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  1. Organizing pneumonia: chest HRCT findings*

    PubMed Central

    Faria, Igor Murad; Zanetti, Gláucia; Barreto, Miriam Menna; Rodrigues, Rosana Souza; Araujo-Neto, Cesar Augusto; Silva, Jorge Luiz Pereira e; Escuissato, Dante Luiz; Souza, Arthur Soares; Irion, Klaus Loureiro; Mançano, Alexandre Dias; Nobre, Luiz Felipe; Hochhegger, Bruno; Marchiori, Edson

    2015-01-01

    OBJECTIVE: To determine the frequency of HRCT findings and their distribution in the lung parenchyma of patients with organizing pneumonia. METHODS: This was a retrospective review of the HRCT scans of 36 adult patients (26 females and 10 males) with biopsy-proven organizing pneumonia. The patients were between 19 and 82 years of age (mean age, 56.2 years). The HRCT images were evaluated by two independent observers, discordant interpretations being resolved by consensus. RESULTS: The most common HRCT finding was that of ground-glass opacities, which were seen in 88.9% of the cases. The second most common finding was consolidation (in 83.3% of cases), followed by peribronchovascular opacities (in 52.8%), reticulation (in 38.9%), bronchiectasis (in 33.3%), interstitial nodules (in 27.8%), interlobular septal thickening (in 27.8%), perilobular pattern (in 22.2%), the reversed halo sign (in 16.7%), airspace nodules (in 11.1%), and the halo sign (in 8.3%). The lesions were predominantly bilateral, the middle and lower lung fields being the areas most commonly affected. CONCLUSIONS: Ground-glass opacities and consolidation were the most common findings, with a predominantly random distribution, although they were more common in the middle and lower thirds of the lungs. PMID:26176521

  2. Cocaine-induced pulmonary changes: HRCT findings *

    PubMed Central

    de Almeida, Renata Rocha; Zanetti, Gláucia; Souza, Arthur Soares; de Souza, Luciana Soares; Silva, Jorge Luiz Pereira e; Escuissato, Dante Luiz; Irion, Klaus Loureiro; Mançano, Alexandre Dias; Nobre, Luiz Felipe; Hochhegger, Bruno; Marchiori, Edson

    2015-01-01

    Abstract Objective: To evaluate HRCT scans of the chest in 22 patients with cocaine-induced pulmonary disease. Methods: We included patients between 19 and 52 years of age. The HRCT scans were evaluated by two radiologists independently, discordant results being resolved by consensus. The inclusion criterion was an HRCT scan showing abnormalities that were temporally related to cocaine use, with no other apparent causal factors. Results: In 8 patients (36.4%), the clinical and tomographic findings were consistent with "crack lung", those cases being studied separately. The major HRCT findings in that subgroup of patients included ground-glass opacities, in 100% of the cases; consolidations, in 50%; and the halo sign, in 25%. In 12.5% of the cases, smooth septal thickening, paraseptal emphysema, centrilobular nodules, and the tree-in-bud pattern were identified. Among the remaining 14 patients (63.6%), barotrauma was identified in 3 cases, presenting as pneumomediastinum, pneumothorax, and hemopneumothorax, respectively. Talcosis, characterized as perihilar conglomerate masses, architectural distortion, and emphysema, was diagnosed in 3 patients. Other patterns were found less frequently: organizing pneumonia and bullous emphysema, in 2 patients each; and pulmonary infarction, septic embolism, eosinophilic pneumonia, and cardiogenic pulmonary edema, in 1 patient each. Conclusions: Pulmonary changes induced by cocaine use are varied and nonspecific. The diagnostic suspicion of cocaine-induced pulmonary disease depends, in most of the cases, on a careful drawing of correlations between clinical and radiological findings. PMID:26398752

  3. The halo sign: HRCT findings in 85 patients

    PubMed Central

    Alves, Giordano Rafael Tronco; Marchiori, Edson; Irion, Klaus; Nin, Carlos Schuler; Watte, Guilherme; Pasqualotto, Alessandro Comarú; Severo, Luiz Carlos; Hochhegger, Bruno

    2016-01-01

    ABSTRACT Objective: The halo sign consists of an area of ground-glass opacity surrounding pulmonary lesions on chest CT scans. We compared immunocompetent and immunosuppressed patients in terms of halo sign features and sought to identify those of greatest diagnostic value. Methods: This was a retrospective study of CT scans performed at any of seven centers between January of 2011 and May of 2015. Patients were classified according to their immune status. Two thoracic radiologists reviewed the scans in order to determine the number of lesions, as well as their distribution, size, and contour, together with halo thickness and any other associated findings. Results: Of the 85 patients evaluated, 53 were immunocompetent and 32 were immunosuppressed. Of the 53 immunocompetent patients, 34 (64%) were diagnosed with primary neoplasm. Of the 32 immunosuppressed patients, 25 (78%) were diagnosed with aspergillosis. Multiple and randomly distributed lesions were more common in the immunosuppressed patients than in the immunocompetent patients (p < 0.001 for both). Halo thickness was found to be greater in the immunosuppressed patients (p < 0.05). Conclusions: Etiologies of the halo sign differ markedly between immunocompetent and immunosuppressed patients. Although thicker halos are more likely to occur in patients with infectious diseases, the number and distribution of lesions should also be taken into account when evaluating patients presenting with the halo sign. PMID:28117474

  4. The halo sign: HRCT findings in 85 patients.

    PubMed

    Alves, Giordano Rafael Tronco; Marchiori, Edson; Irion, Klaus; Nin, Carlos Schuler; Watte, Guilherme; Pasqualotto, Alessandro Comarú; Severo, Luiz Carlos; Hochhegger, Bruno

    2016-01-01

    The halo sign consists of an area of ground-glass opacity surrounding pulmonary lesions on chest CT scans. We compared immunocompetent and immunosuppressed patients in terms of halo sign features and sought to identify those of greatest diagnostic value. This was a retrospective study of CT scans performed at any of seven centers between January of 2011 and May of 2015. Patients were classified according to their immune status. Two thoracic radiologists reviewed the scans in order to determine the number of lesions, as well as their distribution, size, and contour, together with halo thickness and any other associated findings. Of the 85 patients evaluated, 53 were immunocompetent and 32 were immunosuppressed. Of the 53 immunocompetent patients, 34 (64%) were diagnosed with primary neoplasm. Of the 32 immunosuppressed patients, 25 (78%) were diagnosed with aspergillosis. Multiple and randomly distributed lesions were more common in the immunosuppressed patients than in the immunocompetent patients (p < 0.001 for both). Halo thickness was found to be greater in the immunosuppressed patients (p < 0.05). Etiologies of the halo sign differ markedly between immunocompetent and immunosuppressed patients. Although thicker halos are more likely to occur in patients with infectious diseases, the number and distribution of lesions should also be taken into account when evaluating patients presenting with the halo sign. O sinal do halo consiste em uma área de opacidade em vidro fosco ao redor de lesões pulmonares em imagens de TC de tórax. Pacientes imunocompetentes e imunodeprimidos foram comparados quanto a características do sinal do halo a fim de identificar as de maior valor diagnóstico. Estudo retrospectivo de tomografias realizadas em sete centros entre janeiro de 2011 e maio de 2015. Os pacientes foram classificados de acordo com seu estado imunológico. Dois radiologistas torácicos analisaram os exames a fim de determinar o número de lesões e sua distribui

  5. Apollo experience report: The AN/ARD-17 direction finding system

    NASA Technical Reports Server (NTRS)

    Chase, W. R.; Middleton, W. A.

    1975-01-01

    This report contains a statement of the operational philosophy and requirements leading to the development of the AN/ARD-17 direction-finding system. The technical problems encountered and the solutions devised in the AN/ARD-17 development are discussed. An evaluation of the system under actual operational conditions is included.

  6. The role of HRCT and three-dimensional VR CT findings in patients of congenital atresia combined with microtia.

    PubMed

    Gao, Ruzhen; Wang, Yun; Fan, Yue; Ai, Xing; Zhang, Xiaona; Xue, Huadan; Chen, Xiaowei; Jin, Zhengyu

    2012-12-01

    To determine the anatomic differences in patients of atresia by using high-resolution computed tomography (HRCT) and 3D volume rendered (VR) CT. High-resolution computed tomography (HRCT) was performed in 43 atresia patients including 34 unilateral atresia patients (n=34, 26 males, 8 females, mean age 13.82 years, range 8-19 years) and 9 bilateral atresia patients (6 males, 3 females, mean age 13.2 years, range 9-19 years). HRCT and 3D VR findings were compared with those in 43 normal ears of the unilateral atresia patients with normal PTA results (n=34, 26 males, 8 females, mean age 13.82 years, range 8-19 years) and 11 patients with sensorineural hearing loss but with no associated aplasia of the middle and inner ear (n=22, 7 males and 4 females, range 8-20.8 years, median age of 13.4 years) by using the independent one sample T test. On the HRCT images, the angle between the basic line and the tympanic segment of the facial nerve is more acute. And the area of the malleus-incus-joint or the malleus-incus-complex in the diseased ears is smaller than that in the control subjects (P<0.05). The tympanic segment is shorter and the area of the tympanic cavity is smaller in the atresia group, while the diameter of the oval window is also smaller in atresia group than that in the control group (P<0.05). The morphologic differences of the small ossicles and the entire length of the tympanic and mastoid segments can be depicted on a single 3D VR CT image. The facial nerve demonstrates abnormal lateral and anterior displacement in the CAA patients and the area of the Malleus-incus-joint and the tympanic cavity are significantly smaller, and the oval window is much narrower in the control group. HRCT and 3D VR CT provide valuable information about preoperative planning of patients with CAA. Measurements of all the angles and length serve as useful adjunct measurements in determining surgical candidacy. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  7. The Correlation Between Pre and Postoperative Hearing Level with High Resolution Computed Tomography (HRCT) Findings in Congenital Canal Atresia (CAA) Patients.

    PubMed

    Asma, A; Abdul Fatah, A W; Hamzaini, A H; Mazita, A

    2013-12-01

    In managing patient with congenital congenital aural atresia (CAA), preoperative high resolution computed tomography (HRCT) scan and hearing assessment are important. A grading system based on HRCT findings was first introduced by Jahrsdoefer in order to select appropriate candidates for operation and to predict the postoperative hearing outcome in CAA patients. The score of eight and more was considered as a good prognostic factor for hearing reconstruction surgery. However previously in our center this score was not used as the criteria for surgical procedure. This study was conducted at Center A to evaluate the correlation between pre and postoperative hearing level with HRCT based on a Jahrsdoefer grading system in patients with CAA. All records and HRCT films with CAA from January 1997 until December 2007 at Center A were evaluated. The demographic data, operative records, pre and post operative hearing levels and HRCT findings were analyzed. Hearing level in this study was based on a pure tone average of air-bone gap at 500 Hz, 1 kHz and 2 kHz or hearing level obtained from auditory brainstem response eudiometry. This study was approved by Research Ethics Committee (code number, FF-197-2008). Thirty-two ears were retrospectively evaluated. The postoperative hearing level of 30 dB and less was considered as successful hearing result postoperatively. Of the six ears which underwent canalplasty, three had achieved successful hearing result. However, there was no significant correlation between preoperative hearing level (HL) with HRCT score and postoperative HL with HRCT score at 0.05 significant levels (correlation coefficient = -0.292, P = 0.105 and correlation coefficient = -0.127, P = 0.810) respectively. Hearing evaluation and HRCT temporal bone are two independent evaluations for the patients with CAA before going for hearing reconstructive surgery.

  8. Sarcoidosis: assessment of disease severity using HRCT.

    PubMed

    Drent, Marjolein; De Vries, Jolanda; Lenters, Merinke; Lamers, Rob J S; Rothkranz-Kos, Snjezana; Wouters, Emiel F M; van Dieijen-Visser, Marja P; Verschakelen, Johny A

    2003-11-01

    The value of high-resolution computed tomography (HRCT) in diagnosing and assessing inflammatory activity in sarcoidosis is well established. The aim of the present study was to address the intra- and inter-observer agreements of the HRCT score by Oberstein et al. [8], and to evaluate the relationship between HRCT findings and disease severity expressed in respiratory functional impairment in sarcoidosis. The clinical records of 80 known sarcoidosis patients visiting the outpatient clinic between January 2000 and August 2001, who underwent a HRCT as well as lung function tests (including exercise testing), were reviewed. Two readers scored the first 60 HRCT images twice. Weighted kappa and intra-class correlation coefficient were used to assess the reliability of the HRCT scoring system. Spearman's rank correlation coefficients and multiple regression analyses were performed to evaluate the relationship between HRCT findings (first reading, reader A) and respiratory functional impairment. Intra- and inter-reader reliability demonstrated good agreement. All HRCT subscores, except enlargement of lymph nodes, were correlated to the FEV(1), FVC, DLco, Pao(2)max (all p<0.05) and A-aPo(2 )max ( p<0.001). Furthermore, HRCT abnormalities, but not the chest radiographic stage, were strongly associated with functional parameters. Abnormal changes of lung parenchyma, established by HRCT features, were associated with respiratory functional impairment in sarcoidosis. Moreover, compared with the radiographic stages, HRCT findings appeared to be much more sensitive in depicting respiratory disability, especially abnormal gas exchange.

  9. Prevention of ARDS

    PubMed Central

    Festic, Emir; Kor, Daryl J.; Gajic, Ognjen

    2015-01-01

    Purpose of review The paucity of effective therapeutic interventions in patients with the acute respiratory distress syndrome (ARDS) combined with overwhelming evidence on the importance of timely implementation of effective therapies to the critically ill patients have resulted in a recent shift in ARDS research. Increasingly, efforts are being directed towards early identification of patients at risk with a goal of prevention and early treatment, prior to development of the fully established syndrome. The focus of this review is on the prevention of ARDS in patients without this condition at the time of their healthcare encounter. Recent findings The primary thematic categories presented in this review article include: Early identification of patients at risk of developing ARDS, optimization of care delivery and its impact on the incidence of ARDS, pharmacological prevention of ARDS, prevention of postoperative ARDS, and challenges and opportunities with ARDS prevention studies. Summary Recent improvements in clinical care delivery have been associated with a decrease in the incidence of hospital acquired ARDS. Despite the initial challenges, research in ARDS prevention has become increasingly feasible with several randomized controlled trials on ARDS prevention completed or on the way. PMID:25501020

  10. Pulmonary cryptococcosis in immunocompetent patients: HRCT characteristics.

    PubMed

    Murayama, Sadayuki; Sakai, Shuji; Soeda, Hiroyasu; Yabuuchi, Hidetake; Masuda, Kouji; Inoue, Hiromasa; Watanabe, Hideyuki; Matsuo, Yoshitomo

    2004-01-01

    We analyzed the high-resolution CT (HRCT) findings of cryptococcosis in immunocompetent patients. The predominant manifestations were multiple nodules (n=6) and a single nodule (n=7). Regarding the pattern of multiple nodules, two cases of cavities or necrosis, four cases of surrounding centrilobular micronodules and five cases of "acinar" nodules were seen. No "tree-in-bud" appearance was detected. Five of seven cases of a single nodule were classified as polygonal, and two of them were round. Two cases accompanied micronodules and one case cavitation. Although no "tree-in-bud" appearance was observed, pulmonary cryptococcosis mimics tuberculosis.

  11. Aluminosis – Detection of an almost forgotten disease with HRCT

    PubMed Central

    Kraus, Thomas; Schaller, Karl Heinz; Angerer, Jürgen; Hilgers, Ralf-Dieter; Letzel, Stephan

    2006-01-01

    The aim of this study was to investigate whether it is possible to detect high-resolution computed tomography (HRCT) findings in aluminium powder workers, which are consistent with early stages of aluminosis. 62 male workers from 8 departments of two plants producing aluminium (Al) powder were investigated using a standardized questionnaire, physical examination, lung function analysis, biological monitoring of Al in plasma and urine, chest X-ray, HRCT and immunological tests. Chronic bronchitis was observed in 15 (24.2%) of the workers, and four workers (6.5%) reported shortness of breath during exercise. HRCT findings in 15 workers (24.2%) were characterized by ill-defined centrilobular nodular opacities. Workers with ill-defined centrilobular nodular opacities had a lower vital capacity than workers who had no such HRCT-findings (90.9 % pred. vs. 101.8 % pred., p = 0.01). Biological monitoring in plasma and urine revealed higher internal exposure to Al in affected workers (33.5 μg/l plasma to 15.4 μg/l plasma, p = 0.01) and (340.5 μg/g creat. to 135.1 μg/g creat., p = 0.007). Years of exposure and concentration of aluminum in urine and plasma appear to be the best predictors for HRCT findings. Age and decreased vital capacity show borderline significance. We conclude that aluminosis is still relevant in occupational medicine. With HRCT it is possible to detect early stages of aluminosis and biological monitoring can be used to define workers at high risk. PMID:16722569

  12. ARDS User Manual

    NASA Technical Reports Server (NTRS)

    Fleming, David P.

    2001-01-01

    Personal computers (PCs) are now used extensively for engineering analysis. their capability exceeds that of mainframe computers of only a few years ago. Programs originally written for mainframes have been ported to PCs to make their use easier. One of these programs is ARDS (Analysis of Rotor Dynamic Systems) which was developed at Arizona State University (ASU) by Nelson et al. to quickly and accurately analyze rotor steady state and transient response using the method of component mode synthesis. The original ARDS program was ported to the PC in 1995. Several extensions were made at ASU to increase the capability of mainframe ARDS. These extensions have also been incorporated into the PC version of ARDS. Each mainframe extension had its own user manual generally covering only that extension. Thus to exploit the full capability of ARDS required a large set of user manuals. Moreover, necessary changes and enhancements for PC ARDS were undocumented. The present document is intended to remedy those problems by combining all pertinent information needed for the use of PC ARDS into one volume.

  13. How Is ARDS Treated?

    MedlinePlus

    ... that help relieve symptoms, prevent complications, or improve quality of life. Supportive approaches used to treat ARDS include: Medicines to help you relax, relieve discomfort, and treat pain. Ongoing monitoring of heart and lung function (including blood pressure ...

  14. Obesity and ARDS

    PubMed Central

    Rice, Mary; Malhotra, Atul

    2012-01-01

    Obesity prevalence continues to increase globally, with figures exceeding 30% of some populations. Patients who are obese experience alterations in baseline pulmonary mechanics, including airflow obstruction, decreased lung volumes, and impaired gas exchange. These physiologic changes have implications in many diseases, including ARDS. The unique physiology of patients who are obese affects the presentation and pathophysiology of ARDS, and patients who are obese who have respiratory failure present specific management challenges. Although more study is forthcoming, ventilator strategies that focus on transpulmonary pressure as a measure of lung stress show promise in pilot studies. Given the increasing prevalence of obesity and the variable effects of obesity on respiratory mechanics and ARDS pathophysiology, we recommend an individualized approach to the management of the obese patient with ARDS. PMID:22948584

  15. Living with ARDS

    MedlinePlus

    ... weaken. You also may feel very tired following treatment. Depression. Many people who've had ARDS feel depressed for a while after treatment. Problems with memory and thinking clearly. Certain medicines ...

  16. Creating virtual ARDS patients.

    PubMed

    Das, Anup; Haque, Mainul; Chikhani, Marc; Wenfei Wang; Hardman, Jonathan G; Bates, Declan G

    2016-08-01

    This paper presents the methodology used in patient-specific calibration of a novel highly integrated model of the cardiovascular and pulmonary pathophysiology associated with Acute Respiratory Distress Syndrome (ARDS). We focus on data from previously published clinical trials on the static and dynamic cardio-pulmonary responses of three ARDS patients to changes in ventilator settings. From this data, the parameters of the integrated model were identified using an optimization-based methodology in multiple stages. Computational simulations confirm that the resulting model outputs accurately reproduce the available clinical data. Our results open up the possibility of creating in silico a biobank of virtual ARDS patients that could be used to evaluate current, and investigate novel, therapeutic strategies.

  17. Comparative analysis of preoperative diagnostic values of HRCT and CBCT in patients with histologically diagnosed otosclerotic stapes footplates.

    PubMed

    Révész, Péter; Liktor, Balázs; Liktor, Bálint; Sziklai, István; Gerlinger, Imre; Karosi, Tamás

    2016-01-01

    This prospective case review was performed with the aim to compare and asses the diagnostic values of cone-beam computed tomography (CBCT) and high-resolution computed tomography (HRCT) in the preoperative evaluation of otosclerosis. A total of 43 patients with histologically confirmed stapedial otosclerosis, who underwent unilateral stapedectomies were analyzed. Preoperative temporal bone CBCT and HRCT scans were performed in all cases. Both CBCT and HRCT imaging were characterized by a slice thickness of 0.4-0.625 mm and multiplanar image reconstruction. Histopathologic examination of the removed stapes footplates was performed in all cases. Findings of CBCT and HRCT were categorized according to the modified Marshall's grading system (fenestral or retrofenestral lesions). Histopathologic results were correlated with multiplanar reconstructed CBCT and HRCT scans, respectively. Negative control groups for CBCT (n = 36) and HRCT (n = 27) examinations consisted of patients, who underwent CBCT imaging due to various dental disorders or HRCT analysis due to idiopathic sudden sensorineural hearing loss. Histologically active foci of otosclerosis (n = 31, 72 %) were identified by both CBCT and HRCT in all cases with a sensitivity of 100 %. However, CBCT could not detect histologically inactive otosclerosis (n = 12, 23 %; sensitivity 0 %). In contrast, HRCT showed inactive otosclerosis with a sensitivity of 59.3 %. According to CBCT results, no retrofenestral lesions were found and the overall sensitivity for hypodense lesions was 61.37 %. In conclusion, CBCT is a robust imaging method in the detection of histologically active fenestral hypodense foci of otosclerosis with high sensitivity and radiologic specificity. In the light of these results, HRCT still remains the basic imaging method in the preoperative diagnosis of otosclerosis, since it has much greater sensitivity and specificity in the detection of retrofenestral hypodense lesions and histologically inactive

  18. Environmental Risk Factors for ARDS

    PubMed Central

    Moazed, Farzad; Calfee, Carolyn S.

    2014-01-01

    The acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality in critically ill patients. Over the past several decades, alcohol abuse and cigarette smoke exposure have been identified as risk factors for the development of ARDS. The mechanisms underlying these relationships are complex and remain under investigation but are thought to involve pulmonary immune impairment as well as alveolar epithelial and endothelial dysfunction. This review summarizes the epidemiologic data supporting links between these exposures and ARDS susceptibility and outcomes and highlights key mechanistic investigations that provide insight into the pathways by which each exposure is linked to ARDS. PMID:25453414

  19. Plasmid pKM101 encodes two nonhomologous antirestriction proteins (ArdA and ArdB) whose expression is controlled by homologous regulatory sequences.

    PubMed Central

    Belogurov, A A; Delver, E P; Rodzevich, O V

    1993-01-01

    The IncN plasmid pKM101 (a derivative of R46) encodes the antirestriction protein ArdB (alleviation of restriction of DNA) in addition to another antirestriction protein, ArdA, described previously. The relevant gene, ardB, was located in the leading region of pKM101, about 7 kb from oriT. The nucleotide sequence of ardB was determined, and an appropriate polypeptide was identified in maxicells of Escherichia coli. Like ArdA, ArdB efficiently inhibits restriction by members of the three known families of type I systems of E. coli and only slightly affects the type II enzyme, EcoRI. However, in contrast to ArdA, ArdB is ineffective against the modification activity of the type I (EcoK) system. Comparison of deduced amino acid sequences of ArdA and ArdB revealed only one small region of similarity (nine residues), suggesting that this region may be somehow involved in the interaction with the type I restriction systems. We also found that the expression of both ardA and ardB genes is controlled jointly by two pKM101-encoded proteins, ArdK and ArdR, with molecular weights of about 15,000 and 20,000, respectively. The finding that the sequences immediately upstream of ardA and ardB share about 94% identity over 218 bp suggests that their expression may be controlled by ArdK and ArdR at the transcriptional level. Deletion studies and promoter probe analysis of these sequences revealed the regions responsible for the action of ArdK and ArdR as regulatory proteins. We propose that both types of antirestriction proteins may play a pivotal role in overcoming the host restriction barrier by self-transmissible broad-host-range plasmids. It seems likely that the ardKR-dependent regulatory system serves in this case as a genetic switch that controls the expression of plasmid-encoded antirestriction functions during mating. Images PMID:8393008

  20. Role of HRCT Chest in Post Stem Cell Transplant Recipients Suspected of Pulmonary Complications

    PubMed Central

    Kumar, R Ravi; Sharma, Ajay; Pannu, S K

    2016-01-01

    Introduction Stem cell transplantation is today’s procedure of choice for management of various hematopoietic malignant and severe immunogenic disorders. High Resolution Computed Tomography (HRCT) is a common technique for the diagnosis of pulmonary complications in stem cell transplant recipients. There are a large number of complications which can complicate the post-transplant period. Aim To study the role of HRCT chest in stem cell transplant patients developing pulmonary complications, detect any evidence of infection, detect clinical signs of lung infections, Graft versus Host Disease (GvHD) or other regimen related toxicities outlined earlier, detect any evidence of GvHD and correlate these clinical signs with radiological changes in the lungs. Materials and Methods The study was a prospective study of 52 participants with indication of stem cell transplantation. The study included recipients of HSCT transplant and the exclusion criteria was patients who failed for engraftment and having an associated history of pulmonary embolism. Patients were screened for pre-transplant chemotherapy, clinical examination, laboratory investigations including blood and biochemical examinations, imaging by ultrasound, chest radiography, baseline HRCT and a follow-up for post-transplant infections and complications with 16 slice Siemens CT scan. Statistical analysis was done using Pearson’s chi-squared test. Results Four patients among the total 56 were excluded due to non-engraftment. The most common associated findings in decreasing order are (these patients died): consolidation, pancytopenia and gastrointestinal tract symptoms with VOD (Veno-Occlusive Disease). These findings were seen on HRCT as consolidation, cavities, ground glass opacities, fibrotic changes, bronchiectatic changes and tree in bud appearance. Conclusion The study highlights the significant positive findings on the HRCT which were missed on routine chest radiograph and can be used for early diagnoses

  1. Diagnostic workup for ARDS patients.

    PubMed

    Papazian, Laurent; Calfee, Carolyn S; Chiumello, Davide; Luyt, Charles-Edouard; Meyer, Nuala J; Sekiguchi, Hiroshi; Matthay, Michael A; Meduri, Gianfranco Umberto

    2016-05-01

    Acute respiratory distress syndrome (ARDS) is defined by the association of bilateral infiltrates and hypoxaemia following an initial insult. Although a new definition has been recently proposed (Berlin definition), there are various forms of ARDS with potential differences regarding their management (ventilator settings, prone positioning use, corticosteroids). ARDS can be caused by various aetiologies, and the adequate treatment of the responsible cause is crucial to improve the outcome. It is of paramount importance to characterize the mechanisms causing lung injury to optimize both the aetiological treatment and the symptomatic treatment. If there is no obvious cause of ARDS or if a direct lung injury is suspected, bronchoalveolar lavage (BAL) should be strongly considered to identify microorganisms responsible for pneumonia. Blood samples can also help to identify microorganisms and to evaluate biomarkers of infection. If there is no infectious cause of ARDS or no other apparent aetiology is found, second-line examinations should include markers of immunologic diseases. In selected cases, open lung biopsy remains useful to identify the cause of ARDS when all other examinations remain inconclusive. CT scan is fundamental when there is a suspicion of intra-abdominal sepsis and in some cases of pneumonia. Ultrasonography is important not only in evaluating biventricular function but also in identifying pleural effusions and pneumothorax. The definition of ARDS remains clinical and the main objective of the diagnostic workup should be to be focused on identification of its aetiology, especially a treatable infection.

  2. ARDS (Acute Respiratory Distress Syndrome)

    MedlinePlus

    ... Technology Transfer Clinical Trials What Are Clinical Trials? Children & Clinical Studies NHLBI Trials Clinical Trial Websites News & ... Therapy Pleurisy and Other Pleural ... underlying cause of ARDS, associated illnesses, and other factors. Some people who survive ...

  3. Correlation between the degree of air trapping in chest HRCT and cardiopulmonary exercise test parameters: could HRCT be a predictor of disease severity?

    PubMed

    Ghanei, Mostafa; Sheyacy, Mohsen; Abbasi, Mohammad Amin; Ani, Alireza; Aslani, Jafar

    2011-03-01

    The purpose of this study was to examine whether the degree of air trapping in high resolution computed tomography (HRCT) of patients with histories of sulfur mustard gas exposure during suspended full expiration correlated with various parameters of the cardiopulmonary exercise test as the gold standard for assessment of pulmonary function. In this analytic study 75 male patients, each with a history of sulfur mustard gas exposure, were investigated. Each participant underwent an incremental cardiopulmonary exercise test, pulmonary function test and arterial oxygen saturation for hemoglobin measurement. For HRCT examination, both lungs were divided into three parts (upper, middle, and lower) and in each part images were separately observed from the involved area point of view (<25% ≤6/24; >25% ≥6/24). A total of 49.3% of the patients (37/75) had evidence of air trapping in over 25% of their lung segments. The mean age±SD in the patients with air trapping of =25% or <25% were 41.1±6.8 and 39.7±4.0 years, respectively (P=0.281). In our study there was no significant difference in pulmonary function test findings (FEV1, FVC and FEV1/FVC) between the two groups. There was no significant correlation with air trapping of =25% and any of the exercise test parameters. Also, no correlation was found between significant air trapping and exercise test findings in maximum exercise and anaerobic situations. No correlation was found between HRCT and cardiopulmonary exercise test findings. HRCT is neither pathognomic of the disease nor a good predictor of disease severity but it might be suggestive of mustard lung injuries.

  4. Biomarkers in Pediatric ARDS: Future Directions

    PubMed Central

    Orwoll, Benjamin E.; Sapru, Anil

    2016-01-01

    Acute respiratory distress syndrome (ARDS) is common among mechanically ventilated children and accompanies up to 30% of all pediatric intensive care unit deaths. Though ARDS diagnosis is based on clinical criteria, biological markers of acute lung damage have been extensively studied in adults and children. Biomarkers of inflammation, alveolar epithelial and capillary endothelial disruption, disordered coagulation, and associated derangements measured in the circulation and other body fluids, such as bronchoalveolar lavage, have improved our understanding of pathobiology of ARDS. The biochemical signature of ARDS has been increasingly well described in adult populations, and this has led to the identification of molecular phenotypes to augment clinical classifications. However, there is a paucity of data from pediatric ARDS (pARDS) patients. Biomarkers and molecular phenotypes have the potential to identify patients at high risk of poor outcomes, and perhaps inform the development of targeted therapies for specific groups of patients. Additionally, because of the lower incidence of and mortality from ARDS in pediatric patients relative to adults and lack of robust clinical predictors of outcome, there is an ongoing interest in biological markers as surrogate outcome measures. The recent definition of pARDS provides additional impetus for the measurement of established and novel biomarkers in future pediatric studies in order to further characterize this disease process. This chapter will review the currently available literature and discuss potential future directions for investigation into biomarkers in ARDS among children. PMID:27313995

  5. Biomarkers in Pediatric ARDS: Future Directions.

    PubMed

    Orwoll, Benjamin E; Sapru, Anil

    2016-01-01

    Acute respiratory distress syndrome (ARDS) is common among mechanically ventilated children and accompanies up to 30% of all pediatric intensive care unit deaths. Though ARDS diagnosis is based on clinical criteria, biological markers of acute lung damage have been extensively studied in adults and children. Biomarkers of inflammation, alveolar epithelial and capillary endothelial disruption, disordered coagulation, and associated derangements measured in the circulation and other body fluids, such as bronchoalveolar lavage, have improved our understanding of pathobiology of ARDS. The biochemical signature of ARDS has been increasingly well described in adult populations, and this has led to the identification of molecular phenotypes to augment clinical classifications. However, there is a paucity of data from pediatric ARDS (pARDS) patients. Biomarkers and molecular phenotypes have the potential to identify patients at high risk of poor outcomes, and perhaps inform the development of targeted therapies for specific groups of patients. Additionally, because of the lower incidence of and mortality from ARDS in pediatric patients relative to adults and lack of robust clinical predictors of outcome, there is an ongoing interest in biological markers as surrogate outcome measures. The recent definition of pARDS provides additional impetus for the measurement of established and novel biomarkers in future pediatric studies in order to further characterize this disease process. This chapter will review the currently available literature and discuss potential future directions for investigation into biomarkers in ARDS among children.

  6. Phosphorylation of ARD1 by IKK{beta} contributes to its destabilization and degradation

    SciTech Connect

    Kuo, Hsu-Ping; Lee, Dung-Fang; Xia, Weiya; Lai, Chien-Chen; Li, Long-Yuan; Hung, Mien-Chie

    2009-11-06

    I{kappa}B kinase {beta} (IKK{beta}), a major kinase downstream of various proinflammatory signals, mediates multiple cellular functions through phosphorylation and regulation of its substrates. On the basis of protein sequence analysis, we identified arrest-defective protein 1 (ARD1), a protein involved in apoptosis and cell proliferation processes in many human cancer cells, as a new IKK{beta} substrate. We provided evidence showing that ARD1 is indeed a bona fide substrate of IKK{beta}. IKK{beta} physically associated with ARD1 and phosphorylated it at Ser209. Phosphorylation by IKK{beta} destabilized ARD1 and induced its proteasome-mediated degradation. Impaired growth suppression was observed in ARD1 phosphorylation-mimic mutant (S209E)-transfected cells as compared with ARD1 non-phosphorylatable mutant (S209A)-transfected cells. Our findings of molecular interactions between ARD1 and IKK{beta} may enable further understanding of the upstream regulation mechanisms of ARD1 and of the diverse functions of IKK{beta}.

  7. Profiling of ARDS Pulmonary Edema Fluid Identifies a Metabolically Distinct Subset.

    PubMed

    Rogers, Angela J; Contrepois, Kevin; Wu, Manhong; Zheng, Ming; Peltz, Gary; Ware, Lorraine B; Matthay, Michael A

    2017-03-03

    There is considerable biologic and physiologic heterogeneity among patients who meet standard clinical criteria for acute respiratory distress syndrome (ARDS). In this study, we tested the hypothesis that there exists a sub-group of ARDS patients who exhibit a metabolically distinct profile. We examined undiluted pulmonary edema fluid obtained at the time of endotracheal intubation from 16 clinically phenotyped ARDS patients and 13 control patients with hydrostatic pulmonary edema. Non-targeted metabolic profiling was carried out on the undiluted edema fluid. Univariate and multivariate statistical analyses including principal components analysis (PCA) and partial least squares discriminant analysis (PLSDA) were conducted to find discriminant metabolites. 760 unique metabolites were identified in the pulmonary edema fluid of these 29 patients. We found that a subset of ARDS patients (6/16, 38%) presented a distinct metabolic profile with the overrepresentation of 235 metabolites compared to edema fluid from the other 10 ARDS patients, whose edema fluid metabolic profile was indistinguishable from those of the 13 control patients with hydrostatic edema. This "high metabolite" endotype was characterized by higher concentrations of metabolites belonging to all of the main metabolic classes including lipids, amino acids, and carbohydrates. This distinct group with high metabolite levels in the edema fluid was also associated with a higher mortality rate. Thus, metabolic profiling of the edema fluid of ARDS patients supports the hypothesis that there is considerable biologic heterogeneity among ARDS patients who meet standard clinical and physiologic criteria for ARDS.

  8. Mechanical Ventilation and ARDS in the ED

    PubMed Central

    Mohr, Nicholas M.; Miller, Christopher N.; Deitchman, Andrew R.; Castagno, Nicole; Hassebroek, Elizabeth C.; Dhedhi, Adam; Scott-Wittenborn, Nicholas; Grace, Edward; Lehew, Courtney; Kollef, Marin H.

    2015-01-01

    BACKGROUND: There are few data regarding mechanical ventilation and ARDS in the ED. This could be a vital arena for prevention and treatment. METHODS: This study was a multicenter, observational, prospective, cohort study aimed at analyzing ventilation practices in the ED. The primary outcome was the incidence of ARDS after admission. Multivariable logistic regression was used to determine the predictors of ARDS. RESULTS: We analyzed 219 patients receiving mechanical ventilation to assess ED ventilation practices. Median tidal volume was 7.6 mL/kg predicted body weight (PBW) (interquartile range, 6.9-8.9), with a range of 4.3 to 12.2 mL/kg PBW. Lung-protective ventilation was used in 122 patients (55.7%). The incidence of ARDS after admission from the ED was 14.7%, with a mean onset of 2.3 days. Progression to ARDS was associated with higher illness severity and intubation in the prehospital environment or transferring facility. Of the 15 patients with ARDS in the ED (6.8%), lung-protective ventilation was used in seven (46.7%). Patients who progressed to ARDS experienced greater duration in organ failure and ICU length of stay and higher mortality. CONCLUSIONS: Lung-protective ventilation is infrequent in patients receiving mechanical ventilation in the ED, regardless of ARDS status. Progression to ARDS is common after admission, occurs early, and worsens outcome. Patient- and treatment-related factors present in the ED are associated with ARDS. Given the limited treatment options for ARDS, and the early onset after admission from the ED, measures to prevent onset and to mitigate severity should be instituted in the ED. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01628523; URL: www.clinicaltrials.gov PMID:25742126

  9. The incidence of ARDS and associated mortality in severe TBI using the Berlin definition.

    PubMed

    Aisiku, Imoigele P; Yamal, Jose-Miguel; Doshi, Pratik; Rubin, Maria Laura; Benoit, Julia S; Hannay, Julia; Tilley, Barbara C; Gopinath, Shankar; Robertson, Claudia S

    2016-02-01

    The incidence of adult respiratory distress syndrome (ARDS) in severe traumatic brain injury (TBI) is poorly reported. Recently, a new definition for ARDS was proposed, the Berlin definition. The percentage of patients represented by TBI in the Berlin criteria study is limited. This study describes the incidence and associated mortality of ARDS in TBI patients. The study was an analysis of the safety of erythropoietin administration and transfusion threshold on the incidence of ARDS in severe TBI patients. Three reviewers independently assessed all patients enrolled in the study for acute lung injury/ARDS using the Berlin and the American-European Consensus Conference (AECC) definitions. A Cox proportional hazards model was used to assess the relationship between ARDS and mortality and 6-month Glasgow Outcome Scale (GOS) score. Two hundred patients were enrolled in the study. Of the patients, 21% (41 of 200) and 26% (52 of 200) developed ARDS using the AECC and Berlin definitions, respectively, with a median time of 3 days (interquartile range, 3) after injury. ARDS by either definition was associated with increased mortality (p = 0.04) but not with differences in functional outcome as measured by the GOS score at 6 months. Adjusted analysis using the Berlin criteria showed an increased mortality associated with ADS (p = 0.01). Severe TBI is associated with an incidence of ARDS ranging from 20% to 25%. The incidence is comparable between the Berlin and AECC definitions. ARDS is associated with increased mortality in severe TBI patients, but further studies are needed to validate these findings. Epidemiologic study, level II.

  10. ARDS following inhalation of hydrochloric acid.

    PubMed

    Bansal, D P; Ambegaonkar, Rahul; Radhika, P; Sharma, Manish

    2011-02-01

    The clinical spectrum of Inhalation injury can range from mild cough to a devastating ARDS. We herewith present a patient who is a goldsmith by occupation and his work consists of dissolving gold in Hydrochloric acid. He had accidentally inhaled fumes of Hydrochloric acid and presented with cough and breathlessness, later on required mechanical ventilation for ARDS and improved. This highlights the importance of not to neglect mild symptoms like cough and dyspnea in such a scenario which may have some hidden catastrophe.

  11. Imaging Modality of Choice for Pre-Operative Cochlear Imaging: HRCT vs. MRI Temporal Bone

    PubMed Central

    Solanki, Rajendra N.; Shah, Dipali C.; Vishwakarma, Rajesh; Kumar, Sandeep

    2016-01-01

    Introduction Congenital inner ear malformations occur as a result of the arrest or aberrance of inner ear development due to the heredity, gene mutation or other factors. Ever since the availability of cochlear implants, pre-operative evaluation by imaging of temporal bone has gained much attention. Precise selection of the candidate for cochlear implant dependent on preoperative radiological investigations. Only CT (Computed Tomography) and MRI (Magnetic Resonance Imaging) can provide a better picture of anatomy and pathology. Aim To compare pre-operative imaging findings of both MRI and High Resolution Computed Tomography (HRCT) temporal bone and to find the best modality of choice in patients with bilateral profound Sensorineural Hearing Loss (SNHL). Materials and Methods This was a prospective, longitudinal, observational study conducted between June 2010 to November 2012. A total of 144 temporal bones were evaluated in 72 children with bilateral profound SNHL with congenital inner ear malformations. Each temporal bone was considered as a single case (144 cases). All the patients underwent HRCT and high field MRI study. MRI study included T2 W axial 3D FIESTA (Fast Imaging Employing Steady-state Acquisition) sequence. Anatomic abnormalities in each temporal bone were described and noted. For complete and better evaluation of Vestibulo-Cochlear Nerve (VCN) additional 3D oblique parasagittal view was taken perpendicular to the internal auditory canal with a small Field Of View (FOV). Results HRCT and MRI allowed accurate detection of inner ear malformations in children with bilateral SNHL. Majority of the patients presented with multiple structural abnormalities of inner ear. The common pathologies detected in the study were semicircular canal abnormality (89/144) followed by cochlear abnormalities (39/144). Most common cochlear abnormality was Mondini’s deformity (14/144). MRI demonstrated absent of vestibulo-cochlear nerve in 15 cases. Conclusion Few

  12. Surfactant Therapy of ALI and ARDS

    PubMed Central

    Raghavendran, K; Willson, D; Notter, RH

    2011-01-01

    This article examines exogenous lung surfactant replacement therapy and its utility in mitigating clinical acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). Biophysical research has documented that lung surfactant dysfunction can be reversed or mitigated by increasing surfactant concentration, and multiple studies in animals with ALI/ARDS have shown that respiratory function and pulmonary mechanics in vivo can be improved by exogenous surfactant administration. Exogenous surfactant therapy is a routine intervention in neonatal intensive care, and is life-saving in preventing or treating the neonatal respiratory distress syndrome (NRDS) in premature infants. In applications relevant for lung injury-related respiratory failure and ALI/ARDS, surfactant therapy has been shown to be beneficial in term infants with pneumonia and meconium aspiration lung injury, and in children up to age 21 with direct pulmonary forms of ALI/ARDS. However, extension of exogenous surfactant therapy to adults with respiratory failure and clinical ALI/ARDS remains a challenge. Coverage here reviews clinical studies of surfactant therapy in pediatric and adult patients with ALI/ARDS, particularly focusing on its potential advantages in patients with direct pulmonary forms of these syndromes. Also discussed is the rationale for mechanism-based therapies utilizing exogenous surfactant in combination with agents targeting other aspects of the multifaceted pathophysiology of inflammatory lung injury. Additional factors affecting the efficacy of exogenous surfactant therapy in ALI/ARDS are also described, including the difficulty of effectively delivering surfactants to injured lungs and the existence of activity differences between clinical surfactant drugs. PMID:21742216

  13. Serum ACE Level in Sarcoidosis Patients with Typical and Atypical HRCT Manifestation

    PubMed Central

    Kahkouee, Shahram; Samadi, Katayoon; Alai, Ali; Abedini, Atefeh; Rezaiian, Lida

    2016-01-01

    Summary Background Sarcoidosis is an inflammatory disease that affects multiple organs. Before widespread use of computed tomography (CT), the severity of sarcoidosis was assessed based on chest X-ray abnormalities. HRCT can distinguish between active inflammatory changes and irreversible fibrosis. In this study, we analyzed different ACE levels in 148 patients diagnosed with sarcoidosis. Material/Methods We categorized these patients based on their HRCT results into four groups: 1) patients diagnosed with chronic disease; 2) patients diagnosed with non-chronic disease; 3) patients who exhibited typical HRCT changes; and 4) patients who exhibited atypical HRCT changes. Afterward the mean ACE level of each group was calculated and compared. Result The HRCT scans of chronic sarcoidosis patients tended to show more atypical sarcoidosis patterns. Moreover, there was a reverse correlation between chronicity and ACE level (P-value <0.05). Conclusions HRCT is another modality which would be useful when the diagnosis of sarcoidosis is not definite. PMID:27733890

  14. Acute Respiratory Distress Syndrome (ARDS) from Endemic Influenza A/H1N1: Prehospital Management.

    PubMed

    Salihefendic, Nizama; Zildzic, Muharem; Ahmetagic, Sead

    2015-02-01

    Acute respiratory distress syndrome (ARDS) is a form of acute life threatening respiratory failure. In daily practice there is difficulty in diagnostic and therapeutic management of Acute respiratory distress syndrome (ARDS). We observed delay in diagnostic and therapeutic procedures in patients with clinical signs for the presence of severe respiratory disorders. Finding timely evidence of the presence the clinical signs of threatening ARDS and underlying diseases like influenza A/H1N1 during prehospital period in early stage of disease it is possible introduce early adequate treatment: high flow oxygen, fluid replacement and pharmacological and antiviral therapy. This measure can reduce high mortality in patients who develop ARDS. It is important to improve diagnostic criteria for a precise definition of ARDS and transfer it in practice of emergency and family medicine, microbiology, intensive care units, hospital departments of infectious and respiratory diseases. In this article we underlined the key elements of the new definition of ARDS, diagnostic criteria and the importance of early diagnosis in prehospital period following clinical feature and course (a presence of severe dyspnea) by adding chest x-ray and laboratory investigations.

  15. Failure of statins in ARDS: the quest for the Holy Grail continues.

    PubMed

    Grimaldi, David; Durand, Arthur; Gleeson, James; Taccone, Fabio S

    2016-11-01

    Experimental and clinical observational studies have shown potential benefits of statin administration in the acute respiratory distress syndrome (ARDS) by modulating inflammation and preventing worsening respiratory function. More recently, two randomized clinical trials failed to demonstrate an improved survival of ARDS patients treated with statins. In the first study, conducted by the ARDS Network, 745 patients with sepsis‑associated ARDS were randomized within 48-hours of onset to receive either rosuvastatin or placebo. There was no significant difference between the rosuvastatin and placebo groups for hospital mortality (primary outcome, 29% vs. 25%, P=0.21) or ventilator‑free days (15±11 vs. 15±11, respectively; P=0.96). In rosuvastatin‑treated patients, renal and hepatic failure free‑days were significantly lower than in the placebo group, raising serious safety concerns. In the second study (HARP-2 trial), 540 patients with ARDS were randomized within 48-hours of onset to receive either simvastatin (80 mg/day) or placebo. There was no significant difference between the study groups for number of ventilator‑free days (primary outcome, 13±10 in the simvastatin vs. 12±10 in the placebo group, P=0.21) or 28-day mortality (22% vs. 27%, respectively; P=0.23). No significant difference in serious adverse events was reported between groups. Herein, we discuss the main reasons for these negative findings and consider where there could be a role for statins in ARDS patients.

  16. The HRCT features of extrinsic allergic alveolitis.

    PubMed

    Hartman, Thomas E

    2003-08-01

    Exposure to organic dusts can produce an immune-mediated inflammatory response in sensitized individuals. The pulmonary disease caused by this response has been called extrinsic allergic alveolitis (EAA) or hypersensitivity pneumonitis. The clinical phases associated with this process have been termed acute, subacute, and chronic. There are corresponding imaging findings that are characteristic of each of these phases, although there is some overlap between the phases. The acute phase is characterized by confluent opacities that may mimic infection or edema. The subacute phase is characterized by centrilobular nodules, areas of ground-glass attenuation, a mosaic perfusion pattern, and air trapping on expiratory imaging. The chronic phase is characterized by subpleural irregular linear opacities with associated architectural distortion. Honeycombing may sometimes also be present. In the acute and subacute phases, the disease is predominantly in the lower lungs, whereas in chronic EAA the findings are predominant in the mid to upper lungs. Although the high-resolution computed tomography findings individually are nonspecific, the combination of the findings coupled with the distribution of the findings can often narrow the differential or allow a presumptive diagnosis of EAA to be made.

  17. A possible genetic influence in parenchyma and small airway changes in COPD: a pilot study of twins using HRCT.

    PubMed

    Tarnoki, D L; Tarnoki, A D; Lazar, Zs; Korom, Cs; Berczi, V; Horvath, I; Karlinger, K

    2014-06-01

    Genetic effects that contribute to the risk of developing chronic obstructive pulmonary disease (COPD) have been reported. Our purpose was to estimate the possible genetic influence on CT features related to COPD in twins. Two COPD-discordant and one COPD-concordant monozygotic (MZ) twin pair, in addition to 2 control dizygotic (DZ) twin pairs underwent a low-dose high resolution computer tomography (HRCT) in inspiration and expiration (Philips Brilliance 16). Monozygotic twins were more similar in lung volume expiration and in air trapping score compared to dizygotics (382 cm(3) vs. 2303 cm(3) and 17.6% vs. 26.6%, respectively). In general, MZ twin pairs showed almost identical HRCT features independently of smoking attitude and COPD status. The dizygotic twin pairs showed larger differences in HRCT features compared to MZ twins. Lung parenchymal and small airway changes (lung density, presence of bronchial wall thickening, bronchiectasis and/or mucus plug formation, air trapping and emphysema score) seem to be genetically associated traits, independently of smoking/COPD history. A future study with a larger sample size should confirm our findings.

  18. Plasmid-encoded antirestriction protein ArdA can discriminate between type I methyltransferase and complete restriction-modification system.

    PubMed

    Nekrasov, Sergei V; Agafonova, Olga V; Belogurova, Nataly G; Delver, Eugene P; Belogurov, Anatol A

    2007-01-12

    Many promiscuous plasmids encode the antirestriction proteins ArdA (alleviation of restriction of DNA) that specifically affect the restriction activity of heterooligomeric type I restriction-modification (R-M) systems in Escherichia coli cells. In addition, a lot of the putative ardA genes encoded by plasmids and bacterial chromosomes are found as a result of sequencing of complete genomic sequences, suggesting that ArdA proteins and type I R-M systems that seem to be widespread among bacteria may be involved in the regulation of gene transfer among bacterial genomes. Here, the mechanism of antirestriction action of ArdA encoded by IncI plasmid ColIb-P9 has been investigated in comparison with that of well-studied T7 phage-encoded antirestriction protein Ocr using the mutational analysis, retardation assay and His-tag affinity chromatography. Like Ocr, ArdA protein was shown to be able to efficiently interact with EcoKI R-M complex and affect its in vivo and in vitro restriction activity by preventing its interaction with specific DNA. However, unlike Ocr, ArdA protein has a low binding affinity to EcoKI Mtase and the additional C-terminal tail region (VF-motif) is needed for ArdA to efficiently interact with the type I R-M enzymes. It seems likely that this ArdA feature is a basis for its ability to discriminate between activities of EcoKI Mtase (modification) and complete R-M system (restriction) which may interact with unmodified DNA in the cells independently. These findings suggest that ArdA may provide a very effective and delicate control for the restriction and modification activities of type I systems and its ability to discriminate against DNA restriction in favour of the specific modification of DNA may give some advantage for efficient transmission of the ardA-encoding promiscuous plasmids among different bacterial populations.

  19. A genome-wide expression analysis in blood identifies pre-elafin as a biomarker in ARDS.

    PubMed

    Wang, Zhaoxi; Beach, Douglas; Su, Li; Zhai, Rihong; Christiani, David C

    2008-06-01

    Previous microarray-based studies of acute respiratory distress syndrome (ARDS) were performed using various models to mimic disease pathogenesis. The complexity of the pathophysiologic response to direct or indirect lung injury in ARDS is difficult to reconstruct in experimental conditions. Thus, direct analysis of ARDS patient blood may provide valuable information. We investigated genome-wide gene expression profiles in paired whole blood samples from patients with ARDS (n = 8) during the acute stage (within 3 d of diagnosis) and recovery stage of ARDS (around ICU discharge). Among 126 differentially expressed genes, peptidase inhibitor 3 (PI3, encoding elafin, a potent neutrophil elastase inhibitor) had the largest fold-change (-3-fold changes, acute stage/recovery stage) in expression, indicating down-regulation during the acute stage of ARDS. We further examined plasma PI3 levels in 40 patients with ARDS and 23 at-risk control subjects from the same cohort. There was a coincidence of the microarray findings of lower PI3 gene expression with the lower plasma PI3 during the acute-stage. The plasma PI3 levels were statistically significant different among pre-diagnosis, day of diagnosis, and post-diagnosis groups (ANOVA, P = 0.001), with a trend of decreasing from pre- to post-diagnosis group. The time course of plasma PI3 decrease is well correlated with the course of early ARDS development (Pearson correlation coefficient: -0.52, P = 0.0006). Considering that PI3 can covalently binding to extracellular matrix in lung, circulating PI3 may provide a useful clinical marker for monitoring the early development of ARDS and may have implications for ARDS treatment.

  20. A Genome-Wide Expression Analysis in Blood Identifies Pre-Elafin as a Biomarker in ARDS

    PubMed Central

    Wang, Zhaoxi; Beach, Douglas; Su, Li; Zhai, Rihong; Christiani, David C.

    2008-01-01

    Previous microarray-based studies of acute respiratory distress syndrome (ARDS) were performed using various models to mimic disease pathogenesis. The complexity of the pathophysiologic response to direct or indirect lung injury in ARDS is difficult to reconstruct in experimental conditions. Thus, direct analysis of ARDS patient blood may provide valuable information. We investigated genome-wide gene expression profiles in paired whole blood samples from patients with ARDS (n = 8) during the acute stage (within 3 d of diagnosis) and recovery stage of ARDS (around ICU discharge). Among 126 differentially expressed genes, peptidase inhibitor 3 (PI3, encoding elafin, a potent neutrophil elastase inhibitor) had the largest fold-change (−3-fold changes, acute stage/recovery stage) in expression, indicating down-regulation during the acute stage of ARDS. We further examined plasma PI3 levels in 40 patients with ARDS and 23 at-risk control subjects from the same cohort. There was a coincidence of the microarray findings of lower PI3 gene expression with the lower plasma PI3 during the acute-stage. The plasma PI3 levels were statistically significant different among pre-diagnosis, day of diagnosis, and post-diagnosis groups (ANOVA, P = 0.001), with a trend of decreasing from pre- to post-diagnosis group. The time course of plasma PI3 decrease is well correlated with the course of early ARDS development (Pearson correlation coefficient: −0.52, P = 0.0006). Considering that PI3 can covalently binding to extracellular matrix in lung, circulating PI3 may provide a useful clinical marker for monitoring the early development of ARDS and may have implications for ARDS treatment. PMID:18203972

  1. 3 Tesla proton MRI for the diagnosis of pneumonia/lung infiltrates in neutropenic patients with acute myeloid leukemia: initial results in comparison to HRCT.

    PubMed

    Attenberger, U I; Morelli, J N; Henzler, T; Buchheidt, D; Fink, C; Schoenberg, S O; Reichert, M

    2014-01-01

    To evaluate the diagnostic accuracy of 3 Tesla proton MRI for the assessment of pneumonia/lung infiltrates in neutropenic patients with acute myeloid leukemia. In a prospective study, 3 Tesla MRI was performed in 19 febrile neutropenic patients (5 women, 14 men; mean age 61 years ± 14.2; range 23-77 years). All patients underwent high-resolution CT less than 24h prior to MRI. The MRI protocol (Magnetom Tim Trio, Siemens) included a T2-weighted HASTE sequence (TE/TR: 49 ms/∞, slice thickness 6mm) and a high-resolution 3D VIBE sequence with an ultra-short TE<1 ms (TE/TR 0.8/2.9 ms, slice thickness 2mm). The VIBE sequence was examined before and after intravenous injection of 0.1 mmol/kg gadoterate meglumine (Dotarem, Guerbet). The presence of pulmonary abnormalities, their location within the lung, and lesion type (nodules, consolidations, glass opacity areas) were analyzed by one reader and compared to the findings of HRCT, which was evaluated by a second independent radiologist who served as the reference standard. The findings were compared per lobe in each patient and rated as true positive (TP) findings if all three characteristics (presence, location, and lesion type) listed above were concordant to HRCT. Pulmonary abnormalities were characterized by 3 Tesla MRI with a sensitivity of 82.3% and a specificity of 78.6%, resulting in an overall accuracy of 88% (NPV/PPV 66.7%/89.5%). In 51 lobes (19 of 19 patients), pulmonary abnormalities visualized by MR were judged to be concordant in their location and in the lesion type identified by both readers. In 22 lobes (11 of 19 patients), no abnormalities were present on either MR or HRCT (true negative). In 6 lobes (5 of 19 patients), ground glass opacity areas were detected on MRI but were not visible on HRCT (false positives). In 11 lobes (7 of 19 patients), MRI failed to detect ground glass opacity areas identified by HRCT. However, since the abnormalities were disseminated in these patients, accurate treatment

  2. Indoxacarb-Related ARDS, Neurotoxicity and Orange Urine

    PubMed Central

    Viswanathan, Stalin; Kumar, Shanthi; Kandan, Balamurugesan

    2013-01-01

    A 17 year old male developed adult respiratory distress syndrome (ARDS), seizures, intravascular hemolysis and peripheral neuropathy following self-poisoning with a pesticide containing 14.5% indoxacarb. He was managed conservatively with fluid management, antibiotics, mechanical ventilation and physiotherapy. There is limited data concerning the human toxicity of indoxacarb. This case demonstrates that findings from animal studies, such as seizures, respiratory distress, and intravascular hemolysis are possible following self-poisoning in humans. In this patient, partial recovery was achieved following supportive care. PMID:25610267

  3. Segmentation of interstitial lung disease patterns in HRCT images

    NASA Astrophysics Data System (ADS)

    Dash, Jatindra K.; Madhavi, Vaddepalli; Mukhopadhyay, Sudipta; Khandelwal, Niranjan; Kumar, Prafulla

    2015-03-01

    Automated segmentation of pathological bearing region is the first step towards the development of lung CAD. Most of the work reported in the literature related to automated analysis of lung tissue aims towards classification of fixed sized block into one of the classes. This block level classification of lung tissues in the image never results in accurate or smooth boundaries between different regions. In this work, effort is taken to investigate the performance of three automated image segmentation algorithms those results in smooth boundaries among lung tissue patterns commonly encountered in HRCT images of the thorax. A public database that consists of HRCT images taken from patients affected with Interstitial Lung Diseases (ILDs) is used for the evaluation. The algorithms considered are Markov Random Field (MRF), Gaussian Mixture Model (GMM) and Mean Shift (MS). 2-fold cross validation approach is followed for the selection of the best parameter value for individual algorithm as well as to evaluate the performance of all the algorithms. Mean shift algorithm is observed as the best performer in terms of Jaccard Index, Modified Hausdorff Distance, accuracy, Dice Similarity Coefficient and execution speed.

  4. Current Concepts of ARDS: A Narrative Review

    PubMed Central

    Umbrello, Michele; Formenti, Paolo; Bolgiaghi, Luca; Chiumello, Davide

    2016-01-01

    Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of pulmonary edema of non-cardiogenic origin, along with bilateral pulmonary infiltrates and reduction in respiratory system compliance. The hallmark of the syndrome is refractory hypoxemia. Despite its first description dates back in the late 1970s, a new definition has recently been proposed. However, the definition remains based on clinical characteristic. In the present review, the diagnostic workup and the pathophysiology of the syndrome will be presented. Therapeutic approaches to ARDS, including lung protective ventilation, prone positioning, neuromuscular blockade, inhaled vasodilators, corticosteroids and recruitment manoeuvres will be reviewed. We will underline how a holistic framework of respiratory and hemodynamic support should be provided to patients with ARDS, aiming to ensure adequate gas exchange by promoting lung recruitment while minimizing the risk of ventilator-induced lung injury. To do so, lung recruitability should be considered, as well as the avoidance of lung overstress by monitoring transpulmonary pressure or airway driving pressure. In the most severe cases, neuromuscular blockade, prone positioning, and extra-corporeal life support (alone or in combination) should be taken into account. PMID:28036088

  5. Current Concepts of ARDS: A Narrative Review.

    PubMed

    Umbrello, Michele; Formenti, Paolo; Bolgiaghi, Luca; Chiumello, Davide

    2016-12-29

    Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of pulmonary edema of non-cardiogenic origin, along with bilateral pulmonary infiltrates and reduction in respiratory system compliance. The hallmark of the syndrome is refractory hypoxemia. Despite its first description dates back in the late 1970s, a new definition has recently been proposed. However, the definition remains based on clinical characteristic. In the present review, the diagnostic workup and the pathophysiology of the syndrome will be presented. Therapeutic approaches to ARDS, including lung protective ventilation, prone positioning, neuromuscular blockade, inhaled vasodilators, corticosteroids and recruitment manoeuvres will be reviewed. We will underline how a holistic framework of respiratory and hemodynamic support should be provided to patients with ARDS, aiming to ensure adequate gas exchange by promoting lung recruitment while minimizing the risk of ventilator-induced lung injury. To do so, lung recruitability should be considered, as well as the avoidance of lung overstress by monitoring transpulmonary pressure or airway driving pressure. In the most severe cases, neuromuscular blockade, prone positioning, and extra-corporeal life support (alone or in combination) should be taken into account.

  6. Lung Clearance Index and HRCT are complementary markers of lung abnormalities in young children with CF.

    PubMed

    Owens, C M; Aurora, P; Stanojevic, S; Bush, A; Wade, A; Oliver, C; Calder, A; Price, J; Carr, S B; Shankar, A; Stocks, Janet

    2011-06-01

    High resolution computed tomography (HRCT) is a more sensitive tool for detecting early cystic fibrosis (CF) lung disease than either spirometry or plain radiography, but its relationship to other measures of lung function has not been established in young children. (1) To assess whether the lung clearance index (LCI) derived from multiple breath inert-gas washout (MBW) is as effective as HRCT in identifying pulmonary abnormalities; and (2) explore the relationships between abnormalities detected by HRCT and by spirometry, plethysmography and MBW (collectively, LFTs) in young children with CF. Children with CF underwent LFTs and volumetric HRCT on the same day. Healthy age-matched controls underwent identical LFTs without HRCT. Scans were anonymised, and scored using the Brody-II CT scoring system, to assess for presence and extent of bronchiectasis, airway wall thickening, mucus plugging, and parenchymal opacities. Assessments were undertaken in 60 children with CF (mean (SD) 7.8 (1.3 years) and 54 healthy controls (7.9 (1.2) y). Among children with CF, 84% (47/56) had abnormal LCI, 58% (27/47) abnormal plethysmographic lung volumes (FRC(pleth) or RV), 35% (21/60) abnormal sRaw and 47% (28/60) abnormal spirometry (FEV1 or FEF(25-75)); whereas HRCT scans were abnormal in 85% (51/60): median total Brody-II score: 9.5% (range 0-51%). Total CT score correlated more strongly with LCI (Spearman correlation = 0.77) than with spirometry (R = -0.43) or any other marker of lung function. Of the nine children with normal LCI, five had abnormalities on HRCT, whereas five children with normal HRCT had raised LCI. These results suggest that while LCI and HRCT have similar sensitivity to detect CF lung disease, complimentary information may be gained in individual patients.

  7. [The value of high resolution computed tomography (HRCT) in the diagnosis of deep forms of parodontitis].

    PubMed

    Schüller, H; Jervøe-Storm, P M; Frentzen, M

    1993-10-01

    It is difficult to demonstrate the extent of parodontal bone erosions with conventional radiographic techniques. HRCT makes it possible to demonstrate the alveolar structures without superimposition. 10 patients with parodontitis marginalis profunda were examined by conventional methods and HRCT. Comparison showed considerable superiority of HRCT in respect of demonstrating bone destruction. The absence of superimposition produces excellent demonstration of the roots and shows the bifurcation and trifurcation of teeth; consequently, mapping the position and shape of the root canals is possible and this is an important aid in the planning of parodontal surgical treatment.

  8. Antirestriction protein Ard (Type C) encoded by IncW plasmid pSa has a high similarity to the "protein transport" domain of TraC1 primase of promiscuous plasmid RP4.

    PubMed

    Belogurov, A A; Delver, E P; Agafonova, O V; Belogurova, N G; Lee, L Y; Kado, C I

    2000-03-03

    The IncW plasmid pSa contains the gene ard encoding an antirestriction function that is specific for type I restriction and modification systems. The nucleotide sequence of ard was determined and an appropriate polypeptide of about 33 kDa was identified in Escherichia coli T7 expression system. Analysis of deduced amino acid sequence of Ard encoded by pSa revealed that this protein has no significant similarities with the known Ard proteins (ArdA and ArdB types) except the "antirestriction" motif (14 amino acid residues in length) conserved for all known Ard proteins. This finding suggests that pSa Ard may be classified as a new type of Ard proteins which we designated ArdC. The remarkable feature of ArdC is that it has a high degree of similarity (about 38 % identity) to the N-terminal region of RP4 TraC1 primase which includes about 300 amino acid residues and seems to be essential for binding to the single-stranded DNA and TraC1 protein transport to the recipient cells during the conjugal transfer of plasmid DNA. ArdC also binds to single-stranded DNA. In addition, this protein is able in vitro to protect the single-stranded but not double-stranded plasmid DNA against the activity of type II restriction endonuclease HhaI that cleaves both single and double-stranded DNA. We suggest that like TraC1, ArdC would be transported as a result of their interaction with the single-stranded DNA of transferred plasmid strand during conjugative passage through the cell envelope to the recipient bacterium. Such properties of ArdC protein might be useful to protect immediately the incoming single-stranded DNA from the host endonucleases.

  9. Applying metabolomics to uncover novel biology in ARDS.

    PubMed

    Rogers, Angela J; Matthay, Michael A

    2014-06-01

    A better understanding of the pathogenesis and the resolution of the acute respiratory distress syndrome (ARDS) is needed. Although some progress has been made with the use of protein biomarkers and candidate gene studies in understanding the pathobiology of ARDS, we propose that new studies that measure the chemical breakdown products of cellular metabolism (metabolomics) may provide new insights into ARDS, in part because metabolomics targets a later point in the genomics cascade than is possible with studies of DNA, RNA, and protein biomarkers. Technological advances have made large-scale metabolomic profiling increasingly feasible. Metabolomic approaches have already achieved novel insights in nonpulmonary diseases such as diabetes mellitus and malignancy, as well as in sepsis, a major risk factor for developing ARDS. Metabolomic profiling is a promising approach to identify novel pathways in both patients at risk for developing ARDS as well as in the early phase of established ARDS.

  10. Identification of a Novel Antimicrobial Peptide from Human Hepatitis B Virus Core Protein Arginine-Rich Domain (ARD)

    PubMed Central

    Chen, Heng-Li; Su, Pei-Yi; Chang, Ya-Shu; Wu, Szu-Yao; Liao, You-Di; Yu, Hui-Ming; Lauderdale, Tsai-Ling; Chang, Kaichih; Shih, Chiaho

    2013-01-01

    The rise of multidrug-resistant (MDR) pathogens causes an increasing challenge to public health. Antimicrobial peptides are considered a possible solution to this problem. HBV core protein (HBc) contains an arginine-rich domain (ARD) at its C-terminus, which consists of 16 arginine residues separated into four clusters (ARD I to IV). In this study, we demonstrated that the peptide containing the full-length ARD I–IV (HBc147-183) has a broad-spectrum antimicrobial activity at micro-molar concentrations, including some MDR and colistin (polymyxin E)-resistant Acinetobacter baumannii. Furthermore, confocal fluorescence microscopy and SYTOX Green uptake assay indicated that this peptide killed Gram-negative and Gram-positive bacteria by membrane permeabilization or DNA binding. In addition, peptide ARD II–IV (HBc153-176) and ARD I–III (HBc147-167) were found to be necessary and sufficient for the activity against P. aeruginosa and K. peumoniae. The antimicrobial activity of HBc ARD peptides can be attenuated by the addition of LPS. HBc ARD peptide was shown to be capable of direct binding to the Lipid A of lipopolysaccharide (LPS) in several in vitro binding assays. Peptide ARD I–IV (HBc147-183) had no detectable cytotoxicity in various tissue culture systems and a mouse animal model. In the mouse model by intraperitoneal (i.p.) inoculation with Staphylococcus aureus, timely treatment by i.p. injection with ARD peptide resulted in 100-fold reduction of bacteria load in blood, liver and spleen, as well as 100% protection of inoculated animals from death. If peptide was injected when bacterial load in the blood reached its peak, the protection rate dropped to 40%. Similar results were observed in K. peumoniae using an IVIS imaging system. The finding of anti-microbial HBc ARD is discussed in the context of commensal gut microbiota, development of intrahepatic anti-viral immunity and establishment of chronic infection with HBV. Our current results suggested that

  11. Identification of a novel antimicrobial peptide from human hepatitis B virus core protein arginine-rich domain (ARD).

    PubMed

    Chen, Heng-Li; Su, Pei-Yi; Chang, Ya-Shu; Wu, Szu-Yao; Liao, You-Di; Yu, Hui-Ming; Lauderdale, Tsai-Ling; Chang, Kaichih; Shih, Chiaho

    2013-01-01

    The rise of multidrug-resistant (MDR) pathogens causes an increasing challenge to public health. Antimicrobial peptides are considered a possible solution to this problem. HBV core protein (HBc) contains an arginine-rich domain (ARD) at its C-terminus, which consists of 16 arginine residues separated into four clusters (ARD I to IV). In this study, we demonstrated that the peptide containing the full-length ARD I-IV (HBc147-183) has a broad-spectrum antimicrobial activity at micro-molar concentrations, including some MDR and colistin (polymyxin E)-resistant Acinetobacter baumannii. Furthermore, confocal fluorescence microscopy and SYTOX Green uptake assay indicated that this peptide killed Gram-negative and Gram-positive bacteria by membrane permeabilization or DNA binding. In addition, peptide ARD II-IV (HBc153-176) and ARD I-III (HBc147-167) were found to be necessary and sufficient for the activity against P. aeruginosa and K. peumoniae. The antimicrobial activity of HBc ARD peptides can be attenuated by the addition of LPS. HBc ARD peptide was shown to be capable of direct binding to the Lipid A of lipopolysaccharide (LPS) in several in vitro binding assays. Peptide ARD I-IV (HBc147-183) had no detectable cytotoxicity in various tissue culture systems and a mouse animal model. In the mouse model by intraperitoneal (i.p.) inoculation with Staphylococcus aureus, timely treatment by i.p. injection with ARD peptide resulted in 100-fold reduction of bacteria load in blood, liver and spleen, as well as 100% protection of inoculated animals from death. If peptide was injected when bacterial load in the blood reached its peak, the protection rate dropped to 40%. Similar results were observed in K. peumoniae using an IVIS imaging system. The finding of anti-microbial HBc ARD is discussed in the context of commensal gut microbiota, development of intrahepatic anti-viral immunity and establishment of chronic infection with HBV. Our current results suggested that HBc ARD

  12. Evidence for chemokine synergy during neutrophil migration in ARDS.

    PubMed

    Williams, Andrew E; José, Ricardo J; Mercer, Paul F; Brealey, David; Parekh, Dhruv; Thickett, David R; O'Kane, Cecelia; McAuley, Danny F; Chambers, Rachel C

    2017-01-01

    Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterised by pulmonary oedema, respiratory failure and severe inflammation. ARDS is further characterised by the recruitment of neutrophils into the lung interstitium and alveolar space. The factors that regulate neutrophil infiltration into the inflamed lung and our understanding of the pathomechanisms in ARDS remain incomplete. This study aimed at determining the role of the chemokine (C-C motif) ligand (CCL)2 and CCL7 in ARDS. CCL2 and CCL7 protein levels were measured in bronchoalveolar lavage (BAL) fluid obtained from lipopolysaccharide(LPS)-challenged human volunteers and two separate cohorts of patients with ARDS. Neutrophil chemotaxis to ARDS BAL fluid was evaluated and the contribution of each was assessed and compared with chemokine (C-X-C motif) ligand 8 (CXCL8). Chemokine receptor expression on neutrophils from blood or BAL fluid of patients with ARDS was analysed by flow cytometry. CCL2 and CCL7 were significantly elevated in BAL fluid recovered from LPS-challenged volunteers and patients with ARDS. BAL fluid from patients with ARDS was highly chemotactic for human neutrophils and neutralising either CCL2 or CCL7 attenuated the neutrophil chemotactic response. Moreover, CCL2 and CCL7 synergised with CXCL8 to promote neutrophil migration. Furthermore, neutrophils isolated from the blood or BAL fluid differentially regulated the cell surface expression of chemokine (C-X-C motif) receptor 1 and C-C chemokine receptor type 2 during ARDS. This study highlights important inflammatory chemokines involved in regulating neutrophil migration, which may have potential value as therapeutic targets for the treatment of ARDS. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  13. Evidence for chemokine synergy during neutrophil migration in ARDS

    PubMed Central

    Williams, Andrew E; José, Ricardo J; Mercer, Paul F; Brealey, David; Parekh, Dhruv; Thickett, David R; O'Kane, Cecelia; McAuley, Danny F; Chambers, Rachel C

    2017-01-01

    Background Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterised by pulmonary oedema, respiratory failure and severe inflammation. ARDS is further characterised by the recruitment of neutrophils into the lung interstitium and alveolar space. Objectives The factors that regulate neutrophil infiltration into the inflamed lung and our understanding of the pathomechanisms in ARDS remain incomplete. This study aimed at determining the role of the chemokine (C-C motif) ligand (CCL)2 and CCL7 in ARDS. Methods CCL2 and CCL7 protein levels were measured in bronchoalveolar lavage (BAL) fluid obtained from lipopolysaccharide(LPS)-challenged human volunteers and two separate cohorts of patients with ARDS. Neutrophil chemotaxis to ARDS BAL fluid was evaluated and the contribution of each was assessed and compared with chemokine (C-X-C motif) ligand 8 (CXCL8). Chemokine receptor expression on neutrophils from blood or BAL fluid of patients with ARDS was analysed by flow cytometry. Results CCL2 and CCL7 were significantly elevated in BAL fluid recovered from LPS-challenged volunteers and patients with ARDS. BAL fluid from patients with ARDS was highly chemotactic for human neutrophils and neutralising either CCL2 or CCL7 attenuated the neutrophil chemotactic response. Moreover, CCL2 and CCL7 synergised with CXCL8 to promote neutrophil migration. Furthermore, neutrophils isolated from the blood or BAL fluid differentially regulated the cell surface expression of chemokine (C-X-C motif) receptor 1 and C-C chemokine receptor type 2 during ARDS. Conclusion This study highlights important inflammatory chemokines involved in regulating neutrophil migration, which may have potential value as therapeutic targets for the treatment of ARDS. PMID:27496101

  14. Comparison of chest radiography and high-resolution computed tomography findings in early and low-grade coal worker's pneumoconiosis.

    PubMed

    Savranlar, Ahmet; Altin, Remzi; Mahmutyazicioğlu, Kamran; Ozdemir, Hüseyin; Kart, Levent; Ozer, Tülay; Gündoğdu, Sadi

    2004-08-01

    High-resolution computed tomography (HRCT) is more sensitive than chest X-ray (CXR) in the depiction of parenchymal abnormalities. We aimed to present and compare CXR and HRCT findings in coal workers with and without early and low-grade coal worker's pneumoconiosis (CWP). 71 coal workers were enrolled in this study. All workers were male. The CXR and HRCT of those workers were obtained and graded by two trained readers. HRCT's were graded according to Hosoda and Shida's Japanese classification. After grading, 67 workers with CXR profusion 0/0-2/2 were included in the study. Four patients with major opacity were excluded. Profusion 0/1 to 1/1 cases were accepted as early and profusion 1/2 and 2/2 cases as low-grade pneumoconiosis. Discordance between CXR and HRCT was high. Discordance rate was found higher in the early pneumoconiosis cases with negative CXR than low-grade pneumoconiosis (60, 36 and 8%, respectively). When coal miners with normal CXR were evaluated by HRCT, six out of 10 cases were diagnosed as positive. In low-grade pneumoconiosis group, the number of patients with positive CXR but negative HRCT were low in comparison to patients with CXR negative and early pneumoconiosis findings. Most of the CXR category 0 patients (10/16) were diagnosed as category 1 by HRCT. Eleven cases diagnosed as CXR category 1 were diagnosed as category 0 (7/11) and category 2 (4/11) by HRCT. In CXR category 2 (eight cases), there were four cases diagnosed as category 1 by HRCT. Discordance between CXR and HRCT was high, especially for CXR negative and early pneumoconiosis cases. The role of CXR in screening coal workers to detect early pneumoconiosis findings should be questioned. We suggest using HRCT as a standard screening method instead of CXR to distinguish between normal and early pneumoconiosis.

  15. A support vector machine classifier reduces interscanner variation in the HRCT classification of regional disease pattern in diffuse lung disease: Comparison to a Bayesian classifier

    SciTech Connect

    Chang, Yongjun; Lim, Jonghyuck; Kim, Namkug; Seo, Joon Beom; Lynch, David A.

    2013-05-15

    integrated ROI data obtained from both scanners, the classification accuracies with the SVM and Bayesian classifiers were 92% and 77%, respectively. The selected features resulting from the classification process differed by scanner, with more features included for the classification of the integrated HRCT data than for the classification of the HRCT data from each scanner. For the integrated data, consisting of HRCT images of both scanners, the classification accuracy based on the SVM was statistically similar to the accuracy of the data obtained from each scanner. However, the classification accuracy of the integrated data using the Bayesian classifier was significantly lower than the classification accuracy of the ROI data of each scanner. Conclusions: The use of an integrated dataset along with a SVM classifier rather than a Bayesian classifier has benefits in terms of the classification accuracy of HRCT images acquired with more than one scanner. This finding is of relevance in studies involving large number of images, as is the case in a multicenter trial with different scanners.

  16. Construction and management of ARDS/sepsis registry with REDCap

    PubMed Central

    Pang, Xiaoqing; Kozlowski, Natascha; Wu, Sulong; Jiang, Mei; Huang, Yongbo; Mao, Pu; Liu, Xiaoqing; He, Weiqun; Huang, Chaoyi; Zhang, Haibo

    2014-01-01

    Objective The study aimed to construct and manage an acute respiratory distress syndrome (ARDS)/sepsis registry that can be used for data warehousing and clinical research. Methods The workflow methodology and software solution of research electronic data capture (REDCap) was used to construct the ARDS/sepsis registry. Clinical data from ARDS and sepsis patients registered to the intensive care unit (ICU) of our hospital formed the registry. These data were converted to the electronic case report form (eCRF) format used in REDCap by trained medical staff. Data validation, quality control, and database management were conducted to ensure data integrity. Results The clinical data of 67 patients registered to the ICU between June 2013 and December 2013 were analyzed. Of the 67 patients, 45 (67.2%) were classified as sepsis, 14 (20.9%) as ARDS, and eight (11.9%) as sepsis-associated ARDS. The patients’ information, comprising demographic characteristics, medical history, clinical interventions, daily assessment, clinical outcome, and follow-up data, was properly managed and safely stored in the ARDS/sepsis registry. Data efficiency was guaranteed by performing data collection and data entry twice weekly and every two weeks, respectively. Conclusions The ARDS/sepsis database that we constructed and manage with REDCap in the ICU can provide a solid foundation for translational research on the clinical data of interest, and a model for development of other medical registries in the future. PMID:25276372

  17. Construction and management of ARDS/sepsis registry with REDCap.

    PubMed

    Pang, Xiaoqing; Kozlowski, Natascha; Wu, Sulong; Jiang, Mei; Huang, Yongbo; Mao, Pu; Liu, Xiaoqing; He, Weiqun; Huang, Chaoyi; Li, Yimin; Zhang, Haibo

    2014-09-01

    The study aimed to construct and manage an acute respiratory distress syndrome (ARDS)/sepsis registry that can be used for data warehousing and clinical research. The workflow methodology and software solution of research electronic data capture (REDCap) was used to construct the ARDS/sepsis registry. Clinical data from ARDS and sepsis patients registered to the intensive care unit (ICU) of our hospital formed the registry. These data were converted to the electronic case report form (eCRF) format used in REDCap by trained medical staff. Data validation, quality control, and database management were conducted to ensure data integrity. The clinical data of 67 patients registered to the ICU between June 2013 and December 2013 were analyzed. Of the 67 patients, 45 (67.2%) were classified as sepsis, 14 (20.9%) as ARDS, and eight (11.9%) as sepsis-associated ARDS. The patients' information, comprising demographic characteristics, medical history, clinical interventions, daily assessment, clinical outcome, and follow-up data, was properly managed and safely stored in the ARDS/sepsis registry. Data efficiency was guaranteed by performing data collection and data entry twice weekly and every two weeks, respectively. The ARDS/sepsis database that we constructed and manage with REDCap in the ICU can provide a solid foundation for translational research on the clinical data of interest, and a model for development of other medical registries in the future.

  18. The changing face of organ failure in ARDS.

    PubMed

    Suchyta, Mary R; Orme, James F; Morris, Alan H

    2003-11-01

    To study morbidity and mortality in ARDS patients from 1987 to 1999. Review of a prospectively collected database of ARDS patients. Large, community hospital located in Salt Lake City, UT. ARDS patients identified for the years 1987 to 1999. We prospectively identified ARDS patients at LDS Hospital in Salt Lake City, UT, using PaO(2)/fraction of inspired oxygen ratio (P/F) criteria, the presence of bilateral chest radiograph infiltrates, and the absence of left atrial hypertension. We assigned a primary risk factor for ARDS and identified the presence of organ failure before and after ARDS. We compared two temporal groups (ie, 1987 to 1990 vs 1994 to 1999) and used two criteria of arterial hypoxemia (P/F: patients from 1994 to 1999, < or = 105 and < or = 173; patients from 1987 to 1990, < or = 0.2) At 1,500 m (the altitude of Salt Lake City), a PaO(2) of < or = 173 corresponds to an alveolar-arterial oxygen pressure difference of < or = 200 at sea level. We used death at hospital discharge as an end point. We identified 516 ARDS patients with a P/F of < or = 105 (1987 to 1990, 256 patients; 1994 to 1999, 260 patients). Patients who had ARDS between 1994 and 1999 with a P/F of < or = 105 had a lower mortality rate than patients between 1987 and 1990 with a P/F of < or = 105 (44% vs 54%, respectively; p <.05). There were 288 patients with a P/F range of 106 to 173 during 1994 to 1999. Patients from 1994 to 1999 with a P/F of < or = 173 had a lower mortality rate compared to patients from 1987 to 1990 (35% vs 54%, respectively; p <.01). Patients from 1994 to 1999 (for both P/F groups) had statistically fewer total nonpulmonary organ failures (ie, more patients had zero organ failures or single organ failures) and fewer specific organ failures (ie, sepsis, cardiovascular failures, and CNS failures). There were statistically fewer cases of cardiovascular failure, sepsis, and in both periods (ie, prior to ARDS and after the onset of ARDS) for 1994-to-1999 patients with a

  19. An experimental study on the impacts of inspiratory and expiratory muscles activities during mechanical ventilation in ARDS animal model

    PubMed Central

    Zhang, Xianming; Du, Juan; Wu, Weiliang; Zhu, Yongcheng; Jiang, Ying; Chen, Rongchang

    2017-01-01

    In spite of intensive investigations, the role of spontaneous breathing (SB) activity in ARDS has not been well defined yet and little has been known about the different contribution of inspiratory or expiratory muscles activities during mechanical ventilation in patients with ARDS. In present study, oleic acid-induced beagle dogs’ ARDS models were employed and ventilated with the same level of mean airway pressure. Respiratory mechanics, lung volume, gas exchange and inflammatory cytokines were measured during mechanical ventilation, and lung injury was determined histologically. As a result, for the comparable ventilator setting, preserved inspiratory muscles activity groups resulted in higher end-expiratory lung volume (EELV) and oxygenation index. In addition, less lung damage scores and lower levels of system inflammatory cytokines were revealed after 8 h of ventilation. In comparison, preserved expiratory muscles activity groups resulted in lower EELV and oxygenation index. Moreover, higher lung injury scores and inflammatory cytokines levels were observed after 8 h of ventilation. Our findings suggest that the activity of inspiratory muscles has beneficial effects, whereas that of expiratory muscles exerts adverse effects during mechanical ventilation in ARDS animal model. Therefore, for mechanically ventilated patients with ARDS, the demands for deep sedation or paralysis might be replaced by the strategy of expiratory muscles paralysis through epidural anesthesia. PMID:28230150

  20. Is there still a role for the lung injury score in the era of the Berlin definition ARDS?

    PubMed Central

    2014-01-01

    outcomes, these findings suggest that the role of LIS in characterizing lung injury severity in the era of the Berlin definition ARDS may be limited. PMID:24533450

  1. Acute interstitial pneumonia (AIP): relationship to Hamman-Rich syndrome, diffuse alveolar damage (DAD), and acute respiratory distress syndrome (ARDS).

    PubMed

    Mukhopadhyay, Sanjay; Parambil, Joseph G

    2012-10-01

    Acute interstitial pneumonia (AIP) is a term used for an idiopathic form of acute lung injury characterized clinically by acute respiratory failure with bilateral lung infiltrates and histologically by diffuse alveolar damage (DAD), a combination of findings previously known as the Hamman-Rich syndrome. This review aims to clarify the diagnostic criteria of AIP, its relationship with DAD and acute respiratory distress syndrome (ARDS), key etiologies that need to be excluded before making the diagnosis, and the salient clinical features. Cases that meet clinical and pathologic criteria for AIP overlap substantially with those that fulfill clinical criteria for ARDS. The main differences between AIP and ARDS are that AIP requires a histologic diagnosis of DAD and exclusion of known etiologies. AIP should also be distinguished from "acute exacerbation of IPF," a condition in which acute lung injury (usually DAD) supervenes on underlying usual interstitial pneumonia (UIP)/idiopathic pulmonary fibrosis (IPF).

  2. [Antimodification activity of the ArdA and Ocr proteins].

    PubMed

    Zavil'gel'skiĭ, G V; Kotova, V Iu; Rastorguev, S M

    2011-02-01

    The ArdA and Ocr antirestriction proteins, whose genes are in transmissible plasmids (ardA) and bacteriophage genomes (0.3 (ocr)), specifically inhibit type I restriction-modification enzymes. The Ocr protein (T7 bacteriophage) was shown to inhibit both restriction (endonuclease) and modification (methylase) activities of the EcoKI enzyme in a broad range of intracellular concentrations (starting from 10-20 molecules per cell). In contrast to Ocr, the ArdA protein (ColIb-P9 transmissible plasmid) inhibited both of the EcoKI activities only at high intracellular concentrations (30000-40000 molecules per cell). When the ArdA concentration was several fold lower, only endonuclease activity of EcoKI was inhibited. It was assumed that a poorer ArdA ability to inhibit EcoKI modification activity is related to the substantial difference in life cycle between transmissible plasmids (symbiosis with the bacterial cell) and bacteriophages (infection and lysis of bacteria). The Ocr and ArdA mutants that inhibited exclusively endonuclease activity of EcoKI were obtained. Antirestriction proteins incapable of homodimerization were assumed to inhibit only endonuclease activity of type I restriction-modification enzymes.

  3. Differentiation of several interstitial lung disease patterns in HRCT images using support vector machine: role of databases on performance

    NASA Astrophysics Data System (ADS)

    Kale, Mandar; Mukhopadhyay, Sudipta; Dash, Jatindra K.; Garg, Mandeep; Khandelwal, Niranjan

    2016-03-01

    Interstitial lung disease (ILD) is complicated group of pulmonary disorders. High Resolution Computed Tomography (HRCT) considered to be best imaging technique for analysis of different pulmonary disorders. HRCT findings can be categorised in several patterns viz. Consolidation, Emphysema, Ground Glass Opacity, Nodular, Normal etc. based on their texture like appearance. Clinician often find it difficult to diagnosis these pattern because of their complex nature. In such scenario computer-aided diagnosis system could help clinician to identify patterns. Several approaches had been proposed for classification of ILD patterns. This includes computation of textural feature and training /testing of classifier such as artificial neural network (ANN), support vector machine (SVM) etc. In this paper, wavelet features are calculated from two different ILD database, publically available MedGIFT ILD database and private ILD database, followed by performance evaluation of ANN and SVM classifiers in terms of average accuracy. It is found that average classification accuracy by SVM is greater than ANN where trained and tested on same database. Investigation continued further to test variation in accuracy of classifier when training and testing is performed with alternate database and training and testing of classifier with database formed by merging samples from same class from two individual databases. The average classification accuracy drops when two independent databases used for training and testing respectively. There is significant improvement in average accuracy when classifiers are trained and tested with merged database. It infers dependency of classification accuracy on training data. It is observed that SVM outperforms ANN when same database is used for training and testing.

  4. [The prone position in ARDS. A successful therapeutic strategy].

    PubMed

    Hörmann, C; Benzer, H; Baum, M; Wicke, K; Putensen, C; Putz, G; Hartlieb, S

    1994-07-01

    As early as 1974, Brian advocated the prone position for ventilated patients. He suggested that this position might enhance ventilation of the dorsal parts of the lungs, thereby improving oxygenation. These considerations have been confirmed by several experimental and clinical studies. Better secretion removal, decreased intrapulmonary shunting, and an increased FRC are thought to be responsible for the observed improvement of oxygenation. However, the prone position never became very popular in the clinical treatment of the adult respiratory distress syndrome (ARDS). Routine performance of thoracic CT scans in ARDS patients demonstrated preferential distribution of pathological densities in the dependent lung areas. The prone position therefore could possibly benefit these patients, as shown by two recent studies. The aim of our study was to evaluate the influence of repeatedly turning the patient to the prone position on gas exchange and thoracic CT findings in multiple-trauma patients. METHODS. Seven ventilated intensive care patients with severe ARDS (Murray Score > 2.5, Quotient > 0.7, mean airway pressure > 18 cm H2O, thoracic CT scan showing dorsal atelectases) were included in the study. Patients were turned from the supine to the prone position at 12-h intervals using an air-cushion bed (Mediscus, Austria). Redistribution of dystelectatic or atelectatic dependent lung areas was verified by means of repeated thoracic CT scans (Figs. 1, 8). RESULTS. The patients were intermittently turned for 6.5 +/- 1.1 days. The course of gas exchange is shown in Figs. 2 and 3. Initially, improvement of the respiratory quotient could only be achieved during prone positioning, from the 2nd day in the supine position as well. Intrapulmonary shunting showed a similar trend (Figs. 4 and 5). No significant changes in cardiovascular parameters could be observed. Control thoracic CT scans showed uniform reduction of atelectases in dependent lung areas (Figs. 1 and 8). The

  5. Analysis of HRCT-derived xylem network reveals reverse flow in some vessels

    USDA-ARS?s Scientific Manuscript database

    Flow in xylem vessels is modeled based on constructions of three dimensional xylem networks derived from High Resolution Computed Tomography (HRCT) images of grapevine (Vitis vinifera) stems. Flow in 6-14% of the vessels was found to be oriented in the opposite direction to the bulk flow under norma...

  6. Analyzing 3D xylem networks in Vitis vinifera using High Resolution Computed Tomography (HRCT)

    USDA-ARS?s Scientific Manuscript database

    Recent developments in High Resolution Computed Tomography (HRCT) have made it possible to visualize three dimensional (3D) xylem networks without time consuming, labor intensive physical sectioning. Here we describe a new method to visualize complex vessel networks in plants and produce a quantitat...

  7. Timing of Intubation and Clinical outcomes in Adults with ARDS

    PubMed Central

    Kangelaris, Kirsten Neudoerffer; Ware, Lorraine B.; Wang, Chen Yu; Janz, David R.; Hanjing, Zhuo; Matthay, Michael A.; Calfee, Carolyn S.

    2016-01-01

    Objective The incidence, clinical characteristics and outcomes of critically-ill, non-intubated patients with evidence of the acute respiratory distress syndrome (ARDS) remain inadequately characterized. Design Secondary analysis of a prospective observational cohort study. Setting Vanderbilt University Medical Center. Patients Among adult patients enrolled in a large, multi-intensive care unit prospective cohort study between the years of 2006 and 2011, we studied intubated and non-intubated patients with ARDS as defined by acute hypoxemia (PaO2/FiO2 ≤ 300 or SpO2/FiO2 ≤ 315) and bilateral radiographic opacities not explained by cardiac failure. We excluded patients not committed to full respiratory support. Interventions None. Measurements and Main Results Of 457 patients with ARDS, 106 (23%) were not intubated at the time of meeting all other ARDS criteria. Non-intubated patients had lower morbidity and severity of illness compared to intubated patients; however, mortality at 60 days was the same (36%) in both groups (P=0.91). Of the 106 non-intubated patients, 36 (34%) required intubation within the subsequent 3 days of follow-up; this “late” intubation subgroup had significantly higher 60-day mortality (56%) compared to both the “early” intubation group (36%, P<0.03) and to patients never requiring intubation (26%, P=0.002). Increased mortality in the “late” intubation group persisted at 2 years follow-up. Adjustment for baseline clinical and demographic differences did not change the results. Conclusions A substantial proportion of critically ill adults with ARDS were not intubated in their initial days of intensive care, and many were never intubated. Late intubation was associated with increased mortality. Criteria defining ARDS prior to need for positive pressure ventilation are needed so that these patients can be enrolled in clinical trials and to facilitate early recognition and treatment of ARDS. PMID:26474112

  8. Sepsis and ARDS: The Dark Side of Histones.

    PubMed

    Xu, Zhiheng; Huang, Yongbo; Mao, Pu; Zhang, Jianrong; Li, Yimin

    2015-01-01

    Despite advances in management over the last several decades, sepsis and acute respiratory distress syndrome (ARDS) still remain major clinical challenges and the leading causes of death for patients in intensive care units (ICUs) due to insufficient understanding of the pathophysiological mechanisms of these diseases. However, recent studies have shown that histones, also known as chromatin-basic structure proteins, could be released into the extracellular space during severe stress and physical challenges to the body (e.g., sepsis and ARDS). Due to their cytotoxic and proinflammatory effects, extracellular histones can lead to excessive and overwhelming cell damage and death, thus contributing to the pathogenesis of both sepsis and ARDS. In addition, antihistone-based treatments (e.g., neutralizing antibodies, activated protein C, and heparin) have shown protective effects and have significantly improved the outcomes of mice suffering from sepsis and ARDS. Here, we review researches related to the pathological role of histone in context of sepsis and ARDS and evaluate the potential value of histones as biomarkers and therapeutic targets of these diseases.

  9. Sepsis and ARDS: The Dark Side of Histones

    PubMed Central

    Xu, Zhiheng; Huang, Yongbo; Mao, Pu; Zhang, Jianrong; Li, Yimin

    2015-01-01

    Despite advances in management over the last several decades, sepsis and acute respiratory distress syndrome (ARDS) still remain major clinical challenges and the leading causes of death for patients in intensive care units (ICUs) due to insufficient understanding of the pathophysiological mechanisms of these diseases. However, recent studies have shown that histones, also known as chromatin-basic structure proteins, could be released into the extracellular space during severe stress and physical challenges to the body (e.g., sepsis and ARDS). Due to their cytotoxic and proinflammatory effects, extracellular histones can lead to excessive and overwhelming cell damage and death, thus contributing to the pathogenesis of both sepsis and ARDS. In addition, antihistone-based treatments (e.g., neutralizing antibodies, activated protein C, and heparin) have shown protective effects and have significantly improved the outcomes of mice suffering from sepsis and ARDS. Here, we review researches related to the pathological role of histone in context of sepsis and ARDS and evaluate the potential value of histones as biomarkers and therapeutic targets of these diseases. PMID:26609197

  10. BLOCKADE OF ENDOTHELIAL GROWTH FACTOR, ANGIOPOIETIN-2, REDUCES INDICES OF ARDS AND MORTALITY IN MICE RESULTING FROM THE DUAL-INSULTS OF HEMORRHAGIC SHOCK AND SEPSIS.

    PubMed

    Lomas-Neira, Joanne L; Heffernan, Daithi S; Ayala, Alfred; Monaghan, Sean F

    2016-02-01

    We have demonstrated hemorrhagic shock "priming" for the development of indirect acute respiratory distress syndrome (iARDS) in mice following subsequent septic challenge, and show pathology characteristic of patients with iARDS, including increased lung microvascular permeability and arterial PO2/FI02 reduced to levels comparable to mild/moderate ARDS during the 48 h following hemorrhage. Loss of endothelial cell (EC) barrier function is a major component in the development of iARDS. EC growth factors, Angiopoietin (Ang)-1 and 2, maintain vascular homeostasis via tightly regulated competitive interaction with tyrosine kinase receptor, Tie2, expressed on ECs. Ang-2/Tie2 binding, in contrast to Ang-1, is believed to produce vessel destabilization, pulmonary leakage, and inflammation. Recent clinical findings from our trauma/surgical intensive care units and others have reported elevated Ang-2 in the plasma from patients that develop ARDS. We have previously described similarly elevated Ang-2 in plasma and lung tissue in our shock/sepsis model for the development of iARDS, and demonstrated effective reduction in indices of inflammation and lung tissue injury following siRNA inhibition of Ang-2 protein synthesis. In this study we show that Ang-2 in lung tissue and plasma spikes following hemorrhage (priming) and remain elevated at sepsis induction. In addition, that transient inhibition of Ang-2 function immediately following hemorrhage, suppressing priming, but not following sepsis, impacts the development of iARDS in our model. Our data demonstrate that selective temporal blockade of Ang-2 function following hemorrhagic shock priming significantly improved PO2/FIO2, decreased lung protein leak and indices of inflammation, and improved 10-day survival in our murine model for the development iARDS.

  11. ARD remediation with limestone in a CO2 pressurized reactor

    USGS Publications Warehouse

    Sibrell, Philip L.; Watten, Barnaby J.; Friedrich, Andrew E.; Vinci, Brian J.

    2000-01-01

    We evaluated a new process for remediation of acid rock drainage (ARD). The process treats ARD with intermittently fluidized beds of granular limestone maintained within a continuous flow reactor pressurized with CO2. Tests were performed over a thirty day period at the Toby Creek mine drainage treatment plant, Elk County, Pennsylvania in cooperation with the Pennsylvania Department of Environmental Protection. Equipment performance was established at operating pressures of 0, 34, 82, and 117 kPa using an ARD flow of 227 L/min. The ARD had the following characteristics: pH, 3.1; temperature, 10 °C; dissolved oxygen, 6.4 mg/L; acidity, 260 mg/L; total iron, 21 mg/L; aluminum, 22 mg/L; manganese, 7.5 mg/L; and conductivity, 1400 μS/cm. In all cases tested, processed ARD was net alkaline with mean pH and alkalinities of 6.7 and 59 mg/L at a CO2 pressure of 0 kPa, 6.6 and 158 mg/L at 34 kPa, 7.4 and 240 mg/L at 82 kPa, and 7.4 and 290 mg/L at 117 kPa. Processed ARD alkalinities were correlated to the settled bed depth (p<0.001) and CO2 pressure (p<0.001). Iron, aluminum, and manganese removal efficiencies of 96%, 99%, and 5%, respectively, were achieved with filtration following treatment. No indications of metal hydroxide precipitation or armoring of the limestone were observed. The surplus alkalinity established at 82 kPa was successful in treating an equivalent of 1136 L/min (five-fold dilution) of the combined three ARD streams entering the Toby Creek Plant. This side-stream capability provides savings in treatment unit scale as well as flexibility in treatment effect. The capability of the system to handle higher influent acidity was tested by elevating the acidity to 5000 mg/L with sulfuric acid. Net alkaline effluent was produced, indicating applicability of the process to highly acidic ARD.

  12. Relationship between Concentrations of Lutein and StARD3 among Pediatric and Geriatric Human Brain Tissue.

    PubMed

    Tanprasertsuk, Jirayu; Li, Binxing; Bernstein, Paul S; Vishwanathan, Rohini; Johnson, Mary Ann; Poon, Leonard; Johnson, Elizabeth J

    2016-01-01

    Lutein, a dietary carotenoid, selectively accumulates in human retina and brain. While many epidemiological studies show evidence of a relationship between lutein status and cognitive health, lutein's selective uptake in human brain tissue and its potential function in early neural development and cognitive health have been poorly evaluated at a molecular level. The objective of this study was to evaluate the cross-sectional relationship between concentrations of brain lutein and StARD3 (identified as its binding protein in retinal tissue) among three age groups: infants (1-4 months, n = 10), older adults (55-86 years, n = 8), and centenarians (98-105 years, n = 10). Brain lutein concentrations were analyzed by high-performance liquid chromatography and StARD3 levels were analyzed by Western Blot analysis. The strong relationship in infant brains (r = 0.75, P < 0.001) suggests that lutein has a role in neural development. The relationship remained significant but weaker in older adults (r = 0.51, P < 0.05) and insignificant in centenarians (r = 0.08, P > 0.05), seven of whom had mild cognitive impairment (MCI) or dementia. These exploratory findings suggest an age-related decrease or abnormality of StARD3 activity in human brain. Given that StARD3 is also involved in cholesterol transportation, a process that is aberrant in neurodegenerative diseases, the potential protective function of lutein against these diseases remains to be explored.

  13. Findings

    MedlinePlus

    ... Issue All Issues Explore Findings by Topic Cell Biology Cellular Structures, Functions, Processes, Imaging, Stress Response Chemistry ... Glycobiology, Synthesis, Natural Products, Chemical Reactions Computers in Biology Bioinformatics, Modeling, Systems Biology, Data Visualization Diseases Cancer, ...

  14. Diffuse alveolar hemorrhage in patients with hematological malignancies: HRCT patterns of pulmonary involvement and disease course.

    PubMed

    Spira, Daniel; Wirths, Stefan; Skowronski, Felix; Pintoffl, Jan; Kaufmann, Sascha; Brodoefel, Harald; Horger, Marius

    2013-01-01

    To analyze high-resolution computed tomography (HRCT) patterns of lung involvement and disease course in patients with hematological malignancies experiencing diffuse alveolar hemorrhage (DAH) after chemotherapy ± allogeneic stem cell transplantation (allo-SCT). Sixteen patients experiencing DAH after chemotherapy ± allo-SCT were enrolled. A total of 74 computed tomography (CT) scans obtained before, during, and after onset of DAH were evaluated retrospectively. CT features of DAH are each, by oneself, nonspecific. However, conjoint bilateral, diffuse, and dependent ground glass opacity ± crazy paving, accompanied by airspace bronchograms, should suggest this complication. The HRCT course comprises a wide range of trends that are not predictive for patient's outcome, but progression of parenchymal consolidations at follow up was more often detrimental. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Automated Lung Segmentation from HRCT Scans with Diffuse Parenchymal Lung Diseases.

    PubMed

    Pulagam, Ammi Reddy; Kande, Giri Babu; Ede, Venkata Krishna Rao; Inampudi, Ramesh Babu

    2016-08-01

    Performing accurate and fully automated lung segmentation of high-resolution computed tomography (HRCT) images affected by dense abnormalities is a challenging problem. This paper presents a novel algorithm for automated segmentation of lungs based on modified convex hull algorithm and mathematical morphology techniques. Sixty randomly selected lung HRCT scans with different abnormalities are used to test the proposed algorithm, and experimental results show that the proposed approach can accurately segment the lungs even in the presence of disease patterns, with some limitations in the apices and bases of lungs. The algorithm demonstrates a high segmentation accuracy (dice similarity coefficient = 98.62 and shape differentiation metrics dmean = 1.39 mm, and drms = 2.76 mm). Therefore, the developed automated lung segmentation algorithm is a good candidate for the first stage of a computer-aided diagnosis system for diffuse lung diseases.

  16. Rotordynamics on the PC: Further Capabilities of ARDS

    NASA Technical Reports Server (NTRS)

    Fleming, David P.

    1997-01-01

    Rotordynamics codes for personal computers are now becoming available. One of the most capable codes is Analysis of RotorDynamic Systems (ARDS) which uses the component mode synthesis method to analyze a system of up to 5 rotating shafts. ARDS was originally written for a mainframe computer but has been successfully ported to a PC; its basic capabilities for steady-state and transient analysis were reported in an earlier paper. Additional functions have now been added to the PC version of ARDS. These functions include: 1) Estimation of the peak response following blade loss without resorting to a full transient analysis; 2) Calculation of response sensitivity to input parameters; 3) Formulation of optimum rotor and damper designs to place critical speeds in desirable ranges or minimize bearing loads; 4) Production of Poincard plots so the presence of chaotic motion can be ascertained. ARDS produces printed and plotted output. The executable code uses the full array sizes of the mainframe version and fits on a high density floppy disc. Examples of all program capabilities are presented and discussed.

  17. Personalized medicine for ARDS: the 2035 research agenda.

    PubMed

    Beitler, Jeremy R; Goligher, Ewan C; Schmidt, Matthieu; Spieth, Peter M; Zanella, Alberto; Martin-Loeches, Ignacio; Calfee, Carolyn S; Cavalcanti, Alexandre B

    2016-05-01

    In the last 20 years, survival among patients with acute respiratory distress syndrome (ARDS) has increased substantially with advances in lung-protective ventilation and resuscitation. Building on this success, personalizing mechanical ventilation to patient-specific physiology for enhanced lung protection will be a top research priority for the years ahead. However, the ARDS research agenda must be broader in scope. Further understanding of the heterogeneous biology, from molecular to mechanical, underlying early ARDS pathogenesis is essential to inform therapeutic discovery and tailor treatment and prevention strategies to the individual patient. The ARDSne(x)t research agenda for the next 20 years calls for bringing personalized medicine to ARDS, asking simultaneously both whether a treatment affords clinically meaningful benefit and for whom. This expanded scope necessitates standard acquisition of highly granular biological, physiological, and clinical data across studies to identify biologically distinct subgroups that may respond differently to a given intervention. Clinical trials will need to consider enrichment strategies and incorporate long-term functional outcomes. Tremendous investment in research infrastructure and global collaboration will be vital to fulfilling this agenda.

  18. Differences in radiological/HRCT findings in eosinophilic bronchitis and asthma: implication for bronchial responsiveness

    PubMed Central

    Park, S‐W; Park, J‐S; Lee, Y‐M; Lee, J‐H; Jang, A‐S; Kim, D‐J; Hwangbo, Y; Uh, S‐T; Kim, Y‐H; Park, C‐S

    2006-01-01

    Background Airway hyperresponsiveness in asthmatics is considered to be one of the major consequences of airway inflammation and remodelling. Airway responsiveness is normal in patients with eosinophilic bronchitis (EB), despite eosinophilic inflammation of the airways comparable to that which occurs in asthmatics. Comparisons between asthma and EB should clarify the changes in airway morphology that are related specifically to AHR in asthmatics. Methods Eighteen asthmatic patients, 15 patients with EB, and 11 healthy subjects were recruited. Airway wall area percentage (WA%), centrilobular prominence, and air trapping were compared using thin slice section computed tomography. Results WA% was significantly greater in asthmatics than in patients with EB (72 (3.1)% v 54 (2.1)%, p = 0.032) and was similar in EB patients and controls (54 (2.1)% v 57 (1.8)%, p>0.05). Centrilobular prominence and air trapping were similar in EB patients and asthmatics and were significantly greater than in controls. Conclusion WA% rather than air trapping or centrilobular prominence may be associated with the airway hyperresponsiveness that occurs in asthmatics but not in patients with EB. PMID:16244090

  19. The Acute Respiratory Distress Syndrome (ARDS) in mechanically ventilated burn patients: An analysis of risk factors, clinical features, and outcomes using the Berlin ARDS definition.

    PubMed

    Cartotto, Robert; Li, Zeyu; Hanna, Steven; Spano, Stefania; Wood, Donna; Chung, Karen; Camacho, Fernando

    2016-11-01

    The Berlin definition of Acute Respiratory Distress Syndrome (ARDS) has been applied to military burns resulting from combat-related trauma, but has not been widely studied among civilian burns. This study's purpose was to use the Berlin definition to determine the incidence of ARDS, and its associated respiratory morbidity, and mortality among civilian burn patients. Retrospective study of burn patients mechanically ventilated for ≥48h at an American Burn Association-verified burn center. The Berlin criteria identified patients with mild, moderate, and severe ARDS. Logistic regression was used to identify variables predictive of moderate to severe ARDS, and mortality. The outcome measures of interest were duration of mechanical ventilation and in-hospital mortality. Values are shown as the median (Q1-Q3). We included 162 subjects [24% female, age 48 (35-60), % total body surface area (TBSA) burn 28 (19-40), % body surface area (BSA) full thickness (FT) burn 13 (0-30), and 62% with inhalation injury]. The incidence of ARDS was 43%. Patients with ARDS had larger %TBSA burns [30.5 (23.1-47.0) vs. 24.8 (17.1-35), p=0.007], larger FT burns [20.5(5.4-35.5) vs. 7 (0-22.1), p=0.001], but had no significant difference in the incidence of inhalation injury (p=0.216), compared to those without ARDS. The % FT burn predicted the development of moderate to severe ARDS [OR 1.034, 95%CI (1.013-1.055), p=0.001]. ARDS developed in the 1st week after burn in 86% of cases. Worsening severity of ARDS was associated with increased days of mechanical ventilation in survivors (p=0.001), a reduction in ventilator-free days/1st 30 days in all subjects (p=0.004), and a strong indication of increased mortality (0% in mild ARDS vs. 50% in severe ARDS, unadjusted p=0.02). Neither moderate ARDS nor severe ARDS were significant predictors of death. ARDS is common among mechanically ventilated civilian burn patients, and develops early after burn. The extent of full thickness burn predicted

  20. Expiratory model-based method to monitor ARDS disease state

    PubMed Central

    2013-01-01

    Introduction Model-based methods can be used to characterise patient-specific condition and response to mechanical ventilation (MV) during treatment for acute respiratory distress syndrome (ARDS). Conventional metrics of respiratory mechanics are based on inspiration only, neglecting data from the expiration cycle. However, it is hypothesised that expiratory data can be used to determine an alternative metric, offering another means to track patient condition and guide positive end expiratory pressure (PEEP) selection. Methods Three fully sedated, oleic acid induced ARDS piglets underwent three experimental phases. Phase 1 was a healthy state recruitment manoeuvre. Phase 2 was a progression from a healthy state to an oleic acid induced ARDS state. Phase 3 was an ARDS state recruitment manoeuvre. The expiratory time-constant model parameter was determined for every breathing cycle for each subject. Trends were compared to estimates of lung elastance determined by means of an end-inspiratory pause method and an integral-based method. All experimental procedures, protocols and the use of data in this study were reviewed and approved by the Ethics Committee of the University of Liege Medical Faculty. Results The overall median absolute percentage fitting error for the expiratory time-constant model across all three phases was less than 10 %; for each subject, indicating the capability of the model to capture the mechanics of breathing during expiration. Provided the respiratory resistance was constant, the model was able to adequately identify trends and fundamental changes in respiratory mechanics. Conclusion Overall, this is a proof of concept study that shows the potential of continuous monitoring of respiratory mechanics in clinical practice. Respiratory system mechanics vary with disease state development and in response to MV settings. Therefore, titrating PEEP to minimal elastance theoretically results in optimal PEEP selection. Trends matched clinical

  1. Evaluation of endothelial damage in sepsis-related ARDS using circulating endothelial cells.

    PubMed

    Moussa, Mouhamed Djahoum; Santonocito, Cristina; Fagnoul, David; Donadello, Katia; Pradier, Olivier; Gaussem, Pascale; De Backer, Daniel; Vincent, Jean-Louis

    2015-02-01

    Endothelial cell activation and dysfunction are involved in the pathophysiology of ARDS. Circulating endothelial cells (CECs) may be a useful marker of endothelial dysfunction and damage but have been poorly studied in ARDS. We hypothesized that the CEC count may be elevated in patients with sepsis-related ARDS compared to those with sepsis without ARDS. ARDS was defined according to the Berlin consensus definition. The study population included 17 patients with moderate or severe ARDS, 9 with mild ARDS, 13 with sepsis and no ARDS, 13 non-septic patients, and 12 healthy volunteers. Demographic, hemodynamic, and prognostic variables, including PaO(2)/FiO(2) ratio, 28-day survival, blood lactate, APACHE II, and SOFA score, were recorded. CECs were counted in arterial blood samples using the reference CD146 antibody-based immunomagnetic isolation and UEA1-FITC staining method. Measurements were performed 12-24 h after diagnosis of ARDS and repeated daily for 3 days. The median day-1 CEC count was significantly higher in patients with moderate or severe ARDS than in mild ARDS or septic-control patients [27.2 (18.3-49.4) vs. 17.4 (11-24.5) cells/ml (p < 0.034), and 18.4 (9.1-31) cells/ml (p < 0.035), respectively]. All septic patients (with or without ARDS) had higher day-1 CEC counts than the non-septic patients [19.6 (14.2-30.6) vs. 10.8 (5.7-13.2) cells/ml, p = 0.002]. The day-1 CEC count was significantly higher in ARDS patients than in other critically ill patients, and in moderate or severe ARDS patients compared to those with milder disease, making it a potentially useful marker of ARDS severity.

  2. Abort Region Determinator (ARD) module feasibility report. Mission planning, mission analysis and software formulation

    NASA Technical Reports Server (NTRS)

    Draeger, B. G.; Joyner, J. A.

    1976-01-01

    A detailed performance evaluation of the Abort Region Determinator (ARD) module design was provided in support of OFT-1 ascent and OFT-1 intact launch aborts. The evaluation method used compared ARD results against results obtained using the full-up Space Vehicle Dynamic Simulations program under the same conditions. Results were presented for each of the three major ARD math models: (1) the ascent numerical integrator; (2) the mass model, and (3) the second stage predictor as well as the total ARD module. These results demonstrate that the baselined ARD module meets all design objectives for mission control center orbital flight test launch/abort support.

  3. Improvement of in vivo antimicrobial activity of HBcARD peptides by D-arginine replacement.

    PubMed

    Chen, Heng-Li; Su, Pei-Yi; Shih, Chiaho

    2016-11-01

    We previously identified a novel antimicrobial peptide with a broad spectrum bactericidal activity from human hepatitis B virus (HBV) core protein (HBc) arginine-rich domain (ARD). We compared the antimicrobial activities of HBcARD peptides from different hepadnaviruses which share similar amino acid sequences. In general, mammalian HBcARD peptides exhibited stronger antimicrobial activity than avian peptides. Using the strategy of D-amino acid substitutions, we improved the antimicrobial efficacy of human HBcARD peptide. This D-HBcARD peptide was much more resistant than L-HBcARD peptide to proteolytic degradation in vitro. Moreover, this D-HBcARD peptide maintained similar minimal bactericidal concentrations (MBC) against tested bacteria, and showed very low hemolytic activity. In the Staphylococcus aureus-infected mouse model, this D-HBcARD peptide was more protective than the L-HBcARD peptide. Repeated treatments with either L- or D-HBcARD peptides induced no significant immunogenicity. New derivatives of HBcARD peptides could serve as alternatives to the conventional antibiotics in clinical medicine in the future.

  4. Contemporary ventilator management in patients with and at risk of ALI/ARDS.

    PubMed

    Chang, Steven Y; Dabbagh, Ousama; Gajic, Ognen; Patrawalla, Amee; Elie, Marie-Carmelle; Talmor, Daniel S; Malhotra, Atul; Adesanya, Adebola; Anderson, Harry L; Blum, James M; Park, Pauline K; Gong, Michelle Ng

    2013-04-01

    Ventilator practices in patients at risk for acute lung injury (ALI) and ARDS are unclear. We examined factors associated with choice of set tidal volumes (VT), and whether VT < 8 mL/kg predicted body weight (PBW) relates to the development of ALI/ARDS. We performed a secondary analysis of a multicenter cohort of adult subjects at risk of lung injury with and without ALI/ARDS at onset of invasive ventilation. Descriptive statistics were used to describe ventilator practices in specific settings and ALI/ARDS risk groups. Logistic regression analysis was used to determine the factors associated with the use of VT < 8 mL/kg PBW and the relationship of VT to ALI/ARDS development and outcome. Of 829 mechanically ventilated patients, 107 met the criteria for ALI/ARDS at time of intubation, and 161 developed ALI/ARDS after intubation (post-intubation ALI/ARDS). There was significant intercenter variability in initial ventilator settings, and in the incidence of ALI/ARDS and post-intubation ALI/ARDS. The median VT was 7.96 (IQR 7.14-8.94) mL/kg PBW in ALI/ARDS subjects, and 8.45 (IQR 7.50-9.55) mL/kg PBW in subjects without ALI/ARDS (P = .004). VT decreased from 8.40 (IQR 7.38-9.37) mL/kg PBW to 7.97 (IQR 6.90-9.23) mL/kg PBW (P < .001) in those developing post-intubation ALI/ARDS. Among subjects without ALI/ARDS, VT ≥ 8 mL/kg PBW was associated with shorter height and higher body mass index, while subjects with pneumonia were less likely to get ≥ 8 mL/kg PBW. Initial VT ≥ 8 mL/kg PBW was not associated with the post-intubation ALI/ARDS (adjusted odds ratio 1.30, 95% CI 0.74-2.29) or worse outcomes. Post-intubation ALI/ARDS subjects had mortality similar to subjects intubated with ALI/ARDS. Clinicians seem to respond to ALI/ARDS with lower initial VT. Initial VT, however, was not associated with the development of post-intubation ALI/ARDS or other outcomes.

  5. Clinical Course and Changes in High-Resolution Computed Tomography Findings in Patients with Idiopathic Pulmonary Fibrosis without Honeycombing

    PubMed Central

    Bando, Masashi; Baba, Tomohisa; Kataoka, Kensuke; Yamada, Yoshihito; Yamamoto, Hiroshi; Miyamoto, Atsushi; Ikushima, Soichiro; Johkoh, Takeshi; Sakai, Fumikazu; Terasaki, Yasuhiro; Hebisawa, Akira; Kawabata, Yoshinori; Sugiyama, Yukihiko; Ogura, Takashi

    2016-01-01

    Some patients with idiopathic pulmonary fibrosis (IPF) do not have honeycombing on high-resolution computed tomography (HRCT) at their initial evaluation. The clinical course and sequential changes in HRCT findings in these patients are not fully understood. We reviewed the cases of 43 patients with IPF without honeycombing on initial HRCT from institutions throughout Japan. All patients were diagnosed with IPF based on a surgical lung biopsy. Multidisciplinary discussions were held five times between 2011 and 2014, to exclude alternative etiologies. We evaluated the sequential changes in HRCT findings in 30 patients with IPF. We classified these 30 patients into three groups based on their HRCT patterns and clarified the clinical characteristics and prognosis among the groups. The patterns of all 30 patients on initial HRCT corresponded to a possible usual interstitial pneumonia (UIP) pattern which was described in the 2011 International Statement. On long-term follow-up (71.0±38.7 standard deviation [SD] months), honeycombing was seen in 16 patients (53%, the HoneyCo group); traction bronchiectasis or cysts without honeycombing was observed in 12 patients (40%, the NoHoneyCo group), and two patients showed no interval change (7%, the NoChange group) on HRCT. The mean survival periods of the HoneyCo and NoHoneyCo groups were 67.1 and 61.2 months, respectively (p = 0.76). There are some patients with IPF whose conditions chronically progress without honeycombing on HRCT. The appearance of honeycombing on HRCT during the follow-up might not be related to prognosis. PMID:27829068

  6. Rotordynamics on the PC: Transient Analysis With ARDS

    NASA Technical Reports Server (NTRS)

    Fleming, David P.

    1997-01-01

    Personal computers can now do many jobs that formerly required a large mainframe computer. An example is NASA Lewis Research Center's program Analysis of RotorDynamic Systems (ARDS), which uses the component mode synthesis method to analyze the dynamic motion of up to five rotating shafts. As originally written in the early 1980's, this program was considered large for the mainframe computers of the time. ARDS, which was written in Fortran 77, has been successfully ported to a 486 personal computer. Plots appear on the computer monitor via calls programmed for the original CALCOMP plotter; plots can also be output on a standard laser printer. The executable code, which uses the full array sizes of the mainframe version, easily fits on a high-density floppy disk. The program runs under DOS with an extended memory manager. In addition to transient analysis of blade loss, step turns, and base acceleration, with simulation of squeeze-film dampers and rubs, ARDS calculates natural frequencies and unbalance response.

  7. Respiratory mechanics to understand ARDS and guide mechanical ventilation.

    PubMed

    Mauri, Tommaso; Lazzeri, Marta; Bellani, Giacomo; Zanella, Alberto; Grasselli, Giacomo

    2017-10-02

    As precision medicine is becoming standard of care to select tailored rather than average treatments, physiological measurements might represent the first step to apply personalized therapy in the intensive care unit (ICU). Systematic assessment of respiratory mechanics in patients with the acute respiratory distress syndrome (ARDS) could represent a step towards this direction for two main reasons. On the one hand, respiratory mechanics are a powerful physiological method to understand the severity of this syndrome in each single patient. Decreased respiratory system compliance, for example, is associated with low end expiratory lung volume and more severe lung injury. On the other, respiratory mechanics might guide protective mechanical ventilation settings. Improved gravitationally dependent regional lung compliance could support selection of positive end-expiratory pressure and maximize alveolar recruitment. Moreover, the association between driving airway pressure and mortality in ARDS patients potentially underlines the importance of sizing tidal volume on respiratory system compliance rather than on predicted body weight. The present review article aims to describe the main alterations of respiratory mechanics in ARDS as a potent bedside tool to understand severity and guide mechanical ventilation settings, thus representing a readily available clinical resource for ICU physicians. © 2017 Institute of Physics and Engineering in Medicine.

  8. High-resolution CT findings of patients with pulmonary nocardiosis

    PubMed Central

    Tsujimoto, Naoki; Saraya, Takeshi; Kikuchi, Ken; Takata, Saori; Kurihara, Yasuyuki; Hiraoka, Sayuki; Makino, Hiroshi; Yonetani, Shota; Araki, Koji; Ishii, Haruyuki; Takizawa, Hajime

    2012-01-01

    Background Opportunistic pulmonary infection with Nocardia species is rare in humans, and only a few studies have radiologically analyzed patients with pulmonary nocardiosis using high-resolution computed tomography (HRCT). Methods We retrospectively reviewed the medical records of patients with pulmonary nocardiosis at our hospital between April 2006 and December 2011 to assess HRCT and clinical findings. We also searched the medical literature for pulmonary nocardiosis reported in Japan between 2002 and 2011 for comparison. Results We identified seven patients at our institution and 33 reported infections in Japan. Four of our patients were immunocompetent, whereas the other three had impaired cellular immunity due to type 2 diabetes mellitus or having been inappropriately treated with steroid. Thoracic HRCT revealed no zonal predominance, but tropism for distribution from the middle to the peripheral area, and radiological findings of nodules, cavitation, mass, consolidations, bronchial wall thickening, septal line thickening and ground glass opacity (GGO) were evident. The main HRCT finding in our study comprised nodules (n=5, 71.4%) <30 mm and four patients had multiple nodules as described in other reports. Furthermore, we discovered a crazy paving appearance (CPA) around nodules, cavities, masses or consolidations in five patients (71.4%). Conclusions Multiple nodules distributed from the middle to the peripheral area on HRCT might reflect pulmonary nocardiosis, and CPA seemed to be a worth paying attention to the diagnosis. PMID:23205281

  9. High-resolution CT findings of pulmonary tuberculosis in liver transplant patients.

    PubMed

    Schuhmacher Neto, R; Giacomelli, I L; Schuller Nin, C; da Silva Moreira, J; Comaru Pasqualotto, A; Marchiori, E; Loureiro Irion, K; Hochhegger, B

    2017-10-01

    To assess the high-resolution computed tomography (HRCT) findings in liver transplant patients diagnosed with pulmonary Mycobacterium tuberculosis infection. The HRCT findings from 19 patients diagnosed with pulmonary tuberculosis infection after liver transplantation were reviewed. The patients included were 12 men and seven women, age range 23-65 years; mean age 57 years. The diagnosis was established with Mycobacterium tuberculosis detection in bronchoalveolar lavage, sputum, or biopsy. HRCT images were reviewed independently by two observers who reached a consensus decision. The HRCT findings were classified as (1) miliary nodules; (2) cavitation and centrilobular tree-in-bud nodules; (3) ground-glass attenuation and consolidation; and (4) mediastinal lymph node enlargement. The time between the transplantation and the diagnosis of pulmonary tuberculosis ranged from 7 to 153 days with an average of 79 days. The main HRCT pattern was cavitation and centrilobular tree-in-bud nodules (79%) followed by mediastinal lymph node enlargement (10.4%), ground-glass attenuation or consolidation (5.2%) and miliary nodules (5.2%). None of the patients presented pleural effusion. The cavitation and centrilobular tree-in-bud nodules pattern had upper lobe predominance, and ground-glass attenuation and consolidation pattern had middle lobe/lingular segment predominance. The main HRCT pattern of pulmonary tuberculosis in liver transplant patients was cavitation and centrilobular tree-in-bud nodules. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  10. The selective pulmonary vasodilatory effect of inhaled DETA/NO, a novel nitric oxide donor, in ARDS-a pilot human trial.

    PubMed

    Lam, Chen-Fuh; Van Heerden, P Vernon; Blott, John; Roberts, Brigit; Ilett, Kenneth F

    2004-03-01

    To examine the effects of inhaled NONOates in patients with acute respiratory distress syndrome (ARDS). Case-series, phase I clinical trial. A multidisciplinary intensive care unit in a tertiary teaching hospital. Five consecutive patients with ARDS (men; age range, 47-76 years). DETA/NO (150 micromol) was aerosolized into the lungs of patients on mechanical ventilation via the endotracheal tube over 20 minutes. Hemodynamic parameters were measured and blood samples were taken before, during, and after inhalation. Compared to baseline values, pulmonary vascular resistance decreased until the end of the study period (180 minutes) while intrapulmonary shunting decreased significantly up to 45 min after DETA/NO aerosol administration. Inhaled DETA/NO had no effect on the systemic circulation (systemic blood pressure or cardiac output). Inhaled DETA/NO is a selective pulmonary vasodilator in patients with ARDS. However, a larger number of patients is required to confirm the findings of this pilot study.

  11. Effect of Aspirin on Development of ARDS in At-Risk Patients Presenting to the Emergency Department

    PubMed Central

    Kor, Daryl J.; Carter, Rickey E.; Park, Pauline K.; Festic, Emir; Banner-Goodspeed, Valerie M.; Hinds, Richard; Talmor, Daniel; Gajic, Ognjen; Ware, Lorraine B.; Gong, Michelle Ng

    2017-01-01

    .16 (−1.75 to 1.43) .87  Hospital length of stay, mean (SD), d 8.8 (10.3) 9.0 (9.9) −0.27 (−1.96 to 1.42) .79  28-Day survival, % (90% CI) 90 (86 to 93) 90 (86 to 93) HR, 1.03 (90% CI, 0.60 to 1.79) .92  1-Year estimated survival, % (90% CI) 73 (67 to 78) 75 (69 to 80) HR, 1.06 (90% CI, 0.75 to 1.50) .79  Bleeding-related adverse events, No. (%) 11 (5.6) 5 (2.6) OR, 2.27 (90% CI, 0.92 to 5.61) .13 CONCLUSIONS AND RELEVANCE Among at-risk patients presenting to the ED, the use of aspirin compared with placebo did not reduce the risk of ARDS at 7 days. The findings of this phase 2b trial do not support continuation to a larger phase 3 trial. PMID:27179988

  12. Management of ARDS and Refractory Hypoxemia: A Multicenter Observational Study.

    PubMed

    Duan, Erick H; Adhikari, Neill Kj; D'Aragon, Frederick; Cook, Deborah J; Mehta, Sangeeta; Alhazzani, Waleed; Goligher, Ewan; Charbonney, Emmanuel; Arabi, Yaseen M; Karachi, Tim; Turgeon, Alexis F; Hand, Lori; Zhou, Qi; Austin, Peggy; Friedrich, Jan; Lamontagne, Francois; Lauzier, François; Patel, Rakesh; Muscedere, John; Hall, Richard; Aslanian, Pierre; Piraino, Thomas; Albert, Martin; Bagshaw, Sean M; Jacka, Mike; Wood, Gordon; Henderson, William; Dorscheid, Delbert; Ferguson, Niall D; Meade, Maureen O

    2017-09-14

    Clinicians' current practice patterns in the management of acute respiratory distress syndrome (ARDS) and refractory hypoxemia are not well described. To describe mechanical ventilation strategies and treatment adjuncts for adults with ARDS including refractory hypoxemia. Prospective cohort study (March 2014-February 2015) of mechanically ventilated adults with moderate-to-severe ARDS requiring FiO2 ≥0.50 in 24 ICUs. We enrolled 664 patients: 222 (33%) with moderate and 442 (67%) with severe ARDS. On study day 1, mean tidal volume (VT) was 7.5 (SD2.1) ml/kg predicted body weight (n=625); 79% (n=496) received VT>6 ml/kg. Mean positive end-expiratory pressure (PEEP) was 10.5 (3.7) cmH2O (n=653); 568 patients (87%) received PEEP<15 cmH2O. Treatment adjuncts were common (n=440, 66%): neuromuscular blockers (n=276, 42%), pulmonary vasodilators (n=118, 18%), prone positioning (n=67, 10%), extracorporeal life support (n=29, 4%), and high-frequency oscillatory ventilation (n=29, 4%). Refractory hypoxemia, defined as PaO2<60 mmHg on FiO2 1.0, occurred in 138 (21%) patients. At onset of refractory hypoxemia, mean VT was 7.1 (2.0) ml/kg (n=127); 32 patients (26%) received VT>8 ml/kg. Mean PEEP was 12.1 (4.4) cmH2O (n=135); 99 patients (74%) received PEEP<15 cmH2O. Among patients with refractory hypoxemia, 91% received treatment adjuncts (126/138), with increased use of neuromuscular blockers (n=96, 70%), pulmonary vasodilators (n=62, 45%), and prone positioning (n=37, 27%). Patients with moderate-to-severe ARDS, receive treatment adjuncts frequently, especially with refractory hypoxemia. Paradoxically, therapies with less evidence supporting their use (e.g. pulmonary vasodilators) were over-utilized, while those with more evidence (e.g. prone positioning, neuromuscular blockade) were under-utilized. Patients received higher tidal volumes and lower PEEP than would be suggested by the evidence.

  13. Predictive criteria to study the pathogenesis of malaria-associated ALI/ARDS in mice.

    PubMed

    Ortolan, Luana S; Sercundes, Michelle K; Barboza, Renato; Debone, Daniela; Murillo, Oscar; Hagen, Stefano C F; Russo, Momtchilo; D' Império Lima, Maria Regina; Alvarez, José M; Amaku, Marcos; Marinho, Claudio R F; Epiphanio, Sabrina

    2014-01-01

    Malaria-associated acute lung injury/acute respiratory distress syndrome (ALI/ARDS) often results in morbidity and mortality. Murine models to study malaria-associated ALI/ARDS have been described; we still lack a method of distinguishing which mice will develop ALI/ARDS before death. This work aimed to characterize malaria-associated ALI/ARDS in a murine model and to demonstrate the first method to predict whether mice are suffering from ALI/ARDS before death. DBA/2 mice infected with Plasmodium berghei ANKA developing ALI/ARDS or hyperparasitemia (HP) were compared using histopathology, PaO2 measurement, pulmonary X-ray, breathing capacity, lung permeability, and serum vascular endothelial growth factor (VEGF) levels according to either the day of death or the suggested predictive criteria. We proposed a model to predict malaria-associated ALI/ARDS using breathing patterns (enhanced pause and frequency respiration) and parasitemia as predictive criteria from mice whose cause of death was known to retrospectively diagnose the sacrificed mice as likely to die of ALI/ARDS as early as 7 days after infection. Using this method, we showed increased VEGF levels and increased lung permeability in mice predicted to die of ALI/ARDS. This proposed method for accurately identifying mice suffering from ALI/ARDS before death will enable the use of this model to study the pathogenesis of this disease.

  14. Predictive Criteria to Study the Pathogenesis of Malaria-Associated ALI/ARDS in Mice

    PubMed Central

    Ortolan, Luana S.; Sercundes, Michelle K.; Debone, Daniela; Hagen, Stefano C. F.; D' Império Lima, Maria Regina; Alvarez, José M.; Marinho, Claudio R. F.; Epiphanio, Sabrina

    2014-01-01

    Malaria-associated acute lung injury/acute respiratory distress syndrome (ALI/ARDS) often results in morbidity and mortality. Murine models to study malaria-associated ALI/ARDS have been described; we still lack a method of distinguishing which mice will develop ALI/ARDS before death. This work aimed to characterize malaria-associated ALI/ARDS in a murine model and to demonstrate the first method to predict whether mice are suffering from ALI/ARDS before death. DBA/2 mice infected with Plasmodium berghei ANKA developing ALI/ARDS or hyperparasitemia (HP) were compared using histopathology, PaO2 measurement, pulmonary X-ray, breathing capacity, lung permeability, and serum vascular endothelial growth factor (VEGF) levels according to either the day of death or the suggested predictive criteria. We proposed a model to predict malaria-associated ALI/ARDS using breathing patterns (enhanced pause and frequency respiration) and parasitemia as predictive criteria from mice whose cause of death was known to retrospectively diagnose the sacrificed mice as likely to die of ALI/ARDS as early as 7 days after infection. Using this method, we showed increased VEGF levels and increased lung permeability in mice predicted to die of ALI/ARDS. This proposed method for accurately identifying mice suffering from ALI/ARDS before death will enable the use of this model to study the pathogenesis of this disease. PMID:25276057

  15. RB-ARD: A proof of concept rule-based abort

    NASA Technical Reports Server (NTRS)

    Smith, Richard; Marinuzzi, John

    1987-01-01

    The Abort Region Determinator (ARD) is a console program in the space shuttle mission control center. During shuttle ascent, the Flight Dynamics Officer (FDO) uses the ARD to determine the possible abort modes and make abort calls for the crew. The goal of the Rule-based Abort region Determinator (RB/ARD) project was to test the concept of providing an onboard ARD for the shuttle or an automated ARD for the mission control center (MCC). A proof of concept rule-based system was developed on a LMI Lambda computer using PICON, a knowdedge-based system shell. Knowdedge derived from documented flight rules and ARD operation procedures was coded in PICON rules. These rules, in conjunction with modules of conventional code, enable the RB-ARD to carry out key parts of the ARD task. Current capabilities of the RB-ARD include: continuous updating of the available abort mode, recognition of a limited number of main engine faults and recommendation of safing actions. Safing actions recommended by the RB-ARD concern the Space Shuttle Main Engine (SSME) limit shutdown system and powerdown of the SSME Ac buses.

  16. Association of Heme Oxygenase 1 with Lung Protection in Malaria-Associated ALI/ARDS

    PubMed Central

    Pereira, Marcelo L. M.; Ortolan, Luana S.; Sercundes, Michelle K.; Debone, Daniela; Murillo, Oscar; Lima, Flávia A.

    2016-01-01

    Malaria is a serious disease, caused by the parasite of the genus Plasmodium, which was responsible for 440,000 deaths in 2015. Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is one of the main clinical complications in severe malaria. The murine model DBA/2 reproduces the clinical signs of ALI/ARDS in humans, when infected with Plasmodium berghei ANKA. High levels of HO-1 were reported in cases of severe malaria. Our data indicated that the HO-1 mRNA and protein expression are increased in mice that develop malaria-associated ALI/ARDS (MA-ALI/ARDS). Additionally, the hemin, a HO-1 inducing drug, prevented mice from developing MA-ALI/ARDS when administered prior to the development of MA-ALI/ARDS in this model. Also, hemin treatment showed an amelioration of respiratory parameters in mice, high VEGF levels in the sera, and a decrease in vascular permeability in the lung, which are signs of ALI/ARDS. Therefore, the induction of HO-1 before the development of MA-ALI/ARDS could be protective. However, the increased expression of HO-1 on the onset of MA-ALI/ARDS development may represent an effort to revert the phenotype of this syndrome by the host. We therefore confirm that HO-1 inducing drugs could be used for prevention of MA-ALI/ARDS in humans. PMID:27974865

  17. Early detection of right ventricular dysfunction using transthoracic echocardiography in ARDS: a more objective approach.

    PubMed

    Wadia, Subeer Kanwar; Shah, Trushil G; Hedstrom, Grady; Kovach, Julie A; Tandon, Rajive

    2016-12-01

    Right ventricular (RV) dysfunction is an independent predictor of morbidity and mortality in acute respiratory distress syndrome (ARDS). Our goal was to describe morphologic changes in the RV using objective measures on transthoracic echocardiography (TTE) that occur following ARDS. We retrospectively measured changes in the following RV parameters from a pre-ARDS TTE to an ARDS TTE: tricuspid annular plane systolic excursion (TAPSE), myocardial performance index (MPI), fractional area change (FAC), systolic pulmonary artery pressure (SPAP), peak tricuspid regurgitant (TR) velocity, and septal shift. Over 24 months, 14 patients met inclusion/exclusion criteria. Mean TAPSE decreased from 22.4 mm pre-ARDS to 16.3 mm during ARDS, P<.001. Mean MPI increased from 0.19 to 0.38, P=.001. Mean FAC decreased from 60.8% to 41.2%, P=.003. Peak TR velocity increased from 2.67 m/s pre-ARDS to 3.31 m/s during ARDS, P=.02. SPAP and septal shift demonstrated trends but not statistically different between pre-ARDS and ARDS states. TAPSE correlated with ARDS severity (PaO2 /FiO2 ratios), P=.004, and was lower among 30-day nonsurvivors compared with survivors, P=.002. Mild RV dysfunction is common after ARDS onset. RV morphologic changes coupled with dysfunction can be detected noninvasively through TTE changes with TAPSE, MPI, and FAC. Mild RV dysfunction by TAPSE is associated with ARDS severity and mortality. © 2016, Wiley Periodicals, Inc.

  18. Alveolar overdistension is an important mechanism of persistent lung damage following severe protracted ARDS.

    PubMed

    Finfer, S; Rocker, G

    1996-10-01

    It is now widely accepted that mechanical ventilation may damage the lung, but the mechanism of lung damage is not clear. Possible causes include overdistension of aerated alveoli by inappropriately large tidal volumes (volutrauma), shear stresses generated during the recruitment and de-recruitment of lung units at the junction of aerated and collapsed lung, and infective or ischaemic necrosis of persistently collapsed lung. Computerized tomography allows noninvasive assessment of lung structure during and after acute lung injury, and may provide insight into the mechanism of lung damage. Using serial high resolution computed tomography we documented lung structure one month after recovery from severe protracted adult respiratory distress syndrome (ARDS) in three patients who required mechanical ventilation for between 86 and 97 days; the computed tomograms were repeated at between 5 and 14 months. All three patients had persistent abnormalities of lung structure which were most marked in the anterior regions of the lung. These findings suggest that overdistension of non-dependent lung regions in the main mechanism of lung damage persisting after recovery from severe protracted ARDS.

  19. The image variations in mastoid segment of facial nerve and sinus tympani in congenital aural atresia by HRCT and 3D VR CT.

    PubMed

    Wang, Zhen; Hou, Qian; Wang, Pu; Sun, Zhaoyong; Fan, Yue; Wang, Yun; Xue, Huadan; Jin, Zhengyu; Chen, Xiaowei

    2015-09-01

    To find the variations of middle ear structures including the spatial pattern of mastoid segment of facial nerve and the shapes of the sinus tympani in patients with congenital aural atresia (CAA) by using the high-resolution (HR) CT and 3D volume rendered (VR) CT images. HRCT was performed in 25 patients with congenital aural atresia including six bilateral atresia patients (n=25, 21 males, 4 females, mean age 13.8 years, range 6-19). Along the long axis of the posterior semicircular canal ampulla, the oblique axial multiplanar reconstruction (MPR) was set to view the depiction of the round window and the mastoid segment of facial nerve. Volumetric rending technique was used to demonstrate the morphologic features. HRCT and 3D VR findings in atresia ears were compared with those in 19 normal ears of the unilateral ears of atresia patients. On the basic plane, the horizontal line distances between the mastoid segment of the facial nerve and the round window (h-RF) in atresia ears significantly decreased compared to the control ears (P<0.05). There was a significant negative correlation between the sinus tympani area (a-ST) and the distance between the horizontal lines of FN and RW midpoint (h-RF) (P<0.05). The mean area of sinus tympani in atresia group is larger (P<0.05). The shapes of the sinus tympani were classified into three categories: the cup-shaped, the pear-shaped and the boot-shaped. Area measurement indicated that the boot-shaped sinus tympani was a special variation with a large area, which only appears in CAA group. There were a significant difference between the area of the boot-shaped group and the other two groups (P<0.05). The morphologic differences of ST and other middle ear structures can also be observed visually in 3D VR CT images. HRCT and 3D VR CT could help a better understanding of different kinds of variations in mastoid segment of facial nerve and sinus tympani in CAA ears. And it may further help surgeons to make the correct decision

  20. Ventilation/perfusion SPECT in chronic obstructive pulmonary disease: an evaluation by reference to symptoms, spirometric lung function and emphysema, as assessed with HRCT.

    PubMed

    Jögi, Jonas; Ekberg, Marie; Jonson, Björn; Bozovic, Gracijela; Bajc, Marika

    2011-07-01

    Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation which is not fully reversible. Despite the heterogeneity of COPD, its diagnosis and staging is currently based solely on forced expiratory volume in 1 s (FEV(1)). FEV(1) does not explain the underlying pathophysiology of airflow limitation. The relationship between FEV(1), symptoms and emphysema extent is weak. Better diagnostic tools are needed to define COPD. Tomographic lung scintigraphy [ventilation/perfusion single photon emission tomography (V/P SPECT)] visualizes regional V and P. In COPD, relations between V/P SPECT, spirometry, high-resolution computed tomography (HRCT) and symptoms have been insufficiently studied. The aim of this study was to investigate how lung function imaging and obstructive disease grading undertaken using V/P SPECT correlate with symptoms, spirometric lung function and degree of emphysema assessed with HRCT in patients with COPD. Thirty patients with stable COPD were evaluated with the Medical Research Council dyspnoea questionnaire (MRC) and the clinical COPD questionnaire (CCQ). Spirometry was performed. The extent of emphysema was assessed using HRCT. V/P SPECT was used to assess V/P patterns, total reduction in lung function and degree of obstructive disease. The total reduction in lung function and degree of obstructive disease, assessed with V/P SPECT, significantly correlated with emphysema extent (r = 0.66-0.69, p < 0.0001) and spirometric lung function (r = 0.62-0.74, p < 0.0005). The correlation between emphysema extent and spirometric lung function was weaker. No correlation between MRC, CCQ and objective measurements was found. V/P SPECT is sensitive to early changes in COPD. V/P SPECT also has the possibility to identify comorbid disease. V/P SPECT findings show a significant correlation with emphysema extent and spirometric lung function. We therefore recommend that scintigraphic signs of COPD, whenever found, should be reported. V

  1. Past and Present ARDS Mortality Rates: A Systematic Review.

    PubMed

    Máca, Jan; Jor, Ondřej; Holub, Michal; Sklienka, Peter; Burša, Filip; Burda, Michal; Janout, Vladimír; Ševčík, Pavel

    2017-01-01

    ARDS is severe form of respiratory failure with significant impact on the morbidity and mortality of critical care patients. Epidemiological data are crucial for evaluating the efficacy of therapeutic interventions, designing studies, and optimizing resource distribution. The goal of this review is to present general aspects of mortality data published over the past decades. A systematic search of the MEDLINE/PubMed was performed. The articles were divided according to their methodology, type of reported mortality, and time. The main outcome was mortality. Extracted data included study duration, number of patients, and number of centers. The mortality trends and current mortality were calculated for subgroups consisting of in-hospital, ICU, 28/30-d, and 60-d mortality over 3 time periods (A, before 1995; B, 1995-2000; C, after 2000). The retrospectivity and prospectivity were also taken into account. Moreover, we present the most recent mortality rates since 2010. One hundred seventy-seven articles were included in the final analysis. General mortality rates ranged from 11 to 87% in studies including subjects with ARDS of all etiologies (mixed group). Linear regression revealed that the study design (28/30-d or 60-d) significantly influenced the mortality rate. Reported mortality rates were higher in prospective studies, such as randomized controlled trials and prospective observational studies compared with retrospective observational studies. Mortality rates exhibited a linear decrease in relation to time period (P < .001). The number of centers showed a significant negative correlation with mortality rates. The prospective observational studies did not have consistently higher mortality rates compared with randomized controlled trials. The mortality trends over 3 time periods (before 1995, 1995-2000, and after 2000) yielded variable results in general ARDS populations. However, a mortality decrease was present mostly in prospective studies. Since 2010, the

  2. CONTROLLING MECHANICAL VENTILATION IN ARDS WITH FUZZY LOGIC

    PubMed Central

    Nguyen, Binh; Bernstein, David B.; Bates, Jason H.T.

    2014-01-01

    Purpose The current ventilatory care goal for acute respiratory distress syndrome (ARDS), and the only evidence-based approach for managing ARDS, is to ventilate with a tidal volume (VT) of 6 ml/kg predicted body weight (PBW). However, it is not uncommon for some caregivers to feel inclined to deviate from this strategy for one reason or another. To accommodate this inclination in a rationalized manner, we previously developed an algorithm that allows for VT to depart from 6 ml/kg PBW based on physiological criteria. The goal of the present study was to test the feasibility of this algorithm in a small retrospective study. Materials and Methods Current values of peak airway pressure (PAP), positive end-expiratory pressure (PEEP) and arterial oxygen saturation (SaO2) are used in a fuzzy logic algorithm to decide how much VT should differ from 6 ml/kg PBW and how much PEEP should change from its current setting. We retrospectively tested the predictions of the algorithm against 26 cases of decision making in 17 patients with ARDS. Results Differences between algorithm and physician VT decisions were within 2.5 ml/kg PBW except in 1 of 26 cases, and differences between PEEP decisions were within 2.5 cm H2O except in 3 of 26 cases. The algorithm was consistently more conservative than physicians in changing VT, but was slightly less conservative when changing PEEP. Conclusions Within the limits imposed by a small retrospective study, we conclude that our fuzzy logic algorithm makes sensible decisions while at the same time keeping practice close to the current ventilatory care goal. PMID:24721387

  3. Advanced Research Deposition System (ARDS) for processing CdTe solar cells

    NASA Astrophysics Data System (ADS)

    Barricklow, Keegan Corey

    CdTe solar cells have been commercialized at the Gigawatt/year level. The development of volume manufacturing processes for next generation CdTe photovoltaics (PV) with higher efficiencies requires research systems with flexibility, scalability, repeatability and automation. The Advanced Research Deposition Systems (ARDS) developed by the Materials Engineering Laboratory (MEL) provides such a platform for the investigation of materials and manufacturing processes necessary to produce the next generation of CdTe PV. Limited by previous research systems, the ARDS was developed to provide process and hardware flexibility, accommodating advanced processing techniques, and capable of producing device quality films. The ARDS is a unique, in-line process tool with nine processing stations. The system was designed, built and assembled at the Materials Engineering Laboratory. Final assembly, startup, characterization and process development are the focus of this research. Many technical challenges encountered during the startup of the ARDS were addressed in this research. In this study, several hardware modifications needed for the reliable operation of the ARDS were designed, constructed and successfully incorporated into the ARDS. The effect of process condition on film properties for each process step was quantified. Process development to achieve 12% efficient baseline solar cell required investigation of discrete processing steps, troubleshooting process variation, and developing performance correlations. Subsequent to this research, many advances have been demonstrated with the ARDS. The ARDS consistently produces devices of 12% +/-.5% by the process of record (POR). The champion cell produced to date utilizing the ARDS has an efficiency of 16.2% on low cost commercial sodalime glass and utilizes advanced films. The ARDS has enabled investigation of advanced concepts for processing CdTe devices including, Plasma Cleaning, Plasma Enhanced Closed Space Sublimation

  4. Impact of statin therapy on mortality in patients with sepsis-associated acute respiratory distress syndrome (ARDS) depends on ARDS severity: a prospective observational cohort study.

    PubMed

    Mansur, Ashham; Steinau, Maximilian; Popov, Aron Frederik; Ghadimi, Michael; Beissbarth, Tim; Bauer, Martin; Hinz, José

    2015-06-01

    Previous investigations have presumed a potential therapeutic effect of statin therapy in patients with acute respiratory distress syndrome (ARDS). Statins are expected to attenuate inflammation in the lungs of patients with ARDS due to their anti-inflammatory effects. Clinical investigations of the role of statin therapy have revealed contradictory results. This study aimed to investigate whether pretreatment and continuous therapy with statins in patients with sepsis-associated ARDS are associated with 28-day survival according to disease severity (mild, moderate, or severe). Patients with sepsis-associated ARDS from the surgical intensive care were enrolled in this prospective observational investigation. ARDS was classified into three groups (mild, moderate, and severe); 28-day mortality was recorded as the primary outcome variable and organ failure was recorded as secondary outcome variable. Sequential Organ Failure Assessment scores and the requirements for organ support were evaluated throughout the observational period to assess organ failure. 404 patients with sepsis-associated ARDS were enrolled in this investigation. The distribution of the ARDS subgroups was 13 %, 59 %, and 28 % for mild, moderate, and severe disease, respectively. Statin therapy improved 28-day survival exclusively in the patients with severe ARDS compared with patients without statin therapy (88.5 % and 62.5 %, respectively; P = 0.0193). To exclude the effects of several confounders, we performed multivariate Cox regression analysis, which showed that statin therapy remained a significant covariate for mortality (hazard ratio, 5.46; 95 % CI, 1.38-21.70; P = 0.0156). Moreover, after carrying a propensity score-matching in the severe ARDS cohort, Kaplan-Meier survival analysis confirmed the improved 28-day survival among patients with statin therapy (P = 0.0205). Patients with severe ARDS who received statin therapy had significantly more vasopressor-free days compared with those

  5. Quantitative consensus of supervised learners for diffuse lung parenchymal HRCT patterns

    NASA Astrophysics Data System (ADS)

    Raghunath, Sushravya; Rajagopalan, Srinivasan; Karwoski, Ronald A.; Bartholmai, Brian J.; Robb, Richard A.

    2013-03-01

    Automated lung parenchymal classification usually relies on supervised learning of expert chosen regions representative of the visually differentiable HRCT patterns specific to different pathologies (eg. emphysema, ground glass, honey combing, reticular and normal). Considering the elusiveness of a single most discriminating similarity measure, a plurality of weak learners can be combined to improve the machine learnability. Though a number of quantitative combination strategies exist, their efficacy is data and domain dependent. In this paper, we investigate multiple (N=12) quantitative consensus approaches to combine the clusters obtained with multiple (n=33) probability density-based similarity measures. Our study shows that hypergraph based meta-clustering and probabilistic clustering provides optimal expert-metric agreement.

  6. Ray-tracing based registration for HRCT images of the lungs.

    PubMed

    Busayara, Sata; Zrimec, Tatjana

    2006-01-01

    Image registration is a fundamental problem in medical imaging. It is especially challenging in lung images compared, for example, with the brain. The challenges include large anatomical variations of human lung and a lack of fixed landmarks inside the lung. This paper presents a new method for lung HRCT image registration. It employs a landmark-based global transformation and a novel ray-tracing-based lung surface registration. The proposed surface registration method has two desirable properties: 1) it is fully reversible, and 2) it ensures that the registered lung will be inside the target lung. We evaluated the registration performance by applying it to lung regions mapping. Tested on 46 scans, the registered regions were 89% accurate compared with the ground-truth.

  7. Active Reading Documents (ARDs): A Tool to Facilitate Meaningful Learning through Reading

    ERIC Educational Resources Information Center

    Dubas, Justin M.; Toledo, Santiago A.

    2015-01-01

    Presented here is a practical tool called the Active Reading Document (ARD) that can give students the necessary incentive to engage with the text/readings. By designing the tool to incrementally develop student understanding of the material through reading using Marzano's Taxonomy as a framework, the ARD offers support through scaffolding as they…

  8. Ardón: A Long Hidden L6 Chondrite Fall

    NASA Astrophysics Data System (ADS)

    Trigo-Rodriguez, J. M.; Llorca, J.; Weyrauch, M.; Bischoff, A.; Moyano-Cambero, C. E.; Keil, K.; Laubenstein, M.; Pack, A.; Madiedo, J. M.; Alonso-Azcárate, J.; Riebe, M.; Wieler, R.; Ott, U.; Tapia, M.; Mestres, N.

    2014-09-01

    A L6 ordinary chondrite fall that occurred in Ardón, León province, Spain on July 9, 1931 is described. The 5.5 g stone was kept hidden for 83 years by Rosa González Pérez, who recovered the meteorite. Ardón is still a fresh ordinary chondrite.

  9. Active Reading Documents (ARDs): A Tool to Facilitate Meaningful Learning through Reading

    ERIC Educational Resources Information Center

    Dubas, Justin M.; Toledo, Santiago A.

    2015-01-01

    Presented here is a practical tool called the Active Reading Document (ARD) that can give students the necessary incentive to engage with the text/readings. By designing the tool to incrementally develop student understanding of the material through reading using Marzano's Taxonomy as a framework, the ARD offers support through scaffolding as they…

  10. Effects of Pharmacologic Intervention on Oxygenation, Lung Water and Protein Leak in the Pseudomonas ARDS Porcine Model

    DTIC Science & Technology

    1989-07-01

    swine U6 i!D 19, ABSTRACT (Continue on reverse if necessary and identify by block number) A porcine model of Pseudorronas induced acute lung injury...and the clinical picture seen in ARDS unfolds. Pseudomonas- induced ARDS in the porcine model has been used as an effective and reproducible model of...sepsis- induced ARDS in this laboratory. Because ARDS is mediated by numerous inflammatory mediators, it is likely that treatment will require several

  11. Aerosolized prostacyclins for acute respiratory distress syndrome (ARDS).

    PubMed

    Afshari, Arash; Bastholm Bille, Anders; Allingstrup, Mikkel

    2017-07-24

    Acute respiratory distress syndrome (ARDS) is a critical condition that is associated with high mortality and morbidity. Aerosolized prostacyclin has been used to improve oxygenation despite the limited evidence available so far.This review was originally published in 2010 and updated in 2017. To assess the benefits and harms of aerosolized prostacyclin in adults and children with ARDS. In this update, we searched CENTRAL (2017, Issue 4); MEDLINE (OvidSP), Embase (OvidSP), ISI BIOSIS Previews, ISI Web of Science, LILACS, CINAHL (EBSCOhost), and three trials registers. We handsearched the reference lists of the latest reviews, randomized and non-randomized trials, and editorials, and cross-checked them with our search of MEDLINE. We contacted the main authors of included studies to request any missed, unreported or ongoing studies. The search was run from inception to 5 May 2017. We included all randomized controlled trials (RCTs), irrespective of publication status, date of publication, blinding status, outcomes published or language. We contacted trial investigators and study authors to retrieve relevant and missing data. Three authors independently abstracted data and resolved any disagreements by discussion. Our primary outcome measure was all-cause mortality. We planned to perform subgroup and sensitivity analyses to assess the effect of aerosolized prostacyclin in adults and children, and on various clinical and physiological outcomes. We assessed the risk of bias through assessment of methodological trial components and the risk of random error through trial sequential analysis. We included two RCTs with 81 participants.One RCT involved 14 critically ill children with ARDS (very low quality of evidence), and one RCT involved 67 critically ill adults (very low quality evidence).Only one RCT (paediatric trial) provided data on mortality and found no difference between intervention and control. However, this trial was eligible for meta-analysis due to a cross

  12. [Right ventricular function in ARDS and mechanical respiration].

    PubMed

    Engelmann, L

    2004-10-01

    The right ventricle is the stepchild of intensive care medicine. In diseases of the lung mainly when the relationship between ventilation and perfusion is disturbed, assisted respiration with positive end-expiratory pressure (PEEP) is essential to improve oxygenation. The serious damage to the lung parenchyma as seen in adult (acute) respiratory distress syndrome (ARDS) and pneumonia has considerable consequences for cardiac function. Whereas left ventricular function remains almost completely unaffected well into late stages of the disease, the right ventricle is subjected early to stress from the underlying disease and mechanical ventilation. The effects of therapeutic measures aimed at maintaining oxygenation and ventilation partially have negative consequences for right ventricular function and encourage the development of acute cor pulmonale. They can be the cause of right-sided heart failure.

  13. Enhanced production of IGF‐I in the lungs of fibroproliferative ARDS patients

    PubMed Central

    Andonegui, Graciela; Krein, Peter M.; Mowat, Connie; Brisebois, Ronald; Doig, Christopher; Green, Francis H. Y.; Léger, Caroline; Winston, Brent W.

    2014-01-01

    Abstract Insulin‐Like Growth Factor I (IGF‐I) has been identified in the lungs of individuals with fibrotic lung diseases. In a previous retrospective study, we showed enhanced IGF‐I immunoreactivity in individuals with fibroproliferative acute respiratory distress syndrome (FP‐ARDS), but we were unable to determine if this correlation was causative. This study was undertaken to prospectively investigate whether IGF‐I expression correlated with the fibroproliferative process and whether IGF‐I was induced and made in the lungs. We measured IGF‐I and procollagen III peptide (PCP‐III) in the epithelial lining fluid (ELF) from controls, early ALI/ARDS patients and FP‐ARDS patients. We also measured IGF‐I mRNA and immunoreactivity from controls and FP‐ARDS patient lung biopsies. We determined the level of lung permeability by measuring albumin and urea levels in ELF and serum. Our data show that IGF‐I is significantly increased in the ELF in FP‐ARDS patients. A significant correlation between IGF‐I and PCP‐III in the ELF of FP‐ARDS patients is found. IGF‐I mRNA is elevated in the FP‐ARDS lung biopsies. Our data suggest that IGF‐I found in the lungs of FP‐ARDS patients results from both increased lung permeability and local production of IGF‐I. The role of IGF‐I in the fibroproliferative process in the lungs has recently been confirmed in an animal model of lung fibroproliferation. This study importantly suggest that IGF‐I protein is made in the lungs of FP‐ARDS patients and correlates with increased levels of ELF PCP‐III, implicating a role for IGF‐I in the fibroproliferative process in humans. PMID:25367695

  14. Regulation of growth factor receptor degradation by ADP-ribosylation factor domain protein (ARD) 1.

    PubMed

    Meza-Carmen, Victor; Pacheco-Rodriguez, Gustavo; Kang, Gi Soo; Kato, Jiro; Donati, Chiara; Zhang, Chun-Yi; Vichi, Alessandro; Payne, D Michael; El-Chemaly, Souheil; Stylianou, Mario; Moss, Joel; Vaughan, Martha

    2011-06-28

    ADP-ribosylation factor domain protein 1 (ARD1) is a 64-kDa protein containing a functional ADP-ribosylation factor (GTP hydrolase, GTPase), GTPase-activating protein, and E3 ubiquitin ligase domains. ARD1 activation by the guanine nucleotide-exchange factor cytohesin-1 was known. GTPase and E3 ligase activities of ARD1 suggest roles in protein transport and turnover. To explore this hypothesis, we used mouse embryo fibroblasts (MEFs) from ARD1-/- mice stably transfected with plasmids for inducible expression of wild-type ARD1 protein (KO-WT), or ARD1 protein with inactivating mutations in E3 ligase domain (KO-E3), or containing persistently active GTP-bound (KO-GTP), or inactive GDP-bound (KO-GDP) GTPase domains. Inhibition of proteasomal proteases in mifepristone-induced KO-WT, KO-GDP, or KO-GTP MEFs resulted in accumulation of these ARD1 proteins, whereas KO-E3 accumulated without inhibitors. All data were consistent with the conclusion that ARD1 regulates its own steady-state levels in cells by autoubiquitination. Based on reported growth factor receptor-cytohesin interactions, EGF receptor (EGFR) was investigated in induced MEFs. Amounts of cell-surface and total EGFR were higher in KO-GDP and lower in KO-GTP than in KO-WT MEFs, with levels in both mutants greater (p = 0.001) after proteasomal inhibition. Significant differences among MEF lines in content of TGF-β receptor III were similar to those in EGFR, albeit not as large. Differences in amounts of insulin receptor mirrored those in EGFR, but did not reach statistical significance. Overall, the capacity of ARD1 GTPase to cycle between active and inactive forms and its autoubiquitination both appear to be necessary for the appropriate turnover of EGFR and perhaps additional growth factor receptors.

  15. Polyamine biosynthesis regulated by StARD expression plays an important role in potato wound periderm formation.

    PubMed

    Kim, Jae Hyun; Kim, Hyun Soon; Lee, Yong Hwa; Kim, Yoon Sik; Oh, Hyun Woo; Joung, Hyouk; Chae, Suhn Kee; Suh, Kyong Hoon; Jeon, Jae Heung

    2008-10-01

    An acireductone dioxygenase (ARD) gene of potatoes was isolated from the expressed sequence tags (ESTs) of potato post-suberization cDNA libraries. The highest expression levels of the StARD gene and the protein appeared 36 h after suberization. An approximate 9-fold increase in ARD activity was detected at 36 h after wounding. Real-time reverse transcription-PCR (RT-PCR) analysis and immunolocalization studies revealed that StARD transcripts increase at the wound surface of potato tubers. The polyamine (PA) contents increased significantly after wounding at the wound surface. The increased PA content and ARD activity may play an important role in wound periderm formation.

  16. Performance comparison of classifiers for differentiation among obstructive lung diseases based on features of texture analysis at HRCT

    NASA Astrophysics Data System (ADS)

    Lee, Youngjoo; Seo, Joon Beom; Kang, Bokyoung; Kim, Dongil; Lee, June Goo; Kim, Song Soo; Kim, Namkug; Kang, Suk Ho

    2007-03-01

    The performance of classification algorithms for differentiating among obstructive lung diseases based on features from texture analysis using HRCT (High Resolution Computerized Tomography) images was compared. HRCT can provide accurate information for the detection of various obstructive lung diseases, including centrilobular emphysema, panlobular emphysema and bronchiolitis obliterans. Features on HRCT images can be subtle, however, particularly in the early stages of disease, and image-based diagnosis is subject to inter-observer variation. To automate the diagnosis and improve the accuracy, we compared three types of automated classification systems, naÃve Bayesian classifier, ANN (Artificial Neural Net) and SVM (Support Vector Machine), based on their ability to differentiate among normal lung and three types of obstructive lung diseases. To assess the performance and cross-validation of these three classifiers, 5 folding methods with 5 randomly chosen groups were used. For a more robust result, each validation was repeated 100 times. SVM showed the best performance, with 86.5% overall sensitivity, significantly different from the other classifiers (one way ANOVA, p<0.01). We address the characteristics of each classifier affecting performance and the issue of which classifier is the most suitable for clinical applications, and propose an appropriate method to choose the best classifier and determine its optimal parameters for optimal disease discrimination. These results can be applied to classifiers for differentiation of other diseases.

  17. Alternate retrieval technology demonstrations program - test report (ARD Environmental, Inc.)

    SciTech Connect

    Berglin, E.J.

    1997-07-31

    A prototype vehicle, control system, and waste and water scavenging system were designed and fabricated with essentially the full capabilities of the vehicle system proposed by ARD Environmental. A test tank mockup, including riser and decontamination chamber were designed and fabricated, and approximately 830 cubic feet of six varieties of waste simulants poured. The tests were performed by ARD Environmental personnel at its site in Laurel, Maryland, from 4/22/97 through 5/2/97. The capabilities tested were deployment and retrieval, extended mobility and productivity, the ability to operate the system using video viewing only, retrieval after simulated failure, and retrieval and decontamination. Testing commenced with deployment of the vehicle into the tank. Deployment was accomplished using a crane and auxiliary winch to position the vehicle and lower it through the decontamination chamber, into the 36`` diameter x 6` high riser, and touch down on the waste field in the tank. The initial mobility tests were conducted immediately after deployment, prior to sluicing, as the waste field exhibited the greatest amount of variation at this time. This test demonstrated the ability of the vehicle to maneuver over the simulated waste field, and the ability of the operator to work with only video viewing available. In addition, the ability of the vehicle to right itself after being turned on its side was demonstrated. The production rate was evaluated daily through the testing period by measuring the surface and estimating the amount of material removed. The test demonstrated the ability of the vehicle to reduce the waste surface using 400 psi (nominal) water jets, scavenge water and material from the work area, and move to any location, even in the relatively confined space of the 20` diameter test tank. In addition, the ability to sluice to a remote scavenging module was demonstrated. The failure mode test demonstrated the ability to retrieve a stuck vehicle by pulling

  18. Analysis of HRCT-derived xylem network reveals reverse flow in some vessels.

    PubMed

    Lee, Eric F; Matthews, Mark A; McElrone, Andrew J; Phillips, Ronald J; Shackel, Kenneth A; Brodersen, Craig R

    2013-09-21

    Long distance water and nutrient transport in plants is dependent on the proper functioning of xylem networks, a series of interconnected pipe-like cells that are vulnerable to hydraulic dysfunction as a result of drought-induced embolism and/or xylem-dwelling pathogens. Here, flow in xylem vessels was modeled to determine the role of vessel connectivity by using three dimensional xylem networks derived from High Resolution Computed Tomography (HRCT) images of grapevine (Vitis vinifera cv. 'Chardonnay') stems. Flow in 4-27% of the vessel segments (i.e. any section of vessel elements between connection points associated with intervessel pits) was found to be oriented in the direction opposite to the bulk flow under normal transpiration conditions. In order for the flow in a segment to be in the reverse direction, specific requirements were determined for the location of connections, distribution of vessel endings, diameters of the connected vessels, and the conductivity of the connections. Increasing connectivity and decreasing vessel length yielded increasing numbers of reverse flow segments until a maximum value was reached, after which more interconnected networks and smaller average vessel lengths yielded a decrease in the number of reverse flow segments. Xylem vessel relays also encouraged the formation of reverse flow segments. Based on the calculated flow rates in the xylem network, the downward spread of Xylella fastidiosa bacteria in grape stems was modeled, and reverse flow was shown to be an additional mechanism for the movement of bacteria to the trunk of grapevine.

  19. Enhanced Classification of Interstitial Lung Disease Patterns in HRCT Images Using Differential Lacunarity.

    PubMed

    Vasconcelos, Verónica; Barroso, João; Marques, Luis; Silva, José Silvestre

    2015-01-01

    The analysis and interpretation of high-resolution computed tomography (HRCT) images of the chest in the presence of interstitial lung disease (ILD) is a time-consuming task which requires experience. In this paper, a computer-aided diagnosis (CAD) scheme is proposed to assist radiologists in the differentiation of lung patterns associated with ILD and healthy lung parenchyma. Regions of interest were described by a set of texture attributes extracted using differential lacunarity (DLac) and classical methods of statistical texture analysis. The proposed strategy to compute DLac allowed a multiscale texture analysis, while maintaining sensitivity to small details. Support Vector Machines were employed to distinguish between lung patterns. Training and model selection were performed over a stratified 10-fold cross-validation (CV). Dimensional reduction was made based on stepwise regression (F-test, p value < 0.01) during CV. An accuracy of 95.8 ± 2.2% in the differentiation of normal lung pattern from ILD patterns and an overall accuracy of 94.5 ± 2.1% in a multiclass scenario revealed the potential of the proposed CAD in clinical practice. Experimental results showed that the performance of the CAD was improved by combining multiscale DLac with classical statistical texture analysis.

  20. Enhanced Classification of Interstitial Lung Disease Patterns in HRCT Images Using Differential Lacunarity

    PubMed Central

    Vasconcelos, Verónica; Barroso, João; Marques, Luis; Silvestre Silva, José

    2015-01-01

    The analysis and interpretation of high-resolution computed tomography (HRCT) images of the chest in the presence of interstitial lung disease (ILD) is a time-consuming task which requires experience. In this paper, a computer-aided diagnosis (CAD) scheme is proposed to assist radiologists in the differentiation of lung patterns associated with ILD and healthy lung parenchyma. Regions of interest were described by a set of texture attributes extracted using differential lacunarity (DLac) and classical methods of statistical texture analysis. The proposed strategy to compute DLac allowed a multiscale texture analysis, while maintaining sensitivity to small details. Support Vector Machines were employed to distinguish between lung patterns. Training and model selection were performed over a stratified 10-fold cross-validation (CV). Dimensional reduction was made based on stepwise regression (F-test, p value < 0.01) during CV. An accuracy of 95.8 ± 2.2% in the differentiation of normal lung pattern from ILD patterns and an overall accuracy of 94.5 ± 2.1% in a multiclass scenario revealed the potential of the proposed CAD in clinical practice. Experimental results showed that the performance of the CAD was improved by combining multiscale DLac with classical statistical texture analysis. PMID:26798638

  1. High resolution computed tomography findings in smear-negative pulmonary tuberculosis patients according to their culture status.

    PubMed

    Caliskan, Tayfun; Ozkisa, Tuncer; Aribal, Serkan; Kaya, Hatice; Incedayi, Mehmet; Ulcay, Asim; Ciftci, Faruk

    2014-06-01

    The aim of this study was to assess the clinical features and high resolution computed tomography (HRCT) findings in smear-negative pulmonary tuberculosis (PTB) and to evaluate the correlation between these parameters and the culture results. We retrospectively studied 78 active smear-negative PTB patients. They were divided into two groups according to their culture results. The HRCT findings and clinical features at the beginning of the antituberculosis treatment were reviewed. The mean age was 22.48±3.18 years. Micronodules (87%), large nodules (63%) and centrilobular nodules (62%) were the most common HRCT findings. HRCT findings were observed in the right upper (72%), left upper (56%), right lower (32%), and left lower lobes (29%). Cough (37%) and chest pain (32%) were the most frequent symptoms at presentation. There were no significant differences in the HRCT findings and clinical features between the two groups. Thus, in cases of smear-negative and culture-negative PTB, the patient with compatible clinical and radiological features should be considered for tuberculosis treatment.

  2. High resolution computed tomography findings in smear-negative pulmonary tuberculosis patients according to their culture status

    PubMed Central

    Caliskan, Tayfun; Ozkisa, Tuncer; Aribal, Serkan; Kaya, Hatice; Incedayi, Mehmet; Ulcay, Asim; Ciftci, Faruk

    2014-01-01

    Objective The aim of this study was to assess the clinical features and high resolution computed tomography (HRCT) findings in smear-negative pulmonary tuberculosis (PTB) and to evaluate the correlation between these parameters and the culture results. Methods We retrospectively studied 78 active smear-negative PTB patients. They were divided into two groups according to their culture results. The HRCT findings and clinical features at the beginning of the antituberculosis treatment were reviewed. Results The mean age was 22.48±3.18 years. Micronodules (87%), large nodules (63%) and centrilobular nodules (62%) were the most common HRCT findings. HRCT findings were observed in the right upper (72%), left upper (56%), right lower (32%), and left lower lobes (29%). Cough (37%) and chest pain (32%) were the most frequent symptoms at presentation. Conclusions There were no significant differences in the HRCT findings and clinical features between the two groups. Thus, in cases of smear-negative and culture-negative PTB, the patient with compatible clinical and radiological features should be considered for tuberculosis treatment. PMID:24976993

  3. Effective and Safe Use of Glucocorticosteroids for Rescue of Late ARDS

    PubMed Central

    Diana, Paolo; Money, Dustin T.; Gelvin, Michael G.

    2017-01-01

    We describe a case of severe refractory hypoxemia requiring prolonged extra corporeal membrane oxygenation (ECMO) support in a case of postpartum acute respiratory distress syndrome (ARDS). The clinical course was marked by persistently poor lung compliance and several complications of ECMO, that is, significant hemolysis, hemothorax, and intracranial bleeding. We report marked improvement of lung mechanics and respiratory function, leading to accelerated separation from ECMO, following rescue administration of low dose methylprednisolone 24 days after the onset of ARDS. Corticosteroid treatment was safe and well tolerated. In contrast with the conclusions of the 2006 ARDS Network trial, our report establishes a case in support of the use of low dose methylprednisolone as a safe and effective rescue treatment option in selected subsets of patients with nonresolving ARDS. PMID:28337348

  4. The Pitfalls and Important Distances in Temporal Bone HRCT of the Subjects with High Jugular Bulbs - Preliminary Report.

    PubMed

    Inal, Mikail; Muluk, Nuray B; Dağ, Ersel; Arıkan, Osman K; Kara, Simay A

    2015-01-01

    High jugular bulb (HJB) may be detected unilaterally or bilaterally in temporal bone high resolution computerized tomography (HRCT). In this retrospective study, we investigated the pitfalls and important surgical distances in patients with unilateral and bilateral HJB via temporal bone HRCT. In this preliminary report, the study group consisted of 20 adult patients (12 male, 8 female), or 40 ears, all of which underwent temporal bone HRCT. We divided them into groups that consisted of bilateral HJB (14 ears), unilateral HJB (13 ears), and control (No HJB, 13 ears). The anotomical relationships of the sigmoid sinus, jugular bulb, and carotid artery with several landmarks in the temporal bone were studied via temporal bone axial and coronal HRCT. The shortest distances between certain points were measured. These measurements were analyzed in respect to pneumatization. Dehiscence on the jugular bulb (JB) and internal carotid artery (ICA) and the dominance of JB were also evaluated for all of the groups. In the axial sections of the temporal bone HRCTs, the sigmois sinus (SS)-external auditory canal (EAC) distance of the bilateral HJB group (14.00±1.17 mm) was significantly lower than that of the control group (16.46±2.14 mm). The JB-posteromedial points of the umbo on the ear drum (ED) distance of the bilateral HJB (6.28±1.72 mm) and the unilateral HJB groups (7.23±2.00 mm) were significantly lower than that of the control group (11.15±2.30 mm). In the coronal sections of the temporal bone HRCT, the JB-F distance of the bilateral HJB group (5.42±2.10 mm) was significantly lower than that of the control group (8.30±2.28 mm). As the mastoid pneumatisation and mastoid volume increased, the percentage of ICA-dehiscence and the percentage of JB-dehiscence increased. In subjects with well-pneumatised mastoids, the doctors should be aware of the increased risk of ICA-dehiscence and JB-dehiscence. These measurements should be done in greater series to yield more

  5. Joblessness and Lost Earnings After ARDS in a 1-Year National Multicenter Study.

    PubMed

    Kamdar, Biren B; Huang, Minxuan; Dinglas, Victor D; Colantuoni, Elizabeth; von Wachter, Till M; Hopkins, Ramona O; Needham, Dale M

    2017-04-27

    Following acute respiratory distress syndrome (ARDS), joblessness is common, but poorly understood. To evaluate the timing of return to work following ARDS, and associated risk factors, lost earnings, and changes in healthcare coverage Methods: Over 12-month longitudinal follow-up, ARDS survivors from 43 U.S. ARDSNet hospitals provided employment and healthcare coverage data via structured telephone interviews. Factors associated with the timing of return to work were assessed using Fine and Gray regression analysis. Lost earnings were estimated using Bureau of Labor Statistics data. Of 922 consenting survivors, 386(42%) were employed prior to ARDS (56% male; mean±SD age: 45±13 years), with 7 dying by 12-month follow-up. Of 379 previously-employed 12-month survivors, 166(44%) were jobless at 12-month follow-up. Accounting for competing risks of death and retirement, half of enrolled and previously-employed survivors returned to work by 13 weeks after hospital discharge, with 68% ever returning by 12 months. Delays in return to work were associated with longer hospitalization and older age among non-white survivors. Over 12-month follow-up, 274(71%) survivors accrued lost earnings, averaging $26,949±$22,447 (60% of pre-ARDS annual earnings). Jobless survivors experienced a 14% (95%CI 5%-22%, p=0.002) absolute decrease in private health insurance (from 44% pre-ARDS) and a 16% (95%CI 7%-24%, p<0.001) absolute increase in Medicare and Medicaid (from 33%). At 12 months after ARDS, nearly one-half of previously-employed survivors were jobless. Post-ARDS joblessness is associated with readily identifiable patient and hospital variables, and accompanied by substantial lost earnings and a shift toward government-funded healthcare coverage.

  6. Operation Bull's Eye/ARDS (Auditory Reading Development System). Final Report.

    ERIC Educational Resources Information Center

    District of Columbia Public Schools, Washington, DC.

    The Auditory Reading Development Systems (ARDS) was devised to meet the educational needs of a segment of the model cities population that had not been reached by other programs. The ARDS is geared to teach the student whose reading level is 0.0 through 3.9, then 3.9 through 6.9, then 7.0 through 8.9. The target population is reached through…

  7. Should PEEP Titration Be Based on Chest Mechanics in Patients With ARDS?

    PubMed

    Kallet, Richard H

    2016-06-01

    Functional residual capacity (FRC) is essentially the alveolar volume and a determinant of both oxygenation and respiratory system compliance (CRS). ARDS decreases FRC, and sufficient PEEP restores FRC; thus, assessments of PEEP by its impact on oxygenation and CRS are intimately linked. PEEP also can ameliorate or aggravate ventilator-induced lung injury. Therefore, it can be argued that PEEP should be titrated primarily by its impact on CRS The pro position argues that the heterogeneous nature of lung injury and its unique presentation in individual patients results in an uncoupling between oxygenation and CRS Therefore, relying upon oxygenation alone may enhance lung injury and mortality risk, particularly in those with severe ARDS. The con argument is that the preponderance of preclinical and clinical evidence suggests that a relatively narrow range of PEEP is required to manage all but the most severe cases of ARDS. In addition, pathological alterations in chest wall compliance confuse the interpretation of chest mechanics. Moreover, ambiguities and technical limitations in advanced techniques, such as esophageal manometry and pressure-volume curves, add a layer of complexity that renders its broader application in all ARDS patients both impractical and unnecessary. Whether sophisticated monitoring of chest mechanics in severe ARDS might improve outcomes further is open to question and should be studied further. However, it is highly improbable that we will ever discover a PEEP strategy that optimizes all aspects of cardiorespiratory function and chest mechanics for individual patients suffering from ARDS. Copyright © 2016 by Daedalus Enterprises.

  8. Increased expression of neutrophil-related genes in patients with early sepsis-induced ARDS.

    PubMed

    Kangelaris, Kirsten Neudoerffer; Prakash, Arun; Liu, Kathleen D; Aouizerat, Bradley; Woodruff, Prescott G; Erle, David J; Rogers, Angela; Seeley, Eric J; Chu, Jeffrey; Liu, Tom; Osterberg-Deiss, Thomas; Zhuo, Hanjing; Matthay, Michael A; Calfee, Carolyn S

    2015-06-01

    The early sequence of events leading to the development of the acute respiratory distress syndrome (ARDS) in patients with sepsis remains inadequately understood. The purpose of this study was to identify changes in gene expression early in the course of illness, when mechanisms of injury may provide the most relevant treatment and prognostic targets. We collected whole blood RNA in critically ill patients admitted from the Emergency Department to the intensive care unit within 24 h of admission at a tertiary care center. Whole genome expression was compared in patients with sepsis and ARDS to patients with sepsis alone. We selected genes with >1 log2 fold change and false discovery rate <0.25, determined their significance in the literature, and performed pathway analysis. Several genes were upregulated in 29 patients with sepsis with ARDS compared with 28 patients with sepsis alone. The most differentially expressed genes included key mediators of the initial neutrophil response to infection: olfactomedin 4, lipocalin 2, CD24, and bactericidal/permeability-increasing protein. These gene expression differences withstood adjustment for age, sex, study batch, white blood cell count, and presence of pneumonia or aspiration. Pathway analysis demonstrated overrepresentation of genes involved in known respiratory and infection pathways. These data indicate that several neutrophil-related pathways may be involved in the early pathogenesis of sepsis-related ARDS. In addition, identifiable gene expression differences occurring early in the course of sepsis-related ARDS may further elucidate understanding of the neutrophil-related mechanisms in progression to ARDS.

  9. Acetylation of androgen receptor by ARD1 promotes dissociation from HSP90 complex and prostate tumorigenesis

    PubMed Central

    Zhang, Guanyi; Qian, Chiping; Zhang, Haitao; Zabaleta, Jovanny; Liu, Wanguo

    2016-01-01

    Prostate cancer is an androgen receptor (AR)-driven disease and post-translational modification of AR is critical for AR activation. We previously reported that Arrest-defective protein 1 (ARD1) is an oncoprotein in prostate cancer. It acetylates and activates AR to promote prostate tumorigenesis. However, the ARD1-targeted residue within AR and the mechanisms of the acetylation event in prostate tumorigenesis remained unknown. In this study, we show that ARD1 acetylates AR at lysine 618 (K618) in vitro and in vivo. An AR construct with the charged lysine substitution by arginine (AR-618R) reduces RNA Pol II binding, AR transcriptional activity, prostate cancer cell growth, and xenograft tumor formation due to attenuation of AR nuclear translocation, whereas, construct mimicking neutral polar substitution acetylation at K618 by glutamine (AR-618Q) enhanced these effects beyond that of the wild-type AR. Mechanistically, ARD1 forms a ternary complex with AR and HSP90 in vitro and in vivo. Expression of ARD1 increases levels of AR acetylation and AR-HSP90 dissociation in a dose dependent manner. Moreover, the AR acetylation defective K618R mutant is unable to dissociate from HSP90 while the HSP90-dissociated AR is acetylated following ligand exposure. This work identifies a new mechanism for ligand-induced AR-HSP90 dissociation and AR activation. Targeting ARD1-mediated AR acetylation may be a potent intervention for AR-dependent prostate cancer therapy. PMID:27659526

  10. Prescribing Patterns of Drugs in Acute Respiratory Distress Syndrome (ARDS): An Observational Study

    PubMed Central

    Rao, Shobitha; Chogtu, Bharti

    2015-01-01

    Introduction: Acute respiratory distress syndrome (ARDS) is characterized by acute respiratory failure and is associated with wide range of clinical disorders. Controversy prevails over the pharmacological intervention in this disease. The aim of the study was to observe the prescribing pattern of drugs in patients with ARDS managed at a tertiary care hospital. Materials and Methods: This observational study was conducted at tertiary care hospital in India. Data of patients admitted from January 2010 to December 2012 was collected. Patients aged more than 18 years admitted in ICU, who were diagnosed to have ARDS during the study period, were included. A total of 150 patients of ARDS were selected. Data was collected as per the pre designed proforma and it included patients’ age, gender, clinical disorders precipitating ARDS, prescribing pattern of drugs and outcome. The data of the subjects was collected till discharge from hospital or death. Results: Infection was the cause of ARDS in 81.3% (n=122) of subjects. Antibiotics were prescribed in all the subjects and beta-lactams were prescribed in 97.3% (n=146). 41.3% (n=62) were prescribed corticosteroids, 39.3% (n=59) diuretics and 89.3% (n=134) intravenous fluids. Conclusion: The outcome of patients on different pharmacological treatment did not show any statistically significant difference. PMID:25859465

  11. Transbronchial lung biopsy in patients with diffuse parenchymal lung disease without 'idiopathic pulmonary fibrosis pattern' on HRCT scan - Experience from a tertiary care center of North India.

    PubMed

    Sindhwani, Girish; Shirazi, Nadia; Sodhi, Rakhee; Raghuvanshi, Shailendra; Rawat, Jagdish

    2015-01-01

    Diffuse parenchymal lung diseases (DPLD) are a group of disorders characterized by chest radiological findings of bilateral diffuse shadowing. Lung biopsy is generally required to make an etiological diagnosis of DPLD's. Transbronchial lung biopsy (TBLB) is a minimally invasive method to achieve a lung sample which has been found to be a useful diagnostic tool in patients with DPLD. As per American Thoracic Society guidelines for management of idiopathic interstitial pneumonias, TBLB is not required in patients who have findings consistent with idiopathic pulmonary fibrosis (IPF) on HRCT scan thorax. Some Indian researchers have evaluated, on a small number of subjects, the role of TBLB in patients with DPLD, but they had not excluded patients with 'IPF pattern'. This study was planned to assess TBLB in patients with DPLD after excluding patients with 'IPF pattern'. A prospective non-randomized study on 49 patients with DPLD without a characteristic 'IPF pattern' were subjected to TBLB. The overall diagnostic yield of TBLB was 85.7%. Non-specific interstitial pneumonitis, tuberculosis and sarcoidosis were the most common histology patterns found (22.4, 18.4 and 16.3%, respectively). Procedure-related mortality was nil. Iatrogenic pneumothorax occurred in five patients (10.2%). Minor complications included hemorrhage and transient hypoxia. TBLB is a safe and effective tool in the diagnosis of DPLD.

  12. SNAKES manipulator and ARD sluicer testing -- April 1997

    SciTech Connect

    Berglin, E.J.

    1997-05-29

    Long reach arms represent one of the options available for deployment of end effectors which can be used in the retrieval of radioactive waste, from the Hanford single shell tanks. The versatility of an arm based deployment system is such that it has the potential to improve the performance of a wide range of end effectors compared with stand-alone or other deployment methods. The long term reliability and availability of the deployment system is central to the timely completion of a waste retrieval program. However, concerns have been expressed over the dynamic performance of long reach arms and it is essential that an arm based system can cope with operational dynamic loads generated by end effectors. The test program conducted set out to measure static and dynamic loads and responses from a representative arm and sluicer, with the objective of extrapolating the data to a long reach arm system, that can be used for in-tank waste retrieval. As an arm with an appropriate reach was not available, the test program was undertaken to measure dynamic characteristics of a Magnox Electric 18 ft multi-link, hydraulically actuated SNAKES manipulator. This is the longest reach unit in service, albeit only one third of the 50 ft length required for in-tank waste retrieval. In addition operational performance and loading measurements were obtained from a low pressure confined system sluicer under development by ARD Environmental, to add to the end effector data base. When subject to impulse loading, the arm was found to behave in a repeatable manner having fundamental natural frequencies in the vertical and transverse directions of 1 Hz. There were also a large number of higher natural frequencies measured up to 100 Hz.

  13. Combination of Extracorporeal Life Support and Mesenchymal Stem Cell Therapy for Treatment of ARDS in Combat Casualties and Evacuation of Service Members with ARDS

    DTIC Science & Technology

    2016-10-01

    limitations providing ventilator support in flight with a possible further deterioration in patient status. Cell based therapy with adult bone marrow ...adult bone marrow -derived mesenchymal stromal cells (MSC) in experimental models of ARDS has been the focus of intense by investigation. Our

  14. Interstitial pneumonia with autoimmune features: an additional risk factor for ARDS?

    PubMed

    Grasselli, Giacomo; Vergnano, Beatrice; Pozzi, Maria Rosa; Sala, Vittoria; D'Andrea, Gabriele; Scaravilli, Vittorio; Mantero, Marco; Pesci, Alberto; Pesenti, Antonio

    2017-09-18

    Interstitial pneumonia with autoimmune features (IPAF) identifies a recently recognized autoimmune syndrome characterized by interstitial lung disease and autoantibodies positivity, but absence of a specific connective tissue disease diagnosis or alternative etiology. We retrospectively reviewed the clinical presentation, diagnostic workup and management of seven critically ill patients who met diagnostic criteria for IPAF. We compared baseline characteristics and clinical outcome of IPAF patients with those of the population of ARDS patients admitted in the same period. Seven consecutive patients with IPAF admitted to intensive care unit for acute respiratory distress syndrome (ARDS) were compared with 78 patients with ARDS secondary to a known risk factor and with eight ARDS patients without recognized risk factors. Five IPAF patients (71%) survived and were discharged alive from ICU: Their survival rate was equal to that of patients with a known risk factor (71%), while the subgroup of patients without risk factors had a markedly lower survival (38%). According to the Berlin definition criteria, ARDS was severe in four IPAF patients and moderate in the remaining three. All had multiple organ dysfunction at presentation. The most frequent autoantibody detected was anti-SSA/Ro52. All patients required prolonged mechanical ventilation (median duration 49 days, range 10-88); four received extracorporeal membrane oxygenation and one received low-flow extracorporeal CO2 removal. All patients received immunosuppressive therapy. This is the first description of a cohort of critical patients meeting the diagnostic criteria for IPAF presenting with ARDS. This diagnosis should be considered in any critically ill patient with interstitial lung disease of unknown origin. While management is challenging and level of support high, survival appears to be good and comparable to that of patients with ARDS associated with a known clinical insult.

  15. An Ensemble Method for Classifying Regional Disease Patterns of Diffuse Interstitial Lung Disease Using HRCT Images from Different Vendors.

    PubMed

    Jun, Sanghoon; Kim, Namkug; Seo, Joon Beom; Lee, Young Kyung; Lynch, David A

    2017-02-21

    We propose the use of ensemble classifiers to overcome inter-scanner variations in the differentiation of regional disease patterns in high-resolution computed tomography (HRCT) images of diffuse interstitial lung disease patients obtained from different scanners. A total of 600 rectangular 20 × 20-pixel regions of interest (ROIs) on HRCT images obtained from two different scanners (GE and Siemens) and the whole lung area of 92 HRCT images were classified as one of six regional pulmonary disease patterns by two expert radiologists. Textual and shape features were extracted from each ROI and the whole lung parenchyma. For automatic classification, individual and ensemble classifiers were trained and tested with the ROI dataset. We designed the following three experimental sets: an intra-scanner study in which the training and test sets were from the same scanner, an integrated scanner study in which the data from the two scanners were merged, and an inter-scanner study in which the training and test sets were acquired from different scanners. In the ROI-based classification, the ensemble classifiers showed better (p < 0.001) accuracy (89.73%, SD = 0.43) than the individual classifiers (88.38%, SD = 0.31) in the integrated scanner test. The ensemble classifiers also showed partial improvements in the intra- and inter-scanner tests. In the whole lung classification experiment, the quantification accuracies of the ensemble classifiers with integrated training (49.57%) were higher (p < 0.001) than the individual classifiers (48.19%). Furthermore, the ensemble classifiers also showed better performance in both the intra- and inter-scanner experiments. We concluded that the ensemble classifiers provide better performance when using integrated scanner images.

  16. Effect of various binning methods and ROI sizes on the accuracy of the automatic classification system for differentiation between diffuse infiltrative lung diseases on the basis of texture features at HRCT

    NASA Astrophysics Data System (ADS)

    Kim, Namkug; Seo, Joon Beom; Sung, Yu Sub; Park, Bum-Woo; Lee, Youngjoo; Park, Seong Hoon; Lee, Young Kyung; Kang, Suk-Ho

    2008-03-01

    To find optimal binning, variable binning size linear binning (LB) and non-linear binning (NLB) methods were tested. In case of small binning size (Q <= 10), NLB shows significant better accuracy than the LB. K-means NLB (Q = 26) is statistically significant better than every LB. To find optimal binning method and ROI size of the automatic classification system for differentiation between diffuse infiltrative lung diseases on the basis of textural analysis at HRCT Six-hundred circular regions of interest (ROI) with 10, 20, and 30 pixel diameter, comprising of each 100 ROIs representing six regional disease patterns (normal, NL; ground-glass opacity, GGO; reticular opacity, RO; honeycombing, HC; emphysema, EMPH; and consolidation, CONS) were marked by an experienced radiologist from HRCT images. Histogram (mean) and co-occurrence matrix (mean and SD of angular second moment, contrast, correlation, entropy, and inverse difference momentum) features were employed to test binning and ROI effects. To find optimal binning, variable binning size LB (bin size Q: 4~30, 32, 64, 128, 144, 196, 256, 384) and NLB (Q: 4~30) methods (K-means, and Fuzzy C-means clustering) were tested. For automated classification, a SVM classifier was implemented. To assess cross-validation of the system, a five-folding method was used. Each test was repeatedly performed twenty times. Overall accuracies with every combination of variable ROIs, and binning sizes were statistically compared. In case of small binning size (Q <= 10), NLB shows significant better accuracy than the LB. K-means NLB (Q = 26) is statistically significant better than every LB. In case of 30x30 ROI size and most of binning size, the K-means method showed better than other NLB and LB methods. When optimal binning and other parameters were set, overall sensitivity of the classifier was 92.85%. The sensitivity and specificity of the system for each class were as follows: NL, 95%, 97.9%; GGO, 80%, 98.9%; RO 85%, 96.9%; HC, 94

  17. Drosophila variable nurse cells encodes Arrest defective 1 (ARD1), the catalytic subunit of the major N-terminal acetyltransferase complex

    PubMed Central

    Wang, Ying; Mijares, Michelle; Gall, Megan D.; Turan, Tolga; Javier, Anna; Bornemann, Douglas J; Manage, Kevin; Warrior, Rahul

    2010-01-01

    Mutations in the Drosophila variable nurse cells (vnc) gene result in female sterility and oogenesis defects, including egg chambers with too many or too few nurse cells. We show that vnc corresponds to Arrest Defective1 (Ard1) and encodes the catalytic subunit of NatA, the major N-terminal acetyl-transferase complex. While N-terminal acetylation is one of the most prevalent covalent protein modifications in eukaryotes, analysis of its role in development has been challenging since mutants that compromise NatA activity have not been described in any multicellular animal. Our data show that reduced ARD1 levels result in pleiotropic oogenesis defects including abnormal cyst encapsulation, desynchronized cystocyte division, disrupted nurse cell chromosome dispersion and abnormal chorion patterning, consistent with the wide range of predicted NatA substrates. Further we find that loss of Ard1 affects cell survival/proliferation and is lethal for the animal, providing the first demonstration that this modification is essential in higher eukaryotes. PMID:20882681

  18. Retrospective case series of the imaging findings of facial nerve hemangioma.

    PubMed

    Yue, Yunlong; Jin, Yanfang; Yang, Bentao; Yuan, Hui; Li, Jiandong; Wang, Zhenchang

    2015-09-01

    The aim was to compare high-resolution computed tomography (HRCT) and thin-section magnetic resonance imaging (MRI) findings of facial nerve hemangioma. The HRCT and MRI characteristics of 17 facial nerve hemangiomas diagnosed between 2006 and 2013 were retrospectively analyzed. All patients included in the study suffered from a space-occupying lesion of soft tissues at the geniculate ganglion fossa. Affected nerve was compared for size and shape with the contralateral unaffected nerve. HRCT showed irregular expansion and broadening of the facial nerve canal, damage of the bone wall and destruction of adjacent bone, with "point"-like or "needle"-like calcifications in 14 cases. The average CT value was 320.9 ± 141.8 Hu. Fourteen patients had a widened labyrinthine segment; 6/17 had a tympanic segment widening; 2/17 had a greater superficial petrosal nerve canal involvement, and 2/17 had an affected internal auditory canal (IAC) segment. On MRI, all lesions were significantly enhanced due to high blood supply. Using 2D FSE T2WI, the lesion detection rate was 82.4 % (14/17). 3D fast imaging employing steady-state acquisition (3D FIESTA) revealed the lesions in all patients. HRCT showed that the average number of involved segments in the facial nerve canal was 2.41, while MRI revealed an average of 2.70 segments (P < 0.05). HRCT and MR findings of facial nerve hemangioma were typical, revealing irregular masses growing along the facial nerve canal, with calcifications and rich blood supply. Thin-section enhanced MRI was more accurate in lesion detection and assessment compared with HRCT.

  19. [Exploration of the early detection of lung parenchyma micronodules, nodule coalescence and emphysema by CT and HRCT in coal miners with and without coal-worker's pneumoconiosis evidence].

    PubMed

    Ren, Hou-Mao; Xing, Jing-Cai; Yang, Li-Juan; Han, Wen-Hui; Yi, Wan-Jun; Chen, Wei-Hong

    2012-01-01

    To explore the sensitivity and accuracy of CT and HRCT in early detection of coal-worker's pneumoconiosis (CWP) associated micronodules, nodule coalescence and emphysema from coal miners with and without radiographic CWP evidence. Continuously Thorax-Vol. CT scanning and High resolution CT scanning were performed on 113 coal miners with or without radiographic CWP evidence and 37 health controls by the use of Multi Spiral Computed Tomography (MSCT). The CT and HRCT images were evaluated for lung parenchyma opacity profusion category, nodule coalescence, emphysema index and mean lung attenuation, and then compared with that on radiographs. Good agreement for CWP associated opacity profusion grading was achieved between radiographs and CT scans (Kappa = 0.771). The sensitivity of CT and HRCT were 98.70% for CWP diagnosis when compared with radiographs. 8 (22.22%) cases out of 36 radiographic CWP negative coal miners were categorized as grade 1 opacity profusion in consistent with CWP on CT and HRCT scans, and 26 (35.62%) cases out of 73 radiographic grade 1-2 CWP patients were detected to have at least grade 3 nodular profusion on CT and HRCT scans. Among 113 coal miners, 36 (31.86%) were recognized as emphysema positive on CT; whereas only 7 (6.19%) on radiographs. According to CT opacity profusion grading, mean lung attenuation in coal miners with grade 1-2 opacity profusion classification was significantly increased than that in health control, CWP negative coal miner and grade 4 opacity profusion groups (F1 = -45.73, F2 = -23.00 and F3 = 52.72, P < 0.01 and P < 0.05). CT and HRCT acquired from MSCT showed high sensitive and accurate for the early detection of micronodules, nodule coalescence and emphysema in coal miners. It could be used as semi-quantitative and quantitative method in early diagnosis of CWP and its complications.

  20. High-Resolution CT Scan Findings in Familial Interstitial Pneumonia Do Not Conform to Those of Idiopathic Interstitial Pneumonia

    PubMed Central

    Lee, Ho Yun; Seo, Joon Beom; Steele, Mark P.; Schwarz, Marvin I.; Brown, Kevin K.; Loyd, James E.; Talbert, Janet L.

    2012-01-01

    Background: The aim of this study was to describe the high-resolution CT (HRCT) scan features that characterize familial interstitial pneumonia (FIP). Methods: FIP was defined by the presence of two or more cases of probable or definite idiopathic interstitial pneumonia (IIP) in individuals related within three degrees. The cases were collected consecutively from three centers. We identified 371 individuals with potential FIP from 289 families, including 340 individuals who had HRCT scans. Two chest radiologists independently reviewed the HRCT scans, scoring the extent and distribution of HRCT scan findings, and assessed the overall radiologic diagnosis. Results: HRCT scan abnormalities suggestive of IIP were present in 85% (289 of 340 subjects). The most frequent findings were reticular pattern (n = 238, 82%) and ground-glass opacity (GGO) associated with reticular abnormality (n = 231, 80%). Other changes included GGO in 116 (40%), honeycombing in 92 (32%), and micronodules in 65 (22%). In the 289 cases with evidence of IIP, the findings were diffusely distributed in the craniocaudal plane in 186 (64%), and the lower lung zones were predominantly involved in 89 (31%). In the axial plane, 194 (67%) had a subpleural distribution; 88 (30%) were diffuse. The imaging pattern was classified as definite or probable usual interstitial pneumonia (UIP) in only 62 subjects (22%) and definite or probable nonspecific interstitial pneumonia (NSIP) in 35 subjects (12%). In 160 subjects (55%), the imaging findings did not conform to previously described UIP or NSIP patterns. Conclusions: Reticulation and a mixed GGO/reticular pattern are the most common HRCT scan findings in FIP. The parenchymal abnormalities are most often diffuse in the craniocaudal dimension and have a predominantly peripheral distribution in the axial dimension. Although a radiologic UIP pattern is not uncommon, most cases do not conform to typical UIP or NSIP patterns. PMID:23364926

  1. Novel level-set based segmentation method of the lung at HRCT images of diffuse interstitial lung disease (DILD)

    NASA Astrophysics Data System (ADS)

    Lee, Jeongjin; Seo, Joon Beom; Kim, Namkug; Park, Sang Ok; Lee, Ho; Shin, Yeong Gil; Kim, Soo-Hong

    2009-02-01

    In this paper, we propose an algorithm for reliable segmentation of the lung at HRCT of DILD. Our method consists of four main steps. First, the airway and colon are segmented and excluded by thresholding(-974 HU) and connected component analysis. Second, initial lung is identified by thresholding(-474 HU). Third, shape propagation outward the lung is performed on the initial lung. Actual lung boundaries exist inside the propagated boundaries. Finally, subsequent shape modeling level-set inward the lung from the propagated boundary can identify the lung boundary when the curvature term was highly weighted. To assess the accuracy of the proposed algorithm, the segmentation results of 54 patients are compared with those of manual segmentation done by an expert radiologist. The value of 1 minus volumetric overlap is less than 5% error. Accurate result of our method would be useful in determining the lung parenchyma at HRCT, which is the essential step for the automatic classification and quantification of diffuse interstitial lung disease.

  2. Pediatric chest HRCT using the iDose4 Hybrid Iterative Reconstruction Algorithm: Which iDose level to choose?

    NASA Astrophysics Data System (ADS)

    Smarda, M.; Alexopoulou, E.; Mazioti, A.; Kordolaimi, S.; Ploussi, A.; Priftis, K.; Efstathopoulos, E.

    2015-09-01

    Purpose of the study is to determine the appropriate iterative reconstruction (IR) algorithm level that combines image quality and diagnostic confidence, for pediatric patients undergoing high-resolution computed tomography (HRCT). During the last 2 years, a total number of 20 children up to 10 years old with a clinical presentation of chronic bronchitis underwent HRCT in our department's 64-detector row CT scanner using the iDose IR algorithm, with almost similar image settings (80kVp, 40-50 mAs). CT images were reconstructed with all iDose levels (level 1 to 7) as well as with filtered-back projection (FBP) algorithm. Subjective image quality was evaluated by 2 experienced radiologists in terms of image noise, sharpness, contrast and diagnostic acceptability using a 5-point scale (1=excellent image, 5=non-acceptable image). Artifacts existance was also pointed out. All mean scores from both radiologists corresponded to satisfactory image quality (score ≤3), even with the FBP algorithm use. Almost excellent (score <2) overall image quality was achieved with iDose levels 5 to 7, but oversmoothing artifacts appearing with iDose levels 6 and 7 affected the diagnostic confidence. In conclusion, the use of iDose level 5 enables almost excellent image quality without considerable artifacts affecting the diagnosis. Further evaluation is needed in order to draw more precise conclusions.

  3. Physical declines occurring after hospital discharge in ARDS survivors: a 5-year longitudinal study.

    PubMed

    Pfoh, Elizabeth R; Wozniak, Amy W; Colantuoni, Elizabeth; Dinglas, Victor D; Mendez-Tellez, Pedro A; Shanholtz, Carl; Ciesla, Nancy D; Pronovost, Peter J; Needham, Dale M

    2016-10-01

    Survivors of acute respiratory distress syndrome (ARDS) are at high risk for new or ongoing physical declines after hospital discharge. The objective of our study was to evaluate the epidemiology of physical declines over 5-year follow-up and identify patients at risk for decline. This multi-site prospective cohort study evaluated ARDS survivors who completed a physical status assessment at 3 or 6 months post-discharge. Three measures were evaluated: muscle strength (Medical Resource Council sumscore); exercise capacity [6-min walk test (6MWT)]; physical functioning [36-Item Short Form Health Survey (SF-36 survey)]. Patients were defined as "declined" if a comparison of their current and prior score showed a decrease that was greater than the Reliable Change Index-or if the patient died. Risk factors [pre-ARDS baseline status, intensive care unit (ICU) illness severity, and other intensive care variables] were evaluated using longitudinal, generalized linear regression models for each measure. During the follow-up of 193 ARDS survivors (55 % male; median age 49 years), 166 (86 %) experienced decline in ≥1 physical measure (including death) and 133 (69 %) experienced a physical decline (excluding death). For all measures, age was a significant risk factor [odds ratios (OR) 1.34-1.69 per decade; p < 0.001]. Pre-ARDS comorbidity (Charlson Index) was independently associated with declines in strength and exercise capacity (OR 1.10 and 1.18, respectively; p < 0.02), and organ failure [maximum daily Sequential Organ Failure Assessment (SOFA) score in ICU] was associated with declines in strength (OR 1.06 per 1 point of SOFA score; p = 0.02). Over the follow-up period, the majority of ARDS survivors experienced a physical decline, with older age and pre-ICU comorbidity being important risk factors for this decline.

  4. Severity of Hypoxemia and Effect of High Frequency Oscillatory Ventilation in ARDS.

    PubMed

    Meade, Maureen O; Young, Duncan; Hanna, Steven; Zhou, Qi; Bachman, Thomas E; Bollen, Casper; Slutsky, Arthur S; Lamb, Sarah E; Adhikari, Neill Kj; Mentzelopoulos, Spyros D; Cook, Deborah J; Sud, Sachin; Brower, Roy G; Thompson, B Taylor; Shah, Sanjoy; Stenzler, Alex; Guyatt, Gordon; Ferguson, Niall D

    2017-02-28

    High frequency oscillatory ventilation (HFOV) is theoretically beneficial for lung protection but the results of clinical trials are inconsistent, with study-level meta-analyses suggesting no significant effect on mortality. The aim of this individual patient data meta-analysis was to identify ARDS patient subgroups with differential outcomes from HFOV. After a comprehensive search for trials, two reviewers independently identified randomized trials comparing HFOV with conventional ventilation for adults with ARDS. Pre-specified effect modifiers were tested using multi-variable hierarchical logistic regression models, adjusting for important prognostic factors and clustering effects. Measurements & Main Results: Data from 1552 patients in 4 trials were analyzed applying uniform definitions for study variables and outcomes. Patients had a mean baseline partial pressure of oxygen to fraction of inspired oxygen concentration ratio (PaO2:FiO2) of 114 (+39) mmHg; 40% had severe ARDS (PaO2:FiO2 <100 mm Hg). Mortality at 30 days was 321/785 (40.9%) for HFOV patients versus 288/767 (37.6%) for controls (adjusted odds ratio [OR], 1.17; 95% confidence interval [CI], 0.94-1.46; P=0.16). This treatment effect varied, however, depending on baseline severity of hypoxemia (P=0.0003), with harm increasing with PaO2:FiO2 among mild-moderate ARDS patients, and the possibility of decreased mortality in very severe ARDS patients. Compliance and body-mass index did not modify the treatment effect. HFOV increased barotrauma risk compared to conventional ventilation (adjusted OR, 1.75; 95% CI 1.04-2.96; P=0.04). HFOV increases mortality for most patients with ARDS but may improve survival among patients with severe hypoxemia on conventional mechanical ventilation.

  5. Type III procollagen is a reliable marker of ARDS-associated lung fibroproliferation.

    PubMed

    Forel, Jean-Marie; Guervilly, Christophe; Hraiech, Sami; Voillet, François; Thomas, Guillemette; Somma, Claude; Secq, Véronique; Farnarier, Catherine; Payan, Marie-Josée; Donati, Stéphanie-Yannis; Perrin, Gilles; Trousse, Delphine; Dizier, Stéphanie; Chiche, Laurent; Baumstarck, Karine; Roch, Antoine; Papazian, Laurent

    2015-01-01

    A specific biomarker of post-ARDS fibroproliferation could be useful in the identification of patients who could benefit from therapies aiming to modulate fibroproliferation such as corticosteroids.The aim of this prospective study was to determine the best threshold of the N-terminal-peptidetype III procollagen (NT-PCP-III) in non-resolving ARDS to validate this threshold according to the outcome. Concerning the best threshold of NT-PCP-III, all consecutive patients with a non-resolving ARDS were included if all the following criteria were fulfilled: moderate to severe ARDS lasting for at least 5 days, lung biopsy performed, serum and alveolar NT-PCP-III obtained within 1 week prior to biopsy, and no documented infection contra-indicating the corticosteroids. In the validation cohort part of the study, patients were included at day 7 if they presented a persistent moderate to severe ARDS. Nineteen of 32 patients had fibroproliferatio nonbiopsy. Serum and alveolar NT-PCP-III were higher in patients with fibroproliferation. Using a threshold of 9 µg/L, alveolar NT-PCP-III had the highest accuracy for diagnosing fibroproliferation (sensitivity = 89.5 % and specificity = 92.3 %). Regarding the 51 patients included in the validation cohort, the mortality rate at day 60 was increased in patients presenting an alveolar NT-PCP-III level higher than 9 µg/L (69 vs. 17 %, p < 0.001). The mean alveolar level of NT-PCP-III on day 7 was 8.1-fold higher in nonsurvivors (p = 0.03). The determination of NT-PCP-III on BAL done at day 7 in persistent ARDS is able to identify patients with fibroproliferation who could be included in a trial of corticosteroids or any other treatment that might help resolve lung fibroproliferation.

  6. Survival Predictors for Severe ARDS Patients Treated with Extracorporeal Membrane Oxygenation: A Retrospective Study in China

    PubMed Central

    Liu, Xiaoqing; Xu, Yonghao; Zhang, Rong; Huang, Yongbo; He, Weiqun; Sang, Ling; Chen, Sibei; Nong, Lingbo; Li, Xi; Mao, Pu

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) is increasingly being applied as life support for acute respiratory distress syndrome (ARDS) patients. However, the outcomes of this procedure have not yet been characterized in severe ARDS patients. The aim of this study was to evaluate the outcomes of severe ARDS patients supported with ECMO and to identify potential predictors of mortality in these patients. A total of 38 severe ARDS patients (aged 51.39±13.27 years, 32 males) who were treated with ECMO in the specialized medical intensive care unit of Guangzhou Institute of Respiratory Diseases from July 2009 to December 2014 were retrospectively reviewed. The clinical data of the patients on the day before ECMO initiation, on the first day of ECMO treatment and on the day of ECMO removal were collected and analyzed. All patients were treated with veno-venous ECMO after a median mechanical ventilation duration of 6.4±7.6 days. Among the 20 patients (52.6%) who were successfully weaned from ECMO, 16 patients (42.1%) survived to hospital discharge. Of the identified pre-ECMO factors, advanced age, a long duration of ventilation before ECMO, a higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score, underlying lung disease, and pulmonary barotrauma prior to ECMO were associated with unsuccessful weaning from ECMO. Furthermore, multiple logistic regression analysis indicated that both barotrauma pre-ECMO and underlying lung disease were independent predictors of hospital mortality. In conclusion, for severe ARDS patients treated with ECMO, barotrauma prior to ECMO and underlying lung disease may be major predictors of ARDS prognosis based on multivariate analysis. PMID:27336170

  7. The Effect of Omega-3 Fatty Acids on ARDS: A Randomized Double-Blind Study

    PubMed Central

    Parish, Masoud; Valiyi, Farnaz; Hamishehkar, Hadi; Sanaie, Sarvin; Asghari Jafarabadi, Mohammad; Golzari, Samad EJ; Mahmoodpoor, Ata

    2014-01-01

    Purpose: The aim of this study was to evaluate the effect of an enteral nutrition diet, enriched with omega-3 fatty acids because of its anti-inflammatory effects on treatment of patients with mild to moderate ARDS. Methods: This randomized clinical trial was performed in two ICUs of Tabriz University of Medical Sciences from Jun 2011 until Sep 2013 in north west of Iran. Fifty-eight patients with mild to moderate ARDS were enroled in this clinical trial. All patients received standard treatment for ARDS based on ARDS network trial. In intervention group, patients received 6 soft-gels of omega-3/day in addition to the standard treatment. Results: Tidal volume, PEEP, pH, PaO2/FiO2 , SaO2, P platue and PaCO2 on the 7th and 14th days didn’t have significant difference between two groups. Indices of lung mechanics (Resistance, Compliance) had significant difference between the groups on the 14th day. Pao2 had significant difference between two groups on both 7th and 14th days. Trend of PaO2 changes during the study period in two groups were significant. We showed that adjusted mortality rate did not have significant difference between two groups. Conclusion: It seems that adding omega-3 fatty acids to enteral diet of patients with ARDS has positive results in term of ventilator free days, oxygenation, lung mechanic indices; however, we need more multi center trials with large sample size and different doses of omega-3 fatty acids for their routine usage as an adjuant for ARDS treatment. PMID:25671189

  8. Severe ARDS may cause right heart failure with extreme hepatomegaly but without hepatic failure.

    PubMed

    Søreide, E; Harboe, S; Søndenaa, K

    2002-08-01

    A young trauma patient developed severe adult respiratory distress syndrome (ARDS), right heart failure, hepatic congestion and an extreme hepatomegaly but no hepatic failure. The patient needed 100% oxygen during ventilatory support for 80 days and was weaned from the ventilator after more than 100 days. The hepatomegaly gradually disappeared. Four months after the injury, the anatomical shape of the lungs, heart and liver were normalized. This case illustrates that severe ARDS may cause right heart failure and extreme hepatomegaly due to venous congestion in the liver and spleen, but without hepatic failure.

  9. Metastatic pulmonary calcification: high-resolution computed tomography findings in 23 cases

    PubMed Central

    Belém, Luciana Camara; Souza, Carolina A.; Souza Jr., Arthur Soares; Escuissato, Dante Luiz; Hochhegger, Bruno; Nobre, Luiz Felipe; Rodrigues, Rosana Souza; Gomes, Antônio Carlos Portugal; Silva, Claudio S.; Guimarães, Marcos Duarte; Zanetti, Gláucia; Marchiori, Edson

    2017-01-01

    Objective The aim of this study was to evaluate the high-resolution computed tomography (HRCT) findings in patients diagnosed with metastatic pulmonary calcification (MPC). Materials and Methods We retrospectively reviewed the HRCT findings from 23 cases of MPC [14 men, 9 women; mean age, 54.3 (range, 26-89) years]. The patients were examined between 2000 and 2014 in nine tertiary hospitals in Brazil, Chile, and Canada. Diagnoses were established by histopathologic study in 18 patients and clinical-radiological correlation in 5 patients. Two chest radiologists analyzed the images and reached decisions by consensus. Results The predominant HRCT findings were centrilobular ground-glass nodules (n = 14; 60.9%), consolidation with high attenuation (n = 10; 43.5%), small dense nodules (n = 9; 39.1%), peripheral reticular opacities associated with small calcified nodules (n = 5; 21.7%), and ground-glass opacities without centrilobular ground-glass nodular opacity (n = 5; 21.7%). Vascular calcification within the chest wall was found in four cases and pleural effusion was observed in five cases. The abnormalities were bilateral in 21 cases. Conclusion MPC manifested with three main patterns on HRCT, most commonly centrilobular ground-glass nodules, often containing calcifications, followed by dense consolidation and small solid nodules, most of which were calcified. We also described another pattern of peripheral reticular opacities associated with small calcified nodules. These findings should suggest the diagnosis of MPC in the setting of hypercalcemia. PMID:28894330

  10. Regulation of Inflammatory Biomarkers by Intravenous Methylprednisolone in Pediatric ARDS Patients: Results from a Double-Blind, Placebo-Controlled Randomized Pilot Trial

    PubMed Central

    Schwingshackl, Andreas; Kimura, Dai; Rovnaghi, Cynthia R.; Saravia, Jordy S.; Cormier, Stephania A; Teng, Bin; West, Alina N.; Meduri, Umberto G.; Anand, Kanwaljeet J. S.

    2015-01-01

    Objective A double-blind, randomized controlled trial showed that low-dose glucocorticoid therapy in pediatric ARDS patients is feasible and may improve both ventilation and oxygenation indices in these patients. However, the molecular mechanisms underlying potential changes in outcomes remain unclear. Based on these clinical findings, this study was designed to examine the effects of intravenous methylprednisolone on circulating inflammatory biomarkers in pediatric ARDS patients. Design Double-blind, placebo-controlled randomized trial with blood collection on study entry and day 7. Setting Tertiary care children’s hospital. Patients Children (0–18 years) with ARDS undergoing mechanical ventilation. Interventions 35 children were randomized within 72 hours of mechanical ventilation. The glucocorticoid group received methylprednisolone 2 mg/kg loading dose followed by 1 mg/kg/day continuous infusion from days 1–7. Both groups were ventilated following the ARDSnet recommendations. WBC and differential cell counts, plasma cytokines and CRP levels, and coagulation parameters were analyzed on days 0 and 7. Results At study entry, the placebo group had higher IL-15 and basophil levels. On day 7, in comparison to study entry, the placebo group had lower IL-1α, IFN-γ and IL-10 levels. The glucocorticoid group had lower INF-α, IL-6, IL-10, MCP-1, G-CSF and GM-CSF levels, and higher IL-17α levels on day 7 in comparison to study entry. Total and differential cell counts remained unchanged within the placebo group between days 0 and 7, whereas in the glucocorticoid group total WBC and platelets counts were increased on day 7. Pearson’s correlation studies within the placebo and glucocorticoid groups revealed positive and negative correlations between cytokine levels, cell counts, coagulation parameters and relevant clinical parameters of disease severity identified in our previous study. Multiple regression models identified several cytokines as predictors for

  11. Multivariable fractional polynomial interaction to investigate continuous effect modifiers in a meta-analysis on higher versus lower PEEP for patients with ARDS

    PubMed Central

    Kasenda, Benjamin; Sauerbrei, Willi; Royston, Patrick; Mercat, Alain; Slutsky, Arthur S; Cook, Deborah; Guyatt, Gordon H; Brochard, Laurent; Richard, Jean-Christophe M; Stewart, Thomas E; Meade, Maureen; Briel, Matthias

    2016-01-01

    these findings. Conclusions MFPI analyses suggest a nonlinear effect modification of higher PEEP ventilation by PaO2/FiO2 and oxygenation index with reduced mortality for some patients suffering from moderate ARDS. Study registration number CRD42012003129. PMID:27609843

  12. Spectrum of high resolution computed tomography findings in occupational lung disease: experience in a tertiary care institute.

    PubMed

    Bhawna, Satija; Ojha, U C; Kumar, Sanyal; Gupta, Rajiv; Gothi, Dipti; Pal, R S

    2013-01-01

    To study the spectrum of high resolution computed tomography (HRCT) findings in occupational lung disease in industrial workers and to assess the utility of International classification of HRCT for occupational and environmental respiratory diseases (ICHOERD). Retrospective analysis of radiological data (radiographs and computed tomography chest scans) gathered over a period of 3 years (January 2010- December 2012) of industrial workers in an organised sector who presented with respiratory complaints. The HRCT findings were evaluated using ICHOERD. There were 5 females and 114 males in the study, with a mean age of 49 years. These workers were exposed to different harmful agents including silica, asbestos, cotton dust, metal dust, iron oxide, organic dust, rubber fumes, plastic fumes, acid fumes, and oil fumes. There were 10 smokers in the study. The radiograph of chest was normal in 53 patients. 46% of these normal patients (21.8% of total) demonstrated positive findings on HRCT. When the radiograph was abnormal, HRCT provided more accurate information and excluded the other diagnosis. The HRCT findings were appropriately described using the ICHOERD. Bronchiectasis was the most common finding (44.5%) with mild central cylindrical bronchiectasis as the most common pattern. Pleural thickening was seen in 41 patients (34.5%). Enlarged hilar or mediastinal lymphnodes were seen in 10 patients (8.4%) with egg-shell calcification in 1 patient exposed to silica. Bronchogenic carcinoma was seen in 1 patient exposed to asbestos. Occupational lung disease is a common work related condition in industrial workers even in the organized sector. Though chest radiograph is the primary diagnostic tool, HRCT is the undisputed Gold Standard for evaluation of these patients. Despite the disadvantage of radiation exposure, low dose CT may serve as an important tool for screening and surveillance. The ICHOERD is a powerful and reliable tool not only for diagnosis, but also for

  13. Spectrum of High Resolution Computed Tomography Findings in Occupational Lung Disease: Experience in a Tertiary Care Institute

    PubMed Central

    Bhawna, Satija; Ojha, U. C.; Kumar, Sanyal; Gupta, Rajiv; Gothi, Dipti; Pal, R. S.

    2013-01-01

    Objective: To study the spectrum of high resolution computed tomography (HRCT) findings in occupational lung disease in industrial workers and to assess the utility of International classification of HRCT for occupational and environmental respiratory diseases (ICHOERD). Materials and Methods: Retrospective analysis of radiological data (radiographs and computed tomography chest scans) gathered over a period of 3 years (January 2010- December 2012) of industrial workers in an organised sector who presented with respiratory complaints. The HRCT findings were evaluated using ICHOERD. Results: There were 5 females and 114 males in the study, with a mean age of 49 years. These workers were exposed to different harmful agents including silica, asbestos, cotton dust, metal dust, iron oxide, organic dust, rubber fumes, plastic fumes, acid fumes, and oil fumes. There were 10 smokers in the study. The radiograph of chest was normal in 53 patients. 46% of these normal patients (21.8% of total) demonstrated positive findings on HRCT. When the radiograph was abnormal, HRCT provided more accurate information and excluded the other diagnosis. The HRCT findings were appropriately described using the ICHOERD. Bronchiectasis was the most common finding (44.5%) with mild central cylindrical bronchiectasis as the most common pattern. Pleural thickening was seen in 41 patients (34.5%). Enlarged hilar or mediastinal lymphnodes were seen in 10 patients (8.4%) with egg-shell calcification in 1 patient exposed to silica. Bronchogenic carcinoma was seen in 1 patient exposed to asbestos. Conclusions: Occupational lung disease is a common work related condition in industrial workers even in the organized sector. Though chest radiograph is the primary diagnostic tool, HRCT is the undisputed Gold Standard for evaluation of these patients. Despite the disadvantage of radiation exposure, low dose CT may serve as an important tool for screening and surveillance. The ICHOERD is a powerful and

  14. Screening for interstitial lung disease in systemic sclerosis: the diagnostic accuracy of HRCT image series with high increment and reduced number of slices.

    PubMed

    Winklehner, Anna; Berger, Nicole; Maurer, Britta; Distler, Oliver; Alkadhi, Hatem; Frauenfelder, Thomas

    2012-04-01

    The objective of this study is to assess diagnostic accuracy for the detection of interstitial lung disease (ILD) in image series with high increment and reduced number of slices in patients with systemic sclerosis (SSc). 45 patients with SSc underwent high-resolution CT (HRCT). Three series of secondary captures were reconstructed as follows: series 1, series with 10 mm increment and 1 mm slices; series 2, seven axial images with baso-apical gradient; series 3, three axial images were obtained at the apical, at the level of the carina and basal. The presence and extent of ILD, and the degree of diagnostic confidence were recorded. The effective dose for each image series was estimated. Standard HRCT was the standard of reference. The prevalence of ILD was 55% (25/45). Diagnostic sensitivity and accuracy of series 1, series 2 and series 3 were 100% and 94.4%, 94% and 97.8%, 92% and 97.8%, respectively. The extent of ILD was underestimated in series 3 (p<0.05) and was comparable to the standard HRCT in series 1 and 2 (p>0.05). Estimated dose reduction was more than 90% in all image series. HRCT image series with low sampling rate allow an accurate detection of ILD with very-low-radiation dose, making this approach potentially valuable for screening in patients with SSc.

  15. Lung Injury Etiology and Other Factors Influencing the Relationship Between Dead-Space Fraction and Mortality in ARDS.

    PubMed

    Kallet, Richard H; Zhuo, Hanjing; Ho, Kelly; Lipnick, Michael S; Gomez, Antonio; Matthay, Michael A

    2017-10-01

    In ARDS, elevated pulmonary dead-space fraction (VD/VT) is a particularly strong indicator of mortality risk. Whether the magnitude of VD/VT is modified by the underlying etiology of ARDS and whether this influences the strength of its association with mortality remains unknown. We sought to elucidate the impact of ARDS etiology on VD/VT and also to determine whether ARDS severity, as classified by the Berlin definition, has correspondence with changes in VD/VT. This single-center, retrospective, observational study (2010-2016) measured VD/VT in 685 subjects with ARDS as part of clinical management with lung-protective ventilation. Volumetric capnography was used to measure VD/VT with 99% of measurements occurring within 48 h of ARDS onset. Demographic information as well as illness severity scores and pulmonary mechanics data also were collected. Multivariate logistic regression modeling was done to assess the strength of association between VD/VT and mortality. VD/VT was elevated across etiologies, with aspiration and pneumonia having significantly higher VD/VT than non-pulmonary sepsis or trauma. Differences in the magnitude of VD/VT across etiologies did not necessarily correspond with mortality between etiologies. However, within each etiology grouping, VD/VT was significantly elevated in non-survivors versus survivors. The same results were found in both moderate and severe (but not mild) ARDS using the Berlin definition. In the final adjusted model, the strongest mortality risk was VD/VT, wherein the risk of death increased by 22% for every 0.05 increase in VD/VT. VD/VT magnitude varies by ARDS etiology, as does mortality. Only in mild ARDS does VD/VT fail to distinguish non-survivors from survivors. Nonetheless, VD/VT has the strongest association with mortality risk in those with ARDS. Copyright © 2017 by Daedalus Enterprises.

  16. Etiology and Outcomes of ARDS in a Rural-Urban Fringe Hospital of South India.

    PubMed

    George, Tarun; Viswanathan, Stalin; Karnam, Ali Hasan Faiz; Abraham, Georgi

    2014-01-01

    Objectives. Etiology and outcomes of acute lung injury in tropical countries may be different from those of western nations. We describe the etiology and outcomes of illnesses causing acute lung injury in a rural populace. Study Design. A prospective observational study. Setting. Medical ICU of a teaching hospital in a rural-urban fringe location. Patients. Patients ≥13 years, admitted between December 2011 and May 2013, satisfying AECC criteria for ALI/ARDS. Results. Study had 61 patients; 46 had acute lung injury at admission. Scrub typhus was the commonest cause (7/61) and tropical infections contributed to 26% of total cases. Increasing ARDS severity was associated with older age, higher FiO2 and APACHE/SOFA scores, and longer duration of ventilation. Nonsurvivors were generally older, had shorter duration of illness, a nontropical infection, and higher total WBC counts, required longer duration of ventilation, and had other organ dysfunction and higher mean APACHE scores. The mortality rate of ARDS was 36.6% (22/61) in our study. Conclusion. Tropical infections form a major etiological component of acute lung injury in a developing country like India. Etiology and outcomes of ARDS may vary depending upon the geographic location and seasonal illnesses.

  17. Etiology and Outcomes of ARDS in a Rural-Urban Fringe Hospital of South India

    PubMed Central

    Karnam, Ali Hasan Faiz; Abraham, Georgi

    2014-01-01

    Objectives. Etiology and outcomes of acute lung injury in tropical countries may be different from those of western nations. We describe the etiology and outcomes of illnesses causing acute lung injury in a rural populace. Study Design. A prospective observational study. Setting. Medical ICU of a teaching hospital in a rural-urban fringe location. Patients. Patients ≥13 years, admitted between December 2011 and May 2013, satisfying AECC criteria for ALI/ARDS. Results. Study had 61 patients; 46 had acute lung injury at admission. Scrub typhus was the commonest cause (7/61) and tropical infections contributed to 26% of total cases. Increasing ARDS severity was associated with older age, higher FiO2 and APACHE/SOFA scores, and longer duration of ventilation. Nonsurvivors were generally older, had shorter duration of illness, a nontropical infection, and higher total WBC counts, required longer duration of ventilation, and had other organ dysfunction and higher mean APACHE scores. The mortality rate of ARDS was 36.6% (22/61) in our study. Conclusion. Tropical infections form a major etiological component of acute lung injury in a developing country like India. Etiology and outcomes of ARDS may vary depending upon the geographic location and seasonal illnesses. PMID:24660060

  18. Matrix metalloproteinases and protein tyrosine kinases: potential novel targets in acute lung injury and ARDS.

    PubMed

    Aschner, Yael; Zemans, Rachel L; Yamashita, Cory M; Downey, Gregory P

    2014-10-01

    Acute lung injury (ALI) and ARDS fall within a spectrum of pulmonary disease that is characterized by hypoxemia, noncardiogenic pulmonary edema, and dysregulated and excessive inflammation. While mortality rates have improved with the advent of specialized ICUs and lung protective mechanical ventilation strategies, few other therapies have proven effective in the management of ARDS, which remains a significant clinical problem. Further development of biomarkers of disease severity, response to therapy, and prognosis is urgently needed. Several novel pathways have been identified and studied with respect to the pathogenesis of ALI and ARDS that show promise in bridging some of these gaps. This review will focus on the roles of matrix metalloproteinases and protein tyrosine kinases in the pathobiology of ALI in humans, and in animal models and in vitro studies. These molecules can act independently, as well as coordinately, in a feed-forward manner via activation of tyrosine kinase-regulated pathways that are pivotal in the development of ARDS. Specific signaling events involving proteolytic processing by matrix metalloproteinases that contribute to ALI, including cytokine and chemokine activation and release, neutrophil recruitment, transmigration and activation, and disruption of the intact alveolar-capillary barrier, will be explored in the context of these novel molecular pathways.

  19. Assessing the quality of studies supporting genetic susceptibility and outcomes of ARDS

    PubMed Central

    Acosta-Herrera, Marialbert; Pino-Yanes, Maria; Perez-Mendez, Lina; Villar, Jesús; Flores, Carlos

    2014-01-01

    The acute respiratory distress syndrome (ARDS) is a severe inflammatory disease manifested as a result of pulmonary and systemic responses to several insults. It is now well accepted that genetic variation influences these responses. However, little is known about the genes that are responsible for patient susceptibility and outcome of ARDS. Methodological flaws are still abundant among genetic association studies with ARDS and here, we aimed to highlight the quality criteria where the standards have not been reached, to expose the associated genes to facilitate replication attempts, and to provide quick-reference guidance for future studies. We conducted a PubMed search from January 2008 to September 2012 for original articles. Studies were considered if a statistically significant association was declared with either susceptibility or outcomes of all-cause ARDS. Fourteen criteria were used for evaluation and results were compared to those from a previous quality assessment report. Significant improvements affecting study design and statistical analysis were detected. However, major issues such as adjustments for the underlying population stratification and replication studies remain poorly addressed. PMID:24567738

  20. An interdisciplinary tillage erosion experiment: establishing a new field in grassland with reconstructed ard plough of the Bronze Age - Iron Age

    NASA Astrophysics Data System (ADS)

    Pavelka, Jan; Smetanová, Anna; Rejman, Jerzy; Kováčik, Peter

    2017-04-01

    Despite recognising the role of tillage erosion in landforms evolution, little research has documented its effects in prehistoric times. Herein, an interdisciplinary archaeological-geomorphological experiment with reconstructed tillage tools and management was conducted in order to measure tillage erosion when a new field in grasslands was established in the Bronze Age-Iron Age. Three wooden ards were reconstructed based on archaeological findings. They were tested in a cross-tillage experiment, consisting of a tillage pass perpendicular to the primary slope (6.5-9.7%), and a second tillage pass parallel to the primary slope of a convex-convex ridge with mowed grass (0.2 m high, vegetation cover >90%). The standard sole ard proved to be the most effective, with a mean tillage depth of 0.12 m, a mean tillage speed of 3.8 km h-1, and a mean distance between furrows of 0.20-0.25 m. Only 13% of the 264 tracers placed on 6 transects were displaced, and the mean tracers displacement parallel to the primary slope was 0.04 ± 0.17 m. Contour tillage perpendicular to primary slope created V or U shaped furrows with a mean depth of 0.1-0.12 m, a mean width of 0.05-0.1 m, and incision under the main root zone. Only soil in direct contact with the ard was displaced, with a mean translocation distance of 0.06 ± 0.2 m parallel and 0.06 ± 0.3 m perpendicular to the primary slope. During tillage parallel to slope, soil clods of 0.20 x 0.25 x 0.10 m were created and slightly disturbed or turned over one another. The tracers moved within the furrows and with the soil clods. Loose soil, resembling a seedbed, was not covered by soil clods. Mean displacement during the second pass was 0.03 ± 0.19 m parallel and 0.00 ± 0.15 m perpendicular to primary slope. The displacement from cross-tillage with a wooden ard in permanent grasslands was lower than many previously measured values of traditional animal-powered metal ploughs in permanent fields. No relationship between mean soil

  1. The use of high resolution computerized tomography (HRCT) of the chest in evaluating the effect of tobramycin solution for inhalation in cystic fibrosis lung disease.

    PubMed

    Nasr, Samya Z; Sakmar, Ermelinda; Christodoulou, Emmanuel; Eckhardt, Boris P; Streetman, Daniel S; Strouse, Peter J

    2010-05-01

    To compare the usefulness of HRCT of the chest versus spirometric measures (PFTs) in evaluating the effect of tobramycin solution for inhalation (TSI) in cystic fibrosis (CF). Thirty-two CF patients with mostly mild lung disease age > or = 6 years, were enrolled in a double-blind, placebo-controlled pilot study. Patients were chronically colonized with Pseudomonas aeruginosa for at least 6 months prior to and at enrollment. If patients were on TSI, they were taken off for at least 3 months prior to enrollment. Duration was 6 months; 31 subjects completed the study. HRCT and PFTs were evaluated at baseline, after 28 days of treatment and at the end of the study. Study medication was administered as 5 ml nebulized treatment twice a day for 28 days followed by 28 days off (one cycle). Study consisted of three cycles. Two radiologists scored all films using a validated system. A total HRCT score consists of the sum of subscores: linear opacities, hyperinflation, nodular opacities, peribronchial thickening, mucous plugging, and bronchiectasis; each subscore could range from 0 to 80, with potential total scores varying from 0 to 480. The percent of the maximum possible HRCT score was then calculated and used for all comparisons. Using two tailed paired t-test, the percent maximum HRCT score decreased by 1.4 +/- 2.6% (mean +/- SD) (P = 0.049) and 0.3 +/- 2.8% (P = 0.63) for the TSI group and decreased by 0.1 +/- 1.5% (P = 0.74) and increased by 0.6 +/- 1.8% (P = 0.23) for the placebo group between visits 1 and 2, and visits 1 and 3, respectively. The data were then analyzed using a mixed model utilizing changes in scores over the durations of the study for each group. The change of HRCT score for the TSI group was -0.24/day (P = 0.02) and -0.03/day (P = 0.22), and for the control group the change was -0.01 (P = 0.93) and 0.02 (P = 0.29) between visits 1 and 2, and visits 1 and 3 respectively. FEF(25-75)% and FEV(1)% changes were not statistically significant using both

  2. Pulmonary Leptospirosis With Diffuse Alveolar Hemorrhage: High-Resolution Computed Tomographic Findings in 16 Patients.

    PubMed

    von Ranke, Felipe Mussi; Zanetti, Gláucia; Escuissato, Dante Luiz; Hochhegger, Bruno; Marchiori, Edson

    2016-01-01

    The aim of this study was to evaluate the high-resolution computed tomographic (HRCT) findings from patients with leptospirosis and diffuse alveolar hemorrhage (DAH). We retrospectively reviewed HRCT findings from 16 patients diagnosed as having leptospirosis causing DAH. The patient sample was composed of 13 men and 3 women aged 22 to 53 years (mean age, 34.5 years). Diagnosis was established with confirmation of leptospirosis infection by serologic microagglutination test. Histopathological study was performed in 8 patients. Two chest radiologists analyzed the HRCT images and reached decisions by consensus. The predominant HRCT findings were ground-glass opacities and airspace nodules (both n = 12, 75%), ground-glass nodules (n = 9, 56.25%), consolidations (n = 7, 43.75%), "crazy-paving" pattern (n = 3, 18.75%), and interlobular septal thickening without ground-glass opacity (n = 3, 18.75%). Bilateral pleural effusion was an associated finding in 2 (12.5%) patients. Analysis of the axial distribution of the lesions revealed diffuse distribution in 11 (68.75%) patients and peripheral lung zone predominance in 5 (31.25%) patients. Abnormalities were bilateral in all 16 (100%) patients. Analysis of the craniocaudal distribution of the lesions revealed lower zone predominance in 9 (56.25%) patients, diffuse distribution in 5 (31.25%) patients, middle zone predominance in 1 (6.25%) patient, and upper zone predominance in 1 (6.25%) patient. The most frequent HRCT findings in patients with leptospirosis causing DAH were ground-glass opacities, airspace nodules, ground-glass nodules, and consolidations. The lesions showed symmetrical distribution with lower zone predominance in most cases.

  3. The clinical practice guideline for the management of ARDS in Japan.

    PubMed

    Hashimoto, Satoru; Sanui, Masamitsu; Egi, Moritoki; Ohshimo, Shinichiro; Shiotsuka, Junji; Seo, Ryutaro; Tanaka, Ryoma; Tanaka, Yu; Norisue, Yasuhiro; Hayashi, Yoshiro; Nango, Eishu

    2017-01-01

    The Japanese Society of Respiratory Care Medicine and the Japanese Society of Intensive Care Medicine provide here a clinical practice guideline for the management of adult patients with ARDS in the ICU. The guideline was developed applying the GRADE system for performing robust systematic reviews with plausible recommendations. The guideline consists of 13 clinical questions mainly regarding ventilator settings and drug therapies (the last question includes 11 medications that are not approved for clinical use in Japan). The recommendations for adult patients with ARDS include: we suggest against early tracheostomy (GRADE 2C), we suggest using NPPV for early respiratory management (GRADE 2C), we recommend the use of low tidal volumes at 6-8 mL/kg (GRADE 1B), we suggest setting the plateau pressure at 30cmH20 or less (GRADE2B), we suggest using PEEP within the range of plateau pressures less than or equal to 30cmH2O, without compromising hemodynamics (Grade 2B), and using higher PEEP levels in patients with moderate to severe ARDS (Grade 2B), we suggest using protocolized methods for liberation from mechanical ventilation (Grade 2D), we suggest prone positioning especially in patients with moderate to severe respiratory dysfunction (GRADE 2C), we suggest against the use of high frequency oscillation (GRADE 2C), we suggest the use of neuromuscular blocking agents in patients requiring mechanical ventilation under certain circumstances (GRADE 2B), we suggest fluid restriction in the management of ARDS (GRADE 2A), we do not suggest the use of neutrophil elastase inhibitors (GRADE 2D), we suggest the administration of steroids, equivalent to methylprednisolone 1-2mg/kg/ day (GRADE 2A), and we do not recommend other medications for the treatment of adult patients with ARDS (GRADE1B; inhaled/intravenous β2 stimulants, prostaglandin E1, activated protein C, ketoconazole, and lisofylline, GRADE 1C; inhaled nitric oxide, GRADE 1D; surfactant, GRADE 2B; granulocyte

  4. Reabsorption atelectasis in a porcine model of ARDS: regional and temporal effects of airway closure, oxygen, and distending pressure.

    PubMed

    Derosa, Savino; Borges, João Batista; Segelsjö, Monica; Tannoia, Angela; Pellegrini, Mariangela; Larsson, Anders; Perchiazzi, Gaetano; Hedenstierna, Göran

    2013-11-01

    Little is known about the small airways dysfunction in acute respiratory distress syndrome (ARDS). By computed tomography (CT) imaging in a porcine experimental model of early ARDS, we aimed at studying the location and magnitude of peripheral airway closure and alveolar collapse under high and low distending pressures and high and low inspiratory oxygen fraction (FIO2). Six piglets were mechanically ventilated under anesthesia and muscle relaxation. Four animals underwent saline-washout lung injury, and two served as healthy controls. Beyond the site of assumed airway closure, gas was expected to be trapped in the injured lungs, promoting alveolar collapse. This was tested by ventilation with an FIO2 of 0.25 and 1 in sequence during low and high distending pressures. In the most dependent regions, the gas/tissue ratio of end-expiratory CT, after previous ventilation with FIO2 0.25 low-driving pressure, was significantly higher than after ventilation with FIO2 1; with high-driving pressure, this difference disappeared. Also, significant reduction in poorly aerated tissue and a correlated increase in nonaerated tissue in end-expiratory CT with FIO2 1 low-driving pressure were seen. When high-driving pressure was applied or after previous ventilation with FIO2 0.25 and low-driving pressure, this pattern disappeared. The findings suggest that low distending pressures produce widespread dependent airway closure and with high FIO2, subsequent absorption atelectasis. Low FIO2 prevented alveolar collapse during the study period because of slow absorption of gas behind closed airways.

  5. HrcT is a key component of the type III secretion system in Xanthomonas spp. and also regulates the expression of the key hrp transcriptional activator HrpX.

    PubMed

    Liu, Zhi-Yang; Zou, Li-Fang; Xue, Xiao-Bo; Cai, Lu-Lu; Ma, Wen-Xiu; Xiong, Li; Ji, Zhi-Yuan; Chen, Gong-You

    2014-07-01

    The type III secretion system (T3SS), encoded by hrp (hypersensitive response and pathogenicity) genes in Gram-negative phytopathogenic bacteria, delivers repertoires of T3SS effectors (T3SEs) into plant cells to trigger the hypersensitive response (HR) in nonhost or resistant-host plants and promote pathogenicity in susceptible plants. The expression of hrp genes in Xanthomonas is regulated by two key regulatory proteins, HrpG and HrpX. However, the interactions between hrp gene products in directing T3SE secretion are largely unknown. Here we demonstrated that HrcT of X. oryzae pv. oryzicola functions as a T3SS component and positively regulates the expression of hrpX. Transcription of hrcT occurs via two distinct promoters; one (T1) is with the hrpB operon and the second (T3) within hrpB7 Via either promoter T1 or T3, the defect in Hrp phenotype by hrcT deletion was corrected in the presence of hrcT only from Xanthomonas species but not from other phytopathogenic bacteria. An N-terminally truncated HrcT was able to bind the hrpX promoter and activate the expression of hrpX, supporting that HrcT is a positive regulator of hrpX. A revised model showing the regulatory interactions between HrcT, HrpX, and HrpG is proposed.

  6. Lung ultrasonography for assessment of oxygenation response to prone position ventilation in ARDS.

    PubMed

    Haddam, Malik; Zieleskiewicz, Laurent; Perbet, Sebastien; Baldovini, Alice; Guervilly, Christophe; Arbelot, Charlotte; Noel, Alexandre; Vigne, Coralie; Hammad, Emmanuelle; Antonini, François; Lehingue, Samuel; Peytel, Eric; Lu, Qin; Bouhemad, Belaid; Golmard, Jean-Louis; Langeron, Olivier; Martin, Claude; Muller, Laurent; Rouby, Jean-Jacques; Constantin, Jean-Michel; Papazian, Laurent; Leone, Marc

    2016-10-01

    Prone position (PP) improves oxygenation and outcome of acute respiratory distress syndrome (ARDS) patients with a PaO2/FiO2 ratio <150 mmHg. Regional changes in lung aeration can be assessed by lung ultrasound (LUS). Our aim was to predict the magnitude of oxygenation response after PP using bedside LUS. We conducted a prospective multicenter study that included adult patients with severe and moderate ARDS. LUS data were collected at four time points: 1 h before (baseline) and 1 h after turning the patient to PP, 1 h before and 1 h after turning the patient back to the supine position. Regional lung aeration changes and ultrasound reaeration scores were assessed at each time. Overdistension was not assessed. Fifty-one patients were included. Oxygenation response after PP was not correlated with a specific LUS pattern. The patients with focal and non-focal ARDS showed no difference in global reaeration score. With regard to the entire PP session, the patients with non-focal ARDS had an improved aeration gain in the anterior areas. Oxygenation response was not associated with aeration changes. No difference in PaCO2 change was found according to oxygenation response or lung morphology. In ARDS patients with a PaO2/FiO2 ratio ≤150 mmHg, bedside LUS cannot predict oxygenation response after the first PP session. At the bedside, LUS enables monitoring of aeration changes during PP.

  7. Revegetation of Acid Rock Drainage (ARD) Producing Slope Surface Using Phosphate Microencapsulation and Artificial Soil

    NASA Astrophysics Data System (ADS)

    Kim, Jae Gon

    2017-04-01

    Oxidation of sulfides produces acid rock drainage (ARD) upon their exposure to oxidation environment by construction and mining activities. The ARD causes the acidification and metal contamination of soil, surface water and groundwater, the damage of plant, the deterioration of landscape and the reduction of slope stability. The revegetation of slope surface is one of commonly adopted strategies to reduce erosion and to increase slope stability. However, the revegetation of the ARD producing slope surface is frequently failed due to its high acidity and toxic metal content. We developed a revegetation method consisting of microencapsualtion and artificial soil in the laboratory. The revegetation method was applied on the ARD producing slope on which the revegetation using soil coverage and seeding was failed and monitored the plant growth for one year. The phosphate solution was applied on sulfide containing rock to form stable Fe-phosphate mineral on the surface of sulfide, which worked as a physical barrier to prevent contacting oxidants such as oxygen and Fe3+ ion to the sulfide surface. After the microencapsulation, two artificial soil layers were constructed. The first layer containing organic matter, dolomite powder and soil was constructed at 2 cm thickness to neutralize the rising acidic capillary water from the subsurface and to remove the dissolved oxygen from the percolating rain water. Finally, the second layer containing seeds, organic matter, nutrients and soil was constructed at 3 cm thickness on the top. After application of the method, the pH of the soil below the artificial soil layer increased and the ARD production from the rock fragments reduced. The plant growth showed an ordinary state while the plant died two month after germination for the previous revegetation trial. No soil erosion occurred from the slope during the one year field test.

  8. Plasma angiopoietin-2 outperforms other markers of endothelial injury in prognosticating pediatric ARDS mortality.

    PubMed

    Zinter, Matt S; Spicer, Aaron; Orwoll, Benjamin O; Alkhouli, Mustafa; Dvorak, Christopher C; Calfee, Carolyn S; Matthay, Michael A; Sapru, Anil

    2016-02-01

    Angiopoietin-2 (Ang-2) is a key mediator of pulmonary vascular permeability. This study tested the association between plasma Ang-2 and mortality in pediatric acute respiratory distress syndrome (ARDS), with stratification for prior hematopoietic cellular transplantation (HCT), given the severe, yet poorly understood, ARDS phenotype of this subgroup. We enrolled 259 children <18 years of age with ARDS; 25 had prior HCT. Plasma Ang-2, von Willebrand Factor antigen (vWF), and vascular endothelial growth factor (VEGF) were measured on ARDS days 1 and 3 and correlated with patient outcomes. Day 1 and day 3 Ang-2 levels were associated with mortality independent of age, sex, race, and P/F ratio [odds ratio (OR) 3.7, 95% CI 1.1-11.5, P = 0.027; and OR 10.2, 95% confidence interval (CI) 2.2-46.5, P = 0.003, for each log10 increase in Ang-2]. vWF was associated with mortality (P = 0.027), but VEGF was not. The association between day 1 Ang-2 and mortality was independent of levels of both vWF and VEGF (OR 3.6, 95% CI 1.1-12.1, P = 0.039, for each log10 increase in Ang-2). 45% of the cohort had a rising Ang-2 between ARDS day 1 and 3 (adjusted mortality OR 3.3, 95% CI 1.2-9.2, P = 0.026). HCT patients with a rising Ang-2 had 70% mortality compared with 13% mortality for those without (OR 16.3, 95% CI 1.3-197.8, P = 0.028). Elevated plasma levels of Ang-2 were associated with mortality independent of vWF and VEGF. A rising Ang-2 between days 1 and 3 was strongly associated with mortality, particularly in pediatric HCT patients, suggesting vulnerability to ongoing endothelial damage.

  9. Prolonged Glucocorticoid Treatment in ARDS: Impact on Intensive Care Unit-Acquired Weakness

    PubMed Central

    Meduri, Gianfranco Umberto; Schwingshackl, Andreas; Hermans, Greet

    2016-01-01

    Systemic inflammation and duration of immobilization are strong independent risk factors for the development of intensive care unit-acquired weakness (ICUAW). Activation of the pro-inflammatory transcription factor nuclear factor-κB (NF-κB) results in muscle wasting during disuse-induced skeletal muscle atrophy (ICU bed rest) and septic shock. In addition, NF-κB-mediated signaling plays a significant role in mechanical ventilation-induced diaphragmatic atrophy and contractile dysfunction. Older trials investigating high dose glucocorticoid treatment reported a lack of a sustained anti-inflammatory effects and an association with ICUAW. However, prolonged low-to-moderate dose glucocorticoid treatment of sepsis and ARDS is associated with a reduction in NF-κB DNA-binding, decreased transcription of inflammatory cytokines, enhanced resolution of systemic and pulmonary inflammation, leading to fewer days of mechanical ventilation, and lower mortality. Importantly, meta-analyses of a large number of randomized controlled trials investigating low-to-moderate glucocorticoid treatment in severe sepsis and ARDS found no increase in ICUAW. Furthermore, while the ARDS network trial investigating methylprednisolone treatment in persistent ARDS is frequently cited to support an association with ICUAW, a reanalysis of the data showed a similar incidence with the control group. Our review concludes that in patients with sepsis and ARDS, any potential direct harmful neuromuscular effect of glucocorticoids appears outweighed by the overall clinical improvement and reduced duration of organ failure, in particular ventilator dependency and associated immobilization, which are key risk factors for ICUAW. PMID:27532030

  10. The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia.

    PubMed

    Bein, Thomas; Grasso, Salvatore; Moerer, Onnen; Quintel, Michael; Guerin, Claude; Deja, Maria; Brondani, Anita; Mehta, Sangeeta

    2016-05-01

    Severe ARDS is often associated with refractory hypoxemia, and early identification and treatment of hypoxemia is mandatory. For the management of severe ARDS ventilator settings, positioning therapy, infection control, and supportive measures are essential to improve survival. A precise definition of life-threating hypoxemia is not identified. Typical clinical determinations are: arterial partial pressure of oxygen < 60 mmHg and/or arterial oxygenation < 88 % and/or the ratio of PaO2/FIO2 < 100. For mechanical ventilation specific settings are recommended: limitation of tidal volume (6 ml/kg predicted body weight), adequate high PEEP (>12 cmH2O), a recruitment manoeuvre in special situations, and a 'balanced' respiratory rate (20-30/min). Individual bedside methods to guide PEEP/recruitment (e.g., transpulmonary pressure) are not (yet) available. Prone positioning [early (≤ 48 hrs after onset of severe ARDS) and prolonged (repetition of 16-hr-sessions)] improves survival. An advanced infection management/control includes early diagnosis of bacterial, atypical, viral and fungal specimen (blood culture, bronchoalveolar lavage), and of infection sources by CT scan, followed by administration of broad-spectrum anti-infectives. Neuromuscular blockage (Cisatracurium ≤ 48 hrs after onset of ARDS), as well as an adequate sedation strategy (score guided) is an important supportive therapy. A negative fluid balance is associated with improved lung function and the use of hemofiltration might be indicated for specific indications. A specific standard of care is required for the management of severe ARDS with refractory hypoxemia.

  11. Characteristics and provision of care of patients with the acute respiratory distress syndrome: descriptive findings from the DACAPO cohort baseline and comparison with international findings.

    PubMed

    Dodoo-Schittko, Frank; Brandstetter, Susanne; Brandl, Magdalena; Blecha, Sebastian; Quintel, Michael; Weber-Carstens, Steffen; Kluge, Stefan; Meybohm, Patrick; Rolfes, Caroline; Ellger, Björn; Bach, Friedhelm; Welte, Tobias; Muders, Thomas; Thomann-Hackner, Kathrin; Bein, Thomas; Apfelbacher, Christian

    2017-03-01

    Little is known about the characteristics and real world life circumstances of ARDS (acute respiratory distress syndrome) patient populations. This knowledge is essential for transferring evidence-based therapy into routine healthcare. The aim of this study was to report socio-demographic and clinical characteristics in an unselected population of ARDS patients and to compare these results to findings from other large ARDS cohorts. A German based cross-sectional observational study was carried out. A total of 700 ARDS patients were recruited in 59 study sites between September 2014 and January 2016. Socio-demographic, disease and care related variables were recorded. Additionally, characteristics of other large ARDS cohorts identified by a systematic literature search were extracted into evidence tables. Median age of ARDS patients was 58 years, 69% were male. Sixty percent had no employment, predominantly due to retirement. Seventy-one percent lived with a partner. The main cause of ARDS was a pulmonary 'direct' origin (79%). The distribution of severity was as follows: mild (14%), moderate (48%), severe (38%). Overall ICU mortality was calculated to be 34%. The observed prevalence of critical events (hypoxemia, hypoglycemia, re-intubation) was 47%. Supportive measures during ICU-treatment were applied to 60% of the patients. Other ARDS cohorts revealed a high heterogeneity in reported concomitant diseases, but sepsis and pneumonia were most frequently reported. Mean age ranged from 54 to 71 years and most patients were male. Other socio-demographic factors have been almost neglected. The proportion of patients suffering of mild ARDS was lower compared to the only study identified, which also applied the Berlin definition. The frequency of critical events during ICU treatment was high and the implementation of evidence-based therapy (prone positioning, neuro-muscular blockers) was limited. More evidence on socio-demographic characteristics and further studies

  12. Accelerated detection of intracranial space-occupying lesions with CUDA based on statistical texture atlas in brain HRCT.

    PubMed

    Liu, Wei; Feng, Huanqing; Li, Chuanfu; Huang, Yufeng; Wu, Dehuang; Tong, Tong

    2009-01-01

    In this paper, we present a method that detects intracranial space-occupying lesions in two-dimensional (2D) brain high-resolution CT images. Use of statistical texture atlas technique localizes anatomy variation in the gray level distribution of brain images, and in turn, identifies the regions with lesions. The statistical texture atlas involves 147 HRCT slices of normal individuals and its construction is extremely time-consuming. To improve the performance of atlas construction, we have implemented the pixel-wise texture extraction procedure on Nvidia 8800GTX GPU with Compute Unified Device Architecture (CUDA) platform. Experimental results indicate that the extracted texture feature is distinctive and robust enough, and is suitable for detecting uniform and mixed density space-occupying lesions. In addition, a significant speedup against straight forward CPU version was achieved with CUDA.

  13. Directional Multi-scale Modeling of High-Resolution Computed Tomography (HRCT) Lung Images for Diffuse Lung Disease Classification

    NASA Astrophysics Data System (ADS)

    Vo, Kiet T.; Sowmya, Arcot

    A directional multi-scale modeling scheme based on wavelet and contourlet transforms is employed to describe HRCT lung image textures for classifying four diffuse lung disease patterns: normal, emphysema, ground glass opacity (GGO) and honey-combing. Generalized Gaussian density parameters are used to represent the detail sub-band features obtained by wavelet and contourlet transforms. In addition, support vector machines (SVMs) with excellent performance in a variety of pattern classification problems are used as classifier. The method is tested on a collection of 89 slices from 38 patients, each slice of size 512x512, 16 bits/pixel in DICOM format. The dataset contains 70,000 ROIs of those slices marked by experienced radiologists. We employ this technique at different wavelet and contourlet transform scales for diffuse lung disease classification. The technique presented here has best overall sensitivity 93.40% and specificity 98.40%.

  14. Effect of food on the pharmacokinetics and pharmacodynamics of an oral ghrelin agonist (ARD-07) in healthy subjects.

    PubMed

    MacLean, Carol M; Casanova, Anna-Tina; Baselgia-Jeker, Luisa; Neave, Nicola; Larsen, Finn; Skillern, Laurence; Drewe, Juergen; Beglinger, Christoph

    2009-05-01

    ARD-07 (also known as EP01572) is a peptidomimetic growth hormone secretagogue that can be administered orally. The primary objective of this study is to determine the effects of a meal on the oral bioavailability of ARD-07 after a single oral dose (0.5 mg/kg). In addition, the pharmacodynamic effects (growth hormone release, insulin-like growth factor-1 concentrations) and the tolerability of ARD-07 are investigated in this open-label, randomized, crossover study. Sixteen healthy subjects (8 males, 8 females) receive ARD-07 on 2 different days; the treatment consists of a single oral dose of ARD-07 (0.5 mg/kg body weight), once with and the second day without a test meal. Plasma kinetics of ARD-07 and pharmacodynamic effects are quantified by specific assays. Results are given as mean +/- SEM: The area under the curve for 0 to 24 hours is approximately twice as high without food (27.8 +/- 4.1) than with food (13.7 +/- 1.2; P = .002). The maximum observed ARD-07 concentration relative to dose administration (C(max)) is more than twice as high without food (10.6 +/- 1.6 ng/mL) than with food (4.4 +/- 0.5 ng/mL; P = .001). C(max) of growth hormone occurs at a significantly (P = .001) later stage with food (C(max) = 13.0 +/- 3.5 ng/mL) than without food (37.1 +/- 5.3 ng/mL). Food has a marked effect on the absorption of ARD-07: there is a significant difference in bioavailability between administration of oral ARD-07 with and without food.

  15. Is pulmonary resistance constant, within the range of tidal volume ventilation, in patients with ARDS?

    PubMed

    Mols, G; Kessler, V; Benzing, A; Lichtwarck-Aschoff, M; Geiger, K; Guttmann, J

    2001-02-01

    When managing patients with acute respiratory distress syndrome (ARDS), respiratory system compliance is usually considered first and changes in resistance, although recognized, are neglected. Resistance can change considerably between minimum and maximum lung volume, but is generally assumed to be constant in the tidal volume range (V(T)). We measured resistance during tidal ventilation in 16 patients with ARDS or acute lung injury by the slice method and multiple linear regression analysis. Resistance was constant within V(T) in only six of 16 patients. In the remaining patients, resistance decreased, increased or showed complex changes. We conclude that resistance within V(T) varies considerably from patient to patient and that constant resistance within V(T) is not always likely.

  16. Biomarkers of ALI/ARDS: pathogenesis, discovery, and relevance to clinical trials.

    PubMed

    Janz, David R; Ware, Lorraine B

    2013-08-01

    Despite the high incidence and poor prognosis of acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS), it remains challenging to identify patients who are at highest risk of developing these syndromes, differentiate these syndromes from other causes of acute respiratory failure, and accurately prognosticate once the diagnosis is made. The identification and validation of biological markers of ALI has the potential to ameliorate these challenges by facilitating studies of therapies aimed at prevention, identifying patients more accurately that have ALI so they can benefit from evidence-based therapies and enrollment in clinical trials, and determining which patients are unlikely to have a positive outcome to guide therapeutic choices and trials of experimental rescue therapies. This article reviews the current state of biomarker research in ALI/ARDS. New methodologies for identification of novel biomarkers of ALI, including metabolomics, proteomics, gene expression, and genetic studies are also discussed.

  17. Healthcare utilization and costs in ARDS survivors: a 1-year longitudinal national US multicenter study.

    PubMed

    Ruhl, A Parker; Huang, Minxuan; Colantuoni, Elizabeth; Karmarkar, Taruja; Dinglas, Victor D; Hopkins, Ramona O; Needham, Dale M

    2017-07-01

    To evaluate (1) post-discharge healthcare utilization and estimated costs in ARDS survivors, and (2) the association between patient and intensive care-related variables, and 6-month patient status, with subsequent hospitalization and costs. Longitudinal cohort study enrolling from four ARDSNet trials in 44 US hospitals. Healthcare utilization was collected via structured interviews at 6 and 12 months post-ARDS, and hospital costs estimated via the Medical Expenditure Panel Survey. Adjusted odds ratios for hospitalization and adjusted relative medians for hospital costs were calculated using marginal two-part regression models. Of 859 consenting survivors, 839 (98%) reported healthcare utilization, with 52% female and a mean age of 49 years old. Over 12 months, 339 (40%) patients reported at least one post-discharge hospitalization, with median estimated hospital costs of US$18,756 (interquartile range $7852-46,174; 90th percentile $101,500). Of 16 patient baseline and ICU variables evaluated, only cardiovascular comorbidity and length of stay were associated with hospitalization, and sepsis was associated with hospital costs. At 6-month assessment, better patient-reported physical activity and quality of life status were associated with fewer hospitalizations and lower hospital costs during subsequent follow-up, and worse psychiatric symptoms were associated with increased hospitalizations. This multicenter longitudinal study found that 40% of ARDS survivors reported at least one post-discharge hospitalization during 12-month follow-up. Few patient- or ICU-related variables were associated with hospitalization; however, physical, psychiatric, and quality of life measures at 6-month follow-up were associated with subsequent hospitalization. Interventions to reduce post-ARDS morbidity may be important to improve patient outcomes and reduce healthcare utilization.

  18. Acute cor pulmonale in ARDS: rationale for protecting the right ventricle.

    PubMed

    Repessé, Xavier; Charron, Cyril; Vieillard-Baron, Antoine

    2015-01-01

    The ventilatory strategy for ARDS has been regularly amended over the last 40 years as knowledge of the pathophysiology of ARDS has increased. Initially focused mainly on the lung with the objectives of "opening the lung" and optimizing arterial oxygen saturation, this strategy now also takes into account pulmonary vascular injury and its effects on the right ventricle and on hemodynamics. Hemodynamic devices now available at the bedside, such as echocardiography, allow intensivists to evaluate respiratory settings according to right ventricular tolerance. Here, we review the pathophysiology of pulmonary vascular dysfunction in ARDS, consider the beneficial and deleterious effects of mechanical ventilation, describe the incidence and meaning of acute cor pulmonale based on recent studies in large series of patients, and propose a new, although not strictly validated, approach based on the protection of both the lung and right ventricle. One of our conclusions is that evaluating the right ventricle may help intensivists to assess the balance between recruitment and overdistension induced by the ventilatory strategy. Prone positioning with its beneficial effects on the lung and also on hemodynamics (the right ventricle) is a good illustration of this. Readers should be aware that most of the information given in this article reflects the point of view of the authors. Although based on clinical observations, clinical studies, and well-known pathophysiology, there is no evidence-based medicine to support this clinical commentary. Other approaches may be favored, in which case our article should be read as another attempt to help intensivists to improve management of ARDS.

  19. Effects of nitric oxide inhalation on pulmonary serial vascular resistances in ARDS.

    PubMed

    Rossetti, M; Guénard, H; Gabinski, C

    1996-11-01

    The pulmonary vasculature site of action of nitric oxide (NO) in patients with acute respiratory distress syndrome (ARDS) is still unknown. Seven patients were studied during the early stage of ARDS. The bedside pulmonary artery single-occlusion technique, which allows estimation of the pulmonary capillary pressure (Pcap) and segmental pulmonary vascular resistance, was used without NO or with increasing inhaled NO concentrations (15 and 25 parts per million [ppm]). Systemic circulatory parameters remained unaltered during 15 ppm NO inhalation, whereas 25 ppm NO inhalation slightly decreased mean systemic arterial pressure from 76.7 +/- 5.1 (mean +/- SEM) to 69 +/- 5.2 mm Hg (p < 0.01). Mean pulmonary arterial pressure (Ppam) and mean pulmonary capillary pressure (Pcapm) fell during 25 ppm NO inhalation from 27.4 +/- 3.5 to 21 +/- 2.2 mm Hg (p < 0.001) and from 14.8 +/- 1.5 to 10.7 +/- 1.4 mm Hg (p < 0.001) respectively, the total pulmonary resistance decreased by 28% (p < 0.01). The resistance of the capillary-venous compartment fell during 25 ppm NO inhalation from 100 +/- 16 to 47 +/- 16 dyn x s x m(2) x cm(-5) (p < 0.01), whereas the pulmonary arterial resistance was unchanged. In these patients NO inhalation during the early stage of ARDS reduces selectively Ppam and Pcapm by decreasing the pulmonary capillary-venous resistance. This latter effect may reduce the filtration through the capillary bed and hence alveolar edema during ARDS.

  20. Iloprost improves gas exchange in patients with pulmonary hypertension and ARDS.

    PubMed

    Sawheny, Eva; Ellis, Ashley L; Kinasewitz, Gary T

    2013-07-01

    We hypothesized that nebulized iloprost would improve ventilation-perfusion matching in patients with pulmonary hypertension and ARDS as reflected by an improved Pao2/Fio2 ratio and Pao2 without adversely affecting lung mechanics or systemic hemodynamics. Patients with ARDS and pulmonary hypertension were enrolled. With constant ventilator settings, hemodynamics, airway pressures, and gas exchange measured at baseline were compared with values 30 min after administration of 10 μg nebulized iloprost, and again 30 min after a second, larger, 20 μg dose of iloprost, and then a final measurement 2 h after the second dose. The primary outcome variable was Pao2; secondary outcomes were Pao2/Fio2 ratio, mean arterial BP, and lung-compliance ventilatory equivalents for oxygen and CO2. After informed consent was obtained, 20 patients (nine men, 11 women; median age, 59 years [interquartile range, 44-66 years]) with ARDS were enrolled. Baseline PaO2 improved from a mean (±SD) of 82 (13) mm Hg to 100 (25) mm Hg after both the first and second doses of iloprost, and the baseline mean (±SD) PaO2/FIO2 ratio of 177 (60) improved to 213 (67) and 212 (70) (all P<.01). PaCO2, peak and plateau airway pressures, systemic BP, and heart rate were not significantly changed after iloprost. The improvement in gas exchange without any detrimental effects on pulmonary mechanics or systemic hemodynamics suggests nebulized iloprost may be a useful therapeutic agent to improve oxygenation in patients with ARDS. ClinicalTrials.gov; No.: NCT01274481; URL: www.clinicaltrials.gov.

  1. Analysis of bronchoalveolar lavage fluid (Balf) from patients with adult respiratory distress syndrome (ARDS)

    SciTech Connect

    Henderson, R.F.; Baughman, R.P.; Waide, J.J.

    1995-12-01

    The pathogenesis of ARDS is largely unknown, but many factors are known to predispose one to ARDS: sepsis, aspiration of gastric contents, pneumonia, fracture, multiple transfusions, cardiopulmonary bypass, burn, dissemination intravascular coagulation, pulmonary contusion, near drowning, and pancreatitis. ARDS is characterized by severe hypoxemia, diffuse pulmonary infiltrates, and decreased pulmonary compliance. Current treatment methods still result in 50% mortality. Studies are underway at the University of Cincinnati to determine if treatment with a synthetic pulmonary surfactant, Exosurf{sup {reg_sign}} (contains dipalmitoyl phosphatidyl choline, Burroughs-Wellcome), improves the prognosis of these patients. BALF from these patients, before and after treatment, was analyzed to determine if the treatment resulted in an increase in disaturated phospholipids (surfactant phospholipids) in the epithelial lining fluid and if the treatments reduced the concentration of markers of inflammation and toxicity in the BALF. This study indicates that the method of administering Exosurf{sup {reg_sign}} did not lead to an increase in surfactant lipid or protein in the bronchoalveolar region of the respiratory tract.

  2. Atomic Layer Etching of Silicon to Solve ARDE-Selectivity-Profile-Uniformity Trade-Offs

    NASA Astrophysics Data System (ADS)

    Wang, Mingmei; Ranjan, Alok; Ventzek, Peter; Koshiishi, Akira

    2014-10-01

    With shrinking critical dimensions, dry etch faces more and more challenges. Minimizing each of aspect ratio dependent etching (ARDE), bowing, undercut, selectivity, and within die uniformly across a wafer are met by trading off one requirement against another. At the root of the problem is that roles radical flux, ion flux and ion energy play may be both good and bad. Increasing one parameter helps meeting one requirement but hinders meeting the other. Self-limiting processes like atomic layer etching (ALE) promise a way to escape the problem of balancing trade-offs. ALE was realized in the mid-1990s but the industrial implementation has been slow. In recent years interest in ALE has revived. We present how ARDE, bowing/selectivity trade-offs may be overcome by varying radical/ion ratio, byproduct re-deposition. We overcome many of the practical implementation issues associated with ALE by precise passivation process control. The Monte Carlo Feature Profile Model (MCFPM) is used to illustrate realistic scenarios built around an Ar/Cl2 chemistry driven etch of Si masked by SiO2. We demonstrate that ALE can achieve zero ARDE and infinite selectivity. Profile control depends on careful management of the ion energies and angles. For ALE to be realized in production environment, tight control of IAD is a necessary. Experimental results are compared with simulation results to provide context to the work.

  3. ARD1-mediated Hsp70 acetylation balances stress-induced protein refolding and degradation

    PubMed Central

    Seo, Ji Hae; Park, Ji-Hyeon; Lee, Eun Ji; Vo, Tam Thuy Lu; Choi, Hoon; Kim, Jun Yong; Jang, Jae Kyung; Wee, Hee-Jun; Lee, Hye Shin; Jang, Se Hwan; Park, Zee Yong; Jeong, Jaeho; Lee, Kong-Joo; Seok, Seung-Hyeon; Park, Jin Young; Lee, Bong Jin; Lee, Mi-Ni; Oh, Goo Taeg; Kim, Kyu-Won

    2016-01-01

    Heat shock protein (Hsp)70 is a molecular chaperone that maintains protein homoeostasis during cellular stress through two opposing mechanisms: protein refolding and degradation. However, the mechanisms by which Hsp70 balances these opposing functions under stress conditions remain unknown. Here, we demonstrate that Hsp70 preferentially facilitates protein refolding after stress, gradually switching to protein degradation via a mechanism dependent on ARD1-mediated Hsp70 acetylation. During the early stress response, Hsp70 is immediately acetylated by ARD1 at K77, and the acetylated Hsp70 binds to the co-chaperone Hop to allow protein refolding. Thereafter, Hsp70 is deacetylated and binds to the ubiquitin ligase protein CHIP to complete protein degradation during later stages. This switch is required for the maintenance of protein homoeostasis and ultimately rescues cells from stress-induced cell death in vitro and in vivo. Therefore, ARD1-mediated Hsp70 acetylation is a regulatory mechanism that temporally balances protein refolding/degradation in response to stress. PMID:27708256

  4. Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers.

    PubMed

    Herridge, Margaret S; Moss, Marc; Hough, Catherine L; Hopkins, Ramona O; Rice, Todd W; Bienvenu, O Joseph; Azoulay, Elie

    2016-05-01

    Outcomes after acute respiratory distress syndrome (ARDS) are similar to those of other survivors of critical illness and largely affect the nerve, muscle, and central nervous system but also include a constellation of varied physical devastations ranging from contractures and frozen joints to tooth loss and cosmesis. Compromised quality of life is related to a spectrum of impairment of physical, social, emotional, and neurocognitive function and to a much lesser extent discrete pulmonary disability. Intensive care unit-acquired weakness (ICUAW) is ubiquitous and includes contributions from both critical illness polyneuropathy and myopathy, and recovery from these lesions may be incomplete at 5 years after ICU discharge. Cognitive impairment in ARDS survivors ranges from 70 to 100 % at hospital discharge, 46 to 80 % at 1 year, and 20 % at 5 years, and mood disorders including depression and post-traumatic stress disorder (PTSD) are also sustained and prevalent. Robust multidisciplinary and longitudinal interventions that improve these outcomes are still uncertain and data in our literature are conflicting. Studies are needed in family members of ARDS survivors to better understand long-term outcomes of the post-ICU family syndrome and to evaluate how it affects patient recovery.

  5. Extravascular lung water and the pulmonary vascular permeability index may improve the definition of ARDS.

    PubMed

    Perel, Azriel

    2013-01-24

    The recent Berlin definition has made some improvements in the older definition of acute respiratory distress syndrome (ARDS), although the concepts and components of the definition remained largely unchanged. In an effort to improve both predictive and face validity, the Berlin panel has examined a number of additional measures that may reflect increased pulmonary vascular permeability, including extravascular lung water. The panel concluded that although extravascular lung water has improved face validity and higher values are associated with mortality, it is infeasible to mandate on the basis of availability and the fact that it does not distinguish between hydrostatic and inflammatory pulmonary edema. However, the results of a multi-institutional study that appeared in the previous issue of Critical Care show that this latter reservation may not necessarily be true. By using extravascular lung water and the pulmonary vascular permeability index, both of which are derived from transpulmonary thermodilution, the authors could successfully differentiate between patients with ARDS and other patients in respiratory failure due to either cardiogenic edema or pleural effusion with atelectasis. This commentary discusses the merits and limitations of this study in view of the potential improvement that transpulmonary thermodilution may bring to the definition of ARDS.

  6. Preemptive antibiotic treatment based on gram staining reduced the incidence of ARDS in mechanically ventilated patients.

    PubMed

    Matsushima, Asako; Tasaki, Osamu; Shimizu, Kentaro; Tomono, Kazunori; Ogura, Hiroshi; Shimazu, Takeshi; Sugimoto, Hisashi

    2008-08-01

    Ventilator-associated pneumonia (VAP) is one of the major complications in the intensive care unit. VAP sometimes results in acute respiratory distress syndrome (ARDS), and the associated mortality is high. We hypothesized that preemptive antibiotic therapy based on results of bedside gram staining would reduce the incidence of VAP. Patients who were endotracheally intubated in our intensive care unit for more than 72 hours were included. Patients younger than 16 years of age or patients died because of brain death were excluded. The study was divided into two periods. During the first period, we used antibiotics according to the American Thoracic Society guidelines. During the second period, antibiotics were given according to the results of bedside gram staining even before radiographic infiltrate appeared. One hundred twenty-eight patients and 133 patients were included in the first and second periods, respectively. The incidence of VAP was significantly decreased in the second period (first period, 22%; second period, 9%, p < 0.01). The incidence of ARDS was also decreased significantly in the second period (first period, 11%; second period, 3%, p < 0.01). The duration and total amount of antibiotics administered did not increase in the second period. VAP associated mortality was significantly lower in the second period (first period, 5%; second period, 0.8%, p < 0.05). Early diagnosis and treatment of respiratory infection based on results of gram staining significantly reduced the incidences of VAP and ARDS without an increase in the use of antibiotics.

  7. Update in ARDS management: recent randomized controlled trials that changed our practice.

    PubMed

    Santacruz, J Fernando; Diaz Guzman Zavala, Enrique; Arroliga, Alejandro C

    2006-03-01

    In the last 7 years, 14 randomized controlled trials in patients with acute respiratory distress syndrome (ARDS) have shown that: Mechanical ventilation with a tidal volume of 6 mL/kg of predicted body weight is better than mechanical ventilation with a tidal volume of 12 mL/kg of predicted body weight. Prone positioning improves oxygenation but poses safety concerns. A high level of positive end-expiratory pressure does not improve survival. High-frequency oscillatory ventilation is in theory the ideal "lung-protective" method, but its benefits have not been proven. No drug therapy has been shown to improve survival in patients with ARDS. Exogenous surfactant may improve oxygenation but has no significant effect on the death rate or length of use of mechanical ventilation. Low-dose inhaled nitric oxide has no substantial impact on the duration of ventilatory support or on the death rate. Partial liquid ventilation may be beneficial in young patients with acute lung injury or ARDS, although further study is needed to confirm this.

  8. Clinical study on VATS combined mechanical ventilation treatment of ARDS secondary to severe chest trauma

    PubMed Central

    Qi, Yongjun

    2016-01-01

    The aim of the study was to investigate the clinical effects of microinvasive video-assisted thoracoscopic surgery (VATS) combined with mechanical ventilation in the treatment of acute respiratory distress syndrome (ARDS) secondary to severe chest trauma. A total of 62 patients with ARDS secondary to severe chest trauma were divided into the observation and control groups. The patients in the observation groups were treated with VATS combined with early mechanical ventilation while patients in the control group were treated using routine open thoracotomy combined with early mechanical ventilation. Compared to the controls, the survival rate of the observation group was significantly higher. The average operation time of the observation group was significantly shorter than that of the control group, and the incidence of complications in the perioperative period of the observation group was significantly lower than that of the control group (p<0.05). The average application time of the observation group was significantly shorter than that of the control group, and the incidence of ventilator-associated complications was significantly lower than that of the control group (p<0.05). In conclusion, a reasonable understanding of the indications and contraindications of VATS, combined with early mechanical treatment significantly improved the success rate of the treatment of ARDS patients secondary to severe chest trauma and reduced the complications. PMID:27446317

  9. Plasma C-Reactive Protein Levels Are Associated With Improved Outcome in ARDS

    PubMed Central

    Bajwa, Ednan K.; Khan, Uzma A.; Januzzi, James L.; Gong, Michelle N.; Thompson, B. Taylor; Christiani, David C.

    2009-01-01

    Background: C-reactive protein (CRP) has been studied as a marker of systemic inflammation and outcome in a number of diseases, but little is known about its characteristics in ARDS. We sought to examine plasma levels of CRP in patients with ARDS and their relationship to outcome and measures of illness severity. Methods: We measured CRP levels in 177 patients within 48 h of disease onset and tested the association of protein level with 60-day mortality, 28-day daily organ dysfunction scores, and number of ventilator-free days. Results: We found that CRP levels were significantly lower in nonsurvivors when compared with survivors (p = 0.02). Mortality rate decreased with increasing CRP decile (p = 0.02). An increasing CRP level was associated with a significantly higher probability of survival at 60 days (p = 0.005). This difference persisted after adjustment for age and severity of illness in a multivariable model (p = 0.009). Multivariable models were also used to show that patients in the group with higher CRP levels had significantly lower organ dysfunction scores (p = 0.001) and more ventilator-free days (p = 0.02). Conclusions: Increasing plasma levels of CRP within 48 h of ARDS onset are associated with improved survival, lower organ failure scores, and fewer days of mechanical ventilation. These data appear to be contrary to the established view that CRP is solely a marker of systemic inflammation. PMID:19411291

  10. ARD1-mediated Hsp70 acetylation balances stress-induced protein refolding and degradation.

    PubMed

    Seo, Ji Hae; Park, Ji-Hyeon; Lee, Eun Ji; Vo, Tam Thuy Lu; Choi, Hoon; Kim, Jun Yong; Jang, Jae Kyung; Wee, Hee-Jun; Lee, Hye Shin; Jang, Se Hwan; Park, Zee Yong; Jeong, Jaeho; Lee, Kong-Joo; Seok, Seung-Hyeon; Park, Jin Young; Lee, Bong Jin; Lee, Mi-Ni; Oh, Goo Taeg; Kim, Kyu-Won

    2016-10-06

    Heat shock protein (Hsp)70 is a molecular chaperone that maintains protein homoeostasis during cellular stress through two opposing mechanisms: protein refolding and degradation. However, the mechanisms by which Hsp70 balances these opposing functions under stress conditions remain unknown. Here, we demonstrate that Hsp70 preferentially facilitates protein refolding after stress, gradually switching to protein degradation via a mechanism dependent on ARD1-mediated Hsp70 acetylation. During the early stress response, Hsp70 is immediately acetylated by ARD1 at K77, and the acetylated Hsp70 binds to the co-chaperone Hop to allow protein refolding. Thereafter, Hsp70 is deacetylated and binds to the ubiquitin ligase protein CHIP to complete protein degradation during later stages. This switch is required for the maintenance of protein homoeostasis and ultimately rescues cells from stress-induced cell death in vitro and in vivo. Therefore, ARD1-mediated Hsp70 acetylation is a regulatory mechanism that temporally balances protein refolding/degradation in response to stress.

  11. Rationale and Description of Right Ventricle-Protective Ventilation in ARDS.

    PubMed

    Paternot, Alexis; Repessé, Xavier; Vieillard-Baron, Antoine

    2016-10-01

    Pulmonary vascular dysfunction is associated with ARDS and leads to increased right-ventricular afterload and eventually right-ventricular failure, also called acute cor pulmonale. Interest in acute cor pulmonale and its negative impact on outcome in patients with ARDS has grown in recent years. Right-ventricular function in these patients should be closely monitored, and this is helped by the widespread use of echocardiography in intensive care units. Because mechanical ventilation may worsen right-ventricular failure, the interaction between the lungs and the right ventricle appears to be a key factor in the ventilation strategy. In this review, a rationale for a right ventricle-protective ventilation approach is provided, and such a strategy is described, including the reduction of lung stress (ie, the limitation of plateau pressure and driving pressure), the reduction of PaCO2 , and the improvement of oxygenation. Prone positioning seems to be a crucial part of this strategy by protecting both the lungs and the right ventricle, resulting in increased survival of patients with ARDS. Further studies are required to validate the positive impact on prognosis of right ventricle-protective mechanical ventilation. Copyright © 2016 by Daedalus Enterprises.

  12. Effects of Pharmacologic Intervention on Oxygenation, Lung Water and Protein Leak in the Pseudomonas Ards Porcine Model.

    DTIC Science & Technology

    1987-07-01

    during the Korean conflict and Da-Nang lung in the Viet Nam war, and now recognized as ARD%ýresults from blast injuries, direct lung contusion, burn ...protocol with the addition of pre-Pseudomonas baseline scintigraphy. Though the animals developed a characteristic ARDS following psuedomonas infusion...1980. 6. Heindel, N.D. : Principles of target tissue localization of radiopharma- ceuticals. In: Heindel, N.D., Burns . H.D., Honda, T., Brady, L.W. (eds

  13. Thoracic Trauma Severity score on admission allows to determine the risk of delayed ARDS in trauma patients with pulmonary contusion.

    PubMed

    Daurat, Aurélien; Millet, Ingrid; Roustan, Jean-Paul; Maury, Camille; Taourel, Patrice; Jaber, Samir; Capdevila, Xavier; Charbit, Jonathan

    2016-01-01

    Pulmonary contusion is a major risk factor of acute respiratory distress syndrome (ARDS) in trauma patients. As this complication may appear after a free interval of 24-48 h, detection of patients at risk is essential. The main objective of this study was to assess the performance of the Thoracic Trauma Severity (TTS) score upon admission in predicting delayed ARDS in blunt trauma patients with pulmonary contusion. All blunt thoracic trauma patients admitted consecutively to our trauma centre between January 2005 and December 2009 were retrospectively included if they presented a pulmonary contusion on the admission chest computed tomography scan. Main outcome measure was the presence of moderate or severe ARDS (PaO2/FiO2 ratio≤200) for 48 h or more. The global ability of the TTS score to predict ARDS was studied by ROC curves with a threshold analysis using a grey zone approach. Of 329 patients studied (75% men, mean age 36.9 years [SD 17.8 years], mean Injury Severity Score 21.7 [SD 16.0]), 82 (25%) presented with ARDS (mean lowest PaO2/FiO2 ratio of 131 [SD 34]). The area under the ROC curves for the TTS score in predicting ARDS was 0.82 (95% CI 0.78-0.86) in the overall population. TTS scores between 8 and 12 belonged to the inconclusive grey zone. A TTS score of 13-25 was found to be independent risk factors of ARDS (OR 25.8 [95% CI 6.7-99.6] P<0.001). An extreme TTS score on admission accurately predicts the occurrence of delayed ARDS in blunt thoracic trauma patients affected by pulmonary contusion. This simple score could guide early decision making and management for a non-negligible proportion of this specific population. Copyright © 2015. Published by Elsevier Ltd.

  14. Update on the Role of Extracorporeal CO2 Removal as an Adjunct to Mechanical Ventilation in ARDS

    DTIC Science & Technology

    2015-03-16

    energetic aspects of RV-vascular coupling. It can be demonstrated that efficiency of energy transfer from the RV to the pulmonary circulatory system ...the only system specifically designed for CO2 removal and targeting CO2 retention syndromes, such as chronic obstructive pulmonary disease (COPD). The...acute respiratory distress syndrome (ARDS) remains a devastating disease [1,2]. Mortality rates for ARDS have decreased over time but still remain

  15. 3D cine magnetic resonance imaging of rat lung ARDS using gradient-modulated SWIFT with retrospective respiratory gating

    NASA Astrophysics Data System (ADS)

    Kobayashi, Naoharu; Lei, Jianxun; Utecht, Lynn; Garwood, Michael; Ingbar, David H.; Bhargava, Maneesh

    2015-03-01

    SWeep Imaging with Fourier Transformation (SWIFT) with gradient modulation and DC navigator retrospective gating is introduced as a 3D cine magnetic resonance imaging (MRI) method for the lung. In anesthetized normal rats, the quasi-simultaneous excitation and acquisition in SWIFT enabled extremely high sensitivity to the fast-decaying parenchymal signals (TE=~4 μs), which are invisible with conventional MRI techniques. Respiratory motion information was extracted from DC navigator signals and the SWIFT data were reconstructed to 3D cine images with 16 respiratory phases. To test this technique's capabilities, rats exposed to > 95% O2 for 60 hours for induction of acute respiratory distress syndrome (ARDS), were imaged and compared with normal rat lungs (N=7 and 5 for ARDS and normal groups, respectively). SWIFT images showed lung tissue density differences along the gravity direction. In the cine SWIFT images, a parenchymal signal drop at the inhalation phase was consistently observed for both normal and ARDS rats due to lung inflation (i.e. decrease of the proton density), but the drop was less for ARDS rats. Depending on the respiratory phase and lung region, the lungs from the ARDS rats showed 1-24% higher parenchymal signal intensities relative to the normal rat lungs, likely due to accumulated extravascular water (EVLW). Those results demonstrate that SWIFT has high enough sensitivity for detecting the lung proton density changes due to gravity, different phases of respiration and accumulation of EVLW in the rat ARDS lungs.

  16. 3D Cine Magnetic Resonance Imaging of Rat Lung ARDS using Gradient-modulated SWIFT with Retrospective Respiratory Gating.

    PubMed

    Kobayashi, Naoharu; Lei, Jianxun; Utecht, Lynn; Garwood, Michael; Ingbar, David; Bhargava, Maneesh

    2015-02-21

    SWeep Imaging with Fourier Transformation (SWIFT) with gradient modulation and DC navigator retrospective gating is introduced as a 3D cine magnetic resonance imaging (MRI) method for the lung. The quasi-simultaneous excitation and acquisition in SWIFT enabled extremely high sensitivity to the fast-decaying parenchymal signals (TE=~4 μs), which are invisible with conventional MRI techniques. Based on respiratory motion information extracted from DC navigator signals, the SWIFT data were reconstructed to 3D cine images with 16 respiratory phases. To test the capability of the proposed technique, rats exposed to > 95% O2 for 60 hours for induction of acute respiratory distress syndrome (ARDS), were imaged and compared with normal rat lungs (N=7 and 5 for ARDS and normal group, respectively). SWIFT images showed lung tissue density difference along the gravity direction. In the cine SWIFT images, parenchymal signal drop at the inhalation phase was consistently observed for both normal and ARDS rats due to inflation of the lung (i.e. decrease of the proton density), but the drop was less for ARDS rats. Depending on the respiration phase and lung region, the lungs from the ARDS rats showed 1-24% higher parenchymal signal intensities relative to the normal rat lungs, which would be mainly from accumulation of extravascular water (EVLW). Those results demonstrate that SWIFT has high enough sensitivity for detecting the lung proton density changes due to gravity, different respiration phases and accumulation of EVLW in the rat ARDS lungs.

  17. Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy

    PubMed Central

    2012-01-01

    Introduction Ventilator-associated pneumonia (VAP) may contribute to the mortality associated with acute respiratory distress syndrome (ARDS). We aimed to determine the incidence, outcome, and risk factors of bacterial VAP complicating severe ARDS in patients ventilated by using a strictly standardized lung-protective strategy. Methods This prospective epidemiologic study was done in all the 339 patients with severe ARDS included in a multicenter randomized, placebo-controlled double-blind trial of cisatracurium besylate in severe ARDS patients. Patients with suspected VAP underwent bronchoalveolar lavage to confirm the diagnosis. Results Ninety-eight (28.9%) patients had at least one episode of microbiologically documented bacterial VAP, including 41 (41.8%) who died in the ICU, compared with 74 (30.7%) of the 241 patients without VAP (P = 0.05). After adjustment, age and severity at baseline, but not VAP, were associated with ICU death. Cisatracurium besylate therapy within 2 days of ARDS onset decreased the risk of ICU death. Factors independently associated with an increased risk to develop a VAP were male sex and worse admission Glasgow Coma Scale score. Tracheostomy, enteral nutrition, and the use of a subglottic secretion-drainage device were protective. Conclusions In patients with severe ARDS receiving lung-protective ventilation, VAP was associated with an increased crude ICU mortality which did not remain significant after adjustment. PMID:22524447

  18. The Creation and Statistical Evaluation of a Deterministic Model of the Human Bronchial Tree from HRCT Images

    PubMed Central

    Montesantos, Spyridon; Katz, Ira; Pichelin, Marine; Caillibotte, Georges

    2016-01-01

    A quantitative description of the morphology of lung structure is essential prior to any form of predictive modeling of ventilation or aerosol deposition implemented within the lung. The human lung is a very complex organ, with airway structures that span two orders of magnitude and having a multitude of interfaces between air, tissue and blood. As such, current medical imaging protocols cannot provide medical practitioners and researchers with in-vivo knowledge of deeper lung structures. In this work a detailed algorithm for the generation of an individualized 3D deterministic model of the conducting part of the human tracheo-bronchial tree is described. Distinct initial conditions were obtained from the high-resolution computed tomography (HRCT) images of seven healthy volunteers. The algorithm developed is fractal in nature and is implemented as a self-similar space sub-division procedure. The expansion process utilizes physiologically realistic relationships and thresholds to produce an anatomically consistent human airway tree. The model was validated through extensive statistical analysis of the results and comparison of the most common morphological features with previously published morphometric studies and other equivalent models. The resulting trees were shown to be in good agreement with published human lung geometric characteristics and can be used to study, among other things, structure-function relationships in simulation studies. PMID:27977730

  19. Continuous distending pressure effects on variables contributing to oxygenation in healthy and ARDS model pigs during HFOV

    NASA Astrophysics Data System (ADS)

    Laviola, Marianna; Hajny, Ondrej; Roubik, Karel

    2014-10-01

    High frequency oscillatory ventilation (HFOV) is an alternative mode of mechanical ventilation. HFOV has been shown to provide adequate ventilation and oxygenation in acute respiratory distress syndrome (ARDS) patients and may represent an effective lung-protective ventilation in patients where conventional ventilation is failing. The aim of this study is to evaluate effects of continuous distending pressure (CDP) on variables that contribute to the oxygenation in healthy and ARDS lung model pigs. Methods. In order to simulate a lung disease, lung injury was induced by lavage with normal saline with detergent in three pigs. HFOV ventilation was applied before and after the lung lavage. CDP was stepwise increased by 2 cmH2O, until the maximum CDP (before the lung lavage 32 cmH2O and after the lung lavage 42 cmH2O) and then it was stepwise decreased by 2 cmH2O to the initial value. In this paper we analyzed the following parameters acquired during our experiments: partial pressure of oxygen in arterial blood (PaO2), cardiac output (CO) and mixed venous blood oxygen saturation (SvO2). In order to find how both PaO2 and CO affected SvO2 during the increase of CDP before and after lavage, a nonlinear regression fitting of the response in SvO2 on the predictors (PaO2 and CO) was implemented. Results. Before the lavage, with increasing of CDP, PaO2 remained constant, CO strongly decreased and SvO2 slightly decreased. After the lavage, with increasing of CDP, PaO2 strongly increased, CO decreased and SvO2 increased. So, development of SvO2 followed the PaO2 and CO trends. Changes in PaO2 and CO occur at decisive CDP step and it was much higher after the lung lavage compared to the healthy lungs. The implemented nonlinear model gives a good goodness of fitting in all three pigs. The values of PaO2 and CO estimated coefficients changed at the same decisive step of CDP identified by the trends. Also the algorithm identified a CDP step much higher after the lung lavage

  20. High-resolution computed tomographic findings in systemic sclerosis-associated interstitial lung disease: comparison between diffuse and limited systemic sclerosis.

    PubMed

    Patiwetwitoon, Sumawadee; Wangkaew, Suparaporn; Euathrongchit, Juntima; Kasitanon, Nuntana; Louthrenoo, Worawit

    2012-08-01

    This study aimed to compare the high-resolution computed tomographic (HRCT) findings between patients with diffuse cutaneous systemic sclerosis (DcSSc) and limited cutaneous systemic sclerosis (LcSSc) as well as to correlate the HRCT scores and the other variables. The medical records of all patients with SSc who presented at the Rheumatology Clinic, Chiang Mai University Hospital, from March 2005 to 2010 and underwent HRCT of the chest for the presence of interstitial lung disease were retrospectively reviewed. The extent of ground glass, lung fibrosis, and honeycombing was scored. All scores were aggregated to produce a total CT perfusion score. The widest coronal esophageal diameter (WED), the maximum diameter of the main pulmonary artery (MPAD), and ascending aortic diameter (AD) were measured. The ratio of MPAD to AD (MPAD/AD) was calculated. Of the 71 patients with SSc, mean (SD) age and disease duration were 54.8 (11.8) and 3.9 (4.2) years, respectively. Of them, 69.0% were female and 67.6% were classified as having DcSSc. There were no significant differences between patients with DcSSc and LcSSc with respect to age, disease duration, New York Heart Association Functional Classification, the calculated HRCT scores, WED, and MPAD. The lung fibrosis and total CT perfusion score correlated inversely with the SpO2 (r = -0.47, P < 0.01). The honeycombing correlated positively with the New York Heart Association Functional Classification and the WED (r = 0.29 and r = 0.32, respectively, P < 0.05). The HRCT scores of these patients were comparable in both subtypes of SSc. Careful evaluation of lungs and esophageal involvement should be performed irrespective of SSc subtypes. The calculated HRCT scores may be useful to assess the severity of the interstitial lung disease in SSc.

  1. The relation between the extent of radiological findings and respiratory functions in pneumoconiosis cases of dental technicians who are working in Ankara.

    PubMed

    Ergün, Dilek; Ergün, Recai; Evcik, Ender; Nadir Öziş, Türkan; Akkurt, İbrahim

    2016-06-01

    In dental technicians, parenchymal changes caused by dust affect pulmonary functions. The evaluation of the relation between radiological scores (chest X-Ray/HRCT) indicating the extent of pulmonary involvement and the severity of functional findings in dental technicians. 440 dental technicians were evaluated with chest X-Ray, pulmonary function tests (PFTs) and high resolution computed tomography (HRCT). The degree of pulmonary involvement in radiological images was categorized based upon emphysema, the profusion of opacities, ground-glass opacity, honey combing and extent of pleural abnormalities. Mean age of the study population was 34.7 ± 8.5 and mean duration of work was 16.5 ± 7.9 years. The prevalance of Dental technicians' pneumoconiosis (DTP) was 11.1%. The most common opacity in HRCT was round opacity with a rate of 89.7%. The rate of large opacity was %14.3. There was positive correlation between ILO score and HRCT score. Negative correlation was found between ILO and HRCT scores and all pulmonary function tests (except for FEV1/FVC), while no relation was found with age, overall duration of exposure, smoking and the age ofwork onset. In Multiple regression analysis, the extent of pulmonary involvement (HRCT scores) was found to be an independent predictor of functional impairment. Functional parameter reflecting the extent of pulmonary involvement most accurately was (FEV1%). It is our suggestion that radiological measurement should be used along with functional measurements in the evaluation of functional impairment in mixed dust exposed dental technicians.

  2. Evaluation of mosaic pattern areas in HRCT with Min-IP reconstructions in patients with pulmonary hypertension: could this evaluation replace lung perfusion scintigraphy?

    PubMed

    Rossi, A; Attinà, D; Borgonovi, A; Buia, F; De Luca, F; Guidalotti, P L; Fughelli, P; Galiè, N; Zompatori, M

    2012-01-01

    The aim of this study is to evaluate a possible correlation between areas of lung attenuation, found in minimum intensity projection (Min-IP) reconstruction images performed with high resolution computed tomography without contrast medium (HRCT), and areas of lung perfusion alteration, found in lung perfusion scintigraphy (LPS). Two independent radiologists, unaware of LPS results, evaluated retrospectively a group of 113 patients affected by pulmonary hypertension (HP) of different aetiology. These have been examined in a period of two years in our centre both by spiral computed tomography (CT) with and without contrast-medium and by LPS. The final diagnosis was determined on clinical data, right heart catheterisation and contrast enhanced CT in angiographic phase (CTPA). We reconstructed the Min-IP images of lung parenchyma in all the cases both in HRCT without contrast-medium, and in contrast enhanced CT in angiographic phase (CTPA) in axial, sagittal and coronal planes. The obtained images were qualitatively graded into three categories of pulmonary attenuation: homogeneous, inhomogeneous with non-segmental patchy defects, inhomogeneous with segmental defects. The same criteria of classification were used also for LPS images. In the group of patients with chronic thromboembolic pulmonary hypertension (CTEPH) we also compared the number of areas of lung attenuation found in Min-IP images in HRCT without contrast-medium, and their exact localization, with not perfused areas in LPS. Gold standard for the diagnosis of pulmonary embolism was spiral contrast enhanced CT in angiographic phase (CTPA). In all cases we found exact correspondence between the Min-IP images in HRCT with and without contras agent. The attenuation pattern seen on Min-IP images was concordant with those of LPS in 96 out of 113 patients (85%). In the remaining 17 cases (15%) it was discordant: in 12 cases inhomogeneous in Min-IP images (7 with non-segmental patchy defects, 5 with segmental

  3. Disease-specific dynamic biomarkers selected by integrating inflammatory mediators with clinical informatics in ARDS patients with severe pneumonia.

    PubMed

    Chen, Chengshui; Shi, Lin; Li, Yuping; Wang, Xiangdong; Yang, Shuanying

    2016-06-01

    Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome that occurs as a result of various risk factors, including either direct or indirect lung injury, and systemic inflammation triggered also by severe pneumonia (SP). SP-ARDS-associated morbidity and mortality remains high also due to the lack of disease-specific biomarkers. The present study aimed at identifying disease-specific biomarkers in SP or SP-ARDS by integrating proteomic profiles of inflammatory mediators with clinical informatics. Plasma was sampled from the healthy as controls or patients with SP infected with bacteria or infection-associated SP-ARDS on the day of admission, day 3, and day 7. About 15 or 52 cytokines showed significant difference between SP and SP-ARDS patients with controls or 13 between SP-ARDS with SP alone and controls, including bone morphogenetic protein-15 (BMP-15), chemokine (C-X-C motif) ligand 16 (CXCL16), chemokine (C-X-C motif) receptor 3 (CXCR3), interleukin-6 (IL-6), protein NOV homolog (NOV/CCN3), glypican 3, insulin-like growth factor binding protein 4 (IGFBP-4), IL-5, IL-5 R alpha, IL-22 BP, leptin, MIP-1d, and orexin B with a significant correlation with Digital Evaluation Score System (DESS) scores. ARDS patients with overexpressed IL-6, CXCL16, or IGFBP-4 had significantly longer hospital stay and higher incidence of secondary infection. We also found higher levels of those mediators were associated with poor survival rates in patients with lung cancer and involved in the process of the epithelial mesenchymal transition of alveolar epithelial cells. Our preliminary study suggested that integration of proteomic profiles with clinical informatics as part of clinical bioinformatics is important to validate and optimize disease-specific and disease-staged biomarkers.

  4. Pulse oximetry vs. PaO2 metrics in mechanically ventilated children: Berlin definition of ARDS and mortality risk.

    PubMed

    Khemani, Robinder G; Rubin, Sarah; Belani, Sanjay; Leung, Dennis; Erickson, Simon; Smith, Lincoln S; Zimmerman, Jerry J; Newth, Christopher J L

    2015-01-01

    Requiring PaO2/FiO2 ratio (PF) to define ARDS may bias towards children with cardiovascular dysfunction and hypoxemia. We sought to evaluate (1) the Berlin definition of ARDS in children using PF; (2) the effect of substituting SpO2/FiO2(SF) ratio; (3) differences between patients with and without arterial blood gases; and (4) the ability of SpO2 and PaO2 indices to discriminate ICU mortality. Single center retrospective review (3/2009-4/2013) of mechanically ventilated (MV) children. Initial values for PF, SF, oxygenation index (OI), and oxygen saturation index (OSI) after intubation and average values on day 1 of MV were analyzed against ICU mortality, subgrouped by Berlin severity categories. Of the 1,833 children included, 129 met Berlin PF ARDS criteria (33 % mortality); 312 met Berlin SF ARDS criteria (22 % mortality). Children with a PaO2 on day 1 of MV had higher mortality and severity of illness, were older, and had more vasoactive-inotropic infusions (p < 0.001). SF could be calculated for 1,201 children (AUC for ICU mortality 0.821), OSI for 1,034 (0.793), PF for 695 (0.706), and OI for 673 (0.739). Average SF on day 1 discriminated mortality better than PF (p = 0.003). Berlin PF criteria for ARDS identified less than half of the children with ARDS, favoring those with cardiovascular dysfunction. SF or OSI discriminate ICU mortality as well as PF and OI, double the number of children available for risk stratification, and should be considered for severity of illness scores and included in a pediatric-specific definition of ARDS. Multicenter validation is required.

  5. Respiratory Impairment after Early Red Cell Transfusion in Pediatric Patients with ALI/ARDS

    PubMed Central

    Rajasekaran, Surender; Sanfilippo, Dominic; Shoemaker, Allen; Curtis, Scott; Zuiderveen, Sandra; Ndika, Akunne; Stoiko, Michael; Hassan, Nabil

    2012-01-01

    Introduction. In the first 48 hours of ventilating patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), a multipronged approach including packed red blood cell (PRBC) transfusion is undertaken to maintain oxygen delivery. Hypothesis. We hypothesized children with ALI/ARDS transfused within 48 hours of initiating mechanical ventilation would have worse outcome. The course of 34 transfused patients was retrospectively compared to 45 nontransfused control patients admitted to the PICU at Helen DeVos Children's Hospital between January 1st 2008 and December 31st 2009. Results. Mean hemoglobin (Hb) prior to transfusion was 8.2 g/dl compared to 10.1 g/dl in control. P/F ratio decreased from 135.4 ± 7.5 to 116.5 ± 8.8 in transfused but increased from 148.0 ± 8.0 to 190.4 ± 17.8 (P < 0.001) in control. OI increased in the transfused from 11.7 ± 0.9 to 18.7 ± 1.6 but not in control. Ventilator days in the transfused were 15.6 ± 1.7 versus 9.5 ± 0.6 days in control (P < 0.001). There was a trend towards higher rates of MODS in transfused patients; 29.4% versus 17.7%, odds ratio 1.92, 95% CI; 0.6–5.6 Fisher exact P < 0.282. Conclusion. This study suggests that early transfusions of patients with ALI/ARDS were associated with increased ventilatory needs. PMID:22957223

  6. The Effects of Acid Rock Drainage (ARD) on Fluorescent Dissolved Organic Matter (DOM)

    NASA Astrophysics Data System (ADS)

    Lee, R. H.; Gabor, R. S.; SanClements, M.; McKnight, D. M.

    2011-12-01

    Located in the Rocky Mountains of central Colorado, the catchments drained by the headwaters of the Snake River are dominated by metal- and sulfide-rich bedrock. The breakdown of these minerals results in acidic metal-rich waters in the Snake (pH ~3) that persist until the confluence with Deer Creek (pH ~7). Previous research has been conducted examining the interactions of acid-rock drainage (ARD) and dissolved organic matter (DOM), but the effects of ARD on DOM production is not as well understood. In a synoptic study, samples of creek water were collected at evenly spaced intervals along the length of a tributary to the Snake River which drains an area with ARD. At each sampling location, water samples were collected and pH, conductivity, and temperature were measured. Water samples were analyzed for metal chemistry, and the DOM was analyzed with UV-Vis and fluorescence spectroscopy. The character of the DOM was described using PARAFAC and index calculations. This work demonstrates that the introduction of acid and dissolved metal species has notable effects on DOM composition. Preliminary data suggests that the introduction of acid drainage is responsible for the formation of a fluorophore not accounted for in the Cory and McKnight PARAFAC model. Both high concentrations of heavy metals (e.g. zinc) and the novel fluorophore are present downstream from a mining site, which indicates it as a possible source of both species. The data suggest a link between the introduction of fluorophores in acidic waters and acidophile populations at the source of the acid rock drainage.

  7. The Ardón L6 ordinary chondrite: A long-hidden Spanish meteorite fall

    NASA Astrophysics Data System (ADS)

    Trigo-RodríGuez, Josep M.; Llorca, Jordi; Weyrauch, Mona; Bischoff, Addi; Moyano-Cambero, Carles E.; Keil, Klaus; Laubenstein, Matthias; Pack, Andreas; Madiedo, José MaríA.; Alonso-AzcáRate, Jacinto; Riebe, My; Wieler, Rainer; Ott, Uli; Tapia, Mar; Mestres, NarcíS.

    2014-08-01

    We report and describe an L6 ordinary chondrite fall that occurred in Ardón, León province, Spain (longitude 5.5605°W, latitude 42.4364°N) on July 9th, 1931. The 5.5 g single stone was kept hidden for 83 yr by Rosa González Pérez, at the time an 11 yr old who had observed the fall and had recovered the meteorite. According to various newspaper reports, the event was widely observed in Northern Spain. Ardón is a very well-preserved, fresh, strongly metamorphosed (petrologic type 6), and weakly shocked (S3) ordinary chondrite with well-equilibrated and recrystallized minerals. The mineral compositions (olivine Fa23.7±0.3, low-Ca pyroxene Fs20.4±0.2Wo1.5±0.2, plagioclase An10.3±0.5Ab84.3±1.2), magnetic susceptibility (log χ = 4.95 ± 0.05 × 10-9 m3 kg-1), bulk density (3.49 ± 0.05 g cm-3), grain density (3.58 ± 0.05 g cm-3), and porosity (2.5 vol%) are typical for L6 chondrites. Short-lived radionuclides confirm that the meteorite constitutes a recent fall. The 21Ne and 38Ar cosmic ray exposure ages are both about 20-30 Ma, similar to values for many other L chondrites. The cosmogenic 22Ne/21Ne ratio indicates that preatmospheric Ardón was a relatively large body. The fact that the meteorite was hidden in private hands for 83 yr makes one wonder if other meteorite falls may have experienced the same fate, thus possibly explaining the anomalously low number of falls reported in continental Spain in the 20th century.

  8. Respiratory Impairment after Early Red Cell Transfusion in Pediatric Patients with ALI/ARDS.

    PubMed

    Rajasekaran, Surender; Sanfilippo, Dominic; Shoemaker, Allen; Curtis, Scott; Zuiderveen, Sandra; Ndika, Akunne; Stoiko, Michael; Hassan, Nabil

    2012-01-01

    Introduction. In the first 48 hours of ventilating patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), a multipronged approach including packed red blood cell (PRBC) transfusion is undertaken to maintain oxygen delivery. Hypothesis. We hypothesized children with ALI/ARDS transfused within 48 hours of initiating mechanical ventilation would have worse outcome. The course of 34 transfused patients was retrospectively compared to 45 nontransfused control patients admitted to the PICU at Helen DeVos Children's Hospital between January 1st 2008 and December 31st 2009. Results. Mean hemoglobin (Hb) prior to transfusion was 8.2 g/dl compared to 10.1 g/dl in control. P/F ratio decreased from 135.4 ± 7.5 to 116.5 ± 8.8 in transfused but increased from 148.0 ± 8.0 to 190.4 ± 17.8 (P < 0.001) in control. OI increased in the transfused from 11.7 ± 0.9 to 18.7 ± 1.6 but not in control. Ventilator days in the transfused were 15.6 ± 1.7 versus 9.5 ± 0.6 days in control (P < 0.001). There was a trend towards higher rates of MODS in transfused patients; 29.4% versus 17.7%, odds ratio 1.92, 95% CI; 0.6-5.6 Fisher exact P < 0.282. Conclusion. This study suggests that early transfusions of patients with ALI/ARDS were associated with increased ventilatory needs.

  9. Dead space and CO2 elimination related to pattern of inspiratory gas delivery in ARDS patients

    PubMed Central

    2012-01-01

    Introduction The inspiratory flow pattern influences CO2 elimination by affecting the time the tidal volume remains resident in alveoli. This time is expressed in terms of mean distribution time (MDT), which is the time available for distribution and diffusion of inspired tidal gas within resident alveolar gas. In healthy and sick pigs, abrupt cessation of inspiratory flow (that is, high end-inspiratory flow (EIF)), enhances CO2 elimination. The objective was to test the hypothesis that effects of inspiratory gas delivery pattern on CO2 exchange can be comprehensively described from the effects of MDT and EIF in patients with acute respiratory distress syndrome (ARDS). Methods In a medical intensive care unit of a university hospital, ARDS patients were studied during sequences of breaths with varying inspiratory flow patterns. Patients were ventilated with a computer-controlled ventilator allowing single breaths to be modified with respect to durations of inspiratory flow and postinspiratory pause (TP), as well as the shape of the inspiratory flow wave. From the single-breath test for CO2, the volume of CO2 eliminated by each tidal breath was derived. Results A long MDT, caused primarily by a long TP, led to importantly enhanced CO2 elimination. So did a high EIF. Effects of MDT and EIF were comprehensively described with a simple equation. Typically, an efficient and a less-efficient pattern of inspiration could result in ± 10% variation of CO2 elimination, and in individuals, up to 35%. Conclusions In ARDS, CO2 elimination is importantly enhanced by an inspiratory flow pattern with long MDT and high EIF. An optimal inspiratory pattern allows a reduction of tidal volume and may be part of lung-protective ventilation. PMID:22390777

  10. Alternative splicing regulates the production of ARD-1 endoribonuclease and NIPP-1, an inhibitor of protein phosphatase-1, as isoforms encoded by the same gene.

    PubMed

    Chang, A C; Sohlberg, B; Trinkle-Mulcahy, L; Claverie-Martin, F; Cohen, P; Cohen, S N

    1999-11-15

    ARD-1 is an endoribonuclease identified initially as the product of a human cDNA that complements mutations in rne, a gene that encodes Escherichia coli ribonuclease E. NIPP-1 was identified in bovine nuclear extracts as an inhibitor of protein phosphatase-1. Earlier work has shown that the protein-coding sequence of ARD-1 is identical to the carboxy-terminal third of NIPP-1. However, whether ARD-1 is present in eukaryotes as a distinct entity has been unclear, as neither ARD-1-specific transcripts nor ARD-1 protein were detected in mammalian cells in earlier studies. Here we show that ARD-1 exists in human cells as a discrete protein, and that the ARD-1 and NIPP-1 peptides are isoforms encoded by a single gene and the same alternatively spliced precursor RNA. A retained intron containing multiple translation stop codons that are configured to terminate translation and initiate nonsense-mediated decay, limits the production of cellular ARD-1 protein. Our results establish the process by which functionally disparate ARD-1 and NIPP-1 peptides are generated from the protein-coding sequence of the same gene in human cells.

  11. Measurement of the J = 0-1 rotational transitions of three isotopes of ArD(+)

    NASA Technical Reports Server (NTRS)

    Bowman, W. C.; Plummer, G. M.; Herbst, E.; De Lucia, F. C.

    1983-01-01

    The rotational transitions of all three isotopic species of ArD(+) in samples containing the Ar isotopes in their natural abundances have been measured by means of millimeter and submillimeter techniques that employ a magnetically enhanced abnormal glow discharge. All three transition frequency measurements were made from digitally averaged signals detected through a lock-in amplifier with a 10-msec time constant. The Ar-4OD(+) transition was easily visible in real time on an oscilloscope with SNR of about 15. It is noted that the observed transition of Ar-38D(+) is more than five orders of magnitude weaker than that due to HCO(+).

  12. Structural analysis of the KRIT1 ankyrin repeat and FERM domains reveals a conformationally stable ARD-FERM interface

    PubMed Central

    Zhang, Rong; Li, Xiaofeng; Boggon, Titus J.

    2015-01-01

    Cerebral cavernous malformations (CCM) are vascular dysplasias that usually occur in the brain and are associated with mutations in the KRIT1/CCM1, CCM2/MGC4607/OSM/Malcavernin, and PDCD10/CCM3/TFAR15 genes. Here we report the 2.9 Å crystal structure of the ankyrin repeat domain (ARD) and FERM domain of the protein product of KRIT1 (KRIT1; Krev interaction trapped 1). The crystal structure reveals that the KRIT1 ARD contains 4 ankyrin repeats. There is an unusual conformation in the ANK4 repeat that is stabilized by Trp-404, and the structure reveals a solvent exposed ankyrin groove. Domain orientations of the three copies within the asymmetric unit suggest a stable interaction between KRIT1 ARD and FERM domains, indicating a globular ARD-FERM module. This resembles the additional F0 domain found N-terminal to the FERM domain of talin. Structural analysis of KRIT1 ARD-FERM highlights surface regions of high evolutionary conservation, and suggests potential sites that could mediate interaction with binding partners. The structure therefore provides a better understanding of KRIT1 at the molecular level. PMID:26458359

  13. Structural analysis of the KRIT1 ankyrin repeat and FERM domains reveals a conformationally stable ARD-FERM interface.

    PubMed

    Zhang, Rong; Li, Xiaofeng; Boggon, Titus J

    2015-12-01

    Cerebral cavernous malformations (CCM) are vascular dysplasias that usually occur in the brain and are associated with mutations in the KRIT1/CCM1, CCM2/MGC4607/OSM/Malcavernin, and PDCD10/CCM3/TFAR15 genes. Here we report the 2.9 Å crystal structure of the ankyrin repeat domain (ARD) and FERM domain of the protein product of KRIT1 (KRIT1; Krev interaction trapped 1). The crystal structure reveals that the KRIT1 ARD contains 4 ankyrin repeats. There is an unusual conformation in the ANK4 repeat that is stabilized by Trp-404, and the structure reveals a solvent exposed ankyrin groove. Domain orientations of the three copies within the asymmetric unit suggest a stable interaction between KRIT1 ARD and FERM domains, indicating a globular ARD-FERM module. This resembles the additional F0 domain found N-terminal to the FERM domain of talin. Structural analysis of KRIT1 ARD-FERM highlights surface regions of high evolutionary conservation, and suggests potential sites that could mediate interaction with binding partners. The structure therefore provides a better understanding of KRIT1 at the molecular level.

  14. Utility of ventilation and perfusion scan in the diagnosis of young military recruits with an incidental finding of hyperlucent lung.

    PubMed

    Arslan, N; Ilgan, S; Ozkan, M; Yuksekol, I; Bulakbasi, N; Pabuscu, Y; Ozguven; Bayhan, H

    2001-05-01

    Swyer-James-MacLeod syndrome (SJMS) is considered to be a relatively uncommon disease presenting with unilateral hyperlucent lung due to hypoplasia of a pulmonary artery and bronchiectasis of the affected lung. In this report, we describe the ventilation-perfusion (V/Q) scan findings of nine male recruits (aged 20-29 years, mean 24.4+/-2.96 years) with SJMS in whom the diagnosis was first established in adulthood. V/Q scan findings of all patients were compared with those on planar radiographs, pulmonary function studies, high resolution computed tomography (HRCT) and digital subtraction angiography (DSA). The ventilation (133Xe) and perfusion (99Tcm-macro-aggregated albumin) scans showed the characteristic pattern of a matched V/Q defect and marked air trapping on the washout phase on 133Xe scintigraphy. HRCT displayed hypodense lung with integrity of main airways, and markedly diminished vasculature on the affected side in all patients. A smaller pulmonary artery on the affected side with poor peripheral vasculature was observed with DSA in all patients. All patients had features of obstructive airway disease in varying degrees on pulmonary function studies. In contrast to other imaging methods, bronchiectasis as an etiological factor was displayed on HRCT. Some pulmonary areas, which were normal on HRCT and planar radiographs, showed air trapping on V/Q scan. Although a V/Q scan was more helpful in determining the extent of the disease and correlates well with conventional imaging methods, HRCT was the most valuable imaging method for the evaluation of aetiology in unilateral hyperlucent lung.

  15. High-resolution CT scan findings in patients with symptomatic scleroderma-related interstitial lung disease.

    PubMed

    Goldin, Jonathan G; Lynch, David A; Strollo, Diane C; Suh, Robert D; Schraufnagel, Dean E; Clements, Philip J; Elashoff, Robert M; Furst, Daniel E; Vasunilashorn, Sarinnapha; McNitt-Gray, Michael F; Brown, Mathew S; Roth, Michael D; Tashkin, Donald P

    2008-08-01

    Lung disease has become the leading cause of mortality and morbidity in scleroderma (SSc) patients. The frequency, nature, and progression of interstitial lung disease seen on high-resolution CT (HRCT) scans in patients with diffuse SSc (dcSSc) compared with those with limited SSc (lcSSc) has not been well characterized. Baseline HRCT scan images of 162 participants randomized into a National Institutes of Health-funded clinical trial were compared to clinical features, pulmonary function test measures, and BAL fluid cellularity. The extent and distribution of interstitial lung disease HRCT findings, including pure ground-glass opacity (pGGO), pulmonary fibrosis (PF), and honeycomb cysts (HCs), were recorded in the upper, middle, and lower lung zones on baseline and follow-up CT scan studies. HRCT scan findings included 92.9% PF, 49.4% pGGO, and 37.2% HCs. There was a significantly higher incidence of HCs in the three zones in lcSSc patients compared to dcSSc patients (p = 0.034, p = 0.048, and p = 0.0007, respectively). The extent of PF seen on HRCT scans was significantly negatively correlated with FVC (r = - 0.22), diffusing capacity of the lung for carbon monoxide (r = - 0.44), and total lung capacity (r = - 0.36). A positive correlation was found between pGGO and the increased number of acute inflammatory cells found in BAL fluid (r = 0.28). In the placebo group, disease progression was assessed as 30% in the upper and middle lung zones, and 45% in the lower lung zones. No difference in the progression rate was seen between lcSSc and dcSSc patients. PF and GGO were the most common HRCT scan findings in symptomatic SSc patients. HCs were seen in more than one third of cases, being more common in lcSSc vs dcSSc. There was no relationship between progression and baseline PF extent or lcSSc vs dcSSc. Clinicaltrials.gov Identifier: NCT00004563.

  16. Acute respiratory distress syndrome (ARDS) treated successfully by veno-venous extracorporeal membrane oxygenation (ECMO) in a nearly drowned patient.

    PubMed

    Sonoo, Tomohiro; Ohshima, Kazuma; Kobayashi, Hiroaki; Asada, Toshifumi; Hiruma, Takahiro; Doi, Kento; Gunshin, Masataka; Murakawa, Tomohiro; Anraku, Masaki; Nakajima, Susumu; Nakajima, Jun; Yahagi, Naoki

    2014-09-01

    This report highlights about one acute respiratory distress syndrome (ARDS) case after near-drowning resuscitated using extracorporeal membrane oxygenation (ECMO). Few cases have been reported about ECMO use for near-drowning and in most of these cases, ECMO was initiated within the first week. However, in our report, we would like to emphasize that seemingly irreversible secondary worsening of ARDS after nearly drowned patient was successfully treated by ECMO use more than 1 week after near-drowning followed by discharge without home oxygen therapy, social support, or any complication. This is probably due to sufficient lung rest for ventilator-associated lung injury during ECMO use. Based on our case's clinical course, intensive care unit physicians must consider ECMO even in the late phase of worsened ARDS after near-drowning.

  17. Extracorporeal Membrane Oxygenation (ECMO) for Lung Injury in Severe Acute Respiratory Distress Syndrome (ARDS): Review of the Literature.

    PubMed

    Paolone, Summer

    2016-11-10

    Despite advances in mechanical ventilation, severe acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality rates ranging from 26% to 58%. Extracorporeal membrane oxygenation (ECMO) is a modified cardiopulmonary bypass circuit that serves as an artificial membrane lung and blood pump to provide gas exchange and systemic perfusion for patients when their own heart and lungs are unable to function adequately. ECMO is a complex network that provides oxygenation and ventilation and allows the lungs to rest and recover from respiratory failure while minimizing iatrogenic ventilator-induced lung injury. In critical care settings, ECMO is proven to improve survival rates and outcomes in patients with severe ARDS. This review defines severe ARDS; describes the ECMO circuit; and discusses recent research, optimal use of the ECMO circuit, limitations of therapy including potential complications, economic impact, and logistical factors; and discusses future research considerations.

  18. Setting mechanical ventilation in ARDS patients during VV-ECMO: where are we?

    PubMed

    Del Sorbo, L; Goffi, A; Goligher, E; Fan, E; Slutsky, A S

    2015-12-01

    Currently, many centers use venovenous extracorporeal membrane oxygenation (VV-ECMO) as an adjunctive means of gas exchange to mechanical ventilation (MV) in patients with severe ARDS and refractory hypoxemia. One of the most interesting and controversial issues in the management of these patients is how to set the ventilatory strategy. The support provided by VV-ECMO makes the balance between risks and benefits of MV remarkably different from the conventional setting, since the need for MV to facilitate oxygenation and carbon dioxide clearance is greatly reduced or abolished during VV-ECMO. Therefore, the risks of causing ventilator-induced lung injury are of foremost importance; however, the issue of the optimum ventilatory strategy during VV-ECMO has not received sufficient consideration. This paper will describe the diverse MV strategies applied during VV-ECMO in clinical practice and will highlight specific pathophysiological considerations that are crucial in the process of defining optimal ventilation settings in patients with ARDS supported with VV-ECMO.

  19. On the interaction between respiratory compartments during passive expiration in ARDS patients.

    PubMed

    Chelucci, Gian-Luca; Locchi, Fabrizio; Zin, Walter A

    2005-01-15

    Relaxed expiratory volume-time profile has been frequently analysed by fitting exponential functions of time to one- or two-compartment models. In the latter case, the two exponential constants are assumed as representing the time constants of both compartments. Least-square fittings on the experimental data of five consecutive mechanically ventilated supine patients with acute respiratory distress syndrome (ARDS) were performed using rate-constants (flow/volume ratio) as parameters in order to obtain the model matching. Passive expiratory volume-time curves were recorded under PEEP = 0 and 13.6 +/- 3.3 S.D. cmH2O conditions. Model matching was optimal with significant, reliable parameter values. As a result, the use of a PEEP in ARDS patients: (a) delayed expiration; (b) decreased the percentage initial volume contribution of the slow-emptying compartment; and, (c) modified the interaction between compartments. The volume-time profile of the second compartment was found to increase at the beginning of expiration, and, then, progressively decayed towards zero, showing a maximum, although the overall curve decreased throughout expiration.

  20. Insilico study of the A(2A)R-D (2)R kinetics and interfacial contact surface for heteromerization.

    PubMed

    Prakash, Amresh; Luthra, Pratibha Mehta

    2012-10-01

    G-protein-coupled receptors (GPCRs) are cell surface receptors. The dynamic property of receptor-receptor interactions in GPCRs modulates the kinetics of G-protein signaling and stability. In the present work, the structural and dynamic study of A(2A)R-D(2)R interactions was carried to acquire the understanding of the A(2A)R-D(2)R receptor activation and deactivation process, facilitating the design of novel drugs and therapeutic target for Parkinson's disease. The structure-based features (Alpha, Beta, SurfAlpha, and SurfBeta; GapIndex, Leakiness and Gap Volume) and slow mode model (ENM) facilitated the prediction of kinetics (K (off), K (on), and K (d)) of A(2A)R-D(2)R interactions. The results demonstrated the correlation coefficient 0.294 for K (d) and K (on) and the correlation coefficient 0.635 for K (d) and K (off), and indicated stable interfacial contacts in the formation of heterodimer. The coulombic interaction involving the C-terminal tails of the A(2A)R and intracellular loops (ICLs) of D(2)R led to the formation of interfacial contacts between A(2A)R-D(2)R. The properties of structural dynamics, ENM and KFC server-based hot-spot analysis illustrated the stoichiometry of A(2A)R-D(2)R contact interfaces as dimer. The propensity of amino acid residues involved in A(2A)R-D(2)R interaction revealed the presence of positively (R, H and K) and negatively (E and D) charged structural motif of TMs and ICL3 of A(2A)R and D(2)R at interface of dimer contact. Essentially, in silico structural and dynamic study of A(2A)R-D(2)R interactions will provide the basic understanding of the A(2A)R-D(2)R interfacial contact surface for activation and deactivation processes, and could be used as constructive model to recognize the protein-protein interactions in receptor assimilations.

  1. Lung density on high resolution computer tomography (HRCT) reflects degree of inflammation in smokers

    PubMed Central

    2014-01-01

    Background Smokers have increased cell concentration in the lower respiratory tract indicating a chronic inflammatory state, which in some individuals may lead to development of chronic obstructive pulmonary disease (COPD). Computer tomography (CT) imaging provides means of quantifying pulmonary structure and early signs of disease. We investigated whether lung density on high resolution CT differs between smokers and never-smokers and if this were associated to intensity of inflammation. Methods Forty smoking volunteers with normal pulmonary function, 40 healthy never-smokers and 40 patients with COPD of GOLD stage I-II, were included. Mean lung attenuation and percentage of pixels in the lung with attenuation between −750 and −900 HU (percentage higher density spectrum (%HDS)) were calculated on inspiratory CT-scans. Markers of systemic inflammation in blood and cell counts in bronchoalveolar lavage (BAL) fluid were recorded. Results Lung density expressed as %HDS was increased in smokers (44.0 ± 5.8%) compared to both never-smokers (38.3 ± 5.8%) and patients with COPD (39.1 ± 5.8%), (p < 0.001, for both). Females had denser lungs than males, which was dependent on body height. Cell concentration in BAL were correlated to lung density in smokers (r = 0.50, p < 0.001). Conclusions Lung density on CT is associated with cell concentration in BAL in smokers and may mirror an inflammatory response in the lung. Gender difference in lung density is dependent on height. In COPD with emphysema, loss of lung tissue may counterbalance the expected increase in density due to inflammation. The findings may help to interpret high resolution CT in the context of smoking and gender and highlight the heterogeneity of structural changes in COPD. PMID:24564813

  2. Can chest high-resolution computed tomography findings diagnose pulmonary alveolar microlithiasis?*

    PubMed Central

    Francisco, Flávia Angélica Ferreira; Rodrigues, Rosana Souza; Barreto, Miriam Menna; Escuissato, Dante Luiz; Araujo Neto, Cesar Augusto; Silva, Jorge Luiz Pereira e; Silva, Claudio S.; Hochhegger, Bruno; Souza Jr., Arthur Soares; Zanetti, Gláucia; Marchiori, Edson

    2015-01-01

    Objective The present study was aimed at retrospectively reviewing high-resolution computed tomography (HRCT) findings in patients with pulmonary alveolar microlithiasis in order to evaluate the frequency of tomographic findings and their distribution in the lung parenchyma. Materials and Methods Thirteen patients (9 females and 4 males; age, 9 to 59 years; mean age, 34.5 years) were included in the present study. The HRCT images were independently evaluated by two observers whose decisions were made by consensus. The inclusion criterion was the presence of abnormalities typical of pulmonary alveolar microlithiasis at HRCT, which precludes lung biopsy. However, in 6 cases lung biopsy was performed. Results Ground-glass opacities and small parenchymal nodules were the predominant tomographic findings, present in 100% of cases, followed by small subpleural nodules (92.3%), subpleural cysts (84.6%), subpleural linear calcifications (69.2%), crazy-paving pattern (69.2%), fissure nodularity (53.8%), calcification along interlobular septa (46.2%) and dense consolidation (46.2%). Conclusion As regards distribution of the lesions, there was preferential involvement of the lower third of the lungs. No predominance of distribution in axial and anteroposterior directions was observed. PMID:26379317

  3. Elucidating the molecular responses of apple rootstock resistant to ARD pathogens: Challenges and opportunities for development of genomics-assisted breeding tools

    USDA-ARS?s Scientific Manuscript database

    Apple Replant Disease (ARD) is one of the major limitations to the establishment of an economically viable orchard on replant sites due to the buildup and long-term survival of pathogen inoculum. Infection by several soilborne necrotrophic fungi and oomycetes is primarily responsible for ARD and res...

  4. Does the simple dynamical systems approach provide useful information about catchment hydrological functioning in a Mediterranean context? Application to the Ardèche catchment (France)

    NASA Astrophysics Data System (ADS)

    Adamovic, M.; Braud, I.; Branger, F.; Kirchner, J. W.

    2014-09-01

    This study explores how catchment heterogeneity and variability can be summarized in simplified models, representing the dominant hydrological processes. It focuses on Mediterranean catchments, characterized by heterogeneous geology, pedology, and land use, as well as steep topography and a rainfall regime in which summer droughts contrast with high-rainfall periods in autumn. The Ardèche catchment (south-east France), typical of this environment, is chosen to explore the following questions: (1) can such a Mediterranean catchment be adequately characterized by simple dynamical systems approach and what are the limits of the method under such conditions? (2) What information about dominant predictors of hydrological variability can be retrieved from this analysis in such catchments? In this work we apply the data-driven approach of Kirchner (WRR, 2009) to estimate discharge sensitivity functions that summarize the behavior of four sub-catchments of the Ardèche, using non-vegetation periods (November-March) from 9 years of data (2000-2008) from operational networks. The relevance of the inferred sensitivity function is assessed through hydrograph simulations, and through estimating precipitation rates from discharge fluctuations. We find that the discharge-sensitivity function is downward-curving in double-logarithmic space, thus allowing further simulation of discharge and non-divergence of the model, only during non-vegetation periods. The analysis is complemented by a Monte-Carlo sensitivity analysis showing how the parameters summarizing the discharge sensitivity function impact the simulated hydrographs. The resulting discharge simulation results are good for granite catchments, found to be predominantly characterized by saturation excess runoff and sub-surface flow processes. The simple dynamical system hypothesis works especially well in wet conditions (peaks and recessions are well modeled). On the other hand, poor model performance is associated with

  5. Are physical measures related to patient-centred outcomes in ARDS survivors?

    PubMed

    Chan, Kitty S; Aronson Friedman, Lisa; Dinglas, Victor D; Hough, Catherine L; Shanholtz, Carl; Ely, E Wesley; Morris, Peter E; Mendez-Tellez, Pedro A; Jackson, James C; Hopkins, Ramona O; Needham, Dale M

    2017-10-01

    To inform selection of physical measures for studies of acute respiratory distress syndrome (ARDS) survivors within 12 months of ARDS. Secondary analysis of data from 6-month survivors participating in a US multicentre prospective study (ARDSNet Long-Term Outcome Study, N=134) or a multisite prospective study in Baltimore, Maryland, USA (Improving Care of Acute Lung Injury Patients, N=99). Physical measures, assessed at 6-month follow-up, were categorised according to the WHO's International Classification of Disability and Health: body functions and structures, activity and participation. Patient-centred outcomes were evaluated at 6 and 12 months: survival, hospitalisation, alive at home status and health-related quality of life. Pearson correlation, linear and logistic regression models were used to quantify associations of physical measures with patient-centred outcomes. No 6-month body functions and structures measure demonstrated consistent association with 6-month or 12-month outcomes in multivariable regression. The 6 min walk test, an activity measure, was associated with 6-month Short-Form 36 (SF-36) physical component scores (PCS, β range: 0.99 to 1.52, p<0.05). Participation measures (Functional Performance Inventory, FPI; Instrumental Activities of Daily Living, IADLs) were associated with SF-36 PCS (β range: FPI, 1.51-1.52; IADL, -1.88 to -1.32; all p<0.05) and Euro-QOL-5D utility score (β range: FPI, 2.00-3.67; IADL, -2.89 to -2.50; all p<0.01) at 6 and 12 months. Participation measures better reflect patient's quality of life than measures of body functions and structures within 12 months of ARDS among 6-month survivors, and are recommended for inclusion as a core measure in future studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  6. Estimating dead-space fraction for secondary analyses of ARDS clinical trials

    PubMed Central

    Beitler, Jeremy R.; Thompson, B. Taylor; Matthay, Michael A.; Talmor, Daniel; Liu, Kathleen D.; Zhuo, Hanjing; Hayden, Douglas; Spragg, Roger G.; Malhotra, Atul

    2015-01-01

    Objective Pulmonary dead-space fraction is one of few lung-specific independent predictors of mortality from acute respiratory distress syndrome (ARDS). However, it is not measured routinely in clinical trials and thus altogether ignored in secondary analyses that shape future research directions and clinical practice. This study sought to validate an estimate of dead-space fraction for use in secondary analyses of clinical trials. Design Analysis of patient-level data pooled from ARDS clinical trials. Four approaches to estimate dead-space fraction were evaluated: three required estimating metabolic rate; one estimated dead-space fraction directly. Setting U.S. academic teaching hospitals. Patients Data from 210 patients across three clinical trials were used to compare performance of estimating equations with measured dead-space fraction. A second cohort of 3,135 patients from six clinical trials without measured dead-space fraction was used to confirm whether estimates independently predicted mortality. Interventions None. Measurements and Main Results Dead-space fraction estimated using the unadjusted Harris-Benedict equation for energy expenditure was unbiased (mean ± SD Harris-Benedict 0.59 ± 0.13; measured 0.60 ± 0.12). This estimate predicted measured dead-space fraction to within ± 0.10 in 70% of patients and ± 0.20 in 95% of patients. Measured dead-space fraction independently predicted mortality (OR 1.36 per 0.05 increase in dead-space fraction, 95% CI 1.10–1.68; p < .01). The Harris-Benedict estimate closely approximated this association with mortality in the same cohort (OR 1.55, 95% CI 1.21–1.98; p < .01) and remained independently predictive of death in the larger ARDSNet cohort. Other estimates predicted measured dead-space fraction or its association with mortality less well. Conclusions Dead-space fraction should be measured in future ARDS clinical trials to facilitate incorporation into secondary analyses. For analyses where dead

  7. Novel observations during extracorporeal membrane oxygenation in patients with ARDS due to the H1N1 pandemic influenza.

    PubMed

    Kutleša, Marko; Santini, Marija; Krajinović, Vladimir; Raffanelli, Dinko; Baršić, Bruno

    2011-02-01

    We report four patients with novel observations during extracorporeal membrane oxygenation support (ECMO). ECMO was initiated because of severe ARDS due to the primary H1N1 pandemic influenza pneumonia. Two patients had excessive conjugated hyperbilirubinemia and two had unproportional depletion of the coagulation factor IX. Pathogenetic mechanisms and clinical relevance of the noticed phenomena are discussed.

  8. Fifty Years of Research in ARDS. Cell-based Therapy for Acute Respiratory Distress Syndrome. Biology and Potential Therapeutic Value.

    PubMed

    Laffey, John G; Matthay, Michael A

    2017-08-01

    On the basis of several preclinical studies, cell-based therapy has emerged as a potential new therapeutic for acute respiratory distress syndrome (ARDS). Of the various cell-based therapy options, mesenchymal stem/stromal cells (MSCs) from bone marrow, adipose tissue, and umbilical cord have the most experimental data to support their potential efficacy for lung injury from both infectious and noninfectious causes. Mechanistically, MSCs exert their beneficial effects by release of paracrine factors, microvesicles, and transfer of mitochondria, all of which have antiinflammatory and pro-resolving effects on injured lung endothelium and alveolar epithelium, including enhancing the resolution of pulmonary edema by up-regulating sodium-dependent alveolar fluid clearance. MSCs also have antimicrobial effects mediated by release of antimicrobial factors and by up-regulating monocyte/macrophage phagocytosis. Phase 2a clinical trials to establish safety in ARDS are in progress, and two phase 1 trials did not report any serious adverse events. Several issues need further study, including: determining the optimal methods for large-scale production, reconstitution of cryopreserved cells for clinical use, defining cell potency assays, and determining the therapeutic potential of conditioned media derived from MSCs. Because ARDS is a heterogeneous syndrome, targeting MSCs to patients with ARDS with a more hyperinflammatory endotype may further enhance their potential for efficacy.

  9. Dysregulation of the angiopoietin–Tie-2 axis in sepsis and ARDS

    PubMed Central

    Parikh, Samir M

    2013-01-01

    Dynamic changes in microvascular endothelial structure and function are pivotal in the acute inflammatory response, the body’s rapid, coordinated effort to localize, sequester, and eliminate microbial invaders at their portal of entry. To achieve this, the endothelium becomes leaky and inflamed, providing innate immune cells and humoral effector molecules access to the site of infection. During sepsis this locally adaptive response becomes manifest throughout the body, leading to dangerous host consequences. Increased leakiness in the pulmonary circulation contributes to acute respiratory distress syndrome (ARDS), a complication of sepsis associated with 40% mortality. Understanding the molecular governance of vascular leak and inflammation has major diagnostic, prognostic, and potentially therapeutic implications for this common and pernicious disease. This review summarizes results from cell-based experiments, animal models, and observational human studies; together, these studies suggest that an endothelial receptor called Tie2 and its ligands, called angiopoietins, form a signaling axis key to the vascular dyshomeostasis that underlies sepsis. PMID:23652985

  10. A closed-loop controller for mechanical ventilation of patients with ARDS.

    PubMed

    Anderson, Jeffrey R; East, Thomas D

    2002-01-01

    Mechanical ventilators are routinely used to care for patients who cannot adequately breath on their own. Management of mechanical ventilation often involves a careful watch of the patient's arterial blood-oxygen tension and requires frequent adjustment of ventilation parameters to optimize the therapy. This situation lends itself as a candidate for closed-loop control. This report describes a closed-loop control system based on well-established protocols to systematically maintain appropriate levels of positive end-expiratory pressure (PEEP) and inspired oxygen (FiO2) in patients with Adult Respiratory Distress Syndrome (ARDS). The closed-loop control system consists of an in-dwelling arterial oxygenation (PaO2) sensor (Pfizer Continucath), coupled to a Macintosh computer that continuously controls FiO2 and PEEP settings on a Hamilton Amadeus ventilator. The implemented protocols provide continuous closed-loop control of oxygenation and a balance between patient need and minimal therapy. The controller is based on a traditional proportional-integral-derivative (PID) approach. The idea is to control, or maintain, the patient's PaO2 level at a target value determined, or set, by the patient's physician. The controller also features non-linear and adaptive characteristics that allow the system to respond more aggressively to "threatening" levels of PaO2. Another benefit of the control system is the ability to display, monitor, record and store all system parameters, settings, and control variables for future analysis and study. The system was extensively tested in the laboratory and in animal trials prior to use on human subjects. The results of a small clinical trial indicated that the system maintained control of the patient's therapy nearly 84% of the time. During the remainder of this time, the controller was interrupted primarily for suctioning, PaO2 sensor calibration or replacement. The response of the closed-loop controller was found to be appropriate

  11. Differential evaluation of bronchoalveolar lavage cells and leukotrienes in unilateral acute lung injury and ARDS patients.

    PubMed

    Antonelli, M; Lenti, L; Bufi, M; De Blasi, R A; Vivino, G; Conti, G; Pelaia, P; Zicari, A; Pontieri, G; Gasparetto, A

    1989-01-01

    Patients with unilateral acute lung injury (UALI; n = 6) and ARDS (n = 4) were evaluated by bronchoalveolar lavage, as controls we used 5 patients suffering from cerebral hemorrhage and without pulmonary, cardiac or infectious disease who were mechanically ventilated. For each group of patients two independent bronchoalveolar lavages (BAL) were performed. The BAL fluid recovered from the two lungs was immediately analyzed for leukotrienes (LTS) by means of RP-HPLC and stained for cell counts. The BAL from the control group did not show any LTS and the percentage of neutrophils was within the normal range: 1 +/- 0.2% right lung and 1.2 +/- 0.4% left lung. The BAL fluid from UALI patients showed two different patterns, the injured lung showed high levels of LTS (39.1 +/- 8 ng ml-1 LTB4; 25 +/- 6 ng ml-1 LTD4 and 27.8 +/- 8.2 ng ml-1 11-trans LTC4) and an increased percentage of neutrophils (74.2 +/- 7%) compared to controls. Only 2 out of the 6 patients from the UALI group showed small amounts of LTB4 (4 ng ml-1) and LTD4 (3.2 ng ml-1). The BAL obtained from the "healthy lung" in both cases showed values of LTS almost eight fold lower than those present in the injured lung. The percentage of neutrophils from the unaffected lungs (4.3 +/- 7%) was not significantly different from controls. Lavage fluid from ARDS patients showed a similar picture to that of the affected lung from UALI patients.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. [Antirestriction proteins ardA and Ocr as effective inhibitors of the type I restriction-modification enzymes].

    PubMed

    Zavil'gel'skiĭ, G B; Rastorguev, S M

    2009-01-01

    Genes encoding antirestriction proteins (antirestrictases, inasmuch as the antirestriction proteins inhibit the activity of restriction-modification systems, but have no proper enzyme activity, the name antirestrictase is only tentative) are included in the composition of conjugative plasmids (genes ardABC) and some bacteriophages (genes ocr and darA). Antirestriction proteins inhibit of the type I restriction-modification enzymes and thus protect unmodified DNA of plasmids and bacteriophages from degradation. Antirestriction proteins belong to the "protein mimicry of DNA" family: the spatial structure is like the B-form of DNA, and therefore the antirestriction proteins operated on the principle of concurrent inhibition replacing DNA in the complex with the restriction-modification enzyme. Based on the prepared in vitro mutant forms of ArdA and Ocr, and also on natural proteins ArdA selectively inhibiting restriction activity of the type I enzymes, but not affecting their methylase activity, we have developed a model of complex formation between the antirestriction proteins and the restriction-modification enzymes R2M2S. Antirestriction proteins are capable of competing displacement of the DNA strand from two sites which are situated as follows: 1) in S-subunit (enzyme contact with the specific DNA site) and 2) in R-subunit (through this unit translocation of the DNA strand occurs followed by its degradation). Analysis of estriction and antimodification activities of proteins ArdA and Ocr depending on the expression level of genes ardA and ocr was performed (the cloning of the genes was done under strictly regulated promoter).

  13. Identification of StARD3 as a Lutein-binding Protein in the Macula of the Primate Retina†

    PubMed Central

    Li, Binxing; Vachali, Preejith; Frederick, Jeanne M.; Bernstein, Paul S.

    2011-01-01

    Lutein, zeaxanthin and their metabolites are the xanthophyll carotenoids that form the macular pigment of the human retina. Epidemiological evidence suggests that high levels of these carotenoids in the diet, serum and macula are associated with decreased risk of age-related macular degeneration (AMD), and the AREDS2 study is prospectively testing this hypothesis. Understanding the biochemical mechanisms underlying the selective uptakes of lutein and zeaxanthin into the human macula may provide important insights into the physiology of the human macula in health and disease. GSTP1 is the macular zeaxanthin-binding protein, but the identity of the human macular lutein-binding protein has remained elusive. Prior identification of the silkworm lutein-binding protein (CBP) as a member of the steroidogenic acute regulatory domain (StARD) protein family, and selective labeling of monkey photoreceptor inner segments by anti-CBP antibody provided an important clue toward identifying the primate retina lutein-binding protein. Homology of CBP to all 15 human StARD proteins was analyzed using database searches, western blotting and immunohistochemistry, and we here provide evidence to identify StARD3 (also known as MLN64) as a human retinal lutein-binding protein. Further, recombinant StARD3 selectively binds lutein with high affinity (KD = 0.45 micromolar) when assessed by surface plasmon resonance (SPR) binding assays. Our results demonstrate previously unrecognized, specific interactions of StARD3 with lutein and provide novel avenues to explore its roles in human macular physiology and disease. PMID:21322544

  14. A universal definition of ARDS: the PaO2/FiO2 ratio under a standard ventilatory setting--a prospective, multicenter validation study.

    PubMed

    Villar, Jesús; Pérez-Méndez, Lina; Blanco, Jesús; Añón, José Manuel; Blanch, Lluís; Belda, Javier; Santos-Bouza, Antonio; Fernández, Rosa Lidia; Kacmarek, Robert M

    2013-04-01

    The PaO2/FiO2 is an integral part of the assessment of patients with acute respiratory distress syndrome (ARDS). The American-European Consensus Conference definition does not mandate any standardization procedure. We hypothesized that the use of PaO2/FiO2 calculated under a standard ventilatory setting within 24 h of ARDS diagnosis allows a more clinically relevant ARDS classification. We studied 452 ARDS patients enrolled prospectively in two independent, multicenter cohorts treated with protective mechanical ventilation. At the time of ARDS diagnosis, patients had a PaO2/FiO2 ≤ 200. In the derivation cohort (n = 170), we measured PaO2/FiO2 with two levels of positive end-expiratory pressure (PEEP) (≥ 5 and ≥ 10 cmH2O) and two levels of FiO2 (≥ 0.5 and 1.0) at ARDS onset and 24 h later. Dependent upon PaO2 response, patients were reclassified into three groups: mild (PaO2/FiO2 > 200), moderate (PaO2/FiO2 101-200), and severe (PaO2/FiO2 ≤ 100) ARDS. The primary outcome measure was ICU mortality. The standard ventilatory setting that reached the highest significance difference in mortality among these categories was tested in a separate cohort (n = 282). The only standard ventilatory setting that identified the three PaO2/FiO2 risk categories in the derivation cohort was PEEP ≥ 10 cmH2O and FiO2 ≥ 0.5 at 24 h after ARDS onset (p = 0.0001). Using this ventilatory setting, patients in the validation cohort were reclassified as having mild ARDS (n = 47, mortality 17 %), moderate ARDS (n = 149, mortality 40.9 %), and severe ARDS (n = 86, mortality 58.1 %) (p = 0.00001). Our method for assessing PaO2/FiO2 greatly improved risk stratification of ARDS and could be used for enrolling appropriate ARDS patients into therapeutic clinical trials.

  15. Comparative analysis of anti-restriction activities of ArdA (ColIb-P9) and Ocr (T7) proteins.

    PubMed

    Zavilgelsky, G B; Kotova, V Yu; Rastorguev, S M

    2008-08-01

    Anti-restriction proteins ArdA and Ocr are specific inhibitors of type I restriction-modification enzymes. The IncI1 transmissible plasmid ColIb-P9 ardA and bacteriophage T7 0.3(ocr) genes were cloned in pUC18 vector. Both ArdA (ColIb-P9) and Ocr (T7) proteins inhibit both restriction and modification activities of the type I restriction-modification enzyme (EcoKI) in Escherichia coli K12 cells. ColIb-P9 ardA, T7 0.3(ocr), and the Photorhabdus luminescens luxCDABE genes were cloned in pZ-series vectors with the P(ltetO-1) promoter, which is tightly repressible by the TetR repressor. Controlling the expression of the lux-genes encoding bacterial luciferase demonstrates that the P(ltetO-1) promoter can be regulated over an up to 5000-fold range by supplying anhydrotetracycline to the E. coli MG1655Z1 tetR(+) cells. Effectiveness of the anti-restriction activity of the ArdA and Ocr proteins depended on the intracellular concentration. It is shown that the dissociation constants K(d) for ArdA and Ocr proteins with EcoKI enzyme differ 1700-fold: K(d) (Ocr) = 10(-10) M, K(d) (ArdA) = 1.7.10(-7) M.

  16. Neuronal acetylcholine receptors in Drosophila: the ARD protein is a component of a high-affinity alpha-bungarotoxin binding complex.

    PubMed Central

    Schloss, P; Hermans-Borgmeyer, I; Betz, H; Gundelfinger, E D

    1988-01-01

    The ard gene of Drosophila melanogaster encodes a structural homologue of vertebrate nicotinic acetylcholine receptors (AChR) and is expressed exclusively in nervous tissue. To study the nature of the ARD protein, antibodies were raised against fusion constructs containing two regions of this polypeptide. One segment is putatively extracellular (amino acids 65-212), the other domain is exposed to the cytoplasm (amino acids 305-444). The ARD antisera obtained served to investigate the physical relationship between the ARD protein and alpha-bungarotoxin (alpha-Btx) binding sites occurring in Drosophila. Two different high-affinity binding sites for [125I]alpha-Btx, a highly potent antagonist of vertebrate muscle AChR, were detected in fly head membranes. Equilibrium binding and kinetic studies revealed Kd values of approximately 0.1 nM (site 1) and approximately 4 nM (site 2). The estimated maximal binding (Bmax) was approximately 240 and 1080 fmol/mg protein respectively. Both sites exhibited a nicotinic-cholinergic pharmacology. Immunoprecipitation experiments with the ARD antisera indicated that the ARD protein is associated with the [125I]alpha-Btx binding site 1 only. These data support the previously postulated hypothesis that the ARD protein is part of an alpha-Btx binding neuronal AChR of Drosophila. Furthermore, they indicate heterogeneity in nicotinic-cholinergic binding sites in the insect nervous system. PMID:3141150

  17. Pulmonary talcosis: imaging findings.

    PubMed

    Marchiori, Edson; Lourenço, Sílvia; Gasparetto, Taisa Davaus; Zanetti, Gláucia; Mano, Cláudia Mauro; Nobre, Luiz Felipe

    2010-04-01

    Talc is a mineral widely used in the ceramic, paper, plastics, rubber, paint, and cosmetic industries. Four distinct forms of pulmonary disease caused by talc have been defined. Three of them (talcosilicosis, talcoasbestosis, and pure talcosis) are associated with aspiration and differ in the composition of the inhaled substance. The fourth form, a result of intravenous administration of talc, is seen in drug users who inject medications intended for oral use. The disease most commonly affects men, with a mean age in the fourth decade of life. Presentation of patients with talc granulomatosis can range from asymptomatic to fulminant disease. Symptomatic patients typically present with nonspecific complaints, including progressive exertional dyspnea, and cough. Late complications include chronic respiratory failure, emphysema, pulmonary arterial hypertension, and cor pulmonale. History of occupational exposure or of drug addiction is the major clue to the diagnosis. The high-resolution computed tomography (HRCT) finding of small centrilobular nodules associated with heterogeneous conglomerate masses containing high-density amorphous areas, with or without panlobular emphysema in the lower lobes, is highly suggestive of pulmonary talcosis. The characteristic histopathologic feature in talc pneumoconiosis is the striking appearance of birefringent, needle-shaped particles of talc seen within the giant cells and in the areas of pulmonary fibrosis with the use of polarized light. In conclusion, computed tomography can play an important role in the diagnosis of pulmonary talcosis, since suggestive patterns may be observed. The presence of these patterns in drug abusers or in patients with an occupational history of exposure to talc is highly suggestive of pulmonary talcosis.

  18. Pulmonary Abnormalities in Mice with Paracoccidioidomycosis: A Sequential Study Comparing High Resolution Computed Tomography and Pathologic Findings

    PubMed Central

    Hidalgo, José Miguel; de Oliveira Pascarelli, Bernardo Miguel; Patiño, Jairo Hernando; Lenzi, Henrique Leonel; Restrepo, Angela; Cano, Luz Elena

    2010-01-01

    Background Human paracoccidioidomycosis (PCM) is an endemic fungal disease of pulmonary origin. Follow-up of pulmonary lesions by image studies in an experimental model of PCM has not been previously attempted. This study focuses on defining patterns, topography and intensity of lung lesions in experimentally infected PCM mice by means of a comparative analysis between High Resolution Computed Tomography (HRCT) and histopathologic parameters. Methodology Male BALB/c mice were intranasally inoculated with 3×106 Paracoccidioides brasiliensis (Pb) conidia (n = 50) or PBS (n = 50). HRCT was done every four weeks to determine pulmonary lesions, quantify lung density, reconstruct and quantify lung air structure. Lungs were also analyzed by histopathology and histomorphometry. Results Three different patterns of lesions were evidenced by HRCT and histopathology, as follows: nodular-diffuse, confluent and pseudo-tumoral. The lesions were mainly located around the hilus and affected more frequently the left lung. At the 4th week post-challenge HRCT showed that 80% of the Pb-infected mice had peri-bronchial consolidations associated with a significant increase in upper lung density when compared with controls, (−263±25 vs. −422±10 HU, p<0.001). After the 8th and 12th weeks, consolidation had progressed involving also the middle regions. Histopathology revealed that consolidation as assessed by HRCT was equivalent histologically to a confluent granulomatous reaction, while nodules corresponded to individual compact granulomas. At the 16th week of infection, confluent granulomas formed pseudotumoral masses that obstructed large bronchi. Discrete focal fibrosis was visible gradually around granulomas, but this finding was only evident by histopathology. Conclusions/Significance This study demonstrated that conventional HRCT is a useful tool for evaluation and quantification of pulmonary damage occurring in experimental mouse PCM. The experimental design used

  19. The performance improvement of automatic classification among obstructive lung diseases on the basis of the features of shape analysis, in addition to texture analysis at HRCT

    NASA Astrophysics Data System (ADS)

    Lee, Youngjoo; Kim, Namkug; Seo, Joon Beom; Lee, JuneGoo; Kang, Suk Ho

    2007-03-01

    In this paper, we proposed novel shape features to improve classification performance of differentiating obstructive lung diseases, based on HRCT (High Resolution Computerized Tomography) images. The images were selected from HRCT images, obtained from 82 subjects. For each image, two experienced radiologists selected rectangular ROIs with various sizes (16x16, 32x32, and 64x64 pixels), representing each disease or normal lung parenchyma. Besides thirteen textural features, we employed additional seven shape features; cluster shape features, and Top-hat transform features. To evaluate the contribution of shape features for differentiation of obstructive lung diseases, several experiments were conducted with two different types of classifiers and various ROI sizes. For automated classification, the Bayesian classifier and support vector machine (SVM) were implemented. To assess the performance and cross-validation of the system, 5-folding method was used. In comparison to employing only textural features, adding shape features yields significant enhancement of overall sensitivity(5.9, 5.4, 4.4% in the Bayesian and 9.0, 7.3, 5.3% in the SVM), in the order of ROI size 16x16, 32x32, 64x64 pixels, respectively (t-test, p<0.01). Moreover, this enhancement was largely due to the improvement on class-specific sensitivity of mild centrilobular emphysema and bronchiolitis obliterans which are most hard to differentiate for radiologists. According to these experimental results, adding shape features to conventional texture features is much useful to improve classification performance of obstructive lung diseases in both Bayesian and SVM classifiers.

  20. The impact of the PAI-1 4G/5G polymorphism on the outcome of patients with ALI/ARDS.

    PubMed

    Tsangaris, Iraklis; Tsantes, Argiris; Bonovas, Stefanos; Lignos, Michalis; Kopterides, Petros; Gialeraki, Argiro; Rapti, Evdoxia; Orfanos, Stylianos; Dimopoulou, Ioanna; Travlou, Anthi; Armaganidis, Apostolos

    2009-04-01

    Increased levels of plasminogen activator inhibitor-1 (PAI-1) have been associated with worse outcome in ALI/ARDS. A single guanosine insertion/deletion (4G/5G) polymorphism in the promoter region of the PAI-1 gene, may play an important role in the regulation of PAI-1 expression. The objective of the study was to evaluate the effect of this polymorphism on the outcome of critically ill patients with ALI/ARDS. 52 consecutive ventilated patients with ALI/ARDS were studied. Bronchoalveolar lavage was performed within 48 hours from diagnosis. Measurement of plasma and BALF PAI-1 activity and D-dimers levels, and 4G/5G genotyping of PAI-1 were carried out. The primary outcome was 28-day mortality, and secondary outcomes included organ dysfunction and ventilator-free days. 17 patients were homozygotes for the 4G allele. Severity scores were not different between subgroups upon study enrollment. 28-day mortality was 70.6% and 42.9% for the 4G-4G and the non-4G-4G patients, respectively (p=0.06). PAI-1 activity levels and D-dimer in plasma and BALF were not significantly different between the 4G-4G and the non-4G-4G subgroups. In the multivariate analysis, genotype 4G/4G was the only variable independently associated with 28-day mortality (Odds Ratio=9.95, 95% CI: 1.79-55.28, p=0.009). Furthermore, genotype 4G/4G and plasma PAI-1 activity levels were independently negatively associated with ventilator free days (p=0.033 and p=0.008, respectively). ALI/ARDS patients, homozygous for the 4G allele of the PAI-1 gene, experienced higher 28-day mortality. This genotype was associated with a reduction in the number of days of unassisted ventilation and was inversely associated with the number of days without organ failure.

  1. The Predictive Value of Coefficient of PCT × BG for Anastomotic Leak in Esophageal Carcinoma Patients With ARDS After Esophagectomy.

    PubMed

    Li, Huan; Wang, Daofeng; Wei, Wenxiao; Ouyang, Lamei; Lou, Ning

    2017-01-01

    Anastomotic leak was a potentially severe life-threatening complication of esophagectomy, which drew attention in consequence of progressive dyspnea until acute respiratory distress syndrome (ARDS) due to the early asymptomatic presentation. Respiratory failure, caused by ARDS as the severe presentation of anastomotic leak, is the most common organ failure. CRP (C-reactive protein), procalcitonin (PCT), and Blood G (BG) test are the sensitivity markers for inflammatory, sepsis, and fungemia, respectively. Early recognition and intervention treatment of anastomotic leak may alleviate complication and improve outcome. We retrospectively analyzed 71 patients, accepting mechanical ventilation support because of ARDS as the complication after radical resection of esophagus cancer. Clinical data were collected from the patients' electronic medical records, including their clinically hematological examination, drainage fluid cultures, and sputum culture. Accord to appearance of anastomotic leak or not, all patients were divided into 2 groups, leak group and no-leak group. Inflammatory markers, such as CRP, PCT, and the coefficient of BG and PCT, were significantly different between the 2 groups. Respiratory index, white blood cell, hemoglobin (HBG), platelet (PLT), and other clinical factors were not significantly different between the 2 groups. Receiver operating characteristic curves were constructed to calculate the sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve for various cutoff levels of several factors. Blood G tests presented the better predicting value for anastomotic leak. Blood G tests and PCT should be tested after esophagectomy. The coefficient of PCT and BG (>260) is of great significance, and clinical value to predict anastomotic leak for patients with postesophagectomy ARDS, early PCT and BG test, and especially, dynamic variation may alleviate complication and improve outcome.

  2. The pressure-volume curve is greatly modified by recruitment. A mathematical model of ARDS lungs.

    PubMed

    Hickling, K G

    1998-07-01

    A mathematical model of the ARDS lung, with simulated gravitational superimposed pressure, evaluated the effect of varying alveolar threshold opening pressures (TOP), PEEP and peak inspiratory pressure (PIP) on the static pressure-volume (PV) curve. The lower inflection point (Pflex) was affected by SP and TOP, and did not accurately indicate PEEP required to prevent end-expiratory collapse. Reinflation of collapsed lung units (recruitment) continued on the linear portion of the PV curve, which had a slope at any volume greater than the total compliance of aerated alveoli. As recruitment diminished, the reduced PV slope could produce an upper Pflex at 20 to 30 cm H2O pressure. An upper Pflex caused by alveolar overdistension could be modified or eliminated by recruitment with high TOP. With constant PIP as PEEP increased, and TOP range of 5 to 60 cm H2O, PEEP to prevent end-expiratory collapse was indicated by minimum PV slope above 20 cm H2O, minimum hysteresis, and maximum volume at a pressure of 20 cm H2O. With constant inflation volume as PEEP increased, the effect on PV slope was unpredictable. Although increased PV slope indicated recruitment, maximum PV slope usually underestimated PEEP required to prevent end-expiratory collapse. Therefore, with this model the PV curve did not reliably predict optimal ventilator settings.

  3. Neanderthal hand and foot remains from Moula-Guercy, Ardèche, France.

    PubMed

    Mersey, Ben; Jabbour, Rebecca S; Brudvik, Kyle; Defleur, Alban

    2013-12-01

    The hand and foot remains from Moula-Guercy cave (Ardèche, France) comprise 24 specimens of Eemian age (ca. 120 ka). The specimens include primarily complete elements, which are rare among the Moula-Guercy postcrania. The hand remains have several characteristic Neanderthal traits including a laterally facing (parasagittally oriented) second metacarpal-capitate articulation, a short styloid process, a wide proximal articular surface on the third metacarpal, and absolutely expanded apical tuberosities on the distal hand phalanges relative to modern humans. The foot remains include several incomplete elements along with an antimeric pair of naviculars, a medial cuneiform and cuboid, and a single complete element from each of the distal segments (one each: metatarsal, proximal foot phalanx, intermediate foot phalanx, distal foot phalanx). Consistent among the specimens are relatively wide diaphyses for length in the metatarsals and phalanges and large and prominent muscle attachments, both consistent with previously published Neanderthal morphology. The hand and foot collection from Moula-Guercy is an important dataset for future studies of Neanderthal functional morphology, dexterity, and behavior as it represents a previously undersampled time period for European Neanderthals.

  4. Neanderthal axial and appendicular remains from Moula-Guercy, Ardèche, France.

    PubMed

    Mersey, Ben; Brudvik, Kyle; Black, Michael T; Defleur, Alban

    2013-12-01

    Excavations carried out during the 1990s at Moula-Guercy cave Ardèche, France, yielded 108 hominid specimens dating to 100-120 Ka. In this paper, we describe and compare the 39 axial and appendicular specimens not including hand and foot bones. Among these remains are a large adult femur, several clavicles, a likely antimeric pair of radial heads, and a nearly complete superior pubic ramus. Analyses of this material indicate a clear affinity with Neanderthals by the presence of large and robust muscle attachments, thick long bone cortices, a long pubic ramus, and a superoinferiorly flattened clavicle shaft. The recovered remains reveal the presence of a mature male, a smaller mature individual, possibly a reproductive age female, an immature individual of age 10-12, and a second immature individual of age 4. Future analyses on the Moula-Guercy remains will illuminate ties to other known Neanderthal populations and contribute to the ongoing debate over the relative rate of Neanderthal metric growth.

  5. Management of refractory hypoxemia during venovenous extracorporeal membrane oxygenation for ARDS.

    PubMed

    Montisci, Andrea; Maj, Giulia; Zangrillo, Alberto; Winterton, Dario; Pappalardo, Federico

    2015-01-01

    Venovenous extracorporeal membrane oxygenation (VV ECMO) in acute respiratory distress syndrome (ARDS) is currently a widely used therapeutic strategy. However, patients are often still hypoxemic despite complete ECMO support. The major determinants of peripheral oxygen saturation (SpO2) during VV ECMO are pump flow, degree of recirculation, patient's systemic venous return and its oxygen saturation, hemoglobin concentration and residual lung function. Current guidelines state that the support can be considered adequate when the patient's SpO2 is equal or greater than 80%, but a possible objection could be that such a value of O2-tension may be too low and may worsen the patient's prognosis. Moving from the pathophysiology of hypoxemia during VV ECMO, this review focuses on recirculation of blood and on the possible strategies to minimize it, on the pharmacologic modulation of intrapulmonary shunt and on the questions related to management of ECMO flow and the risks and benefits of permissive hypoxemic states. Transfusional strategy during VV ECMO, administration of neuromuscular blocking agents and sedatives, therapeutic hypothermia, and prone positioning is also reviewed. The potential advantages of β-blockers are discussed. Finally, transition from VV ECMO to venoarterial ECMO (VA ECMO) or a hybrid configuration is also examined.

  6. Adult non-cardiac ECMO for the treatment of ARDS--the Mississippi experience.

    PubMed

    Frei, Lonnie W

    2013-07-01

    The University of Mississippi Medical Center (UMMC) has become a center for ECMO (Extracorporeal Membrane Oxygenation), providing this service to patients requiring this life-saving modality. UMMC is the only ECMO center in the state. Prior to the cases presented, ECMO use at UMMC has been limited to neonates and the pediatric patient population as well as by the cardiothoracic service for patients with cardiac failure or inability to wean from bypass. The use of ECMO for non-cardiac support in the adult population has been limited in the past, but recent reports in the literature and experience elsewhere has proven the viability of the technology. This is a retrospective report of the first three adult non-cardiac cases employing ECMO for ARDS (Adult Respiratory Distress Syndrome) in Mississippi. We achieved 100% survival in a disease process which reportedly carries a mortality ranging from 20-50%. A brief review of ECMO and its use in this population is also presented.

  7. Structural analysis of the KRIT1 ankyrin repeat and FERM domains reveals a conformationally stable ARD-FERM interface

    SciTech Connect

    Zhang, Rong; Li, Xiaofeng; Boggon, Titus J.

    2015-10-14

    Cerebral cavernous malformations (CCM) are vascular dysplasias that usually occur in the brain and are associated with mutations in the KRIT1/CCM1, CCM2/MGC4607/OSM/Malcavernin, and PDCD10/CCM3/ TFAR15 genes. Here we report the 2.9 Å crystal structure of the ankyrin repeat domain (ARD) and FERM domain of the protein product of KRIT1 (KRIT1; Krev interaction trapped 1). The crystal structure reveals that the KRIT1 ARD contains 4 ankyrin repeats. There is also an unusual conformation in the ANK4 repeat that is stabilized by Trp-404, and the structure reveals a solvent exposed ankyrin groove. Domain orientations of the three copies within the asymmetric unit suggest a stable interaction between KRIT1 ARD and FERM domains, indicating a globular ARD–FERM module. It resembles the additional F0 domain found N-terminal to the FERM domain of talin. Structural analysis of KRIT1 ARD–FERM highlights surface regions of high evolutionary conservation, and suggests potential sites that could mediate interaction with binding partners. The structure therefore provides a better understanding of KRIT1 at the molecular level.

  8. Evidence for Accelerated Radioactive Decay (ARD) Models of Type I Supernova Lightcurves in the Low Redshift Universe

    NASA Astrophysics Data System (ADS)

    Rust, Bert W.; Leventhal, Marvin

    2014-06-01

    Forty years ago Van Hise [ApJ 192 (1974) 657-659] observed that the post peak light curve for the Type I supernova SN1937C is well represented by a sum of two exponentials with half lives which are ~ 0.75 of the terrestrial half lives of 56Ni and 56Co in the beta decay chain 56Ni → 56Co → 56Fe. Thirty nine years ago Leventhal and McCall [Nature 255 (1975) 690-692] proposed a fully convective, radioactive white dwarf model to account for the observed accelerated decay. Thirty eight years ago ARD models were tested by Rust, et al. [Nature 262 (1976) 118-120] on the data from the 15 fragmentary light curves available at that time. The results offered significant but not overwhelming support for ARD models. In this paper we present a new mathematical model for Type I lightcurves and fit that model, using only 6 free parameters, to an extensive collection of higher quality lightcurves that have been measured over the last 38 years. The fits all capture more than 99% of the total variance in the measured data, thus establishing the reality of an ARD lightcurve model. These new results provide a much improved Phillips relation for calibrating the extragalactic distance scale and testing other cosmological relations.

  9. Combination of aspirin with essential fatty acids is superior to aspirin alone to prevent or ameliorate sepsis or ARDS.

    PubMed

    Das, Undurti N

    2016-11-25

    It has been suggested that aspirin may be of benefit in treating sepsis and ARDS in view of its ability to block cyclo-oxygenase-1 (COX-1) and COX-2 activities; inhibit nuclear factor kappa B (NF-κB); enhance the production of endothelial nitric oxide (eNO) and lipoxin A4 (LXA4). Our previous studies revealed that plasma phospholipid content of arachidonic acid (AA) and eicosapentaenoic acid (EPA) is low in patients with sepsis. This implies that beneficial actions of aspirin in sepsis and ARDS is unlikely to be obtained in view of deficiency of AA and EPA, the precursors of LXA4 and resolvins respectively that are potent anti-inflammatory compounds and enhancers of eNO generation. In view of this, I propose that a combination of aspirin and AA and EPA (and possibly, docosahexaenoic acid, DHA) is likely to be superior in the management of sepsis and ARDS compared to aspirin alone. This suggestion is supported by the recent observation that trauma patients with uncomplicated recoveries had higher resolvin pathway gene expression and lower gene expression ratios of leukotriene: resolvin pathways.

  10. BPD Following Preterm Birth: A Model for Chronic Lung Disease and a Substrate for ARDS in Childhood.

    PubMed

    Bhandari, Anita; Carroll, Christopher; Bhandari, Vineet

    2016-01-01

    It has been suggested that pediatric acute respiratory distress syndrome (PARDS) may be a different entity, vis-à-vis adult acute respiratory distress syndrome (ARDS), based on its epidemiology and outcomes. A more pediatric-specific definition of PARDS to include the subgroup of patients with underlying lung (and heart) disease has been proposed. Epidemiological data suggest that up to 13% of the children with ARDS have a history of prematurity and/or underlying chronic lung disease. However, the specific contribution of bronchopulmonary dysplasia (BPD), the most common chronic lung disease in infants, to the development of PARDS is not known. BPD leads to damaged lungs with long-term consequences secondary to disordered growth and immune function. These damaged lungs could potentially act as a substrate, which given the appropriate noxious stimuli, can predispose a child to PARDS. Interestingly, similar biomarkers [KL-6, interleukin (IL)-6, IL-8, sICAM-1, angiopoietin-2, and matrix metalloproteinase-8 and -9] of pulmonary injury have been associated both with BPD and ARDS. Recognition of a unique pattern of clinical symptomatology and/or outcomes of PARDS, if present, could potentially be useful for investigating targeted therapeutic interventions.

  11. BPD Following Preterm Birth: A Model for Chronic Lung Disease and a Substrate for ARDS in Childhood

    PubMed Central

    Bhandari, Anita; Carroll, Christopher; Bhandari, Vineet

    2016-01-01

    It has been suggested that pediatric acute respiratory distress syndrome (PARDS) may be a different entity, vis-à-vis adult acute respiratory distress syndrome (ARDS), based on its epidemiology and outcomes. A more pediatric-specific definition of PARDS to include the subgroup of patients with underlying lung (and heart) disease has been proposed. Epidemiological data suggest that up to 13% of the children with ARDS have a history of prematurity and/or underlying chronic lung disease. However, the specific contribution of bronchopulmonary dysplasia (BPD), the most common chronic lung disease in infants, to the development of PARDS is not known. BPD leads to damaged lungs with long-term consequences secondary to disordered growth and immune function. These damaged lungs could potentially act as a substrate, which given the appropriate noxious stimuli, can predispose a child to PARDS. Interestingly, similar biomarkers [KL-6, interleukin (IL)-6, IL-8, sICAM-1, angiopoietin-2, and matrix metalloproteinase-8 and -9] of pulmonary injury have been associated both with BPD and ARDS. Recognition of a unique pattern of clinical symptomatology and/or outcomes of PARDS, if present, could potentially be useful for investigating targeted therapeutic interventions. PMID:27379219

  12. The FER rs4957796 TT genotype is associated with unfavorable 90-day survival in Caucasian patients with severe ARDS due to pneumonia.

    PubMed

    Hinz, José; Büttner, Benedikt; Kriesel, Fabian; Steinau, Maximilian; Frederik Popov, Aron; Ghadimi, Michael; Beissbarth, Tim; Tzvetkov, Mladen; Bergmann, Ingo; Mansur, Ashham

    2017-08-29

    A recent genome-wide association study showed that a genetic variant within the FER gene is associated with survival in patients with sepsis due to pneumonia. Because severe pneumonia is the main cause of acute respiratory distress syndrome (ARDS), we aimed to investigate the effect of the FER polymorphism rs4957796 on the 90-day survival in patients with ARDS due to pneumonia. An assessment of a prospectively collected cohort of 441 patients with ARDS admitted to three intensive care units at the University Medical Centre identified 274 patients with ARDS due to pneumonia. The 90-day mortality risk was recorded as the primary outcome parameter. Sepsis-related organ failure assessment (SOFA) scores and organ support-free days were used as the secondary variables. FER rs4957796 TT-homozygous patients were compared with C-allele carriers. The survival analysis revealed a higher 90-day mortality risk among T homozygotes than among C-allele carriers (p = 0.0144) exclusively in patients with severe ARDS due to pneumonia. The FER rs4957796 TT genotype remained a significant covariate for the 90-day mortality risk in the multivariate analysis (hazard ratio, 4.62; 95% CI, 1.58-13.50; p = 0.0050). In conclusion, FER rs4957796 might act as a prognostic variable for survival in patients with severe ARDS due to pneumonia.

  13. Identification and characterization of a novel water-deficit-suppressed gene OsARD encoding an aci-reductone-dioxygenase-like protein in rice.

    PubMed

    Lin, Tao; He, Xiaowei; Yang, Ling; Shou, Huixia; Wu, Ping

    2005-10-24

    The aci-reductone dioxygenase (ARD) family common to bacteria, plants and animals is involved in the methionine salvage pathway. A water-deficit-suppressed gene, OsARD encoding an aci-reductone-dioxygenase-like protein, was identified from rice (Oryza sativa L.). Northern blot and reverse transcriptase-polymerase chain reaction (RT-PCR) analysis revealed that the OsARD expression is regulated by abiotic stresses and phytohormones. OsARD was mainly expressed in roots under flood conditions. It was suppressed by abiotic stresses including water deficit, high salinity and low temperature, and induced by ethylene and gibberellin acid (GA). Our results showed that the genes for S-adenosylmethionine (SAM) synthase and 1-aminocyclopropane-1-carboxylic acid (ACC) synthase were upregulated in RNA-interference (RNAi) transgenic rice plants with a significant reduction of OsARD expression. Furthermore, the expression of two genes for ethylene signal transduction, ETR2 and EIN3, increased in these RNAi transgenic plants, whereas the expression of ERF3 was suppressed. These results suggest that OsARD may play a role in the metabolism of methionine and ethylene in response to abiotic stresses.

  14. Psychometric properties of Patient Reported Outcome Measures (PROMs) in patients diagnosed with Acute Respiratory Distress Syndrome (ARDS).

    PubMed

    Shah, Hiral Anil; Dritsaki, Melina; Pink, Joshua; Petrou, Stavros

    2016-01-27

    The aim of this study was to assess the psychometric properties of the EQ-5D-3 L, the SF-12 v2 and its preference based derivative the SF-6D, and the St Georges Respiratory Questionnaire (SGRQ), in patients diagnosed with Acute Respiratory Distress Syndrome (ARDS). Data from the Oscillation in ARDS (OSCAR) randomised unblinded clinical trial of 795 patients diagnosed with ARDS provided the foundation of this secondary psychometric analysis. The three source patient reported outcome measures (PROMs) (EQ-5D-3 L, SF-12 and SGRQ) were collected at both 6 and 12 months post randomisation. All measures were tested for acceptability, reliability, internal consistency, validity and responsiveness. Data from responders at 6 months was used to test for acceptability, reliability, known groups validity and internal responsiveness. Data from patients who responded at both 6 and 12 months was used to test for convergent validity and external responsiveness. Rates of response at both 6 and 12 months post randomisation were 89.88 % for the EQ-5D-3 L, 77.38 % for the SF-6D, 71.43 % for both the physical and mental components of the SF-12 and 38.10 % for the SGRQ. All measures had a Cronbach's Alpha statistic higher than 0.7. For known group's validity, there was no difference in mean summary or utility scores between known groups for all PROMs with minimal effect sizes. All three source measures showed strong convergent and discriminant validity. There was consistent evidence that the SF-6D is an empirically valid and efficient alternative to the EQ-5D-3 L. The EQ-5D-3 L and SGRQ were more responsive compared to the SF-12 and SF-6D with the EQ-5D-3 L generating greater effect sizes than the SGRQ. The PROMs explored in this study displayed varying psychometric properties in the context of ARDS. Further research should focus on shortening the SGRQ whilst still maintaining its psychometric properties and mapping between the SGRQ and preference-based measures for future application

  15. Microscale Biogeochemical Controls on Manganese Oxyhydroxide Biomineral Formation and Associated Trace Metal Sequestration in ARD Biofilms

    NASA Astrophysics Data System (ADS)

    Haack, E. A.; Warren, L. A.

    2002-12-01

    Identifying the processes controlling reactive metal transport is a necessary prerequisite to the design of effective, mitigative, strategies for contaminated aqueous environments, such as acid rock drainage (ARD). Our research investigates the biogeochemical processes affecting trace metal fate in shallow tailings-associated seepage streams from a northern Ontario ARD environment (Onaping mine, Falconbridge Ltd., Sudbury, ON, Canada). Monthly, from June-Sept 2001, in situ characterization of biofilm geochemical parameters and quantification of biofilm-associated metal concentrations, by sequential extraction, was conducted on a diel scale. Results indicate that significant (p<0.05) seasonal accumulation of Mn, Ni, Co and Cr occurred within the biofilms (e.g. Ni, June: 3.60 mmol/kg; September: 25.7 mmol/kg). As much as 75%\\ of the total biofilm concentration of these elements was associated with the amorphous oxyhydroxide fraction. Further, trace metal concentrations were strongly and positively correlated to Mn concentrations in that fraction (R2 > 0.89), implying an important role for Mn oxyhydroxides as a sorbent phase in this system. On a diel basis, Mn concentrations in the amorphous oxyhydroxide fraction decreased significantly in the afternoon compared to morning or late evening values. The magnitude of the loss of Mn was correlated to shifts in the relative depth of the oxic/anoxic boundary. Fine-scale profiling of biofilm pH and O2, using microelectrodes, reflected photosynthesis and respiration; the oxic/anoxic boundary deepened and pH increased within the biofilm during daylight hours. Due to the low pH conditions of the biofilms (3.5-4.5) Mn oxyhydroxide formation is necessarily microbially-catalyzed. Therefore, although the exact mechanisms controlling Mn cycling in this fraction have yet to be elucidated, likely processes include microbially mediated Mn oxidation during non-photosynthetically active hours and abiotic dissolution during

  16. Nur77 attenuates endothelin-1 expression via downregulation of NF-κB and p38 MAPK in A549 cells and in an ARDS rat model.

    PubMed

    Jiang, Yujie; Zeng, Yi; Huang, Xia; Qin, Yueqiu; Luo, Weigui; Xiang, Shulin; Sooranna, Suren R; Pinhu, Liao

    2016-12-01

    Acute respiratory distress syndrome (ARDS) is characterized by inflammatory injury to the alveolar and capillary barriers that results in impaired gas exchange and severe acute respiratory failure. Nuclear orphan receptor Nur77 has emerged as a regulator of gene expression in inflammation, and its role in the pathogenesis of ARDS is not clear. The objective of this study is to investigate the potential role of Nur77 and its underlying mechanism in the regulation of endothelin-1 (ET-1) expression in lipopolysaccharide (LPS)-induced A549 cells and an ARDS rat model. We demonstrate that LPS induced Nur77 expression and nuclear export in A549 cells. Overexpression of Nur77 markedly decreased basal and LPS-induced ET-1 expression in A549 cells, whereas knockdown of Nur77 increased the ET-1 expression. LPS-induced phosphorylation and nuclear translocation of NF-κB and p38 MAPK were blocked by Nur77 overexpression and augmented by Nur77 knockdown in A549 cells. In vivo, LPS induced Nur77 expression in lung in ARDS rats. Pharmacological activation of Nur77 by cytosporone B (CsnB) inhibited ET-1 expression in ARDS rats, decreased LPS-induced phosphorylation of NF-κB and p38 MAPK, and relieved lung, liver, and kidney injury. Pharmacological deactivation of Nur77 by 1,1-bis-(3'-indolyl)-1-(p-hydroxyphenyl)methane (DIM-C-pPhOH, C-DIM8) had no effect on ET-1 expression and lung injury. These results indicated that Nur77 decreases ET-1 expression by suppressing NF-κB and p38 MAPK in LPS-stimulated A549 cells in vitro, and, in an LPS-induced ARDS rat model, CsnB reduced ET-1 expression and lung injury in ARDS rats.

  17. Nur77 attenuates endothelin-1 expression via downregulation of NF-κB and p38 MAPK in A549 cells and in an ARDS rat model

    PubMed Central

    Jiang, Yujie; Zeng, Yi; Huang, Xia; Qin, Yueqiu; Luo, Weigui; Xiang, Shulin; Sooranna, Suren R.

    2016-01-01

    Acute respiratory distress syndrome (ARDS) is characterized by inflammatory injury to the alveolar and capillary barriers that results in impaired gas exchange and severe acute respiratory failure. Nuclear orphan receptor Nur77 has emerged as a regulator of gene expression in inflammation, and its role in the pathogenesis of ARDS is not clear. The objective of this study is to investigate the potential role of Nur77 and its underlying mechanism in the regulation of endothelin-1 (ET-1) expression in lipopolysaccharide (LPS)-induced A549 cells and an ARDS rat model. We demonstrate that LPS induced Nur77 expression and nuclear export in A549 cells. Overexpression of Nur77 markedly decreased basal and LPS-induced ET-1 expression in A549 cells, whereas knockdown of Nur77 increased the ET-1 expression. LPS-induced phosphorylation and nuclear translocation of NF-κB and p38 MAPK were blocked by Nur77 overexpression and augmented by Nur77 knockdown in A549 cells. In vivo, LPS induced Nur77 expression in lung in ARDS rats. Pharmacological activation of Nur77 by cytosporone B (CsnB) inhibited ET-1 expression in ARDS rats, decreased LPS-induced phosphorylation of NF-κB and p38 MAPK, and relieved lung, liver, and kidney injury. Pharmacological deactivation of Nur77 by 1,1-bis-(3′-indolyl)-1-(p-hydroxyphenyl)methane (DIM-C-pPhOH, C-DIM8) had no effect on ET-1 expression and lung injury. These results indicated that Nur77 decreases ET-1 expression by suppressing NF-κB and p38 MAPK in LPS-stimulated A549 cells in vitro, and, in an LPS-induced ARDS rat model, CsnB reduced ET-1 expression and lung injury in ARDS rats. PMID:27765761

  18. A rat model of acute respiratory distress syndrome (ARDS): Part 1. Time dependency of histological and pathological changes.

    PubMed

    Germann, P G; Häfner, D

    1998-08-01

    The time course of histopathological changes in a rat lung lavage model of the acute respiratory distress syndrome (ARDS) was analyzed by sacrificing animals 10, 30, 60, 180, and 210 min after the last lung parenchyma lavage which was performed with physiological saline solution. This lavage depleted the lung from its natural surfactant resources leading into a pathophysiological cascade similar to that of the acute respiratory distress syndrome. Tracheotomized rats (12 animals per time point) were pressure-controlled ventilated (Siemens Servo Ventilator 900C) with 100% oxygen at a respiratory rate of 30 breaths/min, inspiration-expiration ratio of 1:2, peak inspiratory pressure of 28 cm H2O at positive end-expiratory pressure (PEEP) of 8 cm H2O. During the whole experimental period, the ventilation was not changed. Blood gases (partial arterial oxygen pressures [PaO2, mmHg] and partial arterial carbon dioxide pressures [PaCO2, mmHg]) were estimated before, directly after, and 10, 30, 60, 90, 120, 150, 180, and 210 min after the last lavage. For grading lung lavage-induced histopathological changes associated with the time-dependent development of ARDS, slides were coded and evaluated without any knowledge of the sacrifice time. A semiquantitative grading was performed with respect to the severity of the following parameters: hyaline membrane formation (HM), interstitial and intraalveolar edema edema (E), and margination and infiltration of polymorphonuclear neutrophil leukocytes (PMNL) into the lung alveoli. The severity of these parameters showed a time-dependent increase after the last lavage. This was accompanied by a time-dependent decrease in partial arterial oxygen pressure (PaO2) values during the early postlavage period (up to 30 min). Thereafter, PaO2 levels remained fairly stable. The severity of intraalveolar and/or perivascular hemorrhages within the lung was not time dependent. The rat lavage model shows similarities to the pathophysiological sequelae

  19. Importance of Fe(II)-Hydroxide Complexes For the In-Situ Bioremediation of ARD Sites

    NASA Astrophysics Data System (ADS)

    Bilgin, A.; Silverstein, J.; Nordstrom, D. K.

    2003-12-01

    Enhancing the growth of heterotrophic bacteria such as Acidiphilium cryptum that are indigenous to acid rock drainage (ARD) sources is a potential strategy for in-situ inhibition of pyrite oxidation and acid formation. When biodegradable organic carbon was supplied to A. cryptum, oxygen was consumed by rapidly growing heterotrophs, and bacterial iron reduction observed, accompanied by increasing solution pH. A. cryptum (ATCC 33463) cells were incubated in well-aerated liquid media containing Fe2(SO4)3 and glucose at varying initial pH values from 1.5 to 3.5. No more than 1% of the added ferric iron was detected as soluble Fe3+ for any of the media, indicating that the A. cryptum cells were able to reduce precipitated ferric iron. No organic carbon consumption or iron reduction was observed in flasks incubated at pH 1.5 indicating that A. cryptum may not be able to grow at this low pH. In reactors where the initial pH was 3.5, the pH increased to approximately 5.5 during the experiment accompanied by a 0.4 gl-1 decrease in Fe(III) species after aeration stopped. In reactors where the initial pH was 2.5, final pH values were inconsistent between replicate experiments: pH decreased to 2.3 in one experiment and increased to 2.8 in the second. Dissociation of Fe(OH)2+ complexes at pH values near 2.5 could have acted as a buffer, minimizing pH change during iron respiration. The existence of Fe(OH)2+ complexes was investigated using O-square wave voltametry, a pulse polarography technique which allows for identification of metal complexes and estimation of complex stability constants. The presence of ferric hydroxide complexes at pH near 2.5 was confirmed by pulse polarography. When the initial pH was 3.5, the base neutralizing capacity of the solution decreased due to the replacement of Fe(OH)2+ by Fe(OH)3 resulting in the pH increase of over 2 units.

  20. Rainfall estimation using an optical and a microwave link in the Ardèche catchment.

    NASA Astrophysics Data System (ADS)

    Pietersen, Henk; Overeem, Aart; Leijnse, Hidde; Uijlenhoet, Remko

    2013-04-01

    The Mediterranean basin is considered to be one of the "hotspots" for climate change. One of the main factors in these changes is the availability and distribution of water, both in time and space. To gain more understanding about the hydrological cycle in the Mediterranean basin and to quantify the related processes, the HYdrological cycle in the Mediterranean EXperiment (HyMeX) was set up. This experiment focuses on inter-annual to decadal variability in the coupled Mediterranean system, running during the second decade of the 21st century. During this long experiment, special intensive observation periods are planned, of which the first passed during the autumn of 2012. Within the HyMeX framework, one working group pays special attention to (flash) floods and heavy rainfall. To investigate this, several (small) catchments were heavily instrumented during the first special observation period. We show the first results on rainfall estimation employing an optical link, a microwave link, and a disdrometer in the Ardèche catchment in the south of France for the first special observation period of HyMeX. Optical and microwave links can be employed to estimate path-averaged rain intensities along a transect of several kilometers, similar in length to the cross-section of a small catchment. The transmitted signal is attenuated by rain along the link path causing a decrease in received power at the end of the link. The attenuation of this signal has a power-law relation to the average rainfall intensity along the link. As a reference, the disdrometer is placed at one end of the link. Link-based rainfall intensities are compared to those based on disdrometer data. However, due to the nature of the observational technique (point measurement vs. average along a link) errors in representation may occur. The estimation of rainfall intensity from attenuation can be hampered by a number of factors. Principal among these are: moisture on the antennae that is perceived to be

  1. A computer-aided differential diagnosis between UIP and NSIP using automated assessment of the extent and distribution of regional disease patterns at HRCT: comparison with the radiologist's decision

    NASA Astrophysics Data System (ADS)

    Kim, Namkug; Seo, Joon Beom; Park, Sang Ok; Lee, Youngjoo; Lee, Jeongjin

    2009-02-01

    To evaluate the accuracy of computer aided differential diagnosis (CADD) between usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) at HRCT in comparison with that of a radiologist's decision. A computerized classification for six local disease patterns (normal, NL; ground-glass opacity, GGO; reticular opacity, RO; honeycombing, HC; emphysema, EM; and consolidation, CON) using texture/shape analyses and a SVM classifier at HRCT was used for pixel-by-pixel labeling on the whole lung area. The mode filter was applied on the results to reduce noise. Area fraction (AF) of each pattern, directional probabilistic density function (pdf) (dPDF: mean, SD, skewness of pdf /3 directions: superior-inferior, anterior-posterior, central-peripheral), regional cluster distribution pattern (RCDP: number, mean, SD of clusters, mean, SD of centroid of clusters) were automatically evaluated. Spatially normalized left and right lungs were evaluated separately. Disease division index (DDI) on every combination of AFs and asymmetric index (AI) between left and right lung ((left-right)/left) were also evaluated. To assess the accuracy of the system, fifty-four HRCT data sets in patients with pathologically diagnosed UIP (n=26) and NSIP (n=28) were used. For a classification procedure, a CADD-SVM classifier with internal parameter optimization, and sequential forward floating feature selection (SFFS) were employed. The accuracy was assessed by a 5-folding cross validation with 20- times repetition. For comparison, two thoracic radiologists reviewed the whole HRCT images without clinical information and diagnose each case either as UIP or NSIP. The accuracies of radiologists' decision were 0.75 and 0.87, respectively. The accuracies of the CADD system using the features of AF, dPDF, AI of dPDF, RDP, AI of RDP, DDI were 0.70, 0.79, 0.77, 0.80, 0.78, 0.81, respectively. The accuracy of optimized CADD using all features after SFFS was 0.91. We developed the CADD

  2. Relationship between angiotensinogen, alpha 1-protease inhibitor elastase complex, antithrombin III and C-reactive protein in septic ARDS.

    PubMed

    Hilgenfeldt, U; Kellermann, W; Kienapfel, G; Jochum, M

    1990-01-01

    The time-course of plasma angiotensinogen (Ao), elastase-alpha 1-protease inhibitor complex (EL alpha 1PI), antithrombin III (AT III) and C-reactive protein (CRP) have been investigated of six patients suffering from adult respiratory distress syndrome (ARDS). The total plasma Ao level (active and inactive Ao) varied in individuals but was increased up to five-fold. An increasing amount of inactive Ao is found. From the beginning of their stay in the intensive care unit up to five days half of the patients displayed a positive correlation between the plasma CRP and Ao level. The CRP and Ao values were either not or were negatively correlated with the AT III values. In contrast plasma Ao and AT III levels in all patients were positively correlated during a particular period in the subsequent phase of the disease, where there was no or a negative correlation with CRP. The two acute phase reactants CRP and EL alpha 1PI were only correlated in two patients at the beginning of the disease. The markedly increased plasma level at the beginning of the inflammatory disease indicates that Ao is an acute phase reactant, and this is supported by the parallel changes in plasma CRP and Ao levels during the early days of ARDS. The relationship between the plasma levels of Ao and AT III for more than fourteen days suggests similar regulation of these members of the serpin family after termination of the acute-phase.

  3. ARD-353 [4-((2R,5S)-4-(R)-(4-diethylcarbamoylphenyl)(3-hydroxyphenyl)methyl)-2,5-dimethylpiperazin-1-ylmethyl)benzoic acid], a novel nonpeptide delta receptor agonist, reduces myocardial infarct size without central effects.

    PubMed

    Watson, Michael J; Holt, Jonathon D S; O'Neill, Scott J; Wei, Ke; Pendergast, William; Gross, Garrett J; Gengo, Peter J; Chang, Kwen-Jen

    2006-01-01

    A novel delta-receptor selective compound, ARD-353 [4-((2R,5S)-4-(R)-(4-diethylcarbamoylphenyl)(3-hydroxyphenyl)methyl)-2, 5-dimethylpiperazin-1-ylmethyl)benzoic acid], was evaluated for activity on infarct size in a rat model of acute myocardial infarction. ARD-353 was characterized as having delta receptor selectivity using radioligand binding and had no apparent selectivity between delta receptor subtypes as determined by [(3)H] cyclic [D-Pen(2),D-Pen(5)]enkephalin (delta(1)) and [(3)H]Deltorphin II (delta(2)) competition binding. ARD-353 also showed selective delta receptor agonist activity in mouse-isolated vas deferens. There was no evidence of any seizure-like convulsions when ARD-353 was administered to mice either i.v. or p.o., implying minimal penetration of the blood-brain barrier. ARD-353 decreased infarct size in a left anterior descending coronary artery (LAD) occlusion model of myocardial infarction. In animals pretreated with ARD-353 (i.v.) and then subjected to 30 min of LAD occlusion followed by 90 min of reperfusion, infarct size was reduced in a dose-dependent manner compared with vehicle-treated controls. The effects of ARD-353 on infarct size were blocked by the delta(1)-opioid selective antagonist 7-benzylidenenaltrexone, indicating a significant role for the delta(1)-opioid receptor in the cardioprotective mechanism of ARD-353. ARD-353 (0.3 mg/kg i.v.) produced significant protection when administered 5 min and 12 and 48 h before ischemic insult or when given immediately after the ischemic insult (at the start of reperfusion). Given the lack of central nervous system effects and beneficial efficacy in the rat model of myocardial ischemia, it is felt that ARD-353 is the first nonpeptide delta-receptor agonist with true potential for clinical use before surgically induced ischemia or in an emergency setting.

  4. What is the effect of anti-resorptive drugs (ARDs) on the development of medication-related osteonecrosis of the jaw (MRONJ) in osteoporosis patients: A systematic review.

    PubMed

    Aljohani, Suad; Fliefel, Riham; Ihbe, Jacob; Kühnisch, Jan; Ehrenfeld, Michael; Otto, Sven

    2017-09-01

    To conduct a systematic review of the literature to detect the effect of anti-resorptive drugs (ARDs) and their administration characteristics in the development of medication-related osteonecrosis of the jaw (MRONJ) in osteoporosis patients. Systematic search in PubMed, Web of Sciences and Cochrane Library was performed for relevant studies to July 2016. Population variables (age, gender, comorbidities, medications, preceding events, number of patients with MRONJ), ARDs and clinical variables were abstracted independently from these articles. The 44 eligible studies described 680 MRONJ cases in osteoporotic patients. The mean age of MRONJ patients was 69.7 ± 5.2 years. It was more common in females. Mandible was the most common site. Alendronate was the most frequently administered ARD. Oral route of administration was noted in 86.7% of the patients. The mean duration of BPs intake was 50.4 ± 19 months. Extraction was the most frequently preceding event followed by dentoalveolar surgery. Corticosteroids or immunosuppressants were the most common concomitant medications in MRONJ. A long duration of ARDs administration seems to be an important risk factor in MRONJ development. Patients under treatment with corticosteroids or immunosuppressants might be at a higher risk even if the BPs duration is less than 4 years. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  5. Membrane-type 1 matrix metalloproteinase cytoplasmic tail binding protein-1 (MTCBP-1) acts as an eukaryotic aci-reductone dioxygenase (ARD) in the methionine salvage pathway.

    PubMed

    Hirano, Wakako; Gotoh, Isamu; Uekita, Takamasa; Seiki, Motoharu

    2005-06-01

    MTCBP-1 was identified as a protein that binds the cytoplasmic tail of membrane-type 1 matrix metalloproteinase (MT1-MMP/MMP-14). Since MTCBP-1 has a putative beta-barrel structure, it is presumably a member of the recently proposed cupin superfamily that contains tremendously diverged functions of proteins in spite of their well-conserved beta-barrel structure. MTCBP-1 shows significant homology to the bacterial aci-reductone dioxygenase (ARD) in the cupin family, which is an enzyme in the methionine salvage pathway (MTA cycle). Since it is difficult to speculate the functions of cupin proteins simply based on their sequence homology, we examined whether the eukaryotic ARD homologs surely function in the methionine metabolism. Under sulfur-depleted conditions, yeast could grow when substrate of MTA cycle was provided. Disruption of the yeast ARD homolog, YMR009w gene, abolished ability of the cells to grow in this culture condition. Re-expression of either the YMR009w or MTCBP-1 gene restored the cell growth. Mutation analysis revealed that the glutamic acid residue in the beta-barrel fold and the N-terminal extension from the beta-barrel fold were found to be important for the activity to restore the growth. Thus, MTCBP-1 isolated as a binding protein for MT1-MMP was demonstrated to function as an ARD-like enzyme in the MTA cycle in yeast.

  6. A Comparison of Emotional-Motivational (A-R-D Theory) Personality Characteristics in Learning Disabled, Normal Achieving, and High Achieving Children.

    ERIC Educational Resources Information Center

    Hufano, Linda D.

    The study examined emotional-motivational personality characteristics of 15 learning disabled, 15 normal achieving, and 15 high achieving students (grades 3-5). The study tested the hypothesis derived from the A-R-D (attitude-reinforcer-discriminative) theory of motivation that learning disabled (LD) children differ from normal and high achieving…

  7. Development of community based model of Tawanchai Center: sufficiency economy principles for community Development an applicability at Bankhambong Community, Sa-ard Sub-district, Nampong District, Khon Kaen Province, Thailand.

    PubMed

    Kotrmaneetaweetong, Unchana; Choopen, Hhakuan; Chowchuen, Bowornsilp

    2012-11-01

    The objectives of the present study are 1) to study the application of sufficiency economy philosophy in community development as a model for future application of community health care program of Tawanchai Center, 2) study the administrative model for self sufficiency economy community in Bankhambong Community, Sa-ard Sub-district, Nampong District, Khon Kaen Province. The integrated study model included qualitative research by collecting data from documents, textbook, article, report, theory concept, researches and interviewing of relevant persons and the quantitative research by collecting data from questionnaires. The findings of study included objectives for development model of sufficiency economy for understanding of people, and use the philosophy of sufficiency economy model which compose of decrease expenditure, increase income activities, saving activities, learning activities and preservation of environment and sustainable natural resources activities. Decrease in expenditure activities included household gardening, and no allurements leading to ruin. Increase in income activities included supplement occupation and appropriate use of technology. Saving activities included creating saving group in household and community level. Learning activities included community use of local wisdom, and household learnt philosophy of sufficiency economy in daily living. Preservation of environment and sustainable natural resources activities included the use of sustainable raw materials in occupation. The generosity of one another activities included helping each other and solving problems for the poor and disable persons. The community development at in Bankhambong Community, Sa-ard Sub-district, Nampong District, Khon Kaen Province followed all of the above scope and guidelines and is the model for application of sufficiency community philosophy. We recommended method for successful implementation, including the starting from group process with capability of

  8. Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): study protocol for a randomized controlled trial.

    PubMed

    2012-08-28

    Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH2O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure ≤30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to

  9. Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

    PubMed Central

    2012-01-01

    Background Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH2O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure ≤30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this

  10. Tomographic and functional findings in severe COPD: comparison between the wood smoke-related and smoking-related disease *

    PubMed Central

    González-García, Mauricio; Gomez, Dario Maldonado; Torres-Duque, Carlos A.; Barrero, Margarita; Villegas, Claudia Jaramillo; Pérez, Juan Manuel; Varon, Humberto

    2013-01-01

    OBJECTIVE: Wood smoke exposure is a risk factor for COPD. For a given degree of airway obstruction, the reduction in DLCO is smaller in individuals with wood smoke-related COPD than in those with smoking-related COPD, suggesting that there is less emphysema in the former. The objective of this study was to compare HRCT findings between women with wood smoke-related COPD and women with smoking-related COPD. METHODS: Twenty-two women with severe COPD (FEV1/FVC ratio < 70% and FEV1 < 50%) were divided into two groups: those with wood smoke-related COPD (n = 12) and those with smoking-related COPD (n = 10). The two groups were compared regarding emphysema scores and airway involvement (as determined by HRCT); and functional abnormalities-spirometry results, DLCO, alveolar volume (VA), the DLCO/VA ratio, lung volumes, and specific airway resistance (sRaw). RESULTS: There were no significant differences between the two groups in terms of FEV1, sRaw, or lung hyperinflation. Decreases in DLCO and in the DLCO/VA ratio were greater in the smoking-related COPD group subjects, who also had higher emphysema scores, in comparison with the wood smoke-related COPD group subjects. In the wood smoke-related COPD group, HRCT scans showed no significant emphysema, the main findings being peribronchial thickening, bronchial dilation, and subsegmental atelectasis. CONCLUSIONS: Female patients with severe wood smoke-related COPD do not appear to develop emphysema, although they do show severe airway involvement. The reduction in DLCO and VA, with a normal DLCO/VA ratio, is probably due to severe bronchial obstruction and incomplete mixing of inspired gas during the determination of single-breath DLCO. PMID:23670499

  11. Towards finding the linkage between metabolic and age-related disorders using semantic gene data network analysis

    PubMed Central

    Uzzal Hossain, Mohammad; Zaffar Shibly, Abu; Md. Omar, Taimur; Tous Zohora, Fatama; Sara Santona, Umme; Hossain, Md. Jakir; Hosen Khoka, Md. Sadek; Ara Keya, Chaman; Salimullah, Md.

    2016-01-01

    A metabolic disorder (MD) occurs when the metabolic process is disturbed. This process is carried out by thousands of enzymes participating in numerous inter-dependent metabolic pathways. Critical biochemical reactions that involve the processing and transportation of carbohydrates, proteins and lipids are affected in metabolic diseases. Therefore, it is of interest to identify the common pathways of metabolic disorders by building protein-protein interactions (PPI) for network analysis. The molecular network linkages between MD and age related diseases (ARD) are intriguing. Hence, we created networks of protein-protein interactions that are related with MD and ARD using relevant known data in the public domain. The network analysis identified known MD associated proteins and predicted genes and or its products of ARD in common pathways. The genes in the common pathways were isolated from the network and further analyzed for their co-localization and shared domains. Thus, a model hypothesis is proposed using interaction networks that are linked between MD and ARD. This data even if less conclusive finds application in understanding the molecular mechanism of known diseases in relation to observed molecular events PMID:27212841

  12. High Tidal Volume Decreases ARDS, Atelectasis, and Ventilator Days Compared to Low Tidal Volume in Pediatric Burned Patients with Inhalation Injury

    PubMed Central

    Sousse, Linda E; Herndon, David N; Andersen, Clark R; Ali, Arham; Benjamin, Nicole C; Granchi, Thomas; Suman, Oscar E; Mlcak, Ronald P

    2015-01-01

    Background Inhalation injury, which is among the causes of acute lung injury and acute respiratory distress syndrome (ARDS), continues to represent a significant source of mortality in burned patients. Inhalation injury often requires mechanical ventilation, but the ideal tidal volume strategy is not clearly defined in burned pediatric patients. The aim of the present study is to determine the effects of low and high tidal volume on the number of ventilator days, ventilation pressures, and incidence of atelectasis, pneumonia and ARDS in pediatric burned patients with inhalation injury within one year post burn injury. Methods From 1986–2014, inhalation injury was diagnosed by bronchoscopy in pediatric burned patients (n=932). Patients were divided into three groups: (1) unventilated (n=241), (2) high tidal volume (HTV, 15 ± 3 ml/kg, n=190), and (3) low tidal volume (LTV, 9 ± 3 ml/kg, n = 501). Results HTV was associated with significantly decreased ventilator days (p<0.005) and maximum positive end expiratory pressure (p<0.0001) and significantly increased maximum peak inspiratory pressure (p<0.02) and plateau pressure (p<0.02) compared to patients with LTV. The incidence of atelectasis (p<0.0001) and ARDS (p<0.02) was significantly decreased with HTV compared to LTV. However, the incidence of pneumothorax was significantly increased in the HTV group compared with LTV (p<0.03). Conclusions HTV significantly decreases ventilator days and the incidence of both atelectasis and ARDS compared to low tidal volume in pediatric burned patients with inhalation injury. Thus, the use of HTV may interrupt sequences leading to lung injury in our patient population. PMID:25724604

  13. Jack of all trades: pleiotropy and the application of chemically modified tetracycline-3 in sepsis and the acute respiratory distress syndrome (ARDS).

    PubMed

    Roy, Shreyas K; Kendrick, Daniel; Sadowitz, Benjamin D; Gatto, Louis; Snyder, Kathleen; Satalin, Joshua M; Golub, Lorne M; Nieman, Gary

    2011-12-01

    Sepsis is a disease process that has humbled the medical profession for centuries with its resistance to therapy, relentless mortality, and pathophysiologic complexity. Despite 30 years of aggressive, concerted, well-resourced efforts the biomedical community has been unable to reduce the mortality of sepsis from 30%, nor the mortality of septic shock from greater than 50%. In the last decade only one new drug for sepsis has been brought to the market, drotrecogin alfa-activated (Xigris™), and the success of this drug has been limited by patient safety issues. Clearly a new agent is desperately needed. The advent of recombinant human immune modulators held promise but the outcomes of clinical trials using biologics that target single immune mediators have been disappointing. The complex pathophysiology of the systemic inflammatory response syndrome (SIRS) is self-amplifying and redundant at multiple levels. In this review we argue that perhaps pharmacologic therapy for sepsis will only be successful if it addresses this pathophysiologic complexity; the drug would have to be pleiotropic, working on many components of the inflammatory cascade at once. In this context, therapy that targets any single inflammatory mediator will not adequately address the complexity of SIRS. We propose that chemically modified tetracycline-3, CMT-3 (or COL-3), a non-antimicrobial modified tetracycline with pleiotropic anti-inflammatory properties, is an excellent agent for the management of sepsis and its associated complication of the acute respiratory distress syndrome (ARDS). The purpose of this review is threefold: (1) to examine the shortcomings of current approaches to treatment of sepsis and ARDS in light of their pathophysiology, (2) to explore the application of COL-3 in ARDS and sepsis, and finally (3) to elucidate the mechanisms of COL-3 that may have potential therapeutic benefit in ARDS and sepsis. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Effect of Heme Oxygenase-1 on Mitofusin-1 protein in LPS-induced ALI/ARDS in rats

    PubMed Central

    Yu, Jianbo; Wang, Ying; Li, Zhen; Dong, Shuan; Wang, Dan; Gong, Lirong; Shi, Jia; Zhang, Yuan; Liu, Daquan; Mu, Rui

    2016-01-01

    Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is a common and important oxidative stress in the lung. Mitochondrial fusion responds to the normal morphology and function of cells and is finely regulated by mitochondrial fusion proteins, such as mitofusin-1 protein (Mfn1), mitofusin-2 protein (Mfn2) and optical atrophy 1 (OPA1). Additionally, Mfn1 has been identified as the most important protein in mitochondrial fusion. Heme oxygenase-1 (HO-1) is a stress-inducible protein that plays a critical role in protecting against oxidative stress. However, whether the protection of HO-1 is related to mitochondrial fusion is still a question. Thus, our in vitro and in vivo experiments aimed to identify the relationship between HO-1 and Mfn1. Here, we used Hemin and ZnPP-IX as treatments in an in vivo experiment. Then, HO-1 and Mfn1 were measured using RT-PCR and Western blotting. Supernatants were analyzed for MDA, SOD, and ROS. Our results implied that HO-1 upregulation suppressed oxidative stress induced by LPS, and the possible mechanism could be associated with Mfn1 and the PI3K/Akt pathway. PMID:27830717

  15. MOLECULAR DETERMINANTS OF A2AR-D2R ALLOSTERISM: ROLE OF THE INTRACELLULAR LOOP 3 OF THE D2R

    PubMed Central

    Fernández-Dueñas, Víctor; Gómez-Soler, Maricel; Jacobson, Kenneth A.; Kumar, T. Santhosh; Fuxe, Kjell; Borroto-Escuela, Dasiel O.; Ciruela, Francisco

    2012-01-01

    In the central nervous system (CNS), an antagonistic interaction has been shown between adenosine A2A and dopamine D2 receptors (A2ARs and D2Rs) that may be relevant both in normal and pathological conditions (i.e. Parkinson’s disease). Thus, the molecular determinants mediating this receptor-receptor interaction have recently been explored, since the fine tuning of this target (namely the A2AR/D2R oligomer) could possibly improve the treatment of certain CNS diseases. Here, we used a fluorescence resonance energy transfer (FRET)-based approach to examine the allosteric modulation of the D2R within the A2AR/D2R oligomer and the dependence of this receptor-receptor interaction on two regions rich in positive charges on intracellular loop 3 (IL3) of the D2R. Interestingly, we observed a negative allosteric effect of the D2R agonist quinpirole on A2AR ligand binding and activation. However, these allosteric effects were abolished upon mutation of specific arginine residues (217–222 and 267–269) on IL3 of the D2R, thus demonstrating a major role of these positively-charged residues in mediating the observed receptor-receptor interaction. Overall, these results provide structural insights to better understand the functioning of the A2AR/D2R oligomer in living cells. PMID:22924752

  16. The One-Kilobase DNA Fragment Upstream of the ardC Actin Gene of Physarum polycephalum Is Both a Replicator and a Promoter

    PubMed Central

    Pierron, Gérard; Pallotta, Dominick; Bénard, Marianne

    1999-01-01

    The 1-kb DNA fragment upstream of the ardC actin gene of Physarum polycephalum promotes the transcription of a reporter gene either in a transient-plasmid assay or as an integrated copy in an ectopic position, defining this region as the transcriptional promoter of the ardC gene (PardC). Since we mapped an origin of replication activated at the onset of S phase within this same fragment, we examined the pattern of replication of a cassette containing the PardC promoter and the hygromycin phosphotransferase gene, hph, integrated into two different chromosomal sites. In both cases, we show by two-dimensional agarose gel electrophoresis that an efficient, early activated origin coincides with the ectopic PardC fragment. One of the integration sites was a normally late-replicating region. The presence of the ectopic origin converted this late-replicating domain into an early-replicating domain in which replication forks propagate with kinetics indistinguishable from those of the native PardC replicon. This is the first demonstration that initiation sites for DNA replication in Physarum correspond to cis-acting replicator sequences. This work also confirms the close proximity of a replication origin and a promoter, with both functions being located within the 1-kb proximal region of the ardC actin gene. A more precise location of the replication origin with respect to the transcriptional promoter must await the development of a functional autonomously replicating sequence assay in Physarum. PMID:10207074

  17. Blood purification with continuous veno-venous hemofiltration in patients with sepsis or ARDS: a systematic review and meta-analysis.

    PubMed

    Putzu, Alessandro; Fang, Ming-Xing; Boscolo Berto, Martina; Belletti, Alessandro; Cabrini, Luca; Cassina, Tiziano; Landoni, Giovanni

    2017-08-01

    Severe inflammatory conditions, as severe sepsis/septic shock and acute respiratory distress syndrome (ARDS), are related to high morbidity and mortality. We performed a meta-analysis of randomized trials to assess if blood purification with continuous veno-venous hemofiltration (CVVH) reduces mortality in these settings. Online databases were searched for pertinent studies up to March 2017. We included randomized-controlled trials on the use of CVVH as blood purification technique in comparison to conventional therapy in adult patients with severe sepsis/septic shock or ARDS but no acute kidney injury needing renal replacement therapy. Eleven studies and 679 patients were included in the analysis. Patients who received CVVH had significantly lower mortality compared to conventional therapy (96 of 351 [27.35%] patients in the CVVH group vs. 129 of 328 [39.33%] in the conventional therapy group, OR=0.58 [95% CI: 0.42, 0.81], P=0.002, I2=10%, number needed to treat: 8) at longest follow-up available. Overall, low-quality evidence indicates that blood purification with CVVH might be associated with a significant reduction in mortality when performed in patients with sepsis or ARDS. The evidence is still insufficient to support a definitive conclusion of benefit. Further high-quality randomized controlled trials, adequately powered for mortality, are needed to clarify the impact of CVVH on these conditions.

  18. Decitabine and 5-azacitidine both alleviate LPS induced ARDS through anti-inflammatory/antioxidant activity and protection of glycocalyx and inhibition of MAPK pathways in mice.

    PubMed

    Huang, Xiao; Kong, Guiqing; Li, Yan; Zhu, Weiwei; Xu, Haixiao; Zhang, Xiaohua; Li, Jiankui; Wang, Lipeng; Zhang, Zhongwen; Wu, Yaru; Liu, Xiangyong; Wang, Xiaozhi

    2016-12-01

    Decitabine (5-aza-2'-deoxycytidine, DAC) and 5-azacitidine (Aza), an inhibitor of DNA methyltransferases, possess a wide range of anti-metabolic and anti-cancer activities. This study examined the effects of DAC and Aza on inflammatory and oxidative injuries, as well as on glycocalyx and MAPK signaling pathways, in a LPS-stimulated ARDS mouse model. Results of ELISA revealed that DAC and Aza significantly inhibited the production of TNF-α and IL-1β and prevented LPS-induced elevation of myeloperoxidase and malondialdehyde levels in serum. The W/D ratio of lung and histopathologic examination with hematoxylin and eosin staining showed that DAC and Aza pretreatment substantially improved lung tissue injury. DAC and Aza reduced the level of glycocalyx degradation products (e.g., heparan sulfate and haluronic acid) and protected glycocalyx integrity. Western blot assay demonstrated that DAC and Aza both significantly suppressed LPS-induced activation of the MAPK signaling pathways by blocking the phosphorylation of JNK, ERK and P38 in lung tissues. Bisulfite sequencing PCR and real time-PCR showed that DAC reversed the RASSF1A promoter hypermethylation and furthermore elevated the expression of RASSF1A, which is a tumor suppressor that regulates MAPK signaling pathway. These results suggested that DAC inhibited the MAPK signaling pathway in LPS-induced ARDS mice might via demethylation in RASSF1A promoter region and by restoring its expression. This study highlighted the close relationship between DNA methylation and the development and progression of ARDS.

  19. Interaction of the GTP-binding and GTPase-activating domains of ARD1 involves the effector region of the ADP-ribosylation factor domain.

    PubMed

    Vitale, N; Moss, J; Vaughan, M

    1997-02-14

    ADP-ribosylation factors (ARFs) are a family of approximately 20-kDa guanine nucleotide-binding proteins and members of the Ras superfamily, originally identified and purified by their ability to enhance the ADP-ribosyltransferase activity of cholera toxin and more recently recognized as critical participants in vesicular trafficking pathways and phospholipase D activation. ARD1 is a 64-kDa protein with an 18-kDa carboxyl-terminal ARF domain (p3) and a 46-kDa amino-terminal extension (p5) that is widely expressed in mammalian tissues. Using recombinant proteins, we showed that p5, the amino-terminal domain of ARD1, stimulates the GTPase activity of p3, the ARF domain, and appears to be the GTPase-activating protein (GAP) component of this bifunctional protein, whereas in other members of the Ras superfamily a separate GAP molecule interacts with the effector region of the GTP-binding protein. p5 stimulated the GTPase activity of p3 but not of ARF1, which differs from p3 in several amino acids in the effector domain. After substitution of 7 amino acids from p3 in the appropriate position in ARF1, the chimeric protein ARF1(39-45p3) bound to p5, which increased its GTPase activity. Specifically, after Gly40 and Thr45 in the putative effector domain of ARF1 were replaced with the equivalent Asp and Pro, respectively, from p3, functional interaction of the chimeric ARF1 with p5 was increased. Thus, Asp25 and Pro30 of the ARF domain (p3) of ARD1 are involved in its functional and physical interaction with the GTPase-activating (p5) domain of ARD1. After deletion of the amino-terminal 15 amino acids from ARF1(39-45p3), its interaction with p5 was essentially equivalent to that of p3, suggesting that the amino terminus of ARF1(39-45p3) may interfere with binding to p5. These results are consistent with the conclusion that the GAP domain of ARD1 interacts with the effector region of the ARF domain and thereby stimulates GTP hydrolysis.

  20. Rock Finding

    ERIC Educational Resources Information Center

    Rommel-Esham, Katie; Constable, Susan D.

    2006-01-01

    In this article, the authors discuss a literature-based activity that helps students discover the importance of making detailed observations. In an inspiring children's classic book, "Everybody Needs a Rock" by Byrd Baylor (1974), the author invites readers to go "rock finding," laying out 10 rules for finding a "perfect" rock. In this way, the…

  1. Rock Finding

    ERIC Educational Resources Information Center

    Rommel-Esham, Katie; Constable, Susan D.

    2006-01-01

    In this article, the authors discuss a literature-based activity that helps students discover the importance of making detailed observations. In an inspiring children's classic book, "Everybody Needs a Rock" by Byrd Baylor (1974), the author invites readers to go "rock finding," laying out 10 rules for finding a "perfect" rock. In this way, the…

  2. Association between high-resolution computed tomography findings and the IASLC/ATS/ERS classification of small lung adenocarcinomas in Japanese patients.

    PubMed

    Kudo, Yujin; Matsubayashi, Jun; Saji, Hisashi; Akata, Soichi; Shimada, Yoshihisa; Kato, Yasufumi; Kakihana, Masatoshi; Kajiwara, Naohiro; Ohira, Tatsuo; Nagao, Toshitaka; Ikeda, Norihiko

    2015-10-01

    The detection rate of small pulmonary nodules has recently increased and new techniques have been developed to improve diagnostic yield. The IASLC/ATS/ERS classification demonstrated a difference in prognosis depending on the histological subtypes of lung adenocarcinoma. We evaluated the association between high-resolution computed tomography (HRCT) findings and the classification of these tumors. We reviewed the data of 220 lung adenocarcinoma (≤3 cm) patients who received complete resection with lymph node dissection in our hospital. From the HRCT findings, the tumors were classified into the following 3 categories: pure-solid nodules, part-solid nodules, or pure ground-glass opacity (GGO) nodules. Pathological invasion factor (PIF) was evaluated by the degree of blood vessel invasion, lymphatic permeation, and visceral pleural invasion. The tumors were classified as pure GGO nodules in 16 patients, part-solid nodules in 91, and pure-solid nodules in 113 from the HRCT findings. Tumors were diagnosed as noninvasive or minimally invasive adenocarcinomas (NMIADs) in 44 patients, and invasive adenocarcinomas (IADs) in 176. Lymph node metastasis was present in 31 patients (14.1%) and PIF in 101 (45.9%). All pure-solid nodules were IADs with a high PIF frequency (75.2%) or with lymph node metastasis (26.5%). All pure GGO nodules were NMIADs or lepidic-predominant adenocarcinomas. Among the part-solid nodules, IAD was detected in 67.0% of the patients and PIF in 16.5%. The consolidation/tumor (C/T) ratio and consolidation size were associated with IAD (optimal cut-off values: 0.4 and 8mm, respectively) and PIF (0.8 and 15 mm, respectively). The HRCT findings correlated with the IASLC/ATS/ERS classification and were useful for evaluating the histological nature of the tumors. Most pure-solid tumors had the potential for high-grade malignancy, including PIF and lymph node metastasis. For part-solid tumors, the C/T ratio and consolidation size were important for

  3. Alterations in ventral and dorsal striatal allosteric A2AR-D2R receptor-receptor interactions after amphetamine challenge: Relevance for schizophrenia.

    PubMed

    Pintsuk, Julia; Borroto-Escuela, Dasiel O; Lai, Terence K Y; Liu, Fang; Fuxe, Kjell

    2016-10-29

    Striatal dopamine D2R homodimerization is increased in the dorsal striatum after acute amphetamine challenge and in the amphetamine-induced sensitized state, a well-known animal model of schizophrenia. Therefore, it was tested if the increase in D2R homoreceptor complexes found after acute amphetamine challenge in the saline or the amphetamine sensitized state leads to changes in the antagonistic adenosine A2AR-D2R interactions in the striatum. [(3)H]-raclopride binding was performed in membrane preparations from the ventral and dorsal striatum involving competition with the D2R like agonist quinpirole. In the ventral striatum CGS 21680 produced a significant increase of the KiH values (p<0.05) in the amphetamine sensitized group when expressed in percent versus the corresponding values in saline sensitized rats after amphetamine challenge. However, in the dorsal striatum a significant change did not develop in the KiH values when expressed in percent of the corresponding values in saline sensitized rats after amphetamine challenge. In fact, the non-significant change was in the opposite direction towards a reduction of the KiH values. Taken together, a reduced affinity of the high affinity D2 agonist binding site (KiH value) developed in the ventral but not in the dorsal striatum as a result of increased antagonistic allosteric A2AR-D2R interactions in the amphetamine-induced sensitized state versus the saline sensitized state after an acute amphetamine challenge. The selective reappearance of antagonistic A2AR-D2R receptor-receptor interactions in the ventral striatum after amphetamine challenge in the amphetamine sensitized rat may give one possible mechanism for the atypical antipsychotic-like actions of A2AR receptor agonists.

  4. Structure of the lutein-binding domain of human StARD3 at 1.74 Å resolution and model of a complex with lutein

    SciTech Connect

    Horvath, Martin P. George, Evan W.; Tran, Quang T.; Baumgardner, Kody; Zharov, Gabe; Lee, Sarah; Sharifzadeh, Hassan; Shihab, Saeed; Mattinson, Ty; Li, Binxing; Bernstein, Paul S.

    2016-07-27

    The structure of a START-domain protein known to bind lutein in the human retina is reported to an improved resolution limit. Rigid-body docking demonstrates that at least a portion of lutein must protrude from the large tunnel-like cavity characteristic of this helix-grip protein and suggests a mechanism for lutein binding specificity. A crystal structure of the lutein-binding domain of human StARD3 (StAR-related lipid-transfer protein 3; also known as MLN64) has been refined to 1.74 Å resolution. A previous structure of the same protein determined to 2.2 Å resolution highlighted homology with StARD1 and shared cholesterol-binding character. StARD3 has since been recognized as a carotenoid-binding protein in the primate retina, where its biochemical function of binding lutein with specificity appears to be well suited to recruit this photoprotective molecule. The current and previous structures correspond closely to each other (r.m.s.d. of 0.25 Å), especially in terms of the helix-grip fold constructed around a solvent-filled cavity. Regions of interest were defined with alternate conformations in the current higher-resolution structure, including Arg351 found within the cavity and Ω1, a loop of four residues found just outside the cavity entrance. Models of the complex with lutein generated by rigid-body docking indicate that one of the ionone rings must protrude outside the cavity, and this insight has implications for molecular interactions with transport proteins and enzymes that act on lutein. Interestingly, models with the ∊-ionone ring characteristic of lutein pointing towards the bottom of the cavity were associated with fewer steric clashes, suggesting that steric complementarity and ligand asymmetry may play a role in discriminating lutein from the other ocular carotenoids zeaxanthin and meso-zeaxanthin, which only have β-ionone rings.

  5. Structure of the lutein-binding domain of human StARD3 at 1.74 Å resolution and model of a complex with lutein

    PubMed Central

    Horvath, Martin P.; George, Evan W.; Tran, Quang T.; Baumgardner, Kody; Zharov, Gabe; Lee, Sarah; Sharifzadeh, Hassan; Shihab, Saeed; Mattinson, Ty; Li, Binxing; Bernstein, Paul S.

    2016-01-01

    A crystal structure of the lutein-binding domain of human StARD3 (StAR-related lipid-transfer protein 3; also known as MLN64) has been refined to 1.74 Å resolution. A previous structure of the same protein determined to 2.2 Å resolution highlighted homology with StARD1 and shared cholesterol-binding character. StARD3 has since been recognized as a carotenoid-binding protein in the primate retina, where its biochemical function of binding lutein with specificity appears to be well suited to recruit this photoprotective molecule. The current and previous structures correspond closely to each other (r.m.s.d. of 0.25 Å), especially in terms of the helix-grip fold constructed around a solvent-filled cavity. Regions of interest were defined with alternate conformations in the current higher-resolution structure, including Arg351 found within the cavity and Ω1, a loop of four residues found just outside the cavity entrance. Models of the complex with lutein generated by rigid-body docking indicate that one of the ionone rings must protrude outside the cavity, and this insight has implications for molecular interactions with transport proteins and enzymes that act on lutein. Interestingly, models with the ∊-ionone ring characteristic of lutein pointing towards the bottom of the cavity were associated with fewer steric clashes, suggesting that steric complementarity and ligand asymmetry may play a role in discriminating lutein from the other ocular carotenoids zeaxanthin and meso-zeaxanthin, which only have β-ionone rings. PMID:27487925

  6. [Complex control of the source of infection in sepsis : Extracorporeal membrane oxygenation (ECMO) as a bridging concept for tracheal fistula repair in sepsis-associated ARDS].

    PubMed

    Weiterer, S; Schmidt, K; Deininger, M; Ulrich, A; Tochtermann, U; Eberhardt, R; Hofer, S; Weigand, M A; Brenner, T

    2016-09-01

    Here, we present a case of a tracheal fistula due to an anastomotic insufficiency following abdominothoracic esophageal resection. Despite immediate discontinuity resection, the tracheal fistula could not be surgically closed, resulting in incomplete control of the source of infection and an alternative treatment concept in the form of interventional fistula closure using a Y-tracheal stent. However, owing to existing severe acute respiratory distress syndrome (ARDS), which is associated with a considerable risk of peri-interventional hypoxia, a temporary bridging concept using venovenous extracorporeal membrane oxygenation (ECMO) was implemented successfully.

  7. Elucidating the molecular responses of apple rootstock resistant to ARD pathogens: challenges and opportunities for development of genomics-assisted breeding tools.

    PubMed

    Zhu, Yanmin; Fazio, Gennaro; Mazzola, Mark

    2014-01-01

    Apple replant disease (ARD) is a major limitation to the establishment of economically viable orchards on replant sites due to the buildup and long-term survival of pathogen inoculum. Several soilborne necrotrophic fungi and oomycetes are primarily responsible for ARD, and symptoms range from serious inhibition of growth to the death of young trees. Chemical fumigation has been the primary method used for control of ARD, and manipulating soil microbial ecology to reduce pathogen density and aggressiveness is being investigated. To date, innate resistance of apple rootstocks as a means to control this disease has not been carefully explored, partly due to the complex etiology and the difficulty in phenotyping the disease resistance. Molecular defense responses of plant roots to soilborne necrotrophic pathogens are largely elusive, although considerable progress has been achieved using foliar disease systems. Plant defense responses to necrotrophic pathogens consist of several interacting modules and operate as a network. Upon pathogen detection by plants, cellular signals such as the oscillation of Ca(2+) concentration, reactive oxygen species (ROS) burst and protein kinase activity, lead to plant hormone biosynthesis and signaling. Jasmonic acid (JA) and ethylene (ET) are known to be fundamental to the induction and regulation of defense mechanisms toward invading necrotrophic pathogens. Complicated hormone crosstalk modulates the fine-tuning of transcriptional reprogramming and metabolic redirection, resulting in production of antimicrobial metabolites, enzyme inhibitors and cell wall refortification to restrict further pathogenesis. Transcriptome profiling of apple roots in response to inoculation with Pythium ultimum demonstrated that there is a high degree of conservation regarding the molecular framework of defense responses compared with those observed with foliar tissues. It is conceivable that the timing and intensity of genotype-specific defense responses

  8. Treatment of sepsis and ARDS with extracorporeal membrane oxygenation and interventional lung assist membrane ventilator in a patient with acute lymphoblastic leukemia.

    PubMed

    Gorjup, Vojka; Fister, Misa; Noc, Marko; Rajic, Vladan; Ribaric, Suada Filekovic

    2012-07-01

    We report an 18-year-old ice skater with acute lymphoblast leukemia. She developed Staphylococcus epidermidis bacteremia, severe sepsis, septic shock, and ARDS following chemotherapy-induced severe bone marrow failure. She was successfully treated with extraordinary life support measures, which included extracorporeal membrane oxygenation, double lumen lung ventilation for management of hemoptysis, and lung assist membrane ventilation. After 57 days of ICU treatment and a year of rehabilitation, the patient has fully regained her functional status, is now finishing high school, and is ice skating again.

  9. Elucidating the molecular responses of apple rootstock resistant to ARD pathogens: challenges and opportunities for development of genomics-assisted breeding tools

    PubMed Central

    Zhu, Yanmin; Fazio, Gennaro; Mazzola, Mark

    2014-01-01

    Apple replant disease (ARD) is a major limitation to the establishment of economically viable orchards on replant sites due to the buildup and long-term survival of pathogen inoculum. Several soilborne necrotrophic fungi and oomycetes are primarily responsible for ARD, and symptoms range from serious inhibition of growth to the death of young trees. Chemical fumigation has been the primary method used for control of ARD, and manipulating soil microbial ecology to reduce pathogen density and aggressiveness is being investigated. To date, innate resistance of apple rootstocks as a means to control this disease has not been carefully explored, partly due to the complex etiology and the difficulty in phenotyping the disease resistance. Molecular defense responses of plant roots to soilborne necrotrophic pathogens are largely elusive, although considerable progress has been achieved using foliar disease systems. Plant defense responses to necrotrophic pathogens consist of several interacting modules and operate as a network. Upon pathogen detection by plants, cellular signals such as the oscillation of Ca2+ concentration, reactive oxygen species (ROS) burst and protein kinase activity, lead to plant hormone biosynthesis and signaling. Jasmonic acid (JA) and ethylene (ET) are known to be fundamental to the induction and regulation of defense mechanisms toward invading necrotrophic pathogens. Complicated hormone crosstalk modulates the fine-tuning of transcriptional reprogramming and metabolic redirection, resulting in production of antimicrobial metabolites, enzyme inhibitors and cell wall refortification to restrict further pathogenesis. Transcriptome profiling of apple roots in response to inoculation with Pythium ultimum demonstrated that there is a high degree of conservation regarding the molecular framework of defense responses compared with those observed with foliar tissues. It is conceivable that the timing and intensity of genotype-specific defense responses

  10. What is the ARD?

    PubMed

    Hiltunen, Neil S

    2014-01-01

    Until as recently as 100 years ago, the concept of retirement had almost no meaning. Now it is a formal stage of life with its own privileges and responsibilities We are living longer and learning more about how to take full advantage of the opportunities this provides. The Association of Retiring Dentists is an organization intended to make that a rich experience for all.

  11. Importance des algues Dasycladales révélée par la cathodoluminescence des évaporites triasiques (Trias des Forages GPF Ardèche, France). Role of Dasycladals algae displayed by the cathodoluminescence of Triassic evaporites (GPF deep bore holes, Ardèche, France)

    NASA Astrophysics Data System (ADS)

    Cros, Pierre; Arbey, François

    1999-06-01

    Two metastable minerals (the biogenic aragonite of Dasycladals algae and the diagenetic gypsum replaced by dolomite, anhydrite and quartz) appear to be significant for the diagenesis of Triassic evaporites of Ardèche, France (GPF cored deep drillings: Balazuc 1 and Morte-Mérie 1). The cathodoluminescence colours of dolomite, anhydrite and authigenic quartz, are digitally enhanced and compared with the high magnification pictures of SEM electron-excited cathodoluminescence (200-800 nm).

  12. Finding food

    PubMed Central

    Forsyth, Ann; Lytle, Leslie; Riper, David Van

    2011-01-01

    A significant amount of travel is undertaken to find food. This paper examines challenges in measuring access to food using Geographic Information Systems (GIS), important in studies of both travel and eating behavior. It compares different sources of data available including fieldwork, land use and parcel data, licensing information, commercial listings, taxation data, and online street-level photographs. It proposes methods to classify different kinds of food sales places in a way that says something about their potential for delivering healthy food options. In assessing the relationship between food access and travel behavior, analysts must clearly conceptualize key variables, document measurement processes, and be clear about the strengths and weaknesses of data. PMID:21837264

  13. A 36,000-Year-Old Volcanic Eruption Depicted in the Chauvet-Pont d’Arc Cave (Ardèche, France)?

    PubMed Central

    Nomade, Sébastien; Genty, Dominique; Sasco, Romain; Scao, Vincent; Féruglio, Valérie; Baffier, Dominique; Guillou, Hervé; Bourdier, Camille; Valladas, Hélène; Reigner, Edouard; Debard, Evelyne; Pastre, Jean–François; Geneste, Jean-Michel

    2016-01-01

    Among the paintings and engravings found in the Chauvet-Pont d’Arc cave (Ardèche, France), several peculiar spray-shape signs have been previously described in the Megaloceros Gallery. Here we document the occurrence of strombolian volcanic activity located 35 km northwest of the cave, and visible from the hills above the cave entrance. The volcanic eruptions were dated, using 40Ar/39Ar, between 29 ± 10 ka and 35 ± 8 ka (2σ), which overlaps with the 14C AMS and thermoluminescence ages of the first Aurignacian occupations of the cave in the Megaloceros Gallery. Our work provides the first evidence of an intense volcanic activity between 40 and 30 ka in the Bas-Vivarais region, and it is very likely that Humans living in the Ardèche river area witnessed one or several eruptions. We propose that the spray-shape signs found in the Chauvet-Pont d’Arc cave could be the oldest known depiction of a volcanic eruption, predating by more than 34 ka the description by Pliny the Younger of the Vesuvius eruption (AD 79) and by 28 ka the Çatalhöyük mural discovered in central Turkey. PMID:26745626

  14. Alba from Thermoplasma volcanium belongs to α-NAT's: An insight into the structural aspects of Tv Alba and its acetylation by Tv Ard1.

    PubMed

    Ma, Chao; Pathak, Chinar; Lee, Sang Jae; Lee, Ki-Young; Jang, Sun-Bok; Nam, Minjoo; Im, Hookang; Yoon, Hye-Jin; Lee, Bong-Jin

    2016-01-15

    The Alba superfamily proteins have been regarded as a conserved group of proteins in archaea and eukarya, which have shown to be important in nucleic acid binding, chromatic organization and gene regulation. These proteins often belong to the N-acetyltransferase (NAT) category (N(α)-acetyltransferases or N(ε)-acetyltransferases) and undergo post-translational modifications. Here, we report the crystal structure of Alba from Thermoplasma volcanium (Tv Alba) at 2.4 Å resolution. The acetylation of Tv Alba was monitored and the N-terminal of Tv Alba has been shown to interact with acetyl coenzyme A (Ac-CoA). The chemical shift perturbation experiments of Tv Alba were performed in the presence of Ac-CoA and/or Tv Ard1, another T. volcanium protein that treats Tv Alba as a substrate. To examine the DNA binding capabilities of Tv Alba alone and in the presence of Ac-CoA and/or Tv Ard1, EMSA experiments were carried out. It is shown that although Tv Alba binds to Ac-CoA, the acetylation of Tv Alba is not related with its binding to dsDNA, and the involvement of the N-terminus in Ac-CoA binding demonstrates that Tv Alba belongs to the N(α)-acetyltransferase family. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. A 36,000-Year-Old Volcanic Eruption Depicted in the Chauvet-Pont d'Arc Cave (Ardèche, France)?

    PubMed

    Nomade, Sébastien; Genty, Dominique; Sasco, Romain; Scao, Vincent; Féruglio, Valérie; Baffier, Dominique; Guillou, Hervé; Bourdier, Camille; Valladas, Hélène; Reigner, Edouard; Debard, Evelyne; Pastre, Jean-François; Geneste, Jean-Michel

    2016-01-01

    Among the paintings and engravings found in the Chauvet-Pont d'Arc cave (Ardèche, France), several peculiar spray-shape signs have been previously described in the Megaloceros Gallery. Here we document the occurrence of strombolian volcanic activity located 35 km northwest of the cave, and visible from the hills above the cave entrance. The volcanic eruptions were dated, using 40Ar/39Ar, between 29 ± 10 ka and 35 ± 8 ka (2σ), which overlaps with the 14C AMS and thermoluminescence ages of the first Aurignacian occupations of the cave in the Megaloceros Gallery. Our work provides the first evidence of an intense volcanic activity between 40 and 30 ka in the Bas-Vivarais region, and it is very likely that Humans living in the Ardèche river area witnessed one or several eruptions. We propose that the spray-shape signs found in the Chauvet-Pont d'Arc cave could be the oldest known depiction of a volcanic eruption, predating by more than 34 ka the description by Pliny the Younger of the Vesuvius eruption (AD 79) and by 28 ka the Çatalhöyük mural discovered in central Turkey.

  16. Cryptogenic organizing pneumonia: serial high-resolution CT findings in 22 patients.

    PubMed

    Lee, Ju Won; Lee, Kyung Soo; Lee, Ho Yun; Chung, Man Pyo; Yi, Chin A; Kim, Tae Sung; Chung, Myung Jin

    2010-10-01

    We conducted a review of serial high-resolution CT (HRCT) findings of cryptogenic organizing pneumonia (COP). Over the course of 14 years, we saw 32 patients with biopsy-confirmed COP. Serial HRCT scans were available for only 22 patients (seven men and 15 women; mean age, 52 years; median follow-up period, 8 months; range, 5-135 months). Serial CT scans were evaluated by two chest radiologists who reached a conclusion by consensus. Overall changes in disease extent were classified as cured, improved (i.e., ≥ 10% decrease in extent), not changed, or progressed (i.e., ≥ 10% increase in extent). When there were remaining abnormalities, the final follow-up CT images were analyzed to express observers' ideas regarding what type of interstitial lung disease the images most likely suggested. The two most common patterns of lung abnormality on initial scans were ground-glass opacification (86% of patients [19/22]) and consolidation (77% of patients [17/22]), distributed along the bronchovascular bundles or subpleural lungs in 13 patients (59%). In six patients (27%), the disease disappeared completely; in 15 patients (68%), the disease was decreased in extent; and in one patient (5%), no change in extent was detected on follow-up CT. When lesions remained, the final follow-up CT findings were reminiscent of fibrotic nonspecific interstitial pneumonia in 10 of 16 patients (63%). Although COP is a disease with a generally good prognosis, most patients (73%) with COP have some remaining disease seen on follow-up CT scans, and, in such cases, the lesions generally resemble a fibrotic nonspecific interstitial pneumonia pattern.

  17. Design and implementation of the START (STem cells for ARDS Treatment) trial, a phase 1/2 trial of human mesenchymal stem/stromal cells for the treatment of moderate-severe acute respiratory distress syndrome

    PubMed Central

    2014-01-01

    Background Despite advances in supportive care, moderate-severe acute respiratory distress syndrome (ARDS) is associated with high mortality rates, and novel therapies to treat this condition are needed. Compelling pre-clinical data from mouse, rat, sheep and ex vivo perfused human lung models support the use of human mesenchymal stem (stromal) cells (MSCs) as a novel intravenous therapy for the early treatment of ARDS. Methods This article describes the study design and challenges encountered during the implementation and phase 1 component of the START (STem cells for ARDS Treatment) trial, a phase 1/2 trial of bone marrow-derived human MSCs for moderate-severe ARDS. A trial enrolling 69 subjects is planned (9 subjects in phase 1, 60 subjects in phase 2 treated with MSCs or placebo in a 2:1 ratio). Results This report describes study design features that are unique to a phase 1 trial in critically ill subjects and the specific challenges of implementation of a cell-based therapy trial in the ICU. Conclusions Experience gained during the design and implementation of the START study will be useful to investigators planning future phase 1 clinical trials based in the ICU, as well as trials of cell-based therapy for other acute illnesses. Trial registration Clinical Trials Registration: NCT01775774 and NCT02097641. PMID:25593740

  18. Mitochondrial Transfer via Tunneling Nanotubes is an Important Mechanism by Which Mesenchymal Stem Cells Enhance Macrophage Phagocytosis in the In Vitro and In Vivo Models of ARDS

    PubMed Central

    Jackson, Megan V.; Morrison, Thomas J.; Doherty, Declan F.; McAuley, Daniel F.; Matthay, Michael A.; Kissenpfennig, Adrien; O'Kane, Cecilia M.

    2016-01-01

    Abstract Mesenchymal stromal cells (MSC) have been reported to improve bacterial clearance in preclinical models of Acute Respiratory Distress Syndrome (ARDS) and sepsis. The mechanism of this effect is not fully elucidated yet. The primary objective of this study was to investigate the hypothesis that the antimicrobial effect of MSC in vivo depends on their modulation of macrophage phagocytic activity which occurs through mitochondrial transfer. We established that selective depletion of alveolar macrophages (AM) with intranasal (IN) administration of liposomal clodronate resulted in complete abrogation of MSC antimicrobial effect in the in vivo model of Escherichia coli pneumonia. Furthermore, we showed that MSC administration was associated with enhanced AM phagocytosis in vivo. We showed that direct coculture of MSC with monocyte‐derived macrophages enhanced their phagocytic capacity. By fluorescent imaging and flow cytometry we demonstrated extensive mitochondrial transfer from MSC to macrophages which occurred at least partially through tunneling nanotubes (TNT)‐like structures. We also detected that lung macrophages readily acquire MSC mitochondria in vivo, and macrophages which are positive for MSC mitochondria display more pronounced phagocytic activity. Finally, partial inhibition of mitochondrial transfer through blockage of TNT formation by MSC resulted in failure to improve macrophage bioenergetics and complete abrogation of the MSC effect on macrophage phagocytosis in vitro and the antimicrobial effect of MSC in vivo. Collectively, this work for the first time demonstrates that mitochondrial transfer from MSC to innate immune cells leads to enhancement in phagocytic activity and reveals an important novel mechanism for the antimicrobial effect of MSC in ARDS. Stem Cells 2016;34:2210–2223 PMID:27059413

  19. A risk tertiles model for predicting mortality in patients with acute respiratory distress syndrome: age, plateau pressure, and P(aO(2))/F(IO(2)) at ARDS onset can predict mortality.

    PubMed

    Villar, Jesús; Pérez-Méndez, Lina; Basaldúa, Santiago; Blanco, Jesús; Aguilar, Gerardo; Toral, Darío; Zavala, Elizabeth; Romera, Miguel A; González-Díaz, Gumersindo; Nogal, Frutos Del; Santos-Bouza, Antonio; Ramos, Luís; Macías, Santiago; Kacmarek, Robert M

    2011-04-01

    Predicting mortality has become a necessary step for selecting patients for clinical trials and defining outcomes. We examined whether stratification by tertiles of respiratory and ventilatory variables at the onset of acute respiratory distress syndrome (ARDS) identifies patients with different risks of death in the intensive care unit. We performed a secondary analysis of data from 220 patients included in 2 multicenter prospective independent trials of ARDS patients mechanically ventilated with a lung-protective strategy. Using demographic, pulmonary, and ventilation data collected at ARDS onset, we derived and validated a simple prediction model based on a population-based stratification of variable values into low, middle, and high tertiles. The derivation cohort included 170 patients (all from one trial) and the validation cohort included 50 patients (all from a second trial). Tertile distribution for age, plateau airway pressure (P(plat)), and P(aO(2))/F(IO(2)) at ARDS onset identified subgroups with different mortalities, particularly for the highest-risk tertiles: age (> 62 years), P(plat) (> 29 cm H(2)O), and P(aO(2))/F(IO(2)) (< 112 mm Hg). Risk was defined by the number of coexisting high-risk tertiles: patients with no high-risk tertiles had a mortality of 12%, whereas patients with 3 high-risk tertiles had 90% mortality (P < .001). A prediction model based on tertiles of patient age, P(plat), and P(aO(2))/F(IO(2)) at the time the patient meets ARDS criteria identifies patients with the lowest and highest risk of intensive care unit death.

  20. The effect of river dynamics induced by the Messinian Salinity Crisis on karst landscape and caves: Example of the Lower Ardèche river (mid Rhône valley)

    NASA Astrophysics Data System (ADS)

    Mocochain, Ludovic; Audra, Philippe; Clauzon, Georges; Bellier, Olivier; Bigot, Jean-Yves; Parize, Olivier; Monteil, Philippe

    2009-05-01

    The karstic canyon of Lower Ardèche is located in the Middle Rhône valley, which is directly tributary to the Mediterranean Sea. The Rhône River is emblematic of the Messinian Salinity Crisis (MSC) impact on landscape morphology. Along the edge of the Saint-Remèze Plateau, the Rhône valley displays four benchmark levels generated by the MSC: the Pre-evaporitic abandonment surface (1), the Messinian erosional surface (2), the Marine/non-marine surface of the Pliocene ria (3) and the Pliocene abandonment surface (4). The study of these benchmark levels allows us to reconstruct the evolution of the regional base level over the last 6 Ma. We obtain a curve for base-level evolution that provides a geodynamic reference, which is used to investigate the morphogenesis of the Saint-Remèze karstic plateau. The Ardèche River downcuts the Saint-Remèze Plateau in a deep canyon, from Vallon-Pont-d'Arc to the West, to its confluence with the Rhône to the East. Several abandoned valleys are present along the western edge of the Saint-Remèze Plateau at the inlet of the Ardèche canyon. In these abandoned valleys, the fluvial deposits are related to several periods, from the Pliocene onwards. They provide important insights into the fluvial dynamics: a 160 m-thick aggradation sequence infilled the Ardèche canyon during the Pliocene. This aggrading river caused the first lateral shifting, as an aggradation epigenesis. This first infilling shows that the Ardèche canyon already existed before the Pliocene. Secondly, it has been demonstrated that the Ardèche Canyon is downcut into the Pre-evaporitic surface of the Saint-Remèze Plateau, dated to 5.45 Ma [Martini, J., 2005. Etude des paléokarsts des environs de Saint-Remèze (Ardèche, France): mise en évidence d'une rivière souterraine fossilisée durant la crise de salinité messinienne. Karstologia 45-46, 1-18]. Consequently, the canyon downcutting is entirely due to the MSC, and occurred during a time span of only 100

  1. ard-1: a human gene that reverses the effects of temperature-sensitive and deletion mutations in the Escherichia coli rne gene and encodes an activity producing RNase E-like cleavages.

    PubMed Central

    Wang, M; Cohen, S N

    1994-01-01

    The Escherichia coli rne gene affects a variety of bacterial functions, including the activity of RNase E. We report the existence of a human gene (ard-1, for activator of RNA decay) that complements temperature-sensitive and deletion mutations of rne in E. coli, allowing growth of rne-defective cells, correcting abnormal cell shape, activating chemical decay of bulk mRNA, and producing site-specific cleavages characteristic of RNase E in vivo and in vitro. ard-1 encodes a highly basic 13.3-kDa proline-rich peptide that has features in common with Rne and also with eukaryotic proteins implicated in RNA binding and macromolecular transport. Images PMID:7524097

  2. The DNA-mimic antirestriction proteins ArdA ColIB-P9, Arn T4, and Ocr T7 as activators of H-NS-dependent gene transcription.

    PubMed

    Melkina, Olga E; Goryanin, Ignatiy I; Zavilgelsky, Gennadii B

    2016-11-01

    The antirestriction proteins ArdA ColIb-P9, Arn T4 and Ocr T7 specifically inhibit type I and type IV restriction enzymes and belong to the family of DNA-mimic proteins because their three-dimensional structure is similar to the double-helical B-form DNA. It is proposed that the DNA-mimic proteins are able to bind nucleoid protein H-NS and alleviate H-NS-silencing of the transcription of bacterial genes. Escherichia coli lux biosensors were constructed by inserting H-NS-dependent promoters into a vector, thereby placing each fragment upstream of the promoterless Photorhabdus luminescens luxCDABE operon. It was demonstrated that the DNA-mimic proteins ArdA, Arn and Ocr activate the transcription of H-NS-dependent promoters of the lux operon of marine luminescent bacteria (mesophilic Aliivibrio fischeri and psychrophilic Aliivibrio logei), and the dps gene from E. coli. It was also demonstrated that the ArdA antirestriction protein, the genes of which are located on transmissive plasmids ColIb-P9, R64, PK101, decreases levels of H-NS silencing of the PluxC promoter during conjugation in the recipient bacteria.

  3. Down-regulation of the expression of the FIH-1 and ARD-1 genes at the transcriptional level by nickel and cobalt in the human lung adenocarcinoma A549 cell line.

    PubMed

    Ke, Qingdong; Kluz, Thomas; Costa, Max

    2005-04-01

    Although nickel and cobalt compounds have been known to cause induction of the transcription factor hypoxia-inducible factor 1 (HIF-1) and activation of a battery of hypoxia-inducible genes in the cell, the molecular mechanisms of this induction remain unclear. The post-translational modification of HIF-1a, the oxygen-sensitive subunit of HIF-1, regulates stabilization, nuclear translocation, DNA binding activity, and transcriptional activity of the protein. Among the enzymes regulating the post-translational modification of HIF-la, the factor inhibiting HIF-1 (FIH-1) hydroxylates the protein at asparagine 803, suppressing the interaction of HIF-1a with transcription coactivators p300/CBP and reducing the transcriptional activity of the protein. ARD-1, the acetyltransferase, acetylates HIF-1a at lysine 532, which enhances the interaction of HIF-1a with pVHL. Therefore, FIH-1 and ARD-1 negatively regulate the transcriptional activity and the stability of HIF-1a. We examined the mRNA levels of FIH-l and ARD-1 genes after exposure nickel (II) or cobalt (II) to the cell and found that both genes were down-regulated by the chemical treatment, which may lead to reduced levels of both proteins and result in increased level of HIF-1 a and its transcriptional activity.

  4. [Recurrence of the acute respiratory distress syndrome (ARDS) in a patient with Sai-rei-to-induced pneumonitis].

    PubMed

    Narita, Yusuke; Yamaguchi, Tetsuo; Tanaka, Kensuke; Urushiyama, Hirokazu; Togashi, Yuki; Zaima, Mika; Kohno, Chiyoko; Yamada, Yoshihito

    2008-10-01

    An 83-year-old woman was admitted to our hospital because of fever and difficulty in walking with marked hypoxemia and diffuse ground glass opacities in bilateral lung fields by chest radiography and CT scanning. Treatment with antibiotics and corticosteroids resulted in improvement of the clinical findings and successful weaning from mechanical ventilation. At first, we diagnosed severe mycoplasma pneumonia because of a 2560 titer in a particle agglutiation (PA) test. Five days after discharge, she was given a second emergency admission, because of fever and difficulty in walking. Chest X-ray film revealed improvement after administration of methylprednisolone. Her detailed medical history proved that she had been treated with a Chinese herbal drug, Sai-rei-to, for several weeks before first admission. We finally diagnosed her disease as Sai-rei-to-induced pneumonitis. Despite intensive treatment, she finally died. The histopathological findings (H-E stain) of the autopsied lungs showed hyaline membrane formation and hyperplasia of type II alveolar epithelium cells, so-called, diffuse alveolar damage. This case and other referred in the literature suggest that Sai-rei-to-induced pneumonitis can become severe.

  5. Effects on hemodynamics and gas exchange of omega-3 fatty acid-enriched lipid emulsion in acute respiratory distress syndrome (ARDS): a prospective, randomized, double-blind, parallel group study

    PubMed Central

    Sabater, Joan; Masclans, Joan Ramon; Sacanell, Judit; Chacon, Pilar; Sabin, Pilar; Planas, Merce

    2008-01-01

    Introduction We investigated the effects on hemodynamics and gas exchange of a lipid emulsion enriched with omega-3 fatty acids in patients with ARDS. Methods The design was a prospective, randomized, double-blind, parallel group study in our Intensive Medicine Department of Vall d'Hebron University Hospital (Barcelona-Spain). We studied 16 consecutive patients with ARDS and intolerance to enteral nutrition (14 men and 2 women; mean age: 58 ± 13 years; APACHE II score: 17.8 ± 2.3; Lung Injury Score: 3.1 ± 0.5; baseline PaO2/FiO2 ratio: 149 ± 40). Patients were randomized into 2 groups: Group A (n = 8) received the study emulsion Lipoplus® 20%, B.Braun Medical (50% MCT, 40% LCT, 10% ω-3); Group B (n = 8) received the control emulsion Intralipid® Fresenius Kabi (100% LCT). Lipid emulsions were administered during 12 h at a dose of 0.12 g/kg/h. Measurements of the main hemodynamic and gas exchange parameters were made at baseline (immediately before administration of the lipid emulsions), every hour during the lipid infusion, at the end of administration, and six hours after the end of administration lipid infusion. Results No statistically significant changes were observed in the different hemodynamic values analyzed. Likewise, the gas exchange parameters did not show statistically significant differences during the study. No adverse effect attributable to the lipid emulsions was seen in the patients analyzed. Conclusion The lipid emulsion enriched with omega-3 fatty acids was safe and well tolerated in short-term administration to patients with ARDS. It did not cause any significant changes in hemodynamic and gas exchange parameters. Trial registration ISRCTN63673813 PMID:18947396

  6. Combination of ECMO and cytokine adsorption therapy for severe sepsis with cardiogenic shock and ARDS due to Panton-Valentine leukocidin-positive Staphylococcus aureus pneumonia and H1N1.

    PubMed

    Lees, N J; Rosenberg, Ajp; Hurtado-Doce, A I; Jones, J; Marczin, N; Zeriouh, M; Weymann, A; Sabashnikov, A; Simon, A R; Popov, A F

    2016-12-01

    Sepsis-induced cardiogenic shock in combination with severe acute respiratory failure represents a life-threatening combination that is often refractory to the conventional methods of treatment. We describe the case of a 33-year-old patient who developed acute cardiovascular collapse and ARDS secondary to superinfection of Panton-Valentine leukocidin-positive Staphylococcus aureus and H1N1 pneumonia who underwent successful combination therapy for severe sepsis-related cardiomyopathy and respiratory failure using extracorporeal membrane oxygenation and cytokine adsorption therapy.

  7. Acute Respiratory Distress Syndrome (ARDS)

    MedlinePlus

    ... Health & Wellness > Health Professionals Lung Health & Wellness > Healthy Air (Indoor & Outdoor) Lung Health & Wellness > LUNG FORCE Updates Lung Health & Wellness > Quit Smoking Lung Health & ...

  8. Datation par thermoluminescence :étude d'une corrélation chronologique possible entre le maar de La Vestide-du-Pal et un niveau de téphra de La Baume-Moula-Guercy (Ardèche, France)Thermoluminescence dating: study of a possible chronological correlation between the maar of La Vestide-du-Pal and a tephra layer from La Baume-Moula-Guercy (Ardèche, France).

    NASA Astrophysics Data System (ADS)

    Sanzelle, Serge; Pilleyre, Thierry; Montret, Michèle; Faïn, Jean; Miallier, Didier; Camus, Guy; de Goër de Hervé, Alain; Defleur, Alban

    2000-04-01

    The origin of an ash level sampled in the archaeological site 'La Baume-Moula-Guercy' (Soyons, Ardèche, France), was previously attributed to the maar 'La Vestide-du-Pal' (Bas-Vivarais, Massif Central, France). In order to test this assumption by means of absolute chronology, thermoluminescence dating was applied to both sites. The results, 72 ± 12 ka for La Baume-Moula and 49 ± 7 ka for La Vestide-du-Pal were not in agreement. The initial assumption must then be questioned.

  9. A Review of the Literature and of Work Done in A.R.D and C.R.D.D. on Picrite and its Intermediates with a View to Finding a Cheap and Economical Process

    DTIC Science & Technology

    1947-05-01

    illegible. DSTL ltr dtd 13 Feb 2007; DSTL ltr dtd 13 Feb 2007 3C7/K/47 l ’ rj COPY Na \\ ON: Mjjlfe£_ h. Date ~k^ CONFIDENTIAL OAljg Ministry of...method of manufacturing picrite other’ than through carbide then the methods most worthy of further study and detailed costing are methods ( l ) and (7...Cyanamide is formed by the action of bromine on potassium cyanide dissolved in liquid ammonia.(4°) ( l ) Cyanamide and carbon dioxide are fof^ed by the

  10. Finding Dental Care

    MedlinePlus

    ... Finding Dental Care Where can I find low-cost dental care? Dental schools often have clinics that allow dental ... can I find more information? See Finding Low Cost Dental Care . ​​​​ WWNRightboxRadEditor2 Contact Us 1-866-232-4528 nidcrinfo@ ...

  11. Find a Surgeon

    MedlinePlus

    ... find out more. Head, Neck and Oral Pathology Head, Neck and Oral Pathology Close to 49,750 Americans ... find out more. Head, Neck and Oral Pathology Head, Neck and Oral Pathology Close to 49,750 Americans ...

  12. Find a Massage Therapist

    MedlinePlus

    ... Newsletter Student Experience Newsletter AMTA News Find a Massage Therapist Find a qualified massage therapist near you ... massage therapy school Proprietary Information and Legal Notice Massage is Good Medicine 25 Reasons to Get a ...

  13. Leiomyosarcoma: computed tomographic findings

    SciTech Connect

    McLeod, A.J.; Zornoza, J.; Shirkhoda, A.

    1984-07-01

    The computed tomographic (CT) findings in 118 patients with the diagnosis of leiomyosarcoma were reviewed. The tumor masses visualized in these patients were often quite large; extensive necrotic or cystic change was a frequent finding. Calcification was not observed in these tumors. The liver was the most common site of metastasis in these patients, with marked necrosis of the liver lesions a common finding. Other manifestations of tumor spread included pulmonary metastases, mesenteric or omental metastases, retroperitoneal lymphadenopathy, soft-tissue metastases, bone metastases, splenic metastases, and ascites. Although the CT appearance of leiomyosarcoma is not specific, these findings, when present, suggest consideration of this diagnosis.

  14. Find a Nurse Practitioner

    MedlinePlus

    Find a Nurse Practitioner AANP Home MyAANP Contact Us Find an NP near me or near Search Reset I accept AANP's Terms of Use Overall Focus All Primary ... practice site(s) to NP Finder, and enjoy many more member benefits.

  15. Find a Midwife

    MedlinePlus

    ... The Find a Midwife practice locator is a web-based service that allows you to find midwifery practices in your area. It also supplies you with basic contact information like practice name, address, phone number, e-mail address, web site and a map of the area. If ...

  16. Controversial ultrasound findings.

    PubMed

    Rochon, Meredith; Eddleman, Keith

    2004-03-01

    This article has reviewed a few of the more controversial findings in the field of obstetric ultrasound. For each one evidence-based strategies for the management of affected pregnancies have been suggested, derived from what the authors believe is the best information available. In some cases, this information is very limited, which can make counseling these patients extremely difficult. Some physicians find using specific likelihood ratios helpful in these complex discussions. An example of the relative likelihood ratios for several markers of trisomy 21 is illustrated in Table 10. Although the management of each of the findings discussed in this article is different, a few generalizations can be made. To begin with, the detection of any abnormal finding on ultrasound should prompt an immediate detailed ultrasound evaluation of the fetus by someone experienced in the diagnosis of fetal anomalies. If there is more than one abnormal finding on ultrasound, if the patient is over the age of 35, or if the multiple marker screen is abnormal, an amniocentesis to rule out aneuploidy should be recommended. Of the six ultrasound findings reviewed here, the authors believe that only echogenic bowel as an isolated finding confers a high enough risk of aneuploidy to recommend an amniocentesis in a low-risk patient. The other findings in isolation in a low-risk patient seem to confer only a modest increased risk of aneuploidy, if any, and this risk is certainly less than the risk of unintended loss from amniocentesis. Wherever possible, modifiers of this risk, such as maternal age, history, and first and second multiple marker screening, should be used to define more clearly the true risk of aneuploidy. As obstetric ultrasound moves forward, particularly into the uncharted waters of clinical use of three- and four-dimensional ultrasound, one can expect a whole new crop of ultrasound findings with uncertain clinical significance. Clinicians are well advised to await well

  17. Lower tidal volume strategy (≈3 ml/kg) combined with extracorporeal CO2 removal versus 'conventional' protective ventilation (6 ml/kg) in severe ARDS: the prospective randomized Xtravent-study.

    PubMed

    Bein, Thomas; Weber-Carstens, Steffen; Goldmann, Anton; Müller, Thomas; Staudinger, Thomas; Brederlau, Jörg; Muellenbach, Ralf; Dembinski, Rolf; Graf, Bernhard M; Wewalka, Marlene; Philipp, Alois; Wernecke, Klaus-Dieter; Lubnow, Matthias; Slutsky, Arthur S

    2013-05-01

    Acute respiratory distress syndrome is characterized by damage to the lung caused by various insults, including ventilation itself, and tidal hyperinflation can lead to ventilator induced lung injury (VILI). We investigated the effects of a low tidal volume (V(T)) strategy (V(T) ≈ 3 ml/kg/predicted body weight [PBW]) using pumpless extracorporeal lung assist in established ARDS. Seventy-nine patients were enrolled after a 'stabilization period' (24 h with optimized therapy and high PEEP). They were randomly assigned to receive a low V(T) ventilation (≈3 ml/kg) combined with extracorporeal CO2 elimination, or to a ARDSNet strategy (≈6 ml/kg) without the extracorporeal device. The primary outcome was the 28-days and 60-days ventilator-free days (VFD). Secondary outcome parameters were respiratory mechanics, gas exchange, analgesic/sedation use, complications and hospital mortality. Ventilation with very low V(T)'s was easy to implement with extracorporeal CO2-removal. VFD's within 60 days were not different between the study group (33.2 ± 20) and the control group (29.2 ± 21, p = 0.469), but in more hypoxemic patients (PaO2/FIO2 ≤150) a post hoc analysis demonstrated significant improved VFD-60 in study patients (40.9 ± 12.8) compared to control (28.2 ± 16.4, p = 0.033). The mortality rate was low (16.5%) and did not differ between groups. The use of very low V(T) combined with extracorporeal CO2 removal has the potential to further reduce VILI compared with a 'normal' lung protective management. Whether this strategy will improve survival in ARDS patients remains to be determined (Clinical trials NCT 00538928).

  18. Find a Dentist

    MedlinePlus

    ... information you need from the Academy of General Dentistry Sunday, April 9, 2017 About | Contact Find an ... more. Disclaimer of Liabilities The Academy of General Dentistry's (AGD) Web site provides a listing of members ...

  19. Find a Doctor

    MedlinePlus

    ... Doctor Finding a doctor with special training in movement disorders can make a big difference in your ... Goldstein Goldstone Gollomp Goodman Gorman Gottschalk Graff Greeley Green Gregory Griffith Grill Grillone Grist Grossman Groves Gudesblatt ...

  20. Find a Rheumatologist

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    ... Opportunities Awards Mentoring Find a Rheumatologist Cart Join Login Keep me signed in Passwords are Case Sensitive. ... as follows: Smith Forgot Username/Password? Toggle navigation Login I Am A Rheumatologist Education Practice & Quality Administrative ...

  1. Finding Treatment Centers

    MedlinePlus

    ... After Treatment Caregivers and Family Children and Cancer End of Life Care Find Support Programs and Services in Your Area Back To Top Imagine a world free from cancer. Help make it a reality. ...

  2. Finding the Correct Location.

    ERIC Educational Resources Information Center

    Seiter, David M.

    1988-01-01

    Provides educational resources from ERIC (Educational Resources Information Center) to help teachers find the material to teach the five themes of geography. An annotated bibliography of seven ERIC documents on geographic location is provided. (LS)

  3. Find a Cancer Doctor

    MedlinePlus

    ... Status message Locating you... The Find an Oncologist Database is made available by ASCO as an informational resource for patients and caregivers. The database includes the names of physicians and other health ...

  4. Pathological findings in homocystinuria

    PubMed Central

    Gibson, J. B.; Carson, Nina A. J.; Neill, D. W.

    1964-01-01

    Pathological findings are described in four cases of a new aminoaciduria in which homocystine is excreted in the urine. All the patients were mentally retarded children. Three of them presented diagnostic features of Marfan's syndrome. Necropsy on one case and biopsy findings in the others are described. Fatty change occurs in the liver. The most striking lesions are vascular. Metachromatic medial degeneration of the aorta and of the elastic arteries in the necropsied case are considered in relation to Marfan's syndrome. Other changes, particularly thrombosis which is prevalent in homocystinuria, suggest the possibility of a platelet defect. The findings are discussed in respect of an upset in the metabolism of sulphur-containing amino-acids and with particular reference to Marfan's syndrome. Images PMID:14195630

  5. Mobious syndrome: MR findings

    PubMed Central

    Srinivas, Maskal Revanna; Vaishali, Dhulappa Mudabasappagol; Vedaraju, Kadaba Shamachar; Nagaraj, Bangalore Rangaswamy

    2016-01-01

    Möbius syndrome is an extremely rare congenital disorder. We report a case of Möbius syndrome in a 2-year-old girl with bilateral convergent squint and left-sided facial weakness. The characteristic magnetic resonance imaging (MRI) findings of Möbius syndrome, which include absent bilateral abducens nerves and absent left facial nerve, were noted. In addition, there was absence of left anterior inferior cerebellar artery (AICA) and absence of bilateral facial colliculi. Clinical features, etiology, and imaging findings are discussed. PMID:28104946

  6. Finding the Common Ground.

    ERIC Educational Resources Information Center

    Wallace, Dawn

    1980-01-01

    Describes an attempt to combine secondary English instruction emphasizing United States literature with science and history by finding "common ground" between these disciplines in (1) the separation of truth from falsehood and (2) logical thinking. Biographies combined history and literature, and science fiction combined science and English;…

  7. Tooth Tutoring: The Findings.

    ERIC Educational Resources Information Center

    Cone, Richard; And Others

    Findings are reported on a three year cross-age tutoring program in which undergraduate dental hygiene students and college students from other disciplines trained upper elementary students to tutor younger students in the techniques of dental hygiene. Data includes pre-post scores on the Oral Hygiene Index of plaque for both experimental and…

  8. Tooth Tutoring: The Findings.

    ERIC Educational Resources Information Center

    Cone, Richard; And Others

    Findings are reported on a three year cross-age tutoring program in which undergraduate dental hygiene students and college students from other disciplines trained upper elementary students to tutor younger students in the techniques of dental hygiene. Data includes pre-post scores on the Oral Hygiene Index of plaque for both experimental and…

  9. Finding Health Care Services

    Cancer.gov

    If you have been diagnosed with cancer, finding a doctor and treatment hospital for your cancer care is an important step to getting the best treatment possible. Learn tips for choosing a doctor and treatment facility to manage your cancer care.

  10. Implementing Institutional Research Findings.

    ERIC Educational Resources Information Center

    Blai, Boris, Jr.

    Although many agree that institutional research in higher education has come of age and is accepted as a part of institutional management, great variations exist in the extent to which institutional research findings are synthesized and utilized in management decision-making. A number of reasons can be identified as accounting for this phenomenon,…

  11. Finding Their Identities

    ERIC Educational Resources Information Center

    Lum, Lydia

    2009-01-01

    Every time Dr. Larry Shinagawa teaches his "Introduction to Asian American Studies" course at the University of Maryland (UMD), College Park, he finds that 10 to 20 percent of his students are adoptees. Among other things, they hunger to better comprehend the social and political circumstances overseas leading to their adoption. In…

  12. Finding Their Identities

    ERIC Educational Resources Information Center

    Lum, Lydia

    2009-01-01

    Every time Dr. Larry Shinagawa teaches his "Introduction to Asian American Studies" course at the University of Maryland (UMD), College Park, he finds that 10 to 20 percent of his students are adoptees. Among other things, they hunger to better comprehend the social and political circumstances overseas leading to their adoption. In…

  13. Finding Those Missing Links

    ERIC Educational Resources Information Center

    Gunn, Holly

    2004-01-01

    In this article, the author stresses not to give up on a site when a URL returns an error message. Many web sites can be found by using strategies such as URL trimming, searching cached sites, site searching and searching the WayBack Machine. Methods and tips for finding web sites are contained within this article.

  14. High-resolution computed tomography findings in elderly patients with asthma.

    PubMed

    Yilmaz, Sevda; Ekici, Aydanur; Ekici, Mehmet; Keles, Hatice

    2006-08-01

    Based on the hypothesis that airway remodelling is related to the duration of asthma, HRCT scanning should show greater abnormalities in the early-onset than the late-onset asthmatics. It was, therefore, intended to assess the presence and the frequency of airway and parenchymal abnormalities with high-resolution computed tomography (HRCT) in elderly asthmatic patients, and to determine whether these abnormalities are related to the duration of asthma. Sixty-eight clinically stable asthmatic patients aged > or =60 yr were included in this prospective study. The patients were separated into two groups according to the duration of symptoms as late-onset asthma (n=31) with disease duration of <5 yr, and early-onset asthma (n=37) with disease duration of > or =5 yr. All patients were lifelong non-smoker and had been using inhaled beta agonists and inhaled steroids. HRCT-scanning and histamine inhalation test were performed on all patients. In comparison with late-onset asthmatic patients, those with early-onset asthma had significantly higher frequency of emphysema (21.6% versus 0.0%, p=0.006), bronchial dilatation (13.9% versus 0.0%, p=0.03) and bronchial wall thickness (41.7% versus 12.9%, p=0.01). Multiple logistic regression analysis identified that early-onset of disease was an independent risk factor for the presence of irreversible HRCT-scan abnormalities in elderly asthmatics [odds ratio (OR): 9.4 (2.7-32.7), p=0.00001]. Present data suggest that HRCT abnormalities in early-onset elderly asthmatics reflect parenchymal and airway changes that become irreversible throughout the long course of the disease.

  15. CT findings in leukemia

    SciTech Connect

    Heiberg, E.; Wolverson, M.K.; Sundaram, M.; Shields, J.B.

    1984-12-01

    Review of 84 computed tomographic (CT) scans in leukemic patients demonstrate a wide spectrum of abnormalities. Findings caused by leukemia were lymphadenopathy, visceral enlargement, focal defects, and tissue infiltration. Hemorrhage was by far the most common complication and could usually be characterized on the noncontrast CT scan. The distinction between old hematomas, foci of infection, and leukemia infiltration could not be made with certainty without CT-guided aspiration. Unusual instances of sepsis, such as microabscesses of the liver and typhlitis, were seen.

  16. Finding voices through writing.

    PubMed

    Gehrke, P

    1994-01-01

    Assisting students to find their writing "voices" is another way to emphasize writing as a professional tool for nursing. The author discusses a teaching strategy that required students to write using a variety of styles. Students wrote fables, poetry, and letters, and used other creative writing styles to illustrate their views and feelings on professional nursing issues. Creation of a class book empowered students to see versatility with writing styles can be a powerful communication tool to use with peers, clients, and society.

  17. Effects of lung surfactant factor (LSF) treatment on gas exchange and histopathological changes in an animal model of adult respiratory distress syndrome (ARDS): comparison of recombinant LSF with bovine LSF.

    PubMed

    Häfner, D; Germann, P G; Hauschke, D

    1994-10-01

    Repetitive lung lavage of adult rats leads to lung injury similar to ARDS resulting in poor gas exchange, protein leakage and infiltration of polymorphonuclear neutrophils (PMN) into the alveolar spaces (J Appl Physiol 1983; 55: 131-138). In a previous dose response comparison we have demonstrated that poor gas exchange could be improved by lung surfactant factor (LSF) instillation soon after lavage. Since Surfacten (Tokyo Tanabe Co. Ltd., Tokyo, Japan) was described in vitro to inhibit PMN activity, we compared this preparation with a Recombinant LSF preparation (Byk Gulden, Konstanz, Germany; phospholipids plus human identical surfactant protein C) at doses of 25, 50 and 100 mg/kg body weight. Their efficacy was compared with an untreated control group with respect to improving gas exchange, inhibition of hyaline membrane formation and inhibition of the inflammatory response after multiple lavage. Tracheotomized rats were pressure-controlled ventilated (Siemens Servo Ventilator 900C, Sweden) with 100% oxygen at a respiratory rate of 30 breaths/min, inspiration:expiration ratio of 1:2, peak inspiratory pressure (PIP) of 28 cmH2O at positive end-expiratory pressure (PEEP) of 8 cmH2O. Two hours after LSF administration PEEP was reduced from 8 to 6 cmH2O (first PEEP-reduction), from 6 to 3 (second reduction) and from 3 to 0 cmH2O (third reduction) and finally raised to 8 cmH2O. Results for the averaged partial arterial oxygen pressure [PaO2 (mmHg)] of the 2 h period [PaO2(5'-120')] and for the PaO2 during the second PEEP reduction [PaO2(PEEP23/3] were calculated. Both LSF preparations caused a dose-dependent increase of the PaO2 (5'-120') and the PaO2(PEEP23/3). Similarly, the formation of hyaline membranes was inhibited by both LSF preparations in a dose-dependent manner. Inhibition of the inflammatory response (infiltration of PMN) was not effected by either of the LSF preparations at any dose level. The described variations in ventilator settings are useful to

  18. Effects of an omega-3 fatty acid-enriched lipid emulsion on eicosanoid synthesis in acute respiratory distress syndrome (ARDS): A prospective, randomized, double-blind, parallel group study

    PubMed Central

    2011-01-01

    Background The use of lipid emulsions has been associated with changes in lung function and gas exchange which may be mediated by biologically active metabolites derived from arachidonic acid. The type and quantity of the lipid emulsions used could modulate this response, which is mediated by the eicosanoids. This study investigates the use of omega-3 fatty acid-enriched lipid emulsions in ARDS patients and their effects on eicosanoid values. Methods Prospective, randomized, double-blind, parallel group study carried out at the Intensive Medicine Department of Vall d'Hebron University Hospital (Barcelona-Spain). We studied 16 consecutive patients with ARDS and intolerance to enteral nutrition (14 men; age: 58 ± 13 years; APACHE II score 17.8 ± 2.3; Lung Injury Score: 3.1 ± 0.5; baseline PaO2/FiO2 ratio: 149 ± 40). Patients were randomized into two groups: Group A (n = 8) received the study emulsion Lipoplus® 20%, B. Braun Medical (50% MCT, 40% LCT, 10% fish oil (FO)); Group B (n = 8) received the control emulsion Intralipid® Fresenius Kabi (100% LCT). Lipid emulsions were administered for 12 h at a dose of 0.12 g/kg/h. We measured LTB4, TXB2, and 6-keto prostaglandin F1α values at baseline [immediately before the administration of the lipid emulsions (T-0)], at the end of the administration (T-12) and 24 hours after the beginning of the infusion (T 24) in arterial and mixed venous blood samples. Results In group A (FO) LTB4, TXB2, 6-keto prostaglandin F1α levels fell during omega-3 administration (T12). After discontinuation (T24), levels of inflammatory markers (both systemic and pulmonary) behaved erratically. In group B (LCT) all systemic and pulmonary mediators increased during lipid administration and returned to baseline levels after discontinuation, but the differences did not reach statistical significance. There was a clear interaction between the treatment in group A (fish oil) and changes in LTB4 over time. Conclusions Infusion of lipids enriched

  19. Mineral find highlights cruise

    NASA Astrophysics Data System (ADS)

    Katzoff, Judith A.

    Heavy minerals with potential commercial value were discovered last month by the U.S. Geological Survey (USGS) in seafloor deposits off the coasts of Virginia and Georgia. The USGS sent the research vessel J. W. Powell on a 25-day cruise along the East Coast to assess the concentrations of commercially important minerals in that segment of the U.S. Exclusive Economic Zone (EEZ).Assistant Secretary of the Interior Robert Broadbent called the findings of the Powell “promising” and said they served as a “reminder of just how little we do know about the seafloor resources just a few miles offshore.”

  20. Quantitative analysis of lung elastic fibers in idiopathic pleuroparenchymal fibroelastosis (IPPFE): comparison of clinical, radiological, and pathological findings with those of idiopathic pulmonary fibrosis (IPF).

    PubMed

    Enomoto, Noriyuki; Kusagaya, Hideki; Oyama, Yoshiyuki; Kono, Masato; Kaida, Yusuke; Kuroishi, Shigeki; Hashimoto, Dai; Fujisawa, Tomoyuki; Yokomura, Koshi; Inui, Naoki; Nakamura, Yutaro; Suda, Takafumi

    2014-05-28

    The pathological appearance of idiopathic pleuroparenchymal fibroelastosis (IPPFE) with hematoxylin-eosin staining is similar to that of usual interstitial pneumonia (UIP) in patients with idiopathic pulmonary fibrosis (IPF). The amount of elastic fibers (EF) and detailed differences between IPPFE and IPF have not been fully elucidated. The aim of this study was to quantify the EF and identify the differences between IPPFE and IPF. We evaluated six patients with IPPFE and 28 patients with IPF who underwent surgical lung biopsy or autopsy. The patients' clinical history, physical findings, chest high-resolution computed tomography (HRCT) findings, and pathological features of lung specimens were retrospectively evaluated. The amounts of EF in lung specimens were quantified with Weigert's staining using a camera with a charge-coupled device and analytic software in both groups. Fewer patients with IPPFE than IPF had fine crackles (50.0% vs. 96.4%, p = 0.012). Patients with IPPFE had a lower forced vital capacity (62.7 ± 10.9% vs. 88.6 ± 21.9% predicted, p = 0.009), higher consolidation scores on HRCT (1.7 ± 0.8 vs. 0.3 ± 0.5, p < 0.0001), lower body mass indices (17.9 ± 0.9 vs. 24.3 ± 2.8, p < 0.0001), and more pneumothoraces than did patients with IPF (66.7 vs. 3.6%, p = 0.002). Lung specimens from patients with IPPFE had more than twice the amount of EF than did those from patients with IPF (28.5 ± 3.3% vs. 12.1 ± 4.4%, p < 0.0001). The amount of EF in the lower lobes was significantly lower than that in the upper lobes, even in the same patient with IPPFE (23.6 ± 2.4% vs. 32.4 ± 5.5%, p = 0.048). However, the amount of EF in the lower lobes of patients with IPPFE was still higher than that of patients with IPF (23.6 ± 2.4% vs. 12.2 ± 4.4%, p < 0.0001). More than twice the amount of EF was found in patients with IPPFE than in those with IPF. Even in the lower lobes, the amount of EF was higher in patients with IPPFE than in those with IPF, although the

  1. [Ultrasound findings in rhabdomyolysis].

    PubMed

    Carrillo-Esper, Raúl; Galván-Talamantes, Yazmin; Meza-Ayala, Cynthia Margarita; Cruz-Santana, Julio Alberto; Bonilla-Reséndiz, Luis Ignacio

    Rhabdomyolysis is defined as skeletal muscle necrosis. Ultrasound assessment has recently become a useful tool for the diagnosis and monitoring of muscle diseases, including rhabdomyolysis. A case is presented on the ultrasound findings in a patient with rhabdomyolysis. To highlight the importance of ultrasound as an essential part in the diagnosis in rhabdomyolysis, to describe the ultrasound findings, and review the literature. A 30 year-old with post-traumatic rhabdomyolysis of both thighs. Ultrasound was performed using a Philips Sparq model with a high-frequency linear transducer (5-10MHz), in low-dimensional scanning mode (2D), in longitudinal and transverse sections at the level of both thighs. The images obtained showed disorganisation of the orientation of the muscle fibres, ground glass image, thickening of the muscular fascia, and the presence of anechoic areas. Ultrasound is a useful tool in the evaluation of rhabdomyolysis. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  2. Subdural empyema: CT findings

    SciTech Connect

    Zimmerman, R.D.; Leeds, N.E.; Danziger, A.

    1984-02-01

    CT scans in 49 patients with surgically proven subdural empyema were evaluated. The empyemas were crescentic or lentiform extra-axial hypodense collections (density approximating that of cerebrospinal fluid) with prominent, sharply etched medial rim enhancement. Enhancement of the adjacent cerebral cortex was identified in many cases. Mass effect was always present and in 10 cases so extensive that it overshadowed a small extra-axial collection. CT allowed for precise localization of the lesion, including contiguous or isolated involvement of the interhemispheric subdural space. Mortality was 12% (6/49 cases), a marked improvement when compared with mortality figures obtained prior to the advent of CT (40%). CT findings indicative of involvement of the adjacent parenchyma via retrograde thrombophlebitis with resultant infarction and/or abscess formation were associated with poor prognosis. Improvement in prognosis since the advent of CT is the direct result of early accurate diagnosis and timely intervention.

  3. Closed-Loop Control of FiO2 Rapidly Identifies Need For Rescue Ventilation and Reduces ARDS Severity in a Conscious Sheep Model of Burn and Smoke Inhalation Injury.

    PubMed

    Liu, Nehemiah T; Salter, Michael G; Khan, Muzna N; Branson, Richard D; Enkhbaatar, Perenlei; Kramer, George C; Salinas, José; Marques, Nicole R; Kinsky, Michael P

    2017-02-01

    Pulmonary injury can be characterized by an increased need for fraction of inspired oxygen or inspired oxygen percentage (FiO2) to maintain arterial blood saturation of oxygenation (SaO2). We tested a smart oxygenation system (SOS) that uses the activity of a closed-loop control FiO2 algorithm (CLC-FiO2) to rapidly assess acute respiratory distress syndrome (ARDS) severity so that rescue ventilation (RscVent) can be initiated earlier. After baseline data, a pulse-oximeter (noninvasive saturation of peripheral oxygenation [SpO2]) was placed. Sheep were then subjected to burn and smoke inhalation injury and followed for 48 h. Initially, sheep were spontaneously ventilating and then randomized to standard of care (SOC) (n = 6), in which RscVent began when partial pressure of oxygen (PaO2) < 90 mmHg or FiO2 < 0.6, versus SOS (n = 7), software that incorporates and displays SpO2, CLC-FiO2, and SpO2/CLC-FiO2 ratio, at which RscVent was initiated when ratio threshold < 250. RscVent was achieved using a G5 Hamilton ventilator (Bonaduz, Switzerland) with adaptive pressure ventilation and adaptive support ventilation modes for SOC and SOS, respectively.

  4. Finding the Next Earth

    NASA Astrophysics Data System (ADS)

    Batalha, Natalie M.; Kepler Team

    2013-01-01

    Twenty years ago, we knew of no planets orbiting other Sun-like stars, yet today, the roll call is nearly 1,000 strong. Statistical studies of exoplanet populations are possible, and words like "habitable zone" are heard around the dinner table. Theorists are scrambling to explain not only the observed physical characteristics but also the orbital and dynamical properties of planetary systems. The taxonomy is diverse but still reflects the observational biases that dominate the detection surveys. We've yet to find another planet that looks anything like home. The scene changed dramatically with the launch of the Kepler spacecraft in 2009 to determine, via transit photometry, the fraction of stars harboring earth-size planets in or near the Habitable Zone of their parent star. Early catalog releases hint that nature makes small planets efficiently: over half of the sample of 2,300 planet candidates discovered in the first two years are smaller than 2.5 times the Earth's radius. I will describe Kepler's milestone discoveries and progress toward an exo-Earth census. Humankind's speculation about the existence of other worlds like our own has become a veritable quest.

  5. Thoracic textilomas: CT findings*

    PubMed Central

    Machado, Dianne Melo; Zanetti, Gláucia; Araujo, Cesar Augusto; Nobre, Luiz Felipe; Meirelles, Gustavo de Souza Portes; Pereira e Silva, Jorge Luiz; Guimarães, Marcos Duarte; Escuissato, Dante Luiz; Souza, Arthur Soares; Hochhegger, Bruno; Marchiori, Edson

    2014-01-01

    OBJECTIVE: The aim of this study was to analyze chest CT scans of patients with thoracic textiloma. METHODS: This was a retrospective study of 16 patients (11 men and 5 women) with surgically confirmed thoracic textiloma. The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus. RESULTS: The majority (62.5%) of the textilomas were caused by previous heart surgery. The most common symptoms were chest pain (in 68.75%) and cough (in 56.25%). In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred in the left. The majority (56.25%) were located in the lower third of the lung. The diameter of the mass was ≤ 10 cm in 10 cases (62.5%) and > 10 cm in the remaining 6 cases (37.5%). Most (81.25%) of the textilomas were heterogeneous in density, with signs of calcification, gas, radiopaque marker, or sponge-like material. Peripheral expansion of the mass was observed in 12 (92.3%) of the 13 patients in whom a contrast agent was used. Intraoperatively, pleural involvement was observed in 14 cases (87.5%) and pericardial involvement was observed in 2 (12.5%). CONCLUSIONS: It is important to recognize the main tomographic aspects of thoracic textilomas in order to include this possibility in the differential diagnosis of chest pain and cough in patients with a history of heart or thoracic surgery, thus promoting the early identification and treatment of this postoperative complication. PMID:25410842

  6. Evolution of imaging findings, laboratory and functional parameters in rheumatoid arthritis patients after one year of treatment with anti-TNF-α agents.

    PubMed

    Detorakis, Efstathios E; Magkanas, Eleftherios; Lasithiotaki, Ismini; Sidiropoulos, Prodromos; Boumpas, Dimitrios T; Gourtsoyiannis, Nicholas; Antoniou, Katerina; Raissaki, Maria

    2017-01-01

    To investigate the efficacy and safety of anti-TNF-α agent treatment compared to non-biologic DMARDs in rheumatoid arthritis patients. 82 consecutive patients, 29 males, 53 females, aged 42-79, diagnosed with RA and suitable for anti-TNF-α treatment composed two study groups: 42 with pre-existing rheumatoid arthritis-related interstitial lung disease (RA-ILD) and 40 without RA-ILD. Respective control groups consisted of 44 patients with pre-existing RA-ILD and 44 patients without RA-ILD, treated with non-biologic DMARDs. All patients underwent chest high resolution computed tomography (HRCT), pulmonary function tests (PFTs) and peripheral blood biomarkers at baseline and after one year of treatment. There was a significant decrease of air trapping extent and bronchial wall thickening after treatment in RA-ILD and RA-non ILD study groups (p<0.05). This was accompanied by a statistically significant improvement of maximum mid-expiratory flow (MMEF75-25), RV and RV/TLC in both study groups (p<0.05). In the RA-ILD study group ILD extent scores remained unchanged after anti-TNF-α treatment. None of the RA-non ILD group developed new-onset ILD. In both RA-ILD and RA-non ILD control groups, HRCT findings and PFTs did not differ significantly at the one-year follow-up study. Methotrexate (MTX) regression analysis showed in both RA-ILD study and control groups a negative correlation between MTX dose and ILD extent score at one-year and between MTX dose and air trapping extent at baseline and after one year of treatment. Anti-TNF-α treatment, in contrast to non-biologic DMARDs, there was an improvement of small airways disease. There was no new-onset ILD or exacerbation of preexisting-ILD, especially in patients treated with anti-TNF-α agents, supporting the efficacy and favourable safety profile of this treatment in RA patients.

  7. Immunological findings in autism.

    PubMed

    Cohly, Hari Har Parshad; Panja, Asit

    2005-01-01

    elevated in autistic brains. In measles virus infection, it has been postulated that there is immune suppression by inhibiting T-cell proliferation and maturation and downregulation MHC class II expression. Cytokine alteration of TNF-alpha is increased in autistic populations. Toll-like-receptors are also involved in autistic development. High NO levels are associated with autism. Maternal antibodies may trigger autism as a mechanism of autoimmunity. MMR vaccination may increase risk for autism via an autoimmune mechanism in autism. MMR antibodies are significantly higher in autistic children as compared to normal children, supporting a role of MMR in autism. Autoantibodies (IgG isotype) to neuron-axon filament protein (NAFP) and glial fibrillary acidic protein (GFAP) are significantly increased in autistic patients (Singh et al., 1997). Increase in Th2 may explain the increased autoimmunity, such as the findings of antibodies to MBP and neuronal axonal filaments in the brain. There is further evidence that there are other participants in the autoimmune phenomenon. (Kozlovskaia et al., 2000). The possibility of its involvement in autism cannot be ruled out. Further investigations at immunological, cellular, molecular, and genetic levels will allow researchers to continue to unravel the immunopathogenic mechanisms' associated with autistic processes in the developing brain. This may open up new avenues for prevention and/or cure of this devastating neurodevelopmental disorder.

  8. Whole-genome Sequencing for Tracing the Transmission Link between Two ARD Outbreaks Caused by a Novel HAdV Serotype 7 Variant, China.

    PubMed

    Qiu, Shaofu; Li, Peng; Liu, Hongbo; Wang, Yong; Liu, Nan; Li, Chengyi; Li, Shenlong; Li, Ming; Jiang, Zhengjie; Sun, Huandong; Li, Ying; Xie, Jing; Yang, Chaojie; Wang, Jian; Li, Hao; Yi, Shengjie; Wu, Zhihao; Jia, Leili; Wang, Ligui; Hao, Rongzhang; Sun, Yansong; Huang, Liuyu; Ma, Hui; Yuan, Zhengquan; Song, Hongbin

    2015-09-04

    From December 2012 to February 2013, two outbreaks of acute respiratory disease caused by HAdV-7 were reported in China. We investigated possible transmission links between these two seemingly unrelated outbreaks by integration of epidemiological and whole-genome sequencing (WGS) data. WGS analyses showed that the HAdV-7 isolates from the two outbreaks were genetically indistinguishable; however, a 12 bp deletion in the virus-associated RNA gene distinguished the outbreak isolates from other HAdV-7 isolates. Outbreak HAdV-7 isolates demonstrated increased viral replication compared to non-outbreak associated HAdV-7 isolate. Epidemiological data supported that the first outbreak was caused by introduction of the novel HAdV-7 virus by an infected recruit upon arrival at the training base. Nosocomial transmission by close contacts was the most likely source leading to onset of the second HAdV-7 outbreak, establishing the apparent transmission link between the outbreaks. Our findings imply that in-hospital contact investigations should be encouraged to reduce or interrupt further spread of infectious agents when treating outbreak cases, and WGS can provide useful information guiding infection-control interventions.

  9. The phylogenetic utility of acetyltransferase (ARD1) and glutaminyl tRNA synthetase (QtRNA) for reconstructing Cenozoic relationships as exemplified by the large Australian cicada Pauropsalta generic complex.

    PubMed

    Owen, Christopher L; Marshall, David C; Hill, Kathy B R; Simon, Chris

    2015-02-01

    The Pauropsalta generic complex is a large group of cicadas (72 described spp.; >82 undescribed spp.) endemic to Australia. No previous molecular work on deep level relationships within this complex has been conducted, but a recent morphological revision and phylogenetic analysis proposed relationships among the 11 genera. We present here the first comprehensive molecular phylogeny of the complex using five loci (1 mtDNA, 4 nDNA), two of which are from nuclear genes new to cicada systematics. We compare the molecular phylogeny to the morphological phylogeny. We evaluate the phylogenetic informativeness of the new loci to traditional cicada systematics loci to generate a baseline of performance and behavior to aid in gene choice decisions in future systematic and phylogenomic studies. Our maximum likelihood and Bayesian inference phylogenies strongly support the monophyly of most of the newly described genera; however, relationships among genera differ from the morphological phylogeny. A comparison of phylogenetic informativeness among all loci revealed that COI 3rd positions dominate the informativeness profiles relative to all other loci but exhibit some among taxon nucleotide bias. After removing COI 3rd positions, COI 1st positions dominate near the terminals, while the period intron has the most phylogenetic informativeness near the root. Among the nuclear loci, ARD1 and QtRNA have lower phylogenetic informativeness than period intron and elongation factor 1 alpha intron, but the informativeness increases at you move from the tips to the root. The increase in phylogenetic informativeness deeper in the tree suggests these loci may be useful for resolving older relationships.

  10. Findings.

    ERIC Educational Resources Information Center

    Viadero, Debra; Coles, Adrienne D.

    1998-01-01

    Studies on race-based admissions, sports and sex, and religion and drugs suggest that: affirmative action policies were successful regarding college admissions; boys who play sports are more likely to be sexually active than their peers, with the opposite true for girls; and religion is a major factor in whether teens use cigarettes, alcohol, and…

  11. Radiographic findings of Proteus Syndrome.

    PubMed

    Gandhi, Nishant Mukesh; Davalos, Eric A; Varma, Rajeev K

    2014-01-01

    The extremely rare Proteus Syndrome is a hamartomatous congenital syndrome with substantial variability between clinical patient presentations. The diagnostic criteria consist of a multitude of clinical findings including hemihypertrophy, macrodactyly, epidermal nevi, subcutaneous hamartomatous tumors, and bony abnormalities. These clinical findings correlate with striking radiographic findings.

  12. Radiographic findings of Proteus Syndrome

    PubMed Central

    Gandhi, Nishant Mukesh; Davalos, Eric A.; Varma, Rajeev K.

    2015-01-01

    The extremely rare Proteus Syndrome is a hamartomatous congenital syndrome with substantial variability between clinical patient presentations. The diagnostic criteria consist of a multitude of clinical findings including hemihypertrophy, macrodactyly, epidermal nevi, subcutaneous hamartomatous tumors, and bony abnormalities. These clinical findings correlate with striking radiographic findings. PMID:27186241

  13. Lung segmentation from HRCT using united geometric active contours

    NASA Astrophysics Data System (ADS)

    Liu, Junwei; Li, Chuanfu; Xiong, Jin; Feng, Huanqing

    2007-12-01

    Accurate lung segmentation from high resolution CT images is a challenging task due to various detail tracheal structures, missing boundary segments and complex lung anatomy. One popular method is based on gray-level threshold, however its results are usually rough. A united geometric active contours model based on level set is proposed for lung segmentation in this paper. Particularly, this method combines local boundary information and region statistical-based model synchronously: 1) Boundary term ensures the integrality of lung tissue.2) Region term makes the level set function evolve with global characteristic and independent on initial settings. A penalizing energy term is introduced into the model, which forces the level set function evolving without re-initialization. The method is found to be much more efficient in lung segmentation than other methods that are only based on boundary or region. Results are shown by 3D lung surface reconstruction, which indicates that the method will play an important role in the design of computer-aided diagnostic (CAD) system.

  14. AR/D image processing system

    NASA Technical Reports Server (NTRS)

    Wookey, Cathy; Nicholson, Bruce

    1991-01-01

    General Dynamics has developed advanced hardware, software, and algorithms for use with the Tomahawk cruise missile and other unmanned vehicles. We have applied this technology to the problem of locating and determining the orientation of the docking port of a target vehicle with respect to an approaching spacecraft. The system described in this presentation utilizes a multi-processor based computer to digitize and process television imagery and extract parameters such as range to the target vehicle, approach, velocity, and pitch and yaw angles. The processor is based on the Inmos T-800 Transputer and is configured as a loosely coupled array. Each processor operates asynchronously and has its own local memory. This allows additional processors to be easily added if additional processing power is required for more complex tasks. Total system throughput is approximately 100 MIPS (scalar) and 60 MFLOPS and can be expanded as desired. The algorithm implemented on the system uses a unique adaptive thresholding technique to locate the target vehicle and determine the approximate position of the docking port. A target pattern surrounding the port is than analyzed in the imagery to determine the range and orientation of the target. This information is passed to an autopilot which uses it to perform course and speed corrections. Future upgrades to the processor are described which will enhance its capabilities for a variety of missions.

  15. Find a Registered Dietitian Nutritionist

    MedlinePlus

    ... Sign In Join / Renew About Us Shopping Cart | Media Find an Expert Submit Search Submit Find an Expert Learn More About Us What an RDN Can Do for You National Nutrition Month® Popular Links Videos Recipes For Kids On eatrightPRO.org Accreditation Info CPE Opportunities Member ...

  16. Revisiting the Archival Finding Aid

    ERIC Educational Resources Information Center

    Cox, Richard J.

    2007-01-01

    Archivists have been creating finding aids for generations, and in the last three decades they have done this work via a succession of standardized formats. However, like many other disciplines, they have carried out such work in violation of systems analysis. Although purporting to have the users of finding aids systems first and foremost in…

  17. Finding the object'' proceedings addendum

    SciTech Connect

    Whiting, M.A.; Devaney, D.M.

    1990-10-01

    The purpose of this workshop was to discuss finding the object -- that is, how software engineers imagine, invent, design, or recycle objects and their behaviors for object-oriented software engineering. The workshop organizers (and, as we subsequently discovered, several of the workshop participants) felt that this issue is crucial to successful object-oriented software engineering (after all, finding objects is what the projects is all about, isn't it ). Unfortunately, when previous workshops have had the opportunity to review and discuss techniques practitioners use to find objects, too often the results were heated debates on what is an object '' which becomes all consuming. We believed that, given appropriate control over the question of which kind of object'' is being discussed (which meant tell us what object you are trying to find, then tell us your method), a workshop to concentrate on techniques for finding objects would be quite appropriate. 8 refs., 2 figs.

  18. Ultrasound findings in trisomy 22.

    PubMed

    Schwendemann, Wade D; Contag, Stephen A; Koty, Patrick P; Miller, Richard C; Devers, Patricia; Watson, William J

    2009-02-01

    We sought to identify the characteristic sonographic findings of fetal trisomy 22 by performing a retrospective review of nine cases of fetal trisomy 22. All cases of chromosomal mosaicism were excluded, as were first-trimester losses. Indications for sonography, gestational age, and sonographically detected fetal anomalies were analyzed. The majority of patients were referred for advanced maternal age or abnormal ultrasound findings on screening exam. Oligohydramnios was the most common sonographic finding, present in 55% of affected fetuses. Intrauterine growth restriction and increased nuchal thickness were slightly less frequent.

  19. NAOS -- finding NAOMI guide stars

    NASA Astrophysics Data System (ADS)

    Davenhall, A. C.

    Observations made with the NAOMI adaptive optics system on the William Herschel Telescope (WHT) usually require a guide star located close to the target object being observed. This manual describes how to find such guide stars. It documents the NAOS package whose purpose is precisely to find suitable guide stars and also describes various related items of software. Details of the potential guide stars are produced as tabular lists in text files, finding charts and tables in a format suitable for input into GAIA or CURSA. This document is aimed at astronomers who are planning to observe with the NAOMI adaptive optics system on the WHT and need to find guide stars for their target objects.

  20. A Family Finds Its Way

    MedlinePlus

    ... Cover Story: Traumatic Brain Injury A Family Finds Its Way Past Issues / Fall 2008 Table of Contents ... spoke recently with NIH MedlinePlus ' Christopher Klose. At its heart, TBI, hearing loss, any health condition is ...

  1. Improved VHF direction finding system

    NASA Technical Reports Server (NTRS)

    Graf, E. R.; Neff, H.

    1969-01-01

    Direction finding device operating at very high frequencies requires a loop antenna, mechanical rotation, and large structures. The system is applicable to an unmanned configuration. Direction information is extracted in the form of a direction cosine analog.

  2. Find a NCCAOM Certified Practitioner

    MedlinePlus

    ... NCCAOM Certification Get Certified Get Recertified PDA Search Engine Find A Practitioner State Licensing Helpful NCCAOM Links ... My Status State Licensure Diplomates Recertification PDA Search Engine State Licensure Consumers Diplomate of Acupuncture Diplomate of ...

  3. Visual direction finding by fishes

    NASA Technical Reports Server (NTRS)

    Waterman, T. H.

    1972-01-01

    The use of visual orientation, in the absence of landmarks, for underwater direction finding exercises by fishes is reviewed. Celestial directional clues observed directly near the water surface or indirectly at an asymptatic depth are suggested as possible orientation aids.

  4. Oral tuberculosis: unusual radiographic findings.

    PubMed

    Sansare, K; Gupta, A; Khanna, V; Karjodkar, F

    2011-05-01

    Oral tuberculosis and its radiographic findings are not commonly encountered in an oral and maxillofacial radiology practice. Literature has occasional mention of the radiographic findings of oral tuberculosis, which are still ambiguous. When affected, it is manifested majorly in the oral mucosa and rarely in the jaw bones. Here, we report certain unusual radiographic findings of oral tuberculosis which have been rarely mentioned in the literature. Four illustrative cases describe bony resorption, condylar resorption, resorption of the inferior border of the mandible and rarefaction of the alveolar bone as radiographic findings of oral tuberculosis. Follow up of the first case demonstrated regeneration of the condylar head after anti-Kochs therapy was completed, a hitherto unreported phenomenon. The importance of including tuberculosis in the differential diagnosis of some of the unusual radiographic manifestations is emphasized.

  5. Radiographic findings in liveborn triploidy.

    PubMed

    Silverthorn, K G; Houston, C S; Newman, D E; Wood, B J

    1989-01-01

    The detailed radiographic features of triploidy, a fatal congenital disorder with 69 chromosomes, have not previously been reported. Radiographs of ten liveborn infants with chromosomally confirmed triploidy showed six findings highly suggestive of this diagnosis: harlequin orbits, small anterior fontanelle, gracile ribs, diaphyseal overtubulation of long bones, upswept clavicles and antimongoloid pelvis. Sixteen other less specific findings showed many similarities to those found in trisomy 18.

  6. Ophthalmologic findings in biotinidase deficiency.

    PubMed

    Salbert, B A; Astruc, J; Wolf, B

    1993-01-01

    Biotinidase deficiency is an autosomal recessively inherited metabolic disorder characterized by neurological and cutaneous manifestations and metabolic abnormalities. We studied 78 symptomatic children and found that 51% had ophthalmologic abnormalities. These include infections (30%), optic neuropathies and visual disturbances (13%), motility disturbances (13%), retinal pigment changes (4%) and pupillary findings (1%). The most commonly reported findings are optic atrophy and keratoconjunctivities. Although the disorder can be effectively treated with biotin therapy, untreated children are at risk of developing permanent neuro-ophthalmic damage.

  7. Finding Nested Common Intervals Efficiently

    NASA Astrophysics Data System (ADS)

    Blin, Guillaume; Stoye, Jens

    In this paper, we study the problem of efficiently finding gene clusters formalized by nested common intervals between two genomes represented either as permutations or as sequences. Considering permutations, we give several algorithms whose running time depends on the size of the actual output rather than the output in the worst case. Indeed, we first provide a straightforward O(n 3) time algorithm for finding all nested common intervals. We reduce this complexity by providing an O(n 2) time algorithm computing an irredundant output. Finally, we show, by providing a third algorithm, that finding only the maximal nested common intervals can be done in linear time. Considering sequences, we provide solutions (modifications of previously defined algorithms and a new algorithm) for different variants of the problem, depending on the treatment one wants to apply to duplicated genes.

  8. Acid corrosive esophagitis: radiographic findings.

    PubMed

    Muhletaler, C A; Gerlock, A J; de Soto, L; Halter, S A

    1980-06-01

    Thirty-nine esophagograms of 24 patients after ingestion of muriatic acid (27% HCI) in suicide attempts were reviewed. All esophagograms were obtained in the acute, subacute, and chronic phases. In the acute and subacute phases, the radiographic findings consisted of mucosal edema, submucosal edema or hemorrhage, ulcerations, sloughing of the mucosa, atony, and dilatation. Strictures of the esophagus were present in the chronic phase. These radiographic findings were not different from those found in alkaline corrosive esophagitis. The severity of the corrosive esophagitis is considered related to the concentration, amount, viscosity, and duration of contact between the caustic agent and the esophageal mucosa.

  9. Scintigraphic findings in ankylosing spondylitis.

    PubMed

    Lentle, B C; Russell, A S; Percy, J S; Jackson, F I

    1977-06-01

    A prospective study of bone scintigraphic findings has been carried out in 63 patients, firmly diagnosed as having ankylosing spondylitis. In addition to abnormal uptake of the radiotracer at the sacroiliac joints, a peripheral arthropathy has been a common finding, particularly in the proximal joints, occurring in up to 50% of patients. Increased uptake of radiotracer in the spine has also been found both diffusely and focally. Focal increases have been noted at the apophyseal joints in 40% of patients and in three patients with a sterile intervertebral diskitis, an unusual complication of this disease only diagnosed in two patients after bone scintigraphy.

  10. Peak finding using biorthogonal wavelets

    SciTech Connect

    Tan, C.Y.

    2000-02-01

    The authors show in this paper how they can find the peaks in the input data if the underlying signal is a sum of Lorentzians. In order to project the data into a space of Lorentzian like functions, they show explicitly the construction of scaling functions which look like Lorentzians. From this construction, they can calculate the biorthogonal filter coefficients for both the analysis and synthesis functions. They then compare their biorthogonal wavelets to the FBI (Federal Bureau of Investigations) wavelets when used for peak finding in noisy data. They will show that in this instance, their filters perform much better than the FBI wavelets.

  11. Autopsy findings of fatal cryptogenic organizing pneumonia.

    PubMed

    Terada, Tadashi

    2013-01-01

    Autopsy cases of cryptogenic organizing pneumonia (COP) have been rarely reported. A 73-year-old Japanese man consulted to a hospital because of flu-like sickness. He was diagnosed as pneumonia, and treated by antibiotics. He was referred to our hospital for further treatment. Chest X-P showed pneumonia involving the whole lungs. Blood laboratory test showed leukocytosis, increased CRP, and decreased PaO2. Despite of steroid therapy, he showed a downhill course and died one month after the first manifestation. The clinical diagnosis was acute pneumonia or ARDS. At autopsy, the both lungs were voluminous. The weight of lungs was 1050 g in the left lung and 1300 g in the right lung. The both lungs were entirely affected. The lungs were hard and little air was recognized. Microscopically, almost all alveolar spaces contained Masson's bodies. Bronchiolitis obliterans was not recognized. The alveolar walls were not affected. The Masson's bodies showed collagenization with lymphocytic infiltration. Hyalinization of Masson's bodies with little inflammatory infiltration was frequently seen. Cartilagenous metaplasia and ossification of Masson's bodies were seen in some places. The pulmonary arteries were affected by fibrosis, and occasionally showed thrombosis. The pathological diagnosis was COP. The heart weighted 500 g, and showed right ventricular hypertrophy (cor pulmonale). Other pathologic changes were pleural effusion (left, 800 ml: right, 1200 ml), acute liver congestion, prostatic hypertrophy, colon adenoma, and hypercellular bone marrow. The cause of death was respiratory failure due to COP and pleural effusion. In conclusion, the author reported an autopsy case of fatal COP.

  12. Autopsy findings of fatal cryptogenic organizing pneumonia

    PubMed Central

    Terada, Tadashi

    2013-01-01

    Autopsy cases of cryptogenic organizing pneumonia (COP) have been rarely reported. A 73-year-old Japanese man consulted to a hospital because of flu-like sickness. He was diagnosed as pneumonia, and treated by antibiotics. He was referred to our hospital for further treatment. Chest X-P showed pneumonia involving the whole lungs. Blood laboratory test showed leukocytosis, increased CRP, and decreased PaO2. Despite of steroid therapy, he showed a downhill course and died one month after the first manifestation. The clinical diagnosis was acute pneumonia or ARDS. At autopsy, the both lungs were voluminous. The weight of lungs was 1050 g in the left lung and 1300 g in the right lung. The both lungs were entirely affected. The lungs were hard and little air was recognized. Microscopically, almost all alveolar spaces contained Masson’s bodies. Bronchiolitis obliterans was not recognized. The alveolar walls were not affected. The Masson’s bodies showed collagenization with lymphocytic infiltration. Hyalinization of Masson’s bodies with little inflammatory infiltration was frequently seen. Cartilagenous metaplasia and ossification of Masson’s bodies were seen in some places. The pulmonary arteries were affected by fibrosis, and occasionally showed thrombosis. The pathological diagnosis was COP. The heart weighted 500 g, and showed right ventricular hypertrophy (cor pulmonale). Other pathologic changes were pleural effusion (left, 800 ml: right, 1200 ml), acute liver congestion, prostatic hypertrophy, colon adenoma, and hypercellular bone marrow. The cause of death was respiratory failure due to COP and pleural effusion. In conclusion, the author reported an autopsy case of fatal COP. PMID:23696931

  13. Going Local to Find Help

    MedlinePlus

    ... activities, such as exercise? Can I drive my car? What drugs should I take or stop taking? May I drink alcohol? If so, how much? What other problems could this injury cause? Will I need any special treatment or therapy? Finding local health and social services for survivors ...

  14. Writing audit findings: Be reasonable!

    SciTech Connect

    Girvin, N.W.

    1992-05-01

    A customary approach to auditing and reporting deficiencies is to keep a running list of those that are found, evaluate the severity of each, and based on the evidence, document findings or observations or concerns in an audit report. The report is issued and the auditee is normally requested to address ``root cause`` as part of their corrective action. This paper describes a ``root problems`` approach to documenting audit findings that is designed not only to put the QA auditor in a more favorable light, but to more effectively enable the auditee to identify root cause and meaningful corrective action. The positive results of this approach are considerable. You will have fewer findings but those you do have will be substantial. You will cite requirements that sound reasonable and make arguments difficult. If some of the supporting deficiencies (examples) prove to be incorrect, you will still have ample support for the original finding. You will be seen as reasonable individual who can help lead the auditee towards identification of root cause without taking away part of the responsibility. You even have a fair chance of fostering a sense of commitment to quality improvement on the auditee`s part. This in itself, is its own reward.

  15. Writing audit findings: Be reasonable

    SciTech Connect

    Girvin, N.W.

    1992-05-01

    A customary approach to auditing and reporting deficiencies is to keep a running list of those that are found, evaluate the severity of each, and based on the evidence, document findings or observations or concerns in an audit report. The report is issued and the auditee is normally requested to address root cause'' as part of their corrective action. This paper describes a root problems'' approach to documenting audit findings that is designed not only to put the QA auditor in a more favorable light, but to more effectively enable the auditee to identify root cause and meaningful corrective action. The positive results of this approach are considerable. You will have fewer findings but those you do have will be substantial. You will cite requirements that sound reasonable and make arguments difficult. If some of the supporting deficiencies (examples) prove to be incorrect, you will still have ample support for the original finding. You will be seen as reasonable individual who can help lead the auditee towards identification of root cause without taking away part of the responsibility. You even have a fair chance of fostering a sense of commitment to quality improvement on the auditee's part. This in itself, is its own reward.

  16. MEMS AO for Planet Finding

    NASA Technical Reports Server (NTRS)

    Rao, Shanti; Wallace, J. Kent; Shao, Mike; Schmidtlin, Edouard; Levine, B. Martin; Samuele, Rocco; Lane, Benjamin; Chakrabarti, Supriya; Cook, Timothy; Hicks, Brian; hide

    2008-01-01

    This slide presentation reviews a method for planet finding using microelectromechanical systems (MEMS) Adaptive Optics (AO). The use of a deformable mirror (DM) is described as a part of the instrument that was designed with a nulling interferometer. The strategy that is used is described in detail.

  17. Finding a Voice through Research

    ERIC Educational Resources Information Center

    Lobo, Jose; Vizcaino, Alida

    2006-01-01

    One question guided this experimental study: What impact does the change from teacher training to educational research have on university teachers' methodology and attitudes to teaching? To find answers to this question, the researchers selected five teachers of English as a Foreign Language (EFL) at the language centre of a private university on…

  18. Imaging findings of Pott's disease.

    PubMed

    Rivas-Garcia, Antonio; Sarria-Estrada, Silvana; Torrents-Odin, Carme; Casas-Gomila, Lourdes; Franquet, Elisa

    2013-06-01

    Tuberculosis (TB) continues to be an important public health problem in developed countries especially in deprived socioeconomic groups, older people, immunocompromised patients, drug-therapy resistant cases and the immigrant population. The spine is the most frequent location of musculoskeletal TB. The wide range of clinical presentations results in difficulties and delays in diagnosis. Advanced disease mimics other infections and malignancy. The diagnosis of spinal infections relies on three main factors: clinical symptoms, imaging and bacteriological culture. Advanced imaging such as Magnetic Resonance Imaging (MRI), Multidetector Computed Tomography (MDCT) and Fluor18-Deoxiglucose Positron Emission Tomography combined with CT (F-18 FDG PET-CT) demonstrate lesion extent, serve as guide for biopsy with aspiration for culture, assist surgery planning and contribute to follow-up. Diagnosis of TB cannot be established solely on the basis of clinical tests or imaging findings and biopsy may be required. Differential diagnosis between tuberculous and pyogenic spondylitis is of clinical importance, but may be difficult on the basis of radiological findings alone. Findings not pathognomonic but favoring tuberculous etiology include: slow progression of lesions with late preservation of disk space, involvement of several contiguous segments, large intraosseous and paraspinal abscesses containing calcifications, and body collapse with kyphotic deformity. In this essay the highlights of TB imaging are reviewed through published literature. In addition, we review retrospectively the radiological findings of 48 patients with tuberculous spondylitis treated from 1993 to 2010. There were 23 male and 25 female patients with a mean age of 53 years.

  19. MR imaging findings of endophthalmitis

    PubMed Central

    Radhakrishnan, Rupa; Cornelius, Rebecca; Cunnane, Mary Beth; Golnik, Karl

    2016-01-01

    Endophthalmitis is a sight-threatening ophthalmologic emergency. The clinical diagnosis is often challenging, and delayed diagnosis may exacerbate the poor visual prognosis. B-scan ultrasonography or spectral domain optical coherence tomography are imaging aids at the clinician’s office. Cross-sectional imaging such as CT and particularly MRI can also help in the assessment of disease extent or complications. MR imaging findings are rarely described in the literature. Here, we discuss the spectrum of imaging findings of endophthalmitis and correlate them with key anatomic and pathophysiologic details of the globe. Early disease is often subtle on MR imaging with thick uveal enhancement, while advanced disease demonstrates retinal/choroidal detachment, vitreal exudates and peribulbar inflammation. Other noninfectious inflammatory diseases of the globe can show similar findings; however, MR diffusion-weighted images help identify infectious exudates and evaluate response to therapy. Knowledge of the spectrum of imaging findings of this disease is important for radiologists and help in the management decision process. PMID:26915896

  20. Finding Geography Using Found Poetry

    ERIC Educational Resources Information Center

    Foster, Ellen J.

    2012-01-01

    Functional literacy is important in both English/language arts and geography. Using the "found poetry" strategy, students will summarize a piece of text, identify main ideas and find geographic connections. While using young adult literature is a great way to incorporate geography into English/language arts classroom, understanding of geography…

  1. Multi-Criteria Path Finding

    NASA Astrophysics Data System (ADS)

    Mohammadi, E.; Hunter, A.

    2012-07-01

    Path finding solutions are becoming a major part of many GIS applications including location based services and web-based GIS services. Most traditional path finding solutions are based on shortest path algorithms that tend to minimize the cost of travel from one point to another. These algorithms make use of some cost criteria that is usually an attribute of the edges in the graph network. Providing one shortest path limits user's flexibility when choosing a possible route, especially when more than one parameter is utilized to calculate cost (e.g., when length, number of traffic lights, and number of turns are used to calculate network cost.) K shortest path solutions tend to overcome this problem by providing second, third, and Kth shortest paths. These algorithms are efficient as long as the graphs edge weight does not change dynamically and no other parameters affect edge weights. In this paper we try to go beyond finding shortest paths based on some cost value, and provide all possible paths disregarding any parameter that may affect total cost. After finding all possible paths, we can rank the results by any parameter or combination of parameters, without a substantial increase in time complexity.

  2. Electroencephalographic findings in panic disorder.

    PubMed

    Carvalho, Marcele Regine de; Velasques, Bruna Brandao; Cagy, Mauricio; Marques, Juliana Bittencourt; Teixeira, Silmar; Nardi, Antonio Egidio; Piedade, Roberto; Ribeiro, Pedro

    2013-12-01

    Some studies have reported the importance of electroencephalography (EEG) as a method for investigating abnormal parameters in psychiatric disorders. Different findings in time and frequency domain analysis with regard to central nervous system arousal during acute panic states have already been obtained. This study aimed to systematically review the EEG findings in panic disorder (PD), discuss them having a currently accepted neuroanatomical hypothesis for this pathology as a basis, and identify limitations in the selected studies. Literature search was conducted in the databases PubMed and ISI Web of Knowledge, using the keywords electroencephalography and panic disorder; 16 articles were selected. Despite the inconsistency of EEG findings in PD, the major conclusions about the absolute power of alpha and beta bands point to a decreased alpha power, while beta power tends to increase. Different asymmetry patterns were found between studies. Coherence studies pointed to a lower degree of inter-hemispheric functional connectivity at the frontal region and intra-hemispheric at the bilateral temporal region. Studies on possible related events showed changes in memory processing in PD patients when exposed to aversive stimuli. It was noticed that most findings reflect the current neurobiological hypothesis of PD, where inhibitory deficits of the prefrontal cortex related to the modulation of amygdala activity, and the subsequent activation of subcortical regions, may be responsible to trigger anxiety responses. We approached some important issues that need to be considered in further researches, especially the use of different methods for analyzing EEG signals.

  3. Findings from ATSDR's Health Assessments.

    ERIC Educational Resources Information Center

    Susten, Allan S.

    1992-01-01

    Summarizes findings from the Agency for Toxic Substances and Disease Registry concerning the evaluation of data about hazardous substance release into the environment. Identifies the hazardous substances, exposure, health effects, and public health impact from 951 facilities identified on the National Priorities List (NPL) by the Environmental…

  4. Finding Cryptography in Object Code

    SciTech Connect

    Jason L. Wright

    2008-10-01

    Finding and identifying Cryptography is a growing concern in the malware analysis community. In this paper, a heuristic method for determining the likelihood that a given function contains a cryptographic algorithm is discussed and the results of applying this method in various environments is shown. The algorithm is based on frequency analysis of opcodes that make up each function within a binary.

  5. 1980-1981 Evaluation Findings.

    ERIC Educational Resources Information Center

    Austin Independent School District, TX. Office of Research and Evaluation.

    This volume summarizes the results of evaluation and testing activities carried out in the Austin, Texas, Independent School District (AISD) during the 1980-81 school year. The text consists of five parts: Section one highlights important findings in the areas of Title I Schoolwide Projects, compensatory programs, early childhood programs,…

  6. [Typical findings of maltreated children].

    PubMed

    Rauch, E; Zinka, B; Schneider, K; Penning, R; Eisenmenger, W

    2006-06-15

    Childhood maltreatment manifests in a variety of forms and the underlying causes are manifold. In contrast to other offences involving physical injury, reporting behavior has, statistically speaking, remained unchanged. Patterns of injury must first be established and documented, and this involves a complete examination of the child's body. Depending on the constellation of findings, a radiological diagnosis is usually necessary. When all the findings have been collected, the further steps to be taken--where indicated a report to the police--must be discussed. All the evidence must be recorded, and photos obtained of all externally visible injuries before they fade. It is not the task of the physician to develop criminalistic ambitions, for example, by grilling (a parent) on the cause of the injuries. However, he/she has a duty to do everything necessary to protect the well-being of the child.

  7. Angiographic findings in tumoral calcinosis.

    PubMed

    Neeman, Ziv; Wood, Bradford J

    2003-01-01

    Tumor calcinosis is uncommon, typically manifesting as paraarticular, extracapsular soft tissue deposits containing amorphous calcium phosphate and calcium carbonate, with associated hydroxyapatite crystal. CT and MRI are the primary diagnostic radiological tools evaluating these lesions. Primary treatment is early surgical excision with wide margins, as there is a high recurrence rate. We describe the angiographic findings in tumoral calcinosis, demonstrating hypervascularity beyond the calcified mass periphery. Exact margin definition with angiography may influence management and surgical approach.

  8. Radiological Findings of Michel Aplasia

    PubMed Central

    Umul, Ayse; Demirtas, Hakan; Celik, Ahmet Orhan

    2016-01-01

    Introduction: Congenital abnormalities of the inner ear is the most common cause of neurosensory hearing loss. Michel inner ear deformity is a rare developmental anomaly refers to the total aplasia of the inner ear. It is caused by developmental arrest of otic placode early during the third week of gestational age. Case report: We have discussed here that three year old girl diagnosed Michel aplasia with temporal bone computed tomography (CT) and temporal magnetic resonance imaging (MRI) findings. PMID:27482139

  9. Breast Ultrasound: Indications and Findings.

    PubMed

    Gundry, Kathleen R

    2016-06-01

    Breast ultrasound is a widely used adjuvant to mammography for the detection of breast cancer. This chapter will review some of the basic ultrasound technical factors and techniques, describe findings on ultrasound with an emphasis on the Breast Imaging Reporting and Data System terminology, and present the indications for breast ultrasound. New innovations in breast ultrasound, such as elastography, ultrasound contrast, 3-dimensional, and automated whole-breast ultrasound, will be reviewed. Ultrasound-guided breast procedures are also presented.

  10. Electroencephalographic Findings in Posthypoxic Myoclonus.

    PubMed

    van Zijl, J C; Beudel, M; vd Hoeven, H J; Lange, F; Tijssen, M A J; Elting, J W J

    2016-05-01

    The physical examination findings of early posthypoxic myoclonus (PHM) are associated with poor prognosis. Recent findings indicate that patients with multifocal PHM, assumed to have a cortical origin, have a comparable outcome to resuscitated patients without PHM. Generalized PHM, assumed to have a subcortical myoclonus origin, is still associated with a bad clinical outcome. It is not known whether the electroencephalographic (EEG) findings differ between the multifocal and generalized myoclonus groups nor is the clinical significance clearly defined. Forty-three patients with PHM were retrospectively derived from an EEG database. Patients were categorized as having multifocal (i), generalized (ii), or undetermined (iii) PHM. Outcome was expressed in cerebral performance category scores. The EEG background was categorized into isoelectric (I), low voltage (II), burst suppression (III), status epilepticus (SE; IV), diffuse slowing (V), and mild encephalopathic or normal (VI). 17 patients had generalized PHM and 23 had multifocal PHM (3 undetermined). The EEG showed more SE in generalized compared to multifocal PHM (64% vs 13%, P< .001). Diffuse slowing was more often present in multifocal PHM (52% vs 17%, P < .05). Early-onset myoclonus occurred significantly more often in generalized PHM, and early generalized PHM was invariantly associated with poor outcome. In conclusion, patients with generalized PHM showed more SE. These EEG findings might be either subcortical corollaries or primarily cortical phenomena. Our retrospective results conflict with currently used clinical criteria for myoclonus classification, and we suggest that more refined difference may be needed for accurate assessment of PHM. To better understand PHM, prospective research with standardized clinical assessment and quantitative EEG analysis is needed. © The Author(s) 2015.

  11. Painful heel: MR imaging findings.

    PubMed

    Narváez, J A; Narváez, J; Ortega, R; Aguilera, C; Sánchez, A; Andía, E

    2000-01-01

    Heel pain is a common and frequently disabling clinical complaint that may be caused by a broad spectrum of osseous or soft-tissue disorders. These disorders are classified on the basis of anatomic origin and predominant location of heel pain to foster a better understanding of this complaint. The disorders include plantar fascial lesions (fasciitis, rupture, fibromatosis, xanthoma), tendinous lesions (tendinitis, tenosynovitis), osseous lesions (fractures, bone bruises, osteomyelitis, tumors), bursal lesions (retrocalcaneal bursitis, retroachilleal bursitis), tarsal tunnel syndrome, and heel plantar fat pad abnormalities. With its superior soft-tissue contrast resolution and multiplanar capability, magnetic resonance (MR) imaging can help determine the cause of heel pain and help assess the extent and severity of the disease in ambiguous or clinically equivocal cases. Careful analysis of MR imaging findings and correlation of these findings with patient history and findings at physical examination can suggest a specific diagnosis in most cases. The majority of patients with heel pain can be successfully treated conservatively, but in cases requiring surgery (eg, plantar fascia rupture in competitive athletes, deeply infiltrating plantar fibromatosis, masses causing tarsal tunnel syndrome), MR imaging is especially useful in planning surgical treatment by showing the exact location and extent of the lesion.

  12. The current state in the evaluation and treatment of ARdS and SIRS.

    PubMed

    Schroeder, Josh E; Weiss, Yoram G; Mosheiff, Rami

    2009-11-01

    Trauma, the number one cause of death until the fourth decade of life, causes an inflammatory response. This response in its extreme is associated with the development of the systemic inflammatory state, adult respiratory distress syndrome, multi-organ failure, and death. The inflammatory response is mediated via multiple pathways- the inflammatory-cytokine, immunologic, coagulation and endocrine pathways. It is countered by producing antiinflammatory mediators. This reaction is altered in elderly patients. Knowledge of the patient's prior medical problems and the differential diagnosis for the possible causes of the current condition should help direct the surgical intervention and supportive care in an attempt to stabilize the patient. With the improvement of monitoring and diagnostic technologies, understanding the significance of the inflammatory pathways in trauma patients will decrease morbidity and mortality in this group of patients.

  13. [The chest CT findings and pathologic findings of pulmonary tuberculosis].

    PubMed

    Ogata, Hideo

    2009-08-01

    The past research of the radiologic manifestations of pulmonary tuberculosis in Japan was based on morphological pathology of the untreated patient autopsy. I would like to show the chest CT scan of tuberculosis diseases with caseous granuloma at its exudative reaction, proliferative reaction, productive reaction, cirrhotic reaction until self cure. This progress reflects the normal cell mediated immunological responses. Also I would like to show the cavitation of granuloma, which results from liquefaction of caseous materials during the course and results in the formation of the source of infection. And finally I would like to show the morphological differences of acinous lesion, acino-nodular lesion and caseous lobular pneumonia. These differences reflect the amount of bacilli disseminated in the peripheral parts under the lobules. In this study, I do not show old age cases and HIV positive cases, who do not form typical granuloma due to the decreased cell mediated immnunity and whose X ray findings are atypical.

  14. Endoscopic findings in uninvestigated dyspepsia

    PubMed Central

    2014-01-01

    Background It is important to know the causes of dyspepsia to establish the therapeutic approach. Dyspepsia is a frequent syndrome in our country, where there are restrictions to endoscopy and high prevalence of Helicobacter pylori (H. pylori) infection. This study aimed to assess the endoscopic findings of the syndrome, in an outpatient screening clinic of a tertiary hospital in São Paulo. Methods Outpatients with uninvestigated dyspepsia, according to Rome III criteria, answered a dyspepsia questionnaire and underwent esophagogastroduodenoscopy. The Rapid Urease Test was applied to fragments of the antral mucosa and epidemiological data were collected from the studied population. Organic dyspepsia findings were analyzed with different variables to verify statistically significant associations. Results Three hundred and six patients were included and 282 were analyzed in the study. The mean age was 44 years and women comprised 65% of the sample. Forty-five percent of the patients reported alarm symptoms. Functional dyspepsia was found in 66% of the patients (20% with normal endoscopy results and 46% with gastritis), 18% had GERD and 13% had ulcers (duodenal in 9% and gastric in 4%). Four cases of gastric adenocarcinoma were identified (1.4%), one without alarm characteristics, 1 case of adenocarcinoma of the distal esophagus and 1 case of gastric lymphoma. The prevalence of H. pylori was 54% and infection, age and smoking status were associated with organic dyspepsia. The age of 48 years was indicative of alarm signs. Conclusions The endoscopic diagnosis of uninvestigated dyspepsia in our setting showed a predominance of functional disease, whereas cancer was an uncommon finding, despite the high prevalence of H. pylori. Organic dyspepsia was associated with infection, age and smoking status. PMID:24499444

  15. MRI findings in Hirayama disease.

    PubMed

    Raval, Monali; Kumari, Rima; Dung, Aldrin Anthony Dung; Guglani, Bhuvnesh; Gupta, Nitij; Gupta, Rohit

    2010-11-01

    The objective of the study was to study the magnetic resonance imaging (MRI) features of Hirayama disease on a 3 Tesla MRI scanner. Nine patients with clinically suspected Hirayama disease were evaluated with neutral position, flexion, contrast-enhanced MRI and fast imaging employing steady-state acquisition (FIESTA) sequences. The spectrum of MRI features was evaluated and correlated with the clinical and electromyography findings. MRI findings of localized lower cervical cord atrophy (C5-C7), abnormal curvature, asymmetric cord flattening, loss of attachment of the dorsal dural sac and subjacent laminae in the neutral position, anterior displacement of the dorsal dura on flexion and a prominent epidural space were revealed in all patients on conventional MRI as well as with the dynamic 3D-FIESTA sequence. Intramedullary hyperintensity was seen in four patients on conventional MRI and on the 3D-FIESTA sequence. Flow voids were seen in four patients on conventional MRI sequences and in all patients with the 3D-FIESTA sequence. Contrast enhancement of the epidural component was noted in all the five patients with thoracic extensions. The time taken for conventional and contrast-enhanced MRI was about 30-40 min, while that for the 3D-FIESTA sequence was 6 min. Neutral and flexion position MRI and the 3D-FIESTA sequence compliment each other in displaying the spectrum of findings in Hirayama disease. A flexion study should form an essential part of the screening protocol in patients with suspected Hirayama disease. Newer sequences such as the 3D-FIESTA may help in reducing imaging time and obviating the need for contrast.

  16. Lithium nephropathy: unique sonographic findings.

    PubMed

    Di Salvo, Donald N; Park, Joseph; Laing, Faye C

    2012-04-01

    This case series describes a unique sonographic appearance consisting of numerous microcysts and punctate echogenic foci seen on renal sonograms of 10 adult patients receiving chronic lithium therapy. Clinically, chronic renal insufficiency was present in 6 and nephrogenic diabetes insipidus in 2. Sonography showed numerous microcysts and punctate echogenic foci. Computed tomography in 5 patients confirmed microcysts and microcalcifications, which were fewer in number than on sonography. Magnetic resonance imaging in 2 patients confirmed microcysts in each case. Renal biopsy in 1 patient showed chronic interstitial nephritis, microcysts, and tubular dilatation. The diagnosis of lithium nephropathy should be considered when sonography shows these findings.

  17. Radiologic findings in primary hyperoxaluria

    SciTech Connect

    Martijn, A.; Thijn, C.J.P.

    1982-03-01

    Six out of seven patients with primary hyperoxaluria showed various degrees of oxalosis. The radiographic manifestations differ between patients younger than 15 years and those older than 45 years. The mild manifestations in children, only urolithiasis, can be explained by the, as yet, unimpaired renal function. The renal function in the older patients, with extensive pathologic changes like nephrocalcinosis, urolithiasis, soft-tissue calcification, and osseous changes, is very poor. The findings of extensive softtissue calcification and the bony changes are not in complete agreement with those in the literature.

  18. Audiologic findings in Pfeiffer syndrome.

    PubMed

    Desai, Urmen; Rosen, Heather; Mulliken, John B; Gopen, Quinton; Meara, John G; Rogers, Gary F

    2010-09-01

    Hearing loss has been described in patients with certain craniosynostotic syndromes but is poorly defined in Pfeiffer syndrome (PS). Our objective was to characterize the otologic and audiologic findings in PS. The records of PS patients evaluated at our craniofacial center over a 30-year period were culled. Only patients with a confirmed diagnosis and formal audiologic examination were included. Diagnostic criteria were characteristic mutations in fibroblast growth factor receptor 1 or 2 (FGFR1, FGFR2) or, in the absence of genetic testing, typical clinical findings of PS as determined by a clinical geneticist or the most senior author. Twenty patients met the inclusion criteria, and all had hearing loss. Twenty patients had traditional audiologic testing: 14 (70%) had pure conductive loss (minor to severe), and 3 (15%) had a mixed conductive/sensorineural loss (minor to severe). Two additional patients had hearing loss by Behavioral Observational Audiometry (sound fields method). One patient with early conductive hearing loss was subsequently determined to have a pure sensorineural deficit. Nine patients (45%) had permanent hearing loss significant enough to require audiologic amplification. All patients with PS demonstrated hearing loss, although the severity and the anatomic basis (ie., neural vs conductive) were variable. Conductive hearing loss, possibly caused by structural abnormalities, was most common. Sensorineural hearing loss was less common and may be related to the effect of FGFR mutations on cranial nerve and/or inner-ear development.

  19. Atelosteogenesis type I: autopsy findings.

    PubMed

    Wessels, Annasu; Wainwright, Helen C; Beighton, Peter

    2011-01-01

    We have documented the clinical, radiologic, and autopsy findings of 2 fetuses with atelosteogenesis type I, aged 22 and 17 weeks. This rare autosomal dominant lethal skeletal dysplasia is caused by mutation in the FNLB gene. The 17-week-old fetus had some features of atelosteogenesis type II, notably "hitchhiker thumbs," a cleft palate, and midfacial flattening. The histologic demonstration of giant cells in the growth plate cartilage confirmed the diagnosis of atelosteogenesis type I in both fetuses, thereby facilitating accurate prediction of recurrence risks for the parents of the affected fetuses. Autopsy findings included tracheal narrowing and stenosis with pulmonary hypoplasia in both fetuses. Renal microcysts and abnormal branching of the pancreatic duct were also present in 1 of the fetuses, and malrotation of the caecum and retinal dysplasia involving the optic nerve were identified in the other. Postmortem and histologic investigations play an important role in the elucidation of the genetic micromelic skeletal disorders that are lethal in the fetus and neonate.

  20. Immunological findings in hemp workers.

    PubMed

    Zuskin, E; Kanceljak, B; Schachter, E N; Witek, T J; Maayani, S; Goswami, S; Marom, Z; Rienzi, N

    1992-12-01

    Immunological status and its relation to respiratory findings were studied in 42 female textile workers occupationally exposed to hemp dust and in 49 female control workers. Skin prick tests with hemp or flax dust extracts from different parts of the mill in hemp workers demonstrated the following frequencies of positive tests to antigens: a mixture of hemp and flax extracts (64%), followed by flax extracts (48%), hemp from combing machines (41%), hemp from carding machines (38%), hemp from spinning and weaving machines (33%), and hemp from softening machines (20%). The prevalence of positive skin tests to hemp or flax allergens in control workers was consistently lower, ranging from 21 to 5%. Increased total serum IgE was recorded in 35.7% of hemp workers compared to only 5.0% of control workers (P < 0.05). Hemp workers with positive skin tests had significantly higher prevalences of chronic respiratory symptoms than those with negative skin tests. There were, however, no differences for acute symptoms between workers with positive and negative skin tests. Across-shift changes and baseline lung function were not different when compared by immunologic status. We showed additionally that a water-soluble extract of hemp dust causes a dose-related contraction of nonsensitized guinea pig tracheal smooth muscle when studied in vitro. Our results suggest that frequent immunologic abnormalities can be documented in hemp workers but, with the exception of chronic respiratory symptoms, in general, these do not correlate with respiratory findings.

  1. Research Findings on Overactive Bladder

    PubMed Central

    Patra, Phani B.; Patra, Sayani

    2015-01-01

    Several physiopathologic conditions lead to the manifestation of overactive bladder (OAB). These conditions include ageing, diabetes mellitus, bladder outlet obstruction, spinal cord injury, stroke and brain injury, Parkinson's disease, multiple sclerosis, interstitial cystitis, stress and depression. This review has discussed research findings in human and animal studies conducted on the above conditions. Several structural and functional changes under these conditions have not only been observed in the lower urinary tract, but also in the brain and spinal cord. Significant changes were observed in the following areas: neurotransmitters, prostaglandins, nerve growth factor, Rho-kinase, interstitial cells of Cajal, and ion and transient receptor potential channels. Interestingly, alterations in these areas showed great variation in each of the conditions of the OAB, suggesting that the pathophysiology of the OAB might be different in each condition of the disease. It is anticipated that this review will be helpful for further research on new and specific drug development against OAB. PMID:26195957

  2. Magellan: Principal Venus science findings

    NASA Technical Reports Server (NTRS)

    Saunders, R. Stephen

    1993-01-01

    This is a brief summary of the science findings of the Magellan mission, principally based on data from the radar system. Future plans for Magellan include acquisition of high resolution gravity data from a nearly circular orbit and atmospheric drag and occultation experiments. The Magellan science results represent the combined effort of more than 100 Magellan investigators and their students and colleagues. More extensive discussions can be found in the August and October, 1992 issues of the Journal of Geophysical Research, Planets. The Magellan mission's scientific objectives were to provide a global characterization of landforms and tectonic features; to distinguish and understand impact processes; to define and explain erosion, deposition, and chemical processes; and to model the interior density distribution. All but the last objective, which requires new global gravity data, have been accomplished, or we have acquired the data that are required to accomplish them.

  3. Imaging findings in pulmonary vasculitis.

    PubMed

    Castañer, Eva; Alguersuari, Anna; Andreu, Marta; Gallardo, Xavier; Spinu, Cristina; Mata, Josep M

    2012-12-01

    Vasculitis is a destructive inflammatory process affecting blood vessels. Pulmonary vasculitis may develop secondary to other conditions or constitute a primary idiopathic disorder. Thoracic involvement is most common in primary idiopathic large-vessel vasculitides (Takayasu arteritis, giant cell arteritis, Behçet disease) and primary antineutrophil cytoplasmic autoantibody-associated small-vessel vasculitides (Wegener granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome). Primary pulmonary vasculitides are rare, and their signs and symptoms are nonspecific, overlapping with those of infections, connective tissue diseases, and malignancies. The radiologic findings in primary pulmonary vasculitis vary widely and can include vessel wall thickening, nodular or cavitary lesions, ground-glass opacities, and consolidations, among others. Diffuse alveolar hemorrhage usually results from primary small-vessel vasculitis in the lungs. To diagnose vasculitis, medical teams must recognize characteristic combinations of clinical, radiologic, laboratory, and histopathologic features.

  4. Dental findings in Lowe syndrome.

    PubMed

    Harrison, M; Odell, E W; Sheehy, E C

    1999-01-01

    This paper presents the dental findings of a child with the oculocerebrorenal syndrome of Lowe. The genetic abnormality in this condition results in an inborn error of inositol phosphate metabolism. Renal tubular dysfunction leads to metabolic acidosis and phosphaturia. At 4 years, generalised mobility of all primary teeth was noted. It is postulated that a defective inositol phosphate metabolism was responsible for the periodontal pathology found in this case. This is in direct contrast with previous reports of prolonged retention of primary teeth in children with this condition. Histology of extracted primary incisors demonstrated enlarged pulp chambers and mildly dysplastic dentin formation. This is consistent with a chronic subrachitic state, a known feature of Lowe syndrome, but no prominent interglobular dentin was present.

  5. Finding reliable information about vaccines.

    PubMed

    Pineda, Diego; Myers, Martin G

    2011-05-01

    Misinformation about vaccines confuses parents who may delay or refuse vaccines for their children, which places them and others at risk of vaccine-preventable diseases. Many parents do not understand the risks and severity of these diseases but also are unaware that they are uninformed. There are a number of favorable factors available for educating parents about these diseases, their prevention, and how to counter misinformation: most parents are seeking a trusting health care relationship; they want more information; they appreciate guidance; and they are looking for means to validate the information that they find. These factors represent opportunities to enhance confidence in immunization programs by providing parents with the tools that they need.

  6. Finding and Not Finding Rat Perirhinal Neuronal Responses to Novelty

    PubMed Central

    Muller, Robert U.; Brown, Malcolm W.

    2016-01-01

    ABSTRACT There is much evidence that the perirhinal cortex of both rats and monkeys is important for judging the relative familiarity of visual stimuli. In monkeys many studies have found that a proportion of perirhinal neurons respond more to novel than familiar stimuli. There are fewer studies of perirhinal neuronal responses in rats, and those studies based on exploration of objects, have raised into question the encoding of stimulus familiarity by rat perirhinal neurons. For this reason, recordings of single neuronal activity were made from the perirhinal cortex of rats so as to compare responsiveness to novel and familiar stimuli in two different behavioral situations. The first situation was based upon that used in “paired viewing” experiments that have established rat perirhinal differences in immediate early gene expression for novel and familiar visual stimuli displayed on computer monitors. The second situation was similar to that used in the spontaneous object recognition test that has been widely used to establish the involvement of rat perirhinal cortex in familiarity discrimination. In the first condition 30 (25%) of 120 perirhinal neurons were visually responsive; of these responsive neurons 19 (63%) responded significantly differently to novel and familiar stimuli. In the second condition eight (53%) of 15 perirhinal neurons changed activity significantly in the vicinity of objects (had “object fields”); however, for none (0%) of these was there a significant activity change related to the familiarity of an object, an incidence significantly lower than for the first condition. Possible reasons for the difference are discussed. It is argued that the failure to find recognition‐related neuronal responses while exploring objects is related to its detectability by the measures used, rather than the absence of all such signals in perirhinal cortex. Indeed, as shown by the results, such signals are found when a different methodology is used.

  7. Mental Findings in Trauma Victims

    PubMed Central

    CAN, İsmail Özgür; DEMİROĞLU UYANIKER, Zehra; ULAŞ, Halis; KARABAĞ, Gökmen; CİMİLLİ, Can; SALAÇİN, Serpil

    2013-01-01

    Introduction In medico-legal evaluation of trauma patients, the bio-psychological effects of the trauma and the severity of the injuries require to be evaluated. In this study, assuming the fact that psychiatric assessment is not taken into consideration in physical trauma cases, we planned to show the presence of psychological trauma in our medico-legally evaluated patients who presented with different types of traumas and to review the mental findings and diagnoses in trauma victims. Method We retrospectively analyzed the hospital records of 1975 patients aged 18 years or older who presented to the Department of Forensic Medicine at Dokuz Eylül University School of Medicine for medico-legal evaluation between 1999 and 2009. Psychiatric assessment was performed in 142 patients by the Department of Psychiatry. The data contained in medico-legal reports and patient records were then examined with respect to patients’ age, gender, nature of traumatic events, psychiatric diagnoses, descriptive characteristics of the patients, severity of trauma and past history of mental disorder and trauma experience. Results of the medicolegal evaluations were also analyzed. Result Of the 142 patients, 80 (56.3%) were female and their average age was 40.30±17.17 years. The most frequent traumatic events were traffic accidents (29.6%) and violence-related blunt force trauma (28.9%). When the distribution of the most common psychiatric diagnoses was examined, it was found that anxiety disorders were found in 69 cases (48.6%), adjustment disorders were found in 16 cases (11.3%) and mood disorders were found in 12 cases (8.5%). Among anxiety disorders, acute stress disorder (n=39) and post-traumatic stress disorder (PTSD) (n=27) were the most common ones. In 27 cases of the 142, it was determined that, psychiatric symptoms and findings did not meet the diagnostic criteria of any psychiatric disorder. Diagnosis of psychiatric disorder was not significantly related with traumatic

  8. Knowledge translation of research findings.

    PubMed

    Grimshaw, Jeremy M; Eccles, Martin P; Lavis, John N; Hill, Sophie J; Squires, Janet E

    2012-05-31

    One of the most consistent findings from clinical and health services research is the failure to translate research into practice and policy. As a result of these evidence-practice and policy gaps, patients fail to benefit optimally from advances in healthcare and are exposed to unnecessary risks of iatrogenic harms, and healthcare systems are exposed to unnecessary expenditure resulting in significant opportunity costs. Over the last decade, there has been increasing international policy and research attention on how to reduce the evidence-practice and policy gap. In this paper, we summarise the current concepts and evidence to guide knowledge translation activities, defined as T2 research (the translation of new clinical knowledge into improved health). We structure the article around five key questions: what should be transferred; to whom should research knowledge be transferred; by whom should research knowledge be transferred; how should research knowledge be transferred; and, with what effect should research knowledge be transferred? We suggest that the basic unit of knowledge translation should usually be up-to-date systematic reviews or other syntheses of research findings. Knowledge translators need to identify the key messages for different target audiences and to fashion these in language and knowledge translation products that are easily assimilated by different audiences. The relative importance of knowledge translation to different target audiences will vary by the type of research and appropriate endpoints of knowledge translation may vary across different stakeholder groups. There are a large number of planned knowledge translation models, derived from different disciplinary, contextual (i.e., setting), and target audience viewpoints. Most of these suggest that planned knowledge translation for healthcare professionals and consumers is more likely to be successful if the choice of knowledge translation strategy is informed by an assessment of the

  9. Knowledge translation of research findings

    PubMed Central

    2012-01-01

    Background One of the most consistent findings from clinical and health services research is the failure to translate research into practice and policy. As a result of these evidence-practice and policy gaps, patients fail to benefit optimally from advances in healthcare and are exposed to unnecessary risks of iatrogenic harms, and healthcare systems are exposed to unnecessary expenditure resulting in significant opportunity costs. Over the last decade, there has been increasing international policy and research attention on how to reduce the evidence-practice and policy gap. In this paper, we summarise the current concepts and evidence to guide knowledge translation activities, defined as T2 research (the translation of new clinical knowledge into improved health). We structure the article around five key questions: what should be transferred; to whom should research knowledge be transferred; by whom should research knowledge be transferred; how should research knowledge be transferred; and, with what effect should research knowledge be transferred? Discussion We suggest that the basic unit of knowledge translation should usually be up-to-date systematic reviews or other syntheses of research findings. Knowledge translators need to identify the key messages for different target audiences and to fashion these in language and knowledge translation products that are easily assimilated by different audiences. The relative importance of knowledge translation to different target audiences will vary by the type of research and appropriate endpoints of knowledge translation may vary across different stakeholder groups. There are a large number of planned knowledge translation models, derived from different disciplinary, contextual (i.e., setting), and target audience viewpoints. Most of these suggest that planned knowledge translation for healthcare professionals and consumers is more likely to be successful if the choice of knowledge translation strategy is informed by

  10. Neuroimaging findings in primary insomnia.

    PubMed

    O'Byrne, J N; Berman Rosa, M; Gouin, J-P; Dang-Vu, T T

    2014-10-01

    State-of-the-art neuroimaging techniques have accelerated progress in the study and understanding of sleep in humans. Neuroimaging studies in primary insomnia remain relatively few, considering the important prevalence of this disorder in the general population. This review examines the contribution of functional and structural neuroimaging to our current understanding of primary insomnia. Functional studies during sleep provided support for the hyperarousal theory of insomnia. Functional neuroimaging also revealed abnormalities in cognitive and emotional processing in primary insomnia. Results from structural studies suggest neuroanatomical alterations in primary insomnia, mostly in the hippocampus, anterior cingulate cortex and orbitofrontal cortex. However, these results are not well replicated across studies. A few magnetic resonance spectroscopy studies revealed abnormalities in neurotransmitter concentrations and bioenergetics in primary insomnia. The inconsistencies among neuroimaging findings on insomnia are likely due to clinical heterogeneity, differences in imaging and overall diversity of techniques and designs employed. Larger samples, replication, as well as innovative methodologies are necessary for the progression of this perplexing, yet promising area of research. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  11. MR findings in pontocerebellar hypoplasia.

    PubMed

    Uhl, M; Pawlik, H; Laubenberger, J; Darge, K; Baborie, A; Korinthenberg, R; Langer, M

    1998-07-01

    We present four cases with combined hypoplasia of the cerebellum and the ventral pons-pontocerebellar hypoplasia (PCH). PCH represents an autosomal recessive neurodegenerative disorder with fetal onset. The disease is rare, with less than 20 cases having been reported. The main findings of PCH and the inclusion criteria for our cases can be summarised as progressive microcephaly from birth, pontocerebellar hypoplasia documented by MRI and marked chorea, which may change, later in childhood, to more dystonic patterns. The cerebral cortex becomes progressively atrophic. Motor and mental development are delayed, and epilepsy, mainly tonic-clonic seizures, is frequent. The MRI features in all of our cases were: (1) Hypoplastic cerebellum situated close to the tentorium. The hypoplastic cerebellum has a reduced number of folia, in contrast to the normal number of thin folia in simple cerebellar atrophy. (2) The cerebellar hemispheres are reduced to bean-like or wing-like structures. The cerebellar hemispheres appear to 'float' in the posterior fossa. (3) Markedly hypoplastic ventral pons. (4) Slight atrophy of the supratentorial gyral pattern. (5) Dilated cerebromedullary cistern and fourth ventricle. (6) Delayed myelination of the white matter. (7) No significant disorganisation of brain architecture and no severe corpus callosum defect.

  12. Hodgkin's disease: update of findings.

    PubMed

    Pileri, S; Sabattini, E; Tazzari, P L; Gherlinzoni, F; Zucchini, L; Bigerna, B; Leoncini, L; Rosso, R; Stein, H; Falini, B

    1991-01-01

    The authors critically review the problem of Hodgkin's disease (HD) in the light of new morphological, immunohistochemical, kinetic, genotypic, and virological findings. These support the lymphoid origin of neoplastic Hodgkin's and Reed-Sternberg cells, because of regular expression of the CD30 lymphoid activation antigen and frequent detection of B- or T-cell phenotypic and/or genotypic markers. It is possible to hypothesize the release of cytokines by tumoral elements as well as the presence of specific cytokine receptors on their surface. This might explain some clinical and pathological features, such as fever, loss of weight, eosinophilia and attraction of reactive elements that make up the composite cellular milieu of typical HD. Integration of monoclonal EBV in the genoma of neoplastic elements has repeatedly been shown, and this might play an essential role in the pathogenesis of the disease. On the basis of present concepts, the borderlines between HD and some categories of non-Hodgkin's lymphomas--especially the anaplastic large cell forms--have become somewhat blurred. Additional research work in the field of HD is desirable and might pave the way for new and more effective therapeutic approaches, designed on the basis of the natural history of the neoplasm.

  13. Somatosensory findings in postherpetic neuralgia.

    PubMed Central

    Nurmikko, T; Bowsher, D

    1990-01-01

    Somatic sensory perception thresholds (warm, cold, hot pain, touch, pinprick, vibration, two-point discrimination), allodynia and skin temperature were assessed in the affected area of 42 patients with unilateral postherpetic neuralgia (PHN) and 20 patients who had had unilateral shingles not followed by PHN (NoPHN), and in the mirror-image area on the other side. There was no difference between the two groups for age or length of time after the acute herpes zoster infection. The PHN group showed significant changes in all sensory threshold measurements when the affected area was compared with the mirror-image area on the unaffected side, while the NoPHN group exhibited no threshold changes. Mechanical allodynia was present in 87% of the PHN group; half of the 12 patients with ophthalmic PHN showed extension of allodynia to the maxillary distribution. No differences in skin temperature were recorded between affected and unaffected regions in either group. Our findings show a deficit of sensory functions mediated by both large and small primary afferent fibres and also suggest major central involvement in the pathophysiology of the condition. If PHN does not occur following acute herpes zoster, recovery of neural functions appears to be good. PMID:2313300

  14. Pollution! Find a STEM solution!

    NASA Astrophysics Data System (ADS)

    Takač, Danijela; Moćan, Marina

    2016-04-01

    Primary and secondary school Pantovčak is an innovative school in downtown Zagreb, Croatia. The school is involved in many projects concerning STEM education. Pollution! Find a STEM solution! is a two year long cross-curricular project that grew out of identified need to develop STEM and ICT skills more. Pisa results make evident that students' knowledge is poor and motivation for math and similar subjects is low. Implying priorities of European Commission, like e-learning, raises motivation and also develops basic skills and improves knowledge in science, math, physic, ICT. Main objectives are to increase students' interest in STEM education and careers and introduce them to all available new trends in technology, engineering and science in their region by visiting clean technology industries and strengthening links with them, to introduce some future digital jobs and prepare students for rapid technological changes by integrating ICT into classroom practice more, to highlight the importance of global environmental issues and improve the knowledge in the areas of sustainable development and renewable energy, to develop collaborative partnership between schools and the wider community in formal, non-formal and informal learning, to support multilingualism by publishing Open Educational Resources in 8 different languages and to strengthen the professional profile of the teaching profession. The project brings together 231 teachers and 2729 students from five different European countries in learning to think globally and work on activities that contribute to the community's well-being. There are altogether 33 activities, divided in 4 categories. STEM activities are focused on students building the devices for measuring air, light and noise pollution in their school and homes. They use the scientific method to analyze the data and compare the results with their peers to find a solution. Eskills, digital literacy and digital jobs are focused on introducing career

  15. Skin findings in Williams syndrome.

    PubMed

    Kozel, Beth A; Bayliss, Susan J; Berk, David R; Waxler, Jessica L; Knutsen, Russell H; Danback, Joshua R; Pober, Barbara R

    2014-09-01

    Previous examination in a small number of individuals with Williams syndrome (also referred to as Williams-Beuren syndrome) has shown subtly softer skin and reduced deposition of elastin, an elastic matrix protein important in tissue recoil. No quantitative information about skin elasticity in individuals with Williams syndrome is available; nor has there been a complete report of dermatologic findings in this population. To fill this knowledge gap, 94 patients with Williams syndrome aged 7-50 years were recruited as part of the skin and vascular elasticity (WS-SAVE) study. They underwent either a clinical dermatologic assessment by trained dermatologists (2010 WSA family meeting) or measurement of biomechanical properties of the skin with the DermaLab™ suction cup (2012 WSA family meeting). Clinical assessment confirmed that soft skin is common in this population (83%), as is premature graying of the hair (80% of those 20 years or older), while wrinkles (92%), and abnormal scarring (33%) were detected in larger than expected proportions. Biomechanical studies detected statistically significant differences in dP (the pressure required to lift the skin), dT (the time required to raise the skin through a prescribed gradient), VE (viscoelasticity), and E (Young's modulus) relative to matched controls. The RT (retraction time) also trended longer but was not significant. The biomechanical differences noted in these patients did not correlate with the presence of vascular defects also attributable to elastin insufficiency (vascular stiffness, hypertension, and arterial stenosis) suggesting the presence of tissue specific modifiers that modulate the impact of elastin insufficiency in each tissue. © 2014 Wiley Periodicals, Inc.

  16. Regional Transmission Projects: Finding Solutions

    SciTech Connect

    The Keystone Center

    2005-06-15

    The Keystone Center convened and facilitated a year-long Dialogue on "Regional Transmission Projects: Finding Solutions" to develop recommendations that will help address the difficult and contentious issues related to expansions of regional electric transmission systems that are needed for reliable and economic transmission of power within and across regions. This effort brought together a cross-section of affected stakeholders and thought leaders to address the problem with the collective wisdom of their experience and interests. Transmission owners sat at the table with consumer advocates and environmental organizations. Representatives from regional transmission organizations exchanged ideas with state and federal regulators. Generation developers explored common interests with public power suppliers. Together, the Dialogue participants developed consensus solutions about how to begin unraveling some of the more intractable issues surrounding identification of need, allocation of costs, and reaching consensus on siting issues that can frustrate the development of regional transmission infrastructure. The recommendations fall into three broad categories: 1. Recommendations on appropriate institutional arrangements and processes for achieving regional consensus on the need for new or expanded transmission infrastructure 2. Recommendations on the process for siting of transmission lines 3. Recommendations on the tools needed to support regional planning, cost allocation, and siting efforts. List of Dialogue participants: List of Dialogue Participants: American Electric Power American Transmission Company American Wind Energy Association California ISO Calpine Corporation Cinergy Edison Electric Institute Environmental Defense Federal Energy Regulatory Commission Great River Energy International Transmission Company ISO-New England Iowa Public Utility Board Kanner & Associates Midwest ISO National Association of Regulatory Utility Commissioners National Association

  17. MEMS direction finding acoustic sensor

    NASA Astrophysics Data System (ADS)

    Karunasiri, Gamani; Alves, Fabio; Swan, William

    2017-06-01

    Conventional directional sound sensing systems employ an array of spatially separated microphones to achieve directivity. However, there are insects such as the Ormia ochracea fly that can determine the direction of sound using a miniature hearing organ much smaller than the wavelength of sound it detects. The fly's eardrums are coupled mechanically with a separation of only 0.5 mm and yet have a remarkable sensitivity to the direction of sound. The MEMS based sensor mimicking the fly's hearing system was fabricated using an SOI substrate with a 25 μm device layer. The sensor consists of two 1.5 mm x1.6 mm wings connected in the middle by a 2.7 mm x 30 μm bridge. The entire structure is connected to the substrate by two torsional legs at the center. The frequency response of the sensor showed two resonance frequencies at approximately 1.1 kHz (rocking) and 1.5 kHz (bending). The resonance at 1.1 kHz is due to rocking of the wings by twisting the legs and the other at 1.5 kHz is due to bending of the bridge. The response of the sensor was probed electronically using comb finger capacitors integrated to the edges of the wings and with the help of an MS3110 chip. A peak output voltage of about 9V/Pa was measured for sound incident normal to the device at the resonance frequency of the bending mode. The bearing of the incident sound under these conditions could be determined to within a few degrees. These findings indicate the potential use of the MEMS sensor to locate sound sources with high accuracy.

  18. Skin Findings in Williams Syndrome

    PubMed Central

    Kozel, Beth A.; Bayliss, Susan J.; Berk, David R.; Waxler, Jessica L; Knutsen, Russell H.; Danback, Joshua R.; Pober, Barbara R.

    2014-01-01

    Previous examination in a small number of individuals with Williams syndrome (also referred to as Williams-Beuren syndrome) has shown subtly softer skin and reduced deposition of elastin, an elastic matrix protein important in tissue recoil. No quantitative information about skin elasticity in individuals with Williams syndrome is available; nor has there been a complete report of dermatologic findings in this population. To fill this knowledge gap, 94 patients with Williams syndrome aged 7-50 years were recruited as part of the Skin and Vascular Elasticity (WS-SAVE) study. They underwent either a clinical dermatologic assessment by trained dermatologists (2010 WSA family meeting) or measurement of biomechanical properties of the skin with the DermaLab™ suction cup (2012 WSA family meeting). Clinical assessment confirmed that soft skin is common in this population (83%), as is premature graying of the hair (80% of those 20 years or older), while wrinkles (92%) and abnormal scarring (33%) were detected in larger than expected proportions. Biomechanical studies detected statistically significant differences in dP (the pressure required to lift the skin), dT (the time required to raise the skin through a prescribed gradient), VE (viscoelasticity) and E (Young’s modulus) relative to matched controls. The RT (retraction time) also trended longer but was not significant. The biomechanical differences noted in these patients did not correlate with the presence of vascular defects also attributable to elastin insufficiency (vascular stiffness, hypertension, and arterial stenosis) suggesting the presence of tissue specific modifiers that modulate the impact of elastin insufficiency in each tissue. PMID:24920525

  19. Severe malaria - a case of fatal Plasmodium knowlesi infection with post-mortem findings: a case report

    PubMed Central

    2010-01-01

    Background Zoonotic malaria caused by Plasmodium knowlesi is an important, but newly recognized, human pathogen. For the first time, post-mortem findings from a fatal case of knowlesi malaria are reported here. Case presentation A formerly healthy 40 year-old male became symptomatic 10 days after spending time in the jungle of North Borneo. Four days later, he presented to hospital in a state of collapse and died within two hours. He was hyponatraemic and had elevated blood urea, potassium, lactate dehydrogenase and amino transferase values; he was also thrombocytopenic and eosinophilic. Dengue haemorrhagic shock was suspected and a post-mortem examination performed. Investigations for dengue virus were negative. Blood for malaria parasites indicated hyperparasitaemia and single species P. knowlesi infection was confirmed by nested-PCR. Macroscopic pathology of the brain and endocardium showed multiple petechial haemorrhages, the liver and spleen were enlarged and lungs had features consistent with ARDS. Microscopic pathology showed sequestration of pigmented parasitized red blood cells in the vessels of the cerebrum, cerebellum, heart and kidney without evidence of chronic inflammatory reaction in the brain or any other organ examined. Brain sections were negative for intracellular adhesion molecule-1. The spleen and liver had abundant pigment containing macrophages and parasitized red blood cells. The kidney had evidence of acute tubular necrosis and endothelial cells in heart sections were prominent. Conclusions The overall picture in this case was one of systemic malaria infection that fit the WHO classification for severe malaria. Post-mortem findings in this case were unexpectedly similar to those that define fatal falciparum malaria, including cerebral pathology. There were important differences including the absence of coma despite petechial haemorrhages and parasite sequestration in the brain. These results suggest that further study of knowlesi malaria

  20. Can Radio Telescopes Find Axions?

    NASA Astrophysics Data System (ADS)

    Kohler, Susanna

    2017-08-01

    In the search for dark matter, the most commonly accepted candidates are invisible, massive particles commonly referred to as WIMPs. But as time passes and we still havent detected WIMPs, alternative scenarios are becoming more and more appealing. Prime among these is the idea of axions.A Bizarre ParticleThe Italian PVLAS is an example of a laboratory experiment that attempted to confirm the existence of axions. [PVLAS]Axions are a type of particle first proposed in the late 1970s. These theorized particles arose from a new symmetry introduced to solve ongoing problems with the standard model for particle physics, and they were initially predicted to have more than a keV in mass. For this reason, their existence was expected to be quickly confirmed by particle-detector experiments yet no detections were made.Today, after many unsuccessful searches, experiments and theory tell us that if axions exist, their masses must lie between 10-610-3 eV. This is minuscule an electrons mass is around 500,000 eV, and even neutrinos are on the scale of a tenth of an eV!But enough of anything, even something very low-mass, can weigh a lot. If they are real, then axions were likely created in abundance during the Big Bang and unlike heavier particles, they cant decay into anything lighter, so we would expect them all to still be around today. Our universe could therefore be filled with invisible axions, potentially providing an explanation for dark matter in the form of many, many tiny particles.Artists impression of the central core of proposed Square Kilometer Array antennas. [SKA/Swinburne Astronomy Productions]How Do We Find Them?Axions barely interact with ordinary matter and they have no electric charge. One of the few ways we can detect them is with magnetic fields: magnetic fields can change axions to and from photons.While many studies have focused on attempting to detect axions in laboratory experiments, astronomy provides an alternative: we can search for cosmological

  1. Finding time, stopping the frenzy.

    PubMed

    Perlow, L A

    1998-08-01

    While the deleterious consequences of long hours of work for individuals, families and communities have previously been documented, the assumption that long hours are necessary to get the work done, especially in a world where speed is becoming increasingly critical to corporate success, has prompted little challenge. So Leslie Perlow, an assistant professor of business at the University of Michigan, Ann Arbor, set out to explore the necessity for the seemingly endless workdays that so many postindustrial settings require. Her study of a group of software engineers at a Fortune 500 company--identified only as the Ditto Corp--is detailed in her book, Finding Time: How Corporations, Individuals, and Families Can Benefit from New Work Practices (Cornell University Press, 1997). Perlow's research reveals a "sad and all too common tale" of workers harried by competing demands, frequent interruptions and shifting deadlines. To meet the firm's expectations, the engineers she studied sacrificed home life, focused on individual tasks to the detriment of group goals and, in many cases, eventually lost any enthusiasm they'd had for working for the company. There has been some recognition that stress and burnout may be bad for a corporation as employees become less committed, decide to leave or get fired and that this kind of turnover can hurt the firm in the longer term. But Perlow documented the additional, and quite significant, shorter-term costs to the corporation of the current way of using time at work. What she found was a "vicious time cycle:" Time pressures led to a crisis mentality, which led to "individual heroics." That is, I'll do whatever it takes to do my job--even if it means interrupting you while you try to do yours. For the engineers Perlow studied, the lack of helping, the constant interruptions and the perpetual crises--clearly illustrated by the daily log that appears on page 34--made it harder to develop products. Ultimately, they worked long hours to

  2. Find a Diabetes Prevention Program Near You

    MedlinePlus

    ... throughout the country. Find an In-person Class Select From List Find a class near you by ... are available in Spanish at some locations. Location: Select State on Map Find an Online Program Online ...

  3. 7 CFR 3052.510 - Audit findings.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 15 2011-01-01 2011-01-01 false Audit findings. 3052.510 Section 3052.510 Agriculture... AGRICULTURE AUDITS OF STATES, LOCAL GOVERNMENTS, AND NON-PROFIT ORGANIZATIONS Auditors § 3052.510 Audit findings. (a) Audit findings reported. The auditor shall report the following as audit findings in a...

  4. 29 CFR 99.510 - Audit findings.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 1 2011-07-01 2011-07-01 false Audit findings. 99.510 Section 99.510 Labor Office of the Secretary of Labor AUDITS OF STATES, LOCAL GOVERNMENTS, AND NON-PROFIT ORGANIZATIONS Auditors § 99.510 Audit findings. (a) Audit findings reported. The auditor shall report the following as audit findings in a...

  5. 7 CFR 3052.510 - Audit findings.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 15 2014-01-01 2014-01-01 false Audit findings. 3052.510 Section 3052.510 Agriculture... AGRICULTURE AUDITS OF STATES, LOCAL GOVERNMENTS, AND NON-PROFIT ORGANIZATIONS Auditors § 3052.510 Audit findings. (a) Audit findings reported. The auditor shall report the following as audit findings in...

  6. 29 CFR 99.510 - Audit findings.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 1 2014-07-01 2013-07-01 true Audit findings. 99.510 Section 99.510 Labor Office of the Secretary of Labor AUDITS OF STATES, LOCAL GOVERNMENTS, AND NON-PROFIT ORGANIZATIONS Auditors § 99.510 Audit findings. (a) Audit findings reported. The auditor shall report the following as audit findings in...

  7. Efficacy of a Web-Based, Tailored, Alcohol Prevention/Intervention Program for College Students: Initial Findings

    ERIC Educational Resources Information Center

    Bingham, C. Raymond; Barretto, Andrea Ippel; Walton, Maureen A.; Bryant, Christopher M.; Shope, Jean T.; Raghunathan, Trivellore E.

    2010-01-01

    Objective: Reduce college student at-risk drinking (ARD) using a Web-based brief motivational alcohol prevention/intervention called "Michigan Prevention and Alcohol Safety for Students" (M-PASS). Participants: Participants included 1,137 randomly sampled first-year college students, including 59% female, 80% white, and averaged age 18.1…

  8. Efficacy of a Web-Based, Tailored, Alcohol Prevention/Intervention Program for College Students: Initial Findings

    ERIC Educational Resources Information Center

    Bingham, C. Raymond; Barretto, Andrea Ippel; Walton, Maureen A.; Bryant, Christopher M.; Shope, Jean T.; Raghunathan, Trivellore E.

    2010-01-01

    Objective: Reduce college student at-risk drinking (ARD) using a Web-based brief motivational alcohol prevention/intervention called "Michigan Prevention and Alcohol Safety for Students" (M-PASS). Participants: Participants included 1,137 randomly sampled first-year college students, including 59% female, 80% white, and averaged age 18.1…

  9. 7 CFR 1794.43 - Agency finding.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... finding. If RUS finds, based on an EA that the proposed action will not have a significant effect on the quality of the human environment, RUS will prepare a FONSI. Upon authorization of RUS, the applicant shall...

  10. 7 CFR 1794.43 - Agency finding.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... finding. If RUS finds, based on an EA that the proposed action will not have a significant effect on the quality of the human environment, RUS will prepare a FONSI. Upon authorization of RUS, the applicant shall...

  11. 7 CFR 1794.43 - Agency finding.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... finding. If RUS finds, based on an EA that the proposed action will not have a significant effect on the quality of the human environment, RUS will prepare a FONSI. Upon authorization of RUS, the applicant shall...

  12. Breast findings incidentally detected on body MRI.

    PubMed

    Bignotti, Bianca; Succio, Giulia; Nosenzo, Francesca; Perinetti, Michela; Gristina, Licia; Barbagallo, Stella; Secondini, Lucia; Calabrese, Massimo; Tagliafico, Alberto

    2016-01-01

    To evaluate breast findings incidentally detected on body MRI. A retrospective review of the institutional database identified 1752 body MRI performed between January 2015 and September 2015. MRI of women with breast tissue visible in the field-of-view were reviewed for breast findings. Breast findings were classified with the breast imaging reporting and data system (BI-RADS) lexicon. The standard statistic, costs of additional work-up, and the clinical relevance were used to describe breast findings, and we calculated 95 % exact confidence intervals (CIs). 440 body MRI of 440 women (mean age: 57 ± 20 years) included breast tissue in the field-of-view. A total of 41 breast findings were identified in 41 patients. Breast findings were classified BI-RADS 2 N = 25, BI-RADS 3 N = 13, BI-RADS 4 N = 3. A total of 3.6 % [95 % CI 1.6 %, 5.6 %] women with breast tissue visible on MRI had a recommendation for further imaging work-up for a breast finding. The 18.7 % (3 of 16) of these patients had a clinically important finding (breast cancer). Further imaging evaluation increased costs of €108.3 per patient with a breast finding. Clinically important breast findings could be detected on body MRI in up to 0.7 % (3 of 440) of women.

  13. Writing usable qualitative health research findings.

    PubMed

    Sandelowski, Margarete; Leeman, Jennifer

    2012-10-01

    Scholars in diverse health-related disciplines and specialty fields of practice routinely promote qualitative research as an essential component of intervention and implementation programs of research and of a comprehensive evidence base for practice. Remarkably little attention, however, has been paid to the most important element of qualitative studies--the findings in reports of those studies--and specifically to enhancing the accessibility and utilization value of these findings for diverse audiences of users. The findings in reports of qualitative health research are too often difficult to understand and even to find owing to the way they are presented. A basic strategy for enhancing the presentation of these findings is to translate them into thematic statements, which can then in turn be translated into the language of intervention and implementation. Writers of qualitative health research reports might consider these strategies better to showcase the significance and actionability of findings to a wider audience.

  14. Pulmonary diseases with imaging findings mimicking aspergilloma.

    PubMed

    Gazzoni, Fernando Ferreira; Severo, Luiz Carlos; Marchiori, Edson; Guimarães, Marcos Duarte; Garcia, Tiago Severo; Irion, Klaus L; Camargo, José Jesus; Felicetti, José Carlos; de Mattos Oliveira, Flavio; Hochhegger, Bruno

    2014-06-01

    Patients with preexisting lung cavities are at risk of developing intracavitary fungal colonization. Because Aspergillus spp. are the most commonly implicated fungi, these fungal masses are called aspergillomas. Their characteristic "ball-in-hole" appearance, however, may be found in a variety of other conditions that can produce radiologic findings mimicking aspergilloma. In this paper, we review the main diseases that may mimic the radiographic findings of aspergilloma, with brief descriptions of clinical, radiologic, and histopathologic findings.

  15. Escitalopram-induced word finding difficulty.

    PubMed

    Yang, Hao-Ming; Lee, Wen-Kuei; Chang, Shang-Wen; Chiu, Nien-Mu; Huang, Jen-Hung

    2013-01-01

    Escitalopram is the most selective serotonin reuptake inhibitor used for treatment of major depressive disorder and generalized anxiety disorder. No available report indicating escitalopram may induce word finding difficulty. Here we are presenting a 50-year-old patient who suffered from escitalopram-induced word finding difficulty and the symptom resolved after replacing with bupropion. Carefully monitoring word finding difficulty and speech fluency during antidepressant treatment is important in clinical practice when using selective serotonin reuptake inhibitors, especially escitalopram.

  16. Incidental findings: a common law approach.

    PubMed

    Tovino, Stacey A

    2008-01-01

    Federal regulations governing human subjects research do not address key questions raised by incidental neuroimaging findings, including the scope of a researcher's disclosure with respect to the possibility of incidental findings and the question whether a researcher has an affirmative legal cuty to seek, detect, and report incidental findings. The scope of researcher duties may, however, be mapped with reference to common law doctrine, including fiduciary, tort, contract, and bailment theories of liability.

  17. Top 10 Replicated Findings from Behavioral Genetics

    PubMed Central

    Plomin, Robert; DeFries, John C.; Knopik, Valerie S.; Neiderhiser, Jenae M.

    2015-01-01

    In the context of current concerns about replication in psychological science, we describe 10 findings from behavioral genetic research that have robustly replicated. These are ‘big’ findings, both in terms of effect size and potential impact on psychological science, such as linearly increasing heritability of intelligence from infancy (20%) through adulthood (60%). Four of our top-10 findings involve the environment, discoveries that could only have been found using genetically sensitive research designs. We also consider reasons specific to behavioral genetics that might explain why these findings replicate. PMID:26817721

  18. ELECTRONIC OBSERVERS FOR RADIO DIRECTION FINDING,

    DTIC Science & Technology

    RADIO EQUIPMENT, DIRECTION FINDING , RADIO SIGNALS, AMPLITUDE MODULATION, MONITORS, DISPLAY SYSTEMS, INFORMATION THEORY, STATISTICAL ANALYSIS, COMPUTER PROGRAMMING, NAVIGATIONAL AIDS, DETECTION, DATA PROCESSING.

  19. Finding a Doctor for Your New Baby

    MedlinePlus

    ... and the Internet Finding a Doctor for Your New Baby KidsHealth > For Parents > Finding a Doctor for Your New Baby Print A A A What's in this ... recommendations. If you've recently moved to a new area, you may not have personal or social ...

  20. 38 CFR 41.510 - Audit findings.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Audit findings. 41.510 Section 41.510 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) AUDITS OF STATES, LOCAL GOVERNMENTS, AND NON-PROFIT ORGANIZATIONS Auditors § 41.510 Audit findings....

  1. Employment for Spouses Gets Harder to Find

    ERIC Educational Resources Information Center

    June, Audrey Williams

    2009-01-01

    Worries about a partner's finding a job are a major reason why colleges lose faculty and professional-staff recruits. Some institutions have hired people to focus largely on nonfaculty job searches. (Finding faculty jobs for spouses or partners is a more complex negotiation with the university.) But as the economy continues to dip into uncharted…

  2. EnviroSafe Finding of Violation

    EPA Pesticide Factsheets

    This document outlines the U.S. Environmental Protection Agency reissuing an enclosed Finding of Violation (FOV) to Enviro-Safe Refrigerants, Inc. (you). We find that you have violated the Clean Air Act, 42 U.S.C. § 7413(a) (the CAA).

  3. Planar antenna system for direction finding

    NASA Astrophysics Data System (ADS)

    Mardale, Iulia-Cezara; Cocias, Gabriela; Dumitrascu, Ana; Tamas, Razvan; Berescu, Serban

    2015-02-01

    Applications of direction finding techniques include detection and localization of pulsed electromagnetic sources. This paper presents the design and analysis of a planar antenna system for direction finding. Our proposed system includes 4 hybrid couplers that generate 900 shifted signals, 2 crossover couplers also known as 0dB couplers, two 450 phase shifters, two 00 phase shifters and 4 patch antennas.

  4. 5 CFR 2638.504 - Director's finding.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Director's finding. 2638.504 Section 2638... Individual Executive Agency Employees § 2638.504 Director's finding. (a) In general. If the Director has... date by which the employee's comments must be submitted. (d) Employee comments. The respondent employee...

  5. Teacher Retirement Systems: Research Findings. Research Brief

    ERIC Educational Resources Information Center

    Hansen, Janet S.; Podgursky, Michael J.; Costrell, Robert M.

    2009-01-01

    This policy brief summarizes findings presented at a February 2009 research conference on teacher retirement systems hosted by the National Center on Performance Incentives (NCPI) at Vanderbilt University's Peabody College. The 2009 conference was the second in a series of NCPI events focusing on findings from recent research on issues related to…

  6. Experimental interstellar organic chemistry - Preliminary findings

    NASA Technical Reports Server (NTRS)

    Khare, B. N.; Sagan, C.

    1973-01-01

    Review of the results of some explicit experimental simulation of interstellar organic chemistry consisting in low-temperature high-vacuum UV irradiation of condensed simple gases known or suspected to be present in the interstellar medium. The results include the finding that acetonitrile may be present in the interstellar medium. The implication of this and other findings are discussed.

  7. 38 CFR 41.510 - Audit findings.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Audit findings. 41.510 Section 41.510 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) AUDITS OF STATES, LOCAL GOVERNMENTS, AND NON-PROFIT ORGANIZATIONS Auditors § 41.510 Audit findings....

  8. 10 CFR 1022.14 - Findings.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... ENERGY (GENERAL PROVISIONS) COMPLIANCE WITH FLOODPLAIN AND WETLAND ENVIRONMENTAL REVIEW REQUIREMENTS Procedures for Floodplain and Wetland Reviews § 1022.14 Findings. (a) If DOE finds that no practicable alternative to locating or conducting the action in the floodplain or wetland is available, then before...

  9. 10 CFR 1022.14 - Findings.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... ENERGY (GENERAL PROVISIONS) COMPLIANCE WITH FLOODPLAIN AND WETLAND ENVIRONMENTAL REVIEW REQUIREMENTS Procedures for Floodplain and Wetland Reviews § 1022.14 Findings. (a) If DOE finds that no practicable alternative to locating or conducting the action in the floodplain or wetland is available, then before...

  10. 10 CFR 1022.14 - Findings.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... ENERGY (GENERAL PROVISIONS) COMPLIANCE WITH FLOODPLAIN AND WETLAND ENVIRONMENTAL REVIEW REQUIREMENTS Procedures for Floodplain and Wetland Reviews § 1022.14 Findings. (a) If DOE finds that no practicable alternative to locating or conducting the action in the floodplain or wetland is available, then before...

  11. 10 CFR 1022.14 - Findings.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... ENERGY (GENERAL PROVISIONS) COMPLIANCE WITH FLOODPLAIN AND WETLAND ENVIRONMENTAL REVIEW REQUIREMENTS Procedures for Floodplain and Wetland Reviews § 1022.14 Findings. (a) If DOE finds that no practicable alternative to locating or conducting the action in the floodplain or wetland is available, then before...

  12. 10 CFR 1022.14 - Findings.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... ENERGY (GENERAL PROVISIONS) COMPLIANCE WITH FLOODPLAIN AND WETLAND ENVIRONMENTAL REVIEW REQUIREMENTS Procedures for Floodplain and Wetland Reviews § 1022.14 Findings. (a) If DOE finds that no practicable alternative to locating or conducting the action in the floodplain or wetland is available, then before...

  13. Online Finding Aids: Are They Practical?

    ERIC Educational Resources Information Center

    Hostetter, Christina J.

    2004-01-01

    This article explores the uses, practicality, and problems involved in creating online finding aids by state-funded university archivists across the nation. It examines various aspects of online finding aids such as financial considerations, its importance as a research tool, timelines, demographics, and use. The more technical side is also…

  14. 16 CFR 1212.5 - Findings.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Findings. 1212.5 Section 1212.5 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS SAFETY STANDARD FOR MULTI-PURPOSE LIGHTERS Requirements for Child-Resistance § 1212.5 Findings. (a) Before issuing a...

  15. 16 CFR 1213.7 - Findings.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Commission, in order to issue a standard, make the following findings and include them in the rule. 15 U.S.C. 2058(f)(3). These findings are contained in the appendix to this part 1213. (a) The rule in this part (including its effective date of June 19, 2000 is reasonably necessary to eliminate or reduce an...

  16. 16 CFR 1212.5 - Findings.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 2 2013-01-01 2013-01-01 false Findings. 1212.5 Section 1212.5 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS SAFETY STANDARD FOR MULTI-PURPOSE LIGHTERS Requirements for Child-Resistance § 1212.5 Findings. (a) Before issuing a...

  17. 16 CFR 1212.5 - Findings.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 2 2014-01-01 2014-01-01 false Findings. 1212.5 Section 1212.5 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS SAFETY STANDARD FOR MULTI-PURPOSE LIGHTERS Requirements for Child-Resistance § 1212.5 Findings. (a) Before issuing a...

  18. 20 CFR 617.33 - Findings required.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... FOR WORKERS UNDER THE TRADE ACT OF 1974 Job Search Allowances § 617.33 Findings required. (a) Findings by liable State. Before final payment of a job search allowance may be approved, the following... search allowance specified in § 617.32(a) (1) through (4); (2) The application for a job search...

  19. 20 CFR 617.33 - Findings required.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... FOR WORKERS UNDER THE TRADE ACT OF 1974 Job Search Allowances § 617.33 Findings required. (a) Findings by liable State. Before final payment of a job search allowance may be approved, the following... search allowance specified in § 617.32(a) (1) through (4); (2) The application for a job search...

  20. Eye Examination Findings Among Children. United States.

    ERIC Educational Resources Information Center

    Health Services and Mental Health Administration (DHEW), Bethesda, MD.

    Reported were extensive statistical data on the prevalence of abnormal eye conditions found on examination, heterophoria test results, and history of eye problems as well as extent of interrelationship of the eye examination and vision test findings among children aged 6 to 11 years in the United States, based on findings from the Health…

  1. Employment for Spouses Gets Harder to Find

    ERIC Educational Resources Information Center

    June, Audrey Williams

    2009-01-01

    Worries about a partner's finding a job are a major reason why colleges lose faculty and professional-staff recruits. Some institutions have hired people to focus largely on nonfaculty job searches. (Finding faculty jobs for spouses or partners is a more complex negotiation with the university.) But as the economy continues to dip into uncharted…

  2. Ocular findings in conjoined (Siamese) twins.

    PubMed

    Mansour, A M; Mansour, N; Rosenberg, H S

    1991-01-01

    Conjoined twinning is a rare form of congenital anomaly. The ocular findings in six sets of conjoined twins as well as those reported elsewhere include abnormal optic nerve decussation, pseudosynophthalmos, microphthalmia, abnormal eyelids, orbital encephalocele, occipital encephalocele, and eyelid coloboma. These findings are interpreted as due to deformations from appositional fusion-related factors or malformations from developmental factors.

  3. 20 CFR 617.33 - Findings required.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... FOR WORKERS UNDER THE TRADE ACT OF 1974 Job Search Allowances § 617.33 Findings required. (a) Findings by liable State. Before final payment of a job search allowance may be approved, the following... search allowance specified in § 617.32(a) (1) through (4); (2) The application for a job search allowance...

  4. Experimental interstellar organic chemistry - Preliminary findings

    NASA Technical Reports Server (NTRS)

    Khare, B. N.; Sagan, C.

    1973-01-01

    Review of the results of some explicit experimental simulation of interstellar organic chemistry consisting in low-temperature high-vacuum UV irradiation of condensed simple gases known or suspected to be present in the interstellar medium. The results include the finding that acetonitrile may be present in the interstellar medium. The implication of this and other findings are discussed.

  5. 5 CFR 2638.504 - Director's finding.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Director's finding. 2638.504 Section 2638... Individual Executive Agency Employees § 2638.504 Director's finding. (a) In general. If the Director has reason to believe that an employee is violating or has violated an ethics provision, the Director...

  6. 16 CFR 1202.2 - Findings. 1

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... MATCHBOOKS § 1202.2 Findings. 1 1 The Commission's findings apply to the matchbook standard that it published..., the Commission published a revised version of the standard which reflects the court's decision... magazines, newspapers, radio, and television, and that readership retention of the matchbook...

  7. 16 CFR 1202.2 - Findings. 1

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... MATCHBOOKS § 1202.2 Findings. 1 1 The Commission's findings apply to the matchbook standard that it published..., the Commission published a revised version of the standard which reflects the court's decision... magazines, newspapers, radio, and television, and that readership retention of the matchbook...

  8. 34 CFR 300.111 - Child find.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 2 2011-07-01 2010-07-01 true Child find. 300.111 Section 300.111 Education... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH DISABILITIES State Eligibility Other Fape Requirements § 300.111 Child find. (a) General. (1) The State...

  9. 34 CFR 300.111 - Child find.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 2 2012-07-01 2012-07-01 false Child find. 300.111 Section 300.111 Education... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH DISABILITIES State Eligibility Other Fape Requirements § 300.111 Child find. (a) General. (1) The State...

  10. 34 CFR 300.111 - Child find.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 2 2013-07-01 2013-07-01 false Child find. 300.111 Section 300.111 Education... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH DISABILITIES State Eligibility Other Fape Requirements § 300.111 Child find. (a) General. (1) The State...

  11. 34 CFR 300.111 - Child find.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 2 2014-07-01 2013-07-01 true Child find. 300.111 Section 300.111 Education... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH DISABILITIES State Eligibility Other Fape Requirements § 300.111 Child find. (a) General. (1) The State...

  12. 3 CFR - Finding and Recapturing Improper Payments

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 3 The President 1 2011-01-01 2011-01-01 false Finding and Recapturing Improper Payments Presidential Documents Other Presidential Documents Memorandum of March 10, 2010 Finding and Recapturing Improper Payments Memorandum for the Heads of Executive Departments and Agencies My Administration is committed to reducing payment errors and...

  13. Tympanometric findings in superior semicircular canal dehiscence syndrome.

    PubMed

    Castellucci, A; Brandolini, C; Piras, G; Modugno, G C

    2013-04-01

    The diagnostic role of audio-impedancemetry in superior semicircular canal dehiscence (SSCD) disease is well known. In particular, since the first reports, the presence of evoked acoustic reflexes has represented a determining instrumental exhibit in differential diagnosis with other middle ear pathologies that are responsible for a mild-low frequencies air-bone gap (ABG). Even though high resolution computed tomography (HRCT) completed by parasagittal reformatted images still represents the diagnostic gold standard, several instrumental tests can support a suspect of labyrinthine capsule dehiscence when "suggestive" symptoms occur. Objective and subjective audiometry often represents the starting point of the diagnostic course aimed at investigating the cause responsible for the so-called "intra-labyrinthine conductive hearing loss". The purpose of this study is to evaluate the role of tympanometry, in particular of the inter-aural asymmetry ratio in peak compliance as a function of different mild-low frequencies ABG on the affected side, in the diagnostic work-up in patients with unilateral SSCD. The working hypothesis is that an increase in admittance of the "inner-middle ear" conduction system due to a "third mobile window" could be detected by tympanometry. A retrospective review of the clinical records of 45 patients with unilateral dehiscence selected from a pool of 140 subjects diagnosed with SSCD at our institution from 2003 to 2011 was performed. Values of ABG amplitude on the dehiscent side and tympanometric measurements of both ears were collected for each patient in the study group (n = 45). An asymmetry between tympanometric peak compliance of the involved side and that of the contralateral side was investigated by calculating the inter-aural difference and the asymmetry ratio of compliance at the eardrum. A statistically significant correlation (p = 0.015 by Fisher's test) between an asymmetry ratio ≥ 14% in favour of the pathologic ear and an ABG

  14. Family Finding Evaluations: A Summary of Recent Findings--Appendix. Publication #2015-01A

    ERIC Educational Resources Information Center

    Vandivere, Sharon; Malm, Karin

    2015-01-01

    This document was produced by the authors based on their research for the report, "Family Finding Evaluations: A Summary of Recent Findings. Publication #2015-01," and is an added resource for further information. The report reviews the results from 13 evaluations of Family Finding. The Family Finding model provides child welfare…

  15. Family Finding Evaluations: A Summary of Recent Findings--Appendix. Publication #2015-01A

    ERIC Educational Resources Information Center

    Vandivere, Sharon; Malm, Karin

    2015-01-01

    This document was produced by the authors based on their research for the report, "Family Finding Evaluations: A Summary of Recent Findings. Publication #2015-01," and is an added resource for further information. The report reviews the results from 13 evaluations of Family Finding. The Family Finding model provides child welfare…

  16. Benefit finding and resilience in child caregivers.

    PubMed

    Cassidy, Tony; Giles, Melanie; McLaughlin, Marian

    2014-09-01

    A substantial number of children are involved in informal caregiving and make a significant contribution to health care delivery. While this places high levels of demand on their coping resources, there is some evidence that these children find benefit in their caring role. A survey design using questionnaire data collection was used with a sample of 442 children (174 boys and 268 girls) between the ages of 12 and 16. The role of benefit finding and resilience was explored within a stress and coping model of the impact of caregiving. Hierarchical multiple regression analysis (HMRA) identified resilience and benefit finding as accounting for significant amounts of variance in positive health and mediating the impact of caregiving. In regard to negative health, only benefit finding played a significant role. Young caregivers do experience benefit finding and exhibit resilience although the relationship with caregiving burden was inverse. Benefit finding seems to be related to social recognition of the caregiving role and to family support. What is already known on this subject? There is some emerging evidence that child caregivers experience some positive effects or benefits from their caring in spite of the demands of the role. However, the main focus has been on reducing negative outcomes rather than on building resilience. What this study adds? This study provides evidence that young caregivers do experience benefit finding in situations where the role demand is not overly excessive and where the role is socially recognized. © 2013 The British Psychological Society.

  17. Vertex finding with deformable templates at LHC

    NASA Astrophysics Data System (ADS)

    Stepanov, Nikita; Khanov, Alexandre

    1997-02-01

    We present a novel vertex finding technique. The task is formulated as a discrete-continuous optimisation problem in a way similar to the deformable templates approach for the track finding. Unlike the track finding problem, "elastic hedgehogs" rather than elastic arms are used as deformable templates. They are initialised by a set of procedures which provide zero level approximation for vertex positions and track parameters at the vertex point. The algorithm was evaluated using the simulated events for the LHC CMS detector and demonstrated good performance.

  18. MRI findings in pediatric patients with scurvy.

    PubMed

    Gulko, Edwin; Collins, Lee K; Murphy, Robyn C; Thornhill, Beverly A; Taragin, Benjamin H

    2015-02-01

    In modern times scurvy is a rarely encountered disease caused by ascorbic acid (vitamin C) deficiency. However, sporadic cases of scurvy persist, particularly within the pediatric population. Recent individual case reports highlight an increased incidence of scurvy among patients with autism or developmental delay, with isolated case reports detailing the magnetic resonance imaging (MRI) findings of scurvy in these pediatric populations. We present the MRI findings of scurvy in four patients with autism or developmental delay, and review the literature on MRI findings in pediatric patients with scurvy. Despite its rarity, the radiologist must consider scurvy in a pediatric patient with a restricted diet presenting with arthralgia or myalgia.

  19. EEG findings in the persistent vegetative state.

    PubMed

    Kulkarni, Vidya P; Lin, Kaiwen; Benbadis, Selim R

    2007-12-01

    The definition of the persistent vegetative state (PVS) is relatively straightforward, but its diagnosis can be challenging. We reviewed a series of EEG performed in patients with PVS to assess the diagnostic value of EEG. We reviewed records of all hospital patients with a diagnosis of persistent vegetative PVS. EEG findings included normal, continuous generalized slowing, intermittent generalized slowing, background slowing, background suppression, alpha, generalized periodic pattern, PLEDS, and triphasic waves. EEG findings had no association with etiology and varied from one pattern to another in the same patients' EEGs obtained at different times (see table). We conclude that EEG findings in PVS are heterogeneous and too variable to be of diagnostic value.

  20. How to Find Insects Weathering the Winter.

    ERIC Educational Resources Information Center

    Brody, Jane

    1979-01-01

    Discusses how and where to find insects and other invertebrates in winter, as well as how to collect samples in order to watch those animals reappear in spring. Includes crickets, honey bees, mosquitoes, house flies, and butterflies and moths. (MA)

  1. Find a Physical Medicine & Rehabilitation Physician

    MedlinePlus

    ... News & Publications About Physiatry About AAPM&R Education Quality ... PM&R physician in your area. You can also search for physicians by name and city/state/country on the "Find Physicians by Name" ...

  2. Finding Hooks to Catch Reluctant Readers.

    ERIC Educational Resources Information Center

    Grimes, Marijo

    1991-01-01

    Discusses a list of books of varying lengths and difficulty that the reading teacher can use to help reluctant readers find that all-important breakthrough book to discover what reading can do for them. (KEH)

  3. Can you find south using your watch?

    NASA Astrophysics Data System (ADS)

    Jian, Li; Baruch, John

    2011-06-01

    Li Jian and John Baruch examine the astronomical thinking behind the Boy Scout wristwatch compass as a means of direction finding, and assess its usefulness as you move across the surface of the Earth.

  4. 20 CFR 617.44 - Findings required.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... finds, that the individual has obtained suitable employment affording a reasonable expectation of... employment affording a reasonable expectation of employment of long-term duration, or a bona fide offer...

  5. Ebola Can Linger in Lungs, Study Finds

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_162904.html Ebola Can Linger in Lungs, Study Finds Discovery in ... Researchers say they've discovered signs that the Ebola virus could lurk in the lungs and reproduce ...

  6. Online Imagery: Finding Pictures for Business Documents.

    ERIC Educational Resources Information Center

    Cosden, Chris

    1995-01-01

    Discusses the use of America Online and CompuServe to find clip art, photos, and other images for use in desktop publishing projects. Highlights include copyright issues, different graphic formats, graphic conversion programs, compression programs, and downloading. (LRW)

  7. 77 FR 32116 - Findings of Research Misconduct

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-31

    ... HUMAN SERVICES Office of the Secretary Findings of Research Misconduct AGENCY: Office of the Secretary..., engaged in research misconduct in research supported by National Cancer Institute (NCI), National...''). Specifically, Respondent committed research misconduct by knowingly and intentionally: Falsifying...

  8. Find a Bed Bug Pesticide Product

    EPA Pesticide Factsheets

    Introduces the Bed Bug Product Search Tool, to help consumers find EPA-registered pesticides for bed bug infestation control. Inclusion in this database is not an endorsement. Always follow label directions carefully.

  9. Textual Research and Coherence: Findings, Intuition, Application.

    ERIC Educational Resources Information Center

    Haswell, Richard H.

    1989-01-01

    Notes discrepancies between findings from textual studies and classroom practices and textbooks. Reviews research on cohesion and writing development. Argues that teachers must critically examine writing research and apply it in the classroom. (JAD/RAE)

  10. Cardiology Still a Man's Field, Survey Finds

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_162700.html Cardiology Still a Man's Field, Survey Finds Women less ... Dr. Claire Duvernoy, chair of the Women in Cardiology Council at the American College of Cardiology (ACC). ...

  11. How to Find Insects Weathering the Winter.

    ERIC Educational Resources Information Center

    Brody, Jane

    1979-01-01

    Discusses how and where to find insects and other invertebrates in winter, as well as how to collect samples in order to watch those animals reappear in spring. Includes crickets, honey bees, mosquitoes, house flies, and butterflies and moths. (MA)

  12. Online Imagery: Finding Pictures for Business Documents.

    ERIC Educational Resources Information Center

    Cosden, Chris

    1995-01-01

    Discusses the use of America Online and CompuServe to find clip art, photos, and other images for use in desktop publishing projects. Highlights include copyright issues, different graphic formats, graphic conversion programs, compression programs, and downloading. (LRW)

  13. How to Find Gluten-Free Options

    MedlinePlus

    ... Men For Women For Seniors How to Find Gluten-Free Options Reviewed by Sharon Denny, MS, RDN ... Email Digital Vision/DigitalVision/Thinkstock When considering a gluten-free diet, it is not necessary to avoid ...

  14. Finding Good Health Information on the Internet

    MedlinePlus

    ... Health Information Finding Good Health Information on the Internet Past Issues / Fall 2016 Table of Contents Stephanie ... conditions, medications, and wellness issues. Our site provides access to information produced by the National Library of ...

  15. Distinction between forensic evidence and dermatological findings.

    PubMed

    Hammer, U; Boy, D; Rothaupt, D; Büttner, A

    2015-07-01

    The external examination after death requires knowledge in forensics/pathology, dermatology, as well as associated diseases and age-related alterations of the skin. This article highlights some findings with forensic evidence versus dermatological findings. The lectures in forensic medicine should be structured interdisciplinarily, especially to dermatology, internal medicine, surgery, pathology, and toxicology in order to train the overlapping skills required for external and internal postmortem examinations.

  16. Lung in Dengue: Computed Tomography Findings

    PubMed Central

    Rodrigues, Rosana Souza; Brum, Ana Livia Garcia; Paes, Marciano Viana; Póvoa, Tiago Fajardo; Basilio-de-Oliveira, Carlos Alberto; Marchiori, Edson; Borghi, Danielle Provençano; Ramos, Grazielle Viana; Bozza, Fernando Augusto

    2014-01-01

    Background Dengue is the most important mosquito-borne viral disease in the world. Dengue virus infection may be asymptomatic or lead to undifferentiated fever, dengue fever with or without warning signs, or severe dengue. Lower respiratory symptoms are unusual and lung-imaging data in patients with dengue are scarce. Methodology/Principal Findings To evaluate lung changes associated with dengue infection, we retrospectively analyzed 2,020 confirmed cases of dengue. Twenty-nine of these patients (11 females and 18 males aged 16–90 years) underwent chest computed tomography (CT), which yielded abnormal findings in 17 patients: 16 patients had pleural effusion (the sole finding in six patients) and 11 patients had pulmonary abnormalities. Lung parenchyma involvement ranged from subtle to moderate unilateral and bilateral abnormalities. The most common finding was ground-glass opacity in eight patients, followed by consolidation in six patients. Less common findings were airspace nodules (two patients), interlobular septal thickening (two patients), and peribronchovascular interstitial thickening (one patient). Lung histopathological findings in four fatal cases showed thickening of the alveolar septa, hemorrhage, and interstitial edema. Conclusions/Significance In this largest series involving the use of chest CT to evaluate lung involvement in patients with dengue, CT findings of lower respiratory tract involvement were uncommon. When abnormalities were present, pleural effusion was the most frequent finding and lung involvement was often mild or moderate and bilateral. Extensive lung abnormalities are infrequent even in severe disease and when present should lead physicians to consider other diagnostic possibilities. PMID:24836605

  17. Ultrasonography findings of vulvar liposarcoma. Case report.

    PubMed

    Yanik, Bahar; Inceboz, Umit; Bulbul, Erdogan; Demirpolat, Gulen; Uzgoren, Ismail Engin

    2015-09-01

    Liposarcoma (LPS) of vulva is a rare entity. We present the ultrasonographic (US) and color Doppler ultrasonographic (CDUS) findings of a vulvar myxoid LPS. Although LPS cases have been reported in the extremities and trunk, the US or CDUS findings of LPS in vulva have not been described previously. On US the mass appeared as a well-defined, homogeneous hypoechoic structure and on CDUS it was quite hypervascular.

  18. Neuroradiological findings in maple syrup urine disease.

    PubMed

    Indiran, Venkatraman; Gunaseelan, R Emmanuel

    2013-01-01

    Maple syrup urine disease is a rare inborn error of amino acid metabolism involving catabolic pathway of the branched-chain amino acids. This disease, if left untreated, may cause damage to the brain and may even cause death. These patients typically present with distinctive maple syrup odour of sweat and urine. Patients typically present with skin and urine smelling like maple syrup. Here we describe a case with relevant magnetic resonance imaging findings and confirmatory biochemical findings.

  19. How to Find the Students' Inner Geek

    ERIC Educational Resources Information Center

    Zimmer, Marc

    2005-01-01

    As a chemistry professor at a liberal-arts college, the author believes it is his job to find the youthful awe in his students and draw it out so that they will be intrigued once again by science and nature, so that they want to learn about equilibria, pH, and redox reactions. He has to go fishing inside their brains, to find, hook, and reel in…

  20. CT findings of acute pelvic inflammatory disease.

    PubMed

    Lee, Mi Hee; Moon, Min Hoan; Sung, Chang Kyu; Woo, Hyunsik; Oh, Sohee

    2014-12-01

    To determine the computed tomographic (CT) findings of acute pelvic inflammatory disease (PID). This retrospective, single-institution case-control study was approved by our institutional review board, and the informed consent was waived owing to the retrospective nature of the study. CT images of 32 women with clinically proven acute PID and 32 control subjects with other conditions of similar presentation were retrospectively reviewed. Analysis of CT findings included hepatic capsular enhancement, pelvic fat haziness, complicated ascites, uterine serosal enhancement, tubal thickening, endometritis, and oophoritis. Comparison of CT findings was performed with the Chi square test or the Fisher exact test and logistic regression analysis was used to determine significant CT findings in predicting PID. The CT findings that showed a statistically significant difference were hepatic capsular enhancement on late arterial phase (p = 0.003), pelvic fat haziness (p = 0.045), and tubal thickening (p = 0.001). Subsequent multivariate logistic regression analysis revealed that the presence of hepatic capsular enhancement on late arterial phase and tubal thickening were significant predictors of PID (hepatic capsular enhancement on late arterial phase, p = 0.015, odds ratio [OR] = 4.8; tubal thickening, p = 0.005, OR = 10.5). Diagnostic morphological CT findings in women with clinically proven PID and acute abdominal pain include hepatic capsular enhancement on late arterial phase and tubal thickening.