a 16-year-old boy who presented with frequent respiratory insufficiency during the severe attacks. Mutational analysis revealed a heterozygous c.1582C>G substitution in the CACNA1S gene, leading to an Arg528Gly mutation in the protein sequence. The parents were clinically unaffected and did not show a mutation in the CACNA1S gene. A de novo Arg528Gly mutation has not previously been reported. The patient described here presents the unique clinical characteristics, including a severe respiratory phenotype and a reduced susceptibility to cold exposure. The patient did not respond to acetazolamide and showed a marked improvement of the paralytic symptoms on treatment with a combination of spironolactone, amiloride, and potassium supplements. PMID:19822448

  9. 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

  10. Failure to down-regulate the epithelial sodium channel causes salt-sensitivity in Hsd11b2 heterozygote mice

    PubMed Central

    Craigie, Eilidh; Evans, Louise C; Mullins, John J; Bailey, Matthew A

    2012-01-01

    In vivo, the enzyme 11?-hydroxysteroid dehydrogenase type 2 influences ligand access to the mineralocorticoid receptor. Ablation of the encoding gene, HSD11B2, causes the hypertensive syndrome of Apparent Mineralocorticoid Excess. Studies in humans and experimental animals have linked reduced 11?-hydroxysteroid dehydrogenase type 2 activity and salt-sensitivity of blood pressure. In the present study, renal mechanisms underpinning salt-sensitivity were investigated in Hsd11b2+/? mice fed low, standard and high sodium diets. In wild-type mice, there was a strong correlation between dietary sodium content and fractional sodium excretion, but not blood pressure. High sodium feeding abolished amiloride-sensitive sodium reabsorption, consistent with down-regulation of the epithelial sodium channel. In Hsd11b2+/? mice, the natriuretic response to increased dietary sodium content was blunted and epithelial sodium channel activity persisted. High sodium diet also reduced renal blood flow and increased blood pressure in Hsd11b2+/? mice. Aldosterone was modulated by dietary sodium in both genotypes and salt-sensitivity in Hsd11b2+/? mice was associated with increased plasma corticosterone levels. Chronic administration of an epithelial sodium channel blocker or a glucocorticoid receptor antagonist prevented salt-sensitivity in Hsd11b2+/? mice, whereas mineralocorticoid receptor blockade with spironolactone did not. This study shows that reduced 11?-hydroxysteroid dehydrogenase type 2 causes salt-sensitivity of blood pressure due to impaired renal natriuretic capacity. This reflects deregulation of epithelial sodium channels and increased renal vascular resistance. The phenotype is not caused by illicit activation of mineralocorticoid receptors by glucocorticoids, but by direct activation of glucocorticoid receptors. PMID:22777941

  11. Porcine Reproductive and Respiratory Syndrome

    E-print Network

    Lawhorn, D. Bruce

    2001-07-25

    Porcine reproductive and respiratory syndrome (PRRS) is becoming one of the most economically significant diseases of swine. It causes weak, stillborn and mummified pigs, and sometimes losses of entire litters. This publication describes the disease...

  12. CADMIUM AS A RESPIRATORY TOXICANT

    EPA Science Inventory

    Cadmium is a major respiratory toxicant as evidenced by numerous human and animal studies. Controlled animal inhalation studies provide supporting evidence to the associations observed in epidemiological studies that Cd has the potential to cause lung fibrosis, emphysema, cancer,...

  13. Abnormal chromosome segregation at early cleavage is a major cause of the full-term developmental failure of mouse clones.

    PubMed

    Mizutani, Eiji; Yamagata, Kazuo; Ono, Tetsuo; Akagi, Satoshi; Geshi, Masaya; Wakayama, Teruhiko

    2012-04-01

    To clarify the causes of the poor success rate of somatic cell nuclear transfer (SCNT), we addressed the impact of abnormalities observed at early cleavage stages of development on further full-term development using 'less-damage' imaging technology. To visualize the cellular and nuclear division processes, SCNT embryos were injected with a mixture of mRNAs encoding enhanced green fluorescent protein coupled with ?-tubulin (EGFP-?-tubulin) and monomeric red fluorescent protein 1 coupled with histone H2B (H2B-mRFP1) and monitored until the morula/blastocyst stage three-dimensionally. First, the rate of development of SCNT embryos and its effect on the full-term developmental ability were analyzed. The speed of development was retarded and varied in SCNT embryos. Despite the rate of development, SCNT morulae having more than eight cells at 70h after activation could develop to term. Next, chromosomal segregation was investigated in SCNT embryos during early embryogenesis. To our surprise, more than 90% of SCNT embryos showed abnormal chromosomal segregation (ACS) before they developed to morula stage. Importantly, ACS per se did not affect the rate of development, morphology or cellular differentiation in preimplantation development. However, ACS occurring before the 8-cell stage severely inhibited postimplantation development. Thus, the morphology and/or rate of development are not significant predictive markers for the full-term development of SCNT embryos. Moreover, the low efficiency of animal cloning may be caused primarily by genetic abnormalities such as ACS, in addition to the epigenetic errors described previously. PMID:22266425

  14. Combination of Quantitative Capnometry, N-Terminal Pro-brain Natriuretic Peptide, and Clinical Assessment in Differentiating Acute Heart Failure from Pulmonary Disease as Cause of Acute Dyspnea in Pre-hospital Emergency Setting: Study of Diagnostic Accuracy

    PubMed Central

    Klemen, Petra; Golub, Mirjam; Grmec, Štefek

    2009-01-01

    Aim To determine the diagnostic accuracy of the combination of quantitative capnometry (QC), N-terminal pro-brain natriuretic peptide (NT-proBNP), and clinical assessment in differentiating heart failure (HF)-related acute dyspnea from pulmonary-related acute dyspnea in a pre-hospital setting. Methods This prospective study was performed in the Center for Emergency Medicine Maribor, Slovenia, January 2005 - June 2007. Two groups of patients with acute dyspnea apnea were compared: HF-related acute dyspnea group (n?=?238) vs pulmonary-related acute dyspnea (asthma/COPD) group (n?=?203). The primary outcome was the comparison of combination of QC, NT-proBNP, and clinical assessment vs NT-proBNP alone or NT-proBNP in combination with clinical assessment, in differentiating HF-related acute dyspnea from pulmonary-related acute dyspnea (asthma/COPD) in pre-hospital emergency setting, using the area under the receiver operating characteristic curve (AUROC). The secondary outcomes were identification of independent predictors for final diagnosis of acute dyspnea (caused by acute HF or pulmonary diseases), and determination of NT-proBNP levels, as well as capnometry, in the subgroup of patients with a previous history of HF and in the subgroup of patients with a previous history of pulmonary disease. Results In differentiating between cardiac and respiratory causes of acute dyspnea in pre-hospital emergency setting, NT-proBNP in combination with PetCO2 and clinical assessment (AUROC, 0.97; 95% confidence interval [CI], 0.90-0.99) was superior to combination of NT-proBNP and clinical assessment (AUROC, 0.94; 95% CI, 0.88-0.96; P?=?0.006) or NT-proBNP alone (AUROC, 0.90; 95% CI, 0.85-0.94; P?=?0.005). The values of NT-proBNP?2000 pg/mL and PetCO2???4 kPa were strong independent predictors for acute HF. In the group of acute HF dyspneic patients, subgroup of patients with previous COPD/asthma had significantly higher PetCO2 (3.8?±?1.2 vs 5.8?±?1.3 kPa, P?=?0.009). In the group of COPD/asthma dyspneic patients, NT-proBNP was significantly higher in the subgroup of patients with previous HF (1453.3?±?552.3 vs 741.5?±?435.5 pg/mL, P?=?0.010). Conclusion In differentiating between cardiac and respiratory causes of acute dyspnea in pre-hospital emergency setting, NT-proBNP in combination with capnometry and clinical assessment was superior to NT-proBNP alone or NT-proBNP in combination with clinical assessment. ClinicalTrials.gov trial registration number NCT00878475 PMID:19399946

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

    Microsoft Academic Search

    Bor-Jen Lee; Chia-Yi Chen; Sung-Yuan Hu; Yu-Tse Tsan; Tzu-Chieh Lin; Lee-Min Wang

    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.\\u000a \\u000a \\u000a \\u000a \\u000a Case presentations  We encountered a 23-year-old previously healthy Taiwanese male soldier presenting with the right ear pain after training in\\u000a the jungle and an eleven-day history of intermittent high fever up to 39°C. Amoxicillin\\/clavulanate was prescribed for

  16. A survival case of severe liver failure caused by acetylsalicylic acid that was treated with living donor liver transplantation

    PubMed Central

    Hagiwara, S; Kaneko, M; Murata, M; Ikegami, T; Oshima, K

    2014-01-01

    Background: Severe liver dysfunction caused by acetylsalicylic acid (ASA) is quite rare. The purpose is to describe a patient with severe liver dysfunction due to excessive intake of ASA in a suicide attempt, who was successfully treated with living donor liver transplantation (LDLT). Description of Case: We report a 20-year-old woman who took 66 g of ASA in a suicide attempt. She was admitted to our hospital and received forced alkaline diuresis. However, her liver and renal functions worsened after admission. On the 6th day after intake of ASA, she was transferred to the intensive care unit, and plasma exchange (PE) and continuous hemodiafiltration were performed. Since her liver function did not recover despite repeated PE, she was transferred to another hospital for LDLT on the 8th day. She underwent LDLT with a portion of the liver donated from her mother on the 11th day. After the operation, her renal dysfunction continued. Her renal parameters gradually improved, and she was discharged on the 44th post-operative day without renal dysfunction. Conclusion: PE is effective in removing ASA from blood. Liver transplantation is the only effective treatment if liver function does not recover in spite of repeated PE. PMID:25125957

  17. 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

  18. 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

  19. Failure of current cefepime breakpoints to predict clinical outcomes of bacteremia caused by gram-negative organisms.

    PubMed

    Bhat, Sunil V; Peleg, Anton Y; Lodise, Thomas P; Shutt, Kathleen A; Capitano, Blair; Potoski, Brian A; Paterson, David L

    2007-12-01

    For commonly encountered gram-negative bacilli, a MIC of cefepime of 8 mug/ml or less was defined by the Clinical and Laboratory Standards Institute as "susceptible" prior to the commercial release of the antibiotic. We assessed 204 episodes of bacteremia caused by gram-negative organisms for which patients received cefepime (typically 1 to 2 g every 12 h) as the primary mode of therapy. The cefepime MIC breakpoint derived by classification and regression tree (CART) software analysis to delineate the risk of 28-day mortality was 8 microg/ml. Patients infected with gram-negative organisms treated with cefepime at a MIC of > or =8 microg/ml had a mortality rate of 54.8% (17/31 died), compared to 24.1% (35/145 died) for those treated with a cefepime MIC of <8 microg/ml. The rate of mortality for those treated with a cefepime MIC of 8 microg/ml was 56.3% (9/16 died), compared to 53.3% (8/15 died) for those treated with cefepime at a MIC of >8 microg/ml. A multivariable analysis including severity of illness indices showed that treating patients with bacteremia due to gram-negative organisms with a cefepime MIC of > or =8 microg/ml was an independent predictor of mortality (P < or = 0.001). There was no significant difference in outcome according to the dosage regimen utilized. Pharmacodynamic assessments that were presented previously would suggest that cefepime treatment (particularly a dosage of 1 g every 12 h) has a low probability of target attainment associated with successful in vivo outcome when the cefepime MIC is > or =8 microg/ml. It would appear reasonable, based on pharmacodynamic and clinical grounds, to lower the breakpoints for cefepime in countries where the cefepime dosage of 1 to 2 g every 12 h is the licensed therapy for serious infections, so that organisms with a cefepime MIC of 8 microg/ml are no longer regarded as susceptible to the antibiotic. PMID:17938179

  20. A respiratory gas exchange catheter: In vitro and in vivo tests in large animals

    E-print Network

    Federspiel, William J.

    reduction in the therapy of respiratory failure. Conclusions: Progress has been made toward developingA respiratory gas exchange catheter: In vitro and in vivo tests in large animals Brack G. Hattler, PhD Brian Frankowski, AD William J. Federspiel, PhD Objectives: Acute respiratory failure

  1. Lack of effect of nitrates on exercise tolerance in patients with mild to moderate heart failure caused by coronary disease already treated with captopril.

    PubMed Central

    Wieshammer, S; Hetzel, M; Hetzel, J; Kochs, M; Hombach, V

    1993-01-01

    OBJECTIVE--To test the hypothesis that the addition of nitrates improves exercise tolerance in patients with heart failure caused by coronary artery disease already treated with an angiotensin converting enzyme inhibitor and diuretics. DESIGN--Randomised, double blind, placebo controlled, 16 week treatment periods. SETTING--Outpatient clinic at a university hospital. PATIENTS--54 patients with previous myocardial infarction, symptoms of mild to moderate heart failure, left ventricular ejection fraction below 40%, no exercise-induced angina or electrocardiographic signs of ischaemia. Four patients in the nitrate group (n = 24) and one patient of the placebo group (n = 25) were withdrawn from the study. INTERVENTION--After the patients had been on constant doses of captopril and diuretics for at least 2 weeks, they were randomised to receive a target dose of 40 mg isosorbide dinitrate twice daily or placebo in addition to the continuation of captopril and diuretics. MEASUREMENTS--Bicycle exercise tests with measurement of gas exchange were carried out before randomisation and after 1, 6, 12, and 16 weeks of the double blind treatment. The change in peak oxygen uptake from control to week 16 was prospectively defined as the main outcome measure. RESULTS--The increase in peak oxygen uptake from before randomisation tended to be greater in the placebo group (before randomisation 17.4 (3.4) ml/min/kg) than in the nitrate group (before randomisation 17.1 (3.5) ml/min/kg) after 12 weeks (mean increase 1.1 (2.7) v 0.0 (2.7) ml/min/kg, p < 0.12) and 16 weeks (1.7 (3.0) v 0.3 (2.6) ml/min/kg, p < 0.14) of treatment. CONCLUSION--The addition of nitrates to a baseline treatment consisting of captopril and diuretics did not improve exercise tolerance. PMID:8037993

  2. 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

    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

  3. 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

  4. Kidney Failure and Vascular Disease

    MedlinePLUS

    ... the artery (arteriosclerosis) is the most common cause. Primary hypertension can not only damage the renal arteries, but ... renal failure, which can be caused by either primary or secondary hypertension, are chronic renal failure or end state renal ...

  5. Preventing respiratory syncytial virus infections.

    PubMed

    Robinson, Jl

    2011-10-01

    Respiratory syncytial virus infection is the leading cause of lower respiratory tract infections in young children. Palivizumab, a respiratory syncytial virus-specific monoclonal antibody, reduces the hospitalization rate of high-risk children but it is very costly. This statement replaces three previous position statements from the Canadian Paediatric Society about this topic, and was updated primarily to discuss recent changes in the American Academy of Pediatrics guidelines in the Canadian context. It reviews the published literature and provides recommendations regarding palivizumab use in high-risk children. PMID:23024588

  6. 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.

  7. Cause of Flu (Influenza)

    MedlinePLUS

    ... in humans and many animals, including ducks, chickens, pigs, and whales. Type A influenza viruses caused the ... humans. Type C viruses are found in humans, pigs, and dogs and cause mild respiratory infections but ...

  8. Surveillance for emerging respiratory viruses.

    PubMed

    Al-Tawfiq, Jaffar A; Zumla, Alimuddin; Gautret, Philippe; Gray, Gregory C; Hui, David S; Al-Rabeeah, Abdullah A; Memish, Ziad A

    2014-10-01

    Several new viral respiratory tract infectious diseases with epidemic potential that threaten global health security have emerged in the past 15 years. In 2003, WHO issued a worldwide alert for an unknown emerging illness, later named severe acute respiratory syndrome (SARS). The disease caused by a novel coronavirus (SARS-CoV) rapidly spread worldwide, causing more than 8000 cases and 800 deaths in more than 30 countries with a substantial economic impact. Since then, we have witnessed the emergence of several other viral respiratory pathogens including influenza viruses (avian influenza H5N1, H7N9, and H10N8; variant influenza A H3N2 virus), human adenovirus-14, and Middle East respiratory syndrome coronavirus (MERS-CoV). In response, various surveillance systems have been developed to monitor the emergence of respiratory-tract infections. These include systems based on identification of syndromes, web-based systems, systems that gather health data from health facilities (such as emergency departments and family doctors), and systems that rely on self-reporting by patients. More effective national, regional, and international surveillance systems are required to enable rapid identification of emerging respiratory epidemics, diseases with epidemic potential, their specific microbial cause, origin, mode of acquisition, and transmission dynamics. PMID:25189347

  9. Elements of Failure Analysis

    Microsoft Academic Search

    Wayne Reitz

    Failure analysis is conducted to determine the root cause of failure. Sometimes these failures are catastrophic, e.g., Titanic. Other times the failures are a nuisance, e.g., failed o-ring in plastic faucet water valve. In both cases, the component failed unexpectedly, which can result in injury or death, not to mention financial loss due to unscheduled downtime. By using the information

  10. Infertility Associated with Meiotic Failure in the tremor Rat (tm/tm) is Caused by the Deletion of Spermatogenesis Associated 22

    PubMed Central

    Ishishita, Satoshi; Inui, Toshihide; Matsuda, Yoichi; Serikawa, Tadao; Kitada, Kazuhiro

    2013-01-01

    The tremor rat is an autosomal recessive mutant exhibiting sterility with gonadal hypoplasia in both sexes. The causative mutation tremor (tm) is known as a genomic deletion spanning >200 kb in Chr 10q24. Spermatogenesis associated 22 (Spata22) has been shown to be a vertebrate-specific gene essential for the progression of meiosis through prophase I and completion of chromosome synapsis and meiotic recombination using a mouse repro42 mutant carrying an N-ethyl-N-nitrosourea (ENU)-induced nonsense mutation in Spata22. In this study, we show that Spata22 was identified as the gene responsible for the failure of gametogenesis to progress beyond meiosis I in tm homozygous rats by a transgenic rescue experiment. Meiosis was arrested during prophase I in the mutant testis. Precise mapping of the breakage point revealed that the deleted genomic region spanned approximately 240 kb and comprised at least 13 genes, including Spata22. Rat Spata22 was predominantly expressed in the testis, and its transcription increased with the first wave of spermatogenesis, as seen in the mouse ortholog. These results suggest that Spata22 may play an important role in meiotic prophase I in rats, as seen in mice, and that the tm homozygous rat may be useful for investigating the physiological function of Spata22, as an experimental system for clarifying the effect of a null mutation, and may be an animal model for studying the pathogenesis and treatment of infertility caused by impaired meiosis. PMID:23903057

  11. A single crossing-over event in voltage-sensitive Na+ channel genes may cause critical failure of dengue mosquito control by insecticides.

    PubMed

    Hirata, Koichi; Komagata, Osamu; Itokawa, Kentaro; Yamamoto, Atsushi; Tomita, Takashi; Kasai, Shinji

    2014-08-01

    The voltage-sensitive sodium (Na+) channel (Vssc) is the target site of pyrethroid insecticides. Pest insects develop resistance to this class of insecticide by acquisition of one or multiple amino acid substitution(s) in this channel. In Southeast Asia, two major Vssc types confer pyrethroid resistance in the dengue mosquito vector Aedes aegypti, namely, S989P+V1016G and F1534C. We expressed several types of Vssc in Xenopus oocytes and examined the effect of amino acid substitutions in Vssc on pyrethroid susceptibilities. S989P+V1016G and F1534C haplotypes reduced the channel sensitivity to permethrin by 100- and 25-fold, respectively, while S989P+V1016G+F1534C triple mutations reduced the channel sensitivity to permethrin by 1100-fold. S989P+V1016G and F1534C haplotypes reduced the channel sensitivity to deltamethrin by 10- and 1-fold (no reduction), respectively, but S989P+V1016G+F1534C triple mutations reduced the channel sensitivity to deltamethrin by 90-fold. These results imply that pyrethroid insecticides are highly likely to lose their effectiveness against A. aegypti if such a Vssc haplotype emerges as the result of a single crossing-over event; thus, this may cause failure to control this key mosquito vector. Here, we strongly emphasize the importance of monitoring the occurrence of triple mutations in Vssc in the field population of A. aegypti. PMID:25166902

  12. A Single Crossing-Over Event in Voltage-Sensitive Na+ Channel Genes May Cause Critical Failure of Dengue Mosquito Control by Insecticides

    PubMed Central

    Hirata, Koichi; Komagata, Osamu; Itokawa, Kentaro; Yamamoto, Atsushi; Tomita, Takashi; Kasai, Shinji

    2014-01-01

    The voltage-sensitive sodium (Na+) channel (Vssc) is the target site of pyrethroid insecticides. Pest insects develop resistance to this class of insecticide by acquisition of one or multiple amino acid substitution(s) in this channel. In Southeast Asia, two major Vssc types confer pyrethroid resistance in the dengue mosquito vector Aedes aegypti, namely, S989P+V1016G and F1534C. We expressed several types of Vssc in Xenopus oocytes and examined the effect of amino acid substitutions in Vssc on pyrethroid susceptibilities. S989P+V1016G and F1534C haplotypes reduced the channel sensitivity to permethrin by 100- and 25-fold, respectively, while S989P+V1016G+F1534C triple mutations reduced the channel sensitivity to permethrin by 1100-fold. S989P+V1016G and F1534C haplotypes reduced the channel sensitivity to deltamethrin by 10- and 1-fold (no reduction), respectively, but S989P+V1016G+F1534C triple mutations reduced the channel sensitivity to deltamethrin by 90-fold. These results imply that pyrethroid insecticides are highly likely to lose their effectiveness against A. aegypti if such a Vssc haplotype emerges as the result of a single crossing-over event; thus, this may cause failure to control this key mosquito vector. Here, we strongly emphasize the importance of monitoring the occurrence of triple mutations in Vssc in the field population of A. aegypti. PMID:25166902

  13. [Two cases of acute respiratory distress syndrome related to zinc fumes and zinc dust inhalation].

    PubMed

    Ishimoto, Hiroshi; Yatera, Kazuhiro; Oda, Keishi; Kawanami, Toshinori; Soda, Hiroshi; Kohno, Shigeru; Mukae, Hiroshi

    2014-06-01

    Two cases of acute respiratory distress syndrome related to zinc fume inhalation and zinc powder inhalation are presented. Case 1 demonstrated acute respiratory symptoms during the work of distortion correction of iron boards, coated with a rust preventative including rich zinc using an acetylene gas burner. Case 2 occurred after the work of applying a rust preventative that included zinc powder, mainly using an airless compressor. Since both were working in a boathouse, without using protective equipment, the possible causes of Case 1 and 2 were inhalation exposure to zinc fumes and zinc powder, respectively. The two patients showed similar clinical courses, including favorable treatment outcomes, mimicking acute respiratory failure complicated by a metal fume fever. PMID:24930880

  14. Antibacterial activity and mode of action of the Artemisia capillaris essential oil and its constituents against respiratory tract infection-causing pathogens.

    PubMed

    Yang, Chang; Hu, Dong-Hui; Feng, Yan

    2015-04-01

    Inhalation therapy using essential oils has been used to treat acute and chronic sinusitis and bronchitis. The aim of the present study was to determine the chemical composition of the essential oil of Artemisia capillaris, and evaluate the antibacterial effects of the essential oil and its main components, against common clinically relevant respiratory bacterial pathogens. Gas chromatography and gas chromatography?mass spectrometry revealed the presence of 25 chemical constituents, the main constituents being: ??pinene, ??pinene, limonene, 1,8?cineole, piperitone, ??caryophyllene and capillin. The antibacterial activities of the essential oil, and its major constituents, were evaluated against Streptococcus pyogenes, methicillin?resistant Staphylococcus aureus (MRSA), MRSA (clinical strain), methicillin?gentamicin resistant Staphylococcus aureus (MGRSA), Streptococcus pneumoniae, Klebsiella pneumoniae, Haemophilus influenzae and Escherichia coli. The essential oil and its constituents exhibited a broad spectrum and variable degree of antibacterial activity against the various strains. The essential oil was observed to be much more potent, as compared with any of its major chemical constituents, exhibiting low minimum inhibitory and bacteriocidal concentration values against all of the bacterial strains. The essential oil was most active against S. pyogenes, MRSA (clinical strain), S. pneumoniae, K. pneumoniae, H. influenzae and E. coli. Piperitone and capillin were the most potent growth inhibitors, among the major chemical constituents. Furthermore, the essential oil of A. capillaris induced significant and dose?dependent morphological changes in the S. aureus bacterial strain, killing >90% of the bacteria when administered at a higher dose; as determined by scanning electron microscopy. In addition, the essential oil induced a significant leakage of potassium and phosphate ions from the S. aureus bacterial cultures. These results indicate that the antibacterial action of A. capillaris essential oil may be mediated through the leakage of these two important ions. In conclusion, A. capillaris essential oil exhibits potent antibacterial activity by inducing morphological changes and leakage of ions in S. aureus bacterial cultures. PMID:25522803

  15. Atypical respiratory distress in a newborn: a diagnostic dilemma.

    PubMed

    Dey, Pranab Kumar; Mondal, Biswajit; Bagchi, Nilay Ranjan

    2014-01-01

    Neonatal respiratory distress is a very common problem in our practice. The causes may be respiratory, cardiovascular, central, metabolic, haematological and surgical. The cause of distress due to transient myocardial depression is not very common in mild asphyxia. We present a case having transient myocardial depression with severe respiratory distress and features of shock in a mild asphyxiated baby. PMID:25135270

  16. [Long-term results and cause of failure analysis in larynx cancer patients irradiated conventionally and with accelerated fractionation schedules in 1995-1998].

    PubMed

    Szutkowski, Zbigniew; Kawecki, Andrzej; Jarz?bski, Andrzej

    2014-01-01

    The clinical material consists of 217 patients with squamous cell carcinoma in supraglottic and glottic larynx in clinical stage T1-3N0M0 irradiated radically in Warsaw Oncology Centre in 1995-1998. All patients were treated with Co-60, according to two schedules of fractionation, with maintenance of the consistent therapeutic protocol. The same team of doctors worked on the treatment of patients and on the follow-up as well. The clinical material is a part of a three-phased clinical trial KBN 0295. In the course of observation, the progression of cancer was not observed in 157 patients, among whom, 66% were treated conventionally and 79% with accelerated fractionation method. 60 cases of loco-regional recurrences were noted, among which 55 were regional. The majority of failure cases was observed until the 30(th) of the month after the radiotherapy ended. In conventional fractionation treatment, recurrences in T1 were 8/31 (26%), in T2 22/59 (37%) and in T3 8/20 (40%). In patients treated with AF, recurrences were T1 5/39 (13%), T2 15/55 (27%) and T3 2/13 (15%) respectively. The percentage of primary site tumour recurrences for each localization and kind of treatment was analysed. In CF 28/78 (37%) of glottic tumour recurrences and 10/34 (29%) of supraglottic tumour, recurrences were observed. In AF, 12/71 (17%) and 10/36 (28%) were observed respectively. In 48 cases salvage surgery was used, and 12 patients were not qualified because of tumour massive progression or because they refused to have a surgery. Among 34 cases (16%) of the second primary tumour or distant methastases, 25 were observed with glottic cancer, among which 23 were observed in early stages, and 9 cases with supraglottic cancer, among which, 6 showed early stage of tumour. In only 3 cases out of all the patients, distant methastases were confirmed in histopatology examination. The main cause of failure in larynx cancer patients in stage T1 is that 3N0M0 are local recurrences. Second primary or distant methastases constitute 16% of the patients in this paper. PMID:25441938

  17. Comparative virulence of reproductive diseases caused by type 1 (European-like) and type 2 (North American-like) porcine reproductive and respiratory syndrome virus in experimentally infected pregnant gilts.

    PubMed

    Han, K; Seo, H W; Park, C; Kang, I; Youn, S-K; Lee, S Y; Kim, S-H; Chae, C

    2014-01-01

    The aim of this study was to compare the virulence of type 1 and type 2 porcine reproductive and respiratory syndrome virus (PRRSV) as assessed by the level of viral replication, viral distribution and apoptosis in stillborn fetuses and live-born piglets from infected pregnant gilts. Type 1 or type 2 PRRSV was given intranasally to pregnant gilts at 3 weeks before the expected date of parturition. Regardless of virus genotype, PRRSV-infected gilts farrowed between 102 and 109 days of gestation, while control uninfected gilts carried the pregnancy to term and farrowed at 114-115 days of gestation. There were no significant differences in the mean number of virus-infected cells per unit area of tissue when type 1 and type 2 virus infections were compared between stillborn fetuses and live-born piglets. Stillborn fetuses from the type 1 PRRSV-infected pregnant gilts had a significantly higher mean number of apoptotic cells per unit area of thymus (P = 0.013) than those from type 2 PRRSV-infected pregnant gilts. Significant differences in virulence were not observed between types 1 and 2 PRRSV in terms of female reproductive failure, although thymic apoptosis differed in stillborn fetuses from type 1 and type 2 PRRSV-infected pregnant gilts. PMID:24447572

  18. 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

  19. Murine Model of Chronic Respiratory Inflammation

    Microsoft Academic Search

    Amit A. Lugade; Paul N. Bogner; Yasmin Thanavala

    \\u000a The respiratory mucosa is exposed to the external environment each time we breathe and therefore requires a robust and sophisticated\\u000a immune defense system. As with other mucosal sites, the respiratory mucosal immune system must balance its response to pathogens\\u000a while also regulating inflammatory immune cell-mediated tissue damage. In the airways, a failure to tightly control immune\\u000a responses to a pathogen

  20. Human respiratory mechanics demonstration model

    NSDL National Science Digital Library

    Janelle Anderson (University of Wisconsin Biomedical Engineering)

    2009-03-01

    Respiratory mechanics is a difficult topic for instructors and students alike. Existing respiratory mechanics models are limited in their abilities to demonstrate any effects of rib cage movement on alveolar and intrapleural pressures. We developed a model that can be used in both large and small classroom settings. This model contains digital pressure displays and computer integration for real-time demonstration of pressure changes that correspond to the different phases of breathing. Moving the simulated diaphragm and rib cage causes a volume change that results in pressure changes visible on the digital sensors and computer display. Device testing confirmed the model's ability to accurately demonstrate pressure changes in proportion to physiological values. Classroom testing in 427 surveyed students showed improved understanding of respiratory concepts (P < 0.05). We conclude that our respiratory mechanics model is a valuable instructional tool and provide detailed instructions for those who would like to create their own.

  1. 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.

  2. Heart Failure

    MedlinePLUS

    ... Pressure High Blood Pressure Tools & Resources Stroke More Heart Failure Prevention & Treatment of Heart Failure Pause Previous Banner ... you agree to the Terms and Conditions Downloadable Heart Failure Resources What is Heart Failure? (PDF) How Can ...

  3. The first case of H5N1 avian influenza infection in a human with complications of adult respiratory distress syndrome and Reye's syndrome

    Microsoft Academic Search

    ASW KU; LTW CHAN

    Avian influenza virus was not known to cause systemic infection in humans before. We report a 3-year-old boy with good past health who developed pneumonia caused by H5N1 avian influenza A virus (A\\/Hong Kong\\/156\\/97). The virus was isolated from a tracheal aspirate. There were complications of Reye's syndrome, adult respiratory distress syndrome, and multiple organ system failure. He had a

  4. Unusual Intense Fluorodeoxyglucose Uptake in the Intercostal Muscles Due to Severe Shortness of Breath in a Patient with Heart Failure

    PubMed Central

    Shariat, Masoud; Mohan, Ravi; Iwanochko, Mark R.

    2015-01-01

    We present a case of unusually intense Fluorodeoxyglucose uptake in the intercostal muscles during a Fluorodeoxyglucose positron emission tomography (FDG-PET). We hypothesized that severe left ventricular failure causing the patient to be short of breath during the study in association with insulin injection as part of study protocol led to the intense uptake of FDG in the respiratory muscles causing such an unusual appearance. PMID:25709551

  5. 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

  6. Specialized Respiratory Management for Acute Cervical Spinal Cord Injury:

    PubMed Central

    Wong, Sandra Lynn; Shem, Kazuko; Crew, James

    2012-01-01

    Background: In individuals with cervical spinal cord injury (SCI), respiratory complications arise within hours to days of injury. Paralysis of the respiratory muscles predisposes the patient toward respiratory failure. Respiratory complications after cervical SCI include hypoventilation, hypercapnea, reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Ultimately, the patient must use increased work to breathe, which results in respiratory fatigue and may eventually require intubation for mechanical ventilation. Without specialized respiratory management for individuals with tetraplegia, recurrent pneumonias, bronchoscopies, and difficulty in maintaining a stable respiratory status will persist. Objective: This retrospective analysis examined the effectiveness of specialized respiratory management utilized in a regional SCI center. Methods: Individuals with C1-C4 SCI (N = 24) were the focus of this study as these neurological levels present with the most complicated respiratory status. Results: All of the study patients’ respiratory status improved with the specialized respiratory management administered in the SCI specialty unit. For a majority of these patients, respiratory improvements were noted within 1 week of admission to our SCI unit. Conclusion: Utilization of high tidal volume ventilation, high frequency percussive ventilation, and mechanical insufflation– exsufflation have demonstrated efficacy in stabilizing the respiratory status of these individuals. Optimizing respiratory status enables the patients to participate in rehabilitation therapies, allows for the opportunity to vocalize, and results in fewer days on mechanical ventilation for patients who are weanable. PMID:23459555

  7. 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.

  8. Metallization failures

    NASA Technical Reports Server (NTRS)

    Beatty, R.

    1971-01-01

    Metallization-related failure mechanisms were shown to be a major cause of integrated circuit failures under accelerated stress conditions, as well as in actual use under field operation. The integrated circuit industry is aware of the problem and is attempting to solve it in one of two ways: (1) better understanding of the aluminum system, which is the most widely used metallization material for silicon integrated circuits both as a single level and multilevel metallization, or (2) evaluating alternative metal systems. Aluminum metallization offers many advantages, but also has limitations particularly at elevated temperatures and high current densities. As an alternative, multilayer systems of the general form, silicon device-metal-inorganic insulator-metal, are being considered to produce large scale integrated arrays. The merits and restrictions of metallization systems in current usage and systems under development are defined.

  9. 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.

  10. Failure probabilistic model of CNC lathes

    Microsoft Academic Search

    Yiqiang Wang; Yazhou Jia; Junyi Yu; Yuhua Zheng; Shangfeng Yi

    1999-01-01

    A field failure analysis of computerized numerical control (CNC) lathes is described. Field failure data was collected over a period of two years on approximately 80 CNC lathes. A coding system to code failure data was devised and a failure analysis data bank of CNC lathes was established. The failure position and subsystem, failure mode and cause were analyzed to

  11. Warning Signs of Heart Failure

    MedlinePLUS

    Warning Signs of Heart Failure Updated:Jan 12,2015 By themselves, any one sign of heart failure may not be cause for alarm. But ... content was last reviewed on 08/20/2012." Heart Failure • Home • About Heart Failure • Warning Signs of Heart ...

  12. 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 ...

  13. Xanthines in Respiratory Diseases

    PubMed Central

    Mazza, J. A.

    1982-01-01

    Xanthines have been widely used for almost 50 years to treat bronchospastic conditions. They have a number of pharmacological properties, but the clinical applications are limited as bronchodilators. Current applications include intravenous preparations for acute asthma and prophylactically for other respiratory conditions that have bronchospasm as a common denominator. Sustained release preparations provide longterm, smooth plasma concentration levels. With easily performed and reliable blood levels, the risk of toxic, occasionally fatal side effects can be minimized. Not following patients with serial blood determinations of theophylline is almost inexcusable. A better knowledge of pharmacokinetics has established comprehensive guidelines, in particular, to its use in different clinical situations like pulmonary edema or liver failure, as well as its interaction with other drugs. PMID:21286561

  14. Original article Bovine respiratory syncytial virus

    E-print Network

    Boyer, Edmond

    Original article Bovine respiratory syncytial virus: first serological evidence in Uruguay Mauro; accepted 18 November 1999) Abstract ­ Bovine respiratory syncytial virus (BRSV) is a major cause virus / recombinant N protein / epidemiology / baculovirus / Uruguay Résumé ­ Première mise en évidence

  15. 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...

  16. Respiratory Syncytial Virus Activates Innate Immunity through Toll-Like Receptor 2

    Microsoft Academic Search

    Matthew R. Murawski; Glennice N. Bowen; Anna M. Cerny; Larry J. Anderson; Lia M. Haynes; Ralph A. Tripp; Evelyn A. Kurt-Jones; Robert W. Finberg

    2009-01-01

    Respiratory syncytial virus (RSV) is a common cause of infection that is associated with a range of respiratory illnesses, from common cold-like symptoms to serious lower respiratory tract illnesses such as pneumonia and bronchiolitis. RSV is the single most important cause of serious lower respiratory tract illness in children <1 year of age. Host innate and acquired immune responses activated

  17. Respiratory syncytial virus activates innate immunity through Toll-like receptor 2

    Microsoft Academic Search

    Matthew R. Murawski; Glennice N. Bowen; Anna M. Cerny; Larry J. Anderson; Lia M. Haynes; Ralph A. Tripp; Evelyn A. Kurt-Jones; Robert W. Finberg

    2008-01-01

    Respiratory syncytial virus (RSV) is a common cause of infection that is associated with a range of respiratory illnesses, from common cold-like symptoms to serious lower respiratory tract illnesses such as pneumonia and bronchiolitis. RSV is the single most important cause of serious lower respiratory tract illness in children <1 year of age. Host innate and acquired immune responses activated

  18. Detection of Respiratory Viruses by Molecular Methods

    PubMed Central

    Mahony, James B.

    2008-01-01

    Summary: Clinical laboratories historically diagnose seven or eight respiratory virus infections using a combination of techniques including enzyme immunoassay, direct fluorescent antibody staining, cell culture, and nucleic acid amplification tests. With the discovery of six new respiratory viruses since 2000, laboratories are faced with the challenge of detecting up to 19 different viruses that cause acute respiratory disease of both the upper and lower respiratory tracts. The application of nucleic acid amplification technology, particularly multiplex PCR coupled with fluidic or fixed microarrays, provides an important new approach for the detection of multiple respiratory viruses in a single test. These multiplex amplification tests provide a sensitive and comprehensive approach for the diagnosis of respiratory tract infections in individual hospitalized patients and the identification of the etiological agent in outbreaks of respiratory tract infection in the community. This review describes the molecular methods used to detect respiratory viruses and discusses the contribution that molecular testing, especially multiplex PCR, has made to our ability to detect respiratory viruses and to increase our understanding of the roles of various viral agents in acute respiratory disease. PMID:18854489

  19. 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.

  20. Role of RyR2 phosphorylation in heart failure and arrhythmias: protein kinase A-mediated hyperphosphorylation of the ryanodine receptor at serine 2808 does not alter cardiac contractility or cause heart failure and arrhythmias.

    PubMed

    Houser, Steven R

    2014-04-11

    This Controversies in Research article discusses the hypothesis that protein kinase A (PKA)-mediated phosphorylation of the Ryanodine Receptor (RyR) at a single serine (RyRS2808) is essential for normal sympathetic regulation of cardiac myocyte contractility and is responsible for the disturbed Ca(2+) regulation that underlies depressed contractility in heart failure. Studies supporting this hypothesis have associated hyperphosphorylation of RyRS2808 and heart failure progression in animals and humans and have shown that a phosphorylation defective RyR mutant mouse (RyRS2808A) does not respond normally to sympathetic agonists and does not exhibit heart failure symptoms after myocardial infarction. Studies to confirm and extend these ideas have failed to support the original data. Experiments from many different laboratories have convincingly shown that PKA-mediated RyRS2808 phosphorylation does not play any significant role in the normal sympathetic regulation of sarcoplasmic reticulum Ca2+ release or cardiac contractility. Hearts and myocytes from RyRS2808A mice have been shown to respond normally to sympathetic agonists, and to increase Ca(2+) influx, Ca(2+) transients, and Ca(2+) efflux. Although the RyR is involved in heart failure-related Ca(2+) disturbances, this results from Ca(2+)-calmodulin kinase II and reactive oxygen species-mediated regulation rather than by RyR2808 phosphorylation. Also, a new study has shown that RyRS2808A mice are not protected from myocardial infarction. Collectively, there is now a clear consensus in the published literature showing that dysregulated RyRs contribute to the altered Ca(2+) regulatory phenotype of the failing heart, but PKA-mediated phosphorylation of RyRS2808 has little or no role in these alterations. PMID:24723657

  1. Heart Failure

    MedlinePLUS

    ... page from the NHLBI on Twitter. What Is Heart Failure? Heart failure is a condition in which the heart can' ... force. Some people have both problems. The term "heart failure" doesn't mean that your heart has stopped ...

  2. 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 ...

  3. Respiratory Syncytial Virus Vaccines

    PubMed Central

    Dudas, Robert A.; Karron, Ruth A.

    1998-01-01

    Respiratory syncytial virus (RSV) is the most important cause of viral lower respiratory tract illness (LRI) in infants and children worldwide and causes significant LRI in the elderly and in immunocompromised patients. The goal of RSV vaccination is to prevent serious RSV-associated LRI. There are several obstacles to the development of successful RSV vaccines, including the need to immunize very young infants, who may respond inadequately to vaccination; the existence of two antigenically distinct RSV groups, A and B; and the history of disease enhancement following administration of a formalin-inactivated vaccine. It is likely that more than one type of vaccine will be needed to prevent RSV LRI in the various populations at risk. Although vector delivery systems, synthetic peptide, and immune-stimulating complex vaccines have been evaluated in animal models, only the purified F protein (PFP) subunit vaccines and live attenuated vaccines have been evaluated in recent clinical trials. PFP-2 appears to be a promising vaccine for the elderly and for RSV-seropositive children with underlying pulmonary disease, whereas live cold-passaged (cp), temperature-sensitive (ts) RSV vaccines (denoted cpts vaccines) would most probably be useful in young infants. The availability of cDNA technology should allow further refinement of existing live attenuated cpts candidate vaccines to produce engineered vaccines that are satisfactorily attenuated, immunogenic, and phenotypically stable. PMID:9665976

  4. Nutritional factors in the pathogenesis and therapy of respiratory insufficiency in neuromuscular diseases.

    PubMed

    Aldrich, T K

    1993-08-01

    Malnutrition is a serious threat to patients with neuromuscular disease and marginally-compensated respiratory muscle weakness. It causes atrophy of inspiratory muscles, further weakening them. It reduces respiratory drive, potentially aggravating respiratory failure, either directly or indirectly, by promoting atelectasis and pneumonia, and it contributes strongly to such patients' risk of infection, their most common cause of death. In treating such patients, it must be remembered that abrupt increases in nutritional support, particularly with high percentages of carbohydrates, will increase CO2 production, potentially worsening ventilatory failure. Certain selected neuromuscular disease patients benefit from specific nutritional treatments (carnitine for carnitine deficient patients, high-calorie diets for muscular dystrophy and acid-maltase deficiency). Finally, the amino acid, fat, and nucleic acid content of the diet affects the immune response in beneficial or harmful ways, that are just now being elucidate. The potential for useful nutritional interventions in patients with neuromuscular diseases has never looked better, but is not yet fully realized. The challenges for the future will be to work out the beneficial and harmful effects of the various nutrients in the various diseases, to find ways to rapidly identify patients who will benefit, and to determine the safest, least uncomfortable, and most effective methods of delivery of the required nutrients. PMID:8257975

  5. An unusual cause of growth failure in cystic fibrosis: A salutary reminder of the interaction between glucocorticoids and cytochrome P450 inhibiting medication.

    PubMed

    Albert, Benjamin B; Jaksic, Mirjana; Ramirez, Jessica; Bors, Jacqueline; Carter, Philippa; Cutfield, Wayne S; Hofman, Paul L

    2014-10-01

    A 12 ˝year old male with cystic fibrosis presented with growth failure after itraconazole was added to a treatment regimen including inhaled and intranasal glucocorticoids. Investigations showed severe adrenal suppression. This case demonstrates the potential for exogenous glucocorticoids to accumulate when their degradation is inhibited by a CYP3A4 inhibitor. PMID:25286825

  6. Causes and prognostic factors of remission induction failure in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and idarubicin

    Microsoft Academic Search

    Serna de J; P. Montesinos; E. Vellenga; C. Rayón; R. Parody; A. León; J. Esteve; J. M. Bergua; G. Milone; G. Debén; C. Rivas; M. González; M. Tormo; J. Díaz-Mediavilla; J. D. González; S. Negri; E. Amutio; S. Brunet; B. Löwenberg; M. A. Sanz

    2008-01-01

    An understanding of the prognostic factors associated with the various forms of induction mortality in patients with acute promyelocytic leukemia (APL) has remained remarkably limited. This study reports the incidence, time of occurrence, and prognostic factors of the major categories of induction failure in a series of 732 patients of all ages (range, 2-83 years) with newly diagnosed APL who

  7. ABSTRACT.--A removal experiment was conducted to measure how much and by what mechanisms brood parasitic Brown-headed Cowbirds (Molothrus ater) cause nest failures in a

    E-print Network

    Zanette, Liana

    Sparrow (Melospiza melodia). When numbers of female cowbirds were reduced experimentally, nest failures y por qué me- canismos Molothrus ater ocasiona fracasos de nidificación en Melospiza melodia, una frecuencia de fracasos de nidificación a un tercio de los niveles del grupo control de M. melodia durante los

  8. Pathogenesis of Respiratory Syncytial Virus Infection in the Murine Model

    Microsoft Academic Search

    R. Stokes Peebles; Barney S. Graham

    2005-01-01

    There is a wide spectrum of illness caused by respiratory syncytial virus (RSV) infection that is caused in large part by host-related factors, such as age of the patient and degree of host immunocom- petency. Although the vast majority of persons infected with RSV experience symptoms of mild upper respiratory tract infection, in some people these infections cause significant morbidity

  9. [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

  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. Respiratory monitoring: current techniques and some new developments.

    PubMed

    Eberhart, R C; Weigelt, J A

    1985-01-01

    Despite achievements in measurement and monitoring capability, owing especially to the advent of the computer in the intensive care unit, there has not been a commensurate improvement in outlook for adult patients in acute respiratory failure. Development of invasive and noninvasive probes employing biological specific markers, transcutaneous gas tension devices, novel respiratory and anesthetic gas detection equipment, and flowmeters based on ultrasonics offers the promise of improved early warning and diagnostic capability which may improve the prognosis for the patient in acute respiratory failure. These emerging technologies are briefly described and evaluated in the context of the intensive care environment. PMID:3890991

  12. Case histories in failure analysis

    Microsoft Academic Search

    P. M. Unterweiser

    1979-01-01

    The book surveys the precausative factors and causes of failure. The case histories have been identified as design\\/processing-related, service-related, materials-related and environment-related, and causes include fatigue, hydrogen damage corrosion, stress, overheating, forging, casting, and welding. Service-related failures involve pipe, turbine blades, heating coils, camshafts, cable, and gears; materials-related failures are caused by material defects, mixed materials, heat treating, aging, and

  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. On mechanisms triggering the levees failure along the Foenna stream on 1st January 2006 and which caused the flooding in the urban area of Sinalunga, Tuscany Region (Italy). A case study

    NASA Astrophysics Data System (ADS)

    Camici, Stefania; Moramarco, Tommaso; Brocca, Luca; Melone, Florisa; Lapenna, Vincenzo; Perrone, Angela; Loperte, Antonio

    2010-05-01

    On 1st January 2006, during an ordinary flood event, a levee failure along the Foenna stream caused the flooding in the urban area of Sinalunga, a small town located in Tuscany region (Italy). The event was monitored by a public agency with the responsibility for the control and maintenance of the natural channel networks. Long time before of flooding, people living in the surrounding area of the stream blamed the presence of wild animals and of numerous burrows along the levees. Although the numerous actions of maintenance along the levees mainly for removing the burrows, a levee seepage occurred during that flood. The presence of an outflow located on the downstream face, almost 2 m below the levee top, caused the spurt of brown water denoting the presence of sediment erosion. On the upstream face of levee, a little hole of about 30 cm at the same height of the outflow was discovered. Although the agency workers tried to close the hole by using appropriate blankets, in short time the top of the levee subsided and the overtopping flow caused a trapezoidal breach typical for an earth-fill embankment. The formation of breach was so fast that in a little more of one hour the urban area near to the Foenna stream was flooded causing high economic damages. Mechanisms triggered the levees failure are the object of this work. The analysis of the event has been first addressed to assess the state of-fact of levees conditions along the Foenna stream, thus to understand how much the activity of wild animals, in particular that of porcupine, may have affected the hydraulic safety of the embankment. At the purpose, after the event, topographical surveys of cross sections have been done along with tomographic surveys by geoelectric technique for investigating the possible presence, besides of burrows, also of tunnels dug into the levees by animals. Then, the analysis of hydrometeorological conditions of the event has allowed to better understand the evolution of the flood and if its magnitude was able to affect the hydraulic holding of levees. Finally, the seepage vulnerability of these levees has been also assessed to address their hydraulic safety applying two models based on a steady and unsteady infiltration, respectively. Based on the obtained results, the following findings can be drawn. 1) The levees failure near the Sinalunga urban area is certainly due to the presence of the porcupine burrow at middle height of upstream face of levee that has addressed the flow into the embankment and then triggered the seepage phenomenon. 2) The works of the maintenance finalized to the closure of the burrows carried out before of the flood event were necessary but not sufficient to prevent the failure of levees. 3) To prevent the failure due to burrows presence, the levees maintenance should have been addressed through both the closure of burrows and the capture of wild animals; if this action had been done for the Foenna stream then the probability of failure would have been truly low. This last aspect has been also inferred through geoelectrical tomography surveys that showed the possible presence of at least two tunnels along both faces of levees, so emphasizing as the various closure of burrows made in the past by maintenance agency were totally useless. 4) The seepage vulnerability analysis has shown that levees might be to risk of failure for floods whose durations are consistent with the ones might occur in the Foenna basin. However, for this particular event the levees failure can be only ascribed to wild animals activity, seeing that the seepage was caused by a burrow hole.

  16. Student Handbook Respiratory Therapy Program

    E-print Network

    Student Handbook Respiratory Therapy Program Department of Cardiopulmonary Science School of Allied .......................................................................................................... 2 Respiratory Therapy Program Accreditation .................................................................. 2 Respiratory Therapy Program Goal and Objectives

  17. Student Handbook Respiratory Therapy Program

    E-print Network

    Student Handbook Respiratory Therapy Program Department of Cardiopulmonary Science School of Allied ............................................................................. 2 Respiratory Therapy Program Accreditation ............................................... 3 Respiratory Therapy Program Goal and Objectives ..................................... 3 Description

  18. An equine herpesvirus 1 mutant with a lacZ insertion between open reading frames 62 and 63 is replication competent and causes disease in the murine respiratory model.

    PubMed

    Csellner, H; Walker, C; Love, D N; Whalley, J M

    1998-01-01

    An equine herpesvirus 1 (EHV-1) mutant was constructed by inserting a lacZ expression cassette into the intergenic region upstream of gene 62 (glycoprotein L; gL) and downstream of gene 63 (a homologue of the herpes simplex virus transcriptional activator ICP0). The recombinant lacZ62/63-EHV-1 had similar growth kinetics in cell culture to those of the parental wild type (wt) virus, with indistinguishable cytopathic effects and plaque morphology. Reverse transcriptase PCR confirmed that the lacZ insertion did not interfere with transcription of gL and immunoblot analysis indicated there was no modification to late gene expression as monitored by synthesis of EHV-1 glycoproteins C and D. The parental EHV-1 isolate HVS25A used here had almost identical nucleotide sequence to that published for isolate Ab4, in a 1200 bp region surrounding the insert, but lacked a HindIII site corresponding to Ab4 position 109,048. The lacZ62/63-EHV-1 caused respiratory disease in BALB/c mice with clinical signs, histopathology and virus titres in lungs throughout days 1-5 post infection similar to those induced by wt EHV-1. X-gal staining for beta-galactosidase expression in murine lungs clearly demonstrated EHV-1 infection in cells of the bronchiolar epithelium and pulmonary parenchyma, with a peak of infection evident at day 2 post infection, when up to 50% of bronchioles demonstrated blue-staining and thus virus-infected epithelial cells. The construction of this replication competent virus carrying a reporter gene identifies a site for insertion of foreign genes and will facilitate studies on the pathogenesis of EHV-1. PMID:9856103

  19. 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.

  20. 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

  1. MSFC Respiratory Protection Services

    NASA Technical Reports Server (NTRS)

    CoVan, James P.

    1999-01-01

    An overview of the Marshall Space Flight Center Respiratory Protection program is provided in this poster display. Respiratory protection personnel, building, facilities, equipment, customers, maintenance and operational activities, and Dynatech fit testing details are described and illustrated.

  2. 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.

  3. Acute respiratory distress syndrome

    MedlinePLUS

    Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition that prevents enough oxygen from getting to the ... and into the blood. Infants can also have respiratory distress syndrome .

  4. Upper respiratory tract (image)

    MedlinePLUS

    The major passages and structures of the upper respiratory tract include the nose or nostrils, nasal cavity, mouth, throat (pharynx), and voice box (larynx). The respiratory system is lined with a mucous membrane that ...

  5. Respiratory Mechanisms of Support

    E-print Network

    Kay, Mark A.

    the respiratory system is working to compensate for a metabolic issue so as to normalize the blood pH. HCO3 - 22Respiratory Mechanisms of Support Nasal Cannula Hi Flow Nasal Cannula CPAP Continuous positive for toxicity Usually 5-20 +ppm ABG Interpretations Respiratory Acidosis:pCO2 pH *impaired ventilation (example

  6. Kidney Failure

    MedlinePLUS

    ... at Risk? Professional Education Advocacy Donate Kidney Disease Chronic Kidney Disease Kidney-Friendly Diet & Foods for CKD Polycystic Kidney Disease Kidney Failure End Stage Renal Disease Complication: Anemia Complication: Bone Disease Kidney Failure Treatment Kidney Problems ...

  7. Birth and pathogenesis of rogue respiratory viruses.

    PubMed

    Safronetz, David; Feldmann, Heinz; de Wit, Emmie

    2015-01-24

    Emerging infectious diseases of zoonotic origin are shaping today's infectious disease field more than ever. In this article, we introduce and review three emerging zoonotic viruses. Novel hantaviruses emerged in the Americas in the mid-1990s as the cause of severe respiratory infections, designated hantavirus pulmonary syndrome, with case fatality rates of around 40%. Nipah virus emerged a few years later, causing respiratory infections and encephalitis in Southeast Asia, with case fatality rates ranging from 40% to more than 90%. A new coronavirus emerged in 2012 on the Arabian Peninsula with a clinical syndrome of acute respiratory infections, later designated as Middle East respiratory syndrome (MERS), and an initial case fatality rate of more than 40%. Our current state of knowledge on the pathogenicity of these three severe, emerging viral infections is discussed. PMID:25423349

  8. Glycopyrrolate-induced respiratory arrest: an unusual side effect.

    PubMed

    D'Souza, S; Gowler, V

    2015-03-01

    A descriptive case report of a 22-year-old woman, scheduled for elective laparotomy who had a respiratory arrest after premedication with inj glycopyrrolate and ondansetron. Respiratory arrest is an uncommon side effect of glycopyrrolate with very few published reports. Ondansteron can also cause respiratory arrest, however is most often associated with bradycardia. This patient had tachycardia and respiratory arrest and is suggestive of glycopyrrolate-induced respiratory arrest. This case report highlights the importance of strict vigilance by the anaesthesiologist even during premedication. PMID:25557856

  9. Eicosanoids and Respiratory Viral Infection: Coordinators of Inflammation and Potential Therapeutic Targets

    PubMed Central

    McCarthy, Mary K.; Weinberg, Jason B.

    2012-01-01

    Viruses are frequent causes of respiratory infection, and viral respiratory infections are significant causes of hospitalization, morbidity, and sometimes mortality in a variety of patient populations. Lung inflammation induced by infection with common respiratory pathogens such as influenza and respiratory syncytial virus is accompanied by increased lung production of prostaglandins and leukotrienes, lipid mediators with a wide range of effects on host immune function. Deficiency or pharmacologic inhibition of prostaglandin and leukotriene production often results in a dampened inflammatory response to acute infection with a respiratory virus. These mediators may, therefore, serve as appealing therapeutic targets for disease caused by respiratory viral infection. PMID:22665949

  10. Evaluation and treatment of respiratory alkalosis.

    PubMed

    Palmer, Biff F

    2012-11-01

    Respiratory alkalosis is the most frequent acid-base disturbance encountered in clinical practice. This is particularly true in critically ill patients, for whom the degree of hypocapnia directly correlates with adverse outcomes. Although this acid-base disturbance often is considered benign, evidence suggests that the alkalemia of primary hypocapnia can cause clinically significant decreases in tissue oxygen delivery. Mild respiratory alkalosis often serves as a marker of an underlying disease and may not require therapeutic intervention. In contrast, severe respiratory alkalosis should be approached with a sense of urgency and be aggressively corrected. PMID:22871240

  11. Health Care–Acquired Viral Respiratory Diseases

    PubMed Central

    Goins, William P.; Talbot, H. Keipp; Talbot, Thomas R.

    2014-01-01

    Health care–associated viral respiratory infections, common among hospitalized children, also occur among adults and institutionalized persons and result in increased patient morbidity, mortality, and health care costs. Approximately 20% of patients with health care–associated pneumonia have viral respiratory infections, with 70% of these infections caused by adenovirus, influenza virus, parainfluenza virus, and respiratory syncytial virus (RSV).1 These infections typically reflect the level of viral activity within the community.1,2 This article focuses on the epidemiology, transmission, and control of health care–associated RSV and influenza virus. PMID:21316002

  12. Graphical Displays Assist In Analysis Of Failures

    NASA Technical Reports Server (NTRS)

    Pack, Ginger; Wadsworth, David; Razavipour, Reza

    1995-01-01

    Failure Environment Analysis Tool (FEAT) computer program enables people to see and better understand effects of failures in system. Uses digraph models to determine what will happen to system if set of failure events occurs and to identify possible causes of selected set of failures. Digraphs or engineering schematics used. Also used in operations to help identify causes of failures after they occur. Written in C language.

  13. Mechanical Properties of Respiratory Muscles

    PubMed Central

    Sieck, Gary C.; Ferreira, Leonardo F.; Reid, Michael B.; Mantilla, Carlos B.

    2014-01-01

    Striated respiratory muscles are necessary for lung ventilation and to maintain the patency of the upper airway. The basic structural and functional properties of respiratory muscles are similar to those of other striated muscles (both skeletal and cardiac). The sarcomere is the fundamental organizational unit of striated muscles and sarcomeric proteins underlie the passive and active mechanical properties of muscle fibers. In this respect, the functional categorization of different fiber types provides a conceptual framework to understand the physiological properties of respiratory muscles. Within the sarcomere, the interaction between the thick and thin filaments at the level of cross-bridges provides the elementary unit of force generation and contraction. Key to an understanding of the unique functional differences across muscle fiber types are differences in cross-bridge recruitment and cycling that relate to the expression of different myosin heavy chain isoforms in the thick filament. The active mechanical properties of muscle fibers are characterized by the relationship between myoplasmic Ca2+ and cross-bridge recruitment, force generation and sarcomere length (also cross-bridge recruitment), external load and shortening velocity (cross-bridge cycling rate), and cross-bridge cycling rate and ATP consumption. Passive mechanical properties are also important reflecting viscoelastic elements within sarcomeres as well as the extracellular matrix. Conditions that affect respiratory muscle performance may have a range of underlying pathophysiological causes, but their manifestations will depend on their impact on these basic elemental structures. PMID:24265238

  14. 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 and persistence of soil-applied herbicides. MT200405 AG issued 5/04 D-4 Getting the Most from Soil-Applied Herbicides by Fabián D. Menalled, Extension Cropland Weeds Specialist, and William E. Dyer, Professor, Weed

  15. [Cancer of the prostate. Results and causes of failure after exclusive radiotherapy in 131 cases treated at in locoregional stage between 1972 and 1981].

    PubMed

    Pourquier, H; Dubois, J B; Hay, M; Bons, F; Guiter, J; Amar, E; Averous, M; Navratil, H; Grasset, D

    1986-01-01

    A retrospective study was carried out to evaluate results of exclusively physical treatment by external radiotherapy of 131 cases of cancer of prostate treated between 1972 and 1981. Median follow up has been for 8 years in 19 cases (stage A), 61 cases (stage B) and 51 cases (stage C). Patients were treated exclusively by external irradiation after histopathologic diagnosis and assessment of possible extension of tumor. High energy photons were developed by a linear accelerator and irradiation carried out through four portals, two anteroposterior, two lateral, with precise guidance by rectal and bladder opacification. Irradiation delivered to a pelvic volume over 5 weeks was subsequently reduced to the prostate bed until a total dose of about 65 to 70 Gy has been given. Primary glandular chains received 60 to 65 Gy, and critical organs, bladder, rectum, small intestine a smaller dose of less than the tolerance levels for these organs. Clinical, biologic and scintiscan examinations were repeated every three months. Results are presented as actuarial survival, as survival without local recurrence and a detailed analysis of failure of treatment. The 8-year survival rate was 60% for stage A, 47% for stage B and 33% for stage C. Unsuccessful cases were evaluated in terms of isolated metastases, metastases associated with local recurrence and isolated local recurrence. The highest incidence of ineffectiveness of therapy was noted in patients with distant metastases (26%), the rate being higher (41%) in stage C cases than in stage B cases (19%).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3102619

  16. Preliminary results: Root cause investigation of orbital anomalies and failures in NASA standard 50 ampere-hour nickel-cadmium batteries

    NASA Technical Reports Server (NTRS)

    Toft, Mark R.

    1993-01-01

    Two lots of NASA standard 50 A.H. Ni-Cd battery cells, manufactured by Gates Aerospace Batteries and built into batteries by McDonnell Douglas, have experienced significant performance problems. The two lots were used on the Compton Gamma Ray Observatory and the Upper Atmosphere Research Satellite. Both of these satellites are Low Earth Orbital (LEO) satellites containing batteries on a parallel bus charged to NASA standard V/T curves using a NASA standard power regulator. The following preliminary conclusions were reached: (1) several plate and cell parameters have migrated within their spec limits over the years (in some cases, from one extreme to the other); (2) several parametric relationships, not generally monitored and therefore not under specification control, have also migrated over the years; (3) many of these changes appear to have taken place as a natural consequence of changes in GE/GAB materials and processes; (4) several of these factors may be 'conspiring' to aggravate known cell failure mechanisms (factors such as heavier plate, less teflon and/or less-uniform teflon, and less electrolyte) but all are still in spec (where specs exist); (5) the weight of the evidence collected to characterize the anomalies and to characterize the negative electrode itself, strongly suggests that alterations to the structure, composition, uniformity, and efficiency of the negative electrode are at the heart of the battery performance problems currently being experienced; and (6) further investigation at all levels (plate, cell, battery, and system) continues to be warranted.

  17. Mutations in the Mitochondrial Seryl-tRNA Synthetase Cause Hyperuricemia, Pulmonary Hypertension, Renal Failure in Infancy and Alkalosis, HUPRA Syndrome

    PubMed Central

    Belostotsky, Ruth; Ben-Shalom, Efrat; Rinat, Choni; Becker-Cohen, Rachel; Feinstein, Sofia; Zeligson, Sharon; Segel, Reeval; Elpeleg, Orly; Nassar, Suheir; Frishberg, Yaacov

    2011-01-01

    An uncharacterized multisystemic mitochondrial cytopathy was diagnosed in two infants from consanguineous Palestinian kindred living in a single village. The most significant clinical findings were tubulopathy (hyperuricemia, metabolic alkalosis), pulmonary hypertension, and progressive renal failure in infancy (HUPRA syndrome). Analysis of the consanguineous pedigree suggested that the causative mutation is in the nuclear DNA. By using genome-wide SNP homozygosity analysis, we identified a homozygous identity-by-descent region on chromosome 19 and detected the pathogenic mutation c.1169A>G (p.Asp390Gly) in SARS2, encoding the mitochondrial seryl-tRNA synthetase. The same homozygous mutation was later identified in a third infant with HUPRA syndrome. The carrier rate of this mutation among inhabitants of this Palestinian isolate was found to be 1:15. The mature enzyme catalyzes the ligation of serine to two mitochondrial tRNA isoacceptors: tRNASerAGY and tRNASerUCN. Analysis of amino acylation of the two target tRNAs, extracted from immortalized peripheral lymphocytes derived from two patients, revealed that the p.Asp390Gly mutation significantly impacts on the acylation of tRNASerAGY but probably not that of tRNASerUCN. Marked decrease in the expression of the nonacylated transcript and the complete absence of the acylated tRNASerAGY suggest that this mutation leads to significant loss of function and that the uncharged transcripts undergo degradation. PMID:21255763

  18. Ampoule Failure System

    NASA Technical Reports Server (NTRS)

    Watring, Dale A. (Inventor); Johnson, Martin L. (Inventor)

    1996-01-01

    An ampoule failure system for use in material processing furnaces comprising a containment cartridge and an ampoule failure sensor. The containment cartridge contains an ampoule of toxic material therein and is positioned within a furnace for processing. An ampoule failure probe is positioned in the containment cartridge adjacent the ampoule for detecting a potential harmful release of toxic material therefrom during processing. The failure probe is spaced a predetermined distance from the ampoule and is chemically chosen so as to undergo a timely chemical reaction with the toxic material upon the harmful release thereof. The ampoule failure system further comprises a data acquisition system which is positioned externally of the furnace and is electrically connected to the ampoule failure probe so as to form a communicating electrical circuit. The data acquisition system includes an automatic shutdown device for shutting down the furnace upon the harmful release of toxic material. It also includes a resistance measuring device for measuring the resistance of the failure probe during processing. The chemical reaction causes a step increase in resistance of the failure probe whereupon the automatic shutdown device will responsively shut down the furnace.

  19. 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

  20. Respiratory tract infections in the military environment.

    PubMed

    Korzeniewski, Krzysztof; Nitsch-Osuch, Aneta; Konior, Monika; Lass, Anna

    2015-04-01

    Military personnel fighting in contemporary battlefields as well as those participating in combat training are at risk of contracting respiratory infections. Epidemiological studies have demonstrated that soldiers deployed to the harsh environment have higher rates of newly reported respiratory symptoms than non-deployers. Acute respiratory diseases are the principle reason for outpatient treatment and hospitalization among military personnel, with an incidence exceeding that of the adult civilian population by up to three-fold. Adenoviruses, influenza A and B viruses, Streptococcus pneumoniae, Streptococcus pyogenes, coronaviruses and rhinoviruses have been identified as the main causes of acute respiratory infections among the military population. Although infective pathogens have been extensively studied, a significant proportion of illnesses (over 40%) have been due to unknown causative agents. Other health hazards, which can lead to respiratory illnesses among troops, are extreme air temperatures, desert dust, emissions from burn pits, industrial pollutants, and airborne contaminants originating from degraded soil. Limited diagnostic capabilities, especially inside the area of operations, make it difficult to accurately estimate the exact number of respiratory diseases in the military environment. The aim of the study was to discuss the occurrence of respiratory tract infections in army personnel, existing risk factors and preventive measures. PMID:25278277