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Sample records for respiratory therapy devices

  1. SU-E-J-48: Development of An Abdominal Compression Device for Respiratory Correlated Radiation Therapy

    SciTech Connect

    Kim, T; Kang, S; Kim, D; Suh, T; Kim, S

    2014-06-01

    Purpose: The aim of this study is to develop the abdominal compression device which could control pressure level according to the abdominal respiratory motion and evaluate its feasibility. Methods: In this study, we focused on developing the abdominal compression device which could control pressure level at any point of time so the developed device is possible to use a variety of purpose (gating technique or respiratory training system) while maintaining the merit of the existing commercial device. The compression device (air pad form) was designed to be able to compress the front and side of abdomen and the pressure level of the abdomen is controlled by air flow. Pressure level of abdomen (air flow) was determined using correlation data between external abdominal motion and respiratory volume signal measured by spirometer. In order to verify the feasibility of the device, it was necessary to confirm the correlation between the abdominal respiratory motion and respiratory volume signal and cooperation with respiratory training system also checked. Results: In the previous study, we could find that the correlation coefficient ratio between diaphragm and respiratory volume signal measured by spirometer was 0.95. In this study, we confirmed the correlation between the respiratory volume signal and the external abdominal motion measured by belt-transducer (correlation coefficient ratio was 0.92) and used the correlated respiratory volume data as an abdominal pressure level. It was possible to control the pressure level with negligible time delay and respiratory volume data based guiding waveforms could be properly inserted into the respiratory training system. Conclusion: Through this feasibility study, we confirmed the correlation between the respiratory volume signal and the external abdominal motion. Also initial assessment of the device and its compatibility with the respiratory training system were verified. Further study on application in respiratory gated

  2. Current devices of respiratory physiotherapy.

    PubMed

    Hristara-Papadopoulou, A; Tsanakas, J; Diomou, G; Papadopoulou, O

    2008-01-01

    In recent years patients with respiratory diseases use various devices, which help the removal of mucus from the airways and the improvement of pulmonary function. The aim of the present study is to determine the effectiveness of the current devices of respiratory physiotherapy, as it comes from the review of literature. The current devices of physiotherapy for patients with respiratory diseases, are presented as an alternative therapy method or a supplemental therapy and they can motivate patients to apply therapy by themselves. These devices seem to increase patients' compliance to daily treatment, because they present many benefits, as independent application, full control of therapy and easy use. These devices are the Positive Expiratory Pressure, the High Frequency Chest Wall Oscillation, the Oral High Frequency Oscillation, the Intrapulmonary Percussive Ventilation, the Incentive Spirometry the Flutter and the Acapella and the Cornet. Current devices seem to be effective in terms of mucus expectoration and pulmonary function improvement, as it is shown by published studies. The choice of the suitable device for each patient is a challenge for the physiotherapist in order to achieve better compliance in daily treatment. More controlled studies are needed due to the fact that the number of published studies is limited.

  3. Current devices of respiratory physiotherapy

    PubMed Central

    Hristara-Papadopoulou, A; Tsanakas, J; Diomou, G; Papadopoulou, O

    2008-01-01

    In recent years patients with respiratory diseases use various devices, which help the removal of mucus from the airways and the improvement of pulmonary function. The aim of the present study is to determine the effectiveness of the current devices of respiratory physiotherapy, as it comes from the review of literature. The current devices of physiotherapy for patients with respiratory diseases, are presented as an alternative therapy method or a supplemental therapy and they can motivate patients to apply therapy by themselves. These devices seem to increase patients' compliance to daily treatment, because they present many benefits, as independent application, full control of therapy and easy use. These devices are the Positive Expiratory Pressure, the High Frequency Chest Wall Oscillation, the Oral High Frequency Oscillation, the Intrapulmonary Percussive Ventilation, the Incentive Spirometry the Flutter and the Acapella and the Cornet. Current devices seem to be effective in terms of mucus expectoration and pulmonary function improvement, as it is shown by published studies. The choice of the suitable device for each patient is a challenge for the physiotherapist in order to achieve better compliance in daily treatment. More controlled studies are needed due to the fact that the number of published studies is limited. PMID:19158964

  4. Oxygen therapy devices and portable ventilators for improved physical activity in daily life in patients with chronic respiratory disease.

    PubMed

    Furlanetto, Karina Couto; Pitta, Fabio

    2017-02-01

    Patients with hypoxemia and chronic respiratory failure may need to use oxygen therapy to correct hypoxemia and to use ventilatory support to augment alveolar ventilation, reverse abnormalities in blood gases (in particular hypercapnia) and reduce the work of breathing. Areas covered: This narrative review provides an overview on the use of oxygen therapy devices or portable ventilators for improved physical activity in daily life (PADL) as well as discusses the issue of lower mobility in daily life among stable patients with chronic respiratory disease who present indication for long-term oxygen therapy (LTOT) or home-based noninvasive ventilation (NIV). A literature review of these concepts was performed by using all related search terms. Expert commentary: Technological advances led to the development of light and small oxygen therapy devices and portable ventilators which aim to facilitate patients' mobility and ambulation. However, the day-by-day dependence of a device may reduce mobility and partially impair patients' PADL. Nocturnal NIV implementation in hypercapnic patients seems promising to improve PADL. The magnitude of their equipment-related physical inactivity is underexplored up to this moment and more long-term randomized clinical trials and meta-analysis examining the effects of ambulatory oxygen and NIV on PADL are required.

  5. [Complex therapy of occupational respiratory tract diseases using multifunctional massage device: clinical criteria of efficiency].

    PubMed

    Artemova, L V; Sorkina, N S; Rumiantseva, O I; Komarova, S G; Rudyĭ, S S; Petrykina, M V

    2011-01-01

    Level of efficiency of CERAGEM MASTER CGM-M3500 treatment device applied for occupational patients suffering from bronchi and lung pathological states has been shown in the paper. Positive effects of treatment have been assessed as reliably high and were proved by improvement of clinical and functional indices, subjunctive self-evaluation of health by patients and positive signs in the clinical course of the diseases. Diagnostic complex has been analyzed, including hematological indicators of the peripheral blood, oxygenation of the capillary blood, immunology. Also dynamics of the clinical course has been studied along with the data on self-assessment of health by patients prior and after the therapy by the device. Prospects on treatment of occupational bronchi and lung pathologies with the help of multifunctional massage device are being discussed in the paper.

  6. Respiratory protection devices.

    PubMed

    Vesley, D L

    1995-04-01

    OSHA authority and responsibility have led to the requirement that health care workers potentially exposed to patients with active tuberculosis in situations where engineering controls are not feasible for protection must utilize personal protective equipment at least equivalent to HEPA respirators. ICPs generally believe that this approach is unnecessarily conservative and imposes undue burdens on patient care. The arguments on both sides of this controversy have some merit. Reported cases of tuberculosis and skin-test conversions among health care workers since 1988 and the absence of a demonstrated safe level of exposure have led many to the conclusion that HEPA respirators are justified. On the other side, tuberculosis currently is not a major problem in some areas of the country, and many believe that less stringent personal protective devices (e.g., DM respirators) may provide protection equivalent to HEPA filters--at least in terms of preventing infection if not in terms of filtration efficiency. They believe that the lesser discomfort and lower cost associated with DM respirators justify the argument for a more flexible standard. Perhaps additional research can help to resolve the remaining controversy. Definitive answers are unlikely to surface quickly, however, and it is likely that the controversy and confusion will continue for at least awhile longer.

  7. Respiratory Therapy Assistant. Student's Manual.

    ERIC Educational Resources Information Center

    Jones, Judy A.

    This manual is one in a new series of self-contained materials for students enrolled in training with the allied health field. It includes competencies that are associated with the performance of skills by students beginning the study of respiratory therapy assistance. Intended to be used for individualized instruction under the supervision of an…

  8. Respiratory Therapy Technology Program Guide.

    ERIC Educational Resources Information Center

    Georgia Univ., Athens. Dept. of Vocational Education.

    This guide presents the standard curriculum for technical institutes in Georgia. The curriculum addresses the minimum competencies for a respiratory therapy technology program. The guide contains four sections. The General Information section contains an introduction giving an overview and defining the purpose and objectives, a program…

  9. Health Instruction Packages: Respiratory Therapy.

    ERIC Educational Resources Information Center

    Lavich, Margot; And Others

    Text, illustrations, and exercises are utilized in these four learning modules to teach respiratory therapy students a variety of job-related skills. The first module, "Anatomy and Physiology of the Central Controls of Respiration" by Margot Lavich, describes the functions of the five centers of the brain that control respiration and…

  10. Respiratory Therapy Assistant. Student's Manual.

    ERIC Educational Resources Information Center

    Jones, Judy A.

    This manual is one in a new series of self-contained materials for students enrolled in training with the allied health field. It includes competencies that are associated with the performance of skills by students beginning the study of respiratory therapy assistance. Intended to be used for individualized instruction under the supervision of an…

  11. Health Instruction Packages: Respiratory Therapy.

    ERIC Educational Resources Information Center

    Lavich, Margot; And Others

    Text, illustrations, and exercises are utilized in these four learning modules to teach respiratory therapy students a variety of job-related skills. The first module, "Anatomy and Physiology of the Central Controls of Respiration" by Margot Lavich, describes the functions of the five centers of the brain that control respiration and…

  12. A Guide for Respiratory Therapy Curriculum Design.

    ERIC Educational Resources Information Center

    American Association for Respiratory Therapy, Dallas, TX.

    The document presents educational criterion upon which curriculum builders can create a competency-based program of respiratory therapy education. The 11 modules presented supplement and compliment the document Delineation of Roles and Functions of Respiratory Therapy Personnel (CE 005 945) which is listed as appendix D but not included as such.…

  13. Expanding the Respiratory Therapy Curriculum. Final Report.

    ERIC Educational Resources Information Center

    Burnett, Mary; Allenbaugh, Patricia

    This project was conducted to upgrade Seattle Central Community College's four-quarter respiratory care program to a two-year associate degree program in respiratory therapy. The program needed to include a developmental pathway for entry of nontraditional students and also a college-level prerequisite entry pathway for traditional students. In…

  14. Respiratory Motion Prediction in Radiation Therapy

    NASA Astrophysics Data System (ADS)

    Vedam, Sastry

    Active respiratory motion management has received increasing attention in the past decade as a means to reduce the internal margin (IM) component of the clinical target volume (CTV)—planning target volume (PTV) margin typically added around the gross tumor volume (GTV) during radiation therapy of thoracic and abdominal tumors. Engineering and technical developments in linear accelerator design and respiratory motion monitoring respectively have made the delivery of motion adaptive radiation therapy possible through real-time control of either dynamic multileaf collimator (MLC) motion (gantry based linear accelerator design) or robotic arm motion (robotic arm mounted linear accelerator design).

  15. Aerosol Phage Therapy Efficacy in Burkholderia cepacia Complex Respiratory Infections

    PubMed Central

    Semler, Diana D.; Goudie, Amanda D.; Finlay, Warren H.

    2014-01-01

    Phage therapy has been suggested as a potential treatment for highly antibiotic-resistant bacteria, such as the species of the Burkholderia cepacia complex (BCC). To address this hypothesis, experimental B. cenocepacia respiratory infections were established in mice using a nebulizer and a nose-only inhalation device. Following infection, the mice were treated with one of five B. cenocepacia-specific phages delivered as either an aerosol or intraperitoneal injection. The bacterial and phage titers within the lungs were assayed 2 days after treatment, and mice that received the aerosolized phage therapy demonstrated significant decreases in bacterial loads. Differences in phage activity were observed in vivo. Mice that received phage treatment by intraperitoneal injection did not demonstrate significantly reduced bacterial loads, although phage particles were isolated from their lung tissue. Based on these data, aerosol phage therapy appears to be an effective method for treating highly antibiotic-resistant bacterial respiratory infections, including those caused by BCC bacteria. PMID:24798268

  16. Aerosol phage therapy efficacy in Burkholderia cepacia complex respiratory infections.

    PubMed

    Semler, Diana D; Goudie, Amanda D; Finlay, Warren H; Dennis, Jonathan J

    2014-07-01

    Phage therapy has been suggested as a potential treatment for highly antibiotic-resistant bacteria, such as the species of the Burkholderia cepacia complex (BCC). To address this hypothesis, experimental B. cenocepacia respiratory infections were established in mice using a nebulizer and a nose-only inhalation device. Following infection, the mice were treated with one of five B. cenocepacia-specific phages delivered as either an aerosol or intraperitoneal injection. The bacterial and phage titers within the lungs were assayed 2 days after treatment, and mice that received the aerosolized phage therapy demonstrated significant decreases in bacterial loads. Differences in phage activity were observed in vivo. Mice that received phage treatment by intraperitoneal injection did not demonstrate significantly reduced bacterial loads, although phage particles were isolated from their lung tissue. Based on these data, aerosol phage therapy appears to be an effective method for treating highly antibiotic-resistant bacterial respiratory infections, including those caused by BCC bacteria.

  17. Photodynamic therapy for recurrent respiratory papillomatosis.

    PubMed

    Lieder, Anja; Khan, Muhammad K; Lippert, Burkard M

    2014-06-05

    Recurrent respiratory papillomatosis (RRP) is a benign condition of the mucosa of the upper aerodigestive tract. It is characterised by recurrent papillomatous lesions and is associated with human papillomavirus (HPV). Frequent recurrence and rapid papilloma growth are common and in part responsible for the onset of potentially life-threatening symptoms. Most patients afflicted by the condition will require repeated surgical treatments to maintain their airway, and these may result in scarring and voice problems. Photodynamic therapy introduces a light-sensitising agent, which is administered either orally or by injection. This substance (called a photo-sensitiser) is selectively retained in hyperplastic and neoplastic tissue, including papilloma. It is then activated by light of a specific wavelength and may be used as a sole or adjuvant treatment for RRP. To assess the effects of photodynamic therapy in the management of recurrent respiratory papillomatosis (RRP) in children and adults. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 27 January 2014. Randomised controlled trials utilising photodynamic therapy as sole or adjuvant therapy in participants of any age with proven RRP versus control intervention. Primary outcome measures were symptom improvement (respiratory distress/dyspnoea and voice quality), quality of life improvement and recurrence-free interval. Secondary outcomes included reduction in the frequency of surgical intervention, reduction in disease volume and adverse effects of treatment.   We used the standard methodological procedures expected by The Cochrane Collaboration. Meta-analysis was not possible and results are presented descriptively. We included one trial with a total of 23

  18. Respiratory Magnetogram Detected with a MEMS Device

    PubMed Central

    Dominguez-Nicolas, Saul M.; Juarez-Aguirre, Raul; Herrera-May, Agustin L.; Garcia-Ramirez, Pedro; Figueras, Eduard; Gutierrez-D., Edmundo A.; Tapia, Jesus A.; Trejo, Argelia; Manjarrez, Elias

    2013-01-01

    Magnetic fields generated by the brain or the heart are very useful in clinical diagnostics. Therefore, magnetic signals produced by other organs are also of considerable interest. Here we show first evidence that thoracic muscles can produce a strong magnetic flux density during respiratory activity, that we name respiratory magnetogram. We used a small magnetometer based on microelectromechanical systems (MEMS), which was positioned inside the open thoracic cage of anaesthetized and ventilated rats. With this new MEMS sensor of about 20 nT resolution, we recorded a strong and rhythmic respiratory magnetogram of about 600 nT. PMID:24046516

  19. Inhaled Antibiotic Therapy in Chronic Respiratory Diseases

    PubMed Central

    Maselli, Diego J.; Keyt, Holly; Restrepo, Marcos I.

    2017-01-01

    The management of patients with chronic respiratory diseases affected by difficult to treat infections has become a challenge in clinical practice. Conditions such as cystic fibrosis (CF) and non-CF bronchiectasis require extensive treatment strategies to deal with multidrug resistant pathogens that include Pseudomonas aeruginosa, Methicillin-resistant Staphylococcus aureus, Burkholderia species and non-tuberculous Mycobacteria (NTM). These challenges prompted scientists to deliver antimicrobial agents through the pulmonary system by using inhaled, aerosolized or nebulized antibiotics. Subsequent research advances focused on the development of antibiotic agents able to achieve high tissue concentrations capable of reducing the bacterial load of difficult-to-treat organisms in hosts with chronic respiratory conditions. In this review, we focus on the evidence regarding the use of antibiotic therapies administered through the respiratory system via inhalation, nebulization or aerosolization, specifically in patients with chronic respiratory diseases that include CF, non-CF bronchiectasis and NTM. However, further research is required to address the potential benefits, mechanisms of action and applications of inhaled antibiotics for the management of difficult-to-treat infections in patients with chronic respiratory diseases. PMID:28509852

  20. SU-E-T-582: On-Line Dosimetric Verification of Respiratory Gated Volumetric Modulated Arc Therapy Using the Electronic Portal Imaging Device

    SciTech Connect

    Schaly, B; Gaede, S; Xhaferllari, I

    2015-06-15

    Purpose: To investigate the clinical utility of on-line verification of respiratory gated VMAT dosimetry during treatment. Methods: Portal dose images were acquired during treatment in integrated mode on a Varian TrueBeam (v. 1.6) linear accelerator for gated lung and liver patients that used flattening filtered beams. The source to imager distance (SID) was set to 160 cm to ensure imager clearance in case the isocenter was off midline. Note that acquisition of integrated images resulted in no extra dose to the patient. Fraction 1 was taken as baseline and all portal dose images were compared to that of the baseline, where the gamma comparison and dose difference were used to measure day-to-day exit dose variation. All images were analyzed in the Portal Dosimetry module of Aria (v. 10). The portal imager on the TrueBeam was calibrated by following the instructions for dosimetry calibration in service mode, where we define 1 calibrated unit (CU) equal to 1 Gy for 10×10 cm field size at 100 cm SID. This reference condition was measured frequently to verify imager calibration. Results: The gamma value (3%, 3 mm, 5% threshold) ranged between 92% and 100% for the lung and liver cases studied. The exit dose can vary by as much as 10% of the maximum dose for an individual fraction. The integrated images combined with the information given by the corresponding on-line soft tissue matched cone-beam computed tomography (CBCT) images were useful in explaining dose variation. For gated lung treatment, dose variation was mainly due to the diaphragm position. For gated liver treatment, the dose variation was due to both diaphragm position and weight loss. Conclusion: Integrated images can be useful in verifying dose delivery consistency during respiratory gated VMAT, although the CBCT information is needed to explain dose differences due to anatomical changes.

  1. Mechanisms of cellular therapy in respiratory diseases.

    PubMed

    Abreu, Soraia C; Antunes, Mariana A; Pelosi, Paolo; Morales, Marcelo M; Rocco, Patricia R M

    2011-09-01

    Stem cells present a variety of clinical implications in the lungs. According to their origin, these cells can be divided into embryonic and adult stem cells; however, due to the important ethical and safety limitations that are involved in the embryonic stem cell use, most studies have chosen to focus on adult stem cell therapy. This article aims to present and clarify the recent advances in the field of stem cell biology, as well as to highlight the effects of mesenchymal stem cell (MSC) therapy in the context of acute lung injury/acute respiratory distress syndrome and chronic disorders such as lung fibrosis and chronic obstructive pulmonary disease. For this purpose, we performed a critical review of adult stem cell therapies, covering the main clinical and experimental studies published in Pubmed databases in the past 11 years. Different characteristics were extracted from these articles, such as: the experimental model, strain, cellular type and administration route used as well as the positive or negative effects obtained. There is evidence for beneficial effects of MSC on lung development, repair, and remodeling. The engraftment in the injured lung does not occur easily, but several studies report that paracrine factors can be effective in reducing inflammation and promoting tissue repair. MSC releases several growth factors and anti-inflammatory cytokines that regulate endothelial and epithelial permeability and reduce the severity of inflammation. A better understanding of the mechanisms that control cell division and differentiation, as well as of their paracrine effects, is required to enable the optimal use of bone marrow-derived stem cell therapy to treat human respiratory diseases.

  2. Device therapy for heart failure.

    PubMed

    Boehmer, John P

    2003-03-20

    Although pharmacologic therapy has made impressive advances in the past decade and is the mainstay of therapy for heart failure (HF), there is still a large unmet need, because morbidity and mortality remain unacceptably high. Implanted medical devices are gaining increasing utility in this group of patients and have the potential to revolutionize the treatment of HF. The majority of devices in clinical use or under active investigation in HF can be grouped into 1 of 4 categories: devices to monitor the HF condition, devices to treat rhythm disturbances, devices to improve the mechanical efficiency of the heart, and devices to replace part or all of the heart's function. There are several devices either approved or under development to monitor the HF condition, ranging from interactive weight scales to implantable continuous pressure monitors. The challenge is to demonstrate that this technology can improve patient outcomes. Pacemakers and implantable cardioverter defibrillators (ICDs) are used to treat heart rhythms in a broad range of patients with heart disease, but they now have a special place in HF management with the prophylactic use of ICDs in patients who have advanced systolic dysfunction. The Multicenter Automatic Defibrillator Implantation Trial (MADIT) II study demonstrated a 29% reduction in all-cause mortality with ICDs in patients with a history of a myocardial infarction and a left ventricular (LV) ejection fraction <0.30. LV and multisite pacing are means of improving the mechanical efficiency of the heart. The concept is to create a more coordinated contraction of the ventricles to overcome the inefficiency associated with conduction system delays, which are common in HF. The acute hemodynamic effect can be impressive and is immediate. Several studies of intermediate duration (3 to 6 months) have consistently demonstrated that biventricular pacing improves symptoms and exercise capacity. Mechanical methods of remodeling the heart into a more

  3. [Postoperative respiratory therapy using incentive spirometry].

    PubMed

    Mang, H; Weindler, J; Zapf, C L

    1989-04-01

    The optimal methods of prophylaxis and therapy of postoperative respiratory complications in surgical patients are still open to discussion. In spite of numerous recent clinical investigations, there is still no specific and universally acceptable therapeutic concept. In our department, we identify patients at risk of pulmonary complications by adequate screening, i.e. medical history, physical examination, chest X-ray, and spirometry. In the postoperative period there are a sequence of stages starting with early mobilization, respiratory therapy (including incentive spirometry and IPPB), and when necessary, controlled mechanical ventilation. We have measured and documented the flows and volumes required of patients using various types of incentive spirometer. In addition, we review on the literature and describe our experience with the technique, handling, and organization of sustained maximal inspiration (SMI). After thoracic or major upper abdominal surgery, all lung volumes decrease due to impairment of rib cage movement, changes in chest wall muscle tone, an increase in lung recoil, and airway closure. At the end of each expiration some of the smallest airways collapse either partly or totally. This process continues to some extent until, normally, a deep breath recruits the alveoli. Sighs to the limit of total lung capacity or oscillations of the expiratory baseline ought to be responsible for this effect in healthy humans; the same purpose is intended in incentive spirometry. For this therapy, it is mandatory that the central airways are not occluded by mucus and that the patient is able to breath volumes exceeding his normal tidal volume.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Nanoparticle-based therapy for respiratory diseases.

    PubMed

    Da Silva, Adriana L; Santos, Raquel S; Xisto, Débora G; Alonso, Silvia del V; Morales, Marcelo M; Rocco, Patricia R M

    2013-03-01

    Nanotechnology is an emerging science with the potential to create new materials and strategies involving manipulation of matter at the nanometer scale (<100 nm). With size-dependent properties, nanoparticles have introduced a new paradigm in pharmacotherapy - the possibility of cell-targeted drug delivery with minimal systemic side effects and toxicity. The present review provides a summary of published findings, especially regarding to nanoparticle formulations for lung diseases. The available data have shown some benefits with nanoparticle-based therapy in the development of the disease and lung remodeling in respiratory diseases. However, there is a wide gap between the concepts of nanomedicine and the published experimental data and clinical reality. In addition, studies are still required to determine the potential of nanotherapy and the systemic toxicity of nanomaterials for future human use.

  5. [Kinetic therapy for acute respiratory distress syndrome].

    PubMed

    Chechenin, M G; Voevodin, S V; Pronichev, E Iu; Shuliveĭstrov, Iu V

    2004-01-01

    The authors evaluated the clinical and physiological effects of kinetic therapy (KT) in the treatment of acute respiratory distress syndrome (ARDS). Forty-six patients with ARDS underwent successive postural positioning in accordance with two regimens: 1) lateral, prone, contralateral, supine positions; 2) prone, lateral, contralateral, supine positions. The criterion for changing each position was the change in monitoring indices: SpO2, PaO2, and thoracopulmonary compliance (C). KT was performed until a respirator was withdrawn from the patient. In 25 patients, each maneuver of positioning was made during 30-minute propofol sedation. The control group included 24 patients with ARDS who received neither KT nor propofol sedation. KT caused a decrease in Vd/Vt, Qs/Qt and an increase in PaO2/FiO2 and C was more intensive, as compared with the control group. The duration of the patient's prone position was 3.2-0.7 hours and that of the supine position was 3.4-0.8 hours. The right and left lateral positions lasted 1.1-0.2 and 1.3-0.2 hours, respectively. KT regimen 1 was found to be more effective than KT regimen 2. Propofol sedation enhanced the efficiency of KT. The latter reduced death rates in patients with ARDS.

  6. Respiratory Event Detection by a Positive Airway Pressure Device

    PubMed Central

    Berry, Richard B.; Kushida, Clete A.; Kryger, Meir H.; Soto-Calderon, Haideliza; Staley, Bethany; Kuna, Samuel T.

    2012-01-01

    Study Objectives: Compare automatic event detection (AED) of respiratory events using a positive airway pressure (PAP) device with manual scoring of polysomnography (PSG) during PAP treatment of obstructive sleep apnea (OSA). Design: Prospective PSGs of patients using a PAP device. Setting: Six academic and private sleep disorders centers. Patients: A total of 148 PSGs from 115 participants with OSA (apnea-hypopnea index [AHI] ≥ 15 events/hr) were analyzed. Interventions: A signal generated by the PAP device identifying the AED of respiratory events based on airflow was recorded during PSG. Measurements and Results: The PSGs were manually scored without visualization of the AED signal and scoring of a hypopnea required a ≥ 4% oxygen desaturation. The apnea index (AI), hypopnea index (HI), and AHI by manual score and PAP AED were compared. A customized computer program compared individual events by manual scoring and AED to determine the true positive, false positive, false negative, or true negative events and found a sensitivity of 0.58 and a specificity of 0.98. The AHI, AI, and HI by the two methods were highly correlated. Bland-Altman analysis showed better agreement for AI than HI. Using a manually scored AHI of ≥ 10 events/hr to denote inadequate treatment, an AED AHI ≥ 10 events/hr had a sensitivity of 0.58 and a specificity of 0.94. Conclusions: An AHI < 10 events/hr by PAP AED is usually associated with good treatment efficacy. Differences between manually scored and AED events were primarily due to different criteria for hypopnea detection. Citation: Berry RB; Kushida CA; Kryger MH; Soto-Calderon H; Staley B; Kuna ST. Respiratory event detection by a positive airway pressure device. SLEEP 2012;35(3):361-367. PMID:22379242

  7. Measurement of protection factor of respiratory protective devices toward nanoparticles.

    PubMed

    Brochot, C; Michielsen, N; Chazelet, S; Thomas, D

    2012-07-01

    The use of nanoparticles in industry has increased spectacularly over the past few years. Additionally, nanoscale particles seem to be the cause of new professional exposure situations. Due to their size, these particles may build up within the respiratory tract and may even reach the nervous system via the nasal passages; for this reason, it is generally recommended to wear respiratory protective devices (RPDs) in situations where collective protection is impossible to implement or inadequate. Here, we present the test bench ETNA designed to study the efficiency of RPDs in the presence of nanoparticles. The results of the efficiency measurement of two RPDs for two positions (sealed and unsealed) on a Sheffield head, for two inhalation configurations (constant flow and cyclic flow), and for two different particle size distributions of NaCl aerosol (one centered on 13 nm and the other on 59 nm) are presented below. The measurements indicate that when the leaks are negligible at the interface mask/head, the efficiency of RPD is greater for nanoparticles. For major leaks, the device's protection factor changes independently of the size of the particles. Furthermore, no trends with respect to the effect of the respiration type (constant-flow and cyclic-flow tests) have been shown on the device's protection factor.

  8. Respiratory protective device design using control system techniques

    NASA Technical Reports Server (NTRS)

    Burgess, W. A.; Yankovich, D.

    1972-01-01

    The feasibility of a control system analysis approach to provide a design base for respiratory protective devices is considered. A system design approach requires that all functions and components of the system be mathematically identified in a model of the RPD. The mathematical notations describe the operation of the components as closely as possible. The individual component mathematical descriptions are then combined to describe the complete RPD. Finally, analysis of the mathematical notation by control system theory is used to derive compensating component values that force the system to operate in a stable and predictable manner.

  9. A review on the clinical implementation of respiratory-gated radiation therapy

    PubMed Central

    Saw, CB; Brandner, E; Selvaraj, R; Chen, H; Saiful Huq, M; Heron, DE

    2007-01-01

    Respiratory-gated treatment techniques have been introduced into the radiation oncology practice to manage target or organ motions. This paper will review the implementation of this type of gated treatment technique where the respiratory cycle is determined using an external marker. The external marker device is placed on the abdominal region between the xyphoid process and the umbilicus of the patient. An infrared camera tracks the motion of the marker to generate a surrogate for the respiratory cycle. The relationship, if any, between the respiratory cycle and the movement of the target can be complex. The four-dimensional computed tomography (4DCT) scanner is used to identify this motion for those patients that meet three requirements for the successful implementation of respiratory-gated treatment technique for radiation therapy. These requirements are (a) the respiratory cycle must be periodic and maintained during treatment, (b) the movement of the target must be related to the respiratory cycle, and (c) the gating window can be set sufficiently large to minimise the overall treatment time or increase the duty cycle and yet small enough to be within the gate. If the respiratory-gated treatment technique is employed, the end-expiration image set is typically used for treatment planning purposes because this image set represents the phase of the respiratory cycle where the anatomical movement is often the least for the longest time. Contouring should account for tumour residual motion, setup uncertainty, and also allow for deviation from the expected respiratory cycle during treatment. Respiratory-gated intensity-modulated radiation therapy (IMRT) treatment plans must also be validated prior to treatment. Quality assurance should be performed to check for positional changes and the output in association with the motion-gated technique. To avoid potential treatment errors, radiation therapist (radiographer) should be regularly in-serviced and made aware of the

  10. Destination therapy with ventricular assist devices.

    PubMed

    Raman, Jai; Jeevanadam, Valluvan

    2004-01-01

    Despite extensive research and great strides over the past 40 years, the ideal permanent mechanical assist device remains elusive. The incidence of heart failure is increasing, and the number of heart transplants has remained constant. The HeartMate and Novacor are two pulsatile, long-term ventricular assist devices (VADs) commonly used as a bridge to transplantation. Randomized Evaluation of Mechanical Assistance in the Treatment of Congestive Heart Failure is a randomized study of device therapy in heart failure with treatment either with device (HeartMate) therapy or maximal medical therapy which was recently completed and demonstrated a Kaplan-Meier survival rate at 1 year of 52% for the device group compared to 25% in the medical therapy group. The TCI HeartMate is the only device approved for destination therapy, while others such as the Novacor device are in the process of evaluation. Most of these devices are still plagued by mechanical problems, bleeding, thromboembolism and infection. Other promising new devices include smaller VADs using impeller pump technology, such as the Arrow LionHeart, Micromed Debakey pump and Jarvik 2000 pump. The CardioVAD is an interesting chronically implantable balloon pump inserted into the descending thoracic aorta. While experience with the newer implantable pumps is growing, most of them require some manipulation of the heart perioperatively, in addition to anticoagulation postoperatively and careful monitoring for complications and infection. Copyright 2004 S. Karger AG, Basel

  11. Cooling Devices in Laser therapy.

    PubMed

    Das, Anupam; Sarda, Aarti; De, Abhishek

    2016-01-01

    Cooling devices and methods are now integrated into most laser systems, with a view to protecting the epidermis, reducing pain and erythema and improving the efficacy of laser. On the basis of method employed, it can be divided into contact cooling and non-contact cooling. With respect to timing of irradiation of laser, the nomenclatures include pre-cooling, parallel cooling and post-cooling. The choice of the cooling device is dictated by the laser device, the physician's personal choice with respect to user-friendliness, comfort of the patient, the price and maintenance costs of the device. We hereby briefly review the various techniques of cooling, employed in laser practice.

  12. Cooling Devices in Laser therapy

    PubMed Central

    Das, Anupam; Sarda, Aarti; De, Abhishek

    2016-01-01

    Cooling devices and methods are now integrated into most laser systems, with a view to protecting the epidermis, reducing pain and erythema and improving the efficacy of laser. On the basis of method employed, it can be divided into contact cooling and non-contact cooling. With respect to timing of irradiation of laser, the nomenclatures include pre-cooling, parallel cooling and post-cooling. The choice of the cooling device is dictated by the laser device, the physician's personal choice with respect to user-friendliness, comfort of the patient, the price and maintenance costs of the device. We hereby briefly review the various techniques of cooling, employed in laser practice. PMID:28163450

  13. Respiratory event detection by a positive airway pressure device.

    PubMed

    Berry, Richard B; Kushida, Clete A; Kryger, Meir H; Soto-Calderon, Haideliza; Staley, Bethany; Kuna, Samuel T

    2012-03-01

    Compare automatic event detection (AED) of respiratory events using a positive airway pressure (PAP) device with manual scoring of polysomnography (PSG) during PAP treatment of obstructive sleep apnea (OSA). Prospective PSGs of patients using a PAP device. Six academic and private sleep disorders centers. A total of 148 PSGs from 115 participants with OSA (apnea-hypopnea index [AHI] ≥ 15 events/hr) were analyzed. A signal generated by the PAP device identifying the AED of respiratory events based on airflow was recorded during PSG. The PSGs were manually scored without visualization of the AED signal and scoring of a hypopnea required a ≥ 4% oxygen desaturation. The apnea index (AI), hypopnea index (HI), and AHI by manual score and PAP AED were compared. A customized computer program compared individual events by manual scoring and AED to determine the true positive, false positive, false negative, or true negative events and found a sensitivity of 0.58 and a specificity of 0.98. The AHI, AI, and HI by the two methods were highly correlated. Bland-Altman analysis showed better agreement for AI than HI. Using a manually scored AHI of ≥ 10 events/hr to denote inadequate treatment, an AED AHI ≥ 10 events/hr had a sensitivity of 0.58 and a specificity of 0.94. An AHI < 10 events/hr by PAP AED is usually associated with good treatment efficacy. Differences between manually scored and AED events were primarily due to different criteria for hypopnea detection.

  14. Neglected Respiratory Toxicity Caused by Cancer Therapy

    PubMed Central

    Domingo, Christian; Roig, Jorge

    2007-01-01

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

  15. Chronic respiratory conditions and acupuncture therapy.

    PubMed

    Schwartz, C

    1992-03-01

    Acupuncture effectively enhances the treatment of chronic allergic bronchitis and asthma in the cat and dog. According to Traditional Chinese Medicine, chronic respiratory conditions can arise from lung, spleen/pancreas, liver or kidney deficiencies. Proper diagnosis is made from patient history, as well as examination of tongue and pulse. Acupuncture points are chosen according to involved energy pathways (meridians) and classical acupuncture combinations. In most cases, medication can be reduced as the acupuncture takes effect.

  16. Postoperative chest physical therapy prevents respiratory complications in patients undergoing esophagectomy.

    PubMed

    Lunardi, Adriana C; Cecconello, Ivan; Carvalho, Celso R F

    2011-01-01

    Esophagectomy presents the highest rate of postoperative pulmonary complications among all types of upper abdominal surgery. The benefits of chest physical therapy in patients undergoing upper abdominal surgery have been shown by many studies; however, its specific effect in patients receiving esophagectomy has been seldom investigated. This study aimed to compare the frequency of respiratory complications in patients undergoing esophagectomy receiving chest physical therapy compared to no treatment. 70 consecutive patients were evaluated retrospectively and allocated to two groups: control group (CG=no physical therapy; n=30) and chest physical therapy group (PTG; n=40). Patients received chest physical therapy which includes lung re-expansion and airway clearance maneuvers. They were not submitted to either noninvasive ventilation or exercises with devices that generate airways positive pressure. All patients were instructed to early mobilization. Information about pre-operative and respiratory complications were collected. Statistic analysis to compare the frequency of respiratory complications was performed by the Z test. The significance level was set to 5%. Patients in the CG and PTG were similar in terms of age, BMI, smoking and drinking status, malignant diseases, surgical and anesthesia duration and types of esophagectomy (p>0.05). Our results show that patients received chest physical therapy after esophagectomy had a lower frequency of respiratory complications (15% vs. 37%, p<0.05). In addition, the PTG needed a shorter duration of antibiotic treatment and thoracic drainage as well as less re-intubation compared with the control group (p<0.05). Our results suggest that chest physical therapy treatment reduces respiratory complications and the need for care but does not influence on hospital length of stay.

  17. Evaluation of Lightweight and Low Profile Communications Devices for Respiratory Protective System 21 (RESPO 21)

    DTIC Science & Technology

    1992-02-01

    AD-A253 393 Ir ic EREP ORT ELECTE" S JUL2,3 992 C FINAL REPORT Evaluation of Lightweight and Low Profile Communications Devices for Respiratory ...Evaluation of Lightweight and Low Profile Communications Devices for Respiratory Protective System 21 (RESPO21) to U.S. Army Chemical Research, Development...1 INTRODUCTION The Chemical Research, Development, and Engineering Center (CRDEC) is entering development of the next generation of respiratory

  18. Diode-laser-based therapy device

    NASA Astrophysics Data System (ADS)

    Udrea, Mircea V.; Nica, Adriana S.; Florian, Mariana; Poenaru, Daniela; Udrea, Gabriela; Lungeanu, Mihaela; Sporea, Dan G.; Vasiliu, Virgil V.; Vieru, Roxana

    2004-10-01

    A new therapy laser device is presented. The device consists of a central unit and different types of laser probes. The laser probe model SL7-650 delivers seven red (650 nm), 5 mW diode lasers convergent beams. The beams converge at about 30 cm in front of the laser probe and the irradiated area might be varied by simple displacement of the laser probe with respect to the target. The laser probe SL1-808 emits single infrared laser beam up to 500 mW. The efficiency of the use of this device in physiotherapy, and rheumatology, has been put into evidence after years of testing. Dermatology and microsurgery are users of infrared powerful laser probes. The device has successfully passed technical and clinical tests in order to be certified. The laser device design and some medical results are given.

  19. 21 CFR 882.5940 - Electroconvulsive therapy device.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Electroconvulsive therapy device. 882.5940 Section 882.5940 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Electroconvulsive therapy device. (a) Identification. An electroconvulsive therapy device is a device used...

  20. 21 CFR 882.5940 - Electroconvulsive therapy device.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Electroconvulsive therapy device. 882.5940 Section 882.5940 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Electroconvulsive therapy device. (a) Identification. An electroconvulsive therapy device is a device used...

  1. 21 CFR 882.5940 - Electroconvulsive therapy device.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Electroconvulsive therapy device. 882.5940 Section 882.5940 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Electroconvulsive therapy device. (a) Identification. An electroconvulsive therapy device is a device used...

  2. 21 CFR 882.5940 - Electroconvulsive therapy device.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Electroconvulsive therapy device. 882.5940 Section 882.5940 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Electroconvulsive therapy device. (a) Identification. An electroconvulsive therapy device is a device used...

  3. 21 CFR 882.5940 - Electroconvulsive therapy device.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Electroconvulsive therapy device. 882.5940 Section 882.5940 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Electroconvulsive therapy device. (a) Identification. An electroconvulsive therapy device is a device used...

  4. Needs: importance and satisfaction in respiratory therapy personnel.

    PubMed

    Mathews, P J

    1980-01-01

    Using Maslow's hierarchy of needs as a base, this article attempts to determine the motivational level of respiratory therapy personnel. Also analyzed was the importance of these needs to the individuals studied. The instrument used to obtain the necessary data was a questionnaire designed to indicate a mathematical score relevant to a person's position in the hierarchy. This instrument was designed by Lyman Porter and is called the Porter needs-satisfaction index (PNSI). The respondents, who were representatives of all classes of respiratory therapy personnel, showed high levels of satisfaction in areas concerned with helping others, autonomy, and prestige. They ranked ability to help others, self-fulfillment, and feelings of accomplishment as highly important. Further analysis of the questionnaires is presently under way. It is hoped that data relative to position in the hierarchy based on demographic data will soon be available.

  5. Design and performance of a respiratory amplitude gating device for PET/CT imaging

    SciTech Connect

    Chang Guoping; Chang Tingting; Clark, John W. Jr.; Mawlawi, Osama R.

    2010-04-15

    Purpose: Recently, the authors proposed a free-breathing amplitude gating (FBAG) technique for PET/CT scanners. The implementation of this technique required specialized hardware and software components that were specifically designed to interface with commercial respiratory gating devices to generate the necessary triggers required for the FBAG technique. The objective of this technical note is to introduce an in-house device that integrates all the necessary hardware and software components as well as tracks the patient's respiratory motion to realize amplitude gating on PET/CT scanners. Methods: The in-house device is composed of a piezoelectric transducer coupled to a data-acquisition system in order to monitor the respiratory waveform. A LABVIEW program was designed to control the data-acquisition device and inject triggers into the PET list stream whenever the detected respiratory amplitude crossed a predetermined amplitude range. A timer was also programmed to stop the scan when the accumulated time within the selected amplitude range reached a user-set interval. This device was tested using a volunteer and a phantom study. Results: The results from the volunteer and phantom studies showed that the in-house device can detect similar respiratory signals as commercially available respiratory gating systems and is able to generate the necessary triggers to suppress respiratory motion artifacts. Conclusions: The proposed in-house device can be used to implement the FBAG technique in current PET/CT scanners.

  6. Leveraging respiratory organ motion for non-invasive tumor treatment devices: a feasibility study

    NASA Astrophysics Data System (ADS)

    Möri, Nadia; Jud, Christoph; Salomir, Rares; Cattin, Philippe C.

    2016-06-01

    In noninvasive abdominal tumor treatment, research has focused on minimizing organ motion either by gating, breath holding or tracking of the target. The paradigm shift proposed in this study takes advantage of the respiratory organ motion to passively scan the tumor. In the proposed self-scanning method, the focal point of the HIFU device is held fixed for a given time, while it passively scans the tumor due to breathing motion. The aim of this paper is to present a treatment planning method for such a system and show by simulation its feasibility. The presented planning method minimizes treatment time and ensures complete tumor ablation under free-breathing. We simulated our method on realistic motion patterns from a patient specific statistical respiratory model. With our method, we achieved a shorter treatment time than with the gold-standard motion-compensation approach. The main advantage of the proposed method is that electrically steering of the focal spot is no longer needed. As a consequence, it is much easier to find an optimal solution for both avoiding near field heating and covering the whole tumor. However, the reduced complexity on the beam forming comes at the price of an increased complexity on the planning side as well as a reduced efficiency in the energy distribution. Although we simulate the approach on HIFU, the idea of self-scanning passes over to other tumor treatment modalities such as proton therapy or classical radiation therapy.

  7. Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy.

    PubMed

    Marklund, Marie; Verbraecken, Johan; Randerath, Winfried

    2012-05-01

    Mandibular advancement devices (MADs) represent the main non-continuous positive airway pressure (non-CPAP) therapy for patients with obstructive sleep apnoea (OSA). The aim of the European Respiratory Society Task Force was to review the evidence in favour of MAD therapy. Effects of tongue-retaining devices are not included in this report. Custom-made MADs reduce apnoea/hypopnoea index (AHI) and daytime sleepiness compared with placebo devices. CPAP more effectively diminishes AHI, while increasing data suggest fairly similar outcomes in relation to symptoms and cardiovascular health from these treatments. Patients often prefer MADs to CPAP. Milder cases and patients with a proven increase in upper airway size as a result of mandibular advancement are most likely to experience treatment success with MADs. A custom-made device titrated from an initial 50% of maximum mandibular advancement has been recommended. More research is needed to define the patients who will benefit from MAD treatment compared with CPAP, in terms of the effects on sleep-disordered breathing and on other diseases related to OSA. In conclusion, MADs are recommended for patients with mild to moderate OSA (Recommendation Level A) and for those who do not tolerate CPAP. The treatment must be followed up and the device adjusted or exchanged in relation to the outcome.

  8. Detection of upper airway status and respiratory events by a current generation positive airway pressure device.

    PubMed

    Li, Qing Yun; Berry, Richard B; Goetting, Mark G; Staley, Bethany; Soto-Calderon, Haideliza; Tsai, Sheila C; Jasko, Jeffrey G; Pack, Allan I; Kuna, Samuel T

    2015-04-01

    To compare a positive airway pressure (PAP) device's detection of respiratory events and airway status during device-detected apneas with events scored on simultaneous polysomnography (PSG). Prospective PSGs of patients with sleep apnea using a new-generation PAP device. Four clinical and academic sleep centers. Forty-five patients with obstructive sleep apnea (OSA) and complex sleep apnea (Comp SA) performed a PSG on PAP levels adjusted to induce respiratory events. None. PAP device data identifying the type of respiratory event and whether the airway during a device-detected apnea was open or obstructed were compared to time-synced, manually scored respiratory events on simultaneous PSG recording. Intraclass correlation coefficients between device-detected and PSG scored events were 0.854 for apnea-hypopnea index (AHI), 0.783 for apnea index, 0.252 for hypopnea index, and 0.098 for respiratory event-related arousals index. At a device AHI (AHIFlow) of 10 events/h, area under the receiver operating characteristic curve was 0.98, with sensitivity 0.92 and specificity 0.84. AHIFlow tended to overestimate AHI on PSG at values less than 10 events/h. The device detected that the airway was obstructed in 87.4% of manually scored obstructive apneas. Of the device-detected apneas with clear airway, a minority (15.8%) were manually scored as obstructive apneas. A device-detected apnea-hypopnea index (AHIFlow) < 10 events/h on a positive airway pressure device is strong evidence of good treatment efficacy. Device-detected airway status agrees closely with the presumed airway status during polysomnography scored events, but should not be equated with a specific type of respiratory event. © 2015 Associated Professional Sleep Societies, LLC.

  9. [Designs of optimized microbial therapy systems of respiratory infections].

    PubMed

    Morimoto, Kazuhiro

    2013-01-01

    Several respiratory infections are frequently induced by pathogenic microorganisms in lung epithelial lining fluid (ELF) and alveolar macrophages (AM). Then, two studies concerning designs of antimicrobial therapy systems of respiratory infections were carried out; one was the distribution mechanisms of three macrolide and ketolide antibiotics, clarithromycin (CAM), azithromycin (AZM) and telithromycin (TEL) in plasma, ELF and AM, and the other was the efficient drug delivery to AM by pulmonary administration of fluoroquinolone antibiotic, a ciprofloxacin (CPFX) incorporated into liposomes (CPFX-liposome). In the first study, the areas under drug concentration-time curves (AUCs) in ELF following oral administration of three macrolide and ketolide antibiotics to rats were significantly higher than AUCs in plasma, furthermore AUCs in AM significantly higher than AUCs in ELF. The high distribution of these antibiotics to the respiratory infection site is due to the transport from blood to ELF via MDR1 in lung epithelial cells as well as the uptake by AM. These antibiotics were taken up by AM via active transport system and the trapping in organelles. In the second study, drug delivery efficacy of CPFX-liposome to AM was particle size-dependent over the 100-1000 nm and then become constant at over 1000 nm by pulmonary aerosolization to rats. This result indicates that the most effective size is 1000 nm. Furthermore, the drug delivery efficacy of mannosylated CPFX-liposome (particle size: 1000 nm) was highly delivered to AM and antibacterial effects were significantly higher than those of unmodified CPFX-liposome. This review provides useful findings for microbial therapy systems of respiratory infections.

  10. Detection of Upper Airway Status and Respiratory Events by a Current Generation Positive Airway Pressure Device

    PubMed Central

    Li, Qing Yun; Berry, Richard B.; Goetting, Mark G.; Staley, Bethany; Soto-Calderon, Haideliza; Tsai, Sheila C.; Jasko, Jeffrey G.; Pack, Allan I.; Kuna, Samuel T.

    2015-01-01

    Study Objectives: To compare a positive airway pressure (PAP) device's detection of respiratory events and airway status during device-detected apneas with events scored on simultaneous polysomnography (PSG). Design: Prospective PSGs of patients with sleep apnea using a new-generation PAP device. Settings: Four clinical and academic sleep centers. Patients: Forty-five patients with obstructive sleep apnea (OSA) and complex sleep apnea (Comp SA) performed a PSG on PAP levels adjusted to induce respiratory events. Interventions: None. Measurements and Results: PAP device data identifying the type of respiratory event and whether the airway during a device-detected apnea was open or obstructed were compared to time-synced, manually scored respiratory events on simultaneous PSG recording. Intraclass correlation coefficients between device-detected and PSG scored events were 0.854 for apnea-hypopnea index (AHI), 0.783 for apnea index, 0.252 for hypopnea index, and 0.098 for respiratory event-related arousals index. At a device AHI (AHIFlow) of 10 events/h, area under the receiver operating characteristic curve was 0.98, with sensitivity 0.92 and specificity 0.84. AHIFlow tended to overestimate AHI on PSG at values less than 10 events/h. The device detected that the airway was obstructed in 87.4% of manually scored obstructive apneas. Of the device-detected apneas with clear airway, a minority (15.8%) were manually scored as obstructive apneas. Conclusions: A device-detected apnea-hypopnea index (AHIFlow) < 10 events/h on a positive airway pressure device is strong evidence of good treatment efficacy. Device-detected airway status agrees closely with the presumed airway status during polysomnography scored events, but should not be equated with a specific type of respiratory event. Citation: Li QY, Berry RB, Goetting MG, Staley B, Soto-Calderon H, Tsai SC, Jasko JG, Pack AI, Kuna ST. Detection of upper airway status and respiratory events by a current generation positive

  11. Use of an oscillatory PEP device to enhance bronchial hygiene in a patient of post-H1NI pneumonia and acute respiratory distress syndrome with pneumothorax.

    PubMed

    Narula, Deepali; Nangia, Vivek

    2014-03-07

    A 26-year-old, 14 week pregnant woman was admitted to our hospital with pneumonia with acute respiratory distress syndrome in an intubated and mechanically ventilated state. She was diagnosed to have polymicrobial infection and left-sided pneumothorax and was put on a ventilator for 2 weeks. Postextubation, she found it difficult to clear her respiratory secretions despite aggressive routine chest physiotherapy. She was planned to undergo a mini-tracheostomy for tracheobronchial toileting. However, before that, she was given a trial of Acapella, a hand-held oscillatory positive expiratory pressure (OPEP) therapy device, for facilitating airway clearance, with the aim to speed up the recovery. The patient found it easy to use and clear the secretions optimally, thus averting a mini-tracheostomy. This case report highlights the advantages of the OPEP therapy device in effective management of bronchial hygiene in patients with poor respiratory effort.

  12. Use of an oscillatory PEP device to enhance bronchial hygiene in a patient of post-H1NI pneumonia and acute respiratory distress syndrome with pneumothorax

    PubMed Central

    Narula, Deepali; Nangia, Vivek

    2014-01-01

    A 26-year-old, 14 week pregnant woman was admitted to our hospital with pneumonia with acute respiratory distress syndrome in an intubated and mechanically ventilated state. She was diagnosed to have polymicrobial infection and left-sided pneumothorax and was put on a ventilator for 2 weeks. Postextubation, she found it difficult to clear her respiratory secretions despite aggressive routine chest physiotherapy. She was planned to undergo a mini-tracheostomy for tracheobronchial toileting. However, before that, she was given a trial of Acapella, a hand-held oscillatory positive expiratory pressure (OPEP) therapy device, for facilitating airway clearance, with the aim to speed up the recovery. The patient found it easy to use and clear the secretions optimally, thus averting a mini-tracheostomy. This case report highlights the advantages of the OPEP therapy device in effective management of bronchial hygiene in patients with poor respiratory effort. PMID:24717858

  13. Analyzing non-respiratory movements of the chest: methods and devices

    NASA Astrophysics Data System (ADS)

    Pariaszewska, Katarzyna; Młyńczak, Marcel; Cybulski, Gerard

    2015-09-01

    Respiration is the main reason of the chest movements. However, there are also non-respiratory ones, resulting from e.g. snoring, wheezing, stridor, throat clearing or coughing. They may exist sporadically, however should be examined in case when their incidences increase. Detecting non-respiratory movements is very important, because many of them are symptoms of respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD) or lung cancer. Assessment of the presence of non-respiratory movements could be important element of effective diagnosis. It is also necessary to provide quantitative and objective results for intra-subject studies. Most of these events generate vibroacoustic signals that contain components of sound and vibrations. This work provides the review of the solutions and devices for monitoring of the non-respiratory movements, primarily considering the accuracy of the chest movements' detection and distinguishing.

  14. Respiratory muscle training with the incentive spirometer resistive breathing device.

    PubMed

    Larson, M; Kim, M J

    1984-07-01

    Utilizing the conceptual scheme of Kim, this study focused on the effect of inspiratory muscle training on the strength of the respiratory muscles, exercise performance, clinical manifestations, and activities of daily living. Unlike previous studies, inspiratory muscle training was performed by the use of an ISRBD that gave alinear inspiratory resistance of 50 cm H2O/L/sec at 1 L/sec flow. Subjects used an ISRBD twice a day for 15 minutes each day for 4 weeks. Strength of respiratory muscles as measured by PImax and sputum expectoration improved significantly (P less than 0.05) but there was no significant change in exercise performance (12-minute walk distance), other clinical signs and symptoms, or activities of daily living. Visual feedback given by the bellows of the ISRBD that inflated and deflated with inspiration and expiration apparently served as a positive reinforcer and motivator for most subjects. Daily logs of clinical signs and symptoms and activities of daily living, along with weekly telephone conferences with each subject, provided comprehensive data and may have contributed to the high compliance rate (98%) in this study.

  15. Recent Advances in Developing Antiviral Therapies for Respiratory Syncytial Virus.

    PubMed

    Shook, Brian C; Lin, Kai

    2017-04-01

    Respiratory syncytial virus (RSV) infection presents a significant health challenge in small children, the elderly and immunocompromised patients. There is still a high unmet medical need among patients with RSV infection, and no specific antiviral therapy is available. The only approved agents are palivizumab, which has to be given prophylactically, mainly in high-risk infants, and ribavirin, which is rarely used due to toxicity concerns and questionable benefits. Efforts to develop new antiviral agents have been hampered by the perceived need for high safety hurdles in pediatric patient populations use and the lack of well-characterized druggable targets. Despite these challenges, significant progress has been made in discovering multiple classes of inhibitors targeting various stages of the viral life cycle. Several recent proof-of-concept human studies with specific antivirals have shown promising results and completely reinvigorated the field. In this review we discuss the current status of RSV drug development, remaining challenges and future directions.

  16. The use of sialidase therapy for respiratory viral infections.

    PubMed

    Nicholls, John M; Moss, Ronald B; Haslam, Stuart M

    2013-06-01

    DAS181 is an inhaled bacterial sialidase which functions by removing sialic acid (Sia) from the surface of epithelial cells, preventing attachment and subsequent infection by respiratory viruses that utilize Sia as a receptor. DAS181 is typical of bacterial sialidases in cleaving Sia α2-3 and Sia α2-6 linkages, and it also has a demonstrated effect against acetylated and hydroxylated forms of Sia. The potency of the compound has been enhanced by coupling the active sialidase with an amphiregulin tag, allowing a longer duration of action and minimizing spread to the systemic circulation. DAS181 is now in Phase II development for the treatment of influenza, and it has also demonstrated activity in individual cases of parainfluenza in immunosuppressed patients. Continued evaluation of the roles and activities of bacterial sialidases is required to expand the range of successful antiviral therapies targeting Sia or its derivatives.

  17. Development of Proficiency Examinations and Procedures for Two Levels of Respiratory Therapy Personnel. Final Report.

    ERIC Educational Resources Information Center

    Psychological Corp., New York, NY.

    Under the guidance of an advisory committee from the American Association for Respiratory Therapy (AART), The Psychological Corporation developed three forms of two criterion-referenced proficiency examinations to measure the skills, understandings, and knowledge required in entry level jobs for two levels of respiratory therapy personnel. The…

  18. Dose verification for respiratory-gated volumetric modulated arc therapy

    NASA Astrophysics Data System (ADS)

    Qian, Jianguo; Xing, Lei; Liu, Wu; Luxton, Gary

    2011-08-01

    A novel commercial medical linac system (TrueBeam™, Varian Medical Systems, Palo Alto, CA) allows respiratory-gated volumetric modulated arc therapy (VMAT), a new modality for treating moving tumors with high precision and improved accuracy by allowing for regular motion associated with a patient's breathing during VMAT delivery. The purpose of this work is to adapt a previously-developed dose reconstruction technique to evaluate the fidelity of VMAT treatment during gated delivery under clinic-relevant periodic motion related to patient breathing. A Varian TrueBeam system was used in this study. VMAT plans were created for three patients with lung or pancreas tumors. Conventional 6 and 15 MV beams with flattening filter and high-dose-rate 10 MV beams with no flattening filter were used in these plans. Each patient plan was delivered to a phantom first without gating and then with gating for three simulated respiratory periods (3, 4.5 and 6 s). Using the adapted log-file-based dose reconstruction procedure supplemented with ion chamber array (Seven29™, PTW, Freiburg, Germany) measurements, the delivered dose was used to evaluate the fidelity of gated VMAT delivery. Comparison of Seven29 measurements with and without gating showed good agreement with gamma-index passing rates above 99% for 1%/1 mm dose accuracy/distance-to-agreement criteria. With original plans as reference, gamma-index passing rates were 100% for the reconstituted plans (1%/1 mm criteria) and 93.5-100% for gated Seven29 measurements (3%/3 mm criteria). In the presence of leaf error deliberately introduced into the gated delivery of a pancreas patient plan, both dose reconstruction and Seven29 measurement consistently indicated substantial dosimetric differences from the original plan. In summary, a dose reconstruction procedure was demonstrated for evaluating the accuracy of respiratory-gated VMAT delivery. This technique showed that under clinical operation, the TrueBeam system faithfully

  19. Rapid response to systemic bevacizumab therapy in recurrent respiratory papillomatosis

    PubMed Central

    MOHR, MICHAEL; SCHLIEMANN, CHRISTOPH; BIERMANN, CHRISTOPH; SCHMIDT, LARS-HENNING; KESSLER, TORSTEN; SCHMIDT, JOACHIM; WIEBE, KARSTEN; MÜLLER, KLAUS-MICHAEL; HOFFMANN, THOMAS K.; GROLL, ANDREAS H.; WERNER, CLAUDIUS; KESSLER, CHRISTINA; WIEWRODT, RAINER; RUDACK, CLAUDIA; BERDEL, WOLFGANG E.

    2014-01-01

    Recurrent respiratory papillomatosis (RRP) is a primary benign disease, which is characterized by papillomatous growth in the respiratory tract. Malignant transformation occurs in only 3–5% of cases, however, local growth of the benign papillomas is interpreted as clinically malignant in a markedly higher proportion of patients. Local surgical or endoscopic interventional debulking or excision is currently the commonly selected treatment method and antiviral therapy is a potential adjuvant approach. However, the long-term management of RRP patients, who commonly require multiple procedures over numerous years, is challenging and the overall therapeutic armamentarium remains unsatisfactory. The administration of systemic bevacizumab treatment in a series of five patients with long histories of RRP, who required repeated local interventions to control papilloma growth is evaluated. Treatment with the anti-vascular endothelial growth factor (VEGF) antibody bevacizumab was administered at a dose of 5 mg/kg (n=1), 10 mg/kg (n=3) or 15 mg/kg (n=1) intravenously to the five RRP patients, who were clinically classified as exhibiting progressive disease. Endoscopic evaluations were performed prior to the first infusion of bevacizumab and intermittently at variable time points during the course of therapy. Histopathological analyses were performed using pre- and post-treatment papilloma biopsies, including immunohistochemical analyses of VEGF and phosphorylated VEGF receptor (VEGFR)-2 expression. The patients received between three and 16 courses of bevacizumab (median, six courses). The first course was initiated when progression following the previous intervention was observed. An immediate response to bevacizumab treatment was demonstrated in all five RRP patients. While the cumulative number of interventions in the five patients was 18 throughout the 12 months prior to the initiation of bevacizumab treatment, only one patient required interventional treatment due to a

  20. Mechanical analysis of an oscillatory positive expiratory pressure device used in respiratory rehabilitation.

    PubMed

    Alves, C E; Nunes, L Q; Melo, P L

    2010-01-01

    This article aims to characterize the mechanical behavior of the Acapella Blue, a respiratory rehabilitation device designed to aid sputum clearance. In this scope, the present study initially describes in detail the peak-to-peak oscillation amplitude (App) and peak frequency (fp) behavior, as well as positive pressure level (Ppl), in the flow range more comonly found in practice. The parameters were evaluated in all 5 adjustment levels of the equipment in intervals of 50 mL/s. The device characterization has shown fp up to 23 Hz, App from 0.2 to 2.8 cmH(2)O and Ppl ranging from 1.2 to 13.5 cmH(2)O. The studied device may produce oscillation in the ranges of ciliary movements and respiratory system resonance frequency of patients with respiratory diseases. Data obtained in this work may help to optimize the use of the Acapella Blue device in respiratory rehabilitation. Suggestions for the practical use of the device are also presented.

  1. Respiratory support with nasal high-flow therapy helps to prevent recurrence of postoperative atelectasis: a case report.

    PubMed

    Suzuki, Yasuyuki; Takasaki, Yasushi

    2014-01-01

    Postoperative atelectasis should be avoided in surgical patients with impaired pulmonary function. Nasal high-flow (NHF) therapy delivered by the Optiflow™ system (Fisher & Paykel Healthcare Ltd., Auckland, New Zealand) is a new, simple device that supplies heated and humidified oxygen gas at >30 L/min via a large-bore nasal cannula. We herein describe a case in which respiratory support with NHF therapy was useful for the prevention of postoperative atelectasis recurrence. A 67-year-old man with an upper digestive tract perforation underwent emergency laparoscopic surgery. He appeared malnourished because of severe untreated diabetes mellitus. The proposed surgery was uneventfully completed. On postoperative day (POD) 5, he experienced massive atelectasis of the left lower lobe with desaturation to <90%. After restoration of normal oxygenation by tracheal suction and postural drainage, noninvasive positive-pressure ventilation (NPPV) at a continuous positive airway pressure (CPAP) of 8 cm H2O was conducted to prevent repeated atelectasis. Fifteen hours after the cessation of NPPV on POD 7, he developed recurrence of massive atelectasis. Bronchoscopic suction removed a mucous plaque in the tracheobronchial tree, and NHF therapy at 40 L/min was subsequently performed, delivering a low level of CPAP instead of NPPV. Under the respiratory support with NHF therapy, his condition was more stable than with NPPV, and his respiratory rehabilitation continued uneventfully. In addition, the NHF therapy delivered optimally humidified gas, which improved the bronchial secretion quality. No further atelectasis occurred throughout the remaining stay in the intensive care unit. We conclude that respiratory support with NHF therapy may contribute to the prevention of postoperative atelectasis by delivering CPAP in combination with progressive respiratory rehabilitation.

  2. Emerging Therapies for the Prevention of Acute Respiratory Distress Syndrome

    PubMed Central

    Ruthman, Carl A.; Festic, Emir

    2015-01-01

    The development of the acute respiratory distress syndrome (ARDS) carries significant risk of morbidity and mortality. To date, pharmacologic therapy has been largely ineffective for patients with ARDS. We present our personal review aimed at outlining current and future directions for the pharmacologic prevention of ARDS. Several available risk-stratification or prediction scores strategies for identification of patients at risk of ARDS have been reported. Although not ready for the clinical everyday use, they are and will be instrumental in the ongoing and future trials of pharmacoprevention of ARDS. Several systemic medications established the potential role in ARDS prevention based on the preclinical studies and observational data. Due to potential for systemic adverse effects to neutralize any pharmacologic benefits of systemic therapy, inhaled medications appear particularly attractive candidates for ARDS prevention. This is because of their direct delivery to the site of the proposed action (lungs), while pulmonary epithelial surface is still functional. We postulate that overall morbidity and mortality rates from ARDS in the future will be contingent upon decreasing the overall incidence of ARDS through effective identification of those at risk and early application of proven supportive care and pharmacologic interventions. PMID:26002528

  3. Respiratory variations in the photoplethysmographic waveform amplitude depend on type of pulse oximetry device.

    PubMed

    Høiseth, Lars Øivind; Hoff, Ingrid Elise; Hagen, Ove Andreas; Kirkebøen, Knut Arvid; Landsverk, Svein Aslak

    2016-06-01

    Respiratory variations in the photoplethysmographic waveform amplitude predict fluid responsiveness under certain conditions. Processing of the photoplethysmographic signal may vary between different devices, and may affect respiratory amplitude variations calculated by the standard formula. The aim of the present analysis was to explore agreement between respiratory amplitude variations calculated using photoplethysmographic waveforms available from two different pulse oximeters. Analysis of registrations before and after fluid loads performed before and after open-heart surgery (aortic valve replacement and/or coronary artery bypass grafting) with patients on controlled mechanical ventilation. Photoplethysmographic (Nellcor and Masimo pulse oximeters) and arterial pressure waveforms were recorded. Amplitude variations induced by ventilation were calculated and averaged over ten respiratory cycles. Agreements for absolute values are presented in scatterplots (with least median square regression through the origin, LMSO) and Bland-Altman plots. Agreement for trending presented in a four-quadrant plot. Agreement between respiratory photoplethysmographic amplitude variations from the two pulse oximeters was poor with LMSO ΔPOPNellc = 1.5 × ΔPOPMas and bias ± limits of agreement 7.4 ± 23 %. Concordance rate with a fluid load was 91 %. Agreement between respiratory variations in the photoplethysmographic waveform amplitude calculated from the available signals output by two different pulse oximeters was poor, both evaluated by LMSO and Bland-Altman plot. Respiratory amplitude variations from the available signals output by these two pulse oximeters are not interchangeable.

  4. Test-Retest Reliability of Respiratory Resistance Measured with the Airflow Perturbation Device

    ERIC Educational Resources Information Center

    Gallena, Sally K.; Solomon, Nancy Pearl; Johnson, Arthur T.; Vossoughi, Jafar; Tian, Wei

    2014-01-01

    Purpose: In this study, the authors aimed to determine reliability of the airflow perturbation device (APD) to measure respiratory resistance within and across sessions during resting tidal (RTB) and postexercise breathing in healthy athletes, and during RTB across trials within a session in athletes with paradoxical vocal fold motion (PVFM)…

  5. Test-Retest Reliability of Respiratory Resistance Measured with the Airflow Perturbation Device

    ERIC Educational Resources Information Center

    Gallena, Sally K.; Solomon, Nancy Pearl; Johnson, Arthur T.; Vossoughi, Jafar; Tian, Wei

    2014-01-01

    Purpose: In this study, the authors aimed to determine reliability of the airflow perturbation device (APD) to measure respiratory resistance within and across sessions during resting tidal (RTB) and postexercise breathing in healthy athletes, and during RTB across trials within a session in athletes with paradoxical vocal fold motion (PVFM)…

  6. Balloon Devices for Atrial Fibrillation Therapy.

    PubMed

    Metzner, Andreas; Wissner, Erik; Lin, Tina; Ouyang, Feifan; Kuck, Karl-Heinz

    2015-05-01

    Ablation of atrial fibrillation (AF) is an established treatment option for symptomatic patients refractory to antiarrhythmic medication. In patients with paroxysmal AF, ablation can be offered as first-line therapy when performed in an experienced centre. The accepted cornerstone for all ablation strategies is isolation of the pulmonary veins. However, it is still challenging to achieve contiguous, transmural, permanent lesions using radio-frequency current (RFC) based catheters in conjunction with a three-dimensional mapping system and the learning curve remains long. These limitations have kindled interest in developing and evaluating novel catheter designs that incorporate alternative energy sources. Novel catheters include balloon-based ablation systems, incorporating different energy modalities such as laser (Heartlight(™), CardioFocus, Marlborough, MA, US), RFC (Hot Balloon Catheter, Hayama Arrhythmia Institute, Kanagawa, Japan) and cryo-energy (ArcticFront, Medtronic, Inc., Minneapolis, MN, US). While the cryoballoon (CB) and the radiofrequency hot balloon (RHB) are single-shot devices, the endoscopic ablation system (EAS) allows for point-by-point ablation. The CB and EAS are well established as safe, time-efficient and effective ablation tools. Initial studies using the RHB could also demonstrate promising results. However, more data are required.

  7. Nutrition: A Primary Therapy in Pediatric Acute Respiratory Distress Syndrome

    PubMed Central

    Wilson, Bryan; Typpo, Katri

    2016-01-01

    Appropriate nutrition is an essential component of intensive care management of children with acute respiratory distress syndrome (ARDS) and is linked to patient outcomes. One out of every two children in the pediatric intensive care unit (PICU) will develop malnutrition or have worsening of baseline malnutrition and present with specific micronutrient deficiencies. Early and adequate enteral nutrition (EN) is associated with improved 60-day survival after pediatric critical illness, and, yet, despite early EN guidelines, critically ill children receive on average only 55% of goal calories by PICU day 10. Inadequate delivery of EN is due to perceived feeding intolerance, reluctance to enterally feed children with hemodynamic instability, and fluid restriction. Underlying each of these factors is large practice variation between providers and across institutions for initiation, advancement, and maintenance of EN. Strategies to improve early initiation and advancement and to maintain delivery of EN are needed to improve morbidity and mortality from pediatric ARDS. Both, over and underfeeding, prolong duration of mechanical ventilation in children and worsen other organ function such that precise calorie goals are needed. The gut is thought to act as a “motor” of organ dysfunction, and emerging data regarding the role of intestinal barrier functions and the intestinal microbiome on organ dysfunction and outcomes of critical illness present exciting opportunities to improve patient outcomes. Nutrition should be considered a primary rather than supportive therapy for pediatric ARDS. Precise nutritional therapies, which are titrated and targeted to preservation of intestinal barrier function, prevention of intestinal dysbiosis, preservation of lean body mass, and blunting of the systemic inflammatory response, offer great potential for improving outcomes of pediatric ARDS. In this review, we examine the current evidence regarding dose, route, and timing of nutrition

  8. Pulse steroid therapy in adult respiratory distress syndrome following petroleum naphtha ingestion.

    PubMed

    Kamijo, Y; Soma, K; Asari, Y; Ohwada, T

    2000-01-01

    A suicide attempt by a 23-year-old woman involved ingestion of 1000 mL of petroleum naphtha. Early chemical pneumonitis was complicated by life-threatening, diffuse interstitial lung consolidation with pneumatoceles. Pulse steroid therapy beginning on day 17 was associated with remarkable resolution of interstitial consolidation, although an enlarging secondarily infected pneumatocele ruptured to produce a bronchopleural fistula. Thoracic surgery and antibiotic therapy resulted in improvement of the patient's respiratory condition, and she was discharged with no residual respiratory symptoms. High-dose corticosteroid therapy appears to be a useful addition to aggressive supportive treatment in late adult respiratory distress syndrome following hydrocarbon ingestion.

  9. Acapella vs. PEP mask therapy: a randomised trial in children with cystic fibrosis during respiratory exacerbation.

    PubMed

    West, Kerry; Wallen, Margaret; Follett, Jennifer

    2010-04-22

    The Acapella is a positive pressure device designed to assist mucociliary clearance. This study investigated the effectiveness of the Acapella in comparison to PEP mask therapy. Twenty-three participants with cystic fibrosis (CF) with a median age of 12 years (range 7-18 years), who were admitted to hospital for a respiratory exacerbation were randomised to either the PEP mask or Acapella treatment group. Both groups completed two treatment sessions each day (10 sets of 10 breaths in sitting) over a 10-day period. Outcome measures were change in lung function (FEV1, FVC, FEF(25-75), and PEF) and exercise performance (modified 10-metre shuttle). In addition, total sputum production during treatment (wet weight) and patient satisfaction were assessed over the 10-day period. At the end of 10 days there were no statistically significant differences between the groups for any of the outcome measures. Participants were highly satisfied with both devices. The results suggest that there is no statistically significant difference between the Acapella device and the PEP mask for use in CF during an acute exacerbation. Larger studies are required to determine whether differences between PEP mask and Acapella noted in this trial are clinically worthwhile.

  10. Accuracy Verification of Respiratory-gated Radiotherapy that Combines the Respiration-Monitoring Device and Respiratory-gated System.

    PubMed

    Shintani, Naoya; Monzen, Hajime; Tamura, Masaya; Asai, Yoshiyuki; Shimomura, Kouhei; Matsumoto, Kenji; Okumura, Masahiko; Nishimura, Yasumasa

    The purpose of this study is to evaluate the mechanical accuracy of a respiratory-gated radiation system that combines the Linear Indicator-equipped Abches respiration-monitoring device and the Varian Real-time Position Management system (LI-RPM system). This combined configuration, implemented for the first time in Japan, was compared with the stand-alone Varian RPM system (RPM system). The delay times, dose profiles, and output waveforms of the LI-RPM and RPM systems were evaluated using a self-produced dynamic phantom. The delay times for the LI-RPM and RPM systems were both 0.1 s for 4 s and 8 s test periods. The corresponding output waveform correlation factors (R(2)) for the 4 s and 8 s test periods were 0.9981 and 0.9975, respectively. No difference was observed in the dose profiles of the two systems. Thus, the present results indicate that the proposed LI-RPM combined respiratory-gated radiation system has similar properties to the RPM system. However, it offers several advantages in terms of its versatility, including its alignment assistance capabilities for non-coplanar treatments.

  11. Severe acute respiratory syndrome: pertinent clinical characteristics and therapy.

    PubMed

    File, Thomas M; Tsang, Kenneth W T

    2005-01-01

    Severe acute respiratory syndrome (SARS) is a newly emerged infection that is caused by a previously unrecognized virus - a novel coronavirus designated as SARS-associated coronavirus (SARS-CoV). From November 2002 to July 2003 the cumulative number of worldwide cases was >8000, with a mortality rate of close to 10%. The mortality has been higher in older patients and those with co-morbidities. SARS has been defined using clinical and epidemiological criteria and cases are considered laboratory-confirmed if SARS coronavirus is isolated, if antibody to SARS coronavirus is detected, or a polymerase chain reaction test by appropriate criteria is positive. At the time of writing (24 May 2004), no specific therapy has been recommended. A variety of treatments have been attempted, but there are no controlled data. Most patients have been treated throughout the illness with broad-spectrum antimicrobials, supplemental oxygen, intravenous fluids, and other supportive measures. Transmission of SARS is facilitated by close contact with patients with symptomatic infection. The majority of cases have been reported among healthcare providers and family members of SARS patients. Since SARS-CoV is contagious, measures for prevention center on avoidance of exposure, and infection control strategies for suspected cases and contacts. This includes standard precautions (hand hygiene), contact precautions (gowns, goggles, gloves) and airborne precautions (negative pressure rooms and high efficiency masks). In light of reports of new cases identified during the winter of 2003-4 in China, it seems possible that SARS will be an important cause of pneumonia in the future, and the screening of outpatients at risk for SARS may become part of the pneumonia evaluation.

  12. Cone positioning device for oral radiation therapy.

    PubMed

    Mahanna, G K; Ivanhoe, J R; Attanasio, R A

    1994-06-01

    This article describes the fabrication and modification of a peroral cone-positioning device. The modification provides added cone stability and prevents tongue intrusion into the radiation field. This device provides a repeatable accurate cone/lesion relationship and the fabrication technique is simplified, accurate, and minimizes patient discomfort.

  13. Respiratory muscle dysfunction in animal models of hypoxic disease: antioxidant therapy goes from strength to strength.

    PubMed

    O'Halloran, Ken D; Lewis, Philip

    2017-01-01

    The striated muscles of breathing play a critical role in respiratory homeostasis governing blood oxygenation and pH regulation. Upper airway dilator and thoracic pump muscles retain a remarkable capacity for plasticity throughout life, both in health and disease states. Hypoxia, whatever the cause, is a potent driver of respiratory muscle remodeling with evidence of adaptive and maladaptive outcomes for system performance. The pattern, duration, and intensity of hypoxia are key determinants of respiratory muscle structural-, metabolic-, and functional responses and adaptation. Age and sex also influence respiratory muscle tolerance of hypoxia. Redox stress emerges as the principal protagonist driving respiratory muscle malady in rodent models of hypoxic disease. There is a growing body of evidence demonstrating that antioxidant intervention alleviates hypoxia-induced respiratory muscle dysfunction, and that N-acetyl cysteine, approved for use in humans, is highly effective in preventing hypoxia-induced respiratory muscle weakness and fatigue. We posit that oxygen homeostasis is a key driver of respiratory muscle form and function. Hypoxic stress is likely a major contributor to respiratory muscle malaise in diseases of the lungs and respiratory control network. Animal studies provide an evidence base in strong support of the need to explore adjunctive antioxidant therapies for muscle dysfunction in human respiratory disease.

  14. Implantable drug therapy device: A concept

    NASA Technical Reports Server (NTRS)

    Feldstein, C.

    1972-01-01

    Design is described of small, rechargeable, implantable infusor which contains fluid medicament stored under pressure and which dispenses fluid continuously through catheter. Body of infusor is covered by pliable silicone rubber sheath attached to suture pad for securing device.

  15. Novel Silicon Devices for Radiation Therapy Monitoring

    NASA Astrophysics Data System (ADS)

    Bruzzi, Mara

    2016-02-01

    Modern radiotherapy techniques pose specific constraints in radiation-monitoring and dosimetry due to the occurrence of small radiation fields with high dose gradients, variation in space and time of the dose rate, variation in space and time of the beam energy spectrum. Novel devices coping with these strict conditions are needed. This paper reviews the most advanced technologies developed with silicon-based materials for clinical radiotherapy. Novel Si diodes as Pt-doped Si, epitaxial Si as well as thin devices have optimized performance, their response being independent of the accumulated dose, thus ensuring radiation tolerance and no need of recalibration. Monolithic devices based on segmented Si detectors can be easily tailored to optimize spatial resolution in the large active areas required in clinical radiotherapy. In particular, a monolithic device based on epitaxial p-type silicon, characterized by high spatial resolution and ability to directly measure temporal variations in dose modulation proved to be best viable solution for pre-treatment verifications in IMRT fields.

  16. Ampakine therapy to counter fentanyl-induced respiratory depression.

    PubMed

    Greer, John J; Ren, Jun

    2009-08-31

    Opioid analgesics are the most widely used and effective pharmacological agents for the treatment of acute, postoperative and chronic pain. However, activation of opiate receptors leads to significant depression of respiratory frequency in a subpopulation of patients. Here we test the hypothesis that the AMPAKINE CX717 is effective for alleviating fentanyl-induced respiratory depression without interfering with analgesia. Ampakines are a relatively new class of compounds that are in Phase II clinical trials as potential treatments for cognitive disorders and the enhancement of memory and attentiveness. They function by allosterically binding to amino-3-hydroxy-5-methyl-4-isoxazolepropionate receptors (AMPA)-type glutamate receptors and modulating the kinetics of channel closing, transmitter dissociation and desensitization. AMPA receptor mediated conductances play a central role in controlling respiratory rhythmogenesis and drive to motoneurons. Here, we demonstrate that CX717 counters fentanyl-induced respiratory depression without significantly altering analgesia and sedation, or noticeably affecting the animals' behavior. Collectively, the preclinical data demonstrate the significant potential for the use of ampakines in respiratory medicine.

  17. Comparison of Respiratory Resistance Measurements Made with an Airflow Perturbation Device with Those from Impulse Oscillometry

    PubMed Central

    Pan, J.; Saltos, A.; Smith, D.; Johnson, A.; Vossoughi, J.

    2013-01-01

    The airflow perturbation device (APD) has been developed as a portable, easy to use, and a rapid response instrument for measuring respiratory resistance in humans. However, the APD has limited data validating it against the established techniques. This study used a mechanical system to simulate the normal range of human breathing to validate the APD with the clinically accepted impulse oscillometry (IOS) technique. The validation system consisted of a sinusoidal flow generator with ten standardized resistance configurations that were shown to represent a total range of resistances from 0.12 to 0.95 kPa·L−1 ·s (1.2–9.7 cm H2O·L−1 ·s). Impulse oscillometry measurements and APD measurements of the mechanical system were recorded and compared at a constant airflow of 0.15 L·s−1. Both the IOS and APD measurments were accurate in assessing nominal resistance. In addition, a strong linear relationship was observed between APD measurements and IOS measurements (R 2 = 0.999). A second series of measurements was made on ten human volunteers with external resistors added in their respiratory flow paths. Once calibrated with the mechanical system, the APD gave respiratory resistance measurements within 5% of IOS measurements. Because of their comparability to IOS measurements, APD measurements are shown to be valid representations of respiratory resistance. PMID:27006908

  18. Impact of a Respiratory Therapy Assess-and-Treat Protocol on Adult Cardiothoracic ICU Readmissions.

    PubMed

    Dailey, Robert T; Malinowski, Thomas; Baugher, Mitchel; Rowley, Daniel D

    2017-05-01

    The purpose of this retrospective medical record review was to report on recidivism to the ICU among adult postoperative cardiac and thoracic patients managed with a respiratory therapy assess-and-treat (RTAT) protocol. Our primary null hypothesis was that there would be no difference in all-cause unexpected readmissions and escalations between the RTAT group and the physician-ordered respiratory care group. Our secondary null hypothesis was that there would be no difference in primary respiratory-related readmissions, ICU length of stay, or hospital length of stay. We reviewed 1,400 medical records of cardiac and thoracic postoperative subjects between January 2015 and October 2016. The RTAT is driven by a standardized patient assessment tool, which is completed by a registered respiratory therapist. The tool develops a respiratory severity score for each patient and directs interventions for bronchial hygiene, aerosol therapy, and lung inflation therapy based on an algorithm. The protocol period commenced on December 1, 2015, and continued through October 2016. Data relative to unplanned admissions to the ICU for all causes as well as respiratory-related causes were evaluated. There was a statistically significant difference in the all-cause unplanned ICU admission rate between the RTAT (5.8% [95% CI 4.3-7.9]) and the physician-ordered respiratory care (8.8% [95% CI 6.9-11.1]) groups (P = .034). There was no statistically significant difference in respiratory-related unplanned ICU admissions with RTAT (36% [95% CI 22.7-51.6]) compared with the physician-ordered respiratory care (53% [95% CI 41.1-64.8]) group (P = .09). The RTAT protocol group spent 1 d less in the ICU (P < .001) and in the hospital (P < .001). RTAT protocol implementation demonstrated a statistically significant reduction in all-cause ICU readmissions. The reduction in respiratory-related ICU readmissions did not reach statistical significance. Copyright © 2017 by Daedalus Enterprises.

  19. High flow nasal cannula therapies for respiratory management in pediatric patients.

    PubMed

    Liu, Gang; Fan, Conghai; Wu, Hongwei

    2017-03-27

    High flow nasal cannula (HFNC) oxygen therapy is a non-invasive form of respiratory support that is rapidly being taken up in paediatric intensive care units (PICU). For infants with bronchiolitis - who are the largest non-elective source of admissions to a PICU - there is some evidence that using HFNC therapy reduces the need for intubation and mechanical ventilation. The aim of this review article is is to explore, describe, critique and add to the evidence surrounding the use of HFNC therapy in the pediatric population for the management of respiratory distress.

  20. [Organ replacement therapy - extracorporeal liver assist devices].

    PubMed

    Sinner, Barbara; Kirchner, Gabriele I

    2016-09-01

    Liver failure is a disease with a high mortality rate. Often liver transplantation is the sole therapeutic option. On the one hand, liver support systems probably support the liver to allow regeneration, on the other hand they are an option to bridge for transplantation. This article gives an overview on the clinically used liver assist devices (molecular adsorbent recirculating system [MARS], Prometheus system, single-pass albumin dialysis [SPAD], plasmapheresis) and discusses the applications in liver failure.

  1. Effects of Respiratory Resistance Training With a Concurrent Flow Device on Wheelchair Athletes

    PubMed Central

    Litchke, Lyn G; Russian, Christopher J; Lloyd, Lisa K; Schmidt, Eric A; Price, Larry; Walker, John L

    2008-01-01

    Background/Objective: To determine the effect of respiratory resistance training (RRT) with a concurrent flow respiratory (CFR) device on respiratory function and aerobic power in wheelchair athletes. Methods: Ten male wheelchair athletes (8 with spinal cord injuries, 1 with a neurological disorder, and 1 with postpolio syndrome), were matched by lesion level and/or track rating before random assignment to either a RRT group (n = 5) or a control group (CON, n = 5). The RRT group performed 1 set of breathing exercises using Expand-a-Lung, a CFR device, 2 to 3 times daily for 10 weeks. Pre/posttesting included measurement of maximum voluntary ventilation (MVV), maximum inspiratory pressure (MIP), and peak oxygen consumption ( ). Results: Repeated measures ANOVA revealed a significant group difference in change for MIP from pre- to posttest (P < 0.05). The RRT group improved by 33.0 cm H2O, while the CON group improved by 0.6 cm H2O. Although not significant, the MVV increased for the RRT group and decreased for the CON group. There was no significant group difference between for pre/posttesting. Due to small sample sizes in both groups and violations of some parametric statistical assumptions, nonparametric tests were also conducted as a crosscheck of the findings. The results of the nonparametric tests concurred with the parametric results. Conclusions: These data demonstrate that 10 weeks of RRT training with a CFR device can effectively improve MIP in wheelchair athletes. Further research and a larger sample size are warranted to further characterize the impact of Expand-a-Lung on performance and other cardiorespiratory variables in wheelchair athletes. PMID:18533414

  2. Effects of respiratory resistance training with a concurrent flow device on wheelchair athletes.

    PubMed

    Litchke, Lyn G; Russian, Christopher J; Lloyd, Lisa K; Schmidt, Eric A; Price, Larry; Walker, John L

    2008-01-01

    To determine the effect of respiratory resistance training (RRT) with a concurrent flow respiratory (CFR) device on respiratory function and aerobic power in wheelchair athletes. Ten male wheelchair athletes (8 with spinal cord injuries, 1 with a neurological disorder, and 1 with postpolio syndrome), were matched by lesion level and/or track rating before random assignment to either a RRT group (n = 5) or a control group (CON, n = 5). The RRT group performed 1 set of breathing exercises using Expand-a-Lung, a CFR device, 2 to 3 times daily for 10 weeks. Pre/posttesting included measurement of maximum voluntary ventilation (MVV), maximum inspiratory pressure (MIP), and peak oxygen consumption (V(O2peak)). Repeated measures ANOVA revealed a significant group difference in change for MIP from pre- to posttest (P < 0.05). The RRT group improved by 33.0 cm H2O, while the CON group improved by 0.6 cm H2O. Although not significant, the MW increased for the RRT group and decreased for the CON group. There was no significant group difference between V(O2peak) for pre/posttesting. Due to small sample sizes in both groups and violations of some parametric statistical assumptions, nonparametric tests were also conducted as a crosscheck of the findings. The results of the nonparametric tests concurred with the parametric results. These data demonstrate that 10 weeks of RRT training with a CFR device can effectively improve MIP in wheelchair athletes. Further research and a larger sample size are warranted to further characterize the impact of Expand-a-Lung on performance and other cardiorespiratory variables in wheelchair athletes.

  3. Vaccinator device for delivering propellant-driven aerosols of Streptococcus suis bacterin into the respiratory tracts of swine.

    PubMed

    Brown, A R; George, D W; Matteson, D K

    1997-08-01

    Metered-dose propellant-driven small particle aerosols of a killed whole bacterium, Streptococcus suis, were produced and characterized for their aerodynamic particle sizes and antigenicity as potential respiratory mucosal vaccines against S. suis infections in swine. To facilitate the efficient delivery of such vaccine aerosols to large animals, an electro-mechanical device was developed to synchronize aerosol release to an animal's inhalation cycles. The device was tested for its capacity to deliver a fluorescein conjugate of this bacterin (FITC-S. suis) into the respiratory tracts of 18 pigs. Results showed that FITC-S. suis could be detected in the lungs of swine as small as 4.5 kg with as few as two aerosol actuations. Metered-dose propellant-driven aerosols of bacterin vaccines delivered by this respiratory vaccinating device are discussed as a new approach for stimulated mucosal immunity against respiratory infections in animals.

  4. Using interprofessional simulation to improve collaborative competences for nursing, physiotherapy, and respiratory therapy students.

    PubMed

    King, Judy; Beanlands, Sarah; Fiset, Valerie; Chartrand, Louise; Clarke, Shelley; Findlay, Tarra; Morley, Michelle; Summers, Ian

    2016-09-01

    Within the care of people living with respiratory conditions, nursing, physiotherapy, and respiratory therapy healthcare professionals routinely work in interprofessional teams. To help students prepare for their future professional roles, there is a need for them to be involved in interprofessional education. The purpose of this project was to compare two different methods of patient simulation in improving interprofessional competencies for students in nursing, physiotherapy, and respiratory therapy programmes. The Canadian Interprofessional Health Collaborative competencies of communication, collaboration, conflict resolution patient/family-centred care, roles and responsibilities, and team functioning were measured. Using a quasi-experimental pre-post intervention approach two different interprofessional workshops were compared: the combination of standardised and simulated patients, and exclusively standardised patients. Students from nursing, physiotherapy, and respiratory therapy programmes worked together in these simulation-based activities to plan and implement care for a patient with a respiratory condition. Key results were that participants in both years improved in their self-reported interprofessional competencies as measured by the Interprofessional Collaborative Competencies Attainment Survey (ICCAS). Participants indicated that they found their interprofessional teams did well with communication and collaboration. But the participants felt they could have better involved the patients and their family members in the patient's care. Regardless of method of patient simulation used, mannequin or standardised patients, students found the experience beneficial and appreciated the opportunity to better understand the roles of other healthcare professionals in working together to help patients living with respiratory conditions.

  5. Mold Allergens in Respiratory Allergy: From Structure to Therapy

    PubMed Central

    Twaroch, Teresa E; Curin, Mirela; Swoboda, Ines

    2015-01-01

    Allergic reactions to fungi were described 300 years ago, but the importance of allergy to fungi has been underestimated for a long time. Allergens from fungi mainly cause respiratory and skin symptoms in sensitized patients. In this review, we will focus on fungi and fungal allergens involved in respiratory forms of allergy, such as allergic rhinitis and asthma. Fungi can act as indoor and outdoor respiratory allergen sources, and depending on climate conditions, the rates of sensitization in individuals attending allergy clinics range from 5% to 20%. Due to the poor quality of natural fungal allergen extracts, diagnosis of fungal allergy is hampered, and allergen-specific immunotherapy is rarely given. Several factors are responsible for the poor quality of natural fungal extracts, among which the influence of culture conditions on allergen contents. However, molecular cloning techniques have allowed us to isolate DNAs coding for fungal allergens and to produce a continuously growing panel of recombinant allergens for the diagnosis of fungal allergy. Moreover, technologies are now available for the preparation of recombinant and synthetic fungal allergen derivatives which can be used to develop safe vaccines for the treatment of fungal allergy. PMID:25840710

  6. Development of device therapy for ventricular arrhythmias.

    PubMed

    Holley, Loraine K

    2007-06-01

    The past 25 years have seen the implantable cardioverter defibrillator emerge as the treatment of choice for ventricular arrhythmias with reduction in size but increased therapeutic options. Understanding the complex mechanisms of ventricular arrhythmias and defibrillation in normal and diseased hearts has been the focus of many research teams including that of John Uther at the Westmead Hospital Department of Cardiology. Marked improvements in capacitor and battery technologies, arrhythmia discrimination, pacing algorithms, shock waveforms and monitoring capabilities enable wider use and patient acceptance. Emergence of cardiac resynchronisation therapy and the implantable defibrillator for treatment of chronic heart failure is not only giving quality of life and extended survival for heart failure patients but has also cast new light on the evolution of heart failure.

  7. Prevalence of Respiratory Protective Devices in U.S. Health Care Facilities

    PubMed Central

    Wizner, Kerri; Stradtman, Lindsay; Novak, Debra; Shaffer, Ronald

    2016-01-01

    An online questionnaire was developed to explore respiratory protective device (RPD) prevalence in U.S. health care facilities. The survey was distributed to professional nursing society members in 2014 and again in 2015 receiving 322 and 232 participant responses, respectively. The purpose of this study was to explore if the emergency preparedness climate associated with Ebola virus disease changed the landscape of RPD use and awareness. Comparing response percentages from the two sampling time frames using bivariate analysis, no significant changes were found in types of RPDs used in health care settings. N95 filtering facepiece respirators continue to be the most prevalent RPD used in health care facilities, but powered air-purifying respirators are also popular, with regional use highest in the West and Midwest. Understanding RPD use prevalence could ensure that health care workers receive appropriate device trainings as well as improve supply matching for emergency RPD stockpiling. PMID:27462029

  8. Optimizing an Internal Airway Percussion Device for Facilitating Exhalate Diagnostics of the Human Respiratory System.

    PubMed

    Afshar-Mohajer, Nima; Wu, Chang-Yu; Tsai, Hsiu-Wen; Silverman, Erin; Davenport, Paul; Hegde, Satyanarayan

    2015-03-31

    There is an urgent need for simple, inexpensive, noninvasive, and repeatable technique for the diagnosis of pulmonary diseases. Bronchoalveolar lavage, which is the gold standard diagnostic method for pulmonary diseases, does not meet any of these criteria. This study seeks to develop and optimize a novel technique of Internal Airway Percussion (IAP) to facilitate the collection and characterization of human respiratory system exhalates. The IAP device transmits sound waves into the respiratory tract, thereby increasing the release of aerosolized particles within exhaled breath by vibrating both lungs. Nine combinations of sound wave frequencies and amplitudes were studied to determine optimal frequency and amplitude combination for maximum aerosol particle gain in healthy human subjects. Square-shaped sound waves generated at 15 Hz and 3 cm H2O resulted in 15 times greater total mass of collected particles in the first 2 min of sampling, and 1.2 to 1.5 times increase in count median diameter of the particles. IAP, optimized at the frequency of 15 Hz and the pressure amplitude of 3 cm H2O, increased the total mass of particles exhaled from the human respiratory system. IAP has a broad range of potential clinical applications for noninvasive diagnosis of lung diseases including asthma, cystic fibrosis, pneumonia, and lung cancer, along with improvement of mucus clearance.

  9. Artificial placenta--lung assist devices for term and preterm newborns with respiratory failure.

    PubMed

    Rochow, Niels; Chan, Emily C; Wu, Wen-I; Selvaganapathy, Ponnambalam R; Fusch, Gerhard; Berry, Leslie; Brash, John; Chan, Anthony K; Fusch, Christoph

    2013-06-25

    Respiratory insufficiency is a major cause of neonatal mortality and long-term morbidity, especially in very low birth weight infants. Today, non-invasive and mechanical ventilation are commonly accepted procedures to provide respiratory support to newborns, but they can reach their limit of efficacy. To overcome this technological plateau and further reduce mortality rates, the technology of an "artificial placenta", which is a pumpless lung assist device connected to the umbilical vessels, would serve to expand the therapeutic spectrum when mechanical ventilation becomes inadequate to treat neonates with severe respiratory insufficiency.
The first attempts to create such an artificial placenta took place more than 60 years ago. However, there has been a recent renaissance of this concept, including developments of its major components like the oxygenator, vascular access via umbilical vessels, flow control, as well as methods to achieve hemocompatibility in extracorporeal circuits. This paper gives a review of past and current development, animal experiments and human case studies of artificial placenta technology.

  10. Microbiology devices; reclassification of nucleic acid-based systems for mycobacterium tuberculosis complex in respiratory specimens. Final rule.

    PubMed

    2014-05-30

    The Food and Drug Administration (FDA) is reclassifying nucleic acid-based in vitro diagnostic devices for the detection of Mycobacterium tuberculosis complex in respiratory specimens from class III (premarket approval) into class II (special controls). FDA is also issuing the special controls guideline entitled ''Class II Special Controls Guideline: Nucleic Acid-Based In Vitro Diagnostic Devices for the Detection of Mycobacterium tuberculosis Complex in Respiratory Specimens.'' These devices are intended to be used as an aid in the diagnosis of pulmonary tuberculosis.

  11. Immunoadjuvant Therapy and Noninvasive Ventilation for Acute Respiratory Failure in Lung Tuberculosis: A Case Study

    PubMed Central

    Flores-Franco, René Agustín; Olivas-Medina, Dahyr Alberto; Pacheco-Tena, Cesar Francisco; Duque-Rodríguez, Jorge

    2015-01-01

    Acute respiratory failure caused by pulmonary tuberculosis is a rare event but with a high mortality even while receiving mechanical ventilatory support. We report the case of a young man with severe pulmonary tuberculosis refractory to conventional therapy who successfully overcame the critical period of his condition using noninvasive ventilation and immunoadjuvant therapy that included three doses of etanercept 25 mg subcutaneously. We conclude that the use of etanercept along with antituberculosis treatment appears to be safe and effective in patients with pulmonary tuberculosis presenting with acute respiratory failure. PMID:26273486

  12. Clinician Beliefs and Attitudes Regarding Use of Respiratory Protective Devices and Surgical Masks for Influenza.

    PubMed

    Pillai, Satish K; Beekmann, Susan E; Babcock, Hilary M; Pavia, Andrew T; Koonin, Lisa M; Polgreen, Philip M

    2015-01-01

    While influenza transmission is thought to occur primarily by droplet spread, the role of airborne spread remains uncertain. Understanding the beliefs and attitudes of infectious disease physicians regarding influenza transmission and respiratory and barrier protection preferences can provide insights into workplace decisions regarding respiratory protection planning. Physicians participating in the Infectious Diseases Society of America's Emerging Infections Network were queried in November 2013 to determine beliefs and attitudes on influenza transmission. A subset of physicians involved in their facility's respiratory protection decision making were queried about respirator and surgical mask choices under various pandemic scenarios; availability of, and challenges associated with, respirators in their facility; and protective strategies during disposable N95 shortages. The majority of 686 respondents (98%) believed influenza transmission occurs frequently or occasionally via droplets; 44% of respondents believed transmission occurs via small particles frequently (12%) or occasionally (32%). Among the subset of respondents involved in respiratory protection planning at their facility, over 90% preferred surgical masks during provision of non-aerosol-generating patient care for seasonal influenza. However, for the same type of care during an influenza pandemic, two-thirds of respondents opted for disposable N95 filtering facepiece respirators. In settings where filtering facepiece (disposable) N95 respirators were in short supply, preferred conservation strategies included extended use and reuse of disposable N95s. Use of reusable (elastomeric facepiece) respirator types was viewed less favorably. While respondents identified droplets as the primary mode of influenza transmission, during a high-severity pandemic scenario there was increased support for devices that reduced aerosol-based transmission. Use of potentially less familiar respirator types may partially

  13. Special article: rescue therapies for acute hypoxemic respiratory failure.

    PubMed

    Liu, Linda L; Aldrich, J Matthew; Shimabukuro, David W; Sullivan, Kristina R; Taylor, John M; Thornton, Kevin C; Gropper, Michael A

    2010-09-01

    The recent H1N1 epidemic has resulted in a large number of deaths, primarily from acute hypoxemic respiratory failure. We reviewed the current strategies to rescue patients with severe hypoxemia. Included in these strategies are high-frequency oscillatory ventilation, airway pressure release ventilation, inhaled vasodilators, and the use of extracorporeal life support. All of these strategies are targeted at improving oxygenation, but improved oxygenation alone has yet to be demonstrated to correlate with improved survival. The risks and benefits of these strategies, including cost-effectiveness data, are discussed.

  14. Novel therapies and vaccines against the human respiratory syncytial virus.

    PubMed

    Rivera, Claudia A; Gómez, Roberto S; Díaz, Rodrigo A; Céspedes, Pablo F; Espinoza, Janyra A; González, Pablo A; Riedel, Claudia A; Bueno, Susan M; Kalergis, Alexis M

    2015-01-01

    Human respiratory syncytial virus (hRSV) is the leading cause of acute lower respiratory tract infections worldwide in infants, as well as an important pathogen affecting the elderly and immunocompromised individuals. Despite more than a half a century of research, no licensed vaccines are available and only palivizumab has been approved to use in humans, mostly recommended or limited to high risk infants. Therefore, novel therapeutic and preventive drugs need to be developed to fight this major human pathogen. This review discusses current therapeutic approaches in preclinical and clinical stages, aimed at controlling or preventing hRSV infection. These methods include passive immunization, experimental drugs, vaccine candidates and maternal immunization. Based on the results of various immunization strategies and therapeutic approaches, it is likely that the most effective strategy against hRSV will be a prophylactic tool aimed at developing a strong antiviral T-cell response capable of both, promoting the generation of hRSV-specific high affinity antibodies and leading the protective immunity required to prevent the disease caused by this virus. Alternatively, if prophylactic strategies fail, antiviral drugs and novel passive immunity strategies could significantly contribute to reducing hospitalization rates in susceptible individuals.

  15. New Devices and Old Pitfalls in Shock Wave Therapy

    NASA Astrophysics Data System (ADS)

    Bailey, Michael R.; Matula, Thomas J.; Sapozhnikov, Oleg A.; Cleveland, Robin O.; Pishchalnikov, Yuri A.; McAteer, James A.

    2006-05-01

    Shock waves are now used to treat a variety of musculoskeletal indications and the worldwide demand for shock wave therapy (SWT) is growing rapidly. It is a concern that very little is known about the mechanisms of action of shock waves in SWT. The technology for SWT devices is little changed from that of shock wave lithotripters developed for the treatment of urinary stones. SWT devices are engineered on the same acoustics principles as lithotripters, but the targets of therapy for SWT and shock wave lithotripsy (SWL) are altogether different. For SWT to achieve its potential as a beneficial treatment modality it will be necessary to determine precisely how SWT shock waves interact with biological targets. In addition, for SWT to evolve, the future design of these devices should be approached with caution, and lithotripsy may serve as a useful model. Indeed, there is a great deal to be learned from the basic research that has guided the development of SWL.

  16. Acute respiratory failure caused by organizing pneumonia secondary to antineoplastic therapy for non-Hodgkin's lymphoma

    PubMed Central

    Santana, Adriell Ramalho; Amorim, Fábio Ferreira; Soares, Paulo Henrique Alves; de Moura, Edmilson Bastos; Maia, Marcelo de Oliveira

    2012-01-01

    Interstitial lung diseases belong to a group of diseases that typically exhibit a subacute or chronic progression but that may cause acute respiratory failure. The male patient, who was 37 years of age and undergoing therapy for non-Hodgkin's lymphoma, was admitted with cough, fever, dyspnea and acute hypoxemic respiratory failure. Mechanical ventilation and antibiotic therapy were initiated but were associated with unfavorable progression. Thoracic computed tomography showed bilateral pulmonary "ground glass" opacities. Methylprednisolone pulse therapy was initiated with satisfactory response because the patient had used three drugs related to organizing pneumonia (cyclophosphamide, doxorubicin and rituximab), and the clinical and radiological symptoms were suggestive. Organizing pneumonia may be idiopathic or linked to collagen diseases, drugs and cancer and usually responds to corticosteroid therapy. The diagnosis was anatomopathological, but the patient's clinical condition precluded performing a lung biopsy. Organizing pneumonia should be a differential diagnosis in patients with apparent pneumonia and a progression that is unfavorable to antimicrobial treatment. PMID:23917942

  17. Inhaled therapy in cystic fibrosis: agents, devices and regimens

    PubMed Central

    Parrott, Helen

    2015-01-01

    Key points There have been significant advances in both inhalation medicines and delivery devices with “intelligent nebulisers” and “dry-powder inhalers” becoming commonplace in CF care. Inhaled medicines generate high levels of a drug within the airways with limited systemic effects, offering safe and convenient antibiotic and mucolytic therapy for individuals with CF. Variations in adherence are not unique to CF; however, treatment burden is high and therefore fast inhaled drug delivery devices may assist individuals in completing the prescribed treatment regimes. Prescribers of inhaled medicines have a responsibility to consider, in addition to efficacy, the appropriated drug/device combination for each individual in order to promote adherence and achieve the desired clinical benefit. Summary The recognised mainstay daily treatments for cystic fibrosis (CF) focus on inhaled and oral medications, airway clearance and optimised nutrition. This review discusses recent advances in inhaled therapies for the management of CF, including devices such as intelligent nebulisers, drug formulations and supporting evidence for inhaled antibiotics (for the management of chronic Pseudomonas aeruginosa) and muco-active drugs. We include practical advice for clinicians regarding the optimisation of inhalation technique and education. The influence of adherence on the use of inhaled therapies in CF is also reviewed. Educational aims To inform readers about the history and progression of inhaled therapies for people with CF with reference to the literature supporting current practice. To highlight the factors that may impact the success of inhaled therapies, including those which are device specific such as drug deposition and those which influence adherence. PMID:26306111

  18. Health Services: Clinical. Respiratory Therapy Aide. Instructor's Manual. Competency-Based Education.

    ERIC Educational Resources Information Center

    Cave, Julie; And Others

    This instructor's manual consists of materials for use in presenting a course in the occupational area of respiratory therapy aide. Included in the first part of the guide are a program master sequence; a master listing of instructional materials, equipment, and supplies; an overview of the competency-based vocational education (CBVE) system; and…

  19. Respiratory Therapy Discipline Advisory Group Final Report. Kentucky Allied Health Project.

    ERIC Educational Resources Information Center

    Kentucky Council on Public Higher Education, Frankfort.

    Respiratory therapy education in Kentucky and articulation within the field are examined, based on the Kentucky Allied Health Project (KAHP), which designed a statewide system to promote entry and exit of prepared personnel at a variety of educational levels. The KAHP model promotes articulation in learning, planning, and resource utilization. The…

  20. Delineation of Roles and Functions of Respiratory Therapy Personnel. Final Report.

    ERIC Educational Resources Information Center

    American Association for Respiratory Therapy, Dallas, TX.

    Frequently assigned tasks performed by qualified respiratory therapy personnel are delineated in the document in such a manner that proficiency examinations within the profession can be prepared from them. Four distinct proficiency levels are identified and defined. Due to the fact that proficiency examinations will be assigned for them,…

  1. Delineation of Roles and Functions of Respiratory Therapy Personnel. Final Report.

    ERIC Educational Resources Information Center

    American Association for Respiratory Therapy, Dallas, TX.

    Frequently assigned tasks performed by qualified respiratory therapy personnel are delineated in the document in such a manner that proficiency examinations within the profession can be prepared from them. Four distinct proficiency levels are identified and defined. Due to the fact that proficiency examinations will be assigned for them,…

  2. A Study of Mathematics Needed for Dental Laboratory Technology, Medical Laboratory Technology, and Respiratory Therapy.

    ERIC Educational Resources Information Center

    Roberts, Keith J.

    A study was conducted to determine what mathematics skills were needed for Dental Laboratory Technology, Medical Laboratory Technology, and Respiratory Therapy. Data obtained from studies, course outlines, textbooks, and reports were used to construct a 79-item mathematics skill questionnaire. This questionnaire was administered to employers,…

  3. Health Services: Clinical. Respiratory Therapy Aide. Instructor's Manual. Competency-Based Education.

    ERIC Educational Resources Information Center

    Cave, Julie; And Others

    This instructor's manual consists of materials for use in presenting a course in the occupational area of respiratory therapy aide. Included in the first part of the guide are a program master sequence; a master listing of instructional materials, equipment, and supplies; an overview of the competency-based vocational education (CBVE) system; and…

  4. A Low-Power and Portable Biomedical Device for Respiratory Monitoring with a Stable Power Source.

    PubMed

    Yang, Jiachen; Chen, Bobo; Zhou, Jianxiong; Lv, Zhihan

    2015-08-11

    Continuous respiratory monitoring is an important tool for clinical monitoring. Associated with the development of biomedical technology, it has become more and more important, especially in the measuring of gas flow and CO2 concentration, which can reflect the status of the patient. In this paper, a new type of biomedical device is presented, which uses low-power sensors with a piezoresistive silicon differential pressure sensor to measure gas flow and with a pyroelectric sensor to measure CO2 concentration simultaneously. For the portability of the biomedical device, the sensors and low-power measurement circuits are integrated together, and the airway tube also needs to be miniaturized. Circuits are designed to ensure the stability of the power source and to filter out the existing noise. Modulation technology is used to eliminate the fluctuations at the trough of the waveform of the CO2 concentration signal. Statistical analysis with the coefficient of variation was performed to find out the optimal driving voltage of the pressure transducer. Through targeted experiments, the biomedical device showed a high accuracy, with a measuring precision of 0.23 mmHg, and it worked continuously and stably, thus realizing the real-time monitoring of the status of patients.

  5. A Low-Power and Portable Biomedical Device for Respiratory Monitoring with a Stable Power Source

    PubMed Central

    Yang, Jiachen; Chen, Bobo; Zhou, Jianxiong; Lv, Zhihan

    2015-01-01

    Continuous respiratory monitoring is an important tool for clinical monitoring. Associated with the development of biomedical technology, it has become more and more important, especially in the measuring of gas flow and CO2 concentration, which can reflect the status of the patient. In this paper, a new type of biomedical device is presented, which uses low-power sensors with a piezoresistive silicon differential pressure sensor to measure gas flow and with a pyroelectric sensor to measure CO2 concentration simultaneously. For the portability of the biomedical device, the sensors and low-power measurement circuits are integrated together, and the airway tube also needs to be miniaturized. Circuits are designed to ensure the stability of the power source and to filter out the existing noise. Modulation technology is used to eliminate the fluctuations at the trough of the waveform of the CO2 concentration signal. Statistical analysis with the coefficient of variation was performed to find out the optimal driving voltage of the pressure transducer. Through targeted experiments, the biomedical device showed a high accuracy, with a measuring precision of 0.23 mmHg, and it worked continuously and stably, thus realizing the real-time monitoring of the status of patients. PMID:26270665

  6. Dual device therapy in the setting of changing ICD technology: device-device interaction revisited.

    PubMed

    Sheahan, R G; Dorian, P; Poludnikiewicz, M; Newman, D

    1997-06-01

    This case report concerns an adverse device-device interaction between a replacement ICD and a dual chamber rate responsive pacemaker. It was observed that subtle changes in the design of sensing circuits between an older first-generation ICD and the newer third-generation ICD device led to unexpected and dramatic changes in the interactive behavior of a dual device system. The new ICD was connected to chronically implanted hardware. The sensing behavior of the newer ICD included a shorter time constant in the decay of the automatic gain control function, resulting in triple sensing of both the atrial and ventricular paced stimuli and the evoked QRS complex. Physicians should be aware of new design changes in the future so as to anticipate such interactions. In the setting of rapidly changing technology, extra caution must be exercised when choosing to implant two devices in the same patient.

  7. A cloud-based mobile system to improve respiratory therapy services at home.

    PubMed

    Risso, Nicolas A; Neyem, Andrés; Benedetto, Jose I; Carrillo, Marie J; Farías, Angélica; Gajardo, Macarena J; Loyola, Oscar

    2016-10-01

    Chronic respiratory diseases are one of the most prevalent health problems in the world. Treatment for these kind of afflictions often take place at home, where the continuous care of a medical specialist is frequently beyond the economical means of the patient, therefore having to rely on informal caregivers (family, friends, etc.). Unfortunately, these treatments require a deep involvement on their part, which results in a heavy burden on the caregivers' routine and usually end up deteriorating their quality of life. In recent years, mHealth and eHealth applications have gained a wide interest in academia due to new capabilities enabled by the latest advancements in mobile technologies and wireless communication infrastructure. These innovations have resulted in several applications that have successfully managed to improve automatic patient monitoring and treatment and to bridge the distance between patients, caregivers and medical specialists. We therefore seek to move this trend forward by now pushing these capabilities into the field of respiratory therapies in order to assist patients with chronic respiratory diseases with their treatment, and to improve both their own and their caregivers' quality of life. This paper presents a cloud-based mobile system to support and improve homecare for respiratory diseases. The platform described uses vital signs monitoring as a way of sharing data between hospitals, caregivers and patients. Using an iterative research approach and the user's direct feedback, we show how mobile technologies can improve a respiratory therapy and a family's quality of life.

  8. Validity of a new respiratory resistance measurement device to detect glottal area change.

    PubMed

    Gallena, Sally J K; Tian, Wei; Johnson, Arthur T; Vossoughi, Jafar; Sarles, Stephen A; Solomon, Nancy Pearl

    2013-05-01

    To determine the correlation between respiratory resistance (Rr) values measured with the Airflow Perturbation Device (APD) to laryngoscopic images of glottal area (GA) in feigned paradoxical vocal fold motion (PVFM), also known as vocal cord dysfunction. There is a strong inverse relationship between Rr and GA such that laryngeal constriction can be detected and quantified by APD-measured Rr. Prospective, single subject study. A healthy adult feigned breathing that was characteristic of PVFM. Rr and GA were simultaneously recorded, synchronized, and analyzed for three complete breathing cycles with significant glottal constriction occurring during inspiration. Cross-correlation analysis revealed a strong negative correlation (-0.824) between GA and Rr during feigned PVFM breathing such that Rr increased when GA decreased. APD-measured Rr appears to be a viable noninvasive method for diagnostic screening and monitoring of treatment outcomes for individuals presenting with dyspnea related to PVFM. Copyright © 2013 The Voice Foundation. All rights reserved.

  9. Prevention of Medical Device-Related Pressure Injuries Associated With Respiratory Equipment Use in a Critical Care Unit: A Quality Improvement Project.

    PubMed

    Padula, Cynthia A; Paradis, Heidi; Goodwin, Robert; Lynch, Judith; Hegerich-Bartula, Deborah

    Medical devices have been identified as an extrinsic risk factor for development of pressure injuries, with as many as 30% to 70% of medical device-related pressure injuries resulting from respiratory equipment. This article describes a quality improvement project undertaken to reduce the occurrence of respiratory device-related pressure injuries in a critically care unit. Multiple actions were implemented to achieve this goal. Respiratory therapists were trained to document occurrences on a daily basis, and apparent cause analyses were conducted on each occurrence. An interdisciplinary team conducted biweekly rounds on patients with respiratory devices and consulted other professionals as indicated. Nurses and respiratory therapists attended an evidence-based, collaborative, educational offering and completed a measure of team functioning before the program and at the end of the study period. The occurrence rates of respiratory device-related pressure injuries were reduced over the project period, and these changes were sustained over the subsequent 12 months.

  10. Improving the accuracy and efficiency of respiratory rate measurements in children using mobile devices.

    PubMed

    Karlen, Walter; Gan, Heng; Chiu, Michelle; Dunsmuir, Dustin; Zhou, Guohai; Dumont, Guy A; Ansermino, J Mark

    2014-01-01

    The recommended method for measuring respiratory rate (RR) is counting breaths for 60 s using a timer. This method is not efficient in a busy clinical setting. There is an urgent need for a robust, low-cost method that can help front-line health care workers to measure RR quickly and accurately. Our aim was to develop a more efficient RR assessment method. RR was estimated by measuring the median time interval between breaths obtained from tapping on the touch screen of a mobile device. The estimation was continuously validated by measuring consistency (% deviation from the median) of each interval. Data from 30 subjects estimating RR from 10 standard videos with a mobile phone application were collected. A sensitivity analysis and an optimization experiment were performed to verify that a RR could be obtained in less than 60 s; that the accuracy improves when more taps are included into the calculation; and that accuracy improves when inconsistent taps are excluded. The sensitivity analysis showed that excluding inconsistent tapping and increasing the number of tap intervals improved the RR estimation. Efficiency (time to complete measurement) was significantly improved compared to traditional methods that require counting for 60 s. There was a trade-off between accuracy and efficiency. The most balanced optimization result provided a mean efficiency of 9.9 s and a normalized root mean square error of 5.6%, corresponding to 2.2 breaths/min at a respiratory rate of 40 breaths/min. The obtained 6-fold increase in mean efficiency combined with a clinically acceptable error makes this approach a viable solution for further clinical testing. The sensitivity analysis illustrating the trade-off between accuracy and efficiency will be a useful tool to define a target product profile for any novel RR estimation device.

  11. [Pain and respiratory physical therapy in patients after heart surgery].

    PubMed

    De Haro Marín, S; Torres González, J P; Vela Morales, C; Navarro Arnedo, J M

    1999-06-01

    Between the months of March and June 1997, an extended observational study was carried out on 32 patients hospitalized in the intensive care unit of "Hospital General Universitario" in Alicante for postoperative care after undergoing heart surgery which included extracorporeal circulation. The variables analyzed were of a socio-demographical nature and related to the type of operation in order to homogenize the samples. The main variables under study were pain while resting and pain while carrying out these exercises: coughing, deep breathing, stimulated inspirometer, and clapping; the number of balls the patient could raise; collaboration with the physical therapist and the kind of analgesic administered. The pain measuring instrument was the visual analogous scale. The patients with the highest pain levels when performing the protocolary extubation exercises raised fewer balls in the stimulated inspirometer exercise and did not collaborate with the physical therapist. The patients who receive more doses of sedatives collaborate with the respiratory physical therapist. All those patients who receive an analgesic at a set hour raise one or two balls in the inspirometer exercise and all collaborated with the physical therapist.

  12. Design, development and experimental validation of a non-invasive device for recording respiratory events during bottle feeding.

    PubMed

    Cavaiola, C; Tamilia, E; Massaroni, C; Morbidoni, G; Schena, E; Formica, D; Taffoni, F

    2014-01-01

    In newborns, a poor coordination between sucking, swallowing and breathing may undermine the effectiveness of oral feeding and signal immaturity of Central Nervous System. The aim of this work is to develop and validate a non-invasive device for recording respiratory events of newborns during bottle feeding. The proposed device working principle is based on the convective heat exchanged between two hot bodies and the infants' breathing. The sensing elements are inserted into a duct and the gas exchanged by infants is conveyed into this duct thanks to an ad hoc designed system to be mounted on a commercial feeding bottle. Two sets of experiments have been carried out in order to investigate the discrimination threshold of the device and characterize the sensor response at oscillating flows. The effect of distance and tilt between nostrils and device, and the breathing frequency, have been investigated simulating nostrils and neonatal respiratory pattern. The device has a discrimination threshold lower than 0.5 L/min at both 10° and 20° of tilt. Distance for these two settings does not affect the threshold in the investigated range (10-20 mm). Moreover, the device is able to detect breathing events, and to discriminate the onset of expiratory phase, during a neonatal respiratory task delivered by a lung simulator. The results foster the successful application of this device to the assessment of the temporal breathing pattern of newborns during bottle feeding with a non-invasive approach.

  13. From admission to graduation: the impact of gender on student academic success in respiratory therapy education.

    PubMed

    Ari, Arzu; Atalay, Orcin Telli; Aljamhan, Essam

    2010-01-01

    Despite research in other allied health professions and medicine, the influence of gender on student performance in respiratory therapy (RT) academic programs and on the National Board for Respiratory Care (NBRC) examinations is unknown. Therefore, the purpose of this study was to identify the impact of gender on student academic performance from admission to graduation and to determine whether gender differences affected student success on the NBRC examinations. This study consisted of a retrospective analysis of 91 female and 22 male graduates at a southeastern U.S. university between 2003 and 2007. The variables of academic success included the students' entering GPA, exit GPA, and first-attempt performance on the Certified Respiratory Therapy (CRT) examination and on the Written Registry for Respiratory Therapy (WRRT) examination. Independent sample t-test and paired sample t-test analyses at a level of significance of α = 0.05 were utilized. No significant gender differences were observed in the measures of students' entering GPA, exit GPA, or performance on scaled CRT and WRRT examinations (p > 0.05). When we compared entering GPAs and exit GPAs, a statistically significant difference was found (p < 0.05). Both male and female RT students had significantly higher exit GPAs than entering GPAs. The results of the study showed that gender plays no role in the academic success of RT students. When looking at the changes on academic success, we conclude that RT students work hard, as the graduation scores are higher than admission scores.

  14. The role of high flow oxygen therapy in acute respiratory failure.

    PubMed

    Masclans, J R; Pérez-Terán, P; Roca, O

    2015-11-01

    Acute respiratory failure represents one of the most common causes of intensive care unit admission and oxygen therapy remains the first-line therapy in the management of these patients. In recent years, high-flow oxygen via nasal cannula has been described as a useful alternative to conventional oxygen therapy in patients with acute respiratory failure. High-flow oxygen via nasal cannula rapidly alleviates symptoms of acute respiratory failure and improves oxygenation by several mechanisms, including dead space washout, reduction in oxygen dilution and inspiratory nasopharyngeal resistance, a moderate positive airway pressure effect that may generate alveolar recruitment and an overall greater tolerance and comfort with the interface and the heated and humidified inspired gases. However, the experience in adults is still limited and there are no clinical guidelines to establish recommendations for their use. This article aims to review the existing evidence on the use of high-flow oxygen via nasal cannula in adults with acute respiratory failure and its possible applications, advantages and limitations.

  15. Negative pressure wound therapy limits downgrowth in percutaneous devices

    PubMed Central

    Mitchell, Saranne J.; Jeyapalina, Sujee; Nichols, Francesca R.; Agarwal, Jayant; Bachus, Kent N.

    2016-01-01

    Maintenance of a soft tissue seal around percutaneous devices is challenged by the downgrowth of periprosthetic tissues—a gateway to potential infection. As negative pressure wound therapy (NPWT) is used clinically to facilitate healing of complex soft tissue pathologies, it was hypothesized that NPWT could limit downgrowth of periprosthetic tissues. To test this hypothesis, 20 hairless guinea pigs were randomly assigned into four groups (n = 5/group). Using a One-Stage (Groups 1 and 3) or a Two-Stage (Groups 2 and 4) surgical procedure, each animal was implanted with a titanium-alloy subdermal device porous-coated with commercially pure, medical grade titanium. Each subdermal device had a smooth titanium-alloy percutaneous post. The One-Stage procedure encompassed insertion of a fully assembled device during a single surgery. The Two-Stage procedure involved the implantation of a subdermal device during the first surgery, and then three weeks later, insertion of a percutaneous post. Groups 1 and 2 served as untreated controls and Groups 3 and 4 received NPWT. Four weeks postimplantation of the post, the devices and surrounding tissues were harvested, and histologically evaluated for downgrowth. Within the untreated control groups, the Two-Stage surgical procedure significantly decreased downgrowth (p = 0.027) when compared with the One-Stage procedure. Independent of the surgical procedures performed, NPWT significantly limited downgrowth (p ≤ 0.05) when compared with the untreated controls. PMID:26487170

  16. The fetal respiratory system as target for antenatal therapy

    PubMed Central

    Toelen, J.; Carlon, M.; Claus, F.; Gijsbers, R.; Sandaite, I.; Dierickx, K.; Devlieger, R.; Devriendt, K.; Debeer, A.; Proesmans, M.; Debyser, Z.; Deprest, A.J.

    2011-01-01

    The widespread use of prenatal ultrasound has made the fetus a patient. A number of conditions diagnosed as such may require therapy prior to birth. Herein we describe past, current and potential future procedures designed to treat pulmonary conditions in the antenatal period. When congenital cystic adenomatoid malformation (CCAM) is associated with fetal hydrops, treatment is required. Prior to viability this may be in utero resection of the pathologic lung lobe or shunting of cystic lesions. More recently, fetuses with isolated congenital diaphragmatic hernia (CDH) with lethal lung hypoplasia have been offered percutaneous fetal tracheal occlusion to provoke lung growth. A very rare condition is laryngeal atresia, which requires peripartum re-establishment of the airways. As we get more experience with access to the fetal airways, this may open the doors for novel therapies. One of these is gene delivery to treat fetuses with serious monogenic disorders or to induce transient overexpression of certain proteins. We review the individual hurdles that are being met by researchers when designing fetal gene therapeutic strategies, in particular for the fetal lung. Also the use of stem cells for pulmonary disorders is currently explored. PMID:24753844

  17. Acoustic and Cavitation Fields of Shock Wave Therapy Devices

    NASA Astrophysics Data System (ADS)

    Chitnis, Parag V.; Cleveland, Robin O.

    2006-05-01

    Extracorporeal shock wave therapy (ESWT) is considered a viable treatment modality for orthopedic ailments. Despite increasing clinical use, the mechanisms by which ESWT devices generate a therapeutic effect are not yet understood. The mechanistic differences in various devices and their efficacies might be dependent on their acoustic and cavitation outputs. We report acoustic and cavitation measurements of a number of different shock wave therapy devices. Two devices were electrohydraulic: one had a large reflector (HMT Ossatron) and the other was a hand-held source (HMT Evotron); the other device was a pneumatically driven device (EMS Swiss DolorClast Vet). Acoustic measurements were made using a fiber-optic probe hydrophone and a PVDF hydrophone. A dual passive cavitation detection system was used to monitor cavitation activity. Qualitative differences between these devices were also highlighted using a high-speed camera. We found that the Ossatron generated focused shock waves with a peak positive pressure around 40 MPa. The Evotron produced peak positive pressure around 20 MPa, however, its acoustic output appeared to be independent of the power setting of the device. The peak positive pressure from the DolorClast was about 5 MPa without a clear shock front. The DolorClast did not generate a focused acoustic field. Shadowgraph images show that the wave propagating from the DolorClast is planar and not focused in the vicinity of the hand-piece. All three devices produced measurable cavitation with a characteristic time (cavitation inception to bubble collapse) that varied between 95 and 209 μs for the Ossatron, between 59 and 283 μs for the Evotron, and between 195 and 431 μs for the DolorClast. The high-speed camera images show that the cavitation activity for the DolorClast is primarily restricted to the contact surface of the hand-piece. These data indicate that the devices studied here vary in acoustic and cavitation output, which may imply that the

  18. Home Healthcare Medical Devices: Infusion Therapy - Getting the Most Out of Your Pump

    MedlinePlus

    ... and Consumer Devices Brochure - Home Healthcare Medical Devices: Infusion Therapy - Getting the Most Out of Your Pump ... therapy. What do you do before using your infusion pump? Read your pump's Instructions for Use and ...

  19. Luminous fabric devices for wearable low-level light therapy

    PubMed Central

    Shen, Jing; Chui, Chunghin; Tao, Xiaoming

    2013-01-01

    In this paper, a flexible luminous fabric device was developed and investigated for wearable three-dimensionally fitted low-level light therapy. The fabric device exhibited excellent optical and thermal properties. Its optical power density and operating temperature were stable during usage for 10 hours. In vitro experiments demonstrated a significant increase in collagen production in human fibroblast irradiated by the fabric device, compared with the fibroblast without light irradiation. A series of tests were conducted for the safety of the fabric for human skin contact according to ISO standard ISO 10993-1:2003. The results showed that there was no potential hazard when the luminous fabrics were in direct contact with human skin. PMID:24409391

  20. Luminous fabric devices for wearable low-level light therapy.

    PubMed

    Shen, Jing; Chui, Chunghin; Tao, Xiaoming

    2013-01-01

    In this paper, a flexible luminous fabric device was developed and investigated for wearable three-dimensionally fitted low-level light therapy. The fabric device exhibited excellent optical and thermal properties. Its optical power density and operating temperature were stable during usage for 10 hours. In vitro experiments demonstrated a significant increase in collagen production in human fibroblast irradiated by the fabric device, compared with the fibroblast without light irradiation. A series of tests were conducted for the safety of the fabric for human skin contact according to ISO standard ISO 10993-1:2003. The results showed that there was no potential hazard when the luminous fabrics were in direct contact with human skin.

  1. Fiber bragg grating sensor based device for simultaneous measurement of respiratory and cardiac activities.

    PubMed

    Chethana, K; Guru Prasad, A S; Omkar, S N; Asokan, S

    2017-02-01

    This paper reports a novel optical ballistocardiography technique, which is non-invasive, for the simultaneous measurement of cardiac and respiratory activities using a Fiber Bragg Grating Heart Beat Device (FBGHBD). The unique design of FBGHBD offers additional capabilities such as monitoring nascent morphology of cardiac and breathing activity, heart rate variability, heart beat rhythm, etc., which can assist in early clinical diagnosis of many conditions associated with heart and lung malfunctioning. The results obtained from the FBGHBD positioned around the pulmonic area on the chest have been evaluated against an electronic stethoscope which detects and records sound pulses originated from the cardiac activity. In order to evaluate the performance of the FBGHBD, quantitative and qualitative studies have been carried out and the results are found to be reliable and accurate, validating its potential as a standalone medical diagnostic device. The developed FBGHBD is simple in design, robust, portable, EMI proof, shock proof and non-electric in its operation which are desired features for any clinical diagnostic tool used in hospital environment. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  2. Nasal High-Flow Therapy for Primary Respiratory Support in Preterm Infants.

    PubMed

    Roberts, Calum T; Owen, Louise S; Manley, Brett J; Frøisland, Dag H; Donath, Susan M; Dalziel, Kim M; Pritchard, Margo A; Cartwright, David W; Collins, Clare L; Malhotra, Atul; Davis, Peter G

    2016-09-22

    Background Treatment with nasal high-flow therapy has efficacy similar to that of nasal continuous positive airway pressure (CPAP) when used as postextubation support in neonates. The efficacy of high-flow therapy as the primary means of respiratory support for preterm infants with respiratory distress has not been proved. Methods In this international, multicenter, randomized, noninferiority trial, we assigned 564 preterm infants (gestational age, ≥28 weeks 0 days) with early respiratory distress who had not received surfactant replacement to treatment with either nasal high-flow therapy or nasal CPAP. The primary outcome was treatment failure within 72 hours after randomization. Noninferiority was determined by calculating the absolute difference in the risk of the primary outcome; the chosen margin of noninferiority was 10 percentage points. Infants in whom high-flow therapy failed could receive rescue CPAP; infants in whom CPAP failed were intubated and mechanically ventilated. Results Trial recruitment stopped early at the recommendation of the independent data and safety monitoring committee because of a significant difference in the primary outcome between treatment groups. Treatment failure occurred in 71 of 278 infants (25.5%) in the high-flow group and in 38 of 286 infants (13.3%) in the CPAP group (risk difference, 12.3 percentage points; 95% confidence interval [CI], 5.8 to 18.7; P<0.001). The rate of intubation within 72 hours did not differ significantly between the high-flow and CPAP groups (15.5% and 11.5%, respectively; risk difference, 3.9 percentage points; 95% CI, -1.7 to 9.6; P=0.17), nor did the rate of adverse events. Conclusions When used as primary support for preterm infants with respiratory distress, high-flow therapy resulted in a significantly higher rate of treatment failure than did CPAP. (Funded by the National Health and Medical Research Council and others; Australian New Zealand Clinical Trials Registry number, ACTRN

  3. Efficiency of different respiratory protective devices for removal of particulate and gaseous reactive oxygen species from welding fumes.

    PubMed

    Chen, Hsiu-Ling; Chung, Shih-Hsiang; Jhuo, Ming-Lin

    2013-01-01

    Ultraviolet (UV) light inherent to welding processes generates ozone (O(3)) with subsequent formation of reactive oxygen species (ROS) through photochemical reactions when UV light is present with O(3). This study aimed to determine the performance of filters used as respiratory protective devices by welding personnel to simultaneously mitigate particulate and gaseous inhalation hazards. Four respiratory protective devices were selected for this study, including a surgical facemask, a cotton-fabric facemask, an activated-carbon facemask, and an N95 respirator. The removal efficiencies for the particulates in welding fumes were all above 98%. For particulate-phase ROS, the removal efficiencies of the different respiratory protective devices ranged from 83.5% to 94.1%; however, the removal efficiencies for gaseous ROS were only 1.3% (active carbon facemask) to 21.1% (N95 respirator). The data indicated that the respiratory protective devices commercially available cannot block the passage of the gas-phase ROS found in welding fumes.

  4. Management of antithrombotic therapy in patients undergoing electrophysiological device surgery.

    PubMed

    Zacà, Valerio; Marcucci, Rossella; Parodi, Guido; Limbruno, Ugo; Notarstefano, Pasquale; Pieragnoli, Paolo; Di Cori, Andrea; Bongiorni, Maria Grazia; Casolo, Giancarlo

    2015-06-01

    The aim of this review is to formulate practical recommendations for the management of antithrombotic therapy in patients undergoing cardiac implantable electronic device (CIED) surgery by providing indications for a systematic approach to the problem integrating general technical considerations with patient-specific elements based on a careful evaluation of the balance between haemorrhagic and thromboembolic risk. Hundreds of thousands patients undergo implantation or replacement of CIEDs annually in Europe, and up to 50% of these subjects receive antiplatelet agents or oral anticoagulants. The rate of CIED-related complications, mainly infective, has also significantly increased so that transvenous lead extraction procedures are, consequently, often required. Cardiac implantable electronic device surgery is peculiar and portends specific intrinsic risks of developing potentially fatal haemorrhagic complications; on the other hand, the periprocedural suspension of antithrombotic therapy in patients with high thromboembolic risk cardiac conditions may have catastrophic consequences. Accordingly, the management of the candidate to CIED surgery receiving concomitant antithrombotic therapy is a topic of great clinical relevance yet controversial and only partially, if at all, adequately addressed in evidence-based current guidelines. In spite of the fact that in many procedures it seems reasonably safe to proceed with aspirin only or without interruption of anticoagulants, restricting to selected cases the use of bridging therapy with parenteral heparins, there are lots of variables that may make the therapeutic choices challenging. The decision-making process applied in this document relies on the development of a stratification of the procedural haemorrhagic risk and of the risk deriving from the suspension of antiplatelet or anticoagulant therapy combined to generate different clinical scenarios with specific indications for optimal management of periprocedural

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

    PubMed

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

    2014-04-01

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

  6. [Experience using the isocenter verification device in proton therapy equipment].

    PubMed

    Fuse, Hiraku; Sakae, Takeji; Terunuma, Toshiyuki; Kamizawa, Satoshi; Segawa, Tatsuya; Yoshimura, Yosuke; Yamanashi, Koichi; Sato, Masaru; Sakurai, Hideyuki

    2013-01-01

    In this study, we developed an isocenter verification device for use in proton therapy. Radiation and mechanical isocenters were verified for treatment equipment including room lasers, a digital radiography system and the beam axis of a rotational gantry. The special feature of this device is its ability to correlate the position of the three isocenters in one measurement and thus improve accuracy compared to the conventional method using three separate devices. The reproducibility of the method and the fluctuation of the position of the beam axis isocenter were both investigated using this device for almost a year. Monthly measurements of the isocenter position were acquired for two gantries and it was found that the fluctuation was +/- 0.10mm for the up-to-down direction and +/- 0.16mm for the right-to-left direction in Gantry 1 and was +/-0.14mm for the up-to-down direction and +/-0.18mm for the right-to-left direction in Gantry 2. We could be measured with a repeatability of +/-0.18 mm or less by using developed device for the relative positional relationship between each isocenters. Because we can confirm results in approximately 30 minutes, we can perform a quality control after a clinical practice.

  7. The acoustic fields of shock wave therapy devices

    NASA Astrophysics Data System (ADS)

    Cleveland, Robin O.; Chitnis, Parag V.

    2005-04-01

    We report measurements of a number of different shock wave therapy (SWT) devices. Two devices were electrohydraulic (EH): one had a large shock source (HMT Ossatron) and the other was a small hand-held source (HMT Evotron). The other device was a pneumatically driven device (EMS Swiss Dolorclast) and two different hand pieces were measured, one with an ``unfocused'' head and the other with a ``focused'' head. We found that the EH sources generated focused shock waves with a positive phase about 1 microsec long and peak pressure around 40 MPa, however, the acoustic output of the HMT Evotron appeared to be independent of the power setting of the machine. For the pneumatic source the duration of the positive phase was greater than 4 microsec and the peak pressure about 7 MPa. There was no clear shock front present and the waveform had a complex tail structure that was dependent on the power setting of the machine. We found that the focused hand-piece did not generate a focused acoustic field. The results are compared to reports of measurements from electromagnetic SWT devices. We contrast measurements made with different hydrophone systems: fiber-optic probe hydrophone, PVDF membrane hydrophone and PVDF bullet-shaped hydrophone.

  8. [Physical therapy performance in respiratory and motor involvement during postoperative in children submitted to abdominal surgeries].

    PubMed

    Santo, Caroline C; Gonçalves, Marcela T; Piccolo, Mariana M; Lima, Simone; Rosa, George J da; Paulin, Elaine; Schivinski, Camila S

    2011-01-01

    to verify the physiotherapy performance in the respiratory and motor affections during postoperative period in pediatric patients undergoing abdominal surgery. was a literature review of articles published in the databases Lilacs, Medline and SciELO in the period 1983 to 2010 as well as books, papers presented at scientific meetings and journals of the area, who approached the post-therapy of abdominal surgery in children. The keywords used were: abdominal surgery, children and physiotherapy. 28 articles, one book chapter and one dissertation had been selected that examined the question and proposed that contained all, or at least two of the descriptors listed. Most of the material included covers the incidence of respiratory complications after surgery for pediatric abdominal surgery due to immaturity of the respiratory system of this population, abdominal manipulation of surgical period, the prolonged time in bed, pain at the incision site and waste anesthetic. Some authors also discuss the musculoskeletal and connective tissue arising from the inaction and delay of psychomotor development consequent to periods of hospitalization in early childhood, taking on the role of physiotherapy to prevent motor and respiratory involvement. there are few publications addressing this topic, but the positive aspects of physiotherapy have been described, especially in relation to the prevention of respiratory complications and motor, recognized the constraints and consequences of hospitalizations and surgeries cause in children.

  9. A model for the evaluation of respiratory therapy program admissions criteria.

    PubMed

    Flanigan, K S

    1985-05-01

    Attrition in respiratory therapy programs is a waste of both human and economic resources and may be one cause of the current shortage of qualified personnel. Poor academic performance has been shown to be the leading cause of program attrition. The purposes of this study were to establish the predictive abilities of aptitude and performance measures for classroom and laboratory performance in a respiratory therapy program and to describe a methodology for the development of academic admissions criteria. The preprogram college cumulative grade point average (pPGPA), the preprogram science-mathematics grade point average (S-M GPA), the American College Test (ACT) composite, and four ACT subtest scores of 39 graduates of The Ohio State University Respiratory Therapy Division were compared to their program grade point average (PGPA). We applied a multiple regression analysis and derived regression equations. Multiple regression analysis demonstrated that the S-M GPA is the most significant predictor of program academic performance (P less than or equal to 0.05). The derived regression equation was applied to calculate the minimum S-M GPA for admission by using the standard error of the estimate (SEE) of the regression equation and the mean minimum acceptable PGPA at a 95% confidence interval. For those students who have met the minimum S-M GPA, we have experienced no academic attrition. Multiple regression analysis of student data and the derived regression equations may be used to determine program-specific admissions criteria.

  10. Simplified strategies to determine the mean respiratory position for liver radiation therapy planning.

    PubMed

    Velec, Michael; Moseley, Joanne L; Brock, Kristy K

    2014-01-01

    Establishing the time-weighted mean respiratory position in the liver is challenging due to poor tumor contrast on 4-dimensional (4D) imaging. The purpose of this study is to validate simplified strategies in determining the mean position of liver tumors for radiation therapy planning, and quantify the potential for planning target volume (PTV) reduction. Full, 10-phase 4D computed tomography (CT) data sets from 10 liver radiation therapy patients were analyzed to compare 2 techniques. First, a mid-ventilation CT was chosen from the initial reconstruction of the 4DCT. This was based on the minimum displacement of the diaphragm at each phase relative to its mean respiratory position, calculated using rigid registration over all 4DCT phases. Second, the exhale 4DCT was deformed to the inhale 4DCT using biomechanical-based deformable registration. The diaphragm's mean cranio-caudal position in the respiratory cycle (normalized as a percentage relative to exhale) was applied to the exhale-to-inhale deformation map assuming a linear trajectory to reconstruct a mid-position CT. These strategies were compared with the time-weighted mean respiratory position, calculated with deformable registration over all 10 4DCT phases. PTVs incorporating respiratory motion were then compared for 2 planning strategies: exhale 4DCT using the internal target volume (ITV), or mid-position CT using dose-probability margins. Compared with the mean respiratory tumor position, the mid-ventilation CT and mid-position CT had mean (maximum) tumor vector errors of 1.0 ± 0.5 (2.1) mm and 0.6 ± 0.3 (1.4) mm, respectively, within the image resolution. Compared with ITV-based PTV, dose-probability PTV reduced the irradiated volume by 34% ± 7% on average, up to 43%. Simplified strategies to select a mid-ventilation CT or reconstruct a mid-position CT for the liver were validated with respect to the mean respiratory position. These data sets require significantly smaller PTVs, potentially allowing

  11. The potential of methylxanthine-based therapies in pediatric respiratory tract diseases.

    PubMed

    Oñatibia-Astibia, Ainhoa; Martínez-Pinilla, Eva; Franco, Rafael

    2016-03-01

    Caffeine, theophylline and theobromine are the most known methylxanthines as they are present in coffee, tea and/or chocolate. In the last decades, a huge experimental effort has been devoted to get insight into the variety of actions that these compounds exert in humans. From such knowledge it is known that methylxanthines have a great potential in prevention, therapy and/or management of a variety of diseases. The benefits of methylxanthine-based therapies in the apnea of prematurity and their translational potential in pediatric affections of the respiratory tract are here presented.

  12. Hypoxaemic rescue therapies in acute respiratory distress syndrome: Why, when, what and which one?

    PubMed

    Hodgson, Carol; Carteaux, Guillaume; Tuxen, David V; Davies, Andrew R; Pellegrino, Vin; Capellier, Gilles; Cooper, David J; Nichol, Alistair

    2013-12-01

    Acute respiratory distress syndrome (ARDS) is an inflammatory condition of the lungs which can result in refractory and life-threatening hypoxaemic respiratory failure. The risk factors for the development of ARDS are many but include trauma, multiple blood transfusions, burns and major surgery, therefore this condition is not uncommon in the severely injured patient. When ARDS is severe, high-inspired oxygen concentrations are frequently required to minimise hypoxaemia. In these situations clinicians commonly utilise interventions termed 'hypoxaemic rescue therapies' in an attempt to improve oxygenation, as without these, conventional mechanical ventilation can be associated with high mortality. However, their lack of efficacy on mortality when used prophylactically in generalised ARDS cohorts has resulted in their use being confined to clinical trials and the subset of ARDS patients with refractory hypoxaemia. First line hypoxaemic rescue therapies include inhaled nitric oxide, prone positioning, alveolar recruitment manoeuvres and high frequency oscillatory ventilation, which have all been shown to be effective in improving oxygenation. In situations where these first line rescue therapies are inadequate extra-corporeal membrane oxygenation has emerged as a lifesaving second line rescue therapy. Rescue therapies in critically ill patients with traumatic injuries presents specific challenges and requires careful assessment of both the short and longer term benefits, therapeutic limitations, and specific adverse effects before their use. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Electrical stimulation therapy improves sleep respiratory parameters in obstructive sleep apnea syndrome: a meta-analysis.

    PubMed

    Tan, Jie-wen; Qi, Wei-wei; Ye, Rui-xin; Wu, Yuan-yuan

    2013-10-01

    Recent clinical trials have shown that electrical stimulation has beneficial effects in obstructive sleep apnea syndrome (OSAS). The purpose of this study was to evaluate the efficacy of electrical stimulation therapy for OSAS with a meta-analysis. The meta-analysis of all relative studies was performed through searching international literature, including PUBMED, CNKI, and EMBASE databases. This literature analysis compared all patients undergoing electrical stimulation therapy with respect to the respiratory disturbance index (RDI) and changes in sleep structure. Six studies were selected involving a total of 91 patients. The meta-analysis indicated that electrical stimulation therapy reduced RDI, longest apnea time, and improved the minimum SaO2. Based on the evidence found, electrical stimulation may be a potential therapy for OSAS, warranting further clinical trials.

  14. SU-E-T-439: Fundamental Verification of Respiratory-Gated Spot Scanning Proton Beam Therapy

    SciTech Connect

    Hamano, H; Yamakawa, T; Hayashi, N; Kato, H; Yasui, K

    2015-06-15

    Purpose: The spot-scanning proton beam irradiation with respiratory gating technique provides quite well dose distribution and requires both dosimetric and geometric verification prior to clinical implementation. The purpose of this study is to evaluate the impact of gating irradiation as a fundamental verification. Methods: We evaluated field width, flatness, symmetry, and penumbra in the gated and non-gated proton beams. The respiration motion was distinguished into 3 patterns: 10, 20, and 30 mm. We compared these contents between the gated and non-gated beams. A 200 MeV proton beam from PROBEAT-III unit (Hitachi Co.Ltd) was used in this study. Respiratory gating irradiation was performed by Quasar phantom (MODUS medical devices) with a combination of dedicated respiratory gating system (ANZAI Medical Corporation). For radiochromic film dosimetry, the calibration curve was created with Gafchromic EBT3 film (Ashland) on FilmQA Pro 2014 (Ashland) as film analysis software. Results: The film was calibrated at the middle of spread out Bragg peak in passive proton beam. The field width, flatness and penumbra in non-gated proton irradiation with respiratory motion were larger than those of reference beam without respiratory motion: the maximum errors of the field width, flatness and penumbra in respiratory motion of 30 mm were 1.75% and 40.3% and 39.7%, respectively. The errors of flatness and penumbra in gating beam (motion: 30 mm, gating rate: 25%) were 0.0% and 2.91%, respectively. The results of symmetry in all proton beams with gating technique were within 0.6%. Conclusion: The field width, flatness, symmetry and penumbra were improved with the gating technique in proton beam. The spot scanning proton beam with gating technique is feasible for the motioned target.

  15. [Inhaled treatments: Choice of devices, systemic absorption of inhaled drugs and bitter taste receptors in the respiratory tract].

    PubMed

    Benattia, A; Cavaillon, P; Gachelin, E; Devillier, P; Vecellio, L; Williams, G; Dubus, J-C

    2015-10-01

    Inhaled drugs are now routinely prescribed in daily medical practice. Recent topics about these treatments have been developed during the fourth annual meeting of the Groupe de travail aérosolthérapie (GAT) of the French-speaking respiratory society (Société de pneumologie de langue française). This article focuses mainly upon the choice of devices, systemic absorption of inhaled drugs and bitter taste receptors in the respiratory tract, a potential new target for drug development.

  16. Emerging medical devices for minimally invasive cell therapy.

    PubMed

    O'Cearbhaill, Eoin D; Ng, Kelvin S; Karp, Jeffrey M

    2014-02-01

    The past decade has seen the first wave of cell-based therapeutics undergo clinical trials with varying degrees of success. Although attention is increasingly focused on clinical trial design, owing to spiraling regulatory costs, tools used in delivering cells and sustaining the cells' viability and functions in vivo warrant careful scrutiny. While the clinical administration of cell-based therapeutics often requires additional safeguarding and targeted delivery compared with traditional therapeutics, there is significant opportunity for minimally invasive device-assisted cell therapy to provide the physician with new regenerative options at the point of care. Herein we detail exciting recent advances in medical devices that will aid in the safe and efficacious delivery of cell-based therapeutics.

  17. Nanocomplexes for gene therapy of respiratory diseases: Targeting and overcoming the mucus barrier.

    PubMed

    Di Gioia, Sante; Trapani, Adriana; Castellani, Stefano; Carbone, Annalucia; Belgiovine, Giuliana; Craparo, Emanuela Fabiola; Puglisi, Giovanni; Cavallaro, Gennara; Trapani, Giuseppe; Conese, Massimo

    2015-10-01

    Gene therapy, i.e. the delivery and expression of therapeutic genes, holds great promise for congenital and acquired respiratory diseases. Non-viral vectors are less toxic and immunogenic than viral vectors, although they are characterized by lower efficiency. However, they have to overcome many barriers, including inflammatory and immune mediators and cells. The respiratory and airway epithelial cells, the main target of these vectors, are coated with a layer of mucus, which hampers the effective reaching of gene therapy vectors carrying either plasmid DNA or small interfering RNA. This barrier is thicker in many lung diseases, such as cystic fibrosis. This review summarizes the most important advancements in the field of non-viral vectors that have been achieved with the use of nanoparticulate (NP) systems, composed either of polymers or lipids, in the lung gene delivery. In particular, different strategies of targeting of respiratory and airway lung cells will be described. Then, we will focus on the two approaches that attempt to overcome the mucus barrier: coating of the nanoparticulate system with poly(ethylene glycol) and treatment with mucolytics. Our conclusions are: 1) Ligand and physical targeting can direct therapeutic gene expression in specific cell types in the respiratory tract; 2) Mucopenetrating NPs are endowed with promising features to be useful in treating respiratory diseases and should be now advanced in pre-clinical trials. Finally, we discuss the development of such polymer- and lipid-based NPs in the context of in vitro and in vivo disease models, such as lung cancer, as well as in clinical trials.

  18. Perturbation of water-equivalent thickness as a surrogate for respiratory motion in proton therapy.

    PubMed

    Matney, Jason E; Park, Peter C; Li, Heng; Court, Laurence E; Zhu, X Ron; Dong, Lei; Liu, Wei; Mohan, Radhe

    2016-03-08

    Respiratory motion is traditionally assessed using tumor motion magnitude. In proton therapy, respiratory motion causes density variations along the beam path that result in uncertainties of proton range. This work has investigated the use of water-equivalent thickness (WET) to quantitatively assess the effects of respiratory motion on calculated dose in passively scattered proton therapy (PSPT). A cohort of 29 locally advanced non-small cell lung cancer patients treated with 87 PSPT treatment fields were selected for analysis. The variation in WET (ΔWET) along each field was calculated between exhale and inhale phases of the simulation four-dimensional computed tomography. The change in calculated dose (ΔDose) between full-inhale and full-exhale phase was quantified for each field using dose differences, 3D gamma analysis, and differential area under the curve (ΔAUC) analysis. Pearson correlation coefficients were calculated between ΔDose and ΔWET. Three PSPT plans were redesigned using field angles to minimize variations in ΔWET and compared to the original plans. The median ΔWET over 87 treatment fields ranged from 1-9 mm, while the ΔWET 95th percentile value ranged up to 42 mm. The ΔWET was significantly correlated (p < 0.001) to the ΔDose for all metrics analyzed. The patient plans that were redesigned using ΔWET analysis to select field angles were more robust to the effects of respiratory motion, as ΔAUC values were reduced by more than 60% in all three cases. The tumor motion magnitude alone does not capture the potential dosimetric error due to respiratory motion because the proton range is sensitive to the motion of all patient anatomy. The use of ΔWET has been demonstrated to identify situations where respiratory motion can impact the calculated dose. Angular analysis of ΔWET may be capable of designing radiotherapy plans that are more robust to the effects of respiratory motion.

  19. Perturbation of water-equivalent thickness as a surrogate for respiratory motion in proton therapy

    PubMed Central

    Matney, Jason E.; Park, Peter C.; Li, Heng; Court, Laurence E.; Zhu, X. Ron; Dong, Lei; Liu, Wei; Mohan, Radhe

    2017-01-01

    Respiratory motion is traditionally assessed using tumor motion magnitude. In proton therapy, respiratory motion causes density variations along the beam path that result in uncertainties of proton range. This work has investigated the use of water-equivalent thickness (WET) to quantitatively assess the effects of respiratory motion on calculated dose in passively scattered proton therapy (PSPT). A cohort of 29 locally advanced non-small cell lung cancer patients treated with 87 PSPT treatment fields were selected for analysis. The variation in WET (ΔWET) along each field was calculated between exhale and inhale phases of the simulation four-dimensional computed tomography. The change in calculated dose (ΔDose) between full-inhale and full-exhale phase was quantified for each field using dose differences, 3D gamma analysis, and differential area under the curve (ΔAUC) analysis. Pearson correlation coefficients were calculated between ΔDose and ΔWET. Three PSPT plans were redesigned using field angles to minimize variations in ΔWET and compared to the original plans. The median ΔWET over 87 treatment fields ranged from 1–9 mm, while the ΔWET 95th percentile value ranged up to 42 mm. The ΔWET was significantly correlated (p < 0.001) to the ΔDose for all metrics analyzed. The patient plans that were redesigned using ΔWET analysis to select field angles were more robust to the effects of respiratory motion, as ΔAUC values were reduced by more than 60% in all three cases. The tumor motion magnitude alone does not capture the potential dosimetric error due to respiratory motion because the proton range is sensitive to the motion of all patient anatomy. The use of ΔWET has been demonstrated to identify situations where respiratory motion can impact the calculated dose. Angular analysis of ΔWET may be capable of designing radiotherapy plans that are more robust to the effects of respiratory motion. PMID:27074459

  20. Traditional plant-based therapies for respiratory diseases found in North Jeolla Province, Korea.

    PubMed

    Kim, Hyun; Song, Mi-Jang

    2012-03-01

    This study aims to record and conserve orally transmitted traditional plant-based therapies for respiratory diseases in North Jeolla Province, Korea. Data were collected with semistructured questionnaires through the participatory rural appraisal method. This study reveals that overall, 14 respiratory diseases have been treated with a total of 43 species of medicinal plants belonging to 40 genera in 26 families. This study also reports 149 different modes of plant-based therapeutic application of medicinal material. The informant consensus factor for the common cold is 0.84, the highest among 14 different respiratory ailments, followed by whooping cough, asthma, nosebleed, bronchitis, cough, and so on. Medicinal plants used to treat seven respiratory ailments had a 100% fidelity level. This study can help to preserve the traditional knowledge and local health traditions of North Jeolla Province amid rapid industrialization and urbanization. The findings of this study warrant follow-up clinical research to determine the most effective traditional remedies toward development of herbal medicinal products for integration into the Korean health care system.

  1. Impact of respiratory therapy in vital capacity and functionality of patients undergoing abdominal surgery

    PubMed Central

    Fernandes, Shanlley Cristina da Silva; dos Santos, Rafaella Souza; Giovanetti, Erica Albanez; Taniguchi, Corinne; Silva, Cilene Saghabi de Medeiros; Eid, Raquel Afonso Caserta; Timenetsky, Karina Tavares; Carnieli-Cazati, Denise

    2016-01-01

    ABSTRACT Objective To evaluate the vital capacity after two chest therapy techniques in patients undergoing abdominal surgical. Methods A prospective randomized study carried out with patients admitted to the Intensive Care Unit after abdominal surgery. We checked vital capacity, muscular strength using the Medical Research Council scale, and functionality with the Functional Independence Measure the first time the patient was breathing spontaneously (D1), and also upon discharge from the Intensive Care Unit (Ddis). Between D1 and Ddis, respiratory therapy was carried out according to the randomized group. Results We included 38 patients, 20 randomized to Positive Intermittent Pressure Group and 18 to Volumetric Incentive Spirometer Group. There was no significant gain related to vital capacity of D1 and Ddis of Positive Intermittent Pressure Group (mean 1,410mL±547.2 versus 1,809mL±692.3; p=0.979), as in the Volumetric Incentive Spirometer Group (1,408.3mL±419.1 versus 1,838.8mL±621.3; p=0.889). We observed a significant improvement in vital capacity in D1 (p<0.001) and Ddis (p<0.001) and in the Functional Independence Measure (p<0.001) after respiratory therapy. The vital capacity improvement was not associated with gain of muscle strength. Conclusion Chest therapy, with positive pressure and volumetric incentive spirometer, was effective in improving vital capacity of patients submitted to abdominal surgery. PMID:27462894

  2. Dosimetric evaluation of the interplay effect in respiratory-gated RapidArc radiation therapy

    SciTech Connect

    Riley, Craig; Yang, Yong Li, Tianfang; Zhang, Yongqian; Heron, Dwight E.; Huq, M. Saiful

    2014-01-15

    Purpose: Volumetric modulated arc therapy (VMAT) with gating capability has had increasing adoption in many clinics in the United States. In this new technique, dose rate, gantry rotation speed, and the leaf motion speed of multileaf collimators (MLCs) are modulated dynamically during gated beam delivery to achieve highly conformal dose coverage of the target and normal tissue sparing. Compared with the traditional gated intensity-modulated radiation therapy technique, this complicated beam delivery technique may result in larger dose errors due to the intrafraction tumor motion. The purpose of this work is to evaluate the dosimetric influence of the interplay effect for the respiration-gated VMAT technique (RapidArc, Varian Medical Systems, Palo Alto, CA). Our work consisted of two parts: (1) Investigate the interplay effect for different target residual errors during gated RapidArc delivery using a one-dimensional moving phantom capable of producing stable sinusoidal movement; (2) Evaluate the dosimetric influence in ten clinical patients’ treatment plans using a moving phantom driven with a patient-specific respiratory curve. Methods: For the first part of this study, four plans were created with a spherical target for varying residual motion of 0.25, 0.5, 0.75, and 1.0 cm. Appropriate gating windows were applied for each. The dosimetric effect was evaluated using EDR2 film by comparing the gated delivery with static delivery. For the second part of the project, ten gated lung stereotactic body radiotherapy cases were selected and reoptimized to be delivered by the gated RapidArc technique. These plans were delivered to a phantom, and again the gated treatments were compared to static deliveries by the same methods. Results: For regular sinusoidal motion, the dose delivered to the target was not substantially affected by the gating windows when evaluated with the gamma statistics, suggesting the interplay effect has a small role in respiratory-gated Rapid

  3. Dosimetric evaluation of the interplay effect in respiratory-gated RapidArc radiation therapy

    SciTech Connect

    Riley, Craig; Yang, Yong Li, Tianfang; Zhang, Yongqian; Heron, Dwight E.; Huq, M. Saiful

    2014-01-15

    Purpose: Volumetric modulated arc therapy (VMAT) with gating capability has had increasing adoption in many clinics in the United States. In this new technique, dose rate, gantry rotation speed, and the leaf motion speed of multileaf collimators (MLCs) are modulated dynamically during gated beam delivery to achieve highly conformal dose coverage of the target and normal tissue sparing. Compared with the traditional gated intensity-modulated radiation therapy technique, this complicated beam delivery technique may result in larger dose errors due to the intrafraction tumor motion. The purpose of this work is to evaluate the dosimetric influence of the interplay effect for the respiration-gated VMAT technique (RapidArc, Varian Medical Systems, Palo Alto, CA). Our work consisted of two parts: (1) Investigate the interplay effect for different target residual errors during gated RapidArc delivery using a one-dimensional moving phantom capable of producing stable sinusoidal movement; (2) Evaluate the dosimetric influence in ten clinical patients’ treatment plans using a moving phantom driven with a patient-specific respiratory curve. Methods: For the first part of this study, four plans were created with a spherical target for varying residual motion of 0.25, 0.5, 0.75, and 1.0 cm. Appropriate gating windows were applied for each. The dosimetric effect was evaluated using EDR2 film by comparing the gated delivery with static delivery. For the second part of the project, ten gated lung stereotactic body radiotherapy cases were selected and reoptimized to be delivered by the gated RapidArc technique. These plans were delivered to a phantom, and again the gated treatments were compared to static deliveries by the same methods. Results: For regular sinusoidal motion, the dose delivered to the target was not substantially affected by the gating windows when evaluated with the gamma statistics, suggesting the interplay effect has a small role in respiratory-gated Rapid

  4. [Device-aided therapies in advanced Parkinson's disease].

    PubMed

    Timofeeva, A A

    2016-01-01

    Advanced stages of Parkinson's disease (PD) is a consequence of the severe neurodegenerative process and are characterized by the development of motor fluctuations and dyskinesia, aggravation of non-motor symptoms. Treatment with peroral and transdermal drugs can't provide an adequate control of PD symptoms and quality-of-life of the patients at this stage of disease. Currently, three device-aided therapies: deep brain stimulation (DBS), intrajejunal infusion of duodopa, subcutaneous infusion of apomorphine can be used in treatment of patients with advanced stages of PD. Timely administration of device-aided therapies and right choice of the method determine, to a large extent, the efficacy and safety of their use. Despite the high efficacy of all three methods with respect to the fluctuation of separate symptoms, each method has its own peculiarities. The authors reviewed the data on the expediency of using each method according to the severity of motor and non-motor symptoms, patient's age, PD duration, concomitant pathology and social support of the patients.

  5. SU-E-J-211: Design and Study of In-House Software Based Respiratory Motion Monitoring, Controlling and Breath-Hold Device for Gated Radiotherapy

    SciTech Connect

    Shanmugam, Senthilkumar

    2014-06-01

    Purpose: The purpose of this present work was to fabricate an in-house software based respiratory monitoring, controlling and breath-hold device using computer software programme which guides the patient to have uniform breath hold in response to request during the gated radiotherapy. Methods: The respiratory controlling device consists of a computer, inhouse software, video goggles, a highly sensitive sensor for measurement of distance, mounting systems, a camera, a respiratory signal device, a speaker and a visual indicator. The computer is used to display the respiratory movements of the patient with digital as well as analogue respiration indicators during the respiration cycle, to control, breath-hold and analyze the respiratory movement using indigenously developed software. Results: Studies were conducted with anthropomophic phantoms by simulating the respiratory motion on phantoms and recording the respective movements using the respiratory monitoring device. The results show good agreement between the simulated and measured movements. Further studies were conducted for 60 cancer patients with several types of cancers in the thoracic region. The respiratory movement cycles for each fraction of radiotherapy treatment were recorded and compared. Alarm indications are provided in the system to indicate when the patient breathing movement exceeds the threshold level. This will help the patient to maintain uniform breath hold during the radiotherapy treatment. Our preliminary clinical test results indicate that our device is highly reliable and able to maintain the uniform respiratory motion and breathe hold during the entire course of gated radiotherapy treatment. Conclusion: An indigenous respiratory monitoring device to guide the patient to have uniform breath hold device was fabricated. The alarm feature and the visual waveform indicator in the system guide the patient to have normal respiration. The signal from the device can be connected to the radiation

  6. Clinical review: Acute respiratory distress syndrome - clinical ventilator management and adjunct therapy.

    PubMed

    Silversides, Jonathan A; Ferguson, Niall D

    2013-04-29

    Acute respiratory distress syndrome (ARDS) is a potentially devastating form of acute inflammatory lung injury with a high short-term mortality rate and significant long-term consequences among survivors. Supportive care, principally with mechanical ventilation, remains the cornerstone of therapy - although the goals of this support have changed in recent years - from maintaining normal physiological parameters to avoiding ventilator-induced lung injury while providing adequate gas exchange. In this article we discuss the current evidence base for ventilatory support and adjunctive therapies in patients with ARDS. Key components of such a strategy include avoiding lung overdistension by limiting tidal volumes and airway pressures, and the use of positive end-expiratory pressure with or without lung recruitment manoeuvres in patients with severe ARDS. Adjunctive therapies discussed include pharmacologic techniques (for example, vasodilators, diuretics, neuromuscular blockade) and nonpharmacologic techniques (for example, prone position, alternative modes of ventilation).

  7. Nasal high-flow therapy for type II respiratory failure in COPD: A report of four cases.

    PubMed

    Pavlov, Ivan; Plamondon, Patrice; Delisle, Stéphane

    2017-01-01

    Herein we present a report of four cases of severe type II respiratory failure that had contraindications both to conventional non-invasive ventilation and to endotracheal intubation. In all four cases, we successfully used a high-flow nasal oxygen device as a rescue device, with very reassuring outcomes.

  8. Inspiratory muscle conditioning exercise and diaphragm gene therapy in Pompe disease: Clinical evidence of respiratory plasticity.

    PubMed

    Smith, Barbara K; Martin, A Daniel; Lawson, Lee Ann; Vernot, Valerie; Marcus, Jordan; Islam, Saleem; Shafi, Nadeem; Corti, Manuela; Collins, Shelley W; Byrne, Barry J

    2017-01-01

    Pompe disease is an inherited disorder due to a mutation in the gene that encodes acid α-glucosidase (GAA). Children with infantile-onset Pompe disease develop progressive hypotonic weakness and cardiopulmonary insufficiency that may eventually require mechanical ventilation (MV). Our team conducted a first in human trial of diaphragmatic gene therapy (AAV1-CMV-GAA) to treat respiratory neural dysfunction in infantile-onset Pompe. Subjects (aged 2-15years, full-time MV: n=5, partial/no MV: n=4) underwent a period of preoperative inspiratory muscle conditioning exercise. The change in respiratory function after exercise alone was compared to the change in function after intramuscular delivery of AAV1-CMV-GAA to the diaphragm with continued exercise. Since AAV-mediated gene therapy can reach phrenic motoneurons via retrograde transduction, we hypothesized that AAV1-CMV-GAA would improve dynamic respiratory motor function to a greater degree than exercise alone. Dependent measures were maximal inspiratory pressure (MIP), respiratory responses to inspiratory threshold loads (load compensation: LC), and physical evidence of diaphragm activity (descent on MRI, EMG activity). Exercise alone did not change function. After AAV1-CMV-GAA, MIP was unchanged. Flow and volume LC responses increased after dosing (p<0.05 to p<0.005), but only in the subjects with partial/no MV use. Changes in LC tended to occur on or after 180days. At Day 180, the four subjects with MRI evidence of diaphragm descent had greater maximal voluntary ventilation (p<0.05) and tended to be younger, stronger, and use fewer hours of daily MV. In conclusion, combined AAV1-CMV-GAA and exercise training conferred benefits to dynamic motor function of the diaphragm. Children with a higher baseline neuromuscular function may have greater potential for functional gains. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Challenges, priorities and novel therapies for hypoxemic respiratory failure and pulmonary hypertension in the neonate.

    PubMed

    Aschner, J L; Gien, J; Ambalavanan, N; Kinsella, J P; Konduri, G G; Lakshminrusimha, S; Saugstad, O D; Steinhorn, R H

    2016-06-01

    Future priorities for the management of hypoxemic respiratory failure (HRF) and pulmonary hypertension include primary prevention of neonatal lung diseases, 'precision medicine' and translating promising clinical and preclinical research into novel therapies. Promising areas of investigation include noninvasive ventilation strategies, emerging pulmonary vasodilators (for example, cinaciguat, intravenous bosentan, rho-kinase inhibitors, peroxisome proliferator-activated receptor-γ agonists) and hemodynamic support (arginine vasopressin). Research challenges include the optimal timing for primary prevention interventions and development of validated biomarkers that predict later disease or serve as surrogates for long-term respiratory outcomes. Differentiating respiratory disease endotypes using biomarkers and experimental therapies tailored to the underlying pathobiology are central to the concept of 'precision medicine' (that is, prevention and treatment strategies that take individual variability into account). The ideal biomarker should be expressed early in the neonatal course to offer an opportunity for effective and targeted interventions to modify outcomes. The feasibility of this approach will depend on the identification and validation of accurate, rapid and affordable point-of-care biomarker tests. Trials targeting patient-specific pathobiology may involve less risk than traditional randomized controlled trials that enroll all at-risk neonates. Such approaches would reduce trial costs, potentially with fewer negative trials and improved health outcomes. Initiatives such as the Prematurity and Respiratory Outcomes Program, supported by the National Heart, Lung, and Blood Institute, provide a framework to develop refined outcome measures and early biomarkers that will enhance our understanding of novel, mechanistic therapeutic targets that can be tested in clinical trials in neonates with HRF.

  10. Mechanical circulatory support devices as destination therapy-current evidence.

    PubMed

    Puehler, Thomas; Ensminger, Stephan; Schoenbrodt, Michael; Börgermann, Jochen; Rehn, Erik; Hakim-Meibodi, Kavous; Morshuis, Michiel; Gummert, Jan

    2014-09-01

    Advanced heart failure is an increasing problem worldwide. Nowadays, mechanical circulatory support devices (MSCD) are an established therapeutic option for terminal heart failure after exhaustion of medical and conventional surgical treatment, and are becoming a realistic alternative to heart transplantation (HTX). There are a number of different treatment options for these patients, such as bridge to transplantation (BTT), bridge to candidacy (BTC), bridge to recovery (BTR) and the destination therapy (DT) option. The latter option has become more frequent throughout the last years, due to a donor organ shortage and an increasing number of older patients with terminal heart failure who are not eligible for HTX. These factors have led to a rapidly increasing number of LVAD implantations as well as centers which perform these procedures. This has also been due to improved LVAD survival rates and quality of life following the introduction of smaller, intrapericardial and more durable continuous flow left ventricular devices. The most common complications for these patients are device-related problems, such as coagulation disorders, gastrointestinal bleeding, device related infection, pump thrombosis or cerebrovascular accidents. However, some questions still remain unanswered or under debate, such as the exact time-point for LVAD implantation. In addition, aspects such as better biocompatibility for LVADs remain a major challenge. This review will concentrate on DT for terminal heart failure and provide an overview of the current evidence for LVAD implantation in this patient group, with particular emphasis on indication and time-point of implantation, choice of LVADs, and long term outcomes and quality of life.

  11. Social marketing campaign promoting the use of respiratory protection devices among farmers.

    PubMed

    Pounds, Lea; Duysen, Ellen; Romberger, Debra; Cramer, Mary E; Wendl, Mary; Rautiainen, Risto

    2014-01-01

    This article describes the formal use of marketing concepts in a systematic approach to influence farmers to voluntarily increase respiratory protective device (RPD) use. The planning process for the project incorporated six key decision or action points, each informed by formative research or health behavior theory. The planning process included developing behavior change strategies based on a 4P model (product, price, place, and promotion). The resulting campaign elements included print and e-mail messages that leveraged motivators related to family and health in order to increase farmers' knowledge about the risks of exposure to dusty environments, four instructional videos related to the primary barriers identified in using RPDs, and a brightly colored storage bag to address barriers to using RPDs related to mask storage. Campaign implementation included a series of e-mails using a bulk e-mail subscription service, use of social media in the form of posting instructional videos on a YouTube channel, and in-person interactions with members of the target audience at farm shows throughout the Central States Center for Agricultural Safety and Health seven-state region. Evaluation of the e-mail campaigns indicated increased knowledge about RPD use and intent to use RPDs in dusty conditions. YouTube analytic data indicated continuing exposure of the instructional videos beyond the life of the campaign. The project demonstrates the efficacy of a planning process that incorporates formative research and clear decision points throughout. This process could be used to plan health behavior change interventions to address other agriculture-related health and safety issues.

  12. Enhancement of Aerosol Cisplatin Chemotherapy with Gene Therapy Expressing ABC10 protein in Respiratory System

    PubMed Central

    Hohenforst-Schmidt, Wolfgang; Zarogoulidis, Paul; Linsmeier, Bernd; Kioumis, Ioannis; Li, Qiang; Huang, Haidong; Sachpatzidou, Despoina; Lampaki, Sofia; Organtzis, John; Domvri, Kalliopi; Sakkas, Leonidas; Zachariadis, George A.; Archontas, Konstantinos N.; Kallianos, Anastasios; Rapti, Aggeliki; Yarmus, Lonny; Zarogoulidis, Konstantinos; Brachmann, Johannes

    2014-01-01

    Inhaled therapy for lung cancer is a local form of treatment. Currently inhaled non-specific cytotoxic agents have been evaluated as a future treatment for local disease control and distant metastasis control. There are few information regarding the influence of local transporters and gene expression of the respiratory epithelium to the absorption of administered drugs. In the current work we used adenoviral-type 5(dE1/E3) (Cytomegalovirus promoter) with human ABCA10 transgene (Ad-h-ABCA10) purchased from Vector Labs® in order to investigate whether gene therapy can be used as a pre-treatment to enhance the efficiency of inhaled cisplatin. We included the following groups to our work: a) control, b) aerosol vector, c) aerosol vector plus cisplatin, d) aerosol cisplatin, e) intratumoral cisplatin administration, f) intratumoral vector plus cisplatin administration. The results indicate that the aerosol cisplatin group had a long term survival with the intratumoral cisplatin group following. The enhancement of the ABCA family locally to the respiratory system prior to the aerosol cisplatin administration can be used safely and efficiently. Future treatment design of local therapies should include the investigation of local transporters and genes. PMID:24723977

  13. Respiratory muscle training with enzyme replacement therapy improves muscle strength in late - onset Pompe disease.

    PubMed

    Mitja, Jevnikar; Metka, Kodric; Fabiana, Cantarutti; Cifaldi, Rossella; Longo, Cinzia; Rossana, Della Porta; Bruno, Bembi; Marco, Confalonieri

    2015-12-01

    Pompe disease is an autosomal recessive metabolic disorder caused by the deficiency of the lysosomal enzyme acid α-glucosidase. This deficiency leads to glycogen accumulation in the lysosomes of muscle tissue causing progressive muscular weakness particularly of the respiratory system. Enzyme replacement therapy (ERT) has demonstrated efficacy in slowing down disease progression in infants. Despite the large number of studies describing the effects of physical training in juvenile and adult late onset Pompe disease (LOPD). There are very few reports that analyze the benefits of respiratory muscle rehabilitation or training. The effectiveness of respiratory muscle training was investigated using a specific appliance with adjustable resistance (Threshold). The primary endpoint was effect on respiratory muscular strength by measurements of MIP and MEP. Eight late-onset Pompe patients (aged 13 to 58 years; 4 female, 4 male) with respiratory muscle deficiency on functional respiratory tests were studied. All patients received ERT at the dosage of 20 mg/kg/every 2 weeks and underwent training with Threshold at specified pressures for 24 months. A significant increase in MIP was observed during the follow-up of 24 month: 39.6 cm H2O (+ 25.0%) at month 3; 39.5 cm H2O (+ 24.9%) at month 6; 39.1 cm H2O (+ 23.7%) at month 9; 37.3 cm H2O (+ 18.2%) at month 12; and 37.3 cm H2O (+ 17.8%) at month 24. Median MEP values also showed a significant increase during the first 9 months: 29.8 cm H2O, (+ 14.3%) at month 3; 31.0 cm H2O (+ 18.6) at month 6; and 29.5 cm H2O (+ 12.9) at month 9. MEP was then shown to be decreased at months 12 and 24; median MEP was 27.2 cm H2O (+ 4.3%) at 12 months and 26.6 cm H2O (+ 1.9%) at 24 months. The FVC remain stable throughout the study. An increase in respiratory muscular strength was demonstrated with Threshold training when used in combination with ERT.

  14. [Efficacy of new devices for behavior modification therapy for obesity].

    PubMed

    Ookuma, K

    2001-03-01

    In the treatment of obesity, the behavior modification therapy has aimed at maintaining weight reduction by reforming wrong daily habitual eating behavior which leads obesity. However, a distorted cognitive pattern or a deviated physical lies behind the problematic eating behavior. In that aspect, we have developed new devices as belows. The ingestive behavioral questionnaire discloses problematic eating behavior and its related cognitive and sensational pattern at an early stage of the treatment. The charting of daily weight pattern is convenient for both therapist and patient himself to visually look out an actual ingestive pattern and reinforces maintenance of weight reduction by long term self-monitoring. The chewing chart recording is useful for the recovery of physical satiety sensation, and prevents over eating.

  15. The cardiovascular, respiratory, and metabolic effects of a long duration electronic control device exposure in human volunteers.

    PubMed

    Dawes, Donald M; Ho, Jeffrey D; Reardon, Robert F; Miner, James R

    2010-12-01

    Electronic control devices (ECD) have become popular in law enforcement because they have filled a gap left by other law enforcement devices, tactics, or tools and have been shown to reduce officer and suspect injuries. Civilians are using the same technology for defensive purposes. TASER C2 is the latest generation civilian-marketed device from the manufacturer. Unlike the law enforcement devices, the device discharges for 30 s continuously. This study is the first to look at the cardiovascular, respiratory, and metabolic effects of this device on human subjects. This was a prospective, observational study of human subjects involved in a training course. Subjects were exposed for 30 s on the anterior thorax. Vital signs, ECG, troponin I, pH, lactate, and creatine kinase (CK) were measured before and immediately after the exposure. Troponin I, pH, lactate, and CK were measured again 24 h after the exposure. Continuous spirometry was used to evaluate the respiratory effects. Echocardiography was also performed before, during, and immediately after the exposure to determine heart rate and rhythm. Eleven subjects completed the study. There were no clinically important electrocardiogram changes and no positive troponins. Spirometry showed an increase in minute ventilation during the exposure. There was no important change in CK at 24 h. Lactate was slightly higher and pH was slightly lower after the exposure, but similar to the effects of physical exertion. Echocardiography was performed in 6 subjects. In half of these subjects, the rhythm was determined to be "sinus" and in the other half the rhythm was indeterminant. In our study, the civilian device caused a mild lactic acidosis. No other important physiologic effects were found.

  16. Microsphere interaction with non-Newtonian solid-supported films to model respiratory therapies

    NASA Astrophysics Data System (ADS)

    Lee, Nathan; Ally, Javed; Kappl, Michael; Butt, Hans-Jürgen

    2012-10-01

    Films used as lubricants and particle filters interact with microspheres. One example of a biological particle filter is the mucus lining the human respiratory system. In the conducting airways of the respiratory tract, a 10 μm thick layer of mucus sits on top of a periciliary layer. These cilia sweep the mucus towards the nose and mouth whereby debris, such as dust and bacteria that are trapped by the mucus layer, may be expelled from the body. Mucus, like other biofluids, can be modeled after a non-Newtonian fluid due to their viscoelastic properties. Interactions between particles and non-Newtonian thin films have not been widely characterized. Atomic force microscopy (AFM) is an ideal technique due to its ability to measure in the microNewtown and micrometer scale. The AFM setup also allows for calculation of the force from direct contact of the particle with the film. Data from these experiments may further the development aerosol-based respiratory therapies. Factors such as particle size and approach speed are necessary to determine improved parameters for drug deposition and retention. It is the goal of this study to analyze interaction forces between particles and non-Newtonian solid-supported films.

  17. Acute tropical pulmonary eosinophilia. Characterization of the lower respiratory tract inflammation and its response to therapy.

    PubMed Central

    Pinkston, P; Vijayan, V K; Nutman, T B; Rom, W N; O'Donnell, K M; Cornelius, M J; Kumaraswami, V; Ferrans, V J; Takemura, T; Yenokida, G

    1987-01-01

    Although acute tropical pulmonary eosinophilia (TPE) is well recognized as a manifestation of filarial infection, the processes that mediate the abnormalities of the lung in TPE are unknown. To evaluate the hypothesis that the derangements of the lower respiratory tract in this disorder are mediated by inflammatory cells in the local milieu, we utilized bronchoalveolar lavage to evaluate affected individuals before and after therapy. Inflammatory cells recovered from the lower respiratory tract of individuals with acute, untreated TPE (n = 8) revealed a striking eosinophilic alveolitis, with marked elevations in both the proportion of eosinophils (TPE 54 +/- 5%; normal 2 +/- 5%; P less than 0.001) and the concentration of eosinophils in the recovered epithelial lining fluid (ELF) (TPE 63 +/- 20 X 10(3)/microliter; normal 0.3 +/- 0.1 X 10(3)/microliter; P less than 0.01). Importantly, when individuals (n = 5) with acute TPE were treated with diethylcarbamazine (DEC), there was a marked decrease of the lung eosinophils and concomitant increase in lung function. These observations are consistent with the concept that at least some of the abnormalities found in the lung in acute TPE are mediated by an eosinophil-dominated inflammatory process in the lower respiratory tract. Images PMID:3298321

  18. [Respiratory disorders in preterm and term neonates: an update on diagnostics and therapy].

    PubMed

    Gortner, L; Tutdibi, E

    2011-08-01

    Respiratory disorders remain a major problem in postnatal adaptation. In term neonates, an increased incidence of the risk for transient tachypnoea of the neonate has been observed during the past decade, most likely secondary to an increased usage of primary Caesarean section. The disorder is mainly caused by a delayed resorption of foetal lung fluid. Further disorders in term neonates include meconium aspiration syndrome and congenital diaphragmatic hernia leading to impaired gas exchange and pulmonary hypertension. In preterm neonates, respiratory distress syndrome is the main disorder leading to severe acute and long-term impaired gas exchange. Prenatal administration of glucocorticoids and postnatal surfactant therapy remains an established principle in perinatal care for very preterm neonates. The most relevant long-term sequelae, bronchopulmonary dysplasia, is currently being observed in about 15% of preterms with less than 32 weeks of gestation and is associated with severe pulmonary and extrapulmonary consequences. Due to the overall improvement in perinatal care, respiratory disorders still remain a major problem in pulmonary adaptation. However, mortality secondary to neonatal lung failure has been decreased substantially by the improvements in the whole field of perinatal medicine.

  19. Gastrointestinal Traits: Individualizing Therapy for Obesity with Drugs and Devices

    PubMed Central

    Camilleri, Michael; Acosta, Andres

    2015-01-01

    Objectives The objectives were to review the discrepancy between numbers of people requiring weight loss treatment and results, and to assess the potential effects of pharmacological treatments (recently approved for obesity) and endoscopically deployed devices on quantitative gastrointestinal traits in development for obesity treatment. Methods We conducted a review of relevant literature to achieve our objectives. Results The 2013 guidelines increased the number of adults recommended for weight loss treatment by 20.9% (116.0 million to 140.2 million). There is an imbalance between efficacy and costs of commercial weight loss programs and drug therapy (average weight loss ~5 kg). The number of bariatric procedures performed in the United States has doubled in the past decade. The efficacy of bariatric surgery is attributed to reduction in the volume of the stomach, nutrient malabsorption with some types of surgery, increased postprandial incretin responses, and activation of farnesoid X receptor mechanisms. These gastrointestinal and behavioral traits identify sub-phenotypes of obesity based on recent research. Conclusions The mechanisms or traits targeted by drug and device treatments include centrally mediated alterations of appetite or satiation, diversion of nutrients, and alteration of stomach capacity, gastric emptying, or incretin hormones. Future treatment may be individualized based on quantitative gastrointestinal and behavioral traits measured in obese patients. PMID:26271184

  20. Gastrointestinal traits: individualizing therapy for obesity with drugs and devices.

    PubMed

    Camilleri, Michael; Acosta, Andres

    2016-01-01

    The aims of this article were to review the discrepancy between numbers of people requiring weight loss treatment and results and to assess the potential effects of pharmacologic treatments (recently approved for obesity) and endoscopically deployed devices on quantitative GI traits in development for obesity treatment. We conducted a review of relevant literature to achieve our objectives. The 2013 guidelines increased the number of adults recommended for weight loss treatment by 20.9% (116.0 million to 140.2 million). There is an imbalance between efficacy and costs of commercial weight loss programs and drug therapy (average weight loss about 5 kg). The number of bariatric procedures performed in the United States has doubled in the past decade. The efficacy of bariatric surgery is attributed to reduction in the volume of the stomach, nutrient malabsorption with some types of surgery, increased postprandial incretin responses, and activation of farnesoid X receptor mechanisms. These GI and behavioral traits identify sub-phenotypes of obesity, based on recent research. The mechanisms or traits targeted by drug and device treatments include centrally mediated alterations of appetite or satiation, diversion of nutrients, and alteration of stomach capacity, gastric emptying, or incretin hormones. Future treatment may be individualized based on quantitative GI and behavioral traits measured in obese patients. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  1. Acoustic field of a ballistic shock wave therapy device.

    PubMed

    Cleveland, Robin O; Chitnis, Parag V; McClure, Scott R

    2007-08-01

    Shock wave therapy (SWT) refers to the use of focused shock waves for treatment of musculoskeletal indications including plantar fascitis and dystrophic mineralization of tendons and joint capsules. Measurements were made of a SWT device that uses a ballistic source. The ballistic source consists of a handpiece within which compressed air (1-4 bar) is used to fire a projectile that strikes a metal applicator placed on the skin. The projectile generates stress waves in the applicator that transmit as pressure waves into tissue. The acoustic fields from two applicators were measured: one applicator was 15 mm in diameter and the surface slightly convex and the second was 12 mm in diameter the surface was concave. Measurements were made in a water tank and both applicators generated a similar pressure pulse consisting of a rectangular positive phase (4 micros duration and up to 8 MPa peak pressure) followed by a predominantly negative tail (duration of 20 micros and peak negative pressure of -6 MPa), with many oscillations. The rise times of the waveforms were around 1 micros and were shown to be too long for the pulses to be considered shock waves. Measurements of the field indicated that region of high pressure was restricted to the near-field (20-40 mm) of the source and was consistent with the Rayleigh distance. The measured acoustic field did not display focusing supported by calculations, which demonstrated that the radius of curvature of the concave surface was too large to effect a focusing gain. Other SWT devices use electrohydraulic, electromagnetic and piezoelectric sources that do result in focused shock waves. This difference in the acoustic fields means there is potentially a significant mechanistic difference between a ballistic source and other SWT devices.

  2. Detecting cavitation in vivo from shock-wave therapy devices

    NASA Astrophysics Data System (ADS)

    Matula, Thomas J.; Yu, Jinfei; Bailey, Michael R.

    2005-04-01

    Extracorporeal shock-wave therapy (ESWT) has been used as a treatment for plantar faciitis, lateral epicondylitis, shoulder tendonitis, non-unions, and other indications where conservative treatments have been unsuccessful. However, in many areas, the efficacy of SW treatment has not been well established, and the mechanism of action, particularly the role of cavitation, is not well understood. Research indicates cavitation plays an important role in other ultrasound therapies, such as lithotripsy and focused ultrasound surgery, and in some instances, cavitation has been used as a means to monitor or detect a biological effect. Although ESWT can generate cavitation easily in vitro, it is unknown whether or not cavitation is a significant factor in vivo. The purpose of this investigation is to use diagnostic ultrasound to detect and monitor cavitation generated by ESWT devices in vivo. Diagnostic images are collected at various times during and after treatment. The images are then post-processed with image-processing algorithms to enhance the contrast between bubbles and surrounding tissue. The ultimate goal of this research is to utilize cavitation as a means for optimizing shock wave parameters such as amplitude and pulse repetition frequency. [Work supported by APL internal funds and NIH DK43881 and DK55674.

  3. Immediate effect of manual therapy on respiratory functions and inspiratory muscle strength in patients with COPD

    PubMed Central

    Yilmaz Yelvar, Gul Deniz; Çirak, Yasemin; Demir, Yasemin Parlak; Dalkilinç, Murat; Bozkurt, Bülent

    2016-01-01

    Objective The objective of this study was to investigate the immediate effect of manual therapy (MT) on respiratory functions and inspiratory muscle strength in patients with COPD. Participants and methods Thirty patients with severe COPD (eight females and 22 males; mean age 62.4±6.8 years) referred to pulmonary physiotherapy were included in this study. The patients participated in a single session of MT to measure the short-term effects. The lung function was measured using a portable spirometer. An electronic pressure transducer was used to measure respiratory muscle strength. Heart rate, breathing frequency, and oxygen saturation were measured with a pulse oximeter. For fatigue and dyspnea perception, the modified Borg rating of perceived exertion scale was used. All measurements were taken before and immediately after the first MT session. The ease-of-breathing visual analog scale was used for rating patients’ symptoms subjectively during the MT session. Results There was a significant improvement in the forced expiratory volume in the first second, forced vital capacity, and vital capacity values (P<0.05). The maximal inspiratory pressure and maximal expiratory pressure values increased significantly after MT, compared to the pre-MT session (P<0.05). There was a significant decrease in heart rate, respiratory rate (P<0.05), and dyspnea and fatigue perception (P<0.05). Conclusion A single MT session immediately improved pulmonary function, inspiratory muscle strength, and oxygen saturation and reduced dyspnea, fatigue, and heart and respiratory rates in patients with severe COPD. MT should be added to pulmonary rehabilitation treatment as a new alternative that is fast acting and motivating in patients with COPD. PMID:27382271

  4. Respiratory rate estimation from the oscillometric waveform obtained from a non-invasive cuff-based blood pressure device.

    PubMed

    Pimentel, M A F; Santos, M D; Arteta, C; Domingos, J S; Maraci, M A; Clifford, G D

    2014-01-01

    The presence of respiratory activity in the electrocardiogram (ECG), the pulse oximeter's photoplethysmo-graphic and continuous arterial blood pressure signals is a well-documented phenomenon. In this paper, we demonstrate that such information is also present in the oscillometric signal acquired from automatic non-invasive blood pressure monitors, and may be used to estimate the vital sign respiratory rate (RR). We propose a novel method that combines the information from the two respiratory-induced variations (frequency and amplitude) via frequency analysis to both estimate RR and eliminate estimations considered to be unreliable because of poor signal quality. The method was evaluated using data acquired from 40 subjects containing ECG, respiration and blood pressure waveforms, the latter acquired using an in-house built blood pressure device that is able to connect to a mobile phone. Results demonstrated a good RR estimation accuracy of our method when compared to the reference values extracted from the reference respiration waveforms (mean absolute error of 2.69 breaths/min), which is comparable to existing methods in the literature that extract RR from other physiological signals. The proposed method has been implemented in Java on the Android device for use in an mHealth platform.

  5. [Cerebral blood flow assessment of preterm infants during respiratory therapy with the expiratory flow increase technique].

    PubMed

    Bassani, Mariana Almada; Caldas, Jamil Pedro Siqueira; Netto, Abimael Aranha; Marba, Sérgio Tadeu Martins

    2016-06-01

    To assess the impact of respiratory therapy with the expiratory flow increase technique on cerebral hemodynamics of premature newborns. This is an intervention study, which included 40 preterm infants (≤34 weeks) aged 8-15 days of life, clinically stable in ambient air or oxygen catheter use. Children with heart defects, diagnosis of brain lesion and/or those using vasoactive drugs were excluded. Ultrasonographic assessments with transcranial Doppler flowmetry were performed before, during and after the increase in expiratory flow session, which lasted 5minutes. Cerebral blood flow velocity and resistance and pulsatility indices in the pericallosal artery were assessed. Respiratory physical therapy did not significantly alter flow velocity at the systolic peak (p=0.50), the end diastolic flow velocity (p=0.17), the mean flow velocity (p=0.07), the resistance index (p=0.41) and the pulsatility index (p=0.67) over time. The expiratory flow increase technique did not affect cerebral blood flow in clinically-stable preterm infants. Copyright © 2015 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

  6. Cerebral blood flow assessment of preterm infants during respiratory therapy with the expiratory flow increase technique

    PubMed Central

    Bassani, Mariana Almada; Caldas, Jamil Pedro Siqueira; Netto, Abimael Aranha; Marba, Sérgio Tadeu Martins

    2016-01-01

    Abstract Objective: To assess the impact of respiratory therapy with the expiratory flow increase technique on cerebral hemodynamics of premature newborns. Methods: This is an intervention study, which included 40 preterm infants (≤34 weeks) aged 8-15 days of life, clinically stable in ambient air or oxygen catheter use. Children with heart defects, diagnosis of brain lesion and/or those using vasoactive drugs were excluded. Ultrasonographic assessments with transcranial Doppler flowmetry were performed before, during and after the increase in expiratory flow session, which lasted 5min. Cerebral blood flow velocity and resistance and pulsatility indices in the pericallosal artery were assessed. Results: Respiratory physical therapy did not significantly alter flow velocity at the systolic peak (p=0.50), the end diastolic flow velocity (p=0.17), the mean flow velocity (p=0.07), the resistance index (p=0.41) and the pulsatility index (p=0.67) over time. Conclusions: The expiratory flow increase technique did not affect cerebral blood flow in clinically-stable preterm infants. PMID:26611888

  7. Insight into team competence in medical, nursing and respiratory therapy students.

    PubMed

    Sigalet, Elaine L; Donnon, Tyrone L; Grant, Vincent

    2015-01-01

    This study provides information for educators about levels of competence in teams comprised of medical, nursing and respiratory therapy students after receiving a simulation-based team-training (SBT) curriculum with and without an additional formalized 30-min team-training (TT) module. A two-group pre- and post-test research design was used to evaluate team competence with respect to leadership, roles and responsibilities, communication, situation awareness and resource utilization. All scenarios were digitally recorded and evaluated using the KidSIM Team Performance Scale by six experts from medicine, nursing and respiratory therapy. The lowest scores occurred for items that reflected situation awareness. All teams improved their aggregate scores from Time 1 to Time 2 (p < 0.05). Student teams in the intervention group achieved significantly higher performance scores at Time 1 (Cohen's d = 0.92, p < 0.001) and Time 2 (d = 0.61, p < 0.01). All student teams demonstrated significant improvement in their ability to work more effectively by Time 2. The results suggest that situational awareness is an advanced expectation for the undergraduate student team. The provision of a formalized TT module prior to engaging student teams in a simulation-based TT curriculum led to significantly higher performances at Time 1 and 2.

  8. Intravenous vitamin C as adjunctive therapy for enterovirus/rhinovirus induced acute respiratory distress syndrome.

    PubMed

    Fowler Iii, Alpha A; Kim, Christin; Lepler, Lawrence; Malhotra, Rajiv; Debesa, Orlando; Natarajan, Ramesh; Fisher, Bernard J; Syed, Aamer; DeWilde, Christine; Priday, Anna; Kasirajan, Vigneshwar

    2017-02-04

    We report a case of virus-induced acute respiratory distress syndrome (ARDS) treated with parenteral vitamin C in a patient testing positive for enterovirus/rhinovirus on viral screening. This report outlines the first use of high dose intravenous vitamin C as an interventional therapy for ARDS, resulting from enterovirus/rhinovirus respiratory infection. From very significant preclinical research performed at Virginia Commonwealth University with vitamin C and with the very positive results of a previously performed phase I safety trial infusing high dose vitamin C intravenously into patients with severe sepsis, we reasoned that infusing identical dosing to a patient with ARDS from viral infection would be therapeutic. We report here the case of a 20-year-old, previously healthy, female who contracted respiratory enterovirus/rhinovirus infection that led to acute lung injury and rapidly to ARDS. She contracted the infection in central Italy while on an 8-d spring break from college. During a return flight to the United States, she developed increasing dyspnea and hypoxemia that rapidly developed into acute lung injury that led to ARDS. When support with mechanical ventilation failed, extracorporeal membrane oxygenation (ECMO) was initiated. Twelve hours following ECMO initiation, high dose intravenous vitamin C was begun. The patient's recovery was rapid. ECMO and mechanical ventilation were discontinued by day-7 and the patient recovered with no long-term ARDS sequelae. Infusing high dose intravenous vitamin C into this patient with virus-induced ARDS was associated with rapid resolution of lung injury with no evidence of post-ARDS fibroproliferative sequelae. Intravenous vitamin C as a treatment for ARDS may open a new era of therapy for ARDS from many causes.

  9. Intravenous vitamin C as adjunctive therapy for enterovirus/rhinovirus induced acute respiratory distress syndrome

    PubMed Central

    Fowler III, Alpha A; Kim, Christin; Lepler, Lawrence; Malhotra, Rajiv; Debesa, Orlando; Natarajan, Ramesh; Fisher, Bernard J; Syed, Aamer; DeWilde, Christine; Priday, Anna; Kasirajan, Vigneshwar

    2017-01-01

    We report a case of virus-induced acute respiratory distress syndrome (ARDS) treated with parenteral vitamin C in a patient testing positive for enterovirus/rhinovirus on viral screening. This report outlines the first use of high dose intravenous vitamin C as an interventional therapy for ARDS, resulting from enterovirus/rhinovirus respiratory infection. From very significant preclinical research performed at Virginia Commonwealth University with vitamin C and with the very positive results of a previously performed phase I safety trial infusing high dose vitamin C intravenously into patients with severe sepsis, we reasoned that infusing identical dosing to a patient with ARDS from viral infection would be therapeutic. We report here the case of a 20-year-old, previously healthy, female who contracted respiratory enterovirus/rhinovirus infection that led to acute lung injury and rapidly to ARDS. She contracted the infection in central Italy while on an 8-d spring break from college. During a return flight to the United States, she developed increasing dyspnea and hypoxemia that rapidly developed into acute lung injury that led to ARDS. When support with mechanical ventilation failed, extracorporeal membrane oxygenation (ECMO) was initiated. Twelve hours following ECMO initiation, high dose intravenous vitamin C was begun. The patient’s recovery was rapid. ECMO and mechanical ventilation were discontinued by day-7 and the patient recovered with no long-term ARDS sequelae. Infusing high dose intravenous vitamin C into this patient with virus-induced ARDS was associated with rapid resolution of lung injury with no evidence of post-ARDS fibroproliferative sequelae. Intravenous vitamin C as a treatment for ARDS may open a new era of therapy for ARDS from many causes. PMID:28224112

  10. Life-threatening critical respiratory events: a retrospective study of postoperative patients found unresponsive during analgesic therapy.

    PubMed

    Ramachandran, Satya Krishna; Haider, Naeem; Saran, Kelly A; Mathis, Michael; Kim, Joyce; Morris, Michelle; O'Reilly, Michael

    2011-05-01

    To identify risk factors for life-threatening critical respiratory events occurring during parenteral analgesic therapy for acute postoperative pain. Retrospective, observational, cohort study. University hospital. The electronic records of patients with sudden-onset, life-threatening critical respiratory events during analgesic therapy for postoperative pain were studied. Critical respiratory event data were identified from the hospital risk management database between 8/1/2000 and 7/31//2007. Patients required rescue treatment with naloxone, endototracheal intubation, or cardiopulmonary resusucitation. Pediatric patients were excluded from the study. In addition to the event description (type of analgesia, opioid dose, patient monitoring data, time of day, and time from surgery), each patient's record was reviewed to extract co-morbidities and outcome data. Over the 6-year period, 32 patients experienced a postoperative critical respiratory event. Twenty-six events and three deaths occurred within the first 24 hours of opioid therapy. Four of 32 patients died. Congestive heart failure, postoperative acute renal failure, obstructive sleep apnea, cardiac dysrhythmia, diabetes mellitus, coronary artery disease, and hypertension were significant associations in adult patients. The first 24 hours after commencing opioid-based analgesic therapy represents a high risk period. Obstructive sleep apnea, deep levels of sedation, nocturnal presentation, and postoperative acute renal failure were seen in patients who died as a result of these critical respiratory events. Copyright © 2011 Elsevier Inc. All rights reserved.

  11. [Anaesthetic management in left ventricular assist device implantation as destination therapy: Our first experience].

    PubMed

    del Barrio Gómez, E; Rodríguez, J M; Martínez, S; García, E; Vargas, M C; Sastre, J A

    2016-03-01

    Left ventricular assist devices have emerged as one of the main therapies of advanced cardiac failure due the increase of this disease and lack of organ supply for cardiac transplantation. The anaesthetic management is described on a patient without cardiac transplantation criteria. The device was successfully implanted as a destination therapy.

  12. Muscle activity of leg muscles during unipedal stance on therapy devices with different stability properties.

    PubMed

    Wolburg, Thomas; Rapp, Walter; Rieger, Jochen; Horstmann, Thomas

    2016-01-01

    To test the hypotheses that less stable therapy devices require greater muscle activity and that lower leg muscles will have greater increases in muscle activity with less stable therapy devices than upper leg muscles. Cross-sectional laboratory study. Laboratory setting. Twenty-five healthy subjects. Electromyographic activity of four lower (gastrocnemius medialis, soleus, tibialis anterior, peroneus longus) and four upper leg muscles (vastus medialis and lateralis, biceps femoris, semitendinosus) during unipedal quiet barefoot stance on the dominant leg on a flat rigid surface and on five therapy devices with varying stability properties. Muscle activity during unipedal stance differed significantly between therapy devices (P < 0.001). The order from lowest to highest relative muscle activity matched the order from most to least stable therapy device. There was no significant interaction between muscle location (lower versus upper leg) and therapy device (P = 0.985). Magnitudes of additional relative muscle activity for the respective therapy devices differed substantially among lower extremity muscles. The therapy devices offer a progressive increase in training intensity, and thus may be useful for incremental training programs in physiotherapeutic practice and sports training programs. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. SU-F-I-15: Evaluation of a New MR-Compatible Respiratory Motion Device at 3T

    SciTech Connect

    Soliman, A; Chugh, B; Keller, B; Sahgal, A; Song, W

    2016-06-15

    Purpose: Recent advances in MRI-guided radiotherapy has inspired the development of MRI-compatible motion devices that simulate patient periodic motion in the scanner, particularly respiratory motion. Most commercial devices rely on non MR-safe ferromagnetic stepper motors which are not practical for regular QA testing. This work evaluates the motion performance of a new fully MRI compatible respiratory motion device at 3T. Methods: The QUASAR™ MRI-compatible respiratory motion phantom has been recently developed by Modus QA Inc., London, ON, Canada. The prototype is constructed from diamagnetic materials with linear motion generated using MRI-compatible piezoelectric motors that can be safely inserted in the scanner bore. The tumor was represented by a fillable sphere and is attached to the linear motion generator. The spherical tumor-representative and its surroundings were filled with different concentrations of MnCl2 to produce realistic relaxation times. The motion was generated along the longitudinal (H/F) axis of the bore using sinusoidal reference waveform (amplitude = 15 mm, frequency 0.25 Hz). Imaging was then performed on 3T Philips Achieva using a 32-channel cardiac coil. Fast 2D spoiled gradient-echo was used with a spatial resolution of 1.8 × 1.8 mm{sup 2} and slice thickness of 4 mm. The motion waveform was then measured on the resultant image series by tracking the centroid of the sphere through the time series. This image-derived measured motion was compared to the software-generated reference waveform. Results: No visible distortions from the device were observed on the images. Excellent agreement between the measured and the reference waveforms were obtained. Negligible motion was observed in the lateral (R/L) direction. Conclusion: Our investigation demonstrates that this piezo-electric motor design is effective at simulating periodic motion and is a potential candidate for MRI-radiotherapy respiratory motion simulation. Future work should

  14. SU-E-T-651: Quantification of Dosimetric Accuracy of Respiratory Gated Stereotactic Body Radiation Therapy

    SciTech Connect

    Thiyagarajan, Rajesh; Vikraman, S; Maragathaveni, S; Dhivya, N; Kataria, Tejinder; Nambiraj, N Arunai; Sigamani, Ashokkumar; Sinha, Sujit Nath; Yadav, Girigesh; Raman, Kothanda

    2015-06-15

    Purpose: To quantify the dosimetric accuracy of respiratory gated stereotactic body radiation therapy delivery using dynamic thorax phantom. Methods: Three patients with mobile target (2 lung, 1liver) were chosen. Retrospective 4DCT image sets were acquired for using Varian RPM system. An in-house MATLAB program was designed for MIP, MinIP and AvgIP generation. ITV was contoured on MIP image set for lung patients and on MinIP for liver patient. Dynamic IMRT plans were generated on selected phase bin image set in Eclipse (v10.0) planning system. CIRS dynamic thorax phantom was used to perform the dosimetric quality assurance. Patient breathing pattern file from RPM system was converted to phantom compatible file by an in-house MATLAB program. This respiratory pattern fed to the CIRS dynamic thorax phantom. 4DCT image set was acquired for this phantom using patient breathing pattern. Verification plans were generated using patient gating window and delivered on the phantom. Measurements were carried out using with ion chamber and EBT2 film. Exposed films were analyzed and evaluated in FilmQA software. Results: The stability of gated output in comparison with un-gated output was within 0.5%. The Ion chamber measured and TPS calculated dose compared for all the patients. The difference observed was 0.45%, −0.52% and −0.54 for Patient 1, Patient2 and Patient 3 respectively.Gamma value evaluated from EBT film shows pass rates from 92.41% to 99.93% for 3% dose difference and 3mm distance to agreement criteria. Conclusion: Dosimetric accuracy of respiratory gated SBRT delivery for lung and liver was dosimetrically acceptable. The Ion chamber measured dose was within 0.203±0.5659% of the expected dose. Gamma pass rates were within 96.63±3.84% of the expected dose.

  15. Improved growth and clinical, nutritional, and respiratory changes in response to nutritional therapy in cystic fibrosis.

    PubMed

    Shepherd, R; Cooksley, W G; Cooke, W D

    1980-09-01

    To investigate the role of nutritional factors in growth and in the clinical, nurtitional, and respiratory status in cystic fibrosis, we studied 12 problem CF patients from six months before to six months after a period of supplemental parenteral nutrition. During the initial six months' observation period on appropriate conventional therapy, the patients (aged 0.5 to 11 years) had inadequate growth and weight gain, a total of 21 active pulmonary infections, and, despite dietary supplements, inadequate ad libitum nutrient intakes. After nutritional therapy, providing a balanced consistent hypercaloric intake for 21 days, catch-up weight gain occurred by one month and continued at six months; catch-up in linear growth was observed by three months and continued at six months. In addition, significantly fewer pulmonary infections were observed in the six months' post-therapy (n = 3), sustained and significant improvements were noted in clinical score and plumonary function, and there was a marked improvement in well-being and ad libitum nutrient intake. We conclude that adequate nutritional support can favorably affect growth, clinical status, and the course of chronic pulmonary disease in problem cases of CF.

  16. Mississippi Curriculum Framework for Respiratory Care Technology Programs (CIP: 51.0908--Respiratory Therapy Technology). Postsecondary Programs.

    ERIC Educational Resources Information Center

    Mississippi Research and Curriculum Unit for Vocational and Technical Education, State College.

    This document, which is intended for use by community and junior colleges throughout Mississippi, contains curriculum frameworks for the course sequences in the respiratory care technology program. Presented in the introductory section are a description of the program and suggested course sequence. Section I lists baseline competencies, and…

  17. Intravenous Vitamin C Administered as Adjunctive Therapy for Recurrent Acute Respiratory Distress Syndrome

    PubMed Central

    Bharara, Amit; Grossman, Catherine; Syed, Aamer; DeWilde, Christine

    2016-01-01

    This case report summarizes the first use of intravenous vitamin C employed as an adjunctive interventional agent in the therapy of recurrent acute respiratory distress syndrome (ARDS). The two episodes of ARDS occurred in a young female patient with Cronkhite-Canada syndrome, a rare, sporadically occurring, noninherited disorder that is characterized by extensive gastrointestinal polyposis and malabsorption. Prior to the episodes of sepsis, the patient was receiving nutrition via chronic hyperalimentation administered through a long-standing central venous catheter. The patient became recurrently septic with Gram positive cocci which led to two instances of ARDS. This report describes the broad-based general critical care of a septic patient with acute respiratory failure that includes fluid resuscitation, broad-spectrum antibiotics, and vasopressor support. Intravenous vitamin C infused at 50 mg per kilogram body weight every 6 hours for 96 hours was incorporated as an adjunctive agent in the care of this patient. Vitamin C when used as a parenteral agent in high doses acts “pleiotropically” to attenuate proinflammatory mediator expression, to improve alveolar fluid clearance, and to act as an antioxidant. PMID:27891260

  18. Plasticizers, antioxidants, and other contaminants found in air delivered by PVC tubing used in respiratory therapy.

    PubMed

    Hill, Sandra S; Shaw, Brenda R; Wu, Alan H B

    2003-06-01

    Of the many compounds that leach from respiratory therapy tubing into air passing through it, we selected five compounds to analyze. The five compounds are known to be potentially carcinogenic, toxic or known to induce estrogenic activity. Parts-per-million and parts-per-billion concentrations of these species were found in the air passing through the tubing: the plasticizers di-(2-ethylhexyl) phthalate (DEHP) and di-ethyl phthalate (DEP), the antioxidants butylated hydroxy toluene (BHT) and p-nonylphenol (p-NP), and the contaminant (from commercial preparation of DEHP) 2-ethylhexanol (2-EH). These levels are high enough to cause some concern about exposure for patients who use oxygen on a long-term basis, those sensitive or allergic to these species, or those with asthma. A method was developed for analysis of solid tubing samples, showing great variability in concentrations of small, volatile molecules from sample to sample. A method was also developed for pre-concentration of small molecules onto Tenax adsorbants from air passing through the tubing. Both solid samples and adsorbant loaded with analyte were analyzed by direct dynamic thermal desorption gas chromatography mass spectrometry (GCMS). This study does not imply that adverse reactions by patients to chemical compounds leaching from respiratory medical tubing will occur but that further investigation is warranted.

  19. [Surfactant and ambroxol in the therapy of idiopathic respiratory syndrome in newborn infants].

    PubMed

    Carrera, G; Liberatore, A; Riboni, G; Clementi, M

    1991-11-01

    The Authors have carried out a study on 30 newborns, affected by idiopathic respiratory distress syndrome (IRDS), divided into 3 statistically comparable groups, treated, in addition to mechanical ventilation, respectively with Tokio-Akita (TA) surfactant, placebo (both by endotracheal administration) and ambroxol given by intravenous infusion. The clinical evolution of the three groups was studied, above all as related to mortality, ventilation length, oxygen need, immediate and successive pulmonary complications and cerebral haemorrhage. Mortality was lower in the group treated with ambroxol, while the ventilation length, the average insufflation pressure and the oxygen need were lower in the group treated with surfactant, compared with the other two groups. Pulmonary complications were present only in the group treated with placebo and ambroxol, whereas cerebral haemorrhage rate is higher in the group treated with surfactant. On the basis of the results achieved, some important observations are suggested and possible aetiological therapies of IRDS are formulated.

  20. Analysis of left atrial respiratory and cardiac motion for cardiac ablation therapy

    NASA Astrophysics Data System (ADS)

    Rettmann, M. E.; Holmes, D. R.; Johnson, S. B.; Lehmann, H. I.; Robb, R. A.; Packer, D. L.

    2015-03-01

    Cardiac ablation therapy is often guided by models built from preoperative computed tomography (CT) or magnetic resonance imaging (MRI) scans. One of the challenges in guiding a procedure from a preoperative model is properly synching the preoperative models with cardiac and respiratory motion through computational motion models. In this paper, we describe a methodology for evaluating cardiac and respiratory motion in the left atrium and pulmonary veins of a beating canine heart. Cardiac catheters were used to place metal clips within and near the pulmonary veins and left atrial appendage under fluoroscopic and ultrasound guidance and a contrast-enhanced, 64-slice multidetector CT scan was collected with the clips in place. Each clip was segmented from the CT scan at each of the five phases of the cardiac cycle at both end-inspiration and end-expiration. The centroid of each segmented clip was computed and used to evaluate both cardiac and respiratory motion of the left atrium. A total of three canine studies were completed, with 4 clips analyzed in the first study, 5 clips in the second study, and 2 clips in the third study. Mean respiratory displacement was 0.2+/-1.8 mm in the medial/lateral direction, 4.7+/-4.4 mm in the anterior/posterior direction (moving anterior on inspiration), and 9.0+/-5.0 mm superior/inferior (moving inferior with inspiration). At end inspiration, the mean left atrial cardiac motion at the clip locations was 1.5+/-1.3 mm in the medial/lateral direction, and 2.1+/-2.0 mm in the anterior/posterior and 1.3+/-1.2 mm superior/inferior directions. At end expiration, the mean left atrial cardiac motion at the clip locations was 2.0+/-1.5mm in the medial/lateral direction, 3.0+/-1.8mm in the anterior/posterior direction, and 1.5+/-1.5 mm in the superior/inferior directions.

  1. Calculation and Prediction of the Effect of Respiratory Motion on Whole Breast Radiation Therapy Dose Distributions

    SciTech Connect

    Cao Junsheng; Roeske, John C.; Chmura, Steve J.; Salama, Joseph K.; Shoushtari, Asal N.; Boyer, Arthur L.; Martel, Mary K.

    2009-07-01

    The standard treatment technique used for whole-breast irradiation can result in undesirable dose distributions in the treatment site, leading to skin reaction/fibrosis and pulmonary and cardiac toxicities. Hence, the technique has evolved from conventional wedged technique (CWT) to segment intensity-modulated radiation therapy (SIMRT) and beamlet IMRT (IMRT). However, these newer techniques feature more highly modulated dose distributions that may be affected by respiration. The purpose of this work was to conduct a simple study of the clinical impact of respiratory motion on breast radiotherapy dose distributions for the three treatment planning techniques. The ultimate goal was to determine which patients would benefit most from the use of motion management. Eight patients with early-stage breast cancer underwent a free-breathing (FB) computed tomography (CT) simulation, with medial and lateral markers placed on the skin. Two additional CT scans were obtained at the end of inspiration (EI) and the end of expiration (EE). The FB-CT scan was used to develop treatment plans using each technique. Each plan was then applied to EI and EE-CT scans. Compared with the FB CT scan, the medial markers moved up to 1.8 cm in the anterior-superior direction at the end of inspiration (EI-scan), and on average 8 mm. The CWT and SIMRT techniques were not 'sensitive' to respiratory motion, because the % clinical target volume (CTV) receiving 95% of the prescription dose (V{sub 95%}) remained constant for both techniques. For patients that had large respiratory motion indicated by marker movement >0.6 cm, differences in coverage of the CTV at the V100% between FB and EI for beamlet IMRT plans were on the order of >10% and up to 18%. A linear model was developed to relate the dosimetric coverage difference introduced by respiration with the motion information. With this model, the dosimetric coverage difference introduced by respiratory motion could be evaluated during patient CT

  2. Respiratory gating based on internal electromagnetic motion monitoring during stereotactic liver radiation therapy: First results.

    PubMed

    Poulsen, Per Rugaard; Worm, Esben Schjødt; Hansen, Rune; Larsen, Lars Peter; Grau, Cai; Høyer, Morten

    2015-01-01

    Intrafraction motion may compromise the target dose in stereotactic body radiation therapy (SBRT) of tumors in the liver. Respiratory gating can improve the treatment delivery, but gating based on an external surrogate signal may be inaccurate. This is the first paper reporting on respiratory gating based on internal electromagnetic monitoring during liver SBRT. Two patients with solitary liver metastases were treated with respiratory-gated SBRT guided by three implanted electromagnetic transponders. The treatment was delivered in end-exhale with beam-on when the centroid of the three transponders deviated less than 3 mm [left-right (LR) and anterior-posterior (AP) directions] and 4mm [cranio-caudal (CC)] from the planned position. For each treatment fraction, log files were used to determine the transponder motion during beam-on in the actual gated treatments and in simulated treatments without gating. The motion was used to reconstruct the dose to the clinical target volume (CTV) with and without gating. The reduction in D95 (minimum dose to 95% of the CTV) relative to the plan was calculated for both treatment courses. With gating the maximum course mean (standard deviation) geometrical error in any direction was 1.2 mm (1.8 mm). Without gating the course mean error would mainly increase for Patient 1 [to -2.8 mm (1.6 mm) (LR), 7.1 mm (5.8 mm) (CC), -2.6 mm (2.8mm) (AP)] due to a large systematic cranial baseline drift at each fraction. The errors without gating increased only slightly for Patient 2. The reduction in CTV D95 was 0.5% (gating) and 12.1% (non-gating) for Patient 1 and 0.3% (gating) and 1.7% (non-gating) for Patient 2. The mean duty cycle was 55%. Respiratory gating based on internal electromagnetic motion monitoring was performed for two liver SBRT patients. The gating added robustness to the dose delivery and ensured a high CTV dose even in the presence of large intrafraction motion.

  3. Dose verification for respiratory-gated volumetric modulated arc therapy (VMAT)

    PubMed Central

    Qian, Jianguo; Xing, Lei; Liu, Wu; Luxton, Gary

    2011-01-01

    A novel commercial medical linac system (TrueBeam™, Varian Medical Systems, Palo Alto, CA) allows respiratory-gated volumetric modulated arc therapy (VMAT), a new modality for treating moving tumors with high precision and improved accuracy by allowing for regular motion associated with a patient's breathing during VMAT delivery. The purpose of this work is to adapt a previously-developed dose reconstruction technique to evaluate the fidelity of VMAT treatment during gated delivery under clinic-relevant periodic motion related to patient breathing. A Varian TrueBeam system was used in this study. VMAT plans were created for three patients with lung or pancreas tumors. Conventional 6 MV and 15 MV beams with flattening filter and high dose-rate 10 MV beams with no flattening filter were used in these plans. Each patient plan was delivered to a phantom first without gating and then with gating for three simulated respiratory periods (3, 4.5 and 6 seconds). Using the adapted log file-based dose reconstruction procedure supplemented with ion chamber array (Seven29™, PTW, Freiburg, Germany) measurements, the delivered dose was used to evaluate the fidelity of gated VMAT delivery. Comparison of Seven29 measurements with and without gating showed good agreement with gamma-index passing rates above 99% for 1%/1mm dose accuracy/distance-to-agreement criteria. With original plans as reference, gamma-index passing rates were 100% for the reconstituted plans (1%/1 mm criteria) and 93.5–100% for gated Seven29 measurements (3%/3 mm criteria). In the presence of leaf error deliberately introduced into the gated delivery of a pancreas patient plan, both dose reconstruction and Seven29 measurement consistently indicated substantial dosimetric differences from the original plan. In summary, a dose reconstruction procedure was demonstrated for evaluating the accuracy of respiratory-gated VMAT delivery. This technique showed that under clinical operation, the TrueBeam system

  4. Medicare and Medicaid programs: schedules of guidelines for physical therapy and respiratory therapy services--Health Care Financing Administration. Final notice with a request for comments.

    PubMed

    1981-02-25

    This notice amends the current schedules of salary equivalency guidelines for Medicare program reimbursement for the reasonable costs of physical therapy and respiratory therapy services furnished under an arrangement with a hospital or other provider. The schedules will be used by the program's fiscal intermediaries to determine the maximum allowable cost of such services. These schedules update the schedule published on October 6, 1978 (43 FR 46377), for physical therapy services, and those published on June 3, 1980 (45 FR 37527), for respiratory therapy services. In addition, these guidelines apply to reimbursement under the Medicaid program where they have been incorporated in the State plans or where States follow the Medicare principles of reimbursement.

  5. Continuous positive airway pressure therapy for infants with respiratory distress in non tertiary care centers: a randomized, controlled trial.

    PubMed

    Buckmaster, Adam G; Arnolda, Gaston; Wright, Ian M R; Foster, Jann P; Henderson-Smart, David J

    2007-09-01

    Our objective was to determine whether continuous positive airway pressure therapy would safely reduce the need for up-transfer of infants with respiratory distress from nontertiary centers. We randomly assigned 300 infants at >30 weeks of gestation with respiratory distress to receive either Hudson prong bubble continuous positive airway pressure therapy or headbox oxygen treatment (standard care). The primary end point was "up-transfer or treatment failure." Secondary end points included death, length of nursery stay, time receiving oxygen therapy, cost of care, and other measures of morbidity. Of 151 infants who received continuous positive airway pressure therapy, 35 either were up-transferred or experienced treatment failure, as did 60 of the 149 infants given headbox oxygen treatment. There was no difference in the length of stay or the duration of oxygen treatment. For every 6 infants treated with continuous positive airway pressure therapy, there was an estimated cost saving of $10,000. Pneumothorax was identified for 14 infants in the continuous positive airway pressure group and 5 in the headbox group. There was no difference in any other measure of morbidity or death. Hudson prong bubble continuous positive airway pressure therapy reduces the need for up-transfer of infants with respiratory distress in nontertiary centers. There is a clinically relevant but not statistically significant increase in the risk of pneumothorax. There are significant benefits associated with continuous positive airway pressure use in larger nontertiary centers.

  6. A Community-Based Approach to Developing a Mobile Device for Measuring Ambient Air Exposure, Location, and Respiratory Health

    SciTech Connect

    Rohlman, Diana; Syron, Laura; Hobbie, Kevin; Anderson, Kim A.; Scaffidi, Christopher; Sudakin, Daniel; Peterson, Elena S.; Waters, Katrina M.; Haynes, Erin; Arkin, Lisa; Feezel, Paul; Kincl, Laurel

    2015-08-15

    In west Eugene (Oregon), community research indicates residents are disproportionately exposed to industrial air pollution and exhibit increased asthma incidence. In Carroll County (Ohio), recent increases in unconventional natural gas drilling sparked air quality concerns. These community concerns led to the development of a prototype mobile device to measure personal chemical exposure, location, and respiratory function. Working directly with the environmental justice (EJ) communities, the prototype was developed to (1) meet the needs of the community and; (2) evaluate the use in EJ communities. The prototype was evaluated in 3 community focus groups (n=25) to obtain feedback on the prototype and feasibility study design to evaluate the efficacy of the device to address community concerns. Focus groups were recorded and qualitatively analyzed with discrete feedback tabulated for further refinement. The prototype was improved by community feedback resulting in 8 alterations/additions to software and instructional materials. Overall, focus group participants were supportive of the device and believed it would be a useful environmental health tool. The use of focus groups ensured that community members were engaged in the research design and development of a novel environmental health tool. We found that community-based research strategies resulted in a refined device as well as relevant research questions, specific to the EJ community needs and concerns.

  7. A Community-Based Approach to Developing a Mobile Device for Measuring Ambient Air Exposure, Location, and Respiratory Health

    DOE PAGES

    Rohlman, Diana; Syron, Laura; Hobbie, Kevin; ...

    2015-08-15

    In west Eugene (Oregon), community research indicates residents are disproportionately exposed to industrial air pollution and exhibit increased asthma incidence. In Carroll County (Ohio), recent increases in unconventional natural gas drilling sparked air quality concerns. These community concerns led to the development of a prototype mobile device to measure personal chemical exposure, location, and respiratory function. Working directly with the environmental justice (EJ) communities, the prototype was developed to (1) meet the needs of the community and; (2) evaluate the use in EJ communities. The prototype was evaluated in 3 community focus groups (n=25) to obtain feedback on the prototypemore » and feasibility study design to evaluate the efficacy of the device to address community concerns. Focus groups were recorded and qualitatively analyzed with discrete feedback tabulated for further refinement. The prototype was improved by community feedback resulting in 8 alterations/additions to software and instructional materials. Overall, focus group participants were supportive of the device and believed it would be a useful environmental health tool. The use of focus groups ensured that community members were engaged in the research design and development of a novel environmental health tool. We found that community-based research strategies resulted in a refined device as well as relevant research questions, specific to the EJ community needs and concerns.« less

  8. Mammalian-derived respiratory allergens - implications for diagnosis and therapy of individuals allergic to furry animals.

    PubMed

    Nilsson, Ola B; van Hage, Marianne; Grönlund, Hans

    2014-03-01

    Furry animals cause respiratory allergies in a significant proportion of the population. A majority of all mammalian allergens are spread as airborne particles, and several have been detected in environments where furry animals are not normally kept. The repertoire of allergens from each source belongs to a restricted number of allergen families. Classification of allergen families is particularly important for the characterization of allergenicity and cross-reactivity of allergens. In fact, major mammalian allergens are taken from only three protein families, i.e. the secretoglobin, lipocalin and kallikrein families. In particular, the lipocalin superfamily harbours major allergens in all important mammalian allergen sources, and cross-reactivity between lipocalin allergens may explain cross-species sensitization between mammals. The identification of single allergen components is of importance to improve diagnosis and therapy of allergic patients using component-resolved diagnostics and allergen-specific immunotherapy (ASIT) respectively. Major disadvantages with crude allergen extracts for these applications emphasize the benefits of careful characterization of individual allergens. Furthermore, detailed knowledge of the characteristics of an allergen is crucial to formulate attenuated allergy vaccines, e.g. hypoallergens. The diverse repertoires of individual allergens from different mammalian species influence the diagnostic potential and clinical efficacy of ASIT to furry animals. As such, detailed knowledge of individual allergens is essential for adequate clinical evaluation. This review compiles current knowledge of the allergen families of mammalian species, and discusses how this information may be used for improved diagnosis and therapy of individuals allergic to mammals.

  9. NEW APPLICATION OF PASSIVE SAMPLING DEVICES FOR ASSESSMENT OF RESPIRATORY EXPOSURE TO PESTICIDES IN INDOOR AIR

    EPA Science Inventory

    The United States Environmental Protection Agency (EPA) has long maintained an interest in potential applications of passive sampling devices (PSDs) for estimating the concentrations of various pollutants in air. Typically PSDs were designed for the workplace monitoring of vola...

  10. Method and devices for performing stereotactic microbeam radiation therapy

    DOEpatents

    Dilmanian, F. Avraham

    2010-01-05

    A radiation delivery system generally includes either a synchrotron source or a support frame and a plurality of microbeam delivery devices supported on the support frame, both to deliver a beam in a hemispherical arrangement. Each of the microbeam delivery devices or synchrotron irradiation ports is adapted to deliver at least one microbeam of radiation along a microbeam delivery axis, wherein the microbeam delivery axes of the plurality of microbeam delivery devices cross within a common target volume.

  11. Comparison of performance of three different types of respiratory protection devices.

    PubMed

    Lawrence, Robert B; Duling, Matthew G; Calvert, Catherine A; Coffey, Christopher C

    2006-09-01

    Respiratory protection is offered to American workers in a variety of ways to guard against potential inhalation hazards. Two of the most common ways are elastomeric N95 respirators and N95 filtering-facepiece respirators. Some in the health care industry feel that surgical masks provide an acceptable level of protection in certain situations against particular hazards. This study compared the performance of these types of respiratory protection during a simulated workplace test that measured both filter penetration and face-seal leakage. A panel of 25 test subjects with varying face sizes tested 15 models of elastomeric N95 respirators, 15 models of N95 filtering-facepiece respirators, and 6 models of surgical masks. Simulated workplace testing was conducted using a TSI PORTACOUNT Plus model 8020, and consisted of a series of seven exercises. Six simulated workplace tests were performed with redonning of the respirator/mask occurring between each test. The results of these tests produced a simulated workplace protection factor (SWPF). The geometric mean (GM) and the 5th percentile values of the SWPFs were computed by category of respiratory protection using the six overall SWPF values. The level of protection provided by each of the three respiratory protection types was compared. The GM and 5th percentile SWPF values without fit testing were used for the comparison, as surgical masks were not intended to be fit tested. The GM values were 36 for elastomeric N95 respirators, 21 for N95 filtering-facepiece respirators, and 3 for surgical masks. An analysis of variance demonstrated a statistically significant difference between all three. Elastomeric N95 respirators had the highest 5th percentile SWPF of 7. N95 filtering-facepiece respirators and surgical masks had 5th percentile SWPFs of 3 and 1, respectively. A Fisher Exact Test revealed that the 5th percentile SWPFs for all three types of respiratory protection were statistically different. In addition, both

  12. Respiratory rates measured by a standardised clinical approach, ward staff, and a wireless device.

    PubMed

    Granholm, A; Pedersen, N E; Lippert, A; Petersen, L F; Rasmussen, L S

    2016-11-01

    Respiratory rate is among the first vital signs to change in deteriorating patients. The aim was to investigate the agreement between respiratory rate measurements by three different methods. This prospective observational study included acutely admitted adult patients in a medical ward. Respiratory rate was measured by three methods: a standardised approach over 60 s while patients lay still and refrained from talking, by ward staff and by a wireless electronic patch (SensiumVitals). The Bland-Altman method was used to compare measurements and three breaths per minute (BPM) was considered a clinically relevant difference. We included 50 patients. The mean difference between the standardised approach and the electronic measurement was 0.3 (95% CI: -1.4 to 2.0) BPM; 95% limits of agreement were -11.5 (95% CI: -14.5 to -8.6) and 12.1 (95% CI: 9.2 to 15.1) BPM. Removal of three outliers with huge differences lead to a mean difference of -0.1 (95% CI: -0.7 to 0.5) BPM and 95% limits of agreement of -4.2 (95% CI: -5.3 to -3.2) BPM and 4.0 (95% CI: 2.9 to 5.0) BPM. The mean difference between staff and electronic measurements was 1.7 (95% CI: -0.5 to 3.9) BPM; 95% limits of agreement were -13.3 (95% CI: -17.2 to -9.5) BPM and 16.8 (95% CI: 13.0 to 20.6) BPM. A concerning lack of agreement was found between a wireless monitoring system and a standardised clinical approach. Ward staff's measurements also seemed to be inaccurate. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  13. Surfactant therapy in preterm infants with respiratory distress syndrome and in near-term or term newborns with acute RDS.

    PubMed

    Ramanathan, R

    2006-05-01

    Many different surfactant preparations derived from animal sources, as well as synthetic surfactants, are available for the treatment of preterm infants with respiratory distress syndrome (RDS). Natural, modified surfactants containing surfactant-associated proteins appear to be more effective than non-protein-containing synthetic surfactants. Comparative trials with poractant alfa at a higher initial dose of 200 mg/kg appear to be associated with rapid weaning of FiO2, less need for additional doses, and decreased mortality in infants <32 weeks gestation when compared with beractant. Early rescue (<30 min of age) surfactant therapy is an effective method to minimize over treatment of some preterm infants who may not develop RDS. Surfactant therapy followed by rapid extubation to nasal ventilation appears to be more beneficial than continued mechanical ventilation. In near-term or term newborns with acute RDS, surfactant therapy has been shown to be 70% effective in improving respiratory failure.

  14. Respiratory therapy: a problem among children and adolescents with cystic fibrosis

    PubMed Central

    Feiten, Taiane dos Santos; Flores, Josani Silva; Farias, Bruna Luciano; Rovedder, Paula Maria Eidt; Camargo, Eunice Gus; Dalcin, Paulo de Tarso Roth; Ziegler, Bruna

    2016-01-01

    Objective : To evaluate the level of self-reported adherence to physical therapy recommendations in pediatric patients (6-17 years) with cystic fibrosis (CF) and to ascertain whether the different levels of adherence correlate with pulmonary function, clinical aspects, and quality of life. Methods : This was a cross-sectional study. The patients and their legal guardians completed a questionnaire regarding adherence to physical therapy recommendations and a CF quality of life questionnaire. We collected demographic, spirometric, and bacteriological data, as well as recording the frequency of hospitalizations and Shwachman-Kulczycki (S-K) clinical scores. Results : We included 66 patients in the study. Mean age, FEV1 (% of predicted), and BMI were 12.2 ± 3.2 years, 90 ± 24%, and 18.3 ± 2.5 kg/m2, respectively. The patients were divided into two groups: high-adherence (n = 39) and moderate/poor-adherence (n = 27). No statistically significant differences were found between the groups regarding age, gender, family income, and total S-K clinical scores. There were statistically significant differences between the high-adherence group and the moderate/poor-adherence group, the latter showing lower scores for the "radiological findings" domain of the S-K clinical score (p = 0.030), a greater number of hospitalizations (p = 0.004), and more days of hospitalization in the last year (p = 0.012), as well as lower scores for the quality of life questionnaire domains emotion (p = 0.002), physical (p = 0.019), treatment burden (p < 0.001), health perceptions (p = 0.036), social (p = 0.039), and respiratory (p = 0.048). Conclusions : Low self-reported adherence to physical therapy recommendations was associated with worse radiological findings, a greater number of hospitalizations, and decreased quality of life in pediatric CF patients. PMID:26982038

  15. A computer-aided audit system for respiratory therapy consult evaluations: description of a method and early results.

    PubMed

    Kester, Lucy; Stoller, James K

    2013-05-01

    Use of respiratory therapist (RT)-guided protocols enhances allocation of respiratory care. In the context that optimal protocol use requires a system for auditing respiratory care plans to assure adherence to protocols and expertise of the RTs generating the care plan, a live audit system has been in longstanding use in our Respiratory Therapy Consult Service. Growth in the number of RT positions and the need to audit more frequently has prompted development of a new, computer-aided audit system. The number and results of audits using the old and new systems were compared (for the periods May 30, 2009 through May 30, 2011 and January 1, 2012 through May 30, 2012, respectively). In contrast to the original, live system requiring a patient visit by the auditor, the new system involves completion of a respiratory therapy care plan using patient information in the electronic medical record, both by the RT generating the care plan and the auditor. Completing audits in the new system also uses an electronic respiratory therapy management system. The degrees of concordance between the audited RT's care plans and the "gold standard" care plans using the old and new audit systems were similar. Use of the new system was associated with an almost doubling of the rate of audits (ie, 11 per month vs 6.1 per month). The new, computer-aided audit system increased capacity to audit more RTs performing RT-guided consults while preserving accuracy as an audit tool. Ensuring that RTs adhere to the audit process remains the challenge for the new system, and is the rate-limiting step.

  16. Synchronized moving aperture radiation therapy (SMART): improvement of breathing pattern reproducibility using respiratory coaching

    NASA Astrophysics Data System (ADS)

    Neicu, Toni; Berbeco, Ross; Wolfgang, John; Jiang, Steve B.

    2006-02-01

    Recently, at Massachusetts General Hospital (MGH) we proposed a new treatment technique called synchronized moving aperture radiation therapy (SMART) to account for tumour motion during radiotherapy. The basic idea of SMART is to synchronize the moving radiation beam aperture formed by a dynamic multileaf collimator with the tumour motion induced by respiration. The two key requirements for being able to successfully use SMART in clinical practice are the precise and fast detection of tumour position during the simulation/treatment and the good reproducibility of the tumour motion pattern. To fulfil the first requirement, an integrated radiotherapy imaging system is currently being developed at MGH. The results of a previous study show that breath coaching techniques are required to make SMART an efficient technique in general. In this study, we investigate volunteer and patient respiratory coaching using a commercial respiratory gating system as a respiration coaching tool. Five healthy volunteers, observed during six sessions, and 33 lung cancer patients, observed during one session when undergoing 4D CT scans, were investigated with audio and visual promptings, with free breathing as a control. For all five volunteers, breath coaching was well tolerated and the intra- and inter-session reproducibility of the breathing pattern was greatly improved. Out of 33 patients, six exhibited a regular breathing pattern and needed no coaching, four could not be coached at all due to the patient's medical condition or had difficulty following the instructions, 13 could only be coached with audio instructions and 10 could follow the instructions of and benefit from audio-video coaching. We found that, for all volunteers and for those patients who could be properly coached, breath coaching improves the duty cycle of SMART treatment. However, about half of the patients could not follow both audio and video instructions simultaneously, suggesting that the current coaching

  17. Singing teaching as a therapy for chronic respiratory disease - a randomised controlled trial and qualitative evaluation

    PubMed Central

    2010-01-01

    Background Despite optimal pharmacological therapy and pulmonary rehabilitation, patients with COPD continue to be breathless. There is a need to develop additional strategies to alleviate symptoms. Learning to sing requires control of breathing and posture and might have benefits that translate into daily life. Methods To test this hypothesis we performed a randomised controlled trial, comparing a six week course of twice weekly singing classes to usual care, in 28 COPD patients. The experience of singing was assessed in a qualitative fashion, through interviews with a psychologist. In addition, we surveyed patients with chronic respiratory conditions who participated in a series of open singing workshops. Results In the RCT, the physical component score of the SF36 improved in the singers (n = 15) compared to the controls (n = 13); +7.5(14.6) vs. -3.8(8.4) p = 0.02. Singers also had a significant fall in HAD anxiety score; -1.1(2.7) vs. +0.8(1.7) p = 0.03. Singing did not improve single breath counting, breath hold time or shuttle walk distance. In the qualitative element, 8 patients from the singing group were interviewed. Positive effects on physical sensation, general well-being, community/social support and achievement/efficacy emerged as common themes. 150 participants in open workshops completed a questionnaire. 96% rated the workshops as "very enjoyable" and 98% thought the workshop had taught them something about breathing in a different way. 81% of attendees felt a "marked physical difference" after the workshop. Conclusion Singing classes can improve quality of life measures and anxiety and are viewed as a very positive experience by patients with respiratory disease; no adverse consequences of participation were observed. Trial Registration Current Controlled Trials - ISRCTN17544114. PMID:20682030

  18. Extracorporeal blood therapy in sepsis and acute respiratory distress syndrome: the "purifying dream".

    PubMed

    Xu, Xuefeng; Dai, Huaping; Jia, Chun'e; Wang, Chen

    2014-01-01

    To discuss the rationale, hypothesis, modality of extracorporeal blood purification (EBP) techniques for the critically ill animal models or patients, and to summarize the experimental and clinical studies with inconsistent data which explored the EBP's efficacy in the areas of critical care medicine. Articles referred in this review were collected from the database of PubMed published in English up to June 2014. We had done a literature search by using the term "(sepsis OR acute lung injury OR acute respiratory distress syndrome) AND (extracorporeal blood purification OR hemofiltration OR hemoperfusion OR plasma exchange OR plasmapheresis OR adsorpiton)". Related original or review articles were included and carefully analyzed. Acute cellular and humoral immune disturbances occur in both sepsis and acute respiratory distress syndrome (ARDS). Treatments aimed at targeting one single pro-/anti-inflammatory mediator have largely failed with no proven clinical benefits. Such failure shifts the therapeutic rationale to the nonspecific, broad-spectrum methods for modulating the over-activated inflammatory and anti-inflammatory response. Therefore, EBP techniques have become the potential weapons with high promise for removing the circulating pro-/anti-inflammatory mediators and promoting immune reconstitution. Over the years, multiple extracorporeal techniques for the critically ill animal models or patients have been developed, including hemofiltration (HF), high-volume hemofiltration (HVHF), high-cutoff hemofiltration (HCO-HF), hemo-perfusion or -adsorption (HP/HA), coupled plasma filtration adsorption (CPFA), and plasma exchange (PE). These previous studies showed that EBP therapy was feasible and safe for the critically ill animal models or patients. However, data on their efficacy (especially on the clinical benefits, such as mortality) were inconsistent. It is not now to conclude that EBP intervention can purify septic or ARDS patients with high clinical efficacy

  19. Devices for stem cell isolation and delivery: current need for drug discovery and cell therapy.

    PubMed

    Reinhardt, Martin; Bader, Augustinus; Giri, Shibashish

    2015-05-01

    Isolation and purification of stem cells and their delivery into diseased or aged tissues or organs need special devices for proper transplantation of stem cells in order to achieve high cell retention at transplant site for repair or regeneration of tissues and organs. The clinical and preclinical importance of special devices such as Celution System, Isolex cell separation device, magnetic surface-enhanced Raman spectroscopic dots, microfluidic devices, immunomagnetic cell separation for stem cell separation and isolation are the main focus in this paper. Further, devices like trans-coronary delivery, trans-endocardial delivery, intracoronary delivery devices for stem cell application to the heart are described. Devices for stem cell application to the brain, the spinal cord and other tissues are also explained. We highlighted scaffolds with incorporated stem cells and other encapsulation devices used to transplant stem cells. Current needs of devices for stem cells isolation, purification and delivery for drug discovery and cell therapy are discussed.

  20. Critical Thinking in Respiratory Therapy Students: Comparing Baccalaureate and Associate Degree Students

    ERIC Educational Resources Information Center

    Clark, Myava C.

    2012-01-01

    Respiratory care is an allied health discipline that specializes in cardiopulmonary function and health. Respiratory therapists apply scientific principles to prevent, identify, and treat acute and chronic dysfunction of the cardiopulmonary system. Respiratory care specifically focuses on the assessment, treatment, management, control, diagnostic…

  1. Critical Thinking in Respiratory Therapy Students: Comparing Baccalaureate and Associate Degree Students

    ERIC Educational Resources Information Center

    Clark, Myava C.

    2012-01-01

    Respiratory care is an allied health discipline that specializes in cardiopulmonary function and health. Respiratory therapists apply scientific principles to prevent, identify, and treat acute and chronic dysfunction of the cardiopulmonary system. Respiratory care specifically focuses on the assessment, treatment, management, control, diagnostic…

  2. The impact of respiratory motion and treatment technique on stereotactic body radiation therapy for liver cancer

    SciTech Connect

    Wu, Q. Jackie; Thongphiew, Danthai; Wang Zhiheng; Chankong, Vira; Yin Fangfang

    2008-04-15

    Stereotactic body radiation therapy (SBRT), which delivers a much higher fractional dose than conventional treatment in only a few fractions, is an effective treatment for liver metastases. For patients who are treated under free-breathing conditions, however, respiration-induced tumor motion in the liver is a concern. Limited clinical information is available related to the impact of tumor motion and treatment technique on the dosimetric consequences. This study evaluated the dosimetric deviations between planned and delivered SBRT dose in the presence of tumor motion for three delivery techniques: three-dimensional conformal static beams (3DCRT), dynamic conformal arc (DARC), and intensity-modulated radiation therapy (IMRT). Five cases treated with SBRT for liver metastases were included in the study, with tumor motions ranging from 0.5 to 1.75 cm. For each case, three different treatment plans were developed using 3DCRT, DARC, and IMRT. The gantry/multileaf collimator (MLC) motion in the DARC plans and the MLC motion in the IMRT plans were synchronized to the patient's respiratory motion. Retrospectively sorted four-dimensional computed tomography image sets were used to determine patient-organ motion and to calculate the dose delivered during each respiratory phase. Deformable registration, using thin-plate-spline models, was performed to encode the tumor motion and deformation and to register the dose-per-phase to the reference phase images. The different dose distributions resulting from the different delivery techniques and motion ranges were compared to assess the effect of organ motion on dose delivery. Voxel dose variations occurred mostly in the high gradient regions, typically between the target volume and normal tissues, with a maximum variation up to 20%. The greatest CTV variation of all the plans was seen in the IMRT technique with the largest motion range (D99: -8.9%, D95: -8.3%, and D90: -6.3%). The greatest variation for all 3DCRT plans was less

  3. Legal issues related to vascular access devices and infusion therapy.

    PubMed

    Masoorli, Sue

    2005-01-01

    Infusion therapies are being delivered in many healthcare settings including hospitals, homecare settings, long-term care facilities, occupational health facilities, outpatient units, and physician offices. Nurses who infuse medications must be properly educated to recognize vascular access complications and initiate the proper interventions. This article discusses the high-risk areas of nursing malpractice related to infusion therapies.

  4. Performance of two respiratory protective devices used by home-attending health care workers (a pilot study).

    PubMed

    Elmashae, Reported By Yousef; Grinshpun, Sergey A; Reponen, Tiina; Yermakov, Michael; Riddle, Robert

    2017-09-01

    This pilot study aimed at determining the Workplace Protection Factor (WPF) for respiratory protective devices widely used by health care workers to reduce exposure to potentially hazardous aerosols when attending patients in their homes. Two devices were tested, an N95 filtering facepiece respirator (FFR) and a surgical mask (SM). Three home-attending health care workers were recruited, medically cleared and fit tested. At the workplace, the aerosol concentrations outside (Cout) and inside (Cin) of the tested respiratory protective device worn by a subject were measured using two simultaneously operating P-Trak condensation particle counters within the particle size range of approximately 20-1,000 nm. Real-time and integrated (time-weighted average, TWA) values of WPF = Cout/Cin were determined. This pilot study demonstrated that the WPF of the tested N95 FFR consistently exceeded that of the SM. The WPFTWA(C) values calculated for the entire test time (based on the TWA aerosol concentration values) ranged from 29 to 40 and 2 to 9, respectively. In all cases, the N95 FFR provided protection above the Occupational Safety and Health Administration's (OSHA) assigned protection factor of 10, whereas the SM often offered little or essentially no protection against the measured sub-micrometer aerosol particles. For both devices, the protection level was found to depend on activity. For example, the WPFTWA(C) for one subject wearing the N95 FFR was 56 during normal activity but fell almost 70% during tracheal suctioning. It is explicable considering that different procedures implemented by health care workers in homes generate particles of different sizes and require different body movements; both factors are anticipated to affect the WPF. Wearing an N95-certified respirator helps significantly reduce the aerosol inhalation exposure of home-attending health care workers. An SM offers much lower protection. The WPF depends on several factors, including, but not limited

  5. The Impact of Prior Radiation Therapy on Artificial Urinary Sphincter Device Survival.

    PubMed

    Rivera, Marcelino E; Linder, Brian J; Ziegelmann, Matthew J; Viers, Boyd R; Rangel, Laureano J; Elliott, Daniel S

    2016-04-01

    The literature on artificial urinary sphincter device survival in individuals with a history of radiation therapy is conflicting. We assess device survival outcomes among individuals after prior radiation therapy exposure undergoing primary artificial urinary sphincter placement. An institutional review board approved database of all patients who underwent artificial urinary sphincter surgery from 1999 to 2011 was used to assess device survival in patients treated with radiotherapy compared to individuals without radiotherapy exposure. Hazard regression and competing risk analysis were used to determine the association between radiation therapy and device outcomes. From 1999 to 2011 a total of 872 patients underwent artificial urinary sphincter surgery at our institution. Of these patients 489 underwent primary artificial urinary sphincter placement, with 181 of 489 (37%) having received radiation therapy. Patients with prior radiation therapy were older (median age 72.0 vs 70.1 years, p <0.01) and had a higher median body mass index (29.4 vs 28.6 kg/m(2), p <0.03) than those without radiation exposure. Rates of diabetes mellitus and hypertension were similar between the 2 groups. There was no significant difference in overall device survival between individuals who received radiation therapy and those without radiation therapy exposure, with 1 and 5-year device survival rates of 92% vs 90% and 77% vs 74%, respectively (p=0.24). While individuals who underwent radiation therapy were significantly older and had a higher body mass index, device survival was not significantly different between the 2 groups when using a cuff size greater than 3.5 cm. These findings will assist the urologist with the preoperative counseling of men undergoing primary artificial urinary sphincter placement with a history of radiation therapy. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  6. A System Approach to Navy Medical Education and Training. Appendix 37. Competency Curricula for Respiratory Therapy Assistant and Respiratory Therapy Technician.

    DTIC Science & Technology

    1974-08-31

    of Intermittent Positive Pressure Breathing Treatment . . . . . . . . ... 13 5. Chest Physiotherapy ...... . .. . . . . . 14 6. Respiratory Exercises...12 4 Administration of Intermittent Positive Pressure Breathing Treatment . . .. .. . . . 13 5 Chest Physiotherapy ................... 14...patient and personnel injury or incident MNOWLEDGES AND SKILLS Types and sizes of bottled gas containers I Mechanical dexterity NFPA, ICC and other written

  7. Impact of respiratory therapy in vital capacity and functionality of patients undergoing abdominal surgery.

    PubMed

    Fernandes, Shanlley Cristina da Silva; Santos, Rafaella Souza Dos; Giovanetti, Erica Albanez; Taniguchi, Corinne; Silva, Cilene Saghabi de Medeiros; Eid, Raquel Afonso Caserta; Timenetsky, Karina Tavares; Carnieli-Cazati, Denise

    2016-01-01

    To evaluate the vital capacity after two chest therapy techniques in patients undergoing abdominal surgical. A prospective randomized study carried out with patients admitted to the Intensive Care Unit after abdominal surgery. We checked vital capacity, muscular strength using the Medical Research Council scale, and functionality with the Functional Independence Measure the first time the patient was breathing spontaneously (D1), and also upon discharge from the Intensive Care Unit (Ddis). Between D1 and Ddis, respiratory therapy was carried out according to the randomized group. We included 38 patients, 20 randomized to Positive Intermittent Pressure Group and 18 to Volumetric Incentive Spirometer Group. There was no significant gain related to vital capacity of D1 and Ddis of Positive Intermittent Pressure Group (mean 1,410mL±547.2 versus 1,809mL±692.3; p=0.979), as in the Volumetric Incentive Spirometer Group (1,408.3mL±419.1 versus 1,838.8mL±621.3; p=0.889). We observed a significant improvement in vital capacity in D1 (p<0.001) and Ddis (p<0.001) and in the Functional Independence Measure (p<0.001) after respiratory therapy. The vital capacity improvement was not associated with gain of muscle strength. Chest therapy, with positive pressure and volumetric incentive spirometer, was effective in improving vital capacity of patients submitted to abdominal surgery. Avaliar a capacidade vital comparando duas técnicas de fisioterapia respiratória em pacientes submetidos à cirurgia abdominal. Estudo prospectivo e randomizado realizado com pacientes admitidos em Unidade de Terapia Intensiva após cirurgia abdominal. Verificamos a capacidade vital, a força muscular por meio da escala do Medical Research Council e funcionalidade pela Medida de Independência Funcional no primeiro momento em que o paciente encontrava-se em respiração espontânea (D1) e na alta da Unidade de Terapia Intensiva (Dalta). Entre D1 e Dalta, foi realizada a fisioterapia respirat

  8. The Joint Commission's disease-specific care certification for destination therapy ventricular assist devices.

    PubMed

    Lockard, Kathleen L; Weimer, Ashley; O'Shea, Genevieve; Driggers, Erin; Conroy, Linda; Teuteberg, Jeffrey J; Winowich, Stephen; Lohmann, Douglas; Schaub, Richard D; Severyn, Donald A; Kormos, Robert L

    2010-06-01

    The Centers for Medicare and Medicaid Services announced that all hospitals implanting ventricular assist devices are required to have certification from the The Joint Commission for disease-specific care destination therapy with a ventricular assist device effective March 27, 2009, in order to receive Medicare reimbursement for services rendered to patients who have devices implanted for destination therapy. On February 23, 2007, The Joint Commission released the certification requirements for ventricular assist devices implanted for destination therapy in an 8-page document so that hospitals could prepare to meet the 2009 certification deadline. The Artificial Heart Program of the University of Pittsburgh Medical Center undertook a multidisciplinary project, under the guidance of the nurse coordinator, to prepare the hospital and program for a precertification survey by The Joint Commission for disease-specific destination therapy ventricular assist device certification. The Presbyterian Hospital Artificial Heart Program was awarded The Joint Commission's device-specific certification for destination therapy with ventricular assist devices in June 2008.

  9. Nutritional assessment and therapy in COPD: a European Respiratory Society statement.

    PubMed

    Schols, Annemie M; Ferreira, Ivone M; Franssen, Frits M; Gosker, Harry R; Janssens, Wim; Muscaritoli, Maurizio; Pison, Christophe; Rutten-van Mölken, Maureen; Slinde, Frode; Steiner, Michael C; Tkacova, Ruzena; Singh, Sally J

    2014-12-01

    Nutrition and metabolism have been the topic of extensive scientific research in chronic obstructive pulmonary disease (COPD) but clinical awareness of the impact dietary habits, nutritional status and nutritional interventions may have on COPD incidence, progression and outcome is limited. A multidisciplinary Task Force was created by the European Respiratory Society to deliver a summary of the evidence and description of current practice in nutritional assessment and therapy in COPD, and to provide directions for future research. Task Force members conducted focused reviews of the literature on relevant topics, advised by a methodologist. It is well established that nutritional status, and in particular abnormal body composition, is an important independent determinant of COPD outcome. The Task Force identified different metabolic phenotypes of COPD as a basis for nutritional risk profile assessment that is useful in clinical trial design and patient counselling. Nutritional intervention is probably effective in undernourished patients and probably most when combined with an exercise programme. Providing evidence of cost-effectiveness of nutritional intervention is required to support reimbursement and thus increase access to nutritional intervention. Overall, the evidence indicates that a well-balanced diet is beneficial to all COPD patients, not only for its potential pulmonary benefits, but also for its proven benefits in metabolic and cardiovascular risk. ©ERS 2014.

  10. Potency of parenteral antimicrobials including ceftolozane/tazobactam against nosocomial respiratory tract pathogens: considerations for empiric and directed therapy

    PubMed Central

    Sutherland, Christina A.

    2017-01-01

    Background Empiric therapy decisions are predicated on knowledge of both the epidemiology and antimicrobial susceptibility of the probable infecting pathogen(s). The objective of this study was to evaluate the microbial distribution and phenotypic profiles of nosocomial respiratory isolates collected from multiple US hospitals and assess the clinical utility of various monotherapy and combination regimens. Methods Hospitals provided consecutive non-duplicate adult inpatients Gram-negative nosocomial respiratory isolates from cultures received ≥48 h after hospital admission. Minimum inhibitory concentrations (MICs) for 12 antimicrobials were determined using broth microdilution methods. An antibiogram was constructed for monotherapy regimens as well as combinations inclusive of either tobramycin (TOB) or ciprofloxacin (CIP). Results Six hospitals provided 518 nosocomial respiratory isolates. P. aeruginosa (PSA) comprised 28% of the population followed by Klebsiella pneumoniae (13%), Enterobacter spp. (13%), S. maltophilia (9%), S. marcesens (6%), A. baumannii (6%), and others (18%). When considering monotherapy for the Enterobacteriaceae & PSA ceftolozane/tazobactam (C/T) provided the highest (87%) percent susceptibility (%S) followed by meropenem (MEM), CIP, cefepime (FEP), ceftazidime (CAZ) and piperacillin-tazobactam (TZP) at 71–85%S. The addition of TOB > CIP improved the probability that the antimicrobial combination would provide ≥1 active agent. Conclusions PSA was the predominant nosocomial respiratory pathogen; however, the Enterobacteriaceae comprised an additional 53% in this survey. When considering empiric β-lactam monotherapy therapy for the entire spectrum of pathogens C/T provided the highest (78%) %S followed by MEM, FEP and TZP. The addition of either TOB > CIP to these β-lactams enhances the likelihood that an active agent would be selected when considering empirical therapy choices for nosocomial respiratory tract infections. PMID

  11. Brownie, a Gene Involved in Building Complex Respiratory Devices in Insect Eggshells

    PubMed Central

    Irles, Paula; Bellés, Xavier; Piulachs, M. Dolors

    2009-01-01

    Background Insect eggshells must combine protection for the yolk and embryo with provisions for respiration and for the entry of sperm, which are ensured by aeropyles and micropyles, respectively. Insects which oviposit the eggs in an egg-case have a double problem of respiration as gas exchange then involves two barriers. An example of this situation is found in the cockroach Blattella germanica, where the aeropyle and the micropyle are combined in a complex structure called the sponge-like body. The sponge-like body has been well described morphologically, but nothing is known about how it is built up. Methodology/Principal Findings In a library designed to find genes expressed during late chorion formation in B. germanica, we isolated the novel sequence Bg30009 (now called Brownie), which was outstanding due to its high copy number. In the present work, we show that Brownie is expressed in the follicle cells localized in the anterior pole of the oocyte in late choriogenesis. RNA interference (RNAi) of Brownie impaired correct formation of the sponge-like body and, as a result, the egg-case was also ill-formed and the eggs were not viable. Conclusions/Significance Results indicate that the novel gene Brownie plays a pivotal role in building up the sponge-like body. Brownie is the first reported gene involved in the construction of complex eggshell respiratory structures. PMID:20020062

  12. Comparative Cost of Stockpiling Various Types of Respiratory Protective Devices to Protect the Health Care Workforce During an Influenza Pandemic.

    PubMed

    Baracco, Gio; Eisert, Sheri; Eagan, Aaron; Radonovich, Lewis

    2015-06-01

    Specific guidance on the size and composition of respiratory protective device (RPD) stockpiles for use during a pandemic is lacking. We explore the economic aspects of stockpiling various types and combinations of RPDs by adapting a pandemic model that estimates the impact of a severe pandemic on a defined population, the number of potential interactions between patients and health care personnel, and the potential number of health care personnel needed to fulfill those needs. Our model calculates the number of the different types of RPDs that should be stockpiled and the consequent cost of purchase and storage, prorating this cost over the shelf life of the inventory. Compared with disposable N95 or powered air-purifying respirators, we show that stockpiling reusable elastomeric half-face respirators is the least costly approach. Disposable N95 respirators take up significantly more storage space, which increases relative costs. Reusing or extending the usable period of disposable devices may diminish some of these costs. We conclude that stockpiling a combination of disposable N95 and reusable half-face RPDs is the best approach to preparedness for most health care organizations. We recommend against stockpiling powered air-purifying respirators as they are much more costly than alternative approaches.

  13. Evaluation of the Survivability of Microorganisms Deposited on Filtering Respiratory Protective Devices under Varying Conditions of Humidity.

    PubMed

    Majchrzycka, Katarzyna; Okrasa, Małgorzata; Skóra, Justyna; Gutarowska, Beata

    2016-01-04

    Bioaerosols are common biological factors in work environments, which require routine use of filtering respiratory protective devices (FRPDs). Currently, no studies link humidity changes in the filter materials of such devices, during use, with microorganism survivability. Our aim was to determine the microclimate inside FRPDs, by simulating breathing, and to evaluate microorganism survivability under varying humidity conditions. Breathing was simulated using commercial filtering facepiece respirators in a model system. Polypropylene melt-blown nonwoven fabrics with moisture contents of 40%, 80%, and 200%, were used for assessment of microorganisms survivability. A modified AATCC 100-2004 method was used to measure the survivability of ATCC and NCAIM microorganisms: Escherichia coli, Staphylococcus aureus, Bacillus subtilis, Candida albicans and Aspergillus niger. During simulation relative humidity under the facepiece increased after 7 min of usage to 84%-92% and temperature increased to 29-30 °C. S. aureus survived the best on filter materials with 40%-200% moisture content. A decrease in survivability was observed for E. coli and C. albicans when mass humidity decreased. We found that B. subtilis and A. niger proliferated for 48-72 h of incubation and then died regardless of the moisture content. In conclusion, our tests showed that the survivability of microorganisms on filter materials depends on the amount of accumulated moisture and microorganism type.

  14. Evaluation of the Survivability of Microorganisms Deposited on Filtering Respiratory Protective Devices under Varying Conditions of Humidity

    PubMed Central

    Majchrzycka, Katarzyna; Okrasa, Małgorzata; Skóra, Justyna; Gutarowska, Beata

    2016-01-01

    Bioaerosols are common biological factors in work environments, which require routine use of filtering respiratory protective devices (FRPDs). Currently, no studies link humidity changes in the filter materials of such devices, during use, with microorganism survivability. Our aim was to determine the microclimate inside FRPDs, by simulating breathing, and to evaluate microorganism survivability under varying humidity conditions. Breathing was simulated using commercial filtering facepiece respirators in a model system. Polypropylene melt-blown nonwoven fabrics with moisture contents of 40%, 80%, and 200%, were used for assessment of microorganisms survivability. A modified AATCC 100-2004 method was used to measure the survivability of ATCC and NCAIM microorganisms: Escherichia coli, Staphylococcus aureus, Bacillus subtilis, Candida albicans and Aspergillus niger. During simulation relative humidity under the facepiece increased after 7 min of usage to 84%–92% and temperature increased to 29–30 °C. S. aureus survived the best on filter materials with 40%–200% moisture content. A decrease in survivability was observed for E. coli and C. albicans when mass humidity decreased. We found that B. subtilis and A. niger proliferated for 48–72 h of incubation and then died regardless of the moisture content. In conclusion, our tests showed that the survivability of microorganisms on filter materials depends on the amount of accumulated moisture and microorganism type. PMID:26742049

  15. Therapy of Adult Respiratory Distress Syndrome with Alpha-1- Antiproteinase or Lung Surfactant.

    DTIC Science & Technology

    1991-03-15

    Jacobs, H., A. Jobe, M. Ikegami, T. Glatz, S. J . Jones, and L. Barajas . 1982. Premature lambs rescued from respiratory failure with natural surfactant...D. B. Bigelow, T. L. Petty, and B. E. Levine. 1967. Acute respiratory distress in adults. Lancet 2:319-323. 3. Holter, J.F., J . E. Weiland, E. R...Pacht, J . E. Gadek, and W. B. Davis. 1986. Protein permeability in the adult respiratory distress syndrome Loss of size selectivity of the alveolar

  16. Ethical challenges with the left ventricular assist device as a destination therapy

    PubMed Central

    Rizzieri, Aaron G; Verheijde, Joseph L; Rady, Mohamed Y; McGregor, Joan L

    2008-01-01

    The left ventricular assist device was originally designed to be surgically implanted as a bridge to transplantation for patients with chronic end-stage heart failure. On the basis of the REMATCH trial, the US Food and Drug Administration and the US Centers for Medicare & Medicaid Services approved permanent implantation of the left ventricular assist device as a destination therapy in Medicare beneficiaries who are not candidates for heart transplantation. The use of the left ventricular assist device as a destination therapy raises certain ethical challenges. Left ventricular assist devices can prolong the survival of average recipients compared with optimal medical management of chronic end-stage heart failure. However, the overall quality of life can be adversely affected in some recipients because of serious infections, neurologic complications, and device malfunction. Left ventricular assist devices alter end-of-life trajectories. The caregivers of recipients may experience significant burden (e.g., poor physical health, depression, anxiety, and posttraumatic stress disorder) from destination therapy with left ventricular assist devices. There are also social and financial ramifications for recipients and their families. We advocate early utilization of a palliative care approach and outline prerequisite conditions so that consenting for the use of a left ventricular assist device as a destination therapy is a well informed process. These conditions include: (1) direct participation of a multidisciplinary care team, including palliative care specialists, (2) a concise plan of care for anticipated device-related complications, (3) careful surveillance and counseling for caregiver burden, (4) advance-care planning for anticipated end-of-life trajectories and timing of device deactivation, and (5) a plan to address the long-term financial burden on patients, families, and caregivers. Short-term mechanical circulatory devices (e.g. percutaneous cardiopulmonary

  17. Clinical management of a western lowland gorilla (Gorilla gorilla gorilla) with a cardiac resynchronization therapy device.

    PubMed

    Rush, Elizabeth Marie; Ogburn, Anna L; Monroe, Denise

    2011-06-01

    A 24-yr-old, male western lowland gorilla (Gorilla gorilla gorilla) was diagnosed with congestive heart failure using transesophageal and transthoracic echocardiology. New York Heart Association (NYHA) Class III was assigned to the severity of the condition. Over 16 mo, this progressed to NYHA Class IV despite increasing medical therapy. Repeated evaluations suggested that implantation of a cardiac resynchronization therapy device with a defibrillator (CRT-D) could benefit this animal based on clinical signs and underlying evidence of dyssynchrony and suspected fibrotic myocardial disease. Surgical implantation of leads into the right atrium, right ventricle, and left ventricle was accomplished. The CRT-D device was placed under the thoracic pectoral muscles during an initial surgical procedure. Improvement in the gorilla's clinical condition after implantation of the CRT-D device was immediate and dramatic. Subsequent scanning of the device was accomplished through operant conditioning. The data from these device interrogations included stored and real-time cardiac data, which were used to minimize recognized environmental stressors and change device settings. Over 4 yr, case management was critical to successful device use in treatment of the clinical disease. This involved medications, training for device interrogation, exercise to increase activity and improve body condition, and phlebotomy attempts. Dietary management was necessary to manipulate caloric and sodium intake and encourage medication compliance. Cardiac resynchronization therapy device implantation, although requiring specialized equipment and surgical skill, appears to be a viable option for treatment of fibrosing cardiomyopathy with systolic dysfunction in gorillas refractory to medical management. In addition to treatment, this device provides cardiovascular data at rest that could allow for early diagnosis and treatment of gorillas with this and other cardiac conditions in the future. This

  18. Is the cellular uptake of respiratory aerosols delivered from different devices equivalent?

    PubMed

    Ong, Hui Xin; Traini, Daniela; Loo, Ching-Yee; Sarkissian, Lala; Lauretani, Gianluca; Scalia, Santo; Young, Paul M

    2015-06-01

    The study focuses on the application of a cell integrated modified Andersen Cascade Impactor (ACI) as an in vitro lung model for the evaluation of aerosols' behaviour of different formulation devices, containing the same active drug, specifically nebuliser, pressurised metered dose inhaler (pMDI) and dry powder inhaler (DPI). Deposition and transport profiles of the three different inhaled salbutamol sulphate (SS) formulations with clinically relevant doses were evaluated using a modified ACI coupled with the air interface Calu-3 bronchial cell model. Reproducible amounts of SS were deposited on Snapwells for the different formulations, with no significant difference in SS deposition found between the standard ACI plate and modified plate. The transport of SS aerosols produced from pMDI formulation had similar transport kinetics to nebulised SS but significantly higher compared to the DPI, which could have led to the differences in clinical outcomes. Furthermore, drug absorption of different inhaled formulation devices of the same aerodynamic fraction was found not to be equivalent due to their physical chemical properties upon aerosolisation. This study has established an in vitro platform for the evaluation of the different inhaled formulations in physiologically relevant pulmonary conditions.

  19. In-ear medical devices for acoustic therapies in tinnitus treatments, state of the art.

    PubMed

    Ibarra, David; Tavira-Sanchez, Francisco; Recuero-Lopez, Manuel; Anthony, Brian W

    2017-04-21

    Cochrane reviews indicate there is very limited support for all forms of sound therapy and cognitive behavioral therapy has the strongest support. American Academy of Otolaryngology (AAO) recently published some guidelines which recommends Cognitive Behavioral Therapy (CBT) for tinnitus intervention, and only indicates that sound therapy should be considered an "option" for intervention. Nevertheless, acoustic therapy could lead to cause changes in the tinnitus perception and has been appreciated by the affected people for years. In the last decades, the use of sound or sound enrichment has become a central part of many tinnitus management programs used by audiologists, whether the intention was to mask tinnitus, suppress tinnitus, or interrupt the tinnitus generating neural activity. Several acoustic therapies have been developed and implemented in the last 40 years, but how can we determine which one is the most effective? We can determine the effects based on the results reported in many research studies, but in those studies are many factors that differ from one study to another, like in-ear medical devices used to apply acoustic therapy for tinnitus treatment. In this article, we review and analyze the different types of in-ear medical devices used in the most recently acoustic therapies in treatments against tinnitus, allowing us to identify the pros and cons. By our analysis, an optimal medical device could be characterized to enhance the application of acoustic therapies and in consequence the global results of the sound therapies that already exist. In this review, it was considered acoustic therapies, the technology implemented in medical devices and the clinical needs. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Modeling of the laser device for the stress therapy

    NASA Astrophysics Data System (ADS)

    Matveev, Nikolai V.; Shcheglov, Sergey A.; Romanova, Galina E.; Koneva, Ð.¢atiana A.

    2017-05-01

    Recently there is a great interest to the drug-free methods of treatment of various diseases. For example, audiovisual therapy is used for the stress therapy. The main destination of the method is the health care and well-being. Visual content in the given case is formed when laser radiation is passing through the optical mediums and elements. The therapy effect is achieved owing to the color varying and complicated structure of the picture which is produced by the refraction, dispersion effects, diffraction and interference. As the laser source we use three laser sources with wavelengths of 445 nm, 520 nm and 640 nm and the optical power up to 1 W. The beam is guided to the optical element which is responsible for the final image of the dome surface. The dynamic image can be achieved by the rotating of the optical element when the laser beam is static or by scanning the surface of the element. Previous research has shown that the complexity of the image connected to the therapy effect. The image was chosen experimentally in practice. The evaluation was performed using the fractal dimension calculation for the produced image. In this work we model the optical image on the surface formed by the laser sources together with the optical elements. Modeling is performed in two stages. On the first stage we perform the simple modeling taking into account simple geometrical effects and specify the optical models of the sources.

  1. SU-E-J-89: Motion Effects On Organ Dose in Respiratory Gated Stereotactic Body Radiation Therapy

    SciTech Connect

    Wang, T; Zhu, L; Khan, M; Landry, J; Rajpara, R; Hawk, N

    2014-06-01

    Purpose: Existing reports on gated radiation therapy focus mainly on optimizing dose delivery to the target structure. This work investigates the motion effects on radiation dose delivered to organs at risk (OAR) in respiratory gated stereotactic body radiation therapy (SBRT). A new algorithmic tool of dose analysis is developed to evaluate the optimality of gating phase for dose sparing on OARs while ensuring adequate target coverage. Methods: Eight patients with pancreatic cancer were treated on a phase I prospective study employing 4DCT-based SBRT. For each patient, 4DCT scans are acquired and sorted into 10 respiratory phases (inhale-exhale- inhale). Treatment planning is performed on the average CT image. The average CT is spatially registered to other phases. The resultant displacement field is then applied on the plan dose map to estimate the actual dose map for each phase. Dose values of each voxel are fitted to a sinusoidal function. Fitting parameters of dose variation, mean delivered dose and optimal gating phase for each voxel over respiration cycle are mapped on the dose volume. Results: The sinusoidal function accurately models the dose change during respiratory motion (mean fitting error 4.6%). In the eight patients, mean dose variation is 3.3 Gy on OARs with maximum of 13.7 Gy. Two patients have about 100cm{sup 3} volumes covered by more than 5 Gy deviation. The mean delivered dose maps are similar to plan dose with slight deformation. The optimal gating phase highly varies across the patient, with phase 5 or 6 on about 60% of the volume, and phase 0 on most of the rest. Conclusion: A new algorithmic tool is developed to conveniently quantify dose deviation on OARs from plan dose during the respiratory cycle. The proposed software facilitates the treatment planning process by providing the optimal respiratory gating phase for dose sparing on each OAR.

  2. Magnetic resonance imaging of thermal coagulation effects in a phantom for calibrating thermal therapy devices.

    PubMed

    Bouchard, L S; Bronskill, M J

    2000-05-01

    A material has been developed and tested that permanently records thermal response patterns from heating devices. The material consists of a mixture of polyacrylamide and 18% w/w bovine serum albumin. Thermal denaturation is complete when the local temperature exceeds 70 degrees C, causing a large reduction in the T2 of the material. Three-dimensional distributions of "thermal damage" can be assessed using standard magnetic resonance imaging sequences. The material works well with microwave heating devices and is adaptable for use with ultrasound, radio-frequency, or laser heating devices. Suggested uses include characterizing heating devices prior to treatment and developing new clinical applications for thermal therapies.

  3. Dose Escalated Liver Stereotactic Body Radiation Therapy at the Mean Respiratory Position

    SciTech Connect

    Velec, Michael; Moseley, Joanne L.; Dawson, Laura A.; Brock, Kristy K.

    2014-08-01

    Purpose: The dosimetric impact of dose probability based planning target volume (PTV) margins for liver cancer patients receiving stereotactic body radiation therapy (SBRT) was compared with standard PTV based on the internal target volume (ITV). Plan robustness was evaluated by accumulating the treatment dose to ensure delivery of the intended plan. Methods and Materials: Twenty patients planned on exhale CT for 27 to 50 Gy in 6 fractions using an ITV-based PTV and treated free-breathing were retrospectively evaluated. Isotoxic, dose escalated plans were created on midposition computed tomography (CT), representing the mean breathing position, using a dose probability PTV. The delivered doses were accumulated using biomechanical deformable registration of the daily cone beam CT based on liver targeting at the exhale or mean breathing position, for the exhale and midposition CT plans, respectively. Results: The dose probability PTVs were on average 38% smaller than the ITV-based PTV, enabling an average ± standard deviation increase in the planned dose to 95% of the PTV of 4.0 ± 2.8 Gy (9 ± 5%) on the midposition CT (P<.01). For both plans, the delivered minimum gross tumor volume (GTV) doses were greater than the planned nominal prescribed dose in all 20 patients and greater than the planned dose to 95% of the PTV in 18 (90%) patients. Nine patients (45%) had 1 or more GTVs with a delivered minimum dose more than 5 Gy higher with the midposition CT plan using dose probability PTV, compared with the delivered dose with the exhale CT plan using ITV-based PTV. Conclusions: For isotoxic liver SBRT planned and delivered at the mean respiratory, reduced dose probability PTV enables a mean escalation of 4 Gy (9%) in 6 fractions over ITV-based PTV. This may potentially improve local control without increasing the risk of tumor underdosing.

  4. Lung Sounds in Children before and after Respiratory Physical Therapy for Right Middle Lobe Atelectasis

    PubMed Central

    Adachi, Satoshi; Nakano, Hiroshi; Odajima, Hiroshi; Motomura, Chikako; Yoshioka, Yukiko

    2016-01-01

    Background Chest auscultation is commonly performed during respiratory physical therapy (RPT). However, the changes in breath sounds in children with atelectasis have not been previously reported. The aim of this study was to clarify the characteristics of breath sounds in children with atelectasis using acoustic measurements. Method The subjects of this study were 13 children with right middle lobe atelectasis (3–7 years) and 14 healthy children (3–7 years). Lung sounds at the bilateral fifth intercostal spaces on the midclavicular line were recorded. The right-to-left ratio (R/L ratio) and the expiration to inspiration ratio (E/I ratio) of the breath sound sound pressure were calculated separately for three octave bands (100–200 Hz, 200–400 Hz, and 400–800 Hz). These data were then compared between the atelectasis and control groups. In addition, the same measurements were repeated after treatment, including RPT, in the atelectasis group. Result Before treatment, the inspiratory R/L ratios for all the frequency bands were significantly lower in the atelectasis group than in the control group, and the E/I ratios for all the frequency bands were significantly higher in the atelectasis group than in the control group. After treatment, the inspiratory R/L ratios of the atelectasis group did not increase significantly, but the E/I ratios decreased for all the frequency bands and became similar to those of the control group. Conclusion Breath sound attenuation in the atelectatic area remained unchanged even after radiographical resolution, suggesting a continued decrease in local ventilation. On the other hand, the elevated E/I ratio for the atelectatic area was normalized after treatment. Therefore, the differences between inspiratory and expiration sound intensities may be an important marker of atelectatic improvement in children. PMID:27611433

  5. Lung Sounds in Children before and after Respiratory Physical Therapy for Right Middle Lobe Atelectasis.

    PubMed

    Adachi, Satoshi; Nakano, Hiroshi; Odajima, Hiroshi; Motomura, Chikako; Yoshioka, Yukiko

    2016-01-01

    Chest auscultation is commonly performed during respiratory physical therapy (RPT). However, the changes in breath sounds in children with atelectasis have not been previously reported. The aim of this study was to clarify the characteristics of breath sounds in children with atelectasis using acoustic measurements. The subjects of this study were 13 children with right middle lobe atelectasis (3-7 years) and 14 healthy children (3-7 years). Lung sounds at the bilateral fifth intercostal spaces on the midclavicular line were recorded. The right-to-left ratio (R/L ratio) and the expiration to inspiration ratio (E/I ratio) of the breath sound sound pressure were calculated separately for three octave bands (100-200 Hz, 200-400 Hz, and 400-800 Hz). These data were then compared between the atelectasis and control groups. In addition, the same measurements were repeated after treatment, including RPT, in the atelectasis group. Before treatment, the inspiratory R/L ratios for all the frequency bands were significantly lower in the atelectasis group than in the control group, and the E/I ratios for all the frequency bands were significantly higher in the atelectasis group than in the control group. After treatment, the inspiratory R/L ratios of the atelectasis group did not increase significantly, but the E/I ratios decreased for all the frequency bands and became similar to those of the control group. Breath sound attenuation in the atelectatic area remained unchanged even after radiographical resolution, suggesting a continued decrease in local ventilation. On the other hand, the elevated E/I ratio for the atelectatic area was normalized after treatment. Therefore, the differences between inspiratory and expiration sound intensities may be an important marker of atelectatic improvement in children.

  6. Dose escalated liver stereotactic body radiation therapy at the mean respiratory position.

    PubMed

    Velec, Michael; Moseley, Joanne L; Dawson, Laura A; Brock, Kristy K

    2014-08-01

    The dosimetric impact of dose probability based planning target volume (PTV) margins for liver cancer patients receiving stereotactic body radiation therapy (SBRT) was compared with standard PTV based on the internal target volume (ITV). Plan robustness was evaluated by accumulating the treatment dose to ensure delivery of the intended plan. Twenty patients planned on exhale CT for 27 to 50 Gy in 6 fractions using an ITV-based PTV and treated free-breathing were retrospectively evaluated. Isotoxic, dose escalated plans were created on midposition computed tomography (CT), representing the mean breathing position, using a dose probability PTV. The delivered doses were accumulated using biomechanical deformable registration of the daily cone beam CT based on liver targeting at the exhale or mean breathing position, for the exhale and midposition CT plans, respectively. The dose probability PTVs were on average 38% smaller than the ITV-based PTV, enabling an average ± standard deviation increase in the planned dose to 95% of the PTV of 4.0 ± 2.8 Gy (9 ± 5%) on the midposition CT (P<.01). For both plans, the delivered minimum gross tumor volume (GTV) doses were greater than the planned nominal prescribed dose in all 20 patients and greater than the planned dose to 95% of the PTV in 18 (90%) patients. Nine patients (45%) had 1 or more GTVs with a delivered minimum dose more than 5 Gy higher with the midposition CT plan using dose probability PTV, compared with the delivered dose with the exhale CT plan using ITV-based PTV. For isotoxic liver SBRT planned and delivered at the mean respiratory, reduced dose probability PTV enables a mean escalation of 4 Gy (9%) in 6 fractions over ITV-based PTV. This may potentially improve local control without increasing the risk of tumor underdosing. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. [Quality assurance of respiratory-gated stereotactic body radiation therapy in lung using real-time position management system].

    PubMed

    Nakaguchi, Yuji; Araki, Fujio; Kouno, Tomohiro; Maruyama, Masato

    2012-01-01

    In this study, we investigated comprehensive quality assurance (QA) for respiratory-gated stereotactic body radiation therapy (SBRT) in the lungs using a real-time position management system (RPM). By using the phantom study, we evaluated dose liberality and reproducibility, and dose distributions for low monitor unite (MU), and also checked the absorbed dose at isocenter and dose profiles for the respiratory-gated exposure using RPM. Furthermore, we evaluated isocenter dose and dose distributions for respiratory-gated SBRT plans in the lungs using RPM. The maximum errors for the dose liberality were 4% for 2 MU, 1% for 4-10 MU, and 0.5% for 15 MU and 20 MU. The dose reproducibility was 2% for 1 MU and within 0.1% for 5 MU or greater. The accuracy for dose distributions was within 2% for 2 MU or greater. The dose error along a central axis for respiratory cycles of 2, 4, and 6 sec was within 1%. As for geometric accuracy, 90% and 50% isodose areas for the respiratory-gated exposure became almost 1 mm and 2 mm larger than without gating, respectively. For clinical lung-SBRT plans, the point dose at isocenter agreed within 2.1% with treatment planning system (TPS). And the pass rates of all plans for TPS were more than 96% in the gamma analysis (3 mm/3%). The geometrical accuracy and the dose accuracy of TPS calculation algorithm are more important for the dose evaluation at penumbra region for respiratory-gated SBRT in lung using RPM.

  8. Effects of Respiratory Motion on Passively Scattered Proton Therapy Versus Intensity Modulated Photon Therapy for Stage III Lung Cancer: Are Proton Plans More Sensitive to Breathing Motion?

    SciTech Connect

    Matney, Jason; Park, Peter C.; Bluett, Jaques; Chen, Yi Pei; Liu, Wei; Court, Laurence E.; Liao, Zhongxing; Li, Heng; Mohan, Radhe

    2013-11-01

    Purpose: To quantify and compare the effects of respiratory motion on paired passively scattered proton therapy (PSPT) and intensity modulated photon therapy (IMRT) plans; and to establish the relationship between the magnitude of tumor motion and the respiratory-induced dose difference for both modalities. Methods and Materials: In a randomized clinical trial comparing PSPT and IMRT, radiation therapy plans have been designed according to common planning protocols. Four-dimensional (4D) dose was computed for PSPT and IMRT plans for a patient cohort with respiratory motion ranging from 3 to 17 mm. Image registration and dose accumulation were performed using grayscale-based deformable image registration algorithms. The dose–volume histogram (DVH) differences (4D-3D [3D = 3-dimensional]) were compared for PSPT and IMRT. Changes in 4D-3D dose were correlated to the magnitude of tumor respiratory motion. Results: The average 4D-3D dose to 95% of the internal target volume was close to zero, with 19 of 20 patients within 1% of prescribed dose for both modalities. The mean 4D-3D between the 2 modalities was not statistically significant (P<.05) for all dose–volume histogram indices (mean ± SD) except the lung V5 (PSPT: +1.1% ± 0.9%; IMRT: +0.4% ± 1.2%) and maximum cord dose (PSPT: +1.5 ± 2.9 Gy; IMRT: 0.0 ± 0.2 Gy). Changes in 4D-3D dose were correlated to tumor motion for only 2 indices: dose to 95% planning target volume, and heterogeneity index. Conclusions: With our current margin formalisms, target coverage was maintained in the presence of respiratory motion up to 17 mm for both PSPT and IMRT. Only 2 of 11 4D-3D indices (lung V5 and spinal cord maximum) were statistically distinguishable between PSPT and IMRT, contrary to the notion that proton therapy will be more susceptible to respiratory motion. Because of the lack of strong correlations with 4D-3D dose differences in PSPT and IMRT, the extent of tumor motion was not an adequate predictor of potential

  9. A clinical classification of the acute respiratory distress syndrome for predicting outcome and guiding medical therapy*.

    PubMed

    Villar, Jesús; Fernández, Rosa L; Ambrós, Alfonso; Parra, Laura; Blanco, Jesús; Domínguez-Berrot, Ana M; Gutiérrez, José M; Blanch, Lluís; Añón, José M; Martín, Carmen; Prieto, Francisca; Collado, Javier; Pérez-Méndez, Lina; Kacmarek, Robert M

    2015-02-01

    Current in-hospital mortality of the acute respiratory distress syndrome (ARDS) is above 40%. ARDS outcome depends on the lung injury severity within the first 24 hours of ARDS onset. We investigated whether two widely accepted cutoff values of PaO2/FIO2 and positive end-expiratory pressure (PEEP) would identify subsets of patients with ARDS for predicting outcome and guiding therapy. A 16-month (September 2008 to January 2010) prospective, multicenter, observational study. Seventeen multidisciplinary ICUs in Spain. We studied 300 consecutive, mechanically ventilated patients meeting American-European Consensus Conference criteria for ARDS (PaO2/FIO2 ≤ 200 mm Hg) on PEEP greater than or equal to 5 cm H2O, and followed up until hospital discharge. None. Based on threshold values for PaO2/FIO2 (150 mm Hg) and PEEP (10 cm H2O) at ARDS onset and at 24 hours, we assigned patients to four categories: group I (PaO2/FIO2 ≥ 150 on PEEP < 10), group II (PaO2/FIO2 ≥ 150 on PEEP ≥ 10), group III (PaO2/FIO2 < 150 on PEEP < 10), and group IV (PaO2/FIO2 < 150 on PEEP ≥ 10). The primary outcome was all-cause in-hospital mortality. Overall hospital mortality was 46.3%. Although at study entry, patients with PaO2/FIO2 less than 150 had a higher mortality than patients with a PaO2/FIO2 greater than or equal to 150 (p = 0.044), there was minimal variability in mortality among the four groups (p = 0.186). However, classification of patients in each group changed markedly after 24 hours of usual care. Group categorization at 24 hours provided a strong association with in-hospital mortality (p < 0.00001): group I had the lowest mortality (23.1%), whereas group IV had the highest mortality (60.3%). The degree of lung dysfunction established by a PaO2/FIO2 of 150 mm Hg and a PEEP of 10 cm H2O demonstrated that ARDS is not a homogeneous disorder. Rather, it is a series of four subsets that should be considered for enrollment in clinical trials and for guiding therapy. A major

  10. Materials, Devices and Systems of Soft Bioelectronics for Precision Therapy.

    PubMed

    Wu, Hao; Gao, Wei; Yin, Zhouping

    2017-03-29

    The potential applications of soft bioelectronics in biomedical research and clinical trials have inspired a great deal of research interest in the past decade. While there has been significant amount of work in the fabrication and characterization of soft and stretchable sensors for monitoring of physical conditions and vital signs of human body, the development of soft bioelectronics based medical treatment and intervention systems has just begun. In addition to health monitoring, active treatments are essential for disease control in the healthcare domain, and medical therapy and surgery realized by sophisticated soft bioelectronic systems are better demonstrations of their utility in healthcare. In this Research News, we summarize recent key research achievements in soft bioelectronics enabled precision therapy, with emphasis on drug delivery, therapeutic and surgical mechanisms and tools enabled by integrated systems. Challenges in technology development and prospects for commercialization are also discussed.

  11. A microfluidic respiratory assist device with high gas permeance for artificial lung applications.

    PubMed

    Kniazeva, Tatiana; Hsiao, James C; Charest, Joseph L; Borenstein, Jeffrey T

    2011-04-01

    One of the principal challenges in artificial lung technology has been the ability to provide levels of oxygen and carbon dioxide exchange that rival those of the natural human lung, while mitigating the deleterious interaction between blood and the surface of the synthetic gas exchange membrane. This interaction is exacerbated by the large oxygenator surface area required to achieve sufficient levels of gas transfer. In an effort to address this challenge, microfluidics-based artificial lung technologies comprising stacked microchannel networks have been explored by several groups. Here we report the design, fabrication and initial testing of a parallel plate multilayered silicone-based microfluidic construct containing ultrathin gas exchange membranes, aimed at maximizing gas transfer efficiency while minimizing membrane-blood contact area. The device comprises a branched microvascular network that provides controlled wall shear stress and uniform blood flow, and is designed to minimize blood damage, thrombosis and inflammatory responses seen in current oxygenators. Initial testing indicates that flow distribution through the multilayer structure is uniform and that the thin membrane can withstand pressures equivalent to those expected during operation. Oxygen transfer using phosphate buffered saline as the carrier fluid has also been assessed, demonstrating a sharp increase in oxygen transfer as membrane thickness is reduced, consistent with the expected values of oxygen permeance for thin silicone membranes.

  12. Thoratec paracorporeal biventricular assist device therapy: the Freiburg experience†

    PubMed Central

    Brehm, Kerstin; Heilmann, Claudia; Siepe, Matthias; Benk, Christoph; Beyersdorf, Friedhelm; Schlensak, Christian

    2012-01-01

    OBJECTIVE The treatment of severe biventricular (BV) contractile failure using mechanical circulatory support is challenging. We analyzed our center’s results following implantation of a biventricular assist device (BVAD). METHODS We implanted 39 BVADs between September 2001 and January 2009. All patients were qualified candidates for heart transplantation, without an organ available at time of BVAD implantation. Fifteen patients without a history of chronic cardiomyopathy suffered from acute BV failure (group 1), whereas the other 24 suffered from severe chronic cardiomyopathy (group 2). The indication for BVAD implantation was determined in reference to echocardiography, the degree of end-organ damage, and whether the patient qualified for a heart transplant or was a candidate for bridge to recovery. RESULTS Both groups were similar regarding their preoperative hemodynamics, intraoperative and early postoperative findings, and adverse events. Patients in group 1 were younger (mean age 37 ± 17 years) than those in group 2 (51 ± 12 years). Mean duration of support in group 1 was 137 ± 109 days, and 65 ± 61 days in group 2. In group 1, 33% (5/15) were weaned off the device and 53% (8/15) underwent heart transplantation, whereas 8/24 patients (42%) in the chronic group were transplanted. Group 1’s mortality on the device was lower than that of group 2 (13% vs 67%). Furthermore, 11 patients of group 1 survived for 1 year compared with four in group 2 (73% vs 17%). CONCLUSION Implantation of a BVAD in patients with chronic heart failure and acute decompensation is associated with a high mortality and morbidity rate. By contrast, BVAD implantation can achieve excellent results in patients with acute BV failure without a history of chronic cardiomyopathy, even if they are in cardiogenic shock upon admission. PMID:21592811

  13. Evolution of Endovascular Therapy in Acute Stroke: Implications of Device Development

    PubMed Central

    Balasubramaian, Adithya; Mitchell, Peter; Dowling, Richard

    2015-01-01

    Intravenous thrombolysis is an effective treatment for acute ischaemic stroke. However, vascular recanalization rates remain poor especially in the setting of large artery occlusion. On the other hand, endovascular intra-arterial therapy addresses this issue with superior recanalization rates compared with intravenous thrombolysis. Although previous randomized controlled studies of intra-arterial therapy failed to demonstrate superiority, the failings may be attributed to a combination of inferior intra-arterial devices and suboptimal selection criteria. The recent results of several randomized controlled trials have demonstrated significantly improved outcomes, underpinning the advantage of newer intra-arterial devices and superior recanalization rates, leading to renewed interest in establishing intra-arterial therapy as the gold standard for acute ischaemic stroke. The aim of this review is to outline the history and development of different intra-arterial devices and future directions in research. PMID:26060800

  14. 21 CFR 878.4683 - Non-Powered suction apparatus device intended for negative pressure wound therapy.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Non-Powered suction apparatus device intended for... Surgical Devices § 878.4683 Non-Powered suction apparatus device intended for negative pressure wound therapy. (a) Identification. A non-powered suction apparatus device intended for negative pressure wound...

  15. Hydrogel microfluidic co-culture device for photothermal therapy and cancer migration.

    PubMed

    Lee, Jong Min; Seo, Hye In; Bae, Jun Hyuk; Chung, Bong Geun

    2017-02-07

    We developed the photo-crosslinkable hydrogel microfluidic co-culture device to study photothermal therapy and cancer cell migration. To culture MCF7 human breast carcinoma cells and metastatic U87MG human glioblastoma in the microfluidic device, we used 10 w/v% gelatin methacrylate (GelMA) hydrogels as a semi-permeable physical barrier. We demonstrated the effect of gold nanorod on photothermal therapy of cancer cells in the microfluidic co-culture device. Interestingly, we observed that metastatic U87MG human glioblastoma largely migrated toward vascular endothelial growth factor (VEGF)-treated GelMA hydrogel-embedding microchannels. The main advantage of this hydrogel microfluidic co-culture device is to simultaneously analyze the physiological migration behaviors of two cancer cells with different physiochemical motilities and study gold nanorod-mediated photothermal therapy effect. Therefore, this hydrogel microfluidic co-culture device could be a potentially powerful tool for photothermal therapy and cancer cell migration applications. This article is protected by copyright. All rights reserved.

  16. Multifunctional wearable devices for diagnosis and therapy of movement disorders.

    PubMed

    Son, Donghee; Lee, Jongha; Qiao, Shutao; Ghaffari, Roozbeh; Kim, Jaemin; Lee, Ji Eun; Song, Changyeong; Kim, Seok Joo; Lee, Dong Jun; Jun, Samuel Woojoo; Yang, Shixuan; Park, Minjoon; Shin, Jiho; Do, Kyungsik; Lee, Mincheol; Kang, Kwanghun; Hwang, Cheol Seong; Lu, Nanshu; Hyeon, Taeghwan; Kim, Dae-Hyeong

    2014-05-01

    Wearable systems that monitor muscle activity, store data and deliver feedback therapy are the next frontier in personalized medicine and healthcare. However, technical challenges, such as the fabrication of high-performance, energy-efficient sensors and memory modules that are in intimate mechanical contact with soft tissues, in conjunction with controlled delivery of therapeutic agents, limit the wide-scale adoption of such systems. Here, we describe materials, mechanics and designs for multifunctional, wearable-on-the-skin systems that address these challenges via monolithic integration of nanomembranes fabricated with a top-down approach, nanoparticles assembled by bottom-up methods, and stretchable electronics on a tissue-like polymeric substrate. Representative examples of such systems include physiological sensors, non-volatile memory and drug-release actuators. Quantitative analyses of the electronics, mechanics, heat-transfer and drug-diffusion characteristics validate the operation of individual components, thereby enabling system-level multifunctionalities.

  17. Evaluation of breathing patterns for respiratory-gated radiation therapy using the respiration regularity index

    NASA Astrophysics Data System (ADS)

    Cheong, Kwang-Ho; Lee, MeYeon; Kang, Sei-Kwon; Yoon, Jai-Woong; Park, SoAh; Hwang, Taejin; Kim, Haeyoung; Kim, KyoungJu; Han, Tae Jin; Bae, Hoonsik

    2015-01-01

    worse regularity than the others whereas ρ > 0.7 was suitable for respiratory-gated radiation therapy (RGRT). Fluctuations in the breathing cycle and the amplitude were especially determinative of ρ. If the respiration regularity of a patient's first session was known, it could be estimated through subsequent sessions. Notably, the breathing patterns of the lung cancer patients were more irregular than those of the liver cancer patients. Respiration regularity could be objectively determined by using a composite index, ρ. Such a single-index testing of respiration regularity can facilitate determination of RGRT availability in clinical settings, especially for free-breathing cases.

  18. An analysis of features of respiratory therapy departments that are avid for change.

    PubMed

    Stoller, James K; Kester, Lucy; Roberts, Vincent T; Orens, Douglas K; Babic, Mark D; Lemin, Martha E; Hoisington, Edward R; Dolgan, Colleen M; Cohen, Harlow B; Chatburn, Robert L

    2008-07-01

    Models of organizational change-readiness have been developed, but little attention has been given to features of change-avid health-care institutions, and, to our knowledge, no attention has been given to features of change-avid respiratory therapy (RT) departments. We conducted an exploratory study to compare RT departments we deemed change-avid or non-change-avid, to identify differentiating characteristics. Our assessments regarding change-readiness and avidity were based on structured, in-person interviews of the technical directors and/or medical directors of 8 RT departments. Based on a priori criteria, 4 of the 8 RT departments were deemed change-avid, based on the presence of > or = 2 of the following 3 criteria: (1) uses a management information system, (2) uses a comprehensive RT protocol program, (3) uses noninvasive ventilation in > 20% of patients with exacerbation of chronic obstructive pulmonary disease. Our ratings of the departments were based on 2 scales: one from Integrated Organizational Development Inc, and the 8-stage change model of Kotter. The ratings of the 4 change-avid departments differed significantly from those of the 4 non-change-avid departments, on both the Integrated Organizational Development Inc scale and the Kotter scale. We identified 11 highly desired features of a change-avid RT department: a close working relationship between the medical director and the RT staff; a strong and supportive hospital "champion" for change; using data to define problems and measure the effectiveness of solutions; using redundant types of communication; recognizing resistance and minimizing obstacles to change; being willing to tackle tough issues; maintaining a culture of ongoing education; consistently rewarding change-avid behavior; fostering ownership for change and involving stakeholders; attending to RT leadership succession planning; and having and communicating a vision for the department. In this first exploratory study we found that

  19. Current Treatment Strategies for Heart Failure: Role of Device Therapy and LV Reconstruction.

    PubMed

    Janaswamy, Praneeth; Walters, Tomos E; Nazer, Babak; Lee, Randall J

    2016-09-01

    Medical care of heart failure (HF) begins with the determination of the cause of the heart failure and diagnosing potential reversible causes (i.e., coronary heart disease, hyperthyroidism, etc.). Medical therapy includes pharmacological and nonpharmacological strategies that limit and/or reverse the signs and symptoms of HF. Initial behavior modification includes dietary sodium and fluid restriction to avoid weight gain; and encouraging physical activity when appropriate. Optimization of medical therapy is the first line of treatment that includes the use of diuretics, vasodilators (i.e., ACE inhibitors or ARBs), beta blockers, and potentially inotropic agents and anticoagulation depending on the patient's severity of heart failure and LV dysfunction. As heart failure advances despite optimized medical management, cardiac resynchronization therapy (CRT), and implantable cardioverter defibrillators (ICDs) are appropriate device therapies. The development of progressive end-stage HF, despite maximal medical therapy, necessitates the consideration of mechanical circulatory devices such as ventricular assist devices (VADs) either as a bridge to heart transplantation or as destination therapy. Despite the advances in the treatment of heart failure, there is still a large morbidity and mortality associated with HF, thus the need to develop newer strategies for the treatment of HF.

  20. A Survey of Insulin-Dependent Diabetes—Part I: Therapies and Devices

    PubMed Central

    Takahashi, Daisuke; Xiao, Yang; Hu, Fei; Lewis, Michael

    2008-01-01

    This paper surveys diabetes therapies from telemedicine viewpoint. In type 1 diabetes therapies, the exogenous insulin replacement is generally considered as a primary treatment. However, the complete replacement of exogenous insulin is still a challenging issue because of its complexity of modeling the dynamics, which is typically modeled nonlinearly. On the other hand, thanks to the progress of medical devices, currently the diabetes therapies are being automated. These medical devices include automated insulin pumps and blood glucose sensors. Insulin pumps are designed to create artificial insulin perfusion while they largely rely on the blood glucose profile measurements and these measurements are achieved by one or more blood glucose sensors. The blood glucose measurements are also important for the insulin-dependent diabetes therapies. An insulin pump along with sensors establishes a good feedback system providing the appropriate amount of the exogenous insulin on demand. Controlling the amount of exogenous insulin to suppress the blood glucose levels requires complicated computations. This paper mostly explains both type 1 and 2 diabetes and their mechanisms accompanied by descriptions of diabetes therapy and medical devices currently utilized in the therapy. PMID:18437199

  1. Comparison of high-flow nasal oxygen therapy with conventional oxygen therapy and noninvasive ventilation in adult patients with acute hypoxemic respiratory failure: A meta-analysis and systematic review.

    PubMed

    Maitra, Souvik; Som, Anirban; Bhattacharjee, Sulagna; Arora, Mahesh K; Baidya, Dalim K

    2016-10-01

    The role of high-flow nasal oxygen (HFNO) therapy in adult patients with acute hypoxemic respiratory failure is controversial. This meta-analysis of prospective randomized controlled trials (RCTs) has been designed to compare HFNO with noninvasive ventilation (NIV) and conventional oxygen therapy in such patients. Initial database searching revealed 336 RCTs, of which 7 were included in this meta-analysis. Five RCTs compared HFNO with standard oxygen therapy, one compared HFNO with NIV, and one compared all three. HFNO did not decrease the requirement of higher respiratory support compared with control group. HFNO was associated with improved respiratory rate and dyspnea score, and better comfort in 3 RCTs, whereas other studies did not find any difference. High-flow nasal oxygen does not offer any benefit over NIV or conventional oxygen therapy in terms of requirement of higher respiratory support. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Impact of Respiratory Motion on Worst-Case-Scenario Optimized Intensity-Modulated Proton Therapy for Lung Cancers

    PubMed Central

    Liu, Wei; Liao, Zhongxing; Schild, Steven E.; Liu, Zhong; Li, Heng; Li, Yupeng; Park, Peter C.; Li, Xiaoqiang; Stoker, Joshua; Shen, Jiajian; Keole, Sameer; Anand, Aman; Fatyga, Mirek; Dong, Lei; Sahoo, Narayan; Vora, Sujay; Wong, William; Zhu, X. Ronald; Bues, Martin; Mohan, Radhe

    2014-01-01

    Background We compared conventionally optimized intensity-modulated proton therapy (IMPT) treatment plans against the worst-case scenario optimized treatment plans for lung cancer. The comparison of the two IMPT optimization strategies focused on the resulting plans’ ability to retain dose objectives under the influence of patient set-up, inherent proton range uncertainty, and dose perturbation caused by respiratory motion. Methods For each of the 9 lung cancer cases two treatment plans were created accounting for treatment uncertainties in two different ways: the first used the conventional method: delivery of prescribed dose to the planning target volume (PTV) that is geometrically expanded from the internal target volume (ITV). The second employed the worst-case scenario optimization scheme that addressed set-up and range uncertainties through beamlet optimization. The plan optimality and plan robustness were calculated and compared. Furthermore, the effects on dose distributions of the changes in patient anatomy due to respiratory motion was investigated for both strategies by comparing the corresponding plan evaluation metrics at the end-inspiration and end-expiration phase and absolute differences between these phases. The mean plan evaluation metrics of the two groups were compared using two-sided paired t-tests. Results Without respiratory motion considered, we affirmed that worst-case scenario optimization is superior to PTV-based conventional optimization in terms of plan robustness and optimality. With respiratory motion considered, worst-case-scenario optimization still achieved more robust dose distributions to respiratory motion for targets and comparable or even better plan optimality [D95% ITV: 96.6% versus 96.1% (p=0.26), D5% − D95% ITV: 10.0% versus 12.3% (p=0.082), D1% spinal cord: 31.8% versus 36.5% (p =0.035)]. Conclusions Worst-case scenario optimization led to superior solutions for lung IMPT. Despite of the fact that worst

  3. Impact of respiratory motion on worst-case scenario optimized intensity modulated proton therapy for lung cancers.

    PubMed

    Liu, Wei; Liao, Zhongxing; Schild, Steven E; Liu, Zhong; Li, Heng; Li, Yupeng; Park, Peter C; Li, Xiaoqiang; Stoker, Joshua; Shen, Jiajian; Keole, Sameer; Anand, Aman; Fatyga, Mirek; Dong, Lei; Sahoo, Narayan; Vora, Sujay; Wong, William; Zhu, X Ronald; Bues, Martin; Mohan, Radhe

    2015-01-01

    We compared conventionally optimized intensity modulated proton therapy (IMPT) treatment plans against worst-case scenario optimized treatment plans for lung cancer. The comparison of the 2 IMPT optimization strategies focused on the resulting plans' ability to retain dose objectives under the influence of patient setup, inherent proton range uncertainty, and dose perturbation caused by respiratory motion. For each of the 9 lung cancer cases, 2 treatment plans were created that accounted for treatment uncertainties in 2 different ways. The first used the conventional method: delivery of prescribed dose to the planning target volume that is geometrically expanded from the internal target volume (ITV). The second used a worst-case scenario optimization scheme that addressed setup and range uncertainties through beamlet optimization. The plan optimality and plan robustness were calculated and compared. Furthermore, the effects on dose distributions of changes in patient anatomy attributable to respiratory motion were investigated for both strategies by comparing the corresponding plan evaluation metrics at the end-inspiration and end-expiration phase and absolute differences between these phases. The mean plan evaluation metrics of the 2 groups were compared with 2-sided paired Student t tests. Without respiratory motion considered, we affirmed that worst-case scenario optimization is superior to planning target volume-based conventional optimization in terms of plan robustness and optimality. With respiratory motion considered, worst-case scenario optimization still achieved more robust dose distributions to respiratory motion for targets and comparable or even better plan optimality (D95% ITV, 96.6% vs 96.1% [P = .26]; D5%- D95% ITV, 10.0% vs 12.3% [P = .082]; D1% spinal cord, 31.8% vs 36.5% [P = .035]). Worst-case scenario optimization led to superior solutions for lung IMPT. Despite the fact that worst-case scenario optimization did not explicitly account for

  4. Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device.

    PubMed

    Ischaki, Eleni; Pantazopoulos, Ioannis; Zakynthinos, Spyros

    2017-09-30

    Nasal high flow is a promising novel oxygen delivery device, whose mechanisms of action offer some beneficial effects over conventional oxygen systems. The administration of a high flow of heated and humidified gas mixture promotes higher and more stable inspiratory oxygen fraction values, decreases anatomical dead space and generates a positive airway pressure that can reduce the work of breathing and enhance patient comfort and tolerance. Nasal high flow has been used as a prophylactic tool or as a treatment device mostly in patients with acute hypoxaemic respiratory failure, with the majority of studies showing positive results. Recently, its clinical indications have been expanded to post-extubated patients in intensive care or following surgery, for pre- and peri-oxygenation during intubation, during bronchoscopy, in immunocompromised patients and in patients with "do not intubate" status. In the present review, we differentiate studies that suggest an advantage (benefit) from other studies that do not suggest an advantage (no benefit) compared to conventional oxygen devices or noninvasive ventilation, and propose an algorithm in cases of nasal high flow application in patients with acute hypoxaemic respiratory failure of almost any cause. Copyright ©ERS 2017.

  5. Acoustic regulation of extracorporeal shock wave (ESW) therapy devices in the U.S

    NASA Astrophysics Data System (ADS)

    Maruvada, Subha; Harris, Gerald R.

    2005-04-01

    The focused, large amplitude pressure fields produced by ESW lithotripsy devices were shown in the early 1980s to provide an efficient means for fragmenting urinary tract calculi. More recently, orthopedic applications of intense pressure pulses for pain relief and fracture healing have been developed. Under the US Medical Device Amendments of 1976, ESW therapy devices were deemed Class III, meaning that a pre-market application typically would be supported by both pre-clinical and clinical studies. This classification still applies, except for ESW lithotripters indicated for fragmenting kidney and ureteral calculi. These devices were reclassified to Class II in 2000, resulting in a simpler path to market in which a demonstration of substantial equivalence to a currently marketed device is sufficient. As part of its regulatory responsibility to address the safety and effectiveness of these devices, particularly with regard to acoustic output, the US Food and Drug Administration has recognized two International Electrotechnical Commission (IEC) standards for ESW lithotripters, one covering field measurements (IEC 61846) and the other dealing with labeling and other safety aspects (IEC 60601-2-36). Although these standards were designed primarily for lithotripsy, the FDA has used them where applicable in the regulatory analysis of other ESW therapy devices.

  6. Evaluation of advanced cooling therapy's esophageal cooling device for core temperature control.

    PubMed

    Naiman, Melissa; Shanley, Patrick; Garrett, Frank; Kulstad, Erik

    2016-05-01

    Managing core temperature is critical to patient outcomes in a wide range of clinical scenarios. Previous devices designed to perform temperature management required a trade-off between invasiveness and temperature modulation efficiency. The Esophageal Cooling Device, made by Advanced Cooling Therapy (Chicago, IL), was developed to optimize warming and cooling efficiency through an easy and low risk procedure that leverages heat transfer through convection and conduction. Clinical data from cardiac arrest, fever, and critical burn patients indicate that the Esophageal Cooling Device performs very well both in terms of temperature modulation (cooling rates of approximately 1.3°C/hour, warming of up to 0.5°C/hour) and maintaining temperature stability (variation around goal temperature ± 0.3°C). Physicians have reported that device performance is comparable to the performance of intravascular temperature management techniques and superior to the performance of surface devices, while avoiding the downsides associated with both.

  7. Development of an MRI-compatible device for prostate focal therapy.

    PubMed

    Cepek, Jeremy; Chronik, Blaine; Lindner, Uri; Trachtenberg, John; Fenster, Aaron

    2012-01-01

    We present a device that has been developed for delivering prostate focal thermal therapy under magnetic resonance imaging (MRI) guidance. Unlike most existing devices, ours is capable of delivering needles to targets in the prostate without removing the patient from the scanner. This feature greatly reduces procedure time and increases accuracy. The device consists of a mechanical linkage encoded with optical incremental encoders, and is manually actuated. A custom magnetic resonance (MR) compatible alignment interface allows the user to manually align the device to its target with high accuracy in-bore in very short time. The use of manual actuation over motors greatly reduces the complexity and bulk of the system, making it much more compact and portable. This is important when dealing with such tight space constraints. Needle targeting experiments in gel phantoms have demonstrated the device's ability to deliver needles with an accuracy of 2.1 +/- 1.3 mm.

  8. A devices' game of thrones: cardiac resynchronization therapy vs. pacemaker.

    PubMed

    Moura-Ferreira, Sara; Gonçalves, Helena; Oliveira, Marco; Primo, João; Fonseca, Paulo; Ribeiro, José; Santos, Elisabeth; Pelicano, Nuno; Martins, Dinis; Gama, Vasco

    2017-04-18

    Oversensing can interfere with biventricular pacing. Cardiac Resynchronization Therapy (CRT) output inhibition due to automatic brady mode change from a sensing to a pacing mode of a previously implanted pacemaker as it reached battery capacity depleted indicator has not been previously published in the medical literature. We report the first case of CRT output inhibition in a pacemaker dependent patient due to electrical stimuli from a previously right-sided implanted pacemaker, after unaware reversion of OVO mode (O = no chambers paced; V = ventricular sensing; O = no response to sensing) to backup VVI (V = ventricular pacing; V = ventricular sensing; I = inhibitory response to sensing) when it reached the elective replacement interval. This paper emphasizes the importance of knowing the distinct pacemaker brady mode behaviours after battery capacity depleted indicator has been reached, according to the pacemakers' manufacturer, including the possibility of automatic brady mode change from sensing to pacing mode. It also highlights the potential for severe bradycardia or asystole of this automatic brady mode change from a previously implanted pacemaker in pacemaker dependent patients submitted to CRT upgrade.

  9. Inter-device differences in monitoring for goal-directed fluid therapy.

    PubMed

    Thiele, Robert H; Bartels, Karsten; Gan, Tong-Joo

    2015-02-01

    Goal-directed fluid therapy is an integral component of many Enhanced Recovery After Surgery (ERAS) protocols currently in use. The perioperative clinician is faced with a myriad of devices promising to deliver relevant physiologic data to better guide fluid therapy. The goal of this review is to provide concise information to enable the clinician to make an informed decision when choosing a device to guide goal-directed fluid therapy. The focus of many devices used for advanced hemodynamic monitoring is on providing measurements of cardiac output, while other, more recent, devices include estimates of fluid responsiveness based on dynamic indices that better predict an individual's response to a fluid bolus. Currently available technologies include the pulmonary artery catheter, esophageal Doppler, arterial waveform analysis, photoplethysmography, venous oxygen saturation, as well as bioimpedance and bioreactance. The underlying mechanistic principles for each device are presented as well as their performance in clinical trials relevant for goal-directed therapy in ERAS. The ERAS protocols typically involve a multipronged regimen to facilitate early recovery after surgery. Optimizing perioperative fluid therapy is a key component of these efforts. While no technology is without limitations, the majority of the currently available literature suggests esophageal Doppler and arterial waveform analysis to be the most desirable choices to guide fluid administration. Their performance is dependent, in part, on the interpretation of dynamic changes resulting from intrathoracic pressure fluctuations encountered during mechanical ventilation. Evolving practice patterns, such as low tidal volume ventilation as well as the necessity to guide fluid therapy in spontaneously breathing patients, will require further investigation.

  10. A finite state model for respiratory motion analysis in image guided radiation therapy

    NASA Astrophysics Data System (ADS)

    Wu, Huanmei; Sharp, Gregory C.; Salzberg, Betty; Kaeli, David; Shirato, Hiroki; Jiang, Steve B.

    2004-12-01

    Effective image guided radiation treatment of a moving tumour requires adequate information on respiratory motion characteristics. For margin expansion, beam tracking and respiratory gating, the tumour motion must be quantified for pretreatment planning and monitored on-line. We propose a finite state model for respiratory motion analysis that captures our natural understanding of breathing stages. In this model, a regular breathing cycle is represented by three line segments, exhale, end-of-exhale and inhale, while abnormal breathing is represented by an irregular breathing state. In addition, we describe an on-line implementation of this model in one dimension. We found this model can accurately characterize a wide variety of patient breathing patterns. This model was used to describe the respiratory motion for 23 patients with peak-to-peak motion greater than 7 mm. The average root mean square error over all patients was less than 1 mm and no patient has an error worse than 1.5 mm. Our model provides a convenient tool to quantify respiratory motion characteristics, such as patterns of frequency changes and amplitude changes, and can be applied to internal or external motion, including internal tumour position, abdominal surface, diaphragm, spirometry and other surrogates.

  11. The Effectiveness of Cervical Spondylosis Therapy with Saunders Traction Device and High-Intensity Laser Therapy: A Randomized Controlled Trial

    PubMed Central

    Haładaj, Robert; Pingot, Mariusz; Topol, Mirosław

    2017-01-01

    Background Among all spinal therapies, treatment of the cervical segment is the most difficult. The cervical segment is particularly sensitive to injuries and pain, and it also requires special care due to its great mobility and most delicate construction. The aim of this research was to evaluate analgesic efficacy and improvement of active mobility of the cervical spine after traction therapy with the Saunders device and high-intensity laser therapy (HILT) immediately after therapy, and in short-, medium-, and long-term follow-up in patients with cervical spondylosis. Material/Methods The study included 174 patients (114 women and 60 men) aged 24–67 years. The patients were divided into two randomized groups. In group I (88 subjects) traction therapy with the Saunders device was applied, and in group II (86 subjects) HILT was applied. The measurement of the range of cervical spine movement, a subjective visual scale for pain (Visual Analog Scale [VAS]), and the Neck Disability Index-Polish Version (NDI) questionnaire were used. Results The results obtained by the Saunders and HILT methods were similar immediately after the therapy and after 4 weeks (the medium-term follow-up). However, in long-term follow-up, there was a significant increase in the maintenance of positive therapeutic effects with the HILT method. Conclusions Both therapeutic methods improved the efficiency and demonstrated analgesic efficacy in patients with cervical spondylosis immediately and in the medium term after the therapy. HILT was more effective than the Saunders method in long-term follow-up. PMID:28104903

  12. Amplatzer device and vacuum-assisted closure therapy to treat a thoracic empyema with bronchopleural fistula.

    PubMed

    Passera, Eliseo; Guanella, Giovanni; Meroni, Alberto; Chiesa, Giuseppe; Rizzi, Adriano; Rocco, Gaetano

    2011-08-01

    We present a case of lower bilobectomy complicated by a large bronchopleural fistula and empyema 1 month after primary surgery. The patient was immediately treated with an open window thoracostomy. After surgical debridement, an Amplatzer Septal Occluder device (AGA Medical Corp, Plymouth, MN) was positioned to close the fistula. Thereafter, the thoracostomy rapidly and spontaneously closed with vacuum-assisted closure therapy.

  13. Enhancing Autophagy with Drugs or Lung-directed Gene Therapy Reverses the Pathological Effects of Respiratory Epithelial Cell Proteinopathy*

    PubMed Central

    Hidvegi, Tunda; Stolz, Donna B.; Alcorn, John F.; Yousem, Samuel A.; Wang, Jieru; Leme, Adriana S.; Houghton, A. McGarry; Hale, Pamela; Ewing, Michael; Cai, Houming; Garchar, Evelyn Akpadock; Pastore, Nunzia; Annunziata, Patrizia; Kaminski, Naftali; Pilewski, Joseph; Shapiro, Steven D.; Pak, Stephen C.; Silverman, Gary A.; Brunetti-Pierri, Nicola; Perlmutter, David H.

    2015-01-01

    Recent studies have shown that autophagy mitigates the pathological effects of proteinopathies in the liver, heart, and skeletal muscle but this has not been investigated for proteinopathies that affect the lung. This may be due at least in part to the lack of an animal model robust enough for spontaneous pathological effects from proteinopathies even though several rare proteinopathies, surfactant protein A and C deficiencies, cause severe pulmonary fibrosis. In this report we show that the PiZ mouse, transgenic for the common misfolded variant α1-antitrypsin Z, is a model of respiratory epithelial cell proteinopathy with spontaneous pulmonary fibrosis. Intracellular accumulation of misfolded α1-antitrypsin Z in respiratory epithelial cells of the PiZ model resulted in activation of autophagy, leukocyte infiltration, and spontaneous pulmonary fibrosis severe enough to elicit functional restrictive deficits. Treatment with autophagy enhancer drugs or lung-directed gene transfer of TFEB, a master transcriptional activator of the autophagolysosomal system, reversed these proteotoxic consequences. We conclude that this mouse is an excellent model of respiratory epithelial proteinopathy with spontaneous pulmonary fibrosis and that autophagy is an important endogenous proteostasis mechanism and an attractive target for therapy. PMID:26494620

  14. Validation of a Mobile Device for Acoustic Coordinated Reset Neuromodulation Tinnitus Therapy.

    PubMed

    Hauptmann, Christian; Wegener, Alexander; Poppe, Hendrik; Williams, Mark; Popelka, Gerald; Tass, Peter A

    2016-10-01

    Sound-based tinnitus intervention stimuli include broad-band noise signals with subjectively adjusted bandwidths used as maskers delivered by commercial devices or hearing aids, environmental sounds broadly described and delivered by both consumer devices and hearing aids, music recordings specifically modified and delivered in a variety of different ways, and other stimuli. Acoustic coordinated reset neuromodulation therapy for tinnitus reduction has unique and more stringent requirements compared to all other sound-based tinnitus interventions. These include precise characterization of tinnitus pitch and loudness, and effective provision of patient-controlled daily therapy signals at defined frequencies, levels, and durations outside of the clinic. The purpose of this study was to evaluate an approach to accommodate these requirements including evaluation of a mobile device, validation of an automated tinnitus pitch-matching algorithm and assessment of a patient's ability to control stimuli and collect repeated outcome measures. The experimental design involved direct laboratory measurements of the sound delivery capabilities of a mobile device, comparison of an automated, adaptive pitch-matching method to a traditional manual method and measures of a patient's ability to understand and manipulate a mobile device graphic user interface to both deliver the therapy signals and collect the outcome measures. This study consisted of 5 samples of a common mobile device for the laboratory measures and a total of 30 adult participants: 15 randomly selected normal-hearing participants with simulated tinnitus for validation of a tinnitus pitch-matching algorithm and 15 sequentially selected patients already undergoing tinnitus therapy for evaluation of patient usability. No tinnitus intervention(s) were specifically studied as a component of this study. Data collection involved laboratory measures of mobile devices, comparison of manual and automated adaptive tinnitus

  15. New directions in device therapies among children and adults with congenital heart.

    PubMed

    Khan, Asra; Karpawich, Peter P

    2010-12-01

    Innovative, nonthoracotomy, catheter-delivered therapies have redefined the approach to and treatment of congenital heart defects. Starting in the 1960s with the creation of an opening in the atrial septum to permit effective blood mixing and improve oxygen saturation in cyanotic infants, interventional cardiac procedures continue to replace many of the time-honored surgeries that were the mainstay of repair or correction for infants and children with heart defects. Now as those children reach adulthood and still require modifications of their defects, catheter-based interventions are becoming more important. This article examines some of the more recent applications of device therapy currently available to patients with congenital heart, including heart failure, septal defects, vascular problems and heart valves. Device use in deference to surgery, risks and benefits as well as complications associated with such catheter-delivered therapies are discussed.

  16. Efficacy of metaphylactic florfenicol therapy during natural outbreaks of bovine respiratory disease.

    PubMed

    Catry, B; Duchateau, L; Van de Ven, J; Laevens, H; Opsomer, G; Haesebrouck, F; De Kruif, A

    2008-10-01

    The efficacy of an injectable formulation of florfenicol (300 mg/mL) as metaphylactic control of naturally occurring bovine respiratory disease (BRD) was evaluated in two double-blind randomly controlled field studies on two Dutch veal calf herds (A and B). Cattle aged not older than 3 months and in the direct presence of calves with clinical respiratory disease were randomly allocated to treatment with 40 mg/kg florfenicol subcutaneously (s.c.) a positive control treatment (12.5 mg/kg tilmicosin p.o. twice daily for five consecutive days in herd A, and 12.5 mg/kg doxycycline p.o. twice daily for five consecutive days in herd B), or a negative control (one placebo saline s.c. administration on D0). The predominant respiratory pathogens present in pretreatment respiratory samples from affected animals were Mycoplasma bovis and Pasteurella multocida in outbreaks A and B, respectively. Metaphylactic administration of florfenicol resulted in a statistically significant weight gain, decreased rectal temperature for five consecutive days after treatment and decreased metaphylactic failure percentages compared with both positive and negative control groups. In summary, these studies demonstrated that a single s.c. injection of florfenicol is effective and practical for control of the bacterial component of BRD in veal calves.

  17. Cardio-Pulmonary Function Testing. Continuing Education Curriculum for Respiratory Therapy.

    ERIC Educational Resources Information Center

    Saint Paul Technical Vocational Inst., MN.

    Compiled from interviews with personnel in pulmonary function testing (PFT) laboratories in the Minneapolis/St. Paul area, this competency-based curriculum guide is intended to provide a knowledge of PFT for persons who provide respiratory care. The guide contains 20 sections covering the following topics: vital capacity, flow measurements,…

  18. Severe Acute Respiratory Distress Syndrome during Infliximab Therapy in a Patient with Crohn Disease

    PubMed Central

    Schoehl, Johanna; Mechie, Nicolae-Catalin; Schwoerer, Harald; Moerer, Onnen; Quintel, Michael; Buck, Cordula; Ellenrieder, Volker; Neesse, Albrecht; Amanzada, Ahmad

    2016-01-01

    The occurrence of a noninfectious interstitial lung disease is a rare but life-threatening side effect of infliximab, an antitumor necrosis factor alpha antibody. The following case report of a patient with Crohn disease shows an extremely dramatic progression to a severe acute respiratory distress syndrome. PMID:27920644

  19. Cardio-Pulmonary Function Testing. Continuing Education Curriculum for Respiratory Therapy.

    ERIC Educational Resources Information Center

    Saint Paul Technical Vocational Inst., MN.

    Compiled from interviews with personnel in pulmonary function testing (PFT) laboratories in the Minneapolis/St. Paul area, this competency-based curriculum guide is intended to provide a knowledge of PFT for persons who provide respiratory care. The guide contains 20 sections covering the following topics: vital capacity, flow measurements,…

  20. Advanced Gene Therapy for Treatment of Cardiomyopathy and Respiratory Insufficiency in Duchenne Muscular Dystrophy

    DTIC Science & Technology

    2014-09-01

    lasting and elevated gene expression in cardiac and skeletal muscles in murine, canine, and rhesus monkey models, suggesting the feasibility of using...patients. Juvenile GRMD dogs will be administered a single dose of vector to the intrapleural space and serially assessed for respiratory function

  1. The fetal circulation, pathophysiology of hypoxemic respiratory failure and pulmonary hypertension in neonates, and the role of oxygen therapy.

    PubMed

    Lakshminrusimha, S; Saugstad, O D

    2016-06-01

    Neonatal hypoxemic respiratory failure (HRF), a deficiency of oxygenation associated with insufficient ventilation, can occur due to a variety of etiologies. HRF can result when pulmonary vascular resistance (PVR) fails to decrease at birth, leading to persistent pulmonary hypertension of newborn (PPHN), or as a result of various lung disorders including congenital abnormalities such as diaphragmatic hernia, and disorders of transition such as respiratory distress syndrome, transient tachypnea of newborn and perinatal asphyxia. PVR changes throughout fetal life, evident by the dynamic changes in pulmonary blood flow at different gestational ages. Pulmonary vascular transition at birth requires an interplay between multiple vasoactive mediators such as nitric oxide, which can be potentially inactivated by superoxide anions. Superoxide anions have a key role in the pathophysiology of HRF. Oxygen (O2) therapy, used in newborns long before our knowledge of the complex nature of HRF and PPHN, has continued to evolve. Over time has come the discovery that too much O2 can be toxic. Recommendations on the optimal inspired O2 levels to initiate resuscitation in term newborns have ranged from 100% (pre 1998) to the currently recommended use of room air (21%). Questions remain about the most effective levels, particularly in preterm and low birth weight newborns. Attaining the appropriate balance between hypoxemia and hyperoxemia, and targeting treatments to the pathophysiology of HRF in each individual newborn are critical factors in the development of improved therapies to optimize outcomes.

  2. Validity of Outcome Prediction Scoring Systems in Korean Patients with Severe Adult Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation Therapy.

    PubMed

    Lee, Seunghyun; Yeo, Hye Ju; Yoon, Seong Hoon; Lee, Seung Eun; Cho, Woo Hyun; Jeon, Doo Soo; Kim, Yun Seong; Son, Bong Soo; Kim, Do Hyung

    2016-06-01

    Recently, several prognostic scoring systems for patients with severe acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO) have been published. The aim of this study was to validate the established scoring systems for outcome prediction in Korean patients. We retrospectively reviewed the data of 50 patients on ECMO therapy in our center from 2012 to 2014. A calculation of outcome prediction scoring tools was performed and the comparison across various models was conducted. In our study, the overall hospital survival was 46% and successful weaning rate was 58%. The Predicting Death for Severe ARDS on V-V ECMO (PRESERVE) score showed good discrimination of mortality prediction for patients on ECMO with AUC of 0.80 (95% CI 0.66-0.90). The respiratory extracorporeal membrane oxygenation survival prediction (RESP) score and simplified acute physiology score (SAPS) II score also showed fair prediction ability with AUC of 0.79 (95% CI 0.65-0.89) and AUC of 0.78 (95% CI 0.64-0.88), respectively. However, the ECMOnet score failed to predict mortality with AUC of 0.51 (95% CI 0.37-0.66). When evaluating the predictive accuracy according to optimal cut-off point of each scoring system, RESP score had a best specificity of 91.3% and 66.7% of sensitivity, respectively. This study supports the clinical usefulness of the prognostic scoring tools for severe ARDS with ECMO therapy when applying to the Korean patients receiving ECMO.

  3. Development of computer-assisted system for setting the appropriate margin of the organ with respiratory movement in radiation therapy planning

    NASA Astrophysics Data System (ADS)

    Tanaka, Rie; Sanada, Shigeru; Kobayashi, Takeshi; Suzuki, Masayuki; Kikuchi, Yuzo; Matsui, Takeshi; Matsui, Osamu

    2005-04-01

    External beam radiation therapy is becoming more common due to the increase in cancer rate because of the aging of society and respect for quality of life. Accurate radiation therapy planning is crucial to prevent cancer recurrence and damage to normal tissues. However, the margin for respiratory movement is commonly set based on the operators" experience, and sometimes lacks reproducibility and is not quantitative. The present study was performed to develop a computer-assisted system for setting appropriate margins of organs with respiratory movement in radiation therapy planning. Frontal and lateral chest fluoroscopic images (43×43cm) were obtained during respiration using a dynamic flat-panel detector system. Computer tomography (CT) images were obtained for radiation therapy planning, and digital reconstructed radiographs (DRRs) were created. The respiratory level of CT images was determined by measuring the distance from the lung apex to the diaphragm in DRR, and then one of the fluoroscopic images in the same respiratory level was determined. The thoracic vertebrae were automatically determined as landmarks, and then image registration between DRRs and fluoroscopic images was performed by template-matching. The range of respiratory movement of the target area in the lung was then measured in fluoroscopic images. The quantified range of respiratory movement was then correlated to CT data, and the appropriate margin for respiratory movement was displayed as 3D volume data in the lung. Our system could provide accurate margins for respiratory movement based on the quantified range of movement of the target in the lung during respiration.

  4. Development of an accurate fluid management system for a pediatric continuous renal replacement therapy device

    PubMed Central

    SANTHANAKRISHNAN, ARVIND; NESTLE, TRENT T.; MOORE, BRIAN L.; YOGANATHAN, AJIT P.; PADEN, MATTHEW L.

    2013-01-01

    Acute kidney injury is common in critically ill children and renal replacement therapies provide a life saving therapy to a subset of these children. However, there is no Food and Drug Administration approved device to provide pediatric continuous renal replacement therapy (CRRT). Consequently, clinicians adapt approved adult CRRT devices for use in children due to lack of safer alternatives. Complications occur using adult CRRT devices in children due to inaccurate fluid balance (FB) between the volumes of ultrafiltrate (UF) removed and replacement fluid (RF) delivered. We demonstrate the design and validation of a pediatric fluid management system for obtaining accurate instantaneous and cumulative FB. Fluid transport was achieved via multiple novel pulsatile diaphragm pumps. The conservation of volume principle leveraging the physical property of fluid incompressibility along with mechanical coupling via a crankshaft was used for FB. Accuracy testing was conducted in vitro for 8-hour long continuous operation of the coupled UF and RF pumps. The mean cumulative FB error was <1% across filtration flows from 300 mL/hour to 3000 mL/hour. This approach of FB control in a pediatric specific CRRT device would represent a significant accuracy improvement over currently used clinical implementations. PMID:23644618

  5. Inexpensive Attachment Device for Cell Therapy Administration into Injured Spinal Cord.

    PubMed

    Vaquero, Jesús; Zurita, Mercedes; Fernández, Cecilia; Cotua, Carlos

    2016-12-01

    Cell therapy is configured as a promising strategy for the treatment of spinal cord injury (SCI), but it requires reliable systems to achieve microinjections with different rates and volumes, according to the different characteristics of the injured spinal cord tissue and the targets previously selected. We sought to describe an original and inexpensive device for support of microinjection systems in the course of spinal cord surgery. Our attachment device consists of an arch and a system of bars that can be fixed to the operating table and on which a microinjection pump can be displaced and fixed in the course of surgery. This device has been used for therapy administration into injured spinal cords. It is easy to use and permits reproducible results. We have described an original attachment device for the support of a microinjection pump. It is applicable to spinal cord surgery and should be considered as a cheap solution for intralesional administration of cell therapy after spinal cord injury. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Monitoring of CRT-D devices during radiation therapy in vitro.

    PubMed

    Augustynek, Martin; Korpas, David; Penhaker, Marek; Cvek, Jakub; Binarova, Andrea

    2016-03-09

    Using of active cardiac medical devices increases steadily. In Europe, there were 183 implants of ICD and 944 implants of PM, 119 of biventricular ICD and 41 of biventricular PM, all per million inhabitants in 2014. Healthcare environments, including radiotherapy treatment rooms, are considered challenging for these implantable devices. Exposure to radiation may cause the device to experience premature elective replacement indicator, decreased pacing amplitude or pacing inhibition, inappropriate shocks or inhibition of tachyarrhythmia therapy and loss of device function. These impacts may be temporary or permanent. The aim of this study was to evaluate the influence of linear accelerator ionizing radiation dose of 10 Gy on the activity of the biventricular cardioverter-defibrillator in different position in radiation beam. Two identical wireless communication devices with all three leads were used for the measurement. Both systems were soused into solution saline and exposed in different position in the beam of linear accelerator per 10 Gy fractions. In comparison of usually used maximum recommended dose of 2 Gy, the radiation doses used in test were five times higher. Using the simultaneous monitoring wireless communication between device and its programmer allowed watching of the devices activities, noise occurrence or drop of biventricular pacing on the programmer screen, observed by local television loop camera. At any device position in radiation beam, there were no influences of the device activity at dose of 10 Gy neither a significant increase of a solution saline temperature in any of the measured positions of CRT-D systems in linear accelerator. The results of the study indicated, that the recommendation dose for treating the patients with implantable devices are too conservative and the risk of device failure is not so high. The systems can easily withstand the dose fractions of tens Gy, which would allow current single-dose-procedure treatment in

  7. Silk-based resorbable electronic devices for remotely controlled therapy and in vivo infection abatement

    PubMed Central

    Tao, Hu; Hwang, Suk-Won; Marelli, Benedetto; An, Bo; Moreau, Jodie E.; Yang, Miaomiao; Brenckle, Mark A.; Kim, Stanley; Kaplan, David L.; Rogers, John A.; Omenetto, Fiorenzo G.

    2014-01-01

    A paradigm shift for implantable medical devices lies at the confluence between regenerative medicine, where materials remodel and integrate in the biological milieu, and technology, through the use of recently developed material platforms based on biomaterials and bioresorbable technologies such as optics and electronics. The union of materials and technology in this context enables a class of biomedical devices that can be optically or electronically functional and yet harmlessly degrade once their use is complete. We present here a fully degradable, remotely controlled, implantable therapeutic device operating in vivo to counter a Staphylococcus aureus infection that disappears once its function is complete. This class of device provides fully resorbable packaging and electronics that can be turned on remotely, after implantation, to provide the necessary thermal therapy or trigger drug delivery. Such externally controllable, resorbable devices not only obviate the need for secondary surgeries and retrieval, but also have extended utility as therapeutic devices that can be left behind at a surgical or suturing site, following intervention, and can be externally controlled to allow for infection management by either thermal treatment or by remote triggering of drug release when there is retardation of antibiotic diffusion, deep infections are present, or when systemic antibiotic treatment alone is insufficient due to the emergence of antibiotic-resistant strains. After completion of function, the device is safely resorbed into the body, within a programmable period. PMID:25422476

  8. Silk-based resorbable electronic devices for remotely controlled therapy and in vivo infection abatement.

    PubMed

    Tao, Hu; Hwang, Suk-Won; Marelli, Benedetto; An, Bo; Moreau, Jodie E; Yang, Miaomiao; Brenckle, Mark A; Kim, Stanley; Kaplan, David L; Rogers, John A; Omenetto, Fiorenzo G

    2014-12-09

    A paradigm shift for implantable medical devices lies at the confluence between regenerative medicine, where materials remodel and integrate in the biological milieu, and technology, through the use of recently developed material platforms based on biomaterials and bioresorbable technologies such as optics and electronics. The union of materials and technology in this context enables a class of biomedical devices that can be optically or electronically functional and yet harmlessly degrade once their use is complete. We present here a fully degradable, remotely controlled, implantable therapeutic device operating in vivo to counter a Staphylococcus aureus infection that disappears once its function is complete. This class of device provides fully resorbable packaging and electronics that can be turned on remotely, after implantation, to provide the necessary thermal therapy or trigger drug delivery. Such externally controllable, resorbable devices not only obviate the need for secondary surgeries and retrieval, but also have extended utility as therapeutic devices that can be left behind at a surgical or suturing site, following intervention, and can be externally controlled to allow for infection management by either thermal treatment or by remote triggering of drug release when there is retardation of antibiotic diffusion, deep infections are present, or when systemic antibiotic treatment alone is insufficient due to the emergence of antibiotic-resistant strains. After completion of function, the device is safely resorbed into the body, within a programmable period.

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

    PubMed

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

    2015-06-01

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

  10. The Promise of Bacteriophage Therapy for Burkholderia cepacia Complex Respiratory Infections

    PubMed Central

    Semler, Diana D.; Lynch, Karlene H.; Dennis, Jonathan J.

    2012-01-01

    In recent times, increased attention has been given to evaluating the efficacy of phage therapy, especially in scenarios where the bacterial infectious agent of interest is highly antibiotic resistant. In this regard, phage therapy is especially applicable to infections caused by the Burkholderia cepacia complex (BCC) since members of the BCC are antibiotic pan-resistant. Current studies in BCC phage therapy are unique from many other avenues of phage therapy research in that the investigation is not only comprised of phage isolation, in vitro phage characterization and assessment of in vivo infection model efficacy, but also adapting aerosol drug delivery techniques to aerosol phage formulation delivery and storage. PMID:22919592

  11. Water equivalent thickness analysis of immobilization devices for clinical implementation in proton therapy.

    PubMed

    Wroe, A J; Ghebremedhin, A; Gordon, I R; Schulte, R W; Slater, J D

    2014-10-01

    Immobilization devices can impact not only the inter- and intra-fraction motion of the patient, but also the range uncertainty of the treatment beam in proton therapy. In order to limit additional range uncertainty, the water equivalent thickness (WET) of the immobilization device needs to be well known and accurately reflected in the calculations by the treatment planning system (TPS). The method presented here focusses on the use of a nozzle-mounted variable range shifter and precision-machined polystyrene blocks of known WET to evaluate commercial immobilization devices prior to clinical implementation. CT studies were also completed to evaluate the internal uniformity of the immobilization devices under study. Mul- tiple inserts of the kVue platform (Qfix Systems, Avondale, PA) were evaluated as part of this study. The results indicate that the inserts are largely interchangeable across a given design type and that the measured WET values agree with those generated by the TPS with a maxi- mum difference less than 1 mm. The WET of the devices, as determined by the TPS, was not impacted by CT beam hardening normally experienced during clinical use. The reproduc- ibility of the WET method was also determined to be better than ±0.02 mm. In conclusion, the testing of immobilization prior to implementation in proton therapy is essential in order to ascertain their impact on the proton treatment and the methodology described here can also be applied to other immobilization systems.

  12. A randomised, multicentre study of ceftriaxone versus standard therapy in the treatment of lower respiratory tract infections.

    PubMed

    de Klerk, G J; van Steijn, J H; Lobatto, S; Jaspers, C A; van Veldhuizen, W C; Hensing, C A; Bunnik, M C; Geraedts, W H; Dofferhof, A S; Van Den Berg, J; Melis, J H; Hoepelman, A I

    1999-07-01

    In this study the efficacy and cost-effectiveness of i.v. ceftriaxone 1 g once daily (CTX) was compared with standard i.v. antibiotic treatment (STD) for lower respiratory tract infections (LRTI). STD was given according to the guidelines of the American Thoracic Society and consisted of either cefuroxime 1500 mg three times daily (q8h), amoxicillin/clavulanic acid 1200 mg q8h or ceftriaxone 2 g once daily; each with or without a macrolide. After a minimum of 5 days i.v. therapy, patients could be switched to oral therapy. One hundred patients were enrolled in the study; 52 patients received CTX and 48 STD. Groups were comparable with respect to demographic and baseline characteristics. Seventy patients had a confirmed diagnosis of pneumonia. Twenty-nine patients had a severe type I exacerbation of chronic bronchitis. In one patient the diagnosis of LRTI could not be confirmed. In approximately 50% of the patients a microbiological diagnosis could be made. The most important isolated pathogens from sputum and blood were (positive blood cultures in brackets): Streptococcus pneumoniae 14 (9) and Haemophilus influenzae 16. Mean duration of i.v. therapy was 7.4 days in both groups. Average duration of hospitalisation was 15.0 days for CTX patients and 15.9 days for STD patients. Overall cure and improvement rate at the end of treatment was 47 (90%) for patients receiving ceftriaxone 1 g compared to 37 (77%) for patients receiving standard therapy. Pathogens were eradicated or presumed to be eradicated in 84% of the CTX patients and in 76% of the STD patients. Mean total costs per treatment were lower for CTX than for STD treatment: NLG 169 versus 458. These results show, that i.v. ceftriaxone 1 g once daily is as effective as standard therapy in the treatment of LRTI and that its use reduces treatment costs, in view of the multiple daily dosing regimens of most standard therapies.

  13. Lightpipe device for delivery of uniform illumination for photodynamic therapy of the oral cavity

    PubMed Central

    Canavesi, Cristina; Cassarly, William J.; Foster, Thomas H.; Rolland, Jannick P.

    2011-01-01

    A compact and efficient lightpipe device to deliver light to the human oral cavity for photodynamic therapy was designed and fabricated, having dimensions 6.8 mm × 6.8 mm × 46 mm. An average irradiance of 76 mW/cm2 with an average deviation of 5% was measured on a square 25 mm2 treatment field for an input power of 100 mW. The device limits irradiation of healthy tissue and offers potential for improvement over the current treatment procedure, which requires shielding of the whole cavity to avoid damage to healthy tissue. PMID:21629308

  14. Biomechanical and safety testing of a simplified negative-pressure wound therapy device.

    PubMed

    Mody, Gita N; Zurovcik, Danielle R; Joharifard, Shahrzad; Kansayisa, Grace; Uwimana, Gemimah; Baganizi, Erick; Ntakiyiruta, Georges; Mugenzi, Dominique; Riviello, Robert

    2015-04-01

    There is a large, unmet need for acute and chronic wound care worldwide. Application of proven therapies such as negative-pressure wound therapy in resource-constrained settings is limited by cost and lack of electrical supply. To provide an alternative to existing electrically powered negative-pressure wound therapy systems, a bellows-powered negative-pressure wound therapy system was designed and iteratively improved during field-based testing. The authors describe the design process and the results of safety and biomechanical testing of their simplified negative-pressure wound therapy system. Simplified negative-pressure wound therapy was tested at two hospitals in Rwanda. Patients with wounds ranging from 2 to 150 cm and meeting inclusion and exclusion criteria were enrolled. Wounds were categorized by difficulty of dressing application according to location and contour. Outcomes were maintenance of negative pressure and occurrence of adverse events. Thirty-seven patients with 42 wounds were treated with simplified negative-pressure wound therapy. Eighty-five dressings in total were applied. On average, the final simplified negative-pressure wound therapy dressing maintained negative pressure for 31.7 hours on all wounds (n = 37), and 52.7 hours on wounds in easy-to-dress locations. No unexpected adverse events occurred. This is the first systematic report of the performance of a bellows-powered negative-pressure wound therapy device designed specifically for use in resource-constrained settings. The authors found that elimination of air leaks in the simplified negative-pressure wound therapy dressing is essential, and that their system is safe and feasible for use in these environments. Subsequent trials will study the system's efficacy.

  15. Electromagnetic interference between external defibrillator and cardiac resynchronization therapy-pacemaker (CRT-P) devices.

    PubMed

    Ghanbari, Hamid; Al-Ameri, Hazim; Ottino, Jessica; Hastings, Cordell; Kippola, James; Gueron, Ioni; Daccarett, Marcos; Machado, Christian

    2011-09-01

    Implantable heart rhythm devices are susceptible to interference in hospitals where electromagnetic interference (EMI) sources are ubiquitous. We report three cases in which EMI from the external defibrillator caused the inability to interrogate Boston Scientific cardiac resynchronization therapy-pacemaker (CRT-P) devices. We have documented interference with the Boston Scientific CRT-P Contact Renewal device model numbers H120/H125 (Natick, MA, USA) and two brands of external defibrillators: the Philips Heartstart XL model number M4735A (Andover, MA, USA) and the Hewlett-Packard Codemaster model number M1722B (Palo Alto, CA, USA). For device implants, we routinely place external pacing pads with the external defibrillator in the "standby" mode for transcutaneous pacing so that only the pacer "start/stop" button needs to be pressed when necessary. We have not been able to interrogate three consecutive Boston Scientific CRT-P devices prior to closure while the external defibrillator had the back-up pacing mode on "standby." In our initial case, a second device was opened because this interaction was not recognized. We documented EMI with the standby pacing mode ON and discovered that by disabling only the "standby" pacing mode on the external defibrillator, the device could be interrogated without difficulty. This is a case series reporting EMI with a Boston Scientific CRT-P Contact Renewal device H120/H125 telemetry from an external defibrillator with pacing mode on "standby." Failure to recognize this important interaction may lead to inappropriate device and resource utilization. ©2011, The Authors. Journal compilation ©2011 Wiley Periodicals, Inc.

  16. Catheter-based ultrasound devices and MR thermal monitoring for conformal prostate thermal therapy.

    PubMed

    Diederich, Chris J; Nau, Will H; Kinsey, Adam; Ross, Tony; Wootton, Jeff; Juang, Titania; Butts-Pauly, Kim; Rieke, Viola; Chen, Jing; Bouley, Donna M; Sommer, Graham

    2008-01-01

    Catheter-based ultrasound applicators have been developed for delivering hyperthermia or high-temperature thermal ablation of cancer and benign disease of the prostate. These devices allow for control of heating along the length and angular expanse during therapy delivery. Four types of transurethral applicators were devised for thermal treatment of prostate combined with MR thermal monitoring: sectored tubular transducer devices with directional heating patterns and rotation; planar and curvilinear devices with narrow heating patterns and rotation; and multi-sectored tubular devices capable of dynamic angular control without applicator movement. Interstitial devices (2.4 mm OD) have been developed for percutaneous implantation with directional or dynamic angular control. In vivo experiments in canine prostate under MR temperature imaging were used to evaluate these devices and develop treatment delivery strategies. MR thermal imaging was used to monitor temperature and thermal dose in multiple slices through the target volume. Multi-sectored transurethral applicators can dynamically control the angular heating profile and target large regions of the gland in short treatment times without applicator manipulation. The sectored tubular, planar, and curvilinear transurethral devices produce directional coagulation zones, extending 15-20 mm radial distance to the outer prostate capsule. Sequential rotation under motor control and modulated dwell time can be used to tightly conform thermal ablation to selected regions. Interstitial implants with directional devices can be used to effectively ablate targeted regions of the gland while protecting the rectum. The MR derived 52 degrees C and lethal thermal dose contours (t43=240 min) effectively defined the extent of thermal damage and provided a means for real-time control of the applicators. Catheter-based ultrasound devices, combined with MR thermal monitoring, can produce relatively fast (5-40 min) and precise thermal

  17. Corticosteroid use as adjunct therapy for respiratory syncytial virus infection in adult allogeneic stem cell transplant recipients.

    PubMed

    Damlaj, M; Bartoo, G; Cartin-Ceba, R; Gijima, D; Alkhateeb, H B; Merten, J; Hashmi, S; Litzow, M; Gastineau, D; Hogan, W; Patnaik, M M

    2016-04-01

    Respiratory syncytial virus (RSV) infection causes significant morbidity and mortality in allogeneic stem cell transplant (allo-SCT) recipients. Although ribavirin and immunoglobulins are common components of therapy, the role of adjunct corticosteroids is not established. We sought to evaluate corticosteroid utilization in the setting of post-allo-SCT RSV infection in our center and assess post-transplant outcomes including pulmonary function decline. Patients with a history of RSV infection from 2008 to 2014 seen at our institution were identified. Treatment and outcome data were retrospectively collected. Forced expiratory volume at 1 s (FEV1) and carbon monoxide diffusion capacity (DLCO) were collected pre- and post-RSV infection. During the observation period, RSV was isolated in 53 of 552 patients undergoing allo-SCT (10%) and 45 had evaluable therapy data. RSV-related mortality in this cohort was 4/45 (9%). Twenty-one (47%) were on corticosteroids prior to RSV diagnosis, of whom 11 (24%) had a dose increase post symptom onset. Eight (18%) patients were started on corticosteroids at the time of RSV infection. Corticosteroid therapy at symptom onset was associated with a higher rate of upper respiratory infection (URTI) to lower respiratory infection (LRTI) progression risk ratio (RR) 2.49 (1.21-5.13; P = 0.016), hospital admission RR 2.05 (1.24-3.37; P = 0.005), or intensive care unit admission RR 2.91 (1.89-5.01; P = 0.002). No significant difference was seen with FEV1 and DLCO decline (P = 0.3 and 0.24, respectively) or mortality (P = 0.26). Adjunct corticosteroid use in the setting of RSV infection did not improve RSV-related outcomes including long-term pulmonary function. Our results do not support the routine use of corticosteroids; however, this finding does need to be verified in a larger cohort of patients. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Inappropriate implantable cardioverter defibrillator shock from a transcutaneous muscle stimulation device therapy.

    PubMed

    Siu, Chung-Wah; Tse, Hung-Fat; Lau, Chu-Pak

    2005-06-01

    Inappropriate shock from implantable cardioverter defibrillator (ICD) may result from external electromagnetic interference (EMI), especially for unipolar ventricle sensing. Previous case reports and small in-vitro safety study suggested that endocardial bipolar lead system may be immune from EMI resulting from transcutaneous electrical neuromuscle stimulation (TENS) therapy. This report presents an unusual case of inappropriate discharge in a patient with ICD of endocardial bipolar lead system, receiving TENS from a commercially available device.

  19. Effect of Mandibular Advancement Device Therapy on the Signs and Symptoms of Temporomandibular Disorders

    PubMed Central

    Raunio, Antti; Sipilä, Kirsi; Raustia, Aune

    2012-01-01

    ABSTRACT Objectives Mandibular advancement device therapy is effectively used in the treatment of obstructive sleep apnea, but also several side effects in the masticatory system have been reported. The aim of this study was to evaluate the subjective symptoms and clinical signs of temporomandibular disorders connected to mandibular advancement device therapy. Material and Methods The material consisted of 15 patients (9 men and 6 women, mean age 51.1 years, range 21 to 70 years) diagnosed with obstructive sleep apnea (OSA). Subjective symptoms and clinical temporomandibular disorders (TMD) signs were recorded at the beginning of the treatment (baseline) and at 1-month, 3-month, 6-month and 24-month follow-ups. The degree of TMD was assessed using the anamnestic (Ai) and the clinical dysfunction index (Di) of Helkimo. For assessing the effect of TMD the patients were divided in discontinuing and continuing groups. Results According to Ai and Di, the severity of TMD remained unchanged during the follow-up in most of the patients. Temporomandibular joint (TMJ) crepitation was found more frequently in discontinuing patients at all follow-ups. The difference was statistically significant (P < 0.05) at the six-month follow-up. Masticatory muscle pain during palpation was a frequent clinical sign at the baseline and during the follow-up period but the difference between discontinuing and continuing patients was not significant. Conclusions It seems that signs and symptoms of temporomandibular disorders do not necessarily increase during long-term mandibular advancement device therapy. However, it seems that patients with clinically assessed temporomandibular joint crepitation may discontinue their mandibular advancement device therapy due to temporomandibular disorders. PMID:24422023

  20. Anchoring in Destination-Therapy Left Ventricular Assist Device Decision Making: A Mechanical Turk Survey.

    PubMed

    Paine, Arcadia M; Allen, Larry A; Thompson, Jocelyn S; McIlvennan, Colleen K; Jenkins, Amy; Hammes, Andrew; Kroehl, Miranda; Matlock, Daniel D

    2016-11-01

    People with end-stage heart failure may have to decide about destination-therapy left ventricular assist device (DT-LVAD). Individuals facing difficult decisions often rely on heuristics, such as anchoring, which predictably bias decision outcomes. We aimed to investigate whether showing a larger historical Heartmate XVE creates an anchoring effect, making the smaller Heartmate II (HMII) appear more favorable. With the use of Amazon Mechanical Turk, participants watched videos asking them to imagine themselves dying of end-stage heart failure, then were presented the option of LVAD as potentially life-prolonging therapy. Participants were randomized to a control group who were only shown the HMII device, and the intervention group who saw the XVE device before the HMII. Participants then completed surveys. A total of 487 participants completed the survey (control = 252; intervention = 235); 79% were <40 years of age, 84% were white, and 55% were male. The intervention group was not more likely to accept the LVAD therapy (68% vs 61%; P = .37). However, participants in the intervention group were more likely (51% vs 17%; P < .01) to agree or strongly agree with the statement that the HMII was "smaller than expected." Participants in the intervention group were also more likely to rate the size of the device as "important" or "very important" in their decision (61% vs 46%; P < .01). Although the XVE anchor did not affect likelihood of accepting the LVAD, it did affect device perception. This article highlights an important point with clinical implications: factors such as anchoring have the potential to inappropriately influence perceptions and decisions and should be carefully considered in research and practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Metaphylactic antimicrobial therapy for bovine respiratory disease in stocker and feedlot cattle.

    PubMed

    Nickell, Jason S; White, Brad J

    2010-07-01

    This article provides an overview of implementing metaphylactic antimicrobial protocols to certain classes of cattle on arrival to stocker and feedlot production systems. The goal of this management practice is to reduce the negative health and performance effects induced by bovine respiratory disease (BRD). This article emphasizes the multiple factors that influence the decision for mass medication, including weight (age) of the cattle, distance traveled, environmental conditions, previous health history, visual inspection of the cattle at arrival, and prediction of the risk of disease. Current data suggest that metaphylactic programs significantly reduce negative health effects and improve feed performance that can be observed in cattle stricken with BRD.

  2. Community-acquired pneumonia: impact of empirical antibiotic therapy without respiratory fluoroquinolones nor third-generation cephalosporins.

    PubMed

    Pradelli, J; Risso, K; de Salvador, F G; Cua, E; Ruimy, R; Roger, P-M

    2015-03-01

    Guidelines for inpatients with community-acquired pneumonia (CAP) propose to use respiratory fluoroquinolone (RFQ) and/or third-generation cephalosporins (Ceph-3). However, broad-spectrum antibiotic therapy is associated with the emergence of drug-resistant bacteria. We established a guideline in which RFQ and Ceph-3 were excluded as a first course. Our aim was to evaluate the impact of our therapeutic choices for CAP on the length of hospital stay (LOS) and patient outcome. This was a cohort study of patients with CAP from July 2005 to June 2014. We compared patients benefiting from our guideline established in 2008 to those receiving non-consensual antibiotics. Disease severity was evaluated through the Pneumonia Severity Index (PSI). The empirical treatment for PSI III to V was a combination therapy of amoxicillin-clavulanic acid (AMX-C) + roxithromycin (RX) or AMX + ofloxacin. Adherence to guidelines was defined by the prescription of one of these antibiotic agents. Requirement for intensive care or death defined unfavorable outcome. Among 1,370 patients, 847 were treated according to our guideline (61.8 %, group 1) and 523 without concordant therapy (38.2 %, group 2). The mean PSI was similar: 82 vs. 83, p > 0.5. The mean LOS was lower in group 1: 7.6 days vs. 9.1 days, p < 0.001. An unfavorable outcome was less frequent in group 1: 5.4 % vs. 9.9 %, p = 0.001. In logistic regression models, concordant therapy was associated with a favorable outcome: adjusted odds ratio (AOR) [95 % confidence interval (CI)] 1.85 [1.20-2.88], p = 0.005. CAP therapy without RFQ and Ceph-3 use was associated with a shorter LOS and fewer unfavorable outcomes.

  3. The mismatch between patient life expectancy and the service life of implantable devices in current cardioverter-defibrillator therapy: a call for larger device batteries.

    PubMed

    Neuzner, Jörg

    2015-06-01

    In 2005, Bob Hauser published a paper in the Journal of the American College of Cardiology entitled "The growing mismatch between patient longevity and the service life of Implantable Cardioverter-Defibrillators". Now, nearly a decade later, I would like to perform a second look on the problem of a mismatching between ICD device service life and the survival of ICD recipients. Since 2005, the demographics of the ICD population has changed significantly. Primary prevention has become the dominant indication in defibrillator therapy and device implantation is indicated more and more in earlier stages of cardiac diseases. In former larger scale ICD trials, the patient average 5-year survival probability was in a range of 68-71%; in newer CRT-D trials in a range of 72-88%. Due to a progressively widened ICD indication and implantation preferentially performed in patients with better life expectancy, the problem of inadequate device service life is of growing importance. The early days of defibrillator therapy started with a generator volume of 145 ccm and a device service life <18 months. In this early period, the device miniaturization and extension of service life were similar challenges for the technicians. Today, we have reached a formerly unexpected extent of device miniaturization. However, technologic improvements were often preferentially translated in further device miniaturization and not in prolonging device service life. In his analysis, Bob Hauser reported a prolonged device service life of 2.3 years in ICD models with a larger battery capacity of 0.54 up to 0.69 Ah. Between 2008 and 2014, several studies had been published on the problem of ICD longevity in clinical scenarios. These analyses included "older" and currently used single chamber, dual chamber and CRT devices. The reported average 5-year device service life ranged from 0 to 75%. Assuming today technology, larger battery capacities will only result in minimal increase in device volume. Selected

  4. Gene therapy rescues disease phenotype in a spinal muscular atrophy with respiratory distress type 1 (SMARD1) mouse model

    PubMed Central

    Nizzardo, Monica; Simone, Chiara; Rizzo, Federica; Salani, Sabrina; Dametti, Sara; Rinchetti, Paola; Del Bo, Roberto; Foust, Kevin; Kaspar, Brian K.; Bresolin, Nereo; Comi, Giacomo P.; Corti, Stefania

    2015-01-01

    Spinal muscular atrophy with respiratory distress type 1 (SMARD1) is an autosomal recessive motor neuron disease affecting children. It is caused by mutations in the IGHMBP2 gene (11q13) and presently has no cure. Recently, adeno-associated virus serotype 9 (AAV9)–mediated gene therapy has been shown to rescue the phenotype of animal models of another lower motor neuron disorder, spinal muscular atrophy 5q, and a clinical trial with this strategy is ongoing. We report rescue of the disease phenotype in a SMARD1 mouse model after therapeutic delivery via systemic injection of an AAV9 construct encoding the wild-type IGHMBP2 to replace the defective gene. AAV9-IGHMBP2 administration restored protein levels and rescued motor function, neuromuscular physiology, and life span (450% increase), ameliorating pathological features in the central nervous system, muscles, and heart. To test this strategy in a human model, we transferred wild-type IGHMBP2 into human SMARD1-induced pluripotent stem cell–derived motor neurons; these cells exhibited increased survival and axonal length in long-term culture. Our data support the translational potential of AAV-mediated gene therapies for SMARD1, opening the door for AAV9-mediated therapy in human clinical trials. PMID:26601156

  5. Gene therapy rescues disease phenotype in a spinal muscular atrophy with respiratory distress type 1 (SMARD1) mouse model.

    PubMed

    Nizzardo, Monica; Simone, Chiara; Rizzo, Federica; Salani, Sabrina; Dametti, Sara; Rinchetti, Paola; Del Bo, Roberto; Foust, Kevin; Kaspar, Brian K; Bresolin, Nereo; Comi, Giacomo P; Corti, Stefania

    2015-03-01

    Spinal muscular atrophy with respiratory distress type 1 (SMARD1) is an autosomal recessive motor neuron disease affecting children. It is caused by mutations in the IGHMBP2 gene (11q13) and presently has no cure. Recently, adeno-associated virus serotype 9 (AAV9)-mediated gene therapy has been shown to rescue the phenotype of animal models of another lower motor neuron disorder, spinal muscular atrophy 5q, and a clinical trial with this strategy is ongoing. We report rescue of the disease phenotype in a SMARD1 mouse model after therapeutic delivery via systemic injection of an AAV9 construct encoding the wild-type IGHMBP2 to replace the defective gene. AAV9-IGHMBP2 administration restored protein levels and rescued motor function, neuromuscular physiology, and life span (450% increase), ameliorating pathological features in the central nervous system, muscles, and heart. To test this strategy in a human model, we transferred wild-type IGHMBP2 into human SMARD1-induced pluripotent stem cell-derived motor neurons; these cells exhibited increased survival and axonal length in long-term culture. Our data support the translational potential of AAV-mediated gene therapies for SMARD1, opening the door for AAV9-mediated therapy in human clinical trials.

  6. Impact of High-flow Nasal Cannula Therapy in Quality İmprovement and Clinical Outcomes in a Non-invasive Ventilation Device-free Pediatric İntensive Care Unit.

    PubMed

    Can, Fulva Kamit; Anil, Ayse Berna; Anil, Murat; Zengin, Neslihan; Bal, Alkan; Bicilioglu, Yuksel; Gokalp, Gamze; Durak, Fatih; Ince, Gulberat

    2017-07-11

    To analyze the change in quality indicators due to the use of high-flow nasal cannula therapy as a non-invasive ventilation method in children with respiratory distress/failure in a noninvasive ventilation device-free pediatric intensive care unit. The study was a retrospective chart review of children with respiratory distress/failure admitted 1 year before (period before high-flow nasal cannula therapy) and 1 year after (period after high-flow nasal cannula therapy) the introduction of high-flow nasal cannula therapy. We compared quality indicators as rate of mechanical ventilation, total duration of mechanical ventilation, rate of reintubation, pediatric intensive care unit length of stay, and mortality rate between these periods. Between November 2012 and November 2014, 272 patients: 141before and 131 after highflow nasal cannula therapy were reviewed (median age was 20.5 mo). Of the patients in the severe respiratory distress/failure subgroup, the rate of intubation was significantly lower in period after than in period before high-flow nasal cannula therapy group (58.1% vs. 76.1%; P <0.05). The median pediatric intensive care unit length of stay was significantly shorter in patients who didn't require mechanical ventilation in the period after than in the period before high-flow nasal cannula therapy group (3d vs. 4d; P<0,05). Implementation of high-flow nasal cannula therapy in pediatric intensive care unit significantly improves the quality of therapy and its outcomes.

  7. Current devices for high-performance whole-body hyperthermia therapy.

    PubMed

    Jia, Dewei; Liu, Jing

    2010-05-01

    For late-stage cancer, whole-body hyperthermia (WBH) is highly regarded by physicians as a promising alternative to conventional therapies. Although WBH is still under scrutiny due to potential toxicity, its benefits are incomparable, as diversified devices and very promising treatment protocols in this area are advanced into Phase II and III clinical trials. Following the introduction of the WBH principle, this paper comprehensively reviews the state-of-art high-performance WBH devices based on the heat induction mechanisms - radiation, convection and conduction. Through analyzing each category's physical principle and heat-induction property, the advantages and disadvantages of the devices are evaluated. Technical strategies and critical scientific issues are summarized. For future developments, research directions worth pursuing are presented in this article.

  8. Titanium alloys as fixation device material for cranioplasty and its safety in electroconvulsive therapy.

    PubMed

    Kaido, Takanobu; Noda, Takamasa; Otsuki, Taisuke; Kaneko, Yuu; Takahashi, Akio; Nakai, Tetsuji; Nabatame, Maki; Tani, Mariko

    2011-03-01

    Here, we report the case of a patient successfully treated by a series of electroconvulsive therapy (ECT) who had implanted skull fixation devices made of titanium alloy. The patient was a 57-year-old man with bipolar I disorder. He was hospitalized for the treatment of manic symptoms of bipolar I disorder with pharmacotherapy and ECT. He sustained a fall and hit his head hard on the ground. Acute subdural hematoma developed, and emergent surgery to remove the hematoma was carried out. Cranioplasty was performed using fixation devices made of titanium alloy (Ti 6Al-4V). In order to control his manic symptoms, a series of ECT was readministered from 1 week after surgery. No adverse effects occurred. Devices must be investigated and chosen very carefully for permanent implantation, especially in patients during a course of ECT.

  9. Sleep technologists educational needs assessment: a survey of polysomnography, electroneurodiagnostic technology, and respiratory therapy education program directors.

    PubMed

    Wells, Mary Ellen; Vaughn, Bradley V

    2013-10-15

    In this study, we assessed the community and educational needs for sleep technologists by surveying program directors of nationally accredited polysomnography, electroneurodiagnostic technology, and respiratory care educational programs. Currently, little is known about our educational capacity and the need for advanced degrees for sleep medicine technical support. A questionnaire was developed about current and future community and educational needs for sleep technologists. The questionnaire was sent to directors of CAAHEP-accredited polysomnography and electroneurodiagnostic technology programs (associate degree and certificate programs), and directors of CoARC-accredited respiratory therapy associate degree and bachelor degree programs (n = 358). Qualitative and quantitative data were collected via an internet survey tool. Data analysis was conducted with the IBM SPSS statistical package and included calculating means and standard deviations of the frequency of responses. Qualitative data was analyzed and classified based on emerging themes. One hundred seven of 408 program directors completed the survey. Seventy-four percent agreed that demand for qualified sleep technologists will increase, yet 50% of those surveyed believe there are not enough educational programs to meet the demand. Seventy-eight percent of those surveyed agreed that the educational requirements for sleep technologists will soon increase; 79% of those surveyed believe sleep centers have a need for technologists with advanced training or specialization. Our study shows educators of associate and certificate degree programs believe there is a need for a bachelor's degree in sleep science and technology.

  10. High-flow oxygen therapy in immunocompromised patients with acute respiratory failure: A review and meta-analysis.

    PubMed

    Huang, Hui-Bin; Peng, Jin-Min; Weng, Li; Liu, Guang-Yun; Du, Bin

    2017-09-22

    Acute respiratory failure remains a common hazardous complication in immunocompromised patients and is associated with increased mortality rates when endotracheal intubation is need. We aimed to evaluate the effect of high-flow nasal cannula oxygen therapy (HFNC) compared with other oxygen technique for this patient population. We searched Cochrane library, Embase, PubMed databases before Aug. 15, 2017 for eligible articles. A meta-analysis was performed for measuring short-term mortality (defined as ICU, hospital or 28-days mortality) and intubation rate as the primary outcomes, and length of stay in ICU as the secondary outcome. We included seven studies involving 667 patients. Use of HFNC was significantly association with a reduction in short-term mortality (RR 0.66; 95% CI, 0.52 to 0.84, p=0.0007) and intubation rate (RR 0.76, 95% CI 0.64 to 0.90; p=0.002). In addition, HFNC did not significant increase length of stay in ICU (MD 0.15days; 95% CI, -2.08 to 2.39; p=0.89). The results of current meta-analysis suggest that use of HFNC significantly improve outcomes of acute respiratory failure in immunocompromised patients. Owing to the quality of the included studies, further adequately powered randomized controlled trials are needed to confirm our results. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Implantable left ventricular assist devices: an evolving long-term cardiac replacement therapy.

    PubMed Central

    DeRose, J J; Argenziano, M; Sun, B C; Reemtsma, K; Oz, M C; Rose, E A

    1997-01-01

    OBJECTIVE: The authors' 8-year experience with both inpatient and outpatient left ventricular assist device (LVAD) support is presented to show the possibilities and limitations of long-term outpatient mechanical circulatory assistance. SUMMARY BACKGROUND DATA: The limitation of suitable cardiac donors has led to the use of LVADs as a temporizing measure for patients awaiting cardiac transplantation. The success of such devices in the short and medium term as a bridge to transplantation has led to their evaluation as a long-term destination therapy for end-stage heart disease. METHODS: Between August 1990 and February 1997, 85 patients with end-stage heart disease underwent insertion of implantable LVADs. Fifty-two patients underwent pneumatic device insertion and 32 patients received a vented electric device. RESULTS: Patients were supported for a mean of 109+/-13 days for an overall survival to transplant (54) or explant (3) of 73%. Nineteen patients were discharged from the hospital on a mean of postoperative day 41+/-4 (range, 17-68) for an outpatient support time of 108+/-30 days (range, 2-466). Of 12 patients supported after postcardiotomy cardiogenic shock, 10 (82%) survived to hospital discharge. Perioperative right ventricular failure was treated in most patients with inotropic agents and inhaled nitric oxide with only six patients requiring right ventricular assist device support. Thromboembolic rate was low (0.016 events/patient-month) despite minimal or no anticoagulation in all cases. CONCLUSIONS: Left ventricular assist device support has evolved to become an outpatient therapy with excellent survival rates and an acceptable morbidity. Accordingly, wearable LVADs should be studied as permanent treatment options for patients who are not transplant candidates. Images Figure 2. PMID:9351714

  12. Pneumonia, Acute Respiratory Distress Syndrome, and Early Immune-Modulator Therapy

    PubMed Central

    Lee, Kyung-Yil

    2017-01-01

    Acute respiratory distress syndrome (ARDS) is caused by infectious insults, such as pneumonia from various pathogens or related to other noninfectious events. Clinical and histopathologic characteristics are similar across severely affected patients, suggesting that a common mode of immune reaction may be involved in the immunopathogenesis of ARDS. There may be etiologic substances that have an affinity for respiratory cells and induce lung cell injury in cases of ARDS. These substances originate not only from pathogens, but also from injured host cells. At the molecular level, these substances have various sizes and biochemical characteristics, classifying them as protein substances and non-protein substances. Immune cells and immune proteins may recognize and act on these substances, including pathogenic proteins and peptides, depending upon the size and biochemical properties of the substances (this theory is known as the protein-homeostasis-system hypothesis). The severity or chronicity of ARDS depends on the amount of etiologic substances with corresponding immune reactions, the duration of the appearance of specific immune cells, or the repertoire of specific immune cells that control the substances. Therefore, treatment with early systemic immune modulators (corticosteroids and/or intravenous immunoglobulin) as soon as possible may reduce aberrant immune responses in the potential stage of ARDS. PMID:28208675

  13. Use of dMLC for implementation of dynamic respiratory-gated radiation therapy

    SciTech Connect

    Pepin, Eric W.; Wu, Huanmei; Shirato, Hiroki

    2013-10-15

    Purpose: To simulate and evaluate the use of dynamic multileaf collimators (dMLC) in respiratory gating to compensate for baseline drift.Methods: Tumor motion tracking data from 30 lung tumors over 322 treatment fractions was analyzed with the finite state model. A dynamic respiratory gating window was established in real-time by determining the average positions during the previous two end-of-expiration breathing phases and centering the dMLC aperture on a weighted average of these positions. A simulated dMLC with physical motion constraints was used in dynamic gating treatment simulations. Fluence maps were created to provide a statistical description of radiation delivery for each fraction. Duty cycle was also calculated for each fraction.Results: The average duty cycle was 2.3% greater under dynamic gating conditions. Dynamic gating also showed higher fluences and less tumor obstruction. Additionally, dynamic gating required fewer beam toggles and each delivery period was longer on average than with static gating.Conclusions: The use of dynamic gating showed better performance than static gating and the physical constraints of a dMLC were shown to not be an impediment to dynamic gating.

  14. An ontology-based annotation of cardiac implantable electronic devices to detect therapy changes in a national registry.

    PubMed

    Rosier, Arnaud; Mabo, Philippe; Chauvin, Michel; Burgun, Anita

    2015-05-01

    The patient population benefitting from cardiac implantable electronic devices (CIEDs) is increasing. This study introduces a device annotation method that supports the consistent description of the functional attributes of cardiac devices and evaluates how this method can detect device changes from a CIED registry. We designed the Cardiac Device Ontology, an ontology of CIEDs and device functions. We annotated 146 cardiac devices with this ontology and used it to detect therapy changes with respect to atrioventricular pacing, cardiac resynchronization therapy, and defibrillation capability in a French national registry of patients with implants (STIDEFIX). We then analyzed a set of 6905 device replacements from the STIDEFIX registry. Ontology-based identification of therapy changes (upgraded, downgraded, or similar) was accurate (6905 cases) and performed better than straightforward analysis of the registry codes (F-measure 1.00 versus 0.75 to 0.97). This study demonstrates the feasibility and effectiveness of ontology-based functional annotation of devices in the cardiac domain. Such annotation allowed a better description and in-depth analysis of STIDEFIX. This method was useful for the automatic detection of therapy changes and may be reused for analyzing data from other device registries.

  15. Exercise therapy for an older patient with left ventricular assist device.

    PubMed

    Park, Won Hah; Seo, Yong Gon; Sung, Ji Dong

    2014-06-01

    A left ventricular assist device (LVAD) is a mechanical circulation support implanted for patients with end-stage heart failure. It may be used either as a bridge to cardiac transplantation or as a destination therapy. The health of a 75-year-old man with a medical history of systolic heart failure worsened. Therefore, he was recommended to have implanted a LVAD (Thoratec Corp.) as a destination therapy. After the surgery, he was enrolled in patient cardiac rehabilitation for the improvement of dyspnea and exercise capacity. In results, there is an improvement on his exercise capacity and quality of life. For the first time in Korea, we reported a benefit of exercise therapy after being implanted with a LVAD.

  16. Tumor treating fields therapy device for glioblastoma: physics and clinical practice considerations.

    PubMed

    Lok, Edwin; Swanson, Kenneth D; Wong, Eric T

    2015-01-01

    Alternating electric fields therapy, as delivered by the tumor treating fields device, is a new modality of cancer treatment that has been approved by the US FDA for recurrent glioblastoma. At a frequency of 200 kHz, these fields emanate from transducer arrays on the surface of the patient's scalp into the brain and perturb processes necessary for cytokinesis during tumor cell mitosis. In the registration Phase III trial for recurrent glioblastoma patients, the efficacy of the tumor treating fields as monotherapy was equivalent to chemotherapy, while scalp irritation was its major adverse event compared with systemic toxicities that were associated with cytotoxic chemotherapies. Alternating electric fields therapy is, therefore, an essential option for the treatment of recurrent glioblastoma. Here, we summarize our current knowledge of the physics, cell biology and clinical data supporting the use of the tumor treating fields therapy.

  17. Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure: a meta-analysis of randomized controlled trials

    PubMed Central

    Ou, Xiaofeng; Hua, Yusi; Liu, Jin; Gong, Cansheng; Zhao, Wenling

    2017-01-01

    BACKGROUND: Conflicting recommendations exist on whether high-flow nasal cannula (HFNC) oxygen therapy should be administered to adult patients in critical care with acute hypoxemic respiratory failure. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate its effect on intubation rates. METHODS: We searched electronic databases from inception to April 2016. We included RCTs that compared HFNC oxygen therapy with usual care (conventional oxygen therapy or noninvasive ventilation) in adults with acute hypoxemic respiratory failure. Because of the different methodologies and variation in clinical outcomes, we conducted 2 subgroup analyses according to oxygen therapy used and disease severity. We pooled data using random-effects models. The primary outcome was the proportion of patients who required endotracheal intubation. RESULTS: We included 6 RCTs (n = 1892). Compared with conventional oxygen therapy, HFNC oxygen therapy was associated with a lower intubation rate (risk ratio [RR] 0.60, 95% confidence interval [CI] 0.38 to 0.94; I2 = 49%). We found no significant difference in the rate between HFNC oxygen therapy and noninvasive ventilation (RR 0.86, 95% CI 0.68 to 1.09; I2 = 2%). In the subgroup analysis by disease severity, no significant differences were found in the intubation rate between HFNC oxygen therapy and either conventional oxygen therapy or noninvasive ventilation (interaction p = 0.3 and 0.4, respectively). INTERPRETATION: The intubation rate with HFNC oxygen therapy was lower than the rate with conventional oxygen therapy and similar to the rate with noninvasive ventilation among patients with acute hypoxemic respiratory failure. Larger, high-quality RCTs are needed to confirm these findings. PMID:28246239

  18. A NOVEL SUPPORT DEVICE FOR HEAD IMMOBILIZATION DURING RADIATION THERAPY THAT IS APPLICABLE TO BOTH CATS AND DOGS.

    PubMed

    Nemoto, Yuki; Maruo, Takuya; Fukuyama, Yasuhiro; Kawarai, Shinpei; Shida, Takuo; Nakayama, Tomohiro

    2015-01-01

    Repeatable head immobilization is important for minimizing positioning error during radiation therapy for veterinary patients with head neoplasms. The purpose of this retrospective cross-sectional study was to describe a novel technique for head immobilization (Device II) and compare this technique with a previously described technique (Device I). Device II provided additional support by incorporating three teeth (vs. two teeth with Device I). Between 2011 and 2013, both devices were applied in clinically affected cats (Device I, n = 17; Device II, n = 11) and dogs (Device I, n = 85; Device II, n = 22) of various breeds and sizes. The following data were recorded for each included patient: variability in the angle of the skull (roll, yaw, and pitch), coordinates of the isocenter, and distance from the reference mark to the tumor. Devices I and II differed for skull angle variability during the treatment of dogs (roll, P = 0.0007; yaw, P = 0.0018; pitch, P = 0.0384) and for yaw of during the treatment of cats (P < 0.0001). In each case, Device II was superior to Device I. The distance from the reference mark to the center of the tumor was significantly decreased for Device II vs. Device I (dogs, P < 0.0001; cats, P = 0.0002). Device II also provided more accurate coordinates for the isocenter. Authors recommend the use of, Device II for future clinical patients.

  19. An isocenter detection and verification device for use in proton therapy

    PubMed Central

    Fuse, H.; Sakae, T.; Terunuma, T.; Sato, M.; Aoki, S.

    2012-01-01

    We developed a new device for isocenter detection and verification for use in proton therapy. This device can be used to confirm the isocenters of a room laser, a digital radiography system, and a rotational gantry. Agreement between the isocenters of a room laser and a digital radiography system was examined visually. We used the star-shots method for detecting and verifying the rotational gantry isocenter. The gafchromic film could be irradiated with this method using a 2 mm slitted 200 MeV proton beam. The isocenters of a room laser and digital radiography system were in good agreement. The size distribution of the isocenter by the star-shots method was <2 mm, which is the value recommended by the American Association of Physicists in Medicine Task Group 142. This new device can be used to evaluate comprehensive isocenter detection and verification for related equipment. Subsequent checking using this new device will decrease the uncertainty in measuring an isocenter. When using this device, the working time was significantly reduced to about 30 min, including preparation. These measurements should be useful for high accuracy daily treatments. PMID:23278028

  20. An isocenter detection and verification device for use in proton therapy.

    PubMed

    Fuse, H; Sakae, T; Terunuma, T; Sato, M; Aoki, S

    2012-12-01

    We developed a new device for isocenter detection and verification for use in proton therapy. This device can be used to confirm the isocenters of a room laser, a digital radiography system, and a rotational gantry. Agreement between the isocenters of a room laser and a digital radiography system was examined visually. We used the star-shots method for detecting and verifying the rotational gantry isocenter. The gafchromic film could be irradiated with this method using a 2 mm slitted 200 MeV proton beam. The isocenters of a room laser and digital radiography system were in good agreement. The size distribution of the isocenter by the star-shots method was <2 mm, which is the value recommended by the American Association of Physicists in Medicine Task Group 142. This new device can be used to evaluate comprehensive isocenter detection and verification for related equipment. Subsequent checking using this new device will decrease the uncertainty in measuring an isocenter. When using this device, the working time was significantly reduced to about 30 min, including preparation. These measurements should be useful for high accuracy daily treatments.

  1. An isocenter detection and verification device for use in proton therapy

    NASA Astrophysics Data System (ADS)

    Fuse, H.; Sakae, T.; Terunuma, T.; Sato, M.; Aoki, S.

    2012-12-01

    We developed a new device for isocenter detection and verification for use in proton therapy. This device can be used to confirm the isocenters of a room laser, a digital radiography system, and a rotational gantry. Agreement between the isocenters of a room laser and a digital radiography system was examined visually. We used the star-shots method for detecting and verifying the rotational gantry isocenter. The gafchromic film could be irradiated with this method using a 2 mm slitted 200 MeV proton beam. The isocenters of a room laser and digital radiography system were in good agreement. The size distribution of the isocenter by the star-shots method was <2 mm, which is the value recommended by the American Association of Physicists in Medicine Task Group 142. This new device can be used to evaluate comprehensive isocenter detection and verification for related equipment. Subsequent checking using this new device will decrease the uncertainty in measuring an isocenter. When using this device, the working time was significantly reduced to about 30 min, including preparation. These measurements should be useful for high accuracy daily treatments.

  2. Illumination devices for uniform delivery of light to the oral cavity for photodynamic therapy

    NASA Astrophysics Data System (ADS)

    Canavesi, Cristina; Cassarly, William J.; Foster, Thomas H.; Rolland, Jannick P.

    2011-10-01

    To date, the lack of light delivery mechanisms to the oral cavity remains a barrier to the treatment of oral cancer with photodynamic therapy (PDT). The greatest impediment to medical practitioners is the current need to shield the normal tissues of the oral cavity, a costly and time-consuming procedure. In this research, we present the design of illumination devices to deliver light to the oral cavity for PDT, which will facilitate administration of PDT in the clinic. The goal for such an illumination device, as indicated by our clinical collaborators at Roswell Park Cancer Institute in Buffalo, NY, is to limit exposure of healthy tissue and produce an average irradiance of 100 mW/cm2 over the treatment field, with spatial non-uniformities below 10%. Furthermore, the size of the device must be compact to allow use in the oral cavity. Our research led to the design and fabrication of two devices producing spatial non-uniformities below 6% over a treatment area of 0.25 cm2 by design. One device consisted of an appropriately-sized reflector, inspired by solar concentrators, illuminated by a cylindrical diffusing fiber optimally located within the reflector; another was a solid lightpipe with a combination of optimized tapered and straight components.

  3. An isocenter detection and verification device for use in proton therapy

    SciTech Connect

    Fuse, H.; Sakae, T.; Terunuma, T.; Sato, M.; Aoki, S.

    2012-12-15

    We developed a new device for isocenter detection and verification for use in proton therapy. This device can be used to confirm the isocenters of a room laser, a digital radiography system, and a rotational gantry. Agreement between the isocenters of a room laser and a digital radiography system was examined visually. We used the star-shots method for detecting and verifying the rotational gantry isocenter. The gafchromic film could be irradiated with this method using a 2 mm slitted 200 MeV proton beam. The isocenters of a room laser and digital radiography system were in good agreement. The size distribution of the isocenter by the star-shots method was <2 mm, which is the value recommended by the American Association of Physicists in Medicine Task Group 142. This new device can be used to evaluate comprehensive isocenter detection and verification for related equipment. Subsequent checking using this new device will decrease the uncertainty in measuring an isocenter. When using this device, the working time was significantly reduced to about 30 min, including preparation. These measurements should be useful for high accuracy daily treatments.

  4. A novel vacuum assisted closure therapy model for use with percutaneous devices

    PubMed Central

    Cook, Saranne J.; Nichols, Francesca R.; Brunker, Lucille B.; Bachus, Kent N.

    2016-01-01

    Long-term maintenance of a dermal barrier around a percutaneous prosthetic device remains a common clinical problem. A technique known as Negative Pressure Wound Therapy (NPWT) uses negative pressure to facilitate healing of impaired and complex soft tissue wounds. However, the combination of using negative pressure with percutaneous prosthetic devices has not been investigated. The goal of this study was to develop a methodology to apply negative pressure to the tissues surrounding a percutaneous device in an animal model; no tissue healing outcomes are presented. Specifically, four hairless rats received percutaneous porous coated titanium devices implanted on the dorsum and were bandaged with a semi occlusive film dressing. Two of these animals received NPWT; two animals received no NPWT and served as baseline controls. Over a 28-day period, both the number of dressing changes required between the two groups as well as the pressures were monitored. Negative pressures were successfully applied to the periprosthetic tissues in a clinically relevant range with a manageable number of dressing changes. This study provides a method for establishing, maintaining, and quantifying controlled negative pressures to the tissues surrounding percutaneous devices using a small animal model. PMID:24685323

  5. Left Ventricular Assist Devices for Destination Therapy: A Health Technology Assessment

    PubMed Central

    2016-01-01

    Background Left ventricular assist devices (LVADs) provide circulatory support to assist the damaged left ventricle in patients with end-stage heart failure. Implantation of an LVAD is sometimes a last resort for patients with end stage heart failure who are ineligible for heart transplantation (destination therapy). First-generation LVADs used pulsatile pumps to mimic the natural pulsing action of the heart. Implanted second-generation LVADs use a rapidly spinning rotor to produce a continuous flow of blood into the systemic arterial system. Objectives Our objectives were to: Determine the clinical effectiveness of LVADs for destination therapy for patients with end-stage heart failure who are ineligible for heart transplantation Estimate the cost-effectiveness of destination-therapy LVAD for patients with end-stage heart failure who are ineligible for heart transplantation and to estimate the potential budget impact for the Ontario Ministry of Health and Long-Term Care over the next 5 years Methods We performed a narrative review of the clinical and economic literature for effectiveness and cost-effectiveness and a budget impact analysis from the perspective of the Ministry of Health and Long-Term Care. We did not conduct a meta-analysis of the clinical evidence owing to differences in the type of LVADs included in the studies. Results Three systematic reviews and one observational study contributed to the clinical evidence. Three economic reviews contributed to the economic evidence. There is moderate quality evidence that treatment with continuous-flow LVADs improves survival but has higher adverse events rates compared with drug therapy. Low quality evidence suggests treatment with a continuous-flow LVADs improves quality of life. The incremental cost-effectiveness ratio associated with destination-therapy LVAD over optimal medical management is relatively high and exceeds the traditionally accepted thresholds ($50,000 to $100,000 per quality-adjusted life

  6. [Experiences with therapy of pediatric sleep apnea syndrome and obstructive nasopharyngeal respiratory pattern with nasal BIPAP and CPAP therapy].

    PubMed

    Zwacka, G; Scholle, S

    1995-03-01

    Sleep-apnea in childhood shows a frequency similar to adults but it is caused by many other reasons. Therapeutic effects of nasal CPAP and BIPAP can replace surgical ENT-Therapy in large extent mainly in ages at 2-5 years. But also in older children is it possible to treat obstructive sleep apnea and hypoventilation neuromuscular diseases by BIPAP. Examples for treatment of children by BIPAP who are two years old were given. Other demonstrated cases cover children with stridor congenitus, obstructive sleep apnea, hypoventilation, adenoidal breathing disturbances with primary surgical treated tonsillar hyperplasia and one case of thoracal postobstructive malformation with therapeutic BIPAP options.

  7. 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.

  8. Development of shock wave assisted therapeutic devices and establishment of shock wave therapy.

    PubMed

    Hosseini, S H R; Menezes, V; Moosavi-Nejad, S; Ohki, T; Nakagawa, A; Tominaga, T; Takayama, K

    2006-01-01

    In order to exploit systems for shock wave therapy, we are working for the development of clinical devices that are based on the concept of shock waves or related phenomena. The paper describes these new therapeutic devices designed for the minimally invasive approach to vascular thromboloysis, selective dissection of tissues, and drug or DNA delivery. To investigate the response of cells to shock loading, a precise method of shock waves generation in space and time has been developed. This method has been studied for application in cardiovascular therapy, cancer treatment, and cranioplasty in close vicinity of the brain. A laser ablation shock wave assisted particle acceleration device has been developed for delivering drug and DNA into soft targets in the human body. The penetration depth of microparticles observed in the experimental targets is believed to be sufficient for pharmacological treatments. In order to achieve an efficient method for rapid revascularization of cerebral thrombosis, a laser induced liquid jet (LILJ) system has been developed. The LILJ has been successfully applied for selective dissection of soft tissue preserving nerve and blood vessels. The system has been further improved by using piezoelectric actuators to drive the liquid jets, as an alternative to pulse laser.

  9. Dynamic volume vs respiratory correlated 4DCT for motion assessment in radiation therapy simulation

    SciTech Connect

    Coolens, Catherine; Bracken, John; Driscoll, Brandon; Hope, Andrew; Jaffray, David

    2012-05-15

    Purpose: Conventional (i.e., respiratory-correlated) 4DCT exploits the repetitive nature of breathing to provide an estimate of motion; however, it has limitations due to binning artifacts and irregular breathing in actual patient breathing patterns. The aim of this work was to evaluate the accuracy and image quality of a dynamic volume, CT approach (4D{sub vol}) using a 320-slice CT scanner to minimize these limitations, wherein entire image volumes are acquired dynamically without couch movement. This will be compared to the conventional respiratory-correlated 4DCT approach (RCCT). Methods: 4D{sub vol} CT was performed and characterized on an in-house, programmable respiratory motion phantom containing multiple geometric and morphological ''tumor'' objects over a range of regular and irregular patient breathing traces obtained from 3D fluoroscopy and compared to RCCT. The accuracy of volumetric capture and breathing displacement were evaluated and compared with the ground truth values and with the results reported using RCCT. A motion model was investigated to validate the number of motion samples needed to obtain accurate motion probability density functions (PDF). The impact of 4D image quality on this accuracy was then investigated. Dose measurements using volumetric and conventional scan techniques were also performed and compared. Results: Both conventional and dynamic volume 4DCT methods were capable of estimating the programmed displacement of sinusoidal motion, but patient breathing is known to not be regular, and obvious differences were seen for realistic, irregular motion. The mean RCCT amplitude error averaged at 4 mm (max. 7.8 mm) whereas the 4D{sub vol} CT error stayed below 0.5 mm. Similarly, the average absolute volume error was lower with 4D{sub vol} CT. Under irregular breathing, the 4D{sub vol} CT method provides a close description of the motion PDF (cross-correlation 0.99) and is able to track each object, whereas the RCCT method results in a

  10. Objective assessment of biomagnetic devices and alternative clinical therapies using infrared thermal imaging

    NASA Astrophysics Data System (ADS)

    Rockley, Graham J.

    2001-03-01

    The overwhelming introduction of magnetic devices and other alternative therapies into the health care market prompts the need for objective evaluation of these techniques through the use of infrared thermal imaging. Many of these therapies are reported to promote the stimulation of blood flow or the relief of pain conditions. Infrared imaging is an efficient tool to assess such changes in the physiological state. Therefore, a thermal imager can help document and substantiate whether these therapies are in fact providing an effective change to the local circulation. Thermal images may also indicate whether the change is temporary or sustained. As a specific case example, preliminary findings will be presented concerning the use of magnets and the effect they have on peripheral circulation. This will include a discussion of the recommended protocols for this type of infrared testing. This test model can be applied to the evaluation of other devices and therapeutic procedures which are reputed to affect circulation such as electro acupuncture, orthopedic footwear and topical ointments designed to relieve pain or inflammation.

  11. Preliminary clinical results of pulsed-dye laser therapy for recurrent respiratory papillomatosis

    NASA Astrophysics Data System (ADS)

    McMillan, Kathleen; Shapshay, Stanley M.; McGilligan, J. A.; Wang, Zhi; Rebeiz, Elie E.

    1998-07-01

    Recurrent respiratory papillomatosis (RRP) is a viral disease characterized by the growth of benign tumors on the vocal cords. Standard management of RRP currently consists of CO2 laser microsurgical ablation of the papillomas. Because of the recurrent nature of this disease, patients are often faced with significant cumulative risk of soft tissue complications such as vocal cord scarring. As a minimally traumatic alternative to management of RRP, we have investigated the use of the 585 nm pulsed dye laser (PDL) to cause regression of the papillomas by selective eradication of the tumor microvasculature. Three patients have been treated with the PDL at fluences of 6 J/cm2 (double pulses per irradiated site), 8 J/cm2 (single pulses), and 10 J/cm2 (single pulses), at noncritical areas within the larynx, using a specially designed micromanipulator. Lesions on the true cords were treated with the CO2 laser. Clinical examination showed that PDL treatment appeared to produce complete regression of papillomas. Unlike the sites of lesions treated by the CO2 laser, the epithelial surface at the PDL treatment sites was preserved intact. The presumed mechanism for papilloma regression following PDL treatment involves acute or chronic localized hypoxia caused by loss of tumor microvasculature.

  12. Towards an unsupervised device for the diagnosis of childhood pneumonia in low resource settings: automatic segmentation of respiratory sounds.

    PubMed

    Sola, J; Braun, F; Muntane, E; Verjus, C; Bertschi, M; Hugon, F; Manzano, S; Benissa, M; Gervaix, A

    2016-08-01

    Pneumonia remains the worldwide leading cause of children mortality under the age of five, with every year 1.4 million deaths. Unfortunately, in low resource settings, very limited diagnostic support aids are provided to point-of-care practitioners. Current UNICEF/WHO case management algorithm relies on the use of a chronometer to manually count breath rates on pediatric patients: there is thus a major need for more sophisticated tools to diagnose pneumonia that increase sensitivity and specificity of breath-rate-based algorithms. These tools should be low cost, and adapted to practitioners with limited training. In this work, a novel concept of unsupervised tool for the diagnosis of childhood pneumonia is presented. The concept relies on the automated analysis of respiratory sounds as recorded by a point-of-care electronic stethoscope. By identifying the presence of auscultation sounds at different chest locations, this diagnostic tool is intended to estimate a pneumonia likelihood score. After presenting the overall architecture of an algorithm to estimate pneumonia scores, the importance of a robust unsupervised method to identify inspiratory and expiratory phases of a respiratory cycle is highlighted. Based on data from an on-going study involving pediatric pneumonia patients, a first algorithm to segment respiratory sounds is suggested. The unsupervised algorithm relies on a Mel-frequency filter bank, a two-step Gaussian Mixture Model (GMM) description of data, and a final Hidden Markov Model (HMM) interpretation of inspiratory-expiratory sequences. Finally, illustrative results on first recruited patients are provided. The presented algorithm opens the doors to a new family of unsupervised respiratory sound analyzers that could improve future versions of case management algorithms for the diagnosis of pneumonia in low-resources settings.

  13. 21 CFR 878.4683 - Non-Powered suction apparatus device intended for negative pressure wound therapy.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Non-Powered suction apparatus device intended for negative pressure wound therapy. 878.4683 Section 878.4683 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY...

  14. 21 CFR 878.4683 - Non-Powered suction apparatus device intended for negative pressure wound therapy.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Non-Powered suction apparatus device intended for negative pressure wound therapy. 878.4683 Section 878.4683 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY...

  15. 21 CFR 878.4683 - Non-Powered suction apparatus device intended for negative pressure wound therapy.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Non-Powered suction apparatus device intended for negative pressure wound therapy. 878.4683 Section 878.4683 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY...

  16. Evidence-based practice in the management of vascular access devices for home parenteral nutrition therapy.

    PubMed

    Ryder, Marcia

    2006-01-01

    Catheter-related bloodstream infection and catheter occlusion are potential significant complications of parenteral nutrition therapy. The increased incidence and associated morbidity, mortality, increased costs, and quality-of-life issues experienced with these adverse events necessitate specialized management of vascular access devices. The host coagulation response to biomaterials and the associated development of biofilm on vascular devices are complex phenomena. Multiple interventions are required to prevent access of bacteria to both intraluminal and extraluminal catheter surfaces, and the occurrence of catheter occlusion. The discovery of the biofilm form of microbial life and the associated recalcitrance of biofilm bacteria to antimicrobials has provided insight into the failure of current prevention, diagnostic, and treatment protocols. Critical interventions are presented correlating current evidence with new discoveries in pathogenesis.

  17. Singing teaching as a therapy for chronic respiratory disease--a randomised controlled trial and qualitative evaluation.

    PubMed

    Lord, Victoria M; Cave, Phoene; Hume, Victoria J; Flude, Elizabeth J; Evans, Amanda; Kelly, Julia L; Polkey, Michael I; Hopkinson, Nicholas S

    2010-08-03

    Despite optimal pharmacological therapy and pulmonary rehabilitation, patients with COPD continue to be breathless. There is a need to develop additional strategies to alleviate symptoms. Learning to sing requires control of breathing and posture and might have benefits that translate into daily life. To test this hypothesis we performed a randomised controlled trial, comparing a six week course of twice weekly singing classes to usual care, in 28 COPD patients. The experience of singing was assessed in a qualitative fashion, through interviews with a psychologist. In addition, we surveyed patients with chronic respiratory conditions who participated in a series of open singing workshops. In the RCT, the physical component score of the SF36 improved in the singers (n = 15) compared to the controls (n = 13); +7.5(14.6) vs. -3.8(8.4) p = 0.02. Singers also had a significant fall in HAD anxiety score; -1.1(2.7) vs. +0.8(1.7) p = 0.03. Singing did not improve single breath counting, breath hold time or shuttle walk distance. In the qualitative element, 8 patients from the singing group were interviewed. Positive effects on physical sensation, general well-being, community/social support and achievement/efficacy emerged as common themes. 150 participants in open workshops completed a questionnaire. 96% rated the workshops as "very enjoyable" and 98% thought the workshop had taught them something about breathing in a different way. 81% of attendees felt a "marked physical difference" after the workshop. Singing classes can improve quality of life measures and anxiety and are viewed as a very positive experience by patients with respiratory disease; no adverse consequences of participation were observed. Current Controlled Trials--ISRCTN17544114.

  18. A novel device for intraoperative photodynamic therapy dedicated to glioblastoma treatment.

    PubMed

    Dupont, Clément; Mordon, Serge; Deleporte, Pascal; Reyns, Nicolas; Vermandel, Maximilien

    2017-09-25

    Photodynamic therapy (PDT) appears to be a valuable new treatment modality for cancer therapy. Studies have reported successful application of PDT for glioblastoma. Here, we introduce a new device dedicated to intraoperative PDT delivered early after fluoro-guided resection combined with a transfer function that determines the treatment time based on the size of the surgical resection cavity. First, we describe the device, which is composed of a trocar, a balloon filled with a diffusing solution, and a fiber guide in which a cylindrical light diffuser is inserted. Ex vivo experiments were performed to measure the fluence rate inside biological tissues. A calibration factor was defined to convert power measurements into fluence rate values. Calf brains were used to simulate light propagation in human brain tissue, and the photosensitizer administration effect on optical properties was discussed. The temperature elevation during illumination was evaluated. Light power was measured in tissues surrounding the device during ex vivo experiments. Using the previously characterized calibration factor, power measurements were converted to fluence rate values to obtain the transfer function. No thermal elevation was observed during a 2-h temperature test, and the impact of protoporphyrin IX on brain optical properties was considered negligible. A discussion of experimental precision is presented. The light duration determined by the abacus had a standard deviation of <1 min. This value is weak compared with the total illumination time necessary to treat one patient. The main advantage of our device lies in its straightforward implementation of intraoperative PDT for neurosurgery with acceptable dosimetry and easy treatment time.

  19. Negative pressure wound therapy and external fixation device: a simple way to seal the dressing.

    PubMed

    Bulla, Antonio; Farace, Francesco; Uzel, André-Pierre; Casoli, Vincent

    2014-07-01

    Negative pressure therapy is widely applied to treat lower limb trauma. However, sealing a negative pressure dressing in the presence of an external fixation device may be difficult and time consuming. Therefore, screws, pins, wires, etc, may preclude the vacuum, preventing the plastic drape to perfectly adhere to the foam. To maintain the vacuum, we tried to prevent air leaking around the screws putting bone wax at the junction between the pins and the plastic drape. This solution, in our hands, avoids air leakage and helps maintain vacuum in a fast and inexpensive way.

  20. Spectral matching technology for light-emitting diode-based jaundice photodynamic therapy device

    NASA Astrophysics Data System (ADS)

    Gan, Ru-ting; Guo, Zhen-ning; Lin, Jie-ben

    2015-02-01

    The objective of this paper is to obtain the spectrum of light-emitting diode (LED)-based jaundice photodynamic therapy device (JPTD), the bilirubin absorption spectrum in vivo was regarded as target spectrum. According to the spectral constructing theory, a simple genetic algorithm as the spectral matching algorithm was first proposed in this study. The optimal combination ratios of LEDs were obtained, and the required LEDs number was then calculated. Meanwhile, the algorithm was compared with the existing spectral matching algorithms. The results show that this algorithm runs faster with higher efficiency, the switching time consumed is 2.06 s, and the fitting spectrum is very similar to the target spectrum with 98.15% matching degree. Thus, blue LED-based JPTD can replace traditional blue fluorescent tube, the spectral matching technology that has been put forward can be applied to the light source spectral matching for jaundice photodynamic therapy and other medical phototherapy.

  1. Malfunctions of implantable cardiac devices in patients receiving proton beam therapy: incidence and predictors

    PubMed Central

    Gomez, Daniel R.; Poenisch, Falk; Pinnix, Chelsea C.; Sheu, Tommy; Chang, Joe Y.; Memon, Nada; Mohan, Radhe; Rozner, Marc A.; Dougherty, Anne H.

    2014-01-01

    Purpose Photon therapy has been reported to induce resets of implanted cardiac devices, but the clinical sequelae of treating patients with such devices with proton beam therapy (PBT) are not well known. We reviewed the incidence of device malfunctions among patients undergoing PBT. Methods From March 2009 through July 2012, 42 patients with implanted cardiac implantable electronic devices (CIEDs) (28 pacemakers and 14 cardioverter-defillibrators) underwent 42 courses of PBT for thoracic (23 [55%]), prostate (15 [36%]), liver (3[7%]), or base of skull (1 [2%]) tumors at a single institution. The median prescribed dose was 74 Gy(RBE) [range 46.8–87.5 Gy(RBE)], and the median distance from the treatment field to the CIED was 10 cm (range 0.8–40 cm). Maximum proton and neutron doses were estimated for each treatment course. All CIEDs were checked before radiation delivery and monitored throughout treatment. Results Median estimated peak proton and neutron doses to the CIED in all patients were 0.8 Gy (range 0.13–21 Gy) and 346 Sv (range 11–1100 mSv). Six CIED malfunctions occurred in five patients (2 pacemakers and 3 defibrillators). Five of these malfunctions were CIED resets, and one patient with a defibrillator (in a patient with a liver tumor) had an elective replacement indicator (ERI) after therapy that was not influenced by radiation. The mean distance from the proton beam to the CIED among devices that reset was 7.0 cm (range 0.9–8 cm), and the mean maximum neutron dose was 655 mSv (range 330–1100 mSv). All resets occurred in patients receiving thoracic PBT and were corrected without clinical incident. The generator for the defibrillator with the ERI message was replaced uneventfully after treatment. Conclusions The incidence of CIED resets was about 20% among patients receiving PBT to the thorax. We recommend that PBT be avoided in pacing-dependent patients and that patients with any type of CIED receiving thoracic PBT be followed closely. PMID

  2. Malfunctions of Implantable Cardiac Devices in Patients Receiving Proton Beam Therapy: Incidence and Predictors

    SciTech Connect

    Gomez, Daniel R.; Poenisch, Falk; Pinnix, Chelsea C.; Sheu, Tommy; Chang, Joe Y.; Memon, Nada; Mohan, Radhe; Rozner, Marc A.; Dougherty, Anne H.

    2013-11-01

    Purpose: Photon therapy has been reported to induce resets of implanted cardiac devices, but the clinical sequelae of treating patients with such devices with proton beam therapy (PBT) are not well known. We reviewed the incidence of device malfunctions among patients undergoing PBT. Methods and Materials: From March 2009 through July 2012, 42 patients with implanted cardiac implantable electronic devices (CIED; 28 pacemakers and 14 cardioverter-defibrillators) underwent 42 courses of PBT for thoracic (23, 55%), prostate (15, 36%), liver (3, 7%), or base of skull (1, 2%) tumors at a single institution. The median prescribed dose was 74 Gy (relative biological effectiveness; range 46.8-87.5 Gy), and the median distance from the treatment field to the CIED was 10 cm (range 0.8-40 cm). Maximum proton and neutron doses were estimated for each treatment course. All CIEDs were checked before radiation delivery and monitored throughout treatment. Results: Median estimated peak proton and neutron doses to the CIED in all patients were 0.8 Gy (range 0.13-21 Gy) and 346 Sv (range 11-1100 mSv). Six CIED malfunctions occurred in 5 patients (2 pacemakers and 3 defibrillators). Five of these malfunctions were CIED resets, and 1 patient with a defibrillator (in a patient with a liver tumor) had an elective replacement indicator after therapy that was not influenced by radiation. The mean distance from the proton beam to the CIED among devices that reset was 7.0 cm (range 0.9-8 cm), and the mean maximum neutron dose was 655 mSv (range 330-1100 mSv). All resets occurred in patients receiving thoracic PBT and were corrected without clinical incident. The generator for the defibrillator with the elective replacement indicator message was replaced uneventfully after treatment. Conclusions: The incidence of CIED resets was about 20% among patients receiving PBT to the thorax. We recommend that PBT be avoided in pacing-dependent patients and that patients with any type of CIED receiving

  3. Survival of patients with chronic respiratory failure on long-term oxygen therapy and or non-invasive ventilation at home.

    PubMed

    Cano, Noël J; Pichard, Claude; Court-Fortune, Isabelle; Costes, Frédéric; Cynober, Luc; Gérard-Boncompain, Michèle; Molano, Luis Carlos; Cuvelier, Antoine; Laaban, Jean-Pierre; Melchior, Jean-Claude; Raphaël, Jean-Claude; France, Julie; Lloret, Thomas; Roth, Hubert; Pison, Christophe

    2015-08-01

    Chronic respiratory failure (CRF) is the common fate of respiratory diseases where systemic effects contribute to outcomes. In a prospective cohort of home-treated patients with CRF, we looked for predictors of long-term survival including respiratory, nutritional and inflammatory dimensions. 637 stable outpatients with CRF, 397 men, 68 ± 11 years, on long-term oxygen therapy and/or non-invasive ventilation from 21 chest clinics were enrolled and followed over 53 ± 31 months. CRF resulted from Chronic Obstructive Pulmonary Disease (COPD) in 48.5%, restrictive disorders 32%, mixed (obstructive and restrictive patterns) respiratory failure 13.5%, bronchiectasis 6%. Demographic characteristics, smoking habits, underlying respiratory diseases, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), arterial blood gases, 6-min walking distance (6MWD), hemoglobin, body mass index (BMI), serum albumin, transthyretin, C-reactive protein (CRP), history of respiratory assistance, antibiotic and oral corticosteroid use during the previous year were recorded. 322 deaths occurred during the follow-up. One-, five- and 8-year actuarial survival was 89%, 56% and 47%. By Cox univariate analysis, age, respiratory disease, PaO2, PaCO2, FEV1/FVC, BMI, 6MWD, activity score, type and length of home respiratory assistance, smoking habits, oral corticosteroid and antibiotic uses, albumin, transthyretin, hemoglobin and CRP levels were associated with survival. Multivariate analysis identified eight independent markers of survival: age, FEV1/FVC, PaO2, PaCO2, 6MWD, BMI, serum transthyretin, CRP ≥ 5 mg/l. In CRF, whatever the underlying diseases, besides the levels of obstructive ventilatory defect and gas exchange failure, 6MWD, BMI, serum transthyretin and CRP ≥ 5 mg/l predicted long-term survival identifying potential targets for nutritional rehabilitation. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights

  4. Diagnosis and Anti-Reflux Therapy for GERD with Respiratory Symptoms: A Study Using Multichannel Intraluminal Impedance-pH Monitoring

    PubMed Central

    Zhang, Chao; Wu, Jimin; Hu, Zhiwei; Yan, Chao; Gao, Xiang; Liang, Weitao; Liu, Diangang; Li, Fei; Wang, Zhonggao

    2016-01-01

    Background/Aims Respiratory symptoms are often associated with gastroesophageal reflux disease (GERD). Although the role of multichannel intraluminal impedance–pH (MII-pH) monitoring in GERD is clear, little is known regarding the characteristics of patients with respiratory symptoms based on MII-pH monitoring and anti-reflux therapy. We evaluated a cohort of GERD patients to identify the MII-pH parameters of GERD-related respiratory symptoms and to assess the anti-reflux therapy outcomes. Methods We undertook a prospective study of patients who were referred for GERD evaluation from January 2011 to January 2012. One hundred ninety-five patients underwent MII-pH monitoring and esophageal manometry, and one hundred sixty-five patients underwent invasive anti-reflux therapy that included laparoscopic Toupet fundoplication (LTF) and the Stretta procedure. The patient characteristics and MII-pH parameters were analyzed, and the symptom scores were assessed at baseline and at 1- and 3-year follow-up evaluations. Results Of the 195 patients, 96 (49.2%) exhibited respiratory symptoms and significantly more reflux episodes (70.7±29.3) than patients without respiratory symptoms (64.7±24.4, p = 0.044) based on the MII-pH monitoring results. Moreover, the group of patients with respiratory symptoms exhibited more proximal reflux episodes (35.2±21.3) than the non-respiratory symptomatic group (28.3±17.9, p = 0.013). One hundred twenty-five patients following the Stretta procedure (n = 60, 31 with respiratory symptoms) or LTF (n = 65, 35 with respiratory symptoms) completed the designated 3-year follow-up period and were included in the final analysis. The symptom scores after anti-reflux therapy all decreased relative to the corresponding baseline values (p<0.05), and there were no significant differences in the control of respiration between the Stretta procedure and LTF (p>0.05). However, LTF significantly reduced the recurrence (re-operation) rate compared with the

  5. Restrictive transfusion practice during extracorporeal membrane oxygenation therapy for severe acute respiratory distress syndrome.

    PubMed

    Voelker, Maria T; Busch, Thilo; Bercker, Sven; Fichtner, Falk; Kaisers, Udo X; Laudi, Sven

    2015-04-01

    Recommendations concerning the management of hemoglobin levels and hematocrit in patients on extracorporeal membrane oxygenation (ECMO) still advise maintenance of a normal hematocrit. In contrast, current transfusion guidelines for critically ill patients support restrictive transfusion practice. We report on a series of patients receiving venovenous ECMO (vvECMO) for acute respiratory distress syndrome (ARDS) treated according to the restrictive transfusion regimen recommended for critically ill patients. We retrospectively analyzed 18 patients receiving vvECMO due to severe ARDS. Hemoglobin concentrations were kept between 7 and 9 g/dL with a transfusion trigger at 7 g/dL or when physiological transfusion triggers were apparent. We assessed baseline data, hospital mortality, time on ECMO, hemoglobin levels, hematocrit, quantities of packed red blood cells received, and lactate concentrations and compared survivors and nonsurvivors. The overall mortality of all patients on vvECMO was 38.9%. Mean hemoglobin concentration over all patients and ECMO days was 8.30 ± 0.51 g/dL, and hematocrit was 0.25 ± 0.01, with no difference between survivors and nonsurvivors. Mean numbers of given PRBCs showed a trend towards higher quantities in the group of nonsurvivors, but the difference was not significant (1.97 ± 1.47 vs. 0.96 ± 0.76 units; P = 0.07). Mean lactate clearance from the first to the third day was 45.4 ± 28.3%, with no significant difference between survivors and nonsurvivors (P = 0.19). In our cohort of patients treated with ECMO due to severe ARDS, the application of a restrictive transfusion protocol did not result in an increased mortality. Safety and feasibility of the application of a restrictive transfusion protocol in patients on ECMO must further be evaluated in randomized controlled trials.

  6. Cytokine expression before and after aspirin desensitization therapy in aspirin-exacerbated respiratory disease.

    PubMed

    Aktas, Ayse; Kurt, Emel; Gulbas, Zafer

    2013-12-01

    Aspirin exacerbated respiratory disease (AERD) is induced by acetylsalicylic acid (ASA) and/or nonsteroidal antiinflammatory drugs (NSAIDs). Effects of desensitization on many mediators have been examined previously, but few studies addressed the influence of desensitization on T lymphocytes and T lymphocyte-derived cytokines. This study was performed to examine peripheral blood lymphocyte (PBL) cytokine expression in aspirin-sensitive patients who have asthma before and after aspirin desensitization. In this study, the release of interleukin-2 (IL-2), interleukin-4 (IL-4), and interferon-gamma (IFN-γ) by CD4+ T lymphocytes prior to aspirin desensitization were also measured at intracellular levels, and expression of these cytokines after 1 month aspirin desensitization was evaluated. Twelve patients with AERD were included in the study. Two different control groups were formed, one consisted of 15 healthy people and second 12 aspirin tolerant asthmatic (ATA) patients using aspirin. A blood sample was collected prior to desensitization, and the tests were repeated by taking a second blood sample 1 month after the 4-day desensitization treatment. The proportion of lymphocytes secreting IFN-γ in the study group was 15.61 ± 4.40 % before desensitization and 15.08 ± 5.89 % after desensitization. The rate of IFN-γ secreting CD4+ T lymphocytes was 20.51 ± 4.41 % in the normal control group and 16.07 ± 5.7 % in the ATA group (p = 0.021). The ratio of CD4+ T lymphocyte secreting IFN-γ was reduced in patients with AERD before desensitization compared to normal control group (p = 0.040). The levels of IL-2, IL-4, and the subsets of lymphocyte were not different before and after desensitization compared to control groups.

  7. Narrowing of the Coronary Sinus: A Device-Based Therapy for Persistent Angina Pectoris.

    PubMed

    Konigstein, Maayan; Verheye, Stefan; Jolicœur, E Marc; Banai, Shmuel

    2016-01-01

    Alongside the remarkable advances in medical and invasive therapies for the treatment of ischemic heart disease, an increasing number of patients with advanced coronary artery disease unsuitable for revascularization continue to suffer from angina pectoris despite optimal medical therapy. Patients with chronic angina have poor quality of life and increased levels of anxiety and depression. A considerable number of innovative therapeutic modalities for the treatment of chronic angina have been investigated over the years; however, none of these therapeutic options has become a standard of care, and none are widely utilized. Current treatment options for refractory angina focus on medical therapy and secondary risk factor modification. Interventions to create increased pressure in the coronary sinus may alleviate myocardial ischemia by forcing redistribution of coronary blood flow from the less ischemic subepicardium to the more ischemic subendocardium, thus relieving symptoms of ischemia. Percutaneous, transvenous implantation of a balloon expandable, hourglass-shaped, stainless steel mesh in the coronary sinus to create a fixed focal narrowing and to increase backwards pressure, may serve as a new device-based therapy destined for the treatment of refractory angina pectoris.

  8. The ADMIT series - Issues in inhalation therapy. 4) How to choose inhaler devices for the treatment of COPD.

    PubMed

    Vincken, Walter; Dekhuijzen, Pn Richard; Barnes, Peter

    2010-03-01

    For patients with COPD, inhalation is the preferred route of administration of respiratory drugs for both maintenance and acute treatment. Numerous inhaler types and devices have been developed, each with their own particularities, advantages and disadvantages. Nevertheless, published COPD management guidelines pay little attention to the optimal choice of inhaler devices for COPD patients. Although efficacy and safety are the primary factors determining the choice of an inhaler device, randomised controlled trials (RCTs) directly comparing the efficacy and safety of different inhalers in COPD patients are scarce. Systematic reviews on this subject failed to find significant differences between devices for any of the clinical outcomes studied. When selecting a device for the delivery of inhaled drugs in 'real life' patients with COPD, other factors should be considered. These include availability and affordability of the inhaled drugs and inhaler devices, the uniformity of inhaler devices when several drugs are to be inhaled, the ability of patients to handle correctly the selected device - in particular taking into account the advanced age of the average COPD patient, and finally the patient's preference. The prescribing clinician's task is to provide comprehensive instructions for correct handling of the device and to review regularly the patient's inhalation technique.

  9. SU-E-J-169: The Dosimetric and Temporal Effects of Respiratory-Gated Radiation Therapy in Lung Cancer Patients

    SciTech Connect

    Rouabhi, O; Gross, B; Xia, J; Bayouth, J

    2015-06-15

    Purpose: To evaluate the dosimetric and temporal effects of high dose rate treatment mode for respiratory-gated radiation therapy in lung cancer patients. Methods: Treatment plans from five lung cancer patients (3 nongated (Group 1), 2 gated at 80EX-80IN (Group 2)) were retrospectively evaluated. The maximum tumor motions range from 6–12 mm. Using the same planning criteria, four new treatment plans, corresponding to four gating windows (20EX–20IN, 40EX–40IN, 60EX–60IN, and 80EX–80IN), were generated for each patient. Mean tumor dose (MTD), mean lung dose (MLD), and lung V20 were used to assess the dosimetric effects. A MATLAB algorithm was developed to compute treatment time by considering gantry rotation time, time to position collimator leaves, dose delivery time (scaled relative to the gating window), and communication overhead. Treatment delivery time for each plan was estimated using a 500 MU/min dose rate for the original plans and a 1500 MU/min dose rate for the gated plans. Results: Differences in MTD were less than 1Gy across plans for all five patients. MLD and lung V20 were on average reduced between −16.1% to −6.0% and −20.0% to −7.2%, respectively for non-gated plans when compared with the corresponding gated plans, and between − 5.8% to −4.2% and −7.0% to −5.4%, respectively for plans originally gated at 80EX–80IN when compared with the corresponding 20EX-20IN to 60EX– 60IN gated plans. Treatment delivery times of gated plans using high dose rate were reduced on average between −19.7% (−1.9min) to −27.2% (−2.7min) for originally non-gated plans and −15.6% (−0.9min) to −20.3% (−1.2min) for originally 80EX-80IN gated plans. Conclusion: Respiratory-gated radiation therapy in lung cancer patients can reduce lung toxicity, while maintaining tumor dose. Using a gated high-dose-rate treatment, delivery time comparable to non-gated normal-dose-rate treatment can be achieved. This research is supported by Siemens

  10. Respiratory care management information systems.

    PubMed

    Ford, Richard M

    2004-04-01

    Hospital-wide computerized information systems evolved from the need to capture patient information and perform billing and other financial functions. These systems, however, have fallen short of meeting the needs of respiratory care departments regarding work load assessment, productivity management, and the level of outcome reporting required to support programs such as patient-driven protocols. The respiratory care management information systems (RCMIS) of today offer many advantages over paper-based systems and hospital-wide computer systems. RCMIS are designed to facilitate functions specific to respiratory care, including assessing work demand, assigning and tracking resources, charting, billing, and reporting results. RCMIS incorporate mobile, point-of-care charting and are highly configurable to meet the specific needs of individual respiratory care departments. Important and substantial benefits can be realized with an RCMIS and mobile, wireless charting devices. The initial and ongoing costs of an RCMIS are justified by increased charge capture and reduced costs, by way of improved productivity and efficiency. It is not unusual to recover the total cost of an RCMIS within the first year of its operation. In addition, such systems can facilitate and monitor patient-care protocols and help to efficiently manage the vast amounts of information encountered during the practitioner's workday. Respiratory care departments that invest in RCMIS have an advantage in the provision of quality care and in reducing expenses. A centralized respiratory therapy department with an RCMIS is the most efficient and cost-effective way to monitor work demand and manage the hospital-wide allocation of respiratory care services.

  11. Subatmospheric pressure wound therapy and the vacuum-assisted closure device: basic science and current clinical successes.

    PubMed

    Plikaitis, Christina M; Molnar, Joseph A

    2006-03-01

    This article reviews the development, current theories behind the mechanism of action and clinical use of subatmospheric pressure wound therapy with the vacuum-assisted closure device. An evolving list of indications for subatmospheric pressure therapy is discussed including its use in chronic wounds, traumatic wounds and orthopedic salvage, infected sternal wounds, management of the open abdomen, enterocutaneous fistulae, burn wounds, skin grafts and dermal substitutes, as well as systemic disease processes, such as myoglobinuria. The vacuum-assisted closure device Instill system is also reviewed, in which subatmospheric pressure therapy has been combined with the instillation of therapeutic solutions for the treatment of difficult infected wounds.

  12. Respiratory retraining therapy and management of laryngopharyngeal reflux in the treatment of patients with cough and paradoxical vocal fold movement disorder.

    PubMed

    Murry, Thomas; Tabaee, Abtin; Owczarzak, Vicki; Aviv, Jonathan E

    2006-10-01

    We describe the outcome of patients with cough and paradoxical vocal fold movement disorder (PVFMD) treated with respiratory retraining therapy and management of laryngopharyngeal reflux (LPR). Twenty patients with the complaint of cough were given a diagnosis of PVFMD and treated with proton pump inhibitors for a minimum of 6 months followed by 3 to 5 sessions of respiratory retraining therapy. Pulmonary function testing (PFT) and subjective rating of cough and reflux (reflux symptom index; RSI) were performed. Also, PFT and rating of cough were performed on a group of 10 healthy volunteers with no complaint of cough. The study group comprised 13 women and 7 men. The baseline cough rating and ratio of forced inspiratory volume at 0.5 second to forced inspiratory vital capacity (FIV0.5/FIVC) on PFT were significantly worse in the treatment group than in the control group. After therapy, 20 patients (100%) experienced improvement in cough, 19 patients (95%) experienced improvement on PFT, and 17 patients (85%) experienced improvement in the RSI score. The differences were statistically significant. Respiratory retraining therapy combined with management of LPR is an effective treatment for patients with cough and PVFMD when a single-modality treatment is not sufficient.

  13. [Application of modified plaster material and device in acupoint plaster therapy].

    PubMed

    Liu, Jing-Xing; Wang, Kui; Wang, De-Li; Yang, Zong-Yun

    2013-02-01

    Through the analysis on the methods of medicinal paste preparation, the irritation of skin to medicine and the plaster materials adopted in acupoint plaster therapy for the prevention of winter-attacked disease in summer, the acupoint plaster materials and devices were improved. According to the differences in age, illness condition, acupoint and medicinal irritation of patients, the high-dosage, moderate-dosage and low-dosage series of medicine were prepared in proportion; 2. 5 mL and 5 mL syringes were manually reconstructed as the pushers for the delivery of the medicine paste of different specifications. The new-type materials such as spun-bonded non-woven fabrics, transparent dressing film and spun-laced non-woven skin-color stick plaster were adopted. In the operation, the medicine was classified and prepared more specifically. The dedicated acupoint plaster was characterized as less in skin irritation, breathable in property, convenient in practice and proper in stickiness. The plastic anti-seepage film in the middle and the medicine storage pool for stabilizing medicinal paste could avoid drug leakage. The medicinal paste pusher could achieve the even size, proper thickness and precise dosage of the paste. The new-type plaster material and the self-prepared innovated plaster device contribute to the development of acupoint plaster therapy in clinical application.

  14. Design of a new tracking device for on-line beam range monitor in carbon therapy.

    PubMed

    Traini, Giacomo; Battistoni, Giuseppe; Bollella, Angela; Collamati, Francesco; De Lucia, Erika; Faccini, Riccardo; Ferroni, Fernando; Frallicciardi, Paola Maria; Mancini-Terracciano, Carlo; Marafini, Michela; Mattei, Ilaria; Miraglia, Federico; Muraro, Silvia; Paramatti, Riccardo; Piersanti, Luca; Pinci, Davide; Rucinski, Antoni; Russomando, Andrea; Sarti, Alessio; Sciubba, Adalberto; Senzacqua, Martina; Solfaroli-Camillocci, Elena; Toppi, Marco; Voena, Cecilia; Patera, Vincenzo

    2017-02-01

    Charged particle therapy is a technique for cancer treatment that exploits hadron beams, mostly protons and carbon ions. A critical issue is the monitoring of the beam range so to check the correct dose deposition to the tumor and surrounding tissues. The design of a new tracking device for beam range real-time monitoring in pencil beam carbon ion therapy is presented. The proposed device tracks secondary charged particles produced by beam interactions in the patient tissue and exploits the correlation of the charged particle emission profile with the spatial dose deposition and the Bragg peak position. The detector, currently under construction, uses the information provided by 12 layers of scintillating fibers followed by a plastic scintillator and a pixelated Lutetium Fine Silicate (LFS) crystal calorimeter. An algorithm to account and correct for emission profile distortion due to charged secondaries absorption inside the patient tissue is also proposed. Finally detector reconstruction efficiency for charged particle emission profile is evaluated using a Monte Carlo simulation considering a quasi-realistic case of a non-homogenous phantom.

  15. Integrated microwave thermal imaging system with mechanically steerable HIFU therapy device

    NASA Astrophysics Data System (ADS)

    Zhou, Tian; Meaney, Paul M.; Fanning, Margaret W.; Geimer, Shireen D.; Paulsen, Keith D.

    2009-02-01

    We are developing a microwave tomographic imaging system for non-invasive monitoring of temperature changes during thermal therapy, based on the known tissue conductivity temperature dependence. As with any monitoring system, the actual integration with a therapy device is a significant challenge. The combined high intensity focused ultrasound (HIFU)/microwave imaging approach is intriguing because the necessary characteristics for the microwave data gathering (highly EM attenuating coupling liquid) are not compromised by the HIFU requirements (low ultrasound attenuating coupling liquid) since the physics of the two wave propagations are quite different. We have previously reported results for a configuration for use in breast cancer treatment where the HIFU transducer was positioned within the array of coaxial support rods of the antennas which surrounded the breast while the ultrasound beam propagated towards the breast without being obstructed by the antennas. For our new implementation, we have positioned the heating device outside the antenna array and aimed the beam directly past the monopole antennas to the target tissue within. This configuration is particularly useful for various other anatomical sites where it is not possible to position the transducer inside the antenna array, such as for vital organs in the torso. Our initial results illustrate that the ultrasound beam is not significantly impaired by the presence of the microwave antennas and that the beam is readily steerable to desired locations. Additional dynamic experiments demonstrate good correlation between actual temperature rise and conductivity decreases in targeted positions. These results set the stage for actual animal experiments.

  16. Systematic Review of Evidence-Based Guidelines on Medication Therapy for Upper Respiratory Tract Infection in Children with AGREE Instrument

    PubMed Central

    Zeng, Linan; Zhang, Lingli; Hu, Zhiqiang; Ehle, Emily A.; Chen, Yuan; Liu, Lili; Chen, Min

    2014-01-01

    Objectives To summarize recommendations of existing guidelines on the treatment of upper respiratory tract infections (URTIs) in children, and to assess the methodological quality of these guidelines. Methods We searched seven databases and web sites of relevant academic agencies. Evidence-based guidelines on pediatric URTIs were included. AGREE II was used to assess the quality of these guidelines. Two researchers selected guidelines independently and extracted information on publication years, institutions, target populations, recommendations, quality of evidence, and strength of recommendations. We compared the similarities and differences of recommendations and their strength. We also analyzed the reasons for variation. Results Thirteen guidelines meeting our inclusion criteria were included. Huge differences existed among these 13 guidelines concerning the categorization of evidence and recommendations. Nearly all of these guidelines lacked the sufficient involvement of stake holders. Further, the applicability of these guidelines still needs to be improved. In terms of recommendations, penicillin and amoxicillin were suggested for group A streptococcal pharyngitis. Amoxicillin and amoxicillin-clavulanate were recommended for acute bacterial rhinosinusitis (ABRS). An observation of 2–3 days prior to antibiotic therapy initiation for mild acute otitis media (AOM) was recommended with amoxicillin as the suggested first choice agent. Direct evidence to support strong recommendations on the therapy for influenza is still lacking. In addition, the antimicrobial durations for pharyngitis and ABRS were still controversial. No consensus was reached for the onset of antibiotics for ABRS in children. Conclusions Future guidelines should use a consistent grading system for the quality of evidence and strength of recommendations. More effort needs to be paid to seek the preference of stake holders and to improve the applicability of guidelines. Further, there are still

  17. Cardiac resynchronization therapy pacemaker: critical appraisal of the adaptive CRT-P device.

    PubMed

    Daoud, Georges E; Houmsse, Mahmoud

    2016-01-01

    Cardiac resynchronization therapy (CRT) is an effective and well-established therapy for patients suffering with heart failure, left ventricular (LV) systolic dysfunction (ejection fraction ≤35%), and electrical dyssynchrony, demonstrated by a surface QRS duration of ≥120 ms. Patients undergoing treatment with CRT have shown significant improvement in functional class, quality of life, LV ejection fraction, exercise capacity, hemodynamics, and reverse remodeling of LV, and ultimately, morbidity and mortality. However, 30%-40% of patients who receive a CRT device may not show improvement, and they are termed as non responders. The nonresponders have a poor prognosis; several methods have been developed to try to enhance response to CRT. Echocardiography-guided optimization of CRT has not resulted in significant clinical benefit, since it is done at rest with the patient in supine position. An ideal optimization strategy would provide continuous monitoring and adjustment of device pacing to provide maximal cardiac resynchronization, under a multitude of physiologic states. Intrinsic activation of the right ventricle (RV) with paced activation of the RV, even in the setting of biventricular (BiV) pacing, may result in an adverse effect on cardiac performance. With this physiology, the use of LV-only pacing may be preferred and may enhance CRT. Adaptive CRT is a novel device-based algorithm that was designed to achieve patient-specific adjustment in CRT so as to provide appropriate BiV pacing or LV-only pacing. This article will review the goals of CRT optimization, and implementation and outcomes associated with adaptive CRT.

  18. High-flow nasal oxygen therapy and noninvasive ventilation in the management of acute hypoxemic respiratory failure.

    PubMed

    Frat, Jean-Pierre; Coudroy, Rémi; Marjanovic, Nicolas; Thille, Arnaud W

    2017-07-01

    High-flow nasal cannula (HFNC) oxygen therapy is a recent technique delivering a high flow of heated and humidified gas. HFNC is simpler to use and apply than noninvasive ventilation (NIV) and appears to be a good alternative treatment for hypoxemic acute respiratory failure (ARF). HFNC is better tolerated than NIV, delivers high fraction of inspired oxygen (FiO2), generates a low level of positive pressure and provides washout of dead space in the upper airways, thereby improving mechanical pulmonary properties and unloading inspiratory muscles during ARF. A recent multicenter randomized controlled trial showed benefits of HFNC concerning mortality and intubation in severe patients with hypoxemic ARF. In management of patients with hypoxemic ARF, NIV results have been conflicting. Despite improved oxygenation, NIV delivered with face mask may generate high tidal volumes and subsequent ventilator-induced lung injury. An approach applying NIV with a helmet, high levels of positive end-expiratory pressure (PEEP) and low pressure support (PS) levels seems to open new opportunities in patients with hypoxemic ARF. However, a large-scale randomized controlled study is needed to assess and compare this approach with HFNC.

  19. Respiratory Sinus Arrhythmia in Cognitive Behavioral Therapy for Posttraumatic Stress Symptoms in Children: Preliminary Treatment and Gender Effects.

    PubMed

    Lipschutz, Rebecca S; Gray, Sarah A O; Weems, Carl F; Scheeringa, Michael S

    2017-08-24

    Cognitive behavioral therapy (CBT) is an efficacious treatment for posttraumatic stress disorder (PTSD) symptoms, but the effect of CBT on physiological indicators is largely unknown. Respiratory sinus arrhythmia (RSA) is an established parasympathetic marker of self-regulatory capacity and stress responsivity. The present study tested if and how resting RSA and RSA reactivity changed following treatment among a sample of children (n = 48) who experienced at least one traumatic event and presented with PTSD symptoms. RSA reactivity was measured in response to personalized trauma-related scripts. Results indicated that changes in RSA after treatment were dependent on pretreatment resting levels of RSA, with individuals with high and low pretreatment resting RSA levels appearing to converge over time in both resting RSA and RSA reactivity by the 3-month follow up. Specific to RSA reactivity, a sex difference was evident, as following treatment, females showed less RSA withdrawal whereas males showed more RSA withdrawal. PTSD symptoms were significantly reduced after CBT but symptom change was not associated with pretreatment resting RSA levels. Overall, these results suggest that there may be multiple physiological patterns within children with PTSD and the direction of the physiological changes after CBT may depend on initial differences in resting RSA levels.

  20. Invention of the Guide Catheter Irrigation Monitoring Device for Neuroendovascular Therapy.

    PubMed

    Ozkul, Ayca; Park, Jong-Hyun; Shin, Dong-Seung; Yilmaz, Ali; Kim, Bum-Tae

    2017-07-01

    The thromboembolic events during neuroendovascular therapy (NET) are the major complications of concern that can be occasionally fatal. The thrombotic occlusion of the guide catheter for NET is thought to be the risk of the thromboembolic events. We have developed an idea for inventing the monitoring system of the continuous irrigation through the guide catheter. We herein present a unique invention of the guide catheter irrigation monitoring device. We have developed ideas for preventing the thrombotic occlusion of the guide catheter. In order to design a convenient device working in the practical use, we have consulted and shared the ideas with the electrical engineers about putting the invention. The guide catheter irrigation monitoring device (GCIMD) consisted of three parts of optical sensor, main body and electric adapter. In brief, the basic principles of working of the GCIMD are as follows. The optical sensor is attached to the dripping chamber of the line to irrigation solution. The main body had the small light and speaker to make an alarm sounds. The sensor monitors the dripping of flush solution. If the dripping stops more than three seconds, a warning alarm has been activated. So, the operating physicians can concentrate and check the guide catheter irrigation. After the use of the GCIMD, there was no major thromboembolic complication in conjunction with the thrombotic occlusion of the guide catheter in our institute. We have developed a brilliant invention of the GCIMD for NET.

  1. Examining the mechanism of action of a new device using oral pressure therapy for the treatment of obstructive sleep apnea.

    PubMed

    Schwab, Richard J; Kim, C; Siegel, Lawrence; Keenan, B T; Black, Jed; Farid-Moayer, Mehran; Podmore, Jonathan; Vaska, Matt

    2014-07-01

    The objective of this study was to explore the mechanism of action of the oral pressure therapy (OPT) device, a new treatment for sleep apnea. Case series. Academic medical center. Fifteen subjects with sleep apnea who had been successfully treated (responders) with the OPT device and 4 subjects who were not successfully treated (non-responders) with the OPT device. All subjects underwent a MRI (without the device, with the device in place without vacuum and with the device in place with vacuum) to examine the biomechanical changes associated with the OPT device. Oral pressure therapy significantly (P = 0.002) increased the size of the retropalatal airway in both the lateral and anterior-posterior dimensions by moving the soft palate anteriorly and superiorly and the anterior-superior segment of the tongue forward, toward the teeth. The percentage and absolute increase in the cross-sectional area of the retropalatal region, the superior movement of the soft palate, and the anterior displacement of the tongue were significantly greater in the responders than in the non-responders. In responders, there were significant increases in the mean (P = 0.002), maximum (P = 0.0002), and minimum (P = 0.04) cross-sectional areas of the retropalatal region with the OPT device. However, in the retroglossal region, airway caliber decreased with the OPT device. In those who responded to oral pressure therapy, it increased airway caliber in the retropalatal region by moving the soft palate anteriorly and superiorly and the anterior-superior segment of the tongue forward. Schwab RJ, Kim C, Siegel L, Keenan BT, Black J, Farid-Moayer M, Podmore J, Vaska M. Examining the mechanism of action of a new device using oral pressure therapy for the treatment of obstructive sleep apnea.

  2. Renal replacement therapy in congestive heart failure requiring left ventricular assist device augmentation.

    PubMed

    Thomas, Bernadette A; Logar, Christine M; Anderson, Arthur E

    2012-01-01

    "Cardiorenal syndrome" is a term used to describe a dys-regulation of the heart affecting the kidneys, or vice versa, in an acute or chronic manner (1,2). Renal impairment can range from reversible ischemic damage to renal failure requiring short- or long-term renal replacement therapy (2). Patients who require mechanical circulatory support, such as a left ventricular assist device (LVAD), as definitive treatment for congestive heart failure or as a bridge to cardiac transplantation pose a unique challenge with respect to receiving dialysis, because they experience higher rates of morbidity and mortality from infection in the post-LVAD period (3-7). Acute dialysis access can pose an increased infection risk. In this article, we present a patient who required renal replacement therapy and a LVAD for management of acute-on-chronic cardiorenal syndrome while awaiting heart transplantation. A literature review to determine whether peritoneal dialysis or hemodialysis is superior for patients with profound hemodynamic dysfunction and the need to minimize risk of infection did not offer clear guidance about which modality is superior in patients with advanced congestive heart failure. However, there is clear evidence of the superiority of peritoneal dialysis in reducing the risk of systemic infection secondary to acute dialysis access. Given the high risk of LVAD infection, we therefore conclude that, to decrease mortality secondary to systemic infection, peritoneal dialysis should strongly be considered in patients who require renal replacement therapy before or after LVAD placement.

  3. Multivariate regression approaches for surrogate-based diffeomorphic estimation of respiratory motion in radiation therapy

    NASA Astrophysics Data System (ADS)

    Wilms, M.; Werner, R.; Ehrhardt, J.; Schmidt-Richberg, A.; Schlemmer, H.-P.; Handels, H.

    2014-03-01

    Breathing-induced location uncertainties of internal structures are still a relevant issue in the radiation therapy of thoracic and abdominal tumours. Motion compensation approaches like gating or tumour tracking are usually driven by low-dimensional breathing signals, which are acquired in real-time during the treatment. These signals are only surrogates of the internal motion of target structures and organs at risk, and, consequently, appropriate models are needed to establish correspondence between the acquired signals and the sought internal motion patterns. In this work, we present a diffeomorphic framework for correspondence modelling based on the Log-Euclidean framework and multivariate regression. Within the framework, we systematically compare standard and subspace regression approaches (principal component regression, partial least squares, canonical correlation analysis) for different types of common breathing signals (1D: spirometry, abdominal belt, diaphragm tracking; multi-dimensional: skin surface tracking). Experiments are based on 4D CT and 4D MRI data sets and cover intra- and inter-cycle as well as intra- and inter-session motion variations. Only small differences in internal motion estimation accuracy are observed between the 1D surrogates. Increasing the surrogate dimensionality, however, improved the accuracy significantly; this is shown for both 2D signals, which consist of a common 1D signal and its time derivative, and high-dimensional signals containing the motion of many skin surface points. Eventually, comparing the standard and subspace regression variants when applied to the high-dimensional breathing signals, only small differences in terms of motion estimation accuracy are found.

  4. Multivariate regression approaches for surrogate-based diffeomorphic estimation of respiratory motion in radiation therapy.

    PubMed

    Wilms, M; Werner, R; Ehrhardt, J; Schmidt-Richberg, A; Schlemmer, H-P; Handels, H

    2014-03-07

    Breathing-induced location uncertainties of internal structures are still a relevant issue in the radiation therapy of thoracic and abdominal tumours. Motion compensation approaches like gating or tumour tracking are usually driven by low-dimensional breathing signals, which are acquired in real-time during the treatment. These signals are only surrogates of the internal motion of target structures and organs at risk, and, consequently, appropriate models are needed to establish correspondence between the acquired signals and the sought internal motion patterns. In this work, we present a diffeomorphic framework for correspondence modelling based on the Log-Euclidean framework and multivariate regression. Within the framework, we systematically compare standard and subspace regression approaches (principal component regression, partial least squares, canonical correlation analysis) for different types of common breathing signals (1D: spirometry, abdominal belt, diaphragm tracking; multi-dimensional: skin surface tracking). Experiments are based on 4D CT and 4D MRI data sets and cover intra- and inter-cycle as well as intra- and inter-session motion variations. Only small differences in internal motion estimation accuracy are observed between the 1D surrogates. Increasing the surrogate dimensionality, however, improved the accuracy significantly; this is shown for both 2D signals, which consist of a common 1D signal and its time derivative, and high-dimensional signals containing the motion of many skin surface points. Eventually, comparing the standard and subspace regression variants when applied to the high-dimensional breathing signals, only small differences in terms of motion estimation accuracy are found.

  5. The acute effects of body position strategies and respiratory therapy in paralyzed patients with acute lung injury

    PubMed Central

    Davis, Kenneth; Johannigman, Jay A; Campbell, Robert S; Marraccini, Ann; Luchette, Fred A; Frame, Scott B; Branson, Richard D

    2001-01-01

    Background: Routine turning of critically ill patients is a standard of care. In recent years, specialized beds that provide automated turning have been introduced. These beds have been reported to improve lung function, reduce hospital-acquired pneumonia, and facilitate secretion removal. This trial was designed to measure the physiological effects of routine turning and respiratory therapy in comparison with continuous lateral rotation (CLR). Methods: The study was a prospective, quasi-experimental, random assignment, trial with patients serving as their own controls. Paralyzed, sedated patients with acute respiratory distress syndrome were eligible for study. Patients were randomized to receive four turning and secretion management regimens in random sequence for 6 h each over a period of 24 h: (1) routine turning every 2 h from the left to right lateral position; (2) routine turning every 2 h from the left to right lateral position including a 15-min period of manual percussion and postural drainage (P&PD); (3) CLR with a specialized bed that turned patients from left to right lateral position, pausing at each position for 2 min; and (4) CLR with a specialized bed that turned patients from left to right lateral position pausing at each position for 2 min, and a 15-min period of percussion provided by the pneumatic cushions of the bed every 2 h. Results: Nineteen patients were entered into the study. There were no statistically significant differences in the measured cardiorespiratory variables. There was a tendency for the ratio of partial pressure of arterial oxygen to fractional inspired oxygen concentration (PaO2/FIO2) to increase (174 ± 31 versus 188 ± 36; P = 0.068) and for the ratio of deadspace to tidal volume (Vd/Vt) to decrease (0.62 ± 0.18 versus 0.59 ± 0.18; P = 0.19) during periods of CLR, but these differences did not achieve statistical significance. There were statistically significant increases in sputum volume during the periods of CLR. The

  6. Safety and Efficacy of Combined Extracorporeal Co2 Removal and Renal Replacement Therapy in Patients With Acute Respiratory Distress Syndrome and Acute Kidney Injury: The Pulmonary and Renal Support in Acute Respiratory Distress Syndrome Study*

    PubMed Central

    Castanier, Matthias; Signouret, Thomas; Soundaravelou, Rettinavelou; Lepidi, Anne; Seghboyan, Jean-Marie

    2015-01-01

    Objective: To assess the safety and efficacy of combining extracorporeal Co2 removal with continuous renal replacement therapy in patients presenting with acute respiratory distress syndrome and acute kidney injury. Design: Prospective human observational study. Settings: Patients received volume-controlled mechanical ventilation according to the acute respiratory distress syndrome net protocol. Continuous venovenous hemofiltration therapy was titrated to maintain maximum blood flow and an effluent flow of 45 mL/kg/h with 33% predilution. Patients: Eleven patients presenting with both acute respiratory distress syndrome and acute kidney injury required renal replacement therapy. Interventions: A membrane oxygenator (0.65 m2) was inserted within the hemofiltration circuit, either upstream (n = 7) or downstream (n = 5) of the hemofilter. Baseline corresponded to tidal volume 6 mL/kg of predicted body weight without extracorporeal Co2 removal. The primary endpoint was 20% reduction in Paco2 at 20 minutes after extracorporeal Co2 removal initiation. Tidal volume was subsequently reduced to 4 mL/kg for the remaining 72 hours. Measurements and Main Results: Twelve combined therapies were conducted in the 11 patients. Age was 70 ± 9 years, Simplified Acute Physiology Score II was 69 ± 13, Sequential Organ Failure Assessment score was 14 ± 4, lung injury score was 3 ± 0.5, and Pao2/Fio2 was 135 ± 41. Adding extracorporeal Co2 removal at tidal volume 6 mL/kg decreased Paco2 by 21% (95% CI, 17–25%), from 47 ± 11 to 37 ± 8 Torr (p < 0.001). Lowering tidal volume to 4 mL/kg reduced minute ventilation from 7.8 ± 1.5 to 5.2 ± 1.1 L/min and plateau pressure from 25 ± 4 to 21 ± 3 cm H2O and raised Paco2 from 37 ± 8 to 48 ± 10 Torr (all p < 0.001). On an average of both positions, the oxygenator’s blood flow was 410 ± 30 mL/min and the Co2 removal rate was 83 ± 20 mL/min. The oxygenator blood flow (p <0.001) and the Co2 removal rate (p = 0.083) were higher when

  7. In vitro biomechanical evaluation of single impulse and repetitive mechanical shockwave devices utilized for spinal manipulative therapy.

    PubMed

    Liebschner, Michael A K; Chun, Kwonsoo; Kim, Namhoon; Ehni, Bruce

    2014-12-01

    Mechanical shockwave therapy devices have been in clinical use for almost 40 years. While most often used to treat back pain, our understanding of their biomechanical performance is very limited. From biomechanical studies we know that biological tissue is viscoelastic and preferably excited around its resonance frequency. Targeting these frequencies has been the focus in extracorporeal shock wave lithotripsy, but these concepts are relatively new in orthopedic and rehabilitation therapies. The exact mechanism by which shockwave therapy acts is not known. Knowledge of the performance characteristics of these devices, correlated with clinical outcome studies, may lead to better patient selection, improvement of device functionality, and knowledge of the underlying working principals of therapy. The objectives of this study were to determine the ability of several commercial shockwave devices to achieve a desired thrust profile in a benchtop setting, determine the thrust profile in a clinical analog, and determine the influence of operator experience level on device performance. We conducted two different types of testing: (1) bench testing to evaluate the devices themselves, and (2) clinical equivalent testing to determine the influence of the operator. The results indicated a significant dependence of thrust output on the compliance of the test media. The Activator V-E device matched the ideal half-sine thrust profile to 94%, followed by the Impulse device (84%), the Activator IV/FS (74%), and the Activator II (48%). While most devices deviated from the ideal profile on the return path, the Impulse device exhibited a secondary peak. Moreover, the Activator V-E device provided evidence that the device performs consistently despite operator experience level. This has been a major concern in manual spinal manipulation. Based on our results, a hyper-flexible spine would receive a lower peak thrust force than a hypo-flexible spine at the same power setting. Furthermore

  8. γ-Hydroxybutyrate (GHB)-induced respiratory depression: combined receptor-transporter inhibition therapy for treatment in GHB overdose.

    PubMed

    Morse, Bridget L; Vijay, Nisha; Morris, Marilyn E

    2012-08-01

    Overdose of γ-hydroxybutyrate (GHB) frequently causes respiratory depression, occasionally resulting in death; however, little is known about the dose-response relationship or effects of potential overdose treatment strategies on GHB-induced respiratory depression. In these studies, the parameters of respiratory rate, tidal volume, and minute volume were measured using whole-body plethysmography in rats administered GHB. Intravenous doses of 200, 600, and 1500 mg/kg were administered to assess the dose-dependent effects of GHB on respiration. To determine the receptors involved in GHB-induced respiratory depression, a specific GABA(B) receptor antagonist, (2S)-(+)-5,5-dimethyl-2-morpholineacetic acid (SCH50911), and a specific GABA(A) receptor antagonist, bicuculline, were administered before GHB. The potential therapeutic strategies of receptor inhibition and monocarboxylate transporter (MCT) inhibition were assessed by inhibitor administration 5 min after GHB. The primary effect of GHB on respiration was a dose-dependent decrease in respiratory rate, accompanied by an increase in tidal volume, resulting in little change in minute volume. Pretreatment with 150 mg/kg SCH50911 completely prevented the decrease in respiratory rate, indicating agonism at GABA(B) receptors to be primarily responsible for GHB-induced respiratory depression. Administration of 50 mg/kg SCH50911 after GHB completely reversed the decrease in respiratory rate; lower doses had partial effects. Administration of the MCT inhibitor l-lactate increased GHB renal and total clearance, also improving respiratory rate. Administration of 5 mg/kg SCH50911 plus l-lactate further improved respiratory rate compared with the same dose of either agent alone, indicating that GABA(B) and MCT inhibitors, alone and in combination, represent potential treatment options for GHB-induced respiratory depression.

  9. Early complications. Respiratory failure.

    PubMed

    Zwischenberger, J B; Alpard, S K; Bidani, A

    1999-08-01

    Pulmonary complications following thoracic surgery are common and associated with significant morbidity and mortality. Respiratory failure after pneumonectomy occurs in approximately 5% to 15% of cases and significantly increases patient mortality. Strategies for ventilator support are based on the nature of the underlying complication and the pathophysiology of respiratory failure. This article describes the cause and pathophysiology of respiratory failure and pulmonary embolus postpneumonectomy. Diagnosis, management, and innovative therapies are also reviewed.

  10. A graphene-based electrochemical device with thermoresponsive microneedles for diabetes monitoring and therapy

    NASA Astrophysics Data System (ADS)

    Lee, Hyunjae; Choi, Tae Kyu; Lee, Young Bum; Cho, Hye Rim; Ghaffari, Roozbeh; Wang, Liu; Choi, Hyung Jin; Chung, Taek Dong; Lu, Nanshu; Hyeon, Taeghwan; Choi, Seung Hong; Kim, Dae-Hyeong

    2016-06-01

    Owing to its high carrier mobility, conductivity, flexibility and optical transparency, graphene is a versatile material in micro- and macroelectronics. However, the low density of electrochemically active defects in graphene synthesized by chemical vapour deposition limits its application in biosensing. Here, we show that graphene doped with gold and combined with a gold mesh has improved electrochemical activity over bare graphene, sufficient to form a wearable patch for sweat-based diabetes monitoring and feedback therapy. The stretchable device features a serpentine bilayer of gold mesh and gold-doped graphene that forms an efficient electrochemical interface for the stable transfer of electrical signals. The patch consists of a heater, temperature, humidity, glucose and pH sensors and polymeric microneedles that can be thermally activated to deliver drugs transcutaneously. We show that the patch can be thermally actuated to deliver Metformin and reduce blood glucose levels in diabetic mice.

  11. Physical Therapy for a Child Poststroke With a Left Ventricular Assist Device.

    PubMed

    Lombard, Kelly A

    2016-01-01

    To describe physical therapy (PT) examination and intervention during rehabilitation for a child poststroke with an implanted left ventricular assist device (LVAD). A 10-year-old boy with a history of congenital heart disease awaiting heart transplant was admitted to a pediatric rehabilitation hospital with right hemiplegia, and an external, portable LVAD. This child participated in standard PT examination procedures and interventions with accommodations for the LVAD. Observation was used to evaluate exercise response because of inability to measure vital signs. At admission, impaired muscle tone, balance, and endurance contributed to limitations in functional mobility. By discharge, improvements were seen in all impairments and also in ambulation distance, speed, and independence. This child awaiting heart transplant with an LVAD was able to tolerate intensive individualized PT. With monitoring and adjustments to the plan of care, he demonstrated improvements in functional mobility.

  12. Iatrogenic oesophageal perforation during placement of an endoscopic vacuum therapy device

    PubMed Central

    Halliday, Edwin; Patel, Anant; Hindmarsh, Andrew; Sujendran, Vijay

    2016-01-01

    Endoscopic vacuum-assisted closure (VAC) is increasingly being used as a means of managing perforations or anastomotic leaks of the upper gastrointestinal (GI) tract. Published outcomes are favourable, with few mentions of complications or morbidity. We present a case in which the management of a gastric perforation with endoscopic vacuum therapy was complicated by cervical oesophageal perforation. The case highlights the risks of such endoscopic therapeutic procedures and is the first report in the literature to describe significant visceral injury during placement of a VAC device for upper GI perforation. Iatrogenic oesophageal perforation is an inherent risk to upper GI endoscopy and the risk increases in therapeutic endoscopic procedures. Complications may be reduced by management under a multidisciplinary team in a centre with specialist upper GI services. There is no doubt that the endoscopic VAC approach is becoming established practice, and training in its use must reflect its increasingly widespread adoption. PMID:27470015

  13. Outcomes in advanced heart failure patients with left ventricular assist devices for destination therapy.

    PubMed

    Park, Soon J; Milano, Carmelo A; Tatooles, Antone J; Rogers, Joseph G; Adamson, Robert M; Steidley, D Eric; Ewald, Gregory A; Sundareswaran, Kartik S; Farrar, David J; Slaughter, Mark S

    2012-03-01

    The HeartMate II (HMII) destination therapy (DT) trial demonstrated significant improvements in outcomes in continuous-flow left ventricular assist devices compared with patients implanted with the pulsatile-flow HeartMate XVE. The primary hypothesis of the current study is that trial patients enrolled after the initial data cohort would have better clinical outcomes. Two hundred eighty-one patients who underwent HMII for DT from May 2007 to March 2009 (Mid Trial [MT] group) were compared with the initial 133 HMII patients from March 2005 to May 2007 (Early Trial [ET] group). Patient entry criteria were the same during the 2 time periods. Survival, adverse events, and quality of life were compared between the 2 groups. Baseline characteristics were similar between the groups. Compared with the ET group, patients in the MT group had reduced adverse event rates for bleeding requiring transfusions (1.66 versus 1.13 events per patient-year, P<0.001), sepsis (0.38 versus 0.27, P=0.025), device-related infections (0.47 versus 0.27, P<0.001), and hemorrhagic stroke (0.07 versus 0.03, P=0.01). Other event rates were similar between groups including ischemic stroke (0.06 versus 0.05 events per patient-year, P=0.57). Survival at 1 year in the MT group was 73% versus 68% in the ET group (P=0.21). Additionally, there was a significant reduction in deaths caused by hemorrhagic stroke (P=0.01). Quality of life improvements were significant in both the groups (P<0.001). The benefit of DT therapy with the HMII is confirmed in subsequent trial patients, with improved adverse event rates and a strong trend for improvements in survival. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00121485.

  14. Application of Mixed Effects Limits of Agreement in the Presence of Multiple Sources of Variability: Exemplar from the Comparison of Several Devices to Measure Respiratory Rate in COPD Patients

    PubMed Central

    Weir, Christopher J.; Rubio, Noah; Rabinovich, Roberto; Pinnock, Hilary; Hanley, Janet; McCloughan, Lucy; Drost, Ellen M.; Mantoani, Leandro C.; MacNee, William; McKinstry, Brian

    2016-01-01

    Introduction The Bland-Altman limits of agreement method is widely used to assess how well the measurements produced by two raters, devices or systems agree with each other. However, mixed effects versions of the method which take into account multiple sources of variability are less well described in the literature. We address the practical challenges of applying mixed effects limits of agreement to the comparison of several devices to measure respiratory rate in patients with chronic obstructive pulmonary disease (COPD). Methods Respiratory rate was measured in 21 people with a range of severity of COPD. Participants were asked to perform eleven different activities representative of daily life during a laboratory-based standardised protocol of 57 minutes. A mixed effects limits of agreement method was used to assess the agreement of five commercially available monitors (Camera, Photoplethysmography (PPG), Impedance, Accelerometer, and Chest-band) with the current gold standard device for measuring respiratory rate. Results Results produced using mixed effects limits of agreement were compared to results from a fixed effects method based on analysis of variance (ANOVA) and were found to be similar. The Accelerometer and Chest-band devices produced the narrowest limits of agreement (-8.63 to 4.27 and -9.99 to 6.80 respectively) with mean bias -2.18 and -1.60 breaths per minute. These devices also had the lowest within-participant and overall standard deviations (3.23 and 3.29 for Accelerometer and 4.17 and 4.28 for Chest-band respectively). Conclusions The mixed effects limits of agreement analysis enabled us to answer the question of which devices showed the strongest agreement with the gold standard device with respect to measuring respiratory rates. In particular, the estimated within-participant and overall standard deviations of the differences, which are easily obtainable from the mixed effects model results, gave a clear indication that the Accelerometer

  15. Miniature Swine for Preclinical Modeling of Complexities of Human Disease for Translational Scientific Discovery and Accelerated Development of Therapies and Medical Devices.

    PubMed

    Schomberg, Dominic T; Tellez, Armando; Meudt, Jennifer J; Brady, Dane A; Dillon, Krista N; Arowolo, Folagbayi K; Wicks, Joan; Rousselle, Serge D; Shanmuganayagam, Dhanansayan

    2016-04-01

    Noncommunicable diseases, including cardiovascular disease, diabetes, chronic respiratory disease, and cancer, are the leading cause of death in the world. The cost, both monetary and time, of developing therapies to prevent, treat, or manage these diseases has become unsustainable. A contributing factor is inefficient and ineffective preclinical research, in which the animal models utilized do not replicate the complex physiology that influences disease. An ideal preclinical animal model is one that responds similarly to intrinsic and extrinsic influences, providing high translatability and concordance of preclinical findings to humans. The overwhelming genetic, anatomical, physiological, and pathophysiological similarities to humans make miniature swine an ideal model for preclinical studies of human disease. Additionally, recent development of precision gene-editing tools for creation of novel genetic swine models allows the modeling of highly complex pathophysiology and comorbidities. As such, the utilization of swine models in early research allows for the evaluation of novel drug and technology efficacy while encouraging redesign and refinement before committing to clinical testing. This review highlights the appropriateness of the miniature swine for modeling complex physiologic systems, presenting it as a highly translational preclinical platform to validate efficacy and safety of therapies and devices.

  16. The first clinical case in Japan of destination therapy using the Jarvik 2000 left ventricular assist device.

    PubMed

    Kamata, Sokichi; Sakaguchi, Taichi; Miyagawa, Shigeru; Yoshikawa, Yasushi; Yamauchi, Takashi; Takeda, Koji; Saito, Shunsuke; Ueno, Takayoshi; Kuratani, Toru; Sawa, Yoshiki

    2010-09-01

    A 73-year-old female with a history of surgical ventricular restoration for ischemic cardiomyopathy presented with biventricular heart failure symptoms. After a Toyobo paracorporeal left ventricular assist device (LVAD) was implanted as a bridge, she underwent successful implantation of a Jarvik 2000 LVAD. This device provided excellent symptomatic improvement. This is the first case in Japan of destination therapy using an implantable LVAD.

  17. Speech therapy and communication device: impact on quality of life and mood in patients with amyotrophic lateral sclerosis.

    PubMed

    Körner, Sonja; Sieniawski, Michael; Siniawski, Michael; Kollewe, Katja; Rath, Klaus Jan; Krampfl, Klaus; Zapf, Antonia; Dengler, Reinhard; Petri, Susanne

    2013-01-01

    Dysarthria has a drastic impact on the quality of life of ALS patients. Most patients suffering from dysarthria are offered speech therapy. Communication devices are prescribed less frequently. In the present study we investigated the impact of these therapeutic arrangements on quality of life in ALS patients. Thirty-eight ALS patients with dysarthria or anarthria, who underwent speech therapy and/or used communication devices answered three standardized questionnaires (Beck Depression Inventory - II (BDI), SF-36 Health Survey questionnaire (SF-36) and ALS Functional Rating Scale-revised (ALSFRS-R)) and were further interviewed about their experience with and benefit of speech therapy and communication devices. Most of the patients described a high impact of the communication device on their quality of life while the influence of speech therapy was rated less. By multiple regression analysis we confirmed an independent positive effect of communication device use on depression and psychological distress. In conclusion, communication systems improve or at least stabilize quality of life and mood in dysarthric ALS patients, and should be provided early in the disease course.

  18. Prospective Assessment of Frailty Using the Fried Criteria in Patients Undergoing Left Ventricular Assist Device Therapy.

    PubMed

    Joseph, Susan M; Manghelli, Joshua L; Vader, Justin M; Keeney, Tamra; Novak, Eric L; Felius, Joost; Martinez, Sara C; Nassif, Michael E; Lima, Brian; Silvestry, Scott C; Rich, Michael W

    2017-10-15

    Frail patients are more prone to adverse events after cardiac surgery, particularly after implantation of left ventricular assist devices. Thus, frailty assessment may help identify patients unlikely to benefit from left ventricular assist device therapy. The purpose was to establish a suitable measure of frailty in adults with end-stage heart failure. In a prospective cohort of 75 patients (age 58 ± 12 years) with end-stage heart failure, we assessed the association between frailty (5-component Fried criteria) and the composite primary outcome of inpatient mortality or prolonged length of stay, as well as extubation status, time on ventilator, discharge status, and long-term mortality. Fried frailty criteria were met in 44 (59%) patients, but there was no association with the primary outcome (p = 0.10). However, an abridged set of 3 criteria (exhaustion, inactivity, and grip strength) was predictive of the primary outcome (odds ratio 2.9, 95% confidence interval 1.1 to 7.4), and of time to extubation and time to discharge. In patients with advanced heart failure, the 5-component Fried criteria may not be optimally sensitive to clinical differences. In conclusion, an abridged set of 3 frailty criteria was predictive of the primary outcome and several secondary outcomes, and may therefore be a clinically useful tool in this population. Copyright © 2017. Published by Elsevier Inc.

  19. Development and comparison of two devices for treatment of onychomycosis by photodynamic therapy

    NASA Astrophysics Data System (ADS)

    Silva, Ana Paula da; Chiandrone, Daniel José; Tinta, Jefferson Wanderson Rossi; Kurachi, Cristina; Inada, Natalia Mayumi; Bagnato, Vanderlei Salvador

    2015-06-01

    Onychomycosis is the most common nail disorder. The treatment for this type of infection is one of the main difficult ones in clinical practice, due to the fact that the nails are nonvascularized structures, which compromise the penetration of drugs delivered systemically and favor slow nail growth. We present two devices based on light-emitting diode arrays as light sources for the treatment of onychomycosis by photodynamic therapy (PDT). PDT is an emerging technique that uses a photosensitizer (PS) activated by light in the presence of oxygen. The PS absorbs energy from light and transfers it to oxygen, producing reactive oxygen species such as hydroxyl radicals, superoxide, and singlet oxygen which inactivate fungi and bacteria. Our proposal is the use of a portable and secure light source device in patients with onychomycosis. Additional advantages are the low cost involved, the possibility of topical treatment rather than systemic and the simplicity of operation. These advantages are important to ensure the implementation of this technology for the treatment of an impacting health problem.

  20. Simplified Negative Pressure Wound Therapy Device for Application in Low-Resource Settings

    PubMed Central

    Zurovcik, Danielle R; Mody, Gita N; Riviello, Robert; Slocum, Alexander

    2015-01-01

    Negative pressure wound therapy (NPWT) provides proven wound healing benefits and is often a desirable wound treatment. Unfortunately, NPWT devices are not widely available in low-resource settings (LRSs). In order to overcome identified NPWT barriers, a simplified NPWT (sNPWT) system was designed and iteratively improved during field-based testing. The sNPWT technology, our device design iterations, and the design-based results of our field tests are described. The sNPWT system includes a bellows hand pump, an occlusive drape, and a tube with tube connectors, connecting the drape to the pump. The most critical property of a sNPWT system is that it must be airtight. The details of the design iterations needed to achieve an occlusive system are explained. During the design process, the sNPWT system was tested during the earthquake relief in Haiti. This testing found that a liquid sealant was necessary to seal the drape to the peri-wound skin. A study conducted in Rwanda verified that a liquid latex sealant was safe to use and that the tube connector must be connected to the drape with an airtight method during the manufacturing process. This work has shown that sNPWT is feasible in LRSs. Since the completion of the clinical testing, the design has been further evolved and the developers are working with contract manufactures to produce the final design and preparing for regulatory approval applications. PMID:26356213

  1. Acoustic field characterization of the Duolith: Measurements and modeling of a clinical shock wave therapy device

    PubMed Central

    Perez, Camilo; Chen, Hong; Matula, Thomas J.; Karzova, Maria; Khokhlova, Vera A.

    2013-01-01

    Extracorporeal shock wave therapy (ESWT) uses acoustic pulses to treat certain musculoskeletal disorders. In this paper the acoustic field of a clinical portable ESWT device (Duolith SD1) was characterized. Field mapping was performed in water for two different standoffs of the electromagnetic head (15 or 30 mm) using a fiber optic probe hydrophone. Peak positive pressures at the focus ranged from 2 to 45 MPa, while peak negative pressures ranged from −2 to −11 MPa. Pulse rise times ranged from 8 to 500 ns; shock formation did not occur for any machine settings. The maximum standard deviation in peak pressure at the focus was 1.2%, indicating that the Duolith SD1 generates stable pulses. The results compare qualitatively, but not quantitatively with manufacturer specifications. Simulations were carried out for the short standoff by matching a Khokhlov-Zabolotskaya-Kuznetzov equation to the measured field at a plane near the source, and then propagating the wave outward. The results of modeling agree well with experimental data. The model was used to analyze the spatial structure of the peak pressures. Predictions from the model suggest that a true shock wave could be obtained in water if the initial pressure output of the device were doubled. PMID:23927207

  2. Acoustic field characterization of the Duolith: measurements and modeling of a clinical shock wave therapy device.

    PubMed

    Perez, Camilo; Chen, Hong; Matula, Thomas J; Karzova, Maria; Khokhlova, Vera A

    2013-08-01

    Extracorporeal shock wave therapy (ESWT) uses acoustic pulses to treat certain musculoskeletal disorders. In this paper the acoustic field of a clinical portable ESWT device (Duolith SD1) was characterized. Field mapping was performed in water for two different standoffs of the electromagnetic head (15 or 30 mm) using a fiber optic probe hydrophone. Peak positive pressures at the focus ranged from 2 to 45 MPa, while peak negative pressures ranged from -2 to -11 MPa. Pulse rise times ranged from 8 to 500 ns; shock formation did not occur for any machine settings. The maximum standard deviation in peak pressure at the focus was 1.2%, indicating that the Duolith SD1 generates stable pulses. The results compare qualitatively, but not quantitatively with manufacturer specifications. Simulations were carried out for the short standoff by matching a Khokhlov-Zabolotskaya-Kuznetzov equation to the measured field at a plane near the source, and then propagating the wave outward. The results of modeling agree well with experimental data. The model was used to analyze the spatial structure of the peak pressures. Predictions from the model suggest that a true shock wave could be obtained in water if the initial pressure output of the device were doubled.

  3. Destination therapy: the new gold standard treatment for heart failure patients with left ventricular assist devices.

    PubMed

    Yamakawa, Michael; Kyo, Shunei; Yamakawa, Sean; Ono, Minoru; Kinugawa, Koichiro; Nishimura, Takashi

    2013-03-01

    Heart failure continues to be a growing health problem, eluding large-scale improvement and treatment. Cardiac transplantation has been the gold standard treatment with high post-transplant survival rates and relatively good quality of life. However, there has been an extreme shortage of organ donations, limiting transplants to only a very small portion of patients with the condition. This led to a growing interest in alternative options for the increasing population of patients who are waitlisted or ineligible for transplantation. In recent years, ventricular assist device (VAD) technologies have advanced from pulsatile blood pumps to continuous-flow pumps that have demonstrated unprecedented post-implantation survival rates. The HeartMate II, the only commercially available, continuous flow left ventricular assist device (LVAD) in the United States and Europe, has been implanted in over 10,000 patients worldwide, setting a benchmark for biomedical modalities of advanced heart failure treatment. Thanks to the successes of contemporary LVADs, patients are able to enjoy a better lifestyle, with a significantly prolonged life span and the ability to regularly partake in physical activities. In this new biomedical generation, the usage of LVADs has begun to expand towards the treatment for a wider range of heart conditions, including earlier stages of heart failure. In fact, LVAD implantations have surpassed the number of transplants taken place annually. An increasing number of patients are considering the permanent, circulatory support with an LVAD, namely destination therapy, as a promising option for treating heart failure.

  4. A suppressor to prevent direct wave-induced cavitation in shock wave therapy devices

    NASA Astrophysics Data System (ADS)

    Matula, Thomas J.; Hilmo, Paul R.; Bailey, Michael R.

    2005-07-01

    Cavitation plays a varied but important role in lithotripsy. Cavitation facilitates stone comminution, but can also form an acoustic barrier that may shield stones from subsequent shock waves. In addition, cavitation damages tissue. Spark-gap lithotripters generate cavitation with both a direct and a focused wave. The direct wave propagates as a spherically diverging wave, arriving at the focus ahead of the focused shock wave. It can be modeled with the same waveform (but lower amplitude) as the focused wave. We show with both simulations and experiments that bubbles are forced to grow in response to the direct wave, and that these bubbles can still be large when the focused shock wave arrives. A baffle or ``suppressor'' that blocks the propagation of the direct wave is shown to significantly reduce the direct wave pressure amplitude, as well as direct wave-induced bubble growth. These results are applicable to spark-gap lithotripters and extracorporeal shock wave therapy devices, where cavitation from the direct wave may interfere with treatment. A simple direct-wave suppressor might therefore be used to improve the therapeutic efficacy of these devices.

  5. Antithrombotic Therapy in a Prospective Trial of a Pediatric Ventricular Assist Device

    PubMed Central

    Bomgaars, Lisa R.; Massicotte, M. Patricia

    2016-01-01

    Efficacious ventricular assist device (VAD) support in pediatric patients depends on successful antithrombotic management. The experience with antithrombotic management for the EXCOR Pediatric VAD Investigational Device Exemption (IDE) study is described. All 68 children in North America enrolled in the IDE study from May 9, 2007 to December 10, 2010 are included. The Edmonton Anticoagulation and Platelet Inhibition Protocol was provided for management guidance. Monitoring parameters, drug dosing, targeted serious adverse events, and pump changes were reviewed. Major bleeding occurred in 43% of all subjects with most events occurring within 14 days of implantation. Bleeding events were probably/definitely related in 24% to antithrombotic management. Neurologic events occurred in 28% of subjects and were probably/definitely related in 9% to antithrombotic therapy intensity. Most neurologic events occurred between 4 and 30 days postimplantation and sporadically thereafter. Pump change occurred in 56% of subjects. Use of an antithrombotic protocol for enrolled subjects was possible in this multicenter study. Incidence of significant bleeding and thromboembolic events was acceptable when balanced against life-saving benefits of VADs. Further studies are needed to optimize the antithrombotic management of this patient population. PMID:27556152

  6. A new method and device of aligning patient setup lasers in radiation therapy.

    PubMed

    Hwang, Ui-Jung; Jo, Kwanghyun; Lim, Young Kyung; Kwak, Jung Won; Choi, Sang Hyuon; Jeong, Chiyoung; Kim, Mi Young; Jeong, Jong Hwi; Shin, Dongho; Lee, Se Byeong; Park, Jeong-Hoon; Park, Sung Yong; Kim, Siyong

    2016-01-08

    The aim of this study is to develop a new method to align the patient setup lasers in a radiation therapy treatment room and examine its validity and efficiency. The new laser alignment method is realized by a device composed of both a metallic base plate and a few acrylic transparent plates. Except one, every plate has either a crosshair line (CHL) or a single vertical line that is used for alignment. Two holders for radiochromic film insertion are prepared in the device to find a radiation isocenter. The right laser positions can be found optically by matching the shadows of all the CHLs in the gantry head and the device. The reproducibility, accuracy, and efficiency of laser alignment and the dependency on the position error of the light source were evaluated by comparing the means and the standard deviations of the measured laser positions. After the optical alignment of the lasers, the radiation isocenter was found by the gantry and collimator star shots, and then the lasers were translated parallel to the isocenter. In the laser position reproducibility test, the mean and standard deviation on the wall of treatment room were 32.3 ± 0.93 mm for the new method whereas they were 33.4 ± 1.49 mm for the conventional method. The mean alignment accuracy was 1.4 mm for the new method, and 2.1 mm for the conventional method on the walls. In the test of the dependency on the light source position error, the mean laser position was shifted just by a similar amount of the shift of the light source in the new method, but it was greatly magnified in the conventional method. In this study, a new laser alignment method was devised and evaluated successfully. The new method provided more accurate, more reproducible, and faster alignment of the lasers than the conventional method.

  7. Restricted Crystalloid Fluid Therapy during Orthotopic Liver Transplant Surgery and its Effect on Respiratory and Renal Insufficiency in the Early Post-operative Period: A Randomized Clinical Trial.

    PubMed

    Sahmeddini, M A; Janatmakan, F; Khosravi, M B; Ghaffaripour, S; Eghbal, M H; Nickeghbalian, S; Malek-Hosseini, S A

    2014-01-01

    Respiratory and renal insufficiencies are common dysfunctions during post-liver transplantation period that increase post-operative mortality and morbidity rates. Intra-operative fluid therapy is an important factor associated with pulmonary and renal insufficiency. To evaluate the relation between intra-operative fluid therapy and early renal and respiratory insufficiency after liver transplantation. In this randomized clinical study, 67 adult patients with end-stage liver disease who underwent orthotopic deceased donor liver transplantation were randomly allocated into two groups. The restricted fluid group, which received a controlled fluid administration of normal saline, 5 mL/kg/hr during anesthesia, and non-restricted fluid group received a controlled infusion of normal saline 10 mL/kg/hr during anesthesia. Early post-operative respiratory and renal insufficiency in both groups were assessed. The patients were monitored during the three stages of liver transplantation for their hemodynamic indices. The trial is registered with the Iranian Randomized Clinical Trial Registry, number IRCT2013101811662N4. The baseline demographic and clinical characteristics were similar in both studied groups. The prevalence of respiratory insufficiency in the non-restricted fluid group (15%) significantly (p=0.01) higher than that in the restricted fluid group (0%). The post-operative mean±SD serum creatinine was 1.0±0.1 mg/dL in the non-restricted fluid group and 1.1±0.2 in the restricted fluid group (p=0.43). No patients in the studied groups required post-operative continuous renal replacement therapy. Restricted crystalloid fluid administration during orthotropic liver transplantation though decreased post-operative chance of pulmonary insufficiency, did not increase renal dysfunction.

  8. Restricted Crystalloid Fluid Therapy during Orthotopic Liver Transplant Surgery and its Effect on Respiratory and Renal Insufficiency in the Early Post-operative Period: A Randomized Clinical Trial

    PubMed Central

    Sahmeddini, M. A.; Janatmakan, F.; Khosravi, M. B.; Ghaffaripour, S.; Eghbal, M. H.; Nickeghbalian, S.; Malek-Hosseini, S. A.

    2014-01-01

    Background: Respiratory and renal insufficiencies are common dysfunctions during post-liver transplantation period that increase post-operative mortality and morbidity rates. Intra-operative fluid therapy is an important factor associated with pulmonary and renal insufficiency. Objective: To evaluate the relation between intra-operative fluid therapy and early renal and respiratory insufficiency after liver transplantation. Methods: In this randomized clinical study, 67 adult patients with end-stage liver disease who underwent orthotopic deceased donor liver transplantation were randomly allocated into two groups. The restricted fluid group, which received a controlled fluid administration of normal saline, 5 mL/kg/hr during anesthesia, and non-restricted fluid group received a controlled infusion of normal saline 10 mL/kg/hr during anesthesia. Early post-operative respiratory and renal insufficiency in both groups were assessed. The patients were monitored during the three stages of liver transplantation for their hemodynamic indices. The trial is registered with the Iranian Randomized Clinical Trial Registry, number IRCT2013101811662N4. Results: The baseline demographic and clinical characteristics were similar in both studied groups. The prevalence of respiratory insufficiency in the non-restricted fluid group (15%) significantly (p=0.01) higher than that in the restricted fluid group (0%). The post-operative mean±SD serum creatinine was 1.0±0.1 mg/dL in the non-restricted fluid group and 1.1±0.2 in the restricted fluid group (p=0.43). No patients in the studied groups required post-operative continuous renal replacement therapy. Conclusions: Restricted crystalloid fluid administration during orthotropic liver transplantation though decreased post-operative chance of pulmonary insufficiency, did not increase renal dysfunction. PMID:25184031

  9. The Rematee Bumper Belt® positional therapy device for snoring and obstructive sleep apnea: Positional effectiveness in healthy subjects

    PubMed Central

    Matthews, Les; Fortier, Normand

    2013-01-01

    The present study was designed to investigate body position changes resulting from wearing a Rematee Bumper Belt (Rematee, Canada) during sleep. The majority of obstructive sleep apnea (OSA) patients will experience up to two times as many apneas and hypopneas while supine relative to lateral or prone body positions during sleep. It has been suggested that a positional therapy device could reduce the number of apneas and hypopneas in such patients. The present study was conducted to determine whether the Rematee Bumper Belt positional therapy device could prevent healthy subjects from sleeping in the supine position. Test subjects wore the belt for one to two nights. Each belt was equipped with an accelerometer that was used to measure the orientation of the belt relative to the horizontal plane. The results suggest that the belt creates an exclusion zone approximately 80° wide centred near the supine orientation, where subjects are effectively prevented to enter. Results of the present preliminary study suggests that the Rematee Bumper Belt positional therapy device is effective at limiting healthy subjects from sleeping in a supine position. The device appears to be most effective between 150° and 230°. A device with this capability may provide an inexpensive and potentially effective alternative treatment option for patients with OSA. This device has the capacity for reducing snoring and the apnea-hypopnea index in individuals with positional OSA. PMID:26078596

  10. The Rematee Bumper Belt(®) positional therapy device for snoring and obstructive sleep apnea: Positional effectiveness in healthy subjects.

    PubMed

    Matthews, Les; Fortier, Normand

    2013-01-01

    The present study was designed to investigate body position changes resulting from wearing a Rematee Bumper Belt (Rematee, Canada) during sleep. The majority of obstructive sleep apnea (OSA) patients will experience up to two times as many apneas and hypopneas while supine relative to lateral or prone body positions during sleep. It has been suggested that a positional therapy device could reduce the number of apneas and hypopneas in such patients. The present study was conducted to determine whether the Rematee Bumper Belt positional therapy device could prevent healthy subjects from sleeping in the supine position. Test subjects wore the belt for one to two nights. Each belt was equipped with an accelerometer that was used to measure the orientation of the belt relative to the horizontal plane. The results suggest that the belt creates an exclusion zone approximately 80° wide centred near the supine orientation, where subjects are effectively prevented to enter. Results of the present preliminary study suggests that the Rematee Bumper Belt positional therapy device is effective at limiting healthy subjects from sleeping in a supine position. The device appears to be most effective between 150° and 230°. A device with this capability may provide an inexpensive and potentially effective alternative treatment option for patients with OSA. This device has the capacity for reducing snoring and the apnea-hypopnea index in individuals with positional OSA.

  11. Use of Heart Failure Medical Therapies Among Patients With Left Ventricular Assist Devices: Insights From INTERMACS.

    PubMed

    Khazanie, Prateeti; Hammill, Bradley G; Patel, Chetan B; Kiernan, Michael S; Cooper, Lauren B; Arnold, Suzanne V; Fendler, Timothy J; Spertus, John A; Curtis, Lesley H; Hernandez, Adrian F

    2016-09-01

    Use of left ventricular assist devices (LVADs) for treatment of advanced heart failure has expanded significantly over the past decade. However, concomitant use of heart failure medical therapies after implant is poorly characterized. We examined the use of heart failure medications before and after LVAD implant in adult patients enrolled in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) between 2008 and 2013 (N = 9359). Using logistic regression, we examined relationships between patient characteristics and medication use at 3 months after implant. Baseline rates of heart failure therapies before implant were 38% for angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), 55% for β-blockers, 40% for mineralocorticoid receptor antagonists (MRAs), 87% for loop diuretics, 54% for amiodarone, 11% for phosphodiesterase inhibitors, 22% for warfarin, and 54% for antiplatelet agents. By 3 months after implant, the rates were 50% for ACE inhibitors or ARBs, 68% for β-blockers, 33% for MRAs, 68% for loop diuretics, 42% for amiodarone, 21% for phosphodiesterase inhibitors, 92% for warfarin, and 84% for antiplatelet agents. In general, age, preimplant INTERMACS profile, and prior medication use were associated with medication use at 3 months. Overall use of neurohormonal antagonists was low after LVAD implant, whereas use of loop diuretics and amiodarone remained high. Heart failure medication use is highly variable, but appears to generally increase after LVAD implantation. Low neurohormonal antagonist use may reflect practice uncertainty in the clinical utility of these medications post-LVAD. Copyright © 2016. Published by Elsevier Inc.

  12. Use of Heart Failure Medical Therapies Among Patients With Left Ventricular Assist Devices: Insights From INTERMACS

    PubMed Central

    Khazanie, Prateeti; Hammill, Bradley G.; Patel, Chetan B.; Kiernan, Michael S.; Cooper, Lauren B.; Arnold, Suzanne V.; Fendler, Timothy J.; Spertus, John A.; Curtis, Lesley H.; Hernandez, Adrian F.

    2016-01-01

    Background Use of left ventricular assist devices (LVADs) for treatment of advanced heart failure has expanded significantly over the past decade. However, concomitant use of heart failure medical therapies after implant is poorly characterized. Methods and Results We examined the use of heart failure medications before and after LVAD implant in adult patients enrolled in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) between 2008 and 2013 (N = 9359). Using logistic regression, we examined relationships between patient characteristics and medication use at 3 months after implant. Baseline rates of heart failure therapies before implant were 38% for angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), 55% for β-blockers, 40% for mineralocorticoid receptor antagonists (MRAs), 87% for loop diuretics, 54% for amiodarone, 11% for phosphodiesterase inhibitors, 22% for warfarin, and 54% for antiplatelet agents. By 3 months after implant, the rates were 50% for ACE inhibitors or ARBs, 68% for β-blockers, 33% for MRAs, 68% for loop diuretics, 42% for amiodarone, 21% for phosphodiesterase inhibitors, 92% for warfarin, and 84% for antiplatelet agents. In general, age, pre-implant INTERMACS profile, and prior medication use were associated with medication use at 3 months. Conclusions Overall use of neurohormonal antagonists was low after LVAD implant, whereas use of loop diuretics and amiodarone remained high. Heart failure medication use is highly variable but appears to generally increase after LVAD implantation. Low neurohormonal antagonist use may reflect practice uncertainty in the clinical utility of these medications post-LVAD. PMID:26892975

  13. Introduction to the Canadian Scientific Advisory Committee on Respiratory and Allergy Therapies: in vivo evaluation for clinical testing in COPD and asthma therapy using generics.

    PubMed

    Mayers, Irvin

    2012-08-01

    Health Canada posted a guidance for in vivo testing of subsequent market entry (SME) inhaled corticosteroids (ICS) for treatment of asthma and published proceedings regarding SME products for chronic obstructive pulmonary disease (COPD). This manuscript reviews these recommendations and outlines their rationale. The Scientific Advisory Committee on Respiratory and Allergy Therapies (SAC-RAT) met between 2007 and 2009. The committee reviewed approval processes for SME ICS for asthma treatment and a draft guidance was posted by Health Canada. SAC-RAT also reviewed SME long-acting beta agonists (LABA) and fixed drug dose combinations (FDDC) for COPD treatment. SAC-RAT concluded that measuring airway eosinophils in mild, stable, steroid-naive, subjects was reproducible and measurable. Study duration could be reduced to only 3 weeks using this inflammatory outcome to establish therapeutic equivalence between SME ICS and Canadian reference product. A placebo limb of the trial was added to establish biological activity of the products. The committee recommended that LABA SME products be tested in a clinically stable, representative population with GOLD stage 2 and/or 3 COPD. There was not agreement regarding the extent of allowed FEV(1) reversibility in this population. The FEV(1) area under the curve (AUC) was recommended as a primary endpoint. For equivalence, both AUC and the shape of the curve (assessed by the peak and trough) over a 12-h period should be different from placebo but similar for the SME and reference products. Secondary endpoints were not recommended. Clinical presentations of asthma and COPD may overlap but prespecified disease phenotypes can separate the populations. ICS therapeutic equivalence can be assessed by reduction in eosinophil counts tested in steroid naive subjects. Increases in FEV(1) define LABA effects in moderate to severe COPD. When designing trials to assess therapeutic equivalence, the anticipated mechanism of action of the drug

  14. The Effects of Smartphone-based Nebulizer Therapy Education on Parents' Knowledge and Confidence of Performance in Caring for Children with Respiratory Disease.

    PubMed

    Lee, Jung Min; Kim, Shin-Jeong; Min, Hae Young

    This study aimed to identify the effects of smartphone-based nebulizer therapy education on the knowledge and confidence of parents while performing care for their children with respiratory disease. This quasi-experimental study employed a pretest-posttest design using a nonequivalent control group. Data were collected from children's parents who had not used nebulizer therapy for their children previously. Both the groups were given nebulizer therapy education using the same content but different learning methods. The experimental group (n=36) was taught using smartphones, while the control group (n=36) was taught using verbal and paper-based methods. The data were analyzed using the Chi Square test, repeated measures analysis of variance, and t-test. The mean scores on knowledge improvement (F=100.949, p<0.001) and confidence in performing care (t=-6.959, p<0.001) were significantly higher for the experimental group as compared to the control group. Further, the scores on satisfaction with the learning method were significantly higher for the experimental group as compared to the control group (t=-5.819, p<0.001). Our results suggest that smartphone-based education on nebulizer therapy might be effective in improving parents' knowledge and confidence in performing care for their children. This study suggests that smartphone-based education needs to be considered as an effective educational intervention in providing nursing support for parents of children with respiratory disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. A Comparison of 2 Respiratory Devices for Sputum Clearance in Adults With Non-Cystic Fibrosis Bronchiectasis.

    PubMed

    Silva, Yasmin R; Greer, Tracy A; Morgan, Lucy C; Li, Frank; Farah, Claude S

    2017-10-01

    Airway clearance techniques are a vital part of routine care for patients with bronchiectasis. There is no clear superior modality. The Flutter combines oscillations (6-20 Hz) and positive expiratory pressure; the Lung Flute combines positive expiratory pressure and low frequency acoustic waves (18-22 Hz), to augment clearance. This project aimed to compare these devices. This was a randomized crossover study of adult subjects with stable non-cystic fibrosis bronchiectasis (expectorating > 25 mL/d). Subjects attended 2 separate out-patient visits, 1 week apart, and completed a supervised sputum clearance regime and Lickert scale (8 questions regarding subjects' perception of the experience using each device). Total sputum expectorated during supervised intervention (T1) and after 30 min from the end of T1 (T2) was recorded as wet sputum weight. Total wet sputum weight desiccated in a microwave (10 min at 300 watts), allowed measurement of total dry sputum weight. Data were compared using paired t test. We recruited 40 subjects with a mean ± SD age of 63 ± 16 y. Overall, there was no significant difference in wet sputum weight (Flutter, 5.78 ± 6.47 g; Lung Flute, 5.75 ± 0.22 g) and dry sputum weight (Flutter, 0.40 ± 0.86 g; Lung Flute, 0.22 ± 0.21 g). At T1, wet sputum weight was higher for the Flutter (5.10 ± 6.26 g) compared with the Lung Flute (3.74 ± 3.44 g) (P = .038). At T2, wet sputum weight was higher for the Lung Flute (2.02 ± 3.01 g) compared with the Flutter (0.68 ± 0.75 g) (P = .001). Subjects perceived the Flutter as being significantly better at clearing secretions (P = .01), easy to understand (P = .03), and simple to use (P = .01) compared with the Lung Flute. Both devices were well-tolerated and successfully augmented secretion clearance. Most subjects preferred the Flutter because of increased speed of secretion clearance, and greater ease of use. Copyright © 2017 by Daedalus Enterprises.

  16. A respiratory compensating system: design and performance evaluation.

    PubMed

    Chuang, Ho-Chiao; Huang, Ding-Yang; Tien, Der-Chi; Wu, Ren-Hong; Hsu, Chung-Hsien

    2014-05-08

    This study proposes a respiratory compensating system which is mounted on the top of the treatment couch for reverse motion, opposite from the direction of the targets (diaphragm and hemostatic clip), in order to offset organ displacement generated by respiratory motion. Traditionally, in the treatment of cancer patients, doctors must increase the field size for radiation therapy of tumors because organs move with respiratory motion, which causes radiation-induced inflammation on the normal tissues (organ at risk (OAR)) while killing cancer cells, and thereby reducing the patient's quality of life. This study uses a strain gauge as a respiratory signal capture device to obtain abdomen respiratory signals, a proposed respiratory simulation system (RSS) and respiratory compensating system to experiment how to offset the organ displacement caused by respiratory movement and compensation effect. This study verifies the effect of the respiratory compensating system in offsetting the target displacement using two methods. The first method uses linac (medical linear accelerator) to irradiate a 300 cGy dose on the EBT film (GAFCHROMIC EBT film). The second method uses a strain gauge to capture the patients' respiratory signals, while using fluoroscopy to observe in vivo targets, such as a diaphragm, to enable the respiratory compensating system to offset the displacements of targets in superior-inferior (SI) direction. Testing results show that the RSS position error is approximately 0.45 ~ 1.42 mm, while the respiratory compensating system position error is approximately 0.48 ~ 1.42 mm. From the EBT film profiles based on different input to the RSS, the results suggest that when the input respiratory signals of RSS are sine wave signals, the average dose (%) in the target area is improved by 1.4% ~ 24.4%, and improved in the 95% isodose area by 15.3% ~ 76.9% after compensation. If the respiratory signals input into the RSS respiratory signals are actual human respiratory

  17. TH-C-BRD-08: Reducing the Effect of Respiratory Motion On the Delivered Dose in Proton Therapy Through Proper Field Angle Selection

    SciTech Connect

    Matney, J; Park, P; Court, L; Zhu, X; Li, H; Mohan, R; Liu, W; Dong, L

    2014-06-15

    Purpose: This work investigated a novel planning strategy of selecting radiotherapy beam angles that minimizes the change in water equivalent thickness (dWET) during respiration in order to reduce the effects of respiratory motion in passively scattered proton therapy (PSPT). Methods: In a clinical trial treating locally-advanced lung cancer with proton therapy, 2–4 co-planar beams were previously selected by dosimetrists in the design of physician-approved PSPT treatment plans. The authors identified a cohort of patients in which respiratory motion affected the planned PSPT dose delivery. For this cohort, this work analyzed dWET during respiration over a 360 degree arc of potential treatment angles around the patient: the dWET was defined as the difference in WET between the full-exhale (T50) and full-inhale (T0) phases of the simulation 4DCT. New PSPT plans were redesigned by selecting new beam angles that demonstrated significant reduction in the value of dWET. Between the T50 and T0 phases, the root-mean-square deviation of dose and the change in dose-volume histogram curves (dAUC) for anatomical structures were calculated to compare the original to dWET reduction plans. Results: To date, three plans were retrospectively redesigned based on dWET analysis. In the dWET reduction plan, the root mean square dose (T50-T0) was reduced by 15–35% and the DVH dAUC values were reduced by more than 60%.The PSPT plans redesigned by selecting appropriate field angles to minimize dWET demonstrated less dosimetric variation due to respiration. Conclusion: We have introduced the use of a new metric to quantify respiratory motion in proton therapy: dWET. The use of dWET allows us to minimize the impact of respiratory motion of the entire anatomy in the beam path. This work is a proof of principle that dWET could suggest field angles in proton therapy that are more robust to the effects of respiratory motion.

  18. Management of the baseline shift using a new and simple method for respiratory-gated radiation therapy: Detectability and effectiveness of a flexible monitoring system

    SciTech Connect

    Tachibana, Hidenobu; Kitamura, Nozomi; Ito, Yasushi; Kawai, Daisuke; Nakajima, Masaru; Tsuda, Akihisa; Shiizuka, Hisao

    2011-07-15

    Purpose: In respiratory-gated radiation therapy, a baseline shift decreases the accuracy of target coverage and organs at risk (OAR) sparing. The effectiveness of audio-feedback and audio-visual feedback in correcting the baseline shift in the breathing pattern of the patient has been demonstrated previously. However, the baseline shift derived from the intrafraction motion of the patient's body cannot be corrected by these methods. In the present study, the authors designed and developed a simple and flexible system. Methods: The system consisted of a web camera and a computer running our in-house software. The in-house software was adapted to template matching and also to no preimage processing. The system was capable of monitoring the baseline shift in the intrafraction motion of the patient's body. Another marker box was used to monitor the baseline shift due to the flexible setups required of a marker box for gated signals. The system accuracy was evaluated by employing a respiratory motion phantom and was found to be within AAPM Task Group 142 tolerance (positional accuracy <2 mm and temporal accuracy <100 ms) for respiratory-gated radiation therapy. Additionally, the effectiveness of this flexible and independent system in gated treatment was investigated in healthy volunteers, in terms of the results from the differences in the baseline shift detectable between the marker positions, which the authors evaluated statistically. Results: The movement of the marker on the sternum [1.599 {+-} 0.622 mm (1 SD)] was substantially decreased as compared with the abdomen [6.547 {+-} 0.962 mm (1 SD)]. Additionally, in all of the volunteers, the baseline shifts for the sternum [-0.136 {+-} 0.868 (2 SD)] were in better agreement with the nominal baseline shifts than was the case for the abdomen [-0.722 {+-} 1.56 mm (2 SD)]. The baseline shifts could be accurately measured and detected using the monitoring system, which could acquire the movement of the marker on the

  19. Managing respiratory disease.

    PubMed

    Lunn, Sarah; Restrick, Louise; Stern, Myra

    2017-02-01

    The diverse and evolving role of a psychologist within a respiratory multidisciplinary team (MDT) is described, providing a working model for service provision. The rationale for appointing a psychologist within a respiratory MDT is presented first, citing relevant policy and research and outlining the wider psychosocial impact of respiratory disease. This is followed by an insight into the psychologist's role by highlighting important areas, including key therapy themes and the challenge of patient engagement. The way in which the psychologist supports the collective aims and aspirations of respiratory colleagues to provide a more holistic package of care is illustrated throughout.

  20. NOTE: Pre-clinical evaluation of respiratory-gated delivery of volumetric modulated arc therapy with RapidArc

    NASA Astrophysics Data System (ADS)

    Nicolini, Giorgia; Vanetti, Eugenio; Clivio, Alessandro; Fogliata, Antonella; Cozzi, Luca

    2010-06-01

    A study was carried out to evaluate the possibility of delivering volumetric modulated arc therapy with the RapidArc technology under respiratory-gated conditions. The experiments were performed in the framework of a non-clinically released environment. Plans of six patients, all realized for a single arc, were used for the experiments. The Real-time Position Management™ (RPM) respiratory gating system from Varian was used to generate gate-open signals of different durations. Arcs were delivered applying the different gates creating sequences of beam-hold/beam-on during the dose delivery: the average number of interruptions for a single arc ranged from 0 to 45. Dose prescription was set to 2 Gy and different gate-open periods of 30, 15 and 5 s to keep gantry speed constant at maximum. 5 Gy and 15 Gy doses were then applied to gate-open signals of 5 and 8 s, respectively, to mimic the most challenging conditions of slow gantry rotation and high-frequency interruptions. The 5 and 15 Gy experiments represent dose conditions of clinical interest for stereotactic treatments. For each patient and gating condition, pre-treatment 2D verification measurements were performed using the PTW-729 array in conjunction with the Octavius phantom (PTW, Freiburg); measurements were performed on different days (one per patient, with the complete setup of phantom and detectors every time), while each gating experiment was repeated seven consecutive times for reproducibility (without a new setup of the measurement equipment). Measurements were compared with dose calculations in the treatment planning system (performed without any gating) to appraise the dosimetric impact of the presence of gating and the eventual dependence from the number of interruptions during a single arc. Analysis of machine-registered log files in terms of average deviations between actual and expected positions (from automatic measurements every 50 ms) resulted in mean ΔMU (monitor units) <0.02% for all gating

  1. Pre-clinical evaluation of respiratory-gated delivery of volumetric modulated arc therapy with RapidArc.

    PubMed

    Nicolini, Giorgia; Vanetti, Eugenio; Clivio, Alessandro; Fogliata, Antonella; Cozzi, Luca

    2010-06-21

    A study was carried out to evaluate the possibility of delivering volumetric modulated arc therapy with the RapidArc technology under respiratory-gated conditions. The experiments were performed in the framework of a non-clinically released environment. Plans of six patients, all realized for a single arc, were used for the experiments. The Real-time Position Management (RPM) respiratory gating system from Varian was used to generate gate-open signals of different durations. Arcs were delivered applying the different gates creating sequences of beam-hold/beam-on during the dose delivery: the average number of interruptions for a single arc ranged from 0 to 45. Dose prescription was set to 2 Gy and different gate-open periods of 30, 15 and 5 s to keep gantry speed constant at maximum. 5 Gy and 15 Gy doses were then applied to gate-open signals of 5 and 8 s, respectively, to mimic the most challenging conditions of slow gantry rotation and high-frequency interruptions. The 5 and 15 Gy experiments represent dose conditions of clinical interest for stereotactic treatments. For each patient and gating condition, pre-treatment 2D verification measurements were performed using the PTW-729 array in conjunction with the Octavius phantom (PTW, Freiburg); measurements were performed on different days (one per patient, with the complete setup of phantom and detectors every time), while each gating experiment was repeated seven consecutive times for reproducibility (without a new setup of the measurement equipment). Measurements were compared with dose calculations in the treatment planning system (performed without any gating) to appraise the dosimetric impact of the presence of gating and the eventual dependence from the number of interruptions during a single arc. Analysis of machine-registered log files in terms of average deviations between actual and expected positions (from automatic measurements every 50 ms) resulted in mean Delta MU (monitor units) <0.02% for all

  2. The NHLBI REVIVE-IT study: Understanding its discontinuation in the context of current left ventricular assist device therapy.

    PubMed

    Pagani, Francis D; Aaronson, Keith D; Kormos, Robert; Mann, Douglas L; Spino, Cathie; Jeffries, Neal; Taddei-Peters, Wendy C; Mancini, Donna M; McNamara, Dennis M; Grady, Kathleen L; Gorcsan, John; Petrucci, Ralph; Anderson, Allen S; Glick, Henry A; Acker, Michael A; Eduardo Rame, J; Goldstein, Daniel J; Pamboukian, Salpy V; Miller, Marissa A; Timothy Baldwin, J

    2016-11-01

    The National Institutes of Health National Heart, Lung, and Blood Institute convened a working group in March 2008 to discuss how therapies for heart failure (HF) might be best advanced using clinical trials involving left ventricular assist devices (LVAD). This group opined that the field was ready for a trial to assess the use of long-term ventricular assist device therapy in patients who are less ill than patients currently eligible for destination therapy, which resulted in the Randomized Evaluation of VAD InterVEntion before Inotropic Therapy (REVIVE-IT) pilot study. The specific objective of REVIVE-IT was to compare LVAD therapy with optimal medical management in patients with less advanced HF than current LVAD indications to determine if wider application of permanent LVAD use to less ill patients would be associated with improved survival, quality of life, or functional capacity. REVIVE-IT represented an extraordinary effort to provide data from a randomized clinical trial to inform clinicians, scientists, industry, and regulatory agencies about the efficacy and safety of LVAD therapy in a population with less advanced HF. Despite significant support from the medical community, industry, and governmental agencies, REVIVE-IT failed to accomplish its goal. The reasons for its failure are instructive, and the lessons learned from the REVIVE-IT experience are likely to be relevant to any future study of LVAD therapy in a population with less advanced HF. Copyright © 2016 International Society for Heart and Lung Transplantation. All rights reserved.

  3. Our experience of 200 patients: usage and maintenance of long-term oxygen therapy and non-invasive ventilation devices at home.

    PubMed

    Ulger, A Füsun; Poyraz, Barış; Gulec Balbay, Ege; Binay, Songül

    2014-01-01

    To evaluate the patients' attitudes about the devices, of which they use for long-term respiratory support at home. 200 consecutive patients were questioned about the treatment and devices of respiratory support at home by face to face questionnaire. Their records were taken from the archives of Social Security Agency. 123 (61.5%) of the patients were men and 77 (38.5%) were women. The mean age was 65.8 ± 11.9 (15-92) years. The most frequently prescribed device was oxygen concentrator and BIPAP was the one that follows. The most common indications were hypoxic and hypercapnic respiratory failure due to COPD. The devices were prescribed by the state university hospitals, most commonly. The average daily oxygen usage duration was 16.3 ± 3.1 hours, the average duration was 7.4 ± 3.1 hours, for BIPAP. Twenty one (11.4%) of the patients, who were treated with LTOT, stated that they were taking oxygen less than 15 hours a day. Higher education levels of the patients was correlated with the higher rates of visiting the companies - that they bought the devices- both for information about and control of the devices (p=0.002). The rate of visiting companies/firms was significantly higher in patients, who use BIPAP and respiratory support combined with it (p=0.010). Twenty three (47.9%) of the 48 patients, who notified that their devices were impaired, waited for repairment by the firm, 20 (41.6%) investigated special repair facilities and the rest (10.5%) rented a new device. Effective and continuous technical maintenance support must be provided to the patients, who are treated with long-term respiratory support at home.

  4. Darcy Permeability of Hollow Fiber Membrane Bundles Made from Membrana Polymethylpentene Fibers Used in Respiratory Assist Devices.

    PubMed

    Madhani, Shalv P; D'Aloiso, Brandon D; Frankowski, Brian; Federspiel, William J

    2016-01-01

    Hollow fiber membranes (HFMs) are used in blood oxygenators for cardiopulmonary bypass or in next generation artificial lungs. Flow analyses of these devices is typically done using computational fluid dynamics (CFD) modeling HFM bundles as porous media, using a Darcy permeability coefficient estimated from the Blake-Kozeny (BK) equation to account for viscous drag from fibers. We recently published how well this approach can predict Darcy permeability for fiber bundles made from polypropylene HFMs, showing the prediction can be significantly improved using an experimentally derived correlation between the BK constant (A) and bundle porosity (ε). In this study, we assessed how well our correlation for A worked for predicting the Darcy permeability of fiber bundles made from Membrana polymethylpentene (PMP) HFMs, which are increasingly being used clinically. Swatches in the porosity range of 0.4 to 0.8 were assessed in which sheets of fiber were stacked in parallel, perpendicular, and angled configurations. Our previously published correlation predicted Darcy within ±8%. A new correlation based on current and past measured permeability was determined: A = 497ε - 103; using this correlation measured Darcy permeability was within ±6%. This correlation varied from 8% to -3.5% of our prior correlation over the tested porosity range.

  5. Darcy permeability of hollow fiber membrane bundles made from Membrana® Polymethylpentene (PMP) fibers used in respiratory assist devices

    PubMed Central

    Madhani, Shalv. P.; D’Aloiso, Brandon. D.; Frankowski, Brian.; Federspiel, William. J.

    2016-01-01

    Hollow fiber membranes (HFMs) are used in blood oxygenators for cardiopulmonary bypass or in next generation artificial lungs. Flow analyses of these devices is typically done using computational fluid dynamics (CFD) modeling HFM bundles as porous media, using a Darcy permeability coefficient estimated from the Blake – Kozeny (BK) equation to account for viscous drag from fibers. We recently published how well this approach can predict Darcy permeability for fiber bundles made from polypropylene HFMs, showing the prediction can be significantly improved using an experimentally derived correlation between the BK constant (A) and bundle porosity (ε). In this study, we assessed how well our correlation for A worked for predicting the Darcy permeability of fiber bundles made from Membrana® polymethylpentene (PMP) HFMs, which are increasingly being used clinically. Swatches in the porosity range of 0.4 to 0.8 were assessed in which sheets of fiber were stacked in parallel, perpendicular and angled configurations. Our previously published correlation predicted Darcy within ±8%. A new correlation based on current and past measured permeability was determined: A=497ε-103; using this correlation measured Darcy permeability was within ±6%. This correlation varied from 8% to −3.5% of our prior correlation over the tested porosity range. PMID:26809086

  6. SU-E-J-31: Monitor Interfractional Variation of Tumor Respiratory Motion Using 4D KV Conebeam Computed Tomography for Stereotactic Body Radiation Therapy of Lung Cancer

    SciTech Connect

    Tai, A; Prior, P; Gore, E; Johnstone, C; Li, X

    2015-06-15

    Purpose: 4DCT has been widely used to generate internal tumor volume (ITV) for a lung tumor for treatment planning. However, lung tumors may show different respiratory motion on the treatment day. The purpose of this study is to evaluate 4D KV conebeam computed tomography (CBCT) for monitoring tumor interfractional motion variation between simulation and each fraction of stereotactic body radiation therapy (SBRT) for lung cancer. Methods: 4D KV CBCT was acquired with the Elekta XVI system. The accuracy of 4D KV CBCT for image-guided radiation therapy (IGRT) was tested with a dynamic thorax motion phantom (CIRS, Virginia) with a linear amplitude of 2 cm. In addition, an adult anthropomorphic phantom (Alderson, Rando) with optically stimulated luminescence (OSL) dosimeters embedded at the center and periphery of a slab of solid water was used to measure the dose of 4D KV CBCT and to compare it with the dose with 3D KV CBCT. The image registration was performed by aligning\\ each phase images of 4D KV CBCT to the planning images and the final couch shifts were calculated as a mean of all these individual shifts along each direction.A workflow was established based on these quality assurance tests for lung cancer patients. Results: 4D KV CBCT does not increase imaging dose in comparison to 3D KV CBCT. Acquisition of 4D KV CBCT is 4 minutes as compared to 2 minutes for 3D KV CBCT. Most of patients showed a small daily variation of tumor respiratory motion about 2 mm. However, some patients may have more than 5 mm variations of tumor respiratory motion. Conclusion: The radiation dose does not increase with 4D KV CBCT. 4D KV CBCT is a useful tool for monitoring interfractional variations of tumor respiratory motion before SBRT of lung cancer patients.

  7. A new LED device used for photodynamic therapy in treatment of moderate to severe acne vulgaris.

    PubMed

    Dong, Yiyun; Zhou, Guoyu; Chen, Jinan; Shen, Lingyue; Jianxin, Zhao; Xu, Qing; Zhu, Yulan

    2016-03-01

    This study investigated the efficacy and safety of a newly designed LED device used in photodiagnosis and photodynamic therapy of moderate to severe acne vulgaris in Chinese patients. Forty-six patients with moderate to severe facial acne showing high degrees of fluorescence by ultraviolet light examination were illuminated during ALA-PDT with two wavelengths of light (543-548 nm, and 630±6 nm, respectively) after 2 h of incubation with ALA. Each patient received treatment once every 30 days for two or three sessions. Two independent investigators assigned an acne severity score at baseline, one week after each treatment, as well as 4, 8, and 12 weeks after the completion of treatment. Adverse effects were recorded during and after each treatment. All patients rated their satisfaction with the results of treatment at a 12-week follow up visit. The ALA-PDL treatment regimen showed an overall effectiveness rate of 89.13% (41/46 patients). Some degree of clinical efficacy was seen in 71.42%, 86.67%, and 95.83% of patients with grades IV, V, and VI acne, respectively, and the rate of clinical effectiveness increased with increasing acne severity. When compared with baseline scores, significant reductions in acne scores were obtained at 8, and 12 weeks after completion of treatment. Maximum efficacy was shown at the 12 week follow up. No severe adverse events were observed. ALA-PDT administered with the newly designed LED device was an effective treatment for moderate to severe acne vulgaris, and side effects were mild and reversible. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. Fluence rate variability among light delivery devices for esophageal photodynamic therapy

    NASA Astrophysics Data System (ADS)

    Finlay, Jarod C.; Ginsberg, Gregory G.; Hahn, Stephen M.

    2007-02-01

    Esophageal photodynamic therapy (PDT) is performed using a photosensitizing agent activated by light delivered via a cylindrically symmetric delivery device containing a diffusing optical fiber. In PDT treatment of dysplastic Barrett's esophagus, considerable variability in results is observed due to the non-uniform delivery of treatment light caused by source geometry and by luminal collapse. We compare the fluence rate at the tissue surface resulting from illumination with bare fiber, a centering balloon catheter (X-Cell, Cooke, Inc), and a fixed diameter transparent dilating catheter (Optical Dilator, Inscope, Ethicon ES). Measurements were made in a solid esophagus-simulating phantom illuminated by 2.5 and 5 cm diffusing fibers with and without each delivery device. The diffuser was coupled to a 630 nm dye laser pumped by a 532 nm KTP laser (LaserScope, Inc.) The total power emitted by the diffuser was 1W. The fluence rate as a function of position along the cavity was measured by a calibrated photodiode connected to an optical fiber with a 0.5 mm isotropic scattering tip, which was moved by a computer-controlled positioner. The mean fluence rate measured when the phantom was illuminated using either the centering balloon or the rigid dilator was approximately 50% less than that measured with a bare fiber. The decrease in fluence rate is due to attenuation of the primary light beam and to reduction in scattering from laterally adjacent points in the phantom. The importance of each of these effects as a function of tissue optical properties was confirmed using Monte Carlo simulation.

  9. A Randomized Controlled Trial of the embrace Advanced Scar Therapy Device to Reduce Incisional Scar Formation

    PubMed Central

    Longaker, Michael T.; Rohrich, Rod J.; Greenberg, Lauren; Furnas, Heather; Wald, Robert; Bansal, Vivek; Seify, Hisham; Tran, Anthony; Weston, Jane; Korman, Joshua M.; Chan, Rodney; Kaufman, David; Dev, Vipul R.; Mele, Joseph A.; Januszyk, Michael; Cowley, Christy; McLaughlin, Peggy; Beasley, Bill; Gurtner, Geoffrey C.; Longaker, Michael T.; Gurtner, Geoffrey C.

    2015-01-01

    Background Scarring represents a significant biomedical burden in clinical medicine. Mechanomodulation has been linked to scarring through inflammation, but until now a systematic approach to attenuate mechanical force and reduce scarring has not been possible. Methods The authors conducted a 12-month, prospective, open-label, randomized, multicenter clinical trial to evaluate abdominoplasty scar appearance following postoperative treatment with the embrace Advanced Scar Therapy device to reduce mechanical forces on healing surgical incisions. Incisions from 65 healthy adult subjects were randomized to receive embrace treatment on one half of an abdominoplasty incision and control treatment (surgeon's optimal care methods) on the other half. The primary endpoint for this study was the difference between assessments of scar appearance for the treated and control sides using the visual analogue scale scar score. Results Final 12-month study photographs were obtained from 36 subjects who completed at least 5 weeks of dressing application. The mean visual analogue scale score for embrace-treated scars (2.90) was significantly improved compared with control-treated scars (3.29) at 12 months (difference, 0.39; 95 percent confidence interval, 0.14 to 0.66; p = 0.027). Both subjects and investigators found that embrace-treated scars demonstrated significant improvements in overall appearance at 12 months using the Patient and Observer Scar Assessment Scale evaluation (p = 0.02 and p < 0.001, respectively). No serious adverse events were reported. Conclusions These results demonstrate that the embrace device significantly reduces scarring following abdominoplasty surgery. To the authors’ knowledge, this represents the first level I evidence for postoperative scar reduction. PMID:24804638

  10. Single LED-based device to perform widefield fluorescence imaging and photodynamic therapy

    NASA Astrophysics Data System (ADS)

    Grecco, Clovis; Buzzá, Hilde H.; Stringasci, Mirian D.; Andrade, Cintia T.; Vollet-Filho, Jose D.; Pratavieira, Sebastião.; Zanchin, Anderson L.; Tuboy, Aparecida M.; Bagnato, Vanderlei S.

    2015-06-01

    Photodynamic therapy (PDT) is a treatment modality that can be indicated for several cancer types and pre-cancer lesions. One of the main applications of PDT is the treatment of superficial skin lesions such as basal cell carcinoma, Bowen's disease and actinic keratosis. Three elements are necessary in PDT, a photosensitizer (PS); light at specific wavelength to be absorbed by the PS, and molecular oxygen. A typical PS used for skin lesion is protoporphyrin IX (PpIX), which is an intrinsic PS; its production is stimulated by a pro-drug, such as 5-aminolevulinic acid (ALA). Before starting a treatment, it is very important to follow up the PpIX production (to ensure that enough PS was produced prior to a PDT application) and, during a PDT session, to monitor its photodegradation (as it is evidence of the photodynamic effect taking place). The aim of this paper is to present a unique device, LINCE (MMOptics - São Carlos, Brazil), that brings together two probes that can, respectively, allow for fluorescence imaging and work as a light source for PDT treatment. The fluorescence probe of the system is optically based on 400 nm LED (light emitting diodes) arrays that allow observing the fluorescence emission over 450 nm. The PDT illumination probe options are constituted of 630 nm LED arrays for small areas and, for large areas, of both 630 nm and 450 nm LED arrays. Joining both functions at the same device makes PDT treatment simpler, properly monitorable and, hence, more clinically feasible. LINCE has been used in almost 1000 PDT treatments of superficial skin lesions in Brazil, with 88.4% of clearance of superficial BCC.

  11. SU-E-J-67: Evaluation of Breathing Patterns for Respiratory-Gated Radiation Therapy Using Respiration Regularity Index

    SciTech Connect

    Cheong, K; Lee, M; Kang, S; Yoon, J; Park, S; Hwang, T; Kim, H; Kim, K; Han, T; Bae, H

    2014-06-01

    Purpose: Despite the importance of accurately estimating the respiration regularity of a patient in motion compensation treatment, an effective and simply applicable method has rarely been reported. The authors propose a simple respiration regularity index based on parameters derived from a correspondingly simplified respiration model. Methods: In order to simplify a patient's breathing pattern while preserving the data's intrinsic properties, we defined a respiration model as a power of cosine form with a baseline drift. According to this respiration formula, breathing-pattern fluctuation could be explained using four factors: sample standard deviation of respiration period, sample standard deviation of amplitude and the results of simple regression of the baseline drift (slope and standard deviation of residuals of a respiration signal. Overall irregularity (δ) was defined as a Euclidean norm of newly derived variable using principal component analysis (PCA) for the four fluctuation parameters. Finally, the proposed respiration regularity index was defined as ρ=ln(1+(1/ δ))/2, a higher ρ indicating a more regular breathing pattern. Subsequently, we applied it to simulated and clinical respiration signals from real-time position management (RPM; Varian Medical Systems, Palo Alto, CA) and investigated respiration regularity. Moreover, correlations between the regularity of the first session and the remaining fractions were investigated using Pearson's correlation coefficient. Results: The respiration regularity was determined based on ρ; patients with ρ<0.3 showed worse regularity than the others, whereas ρ>0.7 was suitable for respiratory-gated radiation therapy (RGRT). Fluctuations in breathing cycle and amplitude were especially determinative of ρ. If the respiration regularity of a patient's first session was known, it could be estimated through subsequent sessions. Conclusions: Respiration regularity could be objectively determined using a respiration

  12. A new method and device of aligning patient setup lasers in radiation therapy.

    PubMed

    Hwang, Ui-Jung; Jo, Kwanghyun; Lim, Young Kyung; Kwak, Jung Won; Choi, Sang Hyoun; Jeong, Chiyoung; Kim, Mi Young; Jeong, Jong Hwi; Shin, Dongho; Lee, Se Byeong; Park, Jeong-Hoon; Park, Sung Yong; Kim, Siyong

    2016-01-01

    The aim of this study is to develop a new method to align the patient setup lasers in a radiation therapy treatment room and examine its validity and efficiency. The new laser alignment method is realized by a device composed of both a metallic base plate and a few acrylic transparent plates. Except one, every plate has either a crosshair line (CHL) or a single vertical line that is used for alignment. Two holders for radiochromic film insertion are prepared in the device to find a radiation isocenter. The right laser positions can be found optically by matching the shadows of all the CHLs in the gantry head and the device. The reproducibility, accuracy, and efficiency of laser alignment and the dependency on the position error of the light source were evaluated by comparing the means and the standard deviations of the measured laser positions. After the optical alignment of the lasers, the radiation isocenter was found by the gantry and collimator star shots, and then the lasers were translated parallel to the isocenter. In the laser position reproducibility test, the mean and standard deviation on the wall of treatment room were 32.3±0.93 mm for the new method whereas they were 33.4±1.49 mm for the conventional method. The mean alignment accuracy was 1.4 mm for the new method, and 2.1 mm for the conventional method on the walls. In the test of the dependency on the light source position error, the mean laser position was shifted just by a similar amount of the shift of the light source in the new method, but it was greatly magnified in the conventional method. In this study, a new laser alignment method was devised and evaluated successfully. The new method provided more accurate, more reproducible, and faster alignment of the lasers than the conventional method. PACS numbers: 87.56.Fc, 87.53.Bn, 87.53.Kn, 87.53.Ly, 87.55.Gh.

  13. SU-E-T-452: Impact of Respiratory Motion On Robustly-Optimized Intensity-Modulated Proton Therapy to Treat Lung Cancers

    SciTech Connect

    Liu, W; Schild, S; Bues, M; Liao, Z; Sahoo, N; Park, P; Li, H; Li, Y; Li, X; Shen, J; Anand, A; Dong, L; Zhu, X; Mohan, R

    2014-06-01

    Purpose: We compared conventionally optimized intensity-modulated proton therapy (IMPT) treatment plans against the worst-case robustly optimized treatment plans for lung cancer. The comparison of the two IMPT optimization strategies focused on the resulting plans' ability to retain dose objectives under the influence of patient set-up, inherent proton range uncertainty, and dose perturbation caused by respiratory motion. Methods: For each of the 9 lung cancer cases two treatment plans were created accounting for treatment uncertainties in two different ways: the first used the conventional Method: delivery of prescribed dose to the planning target volume (PTV) that is geometrically expanded from the internal target volume (ITV). The second employed the worst-case robust optimization scheme that addressed set-up and range uncertainties through beamlet optimization. The plan optimality and plan robustness were calculated and compared. Furthermore, the effects on dose distributions of the changes in patient anatomy due to respiratory motion was investigated for both strategies by comparing the corresponding plan evaluation metrics at the end-inspiration and end-expiration phase and absolute differences between these phases. The mean plan evaluation metrics of the two groups were compared using two-sided paired t-tests. Results: Without respiratory motion considered, we affirmed that worst-case robust optimization is superior to PTV-based conventional optimization in terms of plan robustness and optimality. With respiratory motion considered, robust optimization still leads to more robust dose distributions to respiratory motion for targets and comparable or even better plan optimality [D95% ITV: 96.6% versus 96.1% (p=0.26), D5% - D95% ITV: 10.0% versus 12.3% (p=0.082), D1% spinal cord: 31.8% versus 36.5% (p =0.035)]. Conclusion: Worst-case robust optimization led to superior solutions for lung IMPT. Despite of the fact that robust optimization did not explicitly

  14. Multi-Targeted Antithrombotic Therapy for Total Artificial Heart Device Patients.

    PubMed

    Ramirez, Angeleah; Riley, Jeffrey B; Joyce, Lyle D

    2016-03-01

    To prevent thrombotic or bleeding events in patients receiving a total artificial heart (TAH), agents have been used to avoid adverse events. The purpose of this article is to outline the adoption and results of a multi-targeted antithrombotic clinical procedure guideline (CPG) for TAH patients. Based on literature review of TAH anticoagulation and multiple case series, a CPG was designed to prescribe the use of multiple pharmacological agents. Total blood loss, Thromboelastograph(®) (TEG), and platelet light-transmission aggregometry (LTA) measurements were conducted on 13 TAH patients during the first 2 weeks of support in our institution. Target values and actual medians for postimplant days 1, 3, 7, and 14 were calculated for kaolinheparinase TEG, kaolin TEG, LTA, and estimated blood loss. Protocol guidelines were followed and anticoagulation management reduced bleeding and prevented thrombus formation as well as thromboembolic events in TAH patients postimplantation. The patients in this study were susceptible to a variety of possible complications such as mechanical device issues, thrombotic events, infection, and bleeding. Among them all it was clear that patients were at most risk for bleeding, particularly on postoperative days 1 through 3. However, bleeding was reduced into postoperative days 3 and 7, indicating that acceptable hemostasis was achieved with the anticoagulation protocol. The multidisciplinary, multi-targeted anticoagulation clinical procedure guideline was successful to maintain adequate antithrombotic therapy for TAH patients.

  15. Iatrogenic oesophageal perforation during placement of an endoscopic vacuum therapy device.

    PubMed

    Halliday, Edwin; Patel, Anant; Hindmarsh, Andrew; Sujendran, Vijay

    2016-07-28

    Endoscopic vacuum-assisted closure (VAC) is increasingly being used as a means of managing perforations or anastomotic leaks of the upper gastrointestinal (GI) tract. Published outcomes are favourable, with few mentions of complications or morbidity. We present a case in which the management of a gastric perforation with endoscopic vacuum therapy was complicated by cervical oesophageal perforation. The case highlights the risks of such endoscopic therapeutic procedures and is the first report in the literature to describe significant visceral injury during placement of a VAC device for upper GI perforation. Iatrogenic oesophageal perforation is an inherent risk to upper GI endoscopy and the risk increases in therapeutic endoscopic procedures. Complications may be reduced by management under a multidisciplinary team in a centre with specialist upper GI services. There is no doubt that the endoscopic VAC approach is becoming established practice, and training in its use must reflect its increasingly widespread adoption. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

  16. Candelabra aloe (Aloe arborescens) in the therapy and prophylaxis of upper respiratory tract infections: traditional use and recent research results.

    PubMed

    Bastian, Petra; Fal, Andrzej M; Jambor, Jerzy; Michalak, Anna; Noster, Britta; Sievers, Hartwig; Steuber, Anke; Walas-Marcinek, Natalia

    2013-02-01

    Aloe arborescens (Candelabra Aloe) has been used in the treatment of upper respiratory tract infections in Central and Eastern European countries for many decades. Originally introduced to support the healing and recovery in cornea transplant patients, aqueous A. arborescens extracts soon became popular in the treatment of upper respiratory tract infections with a focus on toddlers and children. Recent preclinical and clinical data show that immunomodulatory, antiinflammatory, and antiviral effects contribute to its therapeutic efficacy. Based on its well documented, longstanding traditional use and its excellent safety and tolerability, A. arborescens may be considered a valuable addition to the spectrum of herbal medicinal products for the treatment and prophylaxis of upper respiratory tract infections, in particular common cold, in adults and children.

  17. Clinical outcomes associated with chronic antimicrobial suppression therapy in patients with continuous-flow left ventricular assist devices.

    PubMed

    Jennings, Douglas L; Chopra, Anuvrat; Chambers, Rachel; Morgan, Jeffrey A

    2014-10-01

    This retrospective cohort study evaluates the effect of chronic antimicrobial suppression (CAS) therapy on clinical outcomes in patients with continuous-flow left ventricular assist devices (CF-LVADs) and a history of device-related infection. Patients with CF-LVAD implantation between January 2008 and August 2011 who received systemic CAS after index antibiotic treatment of a device-related infection were included. Chronic suppression was defined as continuation of antibiotics for longer than 6 weeks after the index infection. Standard International Society for Heart and Lung Transplantation definitions were used. The primary outcome is failure of CAS, defined as a clinical deterioration resulting in the need for transition from oral to intravenous (IV) therapy or a need to change to a different IV antibiotic, elevation to status 1A on the transplant list as a result of ongoing infection, or device/driveline exchange. Of 140 patients screened, 16 patients were included (69% male, 63% African American, median age 52 years). The driveline was the most common site of infection (69%). Organisms isolated included Gram-positive cocci (n = 7), Gram-negative bacilli (n = 10), and Candida (n = 1). Oral trimethoprim/sulfamethoxazole treatment was most commonly used for suppression (37.5%). Failure of CAS occurred in 5/16 (31%) patients after a mean time of 175 days on therapy (range 10-598). The majority of failures (60%) required device exchanges. Side effects of nausea, vomiting, or diarrhea were reported in three patients; all required changes in oral suppression regimen. Clostridium difficile infection was noted in two patients. These results, which must be confirmed by a larger analysis, suggest that one-third of CF-LVAD patients may develop recurrent infections while on CAS therapy.

  18. A novel microfluidic anti-factor Xa assay device for monitoring anticoagulant therapy at the point-of-care

    NASA Astrophysics Data System (ADS)

    Harris, Leanne F.; Rainey, Paul; Castro-López, Vanessa; O'Donnell, James S.; Killard, Anthony J.

    2013-05-01

    Millions of patients worldwide are receiving anticoagulant therapy to treat hypercoagulable diseases. While standard testing is still performed in the central laboratory, point-of-care (POC) diagnostics are being developed due to the increasing number of patients requiring long-term anticoagulation and with a need for more personalized and targeted therapy. Many POC devices on the market focus on clot measurement, a technique which is limited in terms of variability, highlighting the need for more reliable assays of anticoagulant status. The anti-Xa assay, a factor specific optical assay, was developed to measure the extent to which exogenous factor Xa (FXa) is inhibited by heparinantithrombin complexes. We have developed a novel microfluidic device and assay for monitoring the effect of heparin anticoagulant therapy at the point-of-care. The assay which was also developed in our institute is based on the anti-Xa assay principle but uses fluorescence as the method of detection. Our device is a disposable laminate microfluidic strip, fabricated from the cyclic polyolefin (COP), Zeonor®, which is extremely suitable for application to fluorescent device platforms. We present data on the execution of the anti-Xa assay in this microfluidic format, demonstrating that the assay can be used to measure heparin in human plasma samples from 0 to 0.8 U/ml, with average assay reproducibility of 8% and a rapid result obtained within 60 seconds. Results indicate that with further development, the fluorogenic anti-Xa assay and device could become a successful method for monitoring anticoagulant therapy.

  19. Physical Medicine Devices; Reclassification of Shortwave Diathermy for All Other Uses, Henceforth To Be Known as Nonthermal Shortwave Therapy. Final order; technical correction.

    PubMed

    2015-10-13

    The Food and Drug Administration (FDA) is issuing a final order to reclassify shortwave diathermy (SWD) for all other uses, a preamendments class III device, into class II (special controls), and to rename the device "nonthermal shortwave therapy'' (SWT). FDA is also making a technical correction in the regulation for the carrier frequency for SWD and SWT devices.

  20. 21 CFR 868.5450 - Respiratory gas humidifier.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Respiratory gas humidifier. 868.5450 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5450 Respiratory gas humidifier. (a) Identification. A respiratory gas humidifier is a device that is intended to add moisture to, and sometimes...

  1. 21 CFR 868.5450 - Respiratory gas humidifier.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Respiratory gas humidifier. 868.5450 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5450 Respiratory gas humidifier. (a) Identification. A respiratory gas humidifier is a device that is intended to add moisture to, and sometimes...

  2. 21 CFR 868.5450 - Respiratory gas humidifier.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Respiratory gas humidifier. 868.5450 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5450 Respiratory gas humidifier. (a) Identification. A respiratory gas humidifier is a device that is intended to add moisture to, and sometimes...

  3. 21 CFR 868.5450 - Respiratory gas humidifier.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Respiratory gas humidifier. 868.5450 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5450 Respiratory gas humidifier. (a) Identification. A respiratory gas humidifier is a device that is intended to add moisture to, and sometimes...

  4. 21 CFR 868.5450 - Respiratory gas humidifier.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Respiratory gas humidifier. 868.5450 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5450 Respiratory gas humidifier. (a) Identification. A respiratory gas humidifier is a device that is intended to add moisture to, and sometimes...

  5. 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

  6. Home-based exercise therapy in patients with ankylosing spondylitis: effects on pain, mobility, disease activity, quality of life, and respiratory functions.

    PubMed

    Aytekin, Ebru; Caglar, Nil Sayıner; Ozgonenel, Levent; Tutun, Sule; Demiryontar, Dilay Yilmaz; Demir, Saliha Eroglu

    2012-01-01

    The home-based exercise therapy recommended to the patients with ankylosing spondylitis (AS) is a simply applicable and cheap method. The aim of this study was to investigate the effects of home-based exercise therapy on pain, mobility, function, disease activity, quality of life, and respiratory functions in patients with AS. Eighty patients diagnosed with AS according to the modified New York criteria were included in the study. Home-based exercise program including range of motion, stretching, strengthening, posture, and respiratory exercises was practically demonstrated by a physiotherapist. A training and exercise manual booklet was given to all patients. Patients following home-based exercise program five times a week at least 30 min per session (exercise group) for 3 months were compared with those exercising less than five times a week (control group). Visual analog scale pain (VASp) values at baseline were significantly higher in the exercise group. The exercise group showed improvements in VASp, tragus-wall distance, morning stiffness, finger-floor distance, modified Schober's test, chest expansion, the Bath Ankylosing Spondylitis Disease Activity Index, the Bath Ankylosing Spondylitis Functional Index, Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL), forced expiratory volume in first second, and forced vital capacity at third month. There was significant difference in ASQoL scores between the two groups in favor of the exercise group at third month. Regular home-based exercise therapy should be a part of main therapy in patients with AS. Physicians should recommend that patients with AS do exercise at least five times a week at least 30 min per session.

  7. SU-E-T-66: Characterization of Radiation Dose Associated with Dark Currents During Beam Hold for Respiratory-Gated Electron Therapy

    SciTech Connect

    Hessler, J; Gupta, N; Rong, Y; Weldon, M

    2014-06-01

    Purpose: The main objective of this study was to estimate the radiation dose contributed by dark currents associated with the respiratory-gated electron therapy during beam hold. The secondary aim was to determine clinical benefits of using respiratory-gated electron therapy for left-sided breast cancer patients with positive internal mammary nodes (IMN). Methods: Measurements of the dark current-induced dose in all electron modes were performed on multiple Siemens and Varian linear accelerators by manually simulating beam-hold during respiratory gating. Dose was quantified at the machine isocenter by comparing the collected charge to the known output for all energies ranging from 6 to 18 MeV for a 10cm × 10cm field at 100 SSD with appropriate solid-water buildup. Using the Eclipse treatment planning system, we compared the additional dose associated with dark current using gated electron fields to the dose uncertainties associated with matching gated photon fields and ungated electron fields. Dose uncertainties were seen as hot and cold spots along the match line of the fields. Results: The magnitude of the dose associated with dark current is highly correlated to the energy of the beam and the amount of time the beam is on hold. For lower energies (6–12 MeV), there was minimal dark current dose (0.1–1.3 cGy/min). Higher energies (15–18 MeV) showed measurable amount of doses. The dark current associated with the electron beam-hold varied between linear accelerator vendors and depended on dark current suppression and the age of the linear accelerator. Conclusion: For energies up to 12 MeV, the dose associated with the dark current for respiratorygated electron therapy was shown to be negligible, and therefore should be considered an option for treating IMN positive left-sided breast cancer patients. However, at higher energies the benefit of respiratory gating may be outweighed by dose due to the dark current.

  8. B-type natriuretic peptide-guided therapy and length of hospital stay post left ventricular assist device implantation.

    PubMed

    Hellman, Yaron; Malik, Adnan S; Lin, Hongbo; Shen, Changyu; Wang, I-Wen; Wozniak, Thomas C; Hashmi, Zubair A; Shaukat, Arslan; Pickrell, Jeanette; Caccamo, Marco A; Gradus-Pizlo, Irmina; Hadi, Azam

    2015-01-01

    B-type natriuretic peptide (BNP)-guided therapy during the early postoperative period following left ventricular assist device (LVAD) implantation has not been well described in the literature. We conducted a retrospective cohort study consisting of consecutive patients who underwent LVAD implantation at our institution during May 2009 to March 2013. The study was limited to patients receiving HeartMate II (Thoratec) or HVAD (HeartWare) LVADs. Patients with acute myocardial infarction were excluded. We compared between patients with multiple postoperative BNP tests (BNP-guided therapy) and earlier period patients who typically had only a baseline BNP measurement (non-BNP-guided therapy). A total of 85 patients underwent LVAD implantation during the study period. Eight patients were excluded (five acute myocardial infarction, three without BNP measurements). The only differences in the baseline characteristics of BNP versus non-BNP-guided therapy included age and female gender. The postoperative length of hospital stay (LOS) in the BNP-guided therapy group was 5 days shorter when compared with the non-BNP-guided therapy group. In multivariate analysis, BNP-guided therapy remained a significant predictor of reduced LOS. The use of repeated BNP measurements during the early postoperative period was associated with a significantly lower LOS post LVAD implantation.

  9. Wound healing and catheter thrombosis after implantable venous access device placement in 266 breast cancers treated with bevacizumab therapy.

    PubMed

    Kriegel, Irène; Cottu, Paul H; Fourchotte, Virginie; Sanchez, Sebastian; Fromantin, Isabelle; Kirov, Krassen; Guillaume, Alain; Pelloquin, Anne; Esteve, Marc; Salmon, Remy J

    2011-11-01

    The aim of this study was to determine, in a population with metastatic breast cancer treated with bevacizumab therapy, the incidence of wound dehiscence after placement of an implantable venous access device (VAD) and to study the risk of catheter thrombosis. This study enrolled all VADs placed by 14 anesthetists between 1 January 2007 and 31 December 2009: 273 VADs in patients treated with bevacizumab therapy and 4196 VADs in patients not treated with bevacizumab therapy. In the bevacizumab therapy group, 13 cases of wound dehiscence occurred in 12 patients requiring removal of the VAD (4.76%). All cases of dehiscence occurred when bevacizumab therapy was initiated less than 7 days after VAD placement. Bevacizumab therapy was initiated less than 7 days after VAD placement in 150 cases (13 of 150: 8.6%). The risk of dehiscence was the same from 0 to 7 days. In parallel, the VAD wound dehiscence rate in patients not receiving bevacizumab therapy was eight of 4197 cases (0.19%) (Fisher's test significant, P<0.001). No risk factors of dehiscence were identified: anesthetists, learning curves, and irradiated patients. VAD thrombosis occurred in four patients (1.5%). In parallel, VAD thrombosis occurred in 51 of 4197 patients (1.2%) not receiving bevacizumab therapy (Fisher's test not significant; P=0.43). Bevacizumab therapy was permanently discontinued in five patients related to wound dehiscence and in one patient due to extensive skin necrosis. These data suggest the need to observe an interval of at least 7 days between VAD placement and initiation of bevacizumab therapy to avoid the risk of a wound dehiscence requiring chest wall port explant. The risk of VAD thrombosis does not require any particular primary prevention.

  10. [I.P.P.B. therapy at home in chronic respiratory insufficiency in France. I. Survey method. Description of the prescribers. 1960-1977 prescription evolution (author's transl)].

    PubMed

    Drouet, D; Kauffmann, F; Brille, D; Hatzfeld, C; Liot, F; Kompalitch, M

    1979-01-01

    In order to assess the usage of IPPB therapy at home in chronic respiratory insufficiency in France, a mail survey has been conducted among 2,062 chest physicians and physicians involved in intensive care. The response rate was 57%. Among those caring for chronic respiratory insufficient patients, 296, i.e. 38%, have prescribed IPPB to 3,778 patients from 1960 till 1977. A study among a sample of the non-spontaneous-responders allows the estimation of about 400 physicians who prescribed IPPB on the whole for France at this time. Those who prescribed, worked more often in hospital though 4% had only a private practice. Those involved in intensive care prescribed more often than the chest physicians (47% versus 37%). The development of this therapy was different according to the different regions in France. But, in a general way, the prescription of IPPB at home particularly spread out since 1975, 65% of all the prescriptions have been done in 1975, 76, 77.

  11. An effective Negative Pressure Wound Therapy-1 compatible Local Antibiotic Delivery Device.

    PubMed

    Rand, Ben C C; Wenke, Joseph C

    2017-07-24

    The current clinical standard for local antibiotic depot is polymethylmethacrylate (PMMA) beads. Unfortunately, these are not ideal and negative pressure wound therapy (NPWT) reduces their limited effectiveness. Recently, a chitosan sponge has been shown to be an effective carrier of antibiotics. Since it acts as a delivery vehicle with increased wound contact area instead of an antibiotic depot, it may be more effective. The objectives of this study are to determine if 1) a chitosan sponge would be more effective than PMMA beads as a local antibiotic delivery device and 2) the chitosan sponge remains an effective method of delivery when used in conjunction with NPWT. Contaminated musculoskeletal wounds were created on the proximal tibia of goats; the animals were assigned to one of four groups (bead pouch, beads with NPWT, sponge pouch, and sponge with NPWT). The animals were survived for 48 hours, and the bacteria in the wound were quantified. The antibiotic levels in the blood and within the NPWT canisters were measured throughout the study period. After treatment, there were significantly fewer bacteria in wounds treated with antibiotic chitosan sponge delivery than antibiotic PMMA bead depot (p<0.05), and NPWT did not reduce the effectiveness of the chitosan sponge even though large amounts of vancomycin was found in the canisters. The peak serum levels of vancomycin were well below what is considered safe levels. Antibiotic delivery to the wound using a chitosan sponge is compatible with NPWT and is more effective than PMMA antibiotic depot. The chitosan sponge works in conjunction with NPWT and may improve the outcomes of open fracture wounds.

  12. A Bayesian Model to Predict Right Ventricular Failure following Left Ventricular Assist Device Therapy

    PubMed Central

    Loghmanpour, Natasha A.; Kormos, Robert L.; Kanwar, Manreet K.; Teuteberg, Jeffrey J.; Murali, Srinivas; Antaki, James F.

    2016-01-01

    Background Right ventricular failure (RVF) continues to be a major adverse event following left ventricular assist device (LVAD) implantation. This study investigates the use of a Bayesian statistical model to address the limited predictive capacity of existing risk scores derived from multivariate analyses. This is based on the hypothesis that it is necessary to consider the inter-relationships and conditional probabilities amongst independent variables to achieve sufficient statistical accuracy. Methods The data used for this study was derived from 10,909 adult patients from INTERMACS who had a primary LVAD from December 2006 – March 2014. An initial set of 176 pre-implant variables were considered. RVF post-implant was categorized as acute (<48 hours), early (48 hours–14 days) and late (>14 days) in onset. For each of these endpoints, a separate tree-augmented Naïve Bayes model was constructed using the most predictive variables using an open source Bayesian inference engine (SMILE.) Results The acute RVF model consisted of 33 variables, including: systolic pulmonary artery pressure (PAP), white blood cell count, left ventricular ejection fraction, cardiac index, sodium levels, and lymphocyte percentage. The early RVF model consisted of 34 variables, including systolic PAP, pre-albumin, LDH, INTERMACS profile, right ventricular ejection fraction, pro-B-type natriuretic peptide, age, heart rate, tricuspid regurgitation and BMI. The late RVF model included 33 variables and was mostly predicted by peripheral vascular resistance, MELD score, albumin, lymphocyte percentage, mean PAP and diastolic PAP. The accuracies of all the Bayesian models were between 91–97%, AUC between 0.83–0.90 sensitivity of 90% and specificity between 98–99%, significantly outperforming previously published risk scores. Conclusion A Bayesian prognostic model of RVF, based on the large, multi-center INTERMACS registry provided highly accurate predictions of acute, early, and late

  13. Septic Pulmonary Embolism Caused by Infected Pacemaker Leads After Replacement of a Cardiac Resynchronization Therapy Device

    PubMed Central

    Said, Salah A.M.; Nijhuis, Rogier; Derks, Anita; Droste, Herman

    2016-01-01

    Patient: Male, 70 Final Diagnosis: Pacemaker leads endocarditis Symptoms: Bacterial lead endocarditis • congestive heart failure • fever • pacemaker dysfunction Medication: — Clinical Procedure: Pacemaker box replacement due to end-of-service Specialty: Cardiology Objective: Unusual clinical course Background: Cardiac resynchronization therapy (CRT) has been demonstrated to reduce morbidity and mortality in patients with advanced, drug-refractory heart failure. Procedure-related mortality is less than 1% in larger studies. Approximately10% of CRT patients have to undergo surgical revision because of infections, dislocations, or unacceptable electrical behavior manifested as high threshold, unstable sensing, or unwanted phrenic nerve stimulation. Case Report: A 70-year-old man with symptomatic congestive heart failure underwent implantation of a biventricular pacemaker on the left anterior chest wall in 2003 and pulse generator exchange in August 2009. The patient responded well to CRT. At follow-up, the pacing system functioned normally. In September 2009, in the context of a predialysis program, an abdominal computed tomography (CT) scan was performed in another hospital for assessment and evaluation of chronic kidney disease. This procedure was complicated with peripheral thrombophlebitis that was managed appropriately with complete recovery. Eight months later (May 2010), the patient was admitted to our hospital with fever, anemia, and elevated infection parameters. During admission, blood cultures grew Staphylococcus epidermidis. The chest X-ray, lung perfusion scintigraphy, and CT scan depicted pulmonary embolism and infarction. The right ventricular lead threshold was found to be increased to 7 volts with unsuccessful capture. Echocardiography demonstrated vegetations on leads. The entire pacing system was explanted, but the patient expired few days later following percutaneous removal due to multiorgan failure. Conclusions: In heart failure

  14. Treatment of ankylosing spondylitis with biologics and targeted physical therapy: positive effect on chest pain, diminished chest mobility, and respiratory function.

    PubMed

    Gyurcsik, Z; Bodnár, N; Szekanecz, Z; Szántó, S

    2013-12-01

    Biologics are highly effective in ankylosing spondylitis (AS). In this self-controlled study, we assessed the additive value of complex physiotherapy in decreasing chest pain and tenderness and improving respiratory function in AS patients treated with tumor necrosis factor α (TNF-α) inhibitors. The trial consisted of 2 parts. In study I, clinical data of AS patients with (n=55) or without biological therapy (n=20) were retrospectively analyzed and compared. Anthropometrical data, duration since diagnosis and patient assessment of disease activity, pain intensity, tender points, sacroiliac joint involvement determined by X-ray, functional condition, and physical activity level were recorded. Subjective, functional, and physical tests were performed. In study II, 10 voluntary patients (6 men and 4 women, age 52.4 ± 13.6 years) with definite AS and receiving anti-TNF therapy were recruited. It was a prospective, non-randomized physiotherapeutic trial. BASFI (Bath Ankylosing Spondylitis Functional Index), BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), modified Schober Index, occiput-to-wall distance, and fingertip-to-floor distance were evaluated. Forced vital capacity, forced 1-s expiratory volume, peak expiratory flow, and maximum voluntary ventilation were recorded. Furthermore, typical tender points were recorded. A targeted physiotherapy program was conducted twice a week for 12 weeks and all above parameters were recorded at baseline and after 12 weeks. Differences in patient assessment of disease activity (p=0.019) and pain intensity (p=0.017) were found in study I. Pain and tenderness of the thoracic spine were observed in both groups. Back pain without biologic therapy was slightly higher than other group. In study II, we found that patient assessment of disease activity and pain intensity significantly improved after the physical therapy program (p=0.002 and p<0.001). BASFI and BASDAI increased after treatment (p=0.004 and p<0.001). The

  15. Ethical Dilemmas and End-of-Life Choices for Patients with Implantable Cardiac Devices: Decisions Regarding Discontinuation of Therapy.

    PubMed

    Grubb, Blair P; Karabin, Beverly

    2011-10-01

    It is our belief that a well-designed cardiac device management program should include end-of-life patient and family planning, addressing potential decisions regarding withdrawal of pacemaker and/or implantable cardioverter defibrillator therapy. Guided by the basic ethical and legal principles outlined in the article, it is the responsibility of the electrophysiologist and other involved health care providers to introduce this topic to patients, provide guidance and resources for decision making, and honor both patient and family requests.

  16. Effects of Device-Facilitated Isometric Progressive Resistance Oropharyngeal Therapy on Swallowing and Health-Related Outcomes in Older Adults with Dysphagia.

    PubMed

    Rogus-Pulia, Nicole; Rusche, Nicole; Hind, Jacqueline A; Zielinski, Jill; Gangnon, Ronald; Safdar, Nasia; Robbins, JoAnne

    2016-02-01

    Swallowing disorders (dysphagia) are associated with malnutrition, aspiration pneumonia, and mortality in older adults. Strengthening interventions have shown promising results, but the effectiveness of treating dysphagia in older adults remains to be established. The Swallow STRengthening OropharyNGeal (Swallow STRONG) Program is a multidisciplinary program that employs a specific approach to oropharyngeal strengthening-device-facilitated (D-F) isometric progressive resistance oropharyngeal (I-PRO) therapy-with the goal of reducing health-related sequelae in veterans with dysphagia. Participants completed 8 weeks of D-F I-PRO therapy while receiving nutritional counseling and respiratory status monitoring. Assessments were completed at baseline, 4, and 8 weeks. At each visit, videofluoroscopic swallowing studies were performed. Dietary and swallowing-related quality of life questionnaires were administered. Long-term monitoring for 6-17 months after enrollment allowed for comparison of pneumonia incidence and hospitalizations to the 6-17 months before the program. Veterans with dysphagia confirmed with videofluoroscopy (N = 56; 55 male, 1 female; mean age 70) were enrolled. Lingual pressures increased at anterior (effect estimate = 92.5, P < .001) and posterior locations (effect estimate = 85.4, P < .001) over 8 weeks. Statistically significant improvements occurred on eight of 11 subscales of the Quality of Life in Swallowing Disorders (SWAL-QOL) Questionnaire (effect estimates = 6.5-19.5, P < .04) and in self-reported sense of effort (effect estimate = -18.1, P = .001). Higher Functional Oral Intake Scale scores (effect estimate = 0.4, P = .02) indicated that participants were able to eat less-restrictive diets. There was a 67% reduction in pneumonia diagnoses, although the difference was not statistically significant. The number of hospital admissions decreased significantly (effect estimate = 0.96; P = .009) from before to after enrollment. Findings suggest

  17. Cardiac resynchronization therapy (CRT) device replacement considerations: upgrade or downgrade? A complex decision in the current clinical setting.

    PubMed

    Nakou, Eleni S; Simantirakis, Emmanuel N; Kallergis, Eleftherios M; Nakos, Konstantinos S; Vardas, Panos E

    2016-12-23

    There are limited data about the management of patients presenting for elective generator replacements in the setting of previously implanted cardiac resynchronization therapy (CRT) devices that are nearing end-of-life. The individual patient's clinical status and concomitant morbidities may evolve so that considerations may include not only replacement of the pulse generator, but also potentially changing the type of device [e.g. downgrading CRT-defibrillator (CRT-D) to CRT-pacemaker (CRT-P) or ICD or upgrading of CRT-P to CRT-D]. Moreover, the clinical evidence for CRT-D/CRT-P implantation may change over time, with ongoing research and availability of new trial data. In this review we discuss the ethical, clinical and financial implications related to CRT generator replacements and the need for additional clinical trials to better understand which patients should undergo CRT device downgrading or upgrading at the time of battery depletion.

  18. Surgical Interventions and the Use of Device-Aided Therapy for the Treatment of Fecal Incontinence and Defecatory Disorders.

    PubMed

    Bharucha, Adil E; Rao, Satish S C; Shin, Andrea

    2017-08-22

    The purpose of this clinical practice update expert review is to describe the key principles in the use of surgical interventions and device-aided therapy for managing fecal incontinence (FI) and defecatory disorders. The best practices outlined in this review are based on relevant publications, including systematic reviews and expert opinion (when applicable). Best Practice Advice 1: A stepwise approach should be followed for management of FI. Conservative therapies (diet, fluids, techniques to improve evacuation, a bowel training program, management of diarrhea and constipation with diet and medications if necessary) will benefit approximately 25% of patients and should be tried first. Best Practice Advice 2: Pelvic floor retraining with biofeedback therapy is recommended for patients with FI who do not respond to the conservative measures indicated above. Best Practice Advice 3: Perianal bulking agents such as intra-anal injection of dextranomer may be considered when conservative measures and biofeedback therapy fail. Best Practice Advice 4: Sacral nerve stimulation should be considered for patients with moderate or severe FI in whom symptoms have not responded after a 3-month or longer trial of conservative measures and biofeedback therapy and who do not have contraindications to these procedures. Best Practice Advice 5: Until further evidence is available, percutaneous tibial nerve stimulation should not be used for managing FI in clinical practice. Best Practice Advice 6: Barrier devices should be offered to patients who have failed conservative or surgical therapy, or in those who have failed conservative therapy who do not want or are not eligible for more invasive interventions. Best Practice Advice 7: Anal sphincter repair (sphincteroplasty) should be considered in postpartum women with FI and in patients with recent sphincter injuries. In patients who present later with symptoms of FI unresponsive to conservative and biofeedback therapy and evidence of

  19. [IPPB therapy at home in chronic respiratory insufficiency in France. II. Indications. Technics and surveillance (author's transl)].

    PubMed

    Kauffmann, F; Drouet, D; Brille, D; Hatzfeld, C; Liot, F; Kompalitch, M

    1979-01-01

    A survey has been conducted among French chest physicians and physicians involved in intensive care. 296 physicians have prescribed IPPB at home to 3 778 patients with chronic respiratory insufficiency between 1960 and 1977. Acute respiratory failure was the first criteria considered in the indications (57% of the patients); hypercapnia, hypoxemia and right heart failure episode frequency were the other criteria of severity the most often taken into account. Since 1960, the indications among those with airflow obstruction have decreased, whereas they have increased for those with restrictive insufficiencies, expressing the questions raised about the efficacy of IPPB in these two types. 18% of the patients have had IPPB through tracheostomy canula. 70% of the patients have used a pressure cycling respirator and 30% a volume or flow cycling respiratory. This second type was quite always used in the case of IPPB through canula. Oxygen was added for half of the patients. The physicians have regularly followed the patients. Great importance was accorded to home care surveillance.

  20. Rescue therapy by switching to total face mask after failure of face mask-delivered noninvasive ventilation in do-not-intubate patients in acute respiratory failure.

    PubMed

    Lemyze, Malcolm; Mallat, Jihad; Nigeon, Olivier; Barrailler, Stéphanie; Pepy, Florent; Gasan, Gaëlle; Vangrunderbeeck, Nicolas; Grosset, Philippe; Tronchon, Laurent; Thevenin, Didier

    2013-02-01

    duration in predicting facial pressure sores was 11 hrs (area under the receiver operating characteristic curve, 0.86 ± 0.04; 95% confidence interval 0.76-0.93; p < 0.0001; sensitivity, 84%; specificity, 71%). In patients in hypercapnic acute respiratory failure, for whom escalation to intubation is deemed inappropriate, switching to total face mask can be proposed as a last resort therapy when face mask-delivered noninvasive mechanical ventilation has already failed to reverse acute respiratory failure. This strategy is particularly adapted to provide prolonged periods of continuous noninvasive mechanical ventilation while preventing facial pressure sores.

  1. Durable left ventricular assist device therapy in advanced heart failure: Patient selection and clinical outcomes

    PubMed Central

    Shah, Sachin P.; Mehra, Mandeep R.

    2016-01-01

    The increasing adoption of left ventricular assist devices (LVADs) into clinical practice is related to a combination of engineering advances in pump technology and improvements in understanding the appropriate clinical use of these devices in the management of patients with advanced heart failure. This review intends to assist the clinician in identifying candidates for LVAD implantation, to examine long-term outcomes and provide an overview of the common complications related to use of these devices. PMID:27056652

  2. Assessment of Haptic Interaction for Home-Based Physical Tele-Therapy using Wearable Devices and Depth Sensors.

    PubMed

    Barmpoutis, Angelos; Alzate, Jose; Beekhuizen, Samantha; Delgado, Horacio; Donaldson, Preston; Hall, Andrew; Lago, Charlie; Vidal, Kevin; Fox, Emily J

    2016-01-01

    In this paper a prototype system is presented for home-based physical tele-therapy using a wearable device for haptic feedback. The haptic feedback is generated as a sequence of vibratory cues from 8 vibrator motors equally spaced along an elastic wearable band. The motors guide the patients' movement as they perform a prescribed exercise routine in a way that replaces the physical therapists' haptic guidance in an unsupervised or remotely supervised home-based therapy session. A pilot study of 25 human subjects was performed that focused on: a) testing the capability of the system to guide the users in arbitrary motion paths in the space and b) comparing the motion of the users during typical physical therapy exercises with and without haptic-based guidance. The results demonstrate the efficacy of the proposed system.

  3. [Subcutaneous emphysema following non-surgical peri-implantitis therapy using an air abrasive device: a case report].

    PubMed

    Bassetti, Mario; Bassetti, Renzo; Sculean, Anton; Salvi, Giovanni E

    2014-01-01

    Subcutaneous emphysema are rare complications in periodontology. In most cases, they resolve spontaneously. However, air might disperse into deeper facial spaces causing life-threatening complications such as compression of the tracheobronchial tree or the development of pneumomediastinum. Moreover, microorganisms might spread from the oral cavity into deeper spaces. Hence, rapid diagnosis of subcutaneous emphysema is important. Characteristic signs are both a shiftable swelling and a crepitation. In this case report, the case of a 69-year old man with a subcutaneous emphysema immediately after peri-implantitis therapy with the use of a glycine-based powder air-polishing device is described. Following therapy, air accumulated in the left side of the face. Seven days after non-surgical peri-implantitis therapy, the patient was asymptomatic with complete resolution of the emphysema.

  4. [Cycloferon, as an agent in the therapy and urgent prophylaxis of influenza and acute respiratory tract viral infection (multicentre randomized controlled comparative study)].

    PubMed

    Sologub, T V; Shul'diakov, A A; Romantsov, M G; Zhekalov, A N; Petlenko, S V; Erofeeva, M K; Maksakova, V L; Isakov, V A; Zarubaev, V V; Gatsan, V V; Kovalenko, A L

    2009-01-01

    Data on the study of the efficacy of the tablets of cycloferon, an early inductor of types 1 and 2 interferon, in the treatment of influenza and acute respiratory tract viral infections in adults are presented. The study enrolled 522 patients with moderate influenza of type A (H1N1) verified in 61% of the patients and type A (H3N2) verified in 7.5% of the cases. The patients were randomized with the envelope procedure. In the patients treated with cycloferon the intensity and period of the fever were stopped earlier and averaged from 1.8 to 3 days vs. 5 days in the reference group (symptomatic therapy). The improvement signs in the general state of the patients treated with cycloferon were noted on the 2nd day. The influenza complication as pneumonia was recorded in 2.2% of the patients treated with cycloferon, whereas in the patients under the symptomatic therapy the complications as bronchitis, pneumonia, angina were stated in 21.4% of the cases. For urgent prophylaxis of the influenza and respiratory tract viral infections (epidemiologic study) a group of 3717 subjects randomized with the table of random numbers was observed. 2080 patients were treated with cycloferon and 1637 patients were under the symptomatic therapy. The results were evaluated by the efficacy index and the protection estimate (T. A. Semenenko, 1991). The total efficacy index and the protection estimate in all the patients of the group were 4.9 and 79.8% respectively. The complicated forms of the disease were recorded in 1.5% of the patients treated with cycloferon and in 10.5 and 11.3% of the patients not treated with cycloferon.

  5. [Pulmonary arterial pressure in chronic bronchitis with respiratory insufficiency on long-term oxygen therapy. Outcome of 16 patients with review of the literature].

    PubMed

    Geraads, A; Pirotte, C; Ligeonnet, D; Levy, P; Brambilla, C

    1984-01-01

    A study was made of pulmonary artery pressure in 16 chronic bronchitics with severe respiratory failure, who were treated with continuous oxygen therapy at home. At the beginning of the study these patients presented with a pure and severe obstructive syndrome with marked hypoxaemia at rest (mean PaO2 = 6.8 kPa), had a suitable interval from a recent exacerbation, in a stable clinical and functional respiratory state. The duration of longterm oxygen therapy was controlled, as the efficacy of the blood gases (PaO2 of O2 greater than or equal to 8 kPa). The pulmonary artery pressure was measured using a microcatheter, at the beginning, and for most of the 18 months breathing ambient air in a stable state. At the end of this time a significant diminution of the FEV1 (VEMS) (a mean of 100 ml, p less than 0.01). This was evidence of the deterioration in the ventilatory state which contrasted with the improvement in the diminution of pulmonary artery hypertension (HTAP) from 3.43 to 2.97 kPa (p less than 0.05) without the deterioration in the other values. The good result above in chronic bronchitics contrasts with a stable or deteriorating pulmonary arterial pressure in a group of emphysematous (n = 6) and bronchiectatic subjects (n = 4) with somewhat similar functional characteristics but in whom the effect was too small to allow for any statistical comparison. Our results are compared with those in the literature much of which applies to only a few patients and for the great part revealed only haemodynamic stability of oxygen therapy. Possible reasons for these discordant findings are discussed.

  6. Evaluation of Absorbed Dose for CBCT in Image-guided Radiation Therapy: Comparison of Each Devices and Facilities.

    PubMed

    Kitazato, Yumiko; Kuga, Noriyuki; Shirieda, Katsutoshi; Enzaki, Masahiro; Nakaguchi, Yuji; Shimohigashi, Yoshinobu; Kawasaki, Toshihisa; Toyoda, Masahiko; Kawahara, Daisuke; Araki, Fujio; Kawamura, Shinji

    Recently, intensity-modulated radiation therapy (IMRT) is used worldwide, highly accurate verification of the location using image-guided radiation therapy (IGRT) has become critical. However, the use of cone-beam computed tomography (CBCT) to ascertain the location each time raises concerns about its influence on radiotherapy dosage and increased radiation exposure. The purpose of this study was to measure the absorbed dose using nine kilovoltage (kV) devices and two megavoltage (MV) devices (total 11 devices) at eight facilities, compare the absorbed dose among the devices, and assess the characteristics of the respective devices to ensure optimal clinical operation. For the measurement of the absorbed dose, a farmer-type ionization chamber dosimeter, calibrated using a (60)Co and an IMRT dose verification phantom manufactured from water-equivalent material RW3, was used to measure the absorbed dose at nine points in the phantom for two regions, the pelvic and cephalic region. The average absorbed dose of the pelvic region was 3.09±0.21 cGy in kV-CBCT (OBI), 1.16±0.16 cGy in kV-CBCT (XVI), 5.64±1.48 cGy in MV-CBCT (4 MV), and 6.33±1.54 cGy in MV-CBCT (6 MV). The average absorbed dose of the cephalic region was 0.38±0.03 cGy in kV-CBCT (OBI), 0.23±0.06 cGy in kV-CBCT (XVI), 4.02±0.72 cGy in MV-CBCT (4 MV), and 4.46±0.77 cGy in MV-CBCT (6 MV). There was a difference in the absorbed dose at the measured points as well as in the dose distribution in the phantom cross section. No major difference was observed in the absorbed dose among identical devices, but a difference was identified among the devices installed at multiple facilities. Therefore, the angle of rotation should be paid attention to when CBCT is taken, and the image-taking conditions should be determined. In addition, it is important to handle the devices only after ascertaining the absorbed dose of each device.

  7. Reduction in stray radiation dose using a body-shielding device during external radiation therapy.

    PubMed

    Zhang, Shuxu; Jiang, Shaohui; Zhang, Quanbin; Lin, Shengqu; Wang, Ruihao; Zhou, Xiang; Zhang, Guoqian; Lei, Huaiyu; Yu, Hui

    2017-03-01

    With the purpose of reducing stray radiation dose (SRD) in out-of-field region (OFR) during radiotherapy with 6 MV intensity-modulated radiation therapy (IMRT), a body-shielding device (BSD) was prepared according to the measurements obtained in experimental testing. In experimental testing, optimal shielding conditions, such as 1 mm lead, 2 mm lead, and 1 mm lead plus 10 mm bolus, were investigated along the medial axis of a phantom using thermoluminescent dosimeters (TLDs). The SRDs at distances from field edge were then measured and analyzed for a clinical IMRT treatment plan for nasopharyngeal carcinoma before and after shielding using the BSD. In addition, SRDs in anterior, posterior, left and right directions of phantom were investigated with and without shielding, respectively. Also, the SRD at the bottom of treatment couch was measured. SRD decreased exponentially to a constant value with increasing distance from field edge. The shielding rate was 50%-80%; however, there were no significant differences in SRDs when shielded by 1 mm lead, 2 mm lead, or 1 mm lead plus 10 mm bolus (P>0.05). Importantly, the 10 mm bolus absorbed back-scattering radiation due to the interaction between photons and lead. As a result, 1 mm lead plus 10 mm bolus was selected to prepare the BSD. After shielding with BSD, total SRDs in the OFR decreased to almost 50% of those without shielding when irradiated with IMRT beams. Due to the effects of treatment couch and gantry angle, SRDs at distances were not identical in anterior, posterior, left and right direction of phantom without BSD. As higher dose in anterior and lower dose in posterior, SRDs were substantial similarities after shielding. There was no significant difference in SRDs for left and right directions with or without shielding. Interestingly, SRDs in the four directions were similar after shielding. From these results, the BSD developed in this study may significantly reduce SRD in the OFR during

  8. A Fiberoptic (Photodynamic Therapy Type) Device with a Photosensitizer and Singlet Oxygen Delivery Probe Tip for Ovarian Cancer Cell Killing

    PubMed Central

    Bartusik, Dorota; Aebisher, David; Ghogare, Ashwini; Ghosh, Goutam; Abramova, Inna; Hasan, Tayyaba; Greer, Alexander

    2013-01-01

    A portable “fiber optic-based sensitizer delivery” device has been developed and studied. Before there might be success in photodynamic therapy (PDT) and anti-bacterial ambitions, an understanding of basic factors on device performance were needed. Thus, the device was examined for the localized delivery of sensitizer molecules in ovarian cancer cells and production of high concentrations of singlet oxygen for their eradication in vitro. The device-tip releases stored pheophorebide by attack of singlet oxygen from sensitized oxygen gas delivered through the hollow fiber using 669-nm laser light. The performance of the device was enhanced when configured with a fluorosiliane tip by virtue of its Teflon-like property compared to a conventional glass tip (greater sensitizer quantities photoreleased and laterally diffused, and greater amounts of ovarian OVCAR-5 cancer cell killing). No cell damage was observed at 2.2 N of force applied by the probe tip itself, an amount used for many of the experiments described here. PMID:23495787

  9. Respiratory papillomas

    PubMed Central

    Alagusundaramoorthy, Sayee Sundar; Agrawal, Abhinav

    2016-01-01

    Papillomas are known to occur in the lower respiratory tract. They are however, rare compared to their occurrence in the upper respiratory tract. These are generally exophytic tumors in the more proximal upper airways however cases with more distal location with an inverted growth pattern have also been described in the literature. These can be solitary or multiple and multifocality associated with multiple papillomas in the upper respiratory/aerodigestive tract. The four major types of respiratory papillomas are (1) Recurrent respiratory papillomas, (2) solitary squamous papillomas, (3) solitary glandular papillomas, (4) mixed papillomas. We review the incidence, etiopathology, diagnosis, and possible treatment modalities and algorithms for these respiratory papillomas. PMID:27625447

  10. Surgical implantation of a cardiac resynchronization therapy device in a western lowland gorilla (Gorilla gorilla gorilla) with fibrosing cardiomyopathy.

    PubMed

    Rush, Elizabeth Marie; Ogburn, Anna L; Hall, Jeffrey; Rush, Dwain; Lau, Yung; Dillon, A R; Garmon, Linda; Tillson, D M; Kay, G Neal

    2010-09-01

    A 24-yr-old, male western lowland gorilla (Gorilla gorilla gorilla) was diagnosed in March of 2003 with congestive heart failure (CHF). Transesophageal and transthoracic echocardiography demonstrated global left and right ventricular hypokinesia with a left ventricular ejection fraction of 0.20. At the time of diagnosis, the animal exhibited symptoms and signs of CHF with minimal exertion (New York Heart Association class III). Over a 16-mo period, the severity of CHF progressed to class IV (resting signs and symptoms) despite angiotensin-converting enzyme inhibition, beta-blockers, and diuretics. Because of intractable CHF and a QRS duration that was markedly prolonged compared with the normal range for this species, a cardiac resynchronization therapy (CRT) device was implanted using implantation techniques based on human surgical procedures. Placement of the right ventricular, right atrial, and left ventricular leads and pulse generator were accomplished in 5.5 hr. Telemetry of the device postoperatively via wand or remote radio frequency has allowed for noninvasive programming and interrogation. The clinical improvement in CHF with this therapy was immediate and dramatic for this animal. Six months after CRT device implantation, the device leads became dislodged during an altercation with another gorilla, with the rapid development of CHF upon cessation of biventricular pacing. A second procedure to replace the leads returned the gorilla to his previous level of activity. In 2007, the pulse generator was electively replaced for battery depletion with a device capable of remote radiofrequency programming and interrogation. CRT implantation, although requiring specialized equipment and surgical skill, appears to be a viable option for treatment of dilated cardiomyopathy in gorillas.

  11. POSTOPERATIVE EFFECT OF PHYSICAL THERAPY RELATED TO FUNCTIONAL CAPACITY AND RESPIRATORY MUSCLE STRENGTH IN PATIENTS SUBMITTED TO BARIATRIC SURGERY

    PubMed Central

    de OLIVEIRA, Josélia Jucirema Jarschel; de FREITAS, Alexandre Coutinho Teixeira; de ALMEIDA, Andréa Adriana

    2016-01-01

    ABSTRACT Background: Respiratory physiotherapy plays an important role preventing complications in bariatric surgery. Aim: To assess the effects of out-patient physiotherapy during post-operative period through respiratory pressures and functional capacity in individuals submitted to bariatric surgery. Method: A prospective longitudinal and controlled study was done in adults with body mass index (BMI) equal or greater than 40 kg/m², who have been submitted to bariatric surgery. They were divided into two groups: intervention-group, who performed out-patient physiotherapy twice a week, from thirty to sixty days after surgery; and the control-group, who only followed home instructions. Both groups were evaluated before surgery and sixty days after surgery through manovacuometry, six-minute walk test and the Borg Scale of perceived exertion. Results: Twenty participants were included the intervention-group and twenty-three in the control-group. Both groups had significant and similar weight loss after surgery. The manovacuometry presented no differences comparing pre- and post-surgery and in the comparison between the groups. The result of the six-minute walk test for the intervention-group increased by 10.1% in the post-operative period in relation to pre-. The Borg scale of perceived exertion in the intervention-group in pre-surgery decreased by 13.5% in the post-surgery compared to pre-surgery. In the control-group there was no difference comparing pre- and post-operative values, as in the comparison with the intervention-group. Conclusion: The low-intensity exercise program, carried out between the 30th and the 60th day after bariatric surgery provided better functional capacity; did not change respiratory muscle strength; and improved the perceived exertion rate. PMID:27683775

  12. [Respiratory therapy with Ez-PAP for treatment of dynamic hyperinflation in patients with severe COPD and emphysema].

    PubMed

    Iberl, G; Bornitz, F; Schellenberg, M; Wiebel, M; Herth, F J F; Kreuter, M

    2014-09-01

    Non-pharmacological respiratory physiotherapy in treatment of COPD with severe emphysema is achieving increasing importance. Ez-PAP, a compact CPAP- or flow-PEP system, supports inspiration by using the Coanda effect in addition to a PE(E)P-effect during expiration. 30 patients with severe COPD and emphysema and hypercapnic respiratory failure under non-(NIV) (n = 28) and invasive ventilation (n = 2) were treated in ventilator-free intervals with Ez-PAP and analyzed retrospectively. Clinical courses such as ventilator-dependency, dyspnea by visual CR-10 Borg scale, results of six-minute walk tests (6MWT), lung function tests and recordings of transcutaneous CO2 measurements were evaluated where possible. Analyzed patients showed less ventilator dependancy (n = 9), reported a median decrease of shortness of breath by 3,3 points (n = 10) and improved by 50,4 m in the 6MWT (n = 5). A median increase of vital capacity by 544 ml (n = 5) was shown by spirometry. Combined with manual techniques for reducing air-trapping, treatment success was documented by a median reduction of pCO2 by 7,3 mmHg (n = 6) using transcutaneous pCO2 measurement. Ez-PAP is a simple mechanical method to reduce dynamic hyperinflation in severe COPD, thus achieving relief of respiratory muscles and more effective breathing. Prospective studies of this promising method are urgently required. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Characteristics of respiratory syncytial virus-induced bronchiolitis co-infection with Mycoplasma pneumoniae and add-on therapy with montelukast.

    PubMed

    Wu, Sheng-Hua; Chen, Xiao-Qing; Kong, Xia; Yin, Pei-Ling; Dong, Ling; Liao, Pei-Yuan; Wu, Jia-Ming

    2016-02-01

    The influence of Mycoplasma pneumoniae (MP) infection on bronchiolitis remains unclear. Additionally, reports on the efficacies of leukotriene receptor antagonists in the treatment of bronchiolitis have been inconclusive. Children with respiratory syncytial virus (RSV)-induced bronchiolitis were divided into two groups: RSV+MP group and RSV group. Each group was randomly divided into two subgroups: one received routine and placebo treatment, while the other received routine and montelukast treatment for 9 months. The cumulative numbers of wheezing episodes and recurrent respiratory tract infections were recorded. Blood parameters were determined. Patients in the RSV+MP group exhibited an older average age, fever, more frequent flaky and patchy shadows in chest X-rays, more frequent extrapulmonary manifestations, and longer hospital stays compared with patients in the RSV group. Additionally, higher baseline blood eosinophil counts, eosinophil cationic protein (ECP), total immunoglobulin E (IgE), interleukin (IL)-4, IL-5, IL-4/interferon-γ ratios, leukotriene (LT) B4, and LTC4, and lower baseline lipoxin A4 (LXA4)/LTB4 ratios were observed in the RSV+MP group compared with the RSV group. Montelukast treatment decreased the cumulative numbers of recurrent wheezing episodes and recurrent respiratory tract infections at 9 and 12 months. This efficacy may be related to the montelukast-induced reductions in peripheral eosinophil counts, ECP and total IgE, as well as the montelukast-dependent recovery in T helper (Th) 1/Th2 balance and LXA4/LTB4 ratios in children with bronchiolitis. RSV bronchiolitis with MP infection was associated with clinical and laboratory features that differed from those of RSV bronchiolitis without MP infection. Add-on therapy with montelukast for 9 months was beneficial for children with bronchiolitis at 9 and 12 months after the initiation of treatment.

  14. Extracorporeal membrane oxygenation as a rescue therapy for acute respiratory failure during chemotherapy in a patient with acute myeloid leukemia.

    PubMed

    Lee, Sang Won; Kim, Youn Seup; Hong, Goohyeon

    2017-02-01

    Acute respiratory distress syndrome (ARDS) caused by pneumonia in patients with hematologic malignancies can be life-threatening. Extracorporeal membrane oxygenation (ECMO) is the only temporary treatment for patients with ARDS who are refractory to conventional treatment. However, the immunosuppression and coagulopathies in hematological malignancies such as lymphoma and acute leukemia are relative contraindications for ECMO, due to high risks of infection and bleeding. Here, we report a 22-year-old man with acute myeloid leukemia (AML) who developed pneumonia and ARDS during induction chemotherapy; he was treated with ECMO.

  15. Extracorporeal membrane oxygenation as a rescue therapy for acute respiratory failure during chemotherapy in a patient with acute myeloid leukemia

    PubMed Central

    Lee, Sang Won; Kim, Youn Seup

    2017-01-01

    Acute respiratory distress syndrome (ARDS) caused by pneumonia in patients with hematologic malignancies can be life-threatening. Extracorporeal membrane oxygenation (ECMO) is the only temporary treatment for patients with ARDS who are refractory to conventional treatment. However, the immunosuppression and coagulopathies in hematological malignancies such as lymphoma and acute leukemia are relative contraindications for ECMO, due to high risks of infection and bleeding. Here, we report a 22-year-old man with acute myeloid leukemia (AML) who developed pneumonia and ARDS during induction chemotherapy; he was treated with ECMO. PMID:28275497

  16. Effect of conventional physical therapy and Pilates in functionality, respiratory muscle strength and ability to exercise in hospitalized chronic renal patients: a randomized controlled trial.

    PubMed

    Sarmento, Lais A; Pinto, Juliana Sst; da Silva, Ana Pp; Cabral, Cristina Mn; Chiavegato, Luciana D

    2017-04-01

    To compare the effect of conventional physical therapy and Pilates on function, restoration, and exercise ability in hospitalized chronic renal patients. A total of 56 inpatients were randomized into two groups: Conventional physical therapy and Pilates. The primary outcomes were functionality (Barthel Index), respiratory muscle strength (manovacuometry), and ability to exercise (step test) evaluated in the following periods: preintervention, after the 5th session, and after the 10th session or at discharge. Three months after randomization, the Barthel Index was applied over the phone. At the end of the 10 sessions or at discharge, the length of hospital stay was calculated and the level of satisfaction with physical therapy care was assessed (MedRisk). Linear mixed models were used for the primary outcomes and the Student's t-test was used for length of stay and satisfaction. There was no significant between-group difference in functionality (MD -1.3; 95% CI -2.8 to 5.4), inspiratory and expiratory muscle strength (MD -1.3; 95% CI -7.3 to 4.5/MD -4.5; 95% CI -0.7 to 9.7, respectively), performance in the step test (MD -3.3; 95% CI -6.2 to 12.8), patient satisfaction with physical therapy care (MD -2.0; 95% CI -5.1 to 9.1), and length of stay (MD 4.5; 95% CI -15.9 to 6.8). Both interventions, conventional physical therapy and Pilates, showed improvements and there is no difference between them. Therefore both can be used in chronic renal patients.

  17. The additional effect of orthotic devices on exercise therapy for patients with patellofemoral pain syndrome: a systematic review.

    PubMed

    Swart, Nynke M; van Linschoten, Robbart; Bierma-Zeinstra, Sita M A; van Middelkoop, Marienke

    2012-06-01

    The aim of the study is to determine "the additional effect of... function" for patellofemoral pain syndrome (PFPS). The additional effect of orthotic devices over exercise therapy on pain and function. A systematic literature search was conducted in MEDLINE, CINAHL, EMBASE, Cochrane and PEDro. Randomised controlled trials and controlled clinical trials of patients diagnosed with PFPS evaluating a clinically relevant outcome were included. Treatment had to include exercise therapy combined with orthotics, compared with an identical exercise programme with or without sham orthotics. Data were summarised using a best evidence synthesis. Eight trials fulfilled the inclusion criteria, of which three had a low risk of bias. There is moderate evidence for no additive effectiveness of knee braces to exercise therapy on pain (effect sizes (ES) varied from -0.14 to 0.04) and conflicting evidence on function (ES -0.33). There is moderate evidence for no difference between knee braces and exercise therapy versus placebo knee braces and exercise therapy on pain and function (ES -0.1-0.10). More studies of high methodological quality are needed to draw definitive conclusions.

  18. Device therapy for atrial septal defects in a multicenter cohort: acute outcomes and adverse events.

    PubMed

    El-Said, Howaida; Hegde, Sanjeet; Foerster, Susan; Hellenbrand, William; Kreutzer, Jacqueline; Trucco, Sara M; Holzer, Ralf; Burch, Grant; Mirani, Ajay; Nicolas, Ramzi; Porras, Diego; Bergersen, Lisa; Moore, John

    2015-02-01

    Secundum atrial septal defect (ASD) closure devices were granted approval based on industry-sponsored, prospective, nonrandomized, single device studies, demonstrating acceptable efficacy and safety in selected patients. We sought to report community practice and outcomes. Procedure specific data was collected on cases considered for ASD closure in the congenital cardiac catheterization project on outcomes (C3PO) between February 1, 2007 and June 31, 2010. Eight centers contributed data during this time period. All adverse events (AE) were independently reviewed and classified by a five level severity scale. In 40 months (2/07-6/10), 653 of 688 ASDs were occluded with a single device using an AMPLATZER(®) Septal Occluder (ASO) in 566 (87%), GORE(®) HELEX(®) Septal Occluder (HSO) in 33 (5%), and a CardioSEAL(®) or STARFlex™ device (CSD) in 54 (8%). Most patients had an isolated ASD (93%). 85% were >2 years of age. The ASD median diameter was 12 mm [8,16] for ASO, with smaller diameters in HSO 8 mm [7,10] and CSD 8 mm [5,10] (P < 0.001). AE (n = 82) were recorded in 76 cases, 11.5% (95% CI 9.2%, 14.1%) and classified as high severity in 4.7% (95% CI 3.2%, 6.5%), with no mortality. A new conduction abnormality was detected during 15 cases and did not resolve in one. Transcatheter device retrieval was possible in 7 of 10 device embolizations. Device erosion occurred in 3 of 566, 0.5% (95% CI 0.1%, 1.5%), ASO implants. Although device closure of ASDs is associated with low morbidity and rare mortality, ongoing assessment of device safety profiles are warranted, and registries offer opportunities to facilitate the required surveillance. © 2014 Wiley Periodicals, Inc.

  19. Analysis of the cost-effectiveness of surfactant treatment (Curosurf®) in respiratory distress syndrome therapy in preterm infants: early treatment compared to late treatment.

    PubMed

    Dani, Carlo; Ravasio, Roberto; Fioravanti, Leonardo; Circelli, Maria

    2014-05-02

    The best criteria for surfactant treatment in the perinatal period are unknown and this makes it of interest to consider the possible economic implications of lessening the use of more restrictive criteria. The objective of this study is the evaluation of the costs of respiratory care for preterm infants with Respiratory Distress Syndrome (RDS) treated with "early rescue" surfactant compared to a "late rescue" strategy. The study was carried out applying the costs of materials used, of staff and pharmacological therapy calculated in the Neonatal Intensive Care Unit (NICU) of an Italian hospital to the Verder et al. study (Pediatrics 1999) clinical data. The cost for patients treated with early strategy was slightly lower than for patients treated with late strategy (Euro 4,901.70 vs. Euro 4,960.07). The cost of treatment with surfactant was greater in the early group (Euro 458.49 vs. Euro 311.74), but this was compensated by the greater cost of treatment with Mechanical Ventilation (MV) in the late group (respectively Euro 108.85 vs. Euro 259.25). The cost-effectiveness analysis performed in this study shows how early treatment with surfactant in preterm infants with RDS, as well as being clinically more effective, is associated with a slightly lower cost.

  20. Analysis of the cost-effectiveness of surfactant treatment (Curosurf®) in respiratory distress syndrome therapy in preterm infants: early treatment compared to late treatment

    PubMed Central

    2014-01-01

    Background The best criteria for surfactant treatment in the perinatal period are unknown and this makes it of interest to consider the possible economic implications of lessening the use of more restrictive criteria. Objective The objective of this study is the evaluation of the costs of respiratory care for preterm infants with Respiratory Distress Syndrome (RDS) treated with "early rescue" surfactant compared to a "late rescue" strategy. Methods The study was carried out applying the costs of materials used, of staff and pharmacological therapy calculated in the Neonatal Intensive Care Unit (NICU) of an Italian hospital to the Verder et al. study (Pediatrics 1999) clinical data. Results The cost for patients treated with early strategy was slightly lower than for patients treated with late strategy (Euro 4,901.70 vs. Euro 4,960.07). The cost of treatment with surfactant was greater in the early group (Euro 458.49 vs. Euro 311.74), but this was compensated by the greater cost of treatment with Mechanical Ventilation (MV) in the late group (respectively Euro 108.85 vs. Euro 259.25). Conclusions The cost-effectiveness analysis performed in this study shows how early treatment with surfactant in preterm infants with RDS, as well as being clinically more effective, is associated with a slightly lower cost. PMID:24886906

  1. Respiratory Failure

    MedlinePlus

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

  2. Respiratory system

    NASA Technical Reports Server (NTRS)

    Bartlett, R. G., Jr.

    1973-01-01

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

  3. Biolite: A Patented Ultra-Low-Level Laser-Therapy Device for Treating Musculoskeletal Pain and Associated Impairments.

    PubMed

    Gallamini, Michele; D'Angelo, Giovanni; Belloni, Gabriele

    2015-08-01

    After an excursus on state-of-the-art knowledge for low-level laser therapy (LLLT), Biolite, a patented ultra-low-level laser therapy device used to treat musculoskeletal pain and associated impairments, is presented. The application protocols include short stimulation of sequences of acupuncture points. The observed effects seem, however, to be far from those that might be expected after acupuncture. The primary effect seems more likely to be an extracellular soft-tissue matrix reaction. The development of the technique, the studies performed, and the evidence collected over > 10 years suggest that specifically modulated laser light can interact with human tissues at light fluences well under those previously considered as being capable of having any effect. Musculoskeletal pain very often becomes an autonomous dysfunction that is independent of the original injury and that can be effectively treated using specific peripheral acupuncture-like stimulation. Because such acupuncture is capable of reducing motor control "interferences" from noxious stimuli, it can improve motor control performance, thereby reducing the risk of falls in the elderly individuals. The proposal of acupuncture-derived protocols to be applied by Western physiotherapists using an ultra-low-level laser therapy device is a further "bridge" between two different, and sometimes very different, clinical worlds to better serve our patients.

  4. A dual therapy of off-pump temporary left ventricular extracorporeal device and amniotic stem cell for cardiogenic shock.

    PubMed

    Kazui, Toshinobu; Tran, Phat L; Pilikian, Tia R; Marsh, Katie M; Runyan, Raymond; Konhilas, John; Smith, Richard; Khalpey, Zain I

    2017-09-07

    Temporary mechanical circulatory support device without sternotomy has been highly advocated for severe cardiogenic shock patient but little is known when coupled with amniotic stem cell therapy. This case reports the first dual therapy of temporary left ventricular extracorporeal device CentriMag with distal banding technique and human amniotic stem cell injection for treating a severe refractory cardiogenic shock of an 68-year-old female patient. A minimally-invasive off-pump LVAD was established by draining from the left ventricle and returning to the right axillary artery with distal arterial banding to prevent right upper extremity hyperperfusion. Amniotic stem cells were injected intramyocardially at the left ventricular apex, lateral wall, inferior wall, and right subclavian vein. The concomitant use of the temporary minimally-invasive off-pump CentriMag placement and stem cell therapy not only provided an alternative to cardiopulmonary bypass and full-median sternotomy procedures but may have also synergistically enhanced myocardial reperfusion and regeneration.

  5. Simulation of irradiation exposure of electronic devices due to heavy ion therapy with Monte Carlo Code MCNP6

    NASA Astrophysics Data System (ADS)

    Lapins, Janis; Guilliard, Nicole; Bernnat, Wolfgang; Buck, Arnulf

    2017-09-01

    During heavy ion irradiation therapy the patient has to be located exactly at the right position to make sure that the Bragg peak occurs in the tumour. The patient has to be moved in the range of millimetres to scan the ill tissue. For that reason a special table was developed which allows exact positioning. The electronic control can be located outside the surgery. But that has some disadvantage for the construction. To keep the system compact it would be much more comfortable to put the electronic control inside the surgery. As a lot of high energetic secondary particles are produced during the therapy causing a high dose in the room it is important to find positions with low dose rates. Therefore, investigations are needed where the electronic devices should be located to obtain a minimum of radiation, help to prevent the failure of sensitive devices. The dose rate was calculated for carbon ions with different initial energy and protons over the entire therapy room with Monte Carlo particle tracking using MCNP6. The types of secondary particles were identified and the dose rate for a thin silicon layer and an electronic mixture material was determined. In addition, the shielding effect of several selected material layers was calculated using MCNP6.

  6. Prostate thermal therapy with catheter-based ultrasound devices and MR thermal monitoring

    NASA Astrophysics Data System (ADS)

    Diederich, Chris J.; Nau, Will H.; Kinsey, Adam; Ross, Tony; Wootton, Jeff; Juang, Titania; Butts-Pauly, Kim; Ricke, Viola; Liu, Erin H.; Chen, Jing; Bouley, Donna M.; Van den Bosch, Maurice; Sommer, Graham

    2007-02-01

    Four types of transurethral applicators were devised for thermal ablation of prostate combined with MR thermal monitoring: sectored tubular transducer devices with directional heating patterns; planar and curvilinear devices with narrow heating patterns; and multi-sectored tubular devices capable of dynamic angular control without applicator movement. These devices are integrated with a 4 mm delivery catheter, incorporate an inflatable cooling balloon (10 mm OD) for positioning within the prostate and capable of rotation via an MR-compatible motor. Interstitial devices (2.4 mm OD) have been developed for percutaneous implantation with directional or dynamic angular control. In vivo experiments in canine prostate under MR temperature imaging were used to evaluate the heating technology and develop treatment control strategies. MR thermal imaging in a 0.5 T interventional MRI was used to monitor temperature and thermal dose in multiple slices through the target volume. Sectored tubular, planar, and curvilinear transurethral devices produce directional coagulation zones, extending 15-20 mm radial distance to the outer prostate capsule. Sequential rotation and modulated dwell time can conform thermal ablation to selected regions. Multi-sectored transurethral applicators can dynamically control the angular heating profile and target large regions of the gland in short treatment times without applicator manipulation. Interstitial implants with directional devices can be used to effectively ablate the posterior peripheral zone of the gland while protecting the rectum. The MR derived 52 °C and lethal thermal dose contours (t 43=240 min) allowed for real-time control of the applicators and effectively defined the extent of thermal damage. Catheter-based ultrasound devices, combined with MR thermal monitoring, can produce relatively fast and precise thermal ablation of prostate, with potential for treatment of cancer or BPH.

  7. Current state-of-the-art of device therapy for advanced heart failure

    PubMed Central

    Lee, Lawrence S.; Shekar, Prem S.

    2014-01-01

    Heart failure remains one of the most common causes of morbidity and mortality worldwide. The advent of mechanical circulatory support devices has allowed significant improvements in patient survival and quality of life for those with advanced or end-stage heart failure. We provide a general overview of past and current mechanical circulatory support devices encompassing options for both short- and long-term ventricular support. PMID:25559828

  8. Four-dimensional computed tomography based respiratory-gated radiotherapy with respiratory guidance system: analysis of respiratory signals and dosimetric comparison.

    PubMed

    Lee, Jung Ae; Kim, Chul Yong; Yang, Dae Sik; Yoon, Won Sup; Park, Young Je; Lee, Suk; Kim, Young Bum

    2014-01-01

    To investigate the effectiveness of respiratory guidance system in 4-dimensional computed tomography (4 DCT) based respiratory-gated radiation therapy (RGRT) by comparing respiratory signals and dosimetric analysis of treatment plans. The respiratory amplitude and period of the free, the audio device-guided, and the complex system-guided breathing were evaluated in eleven patients with lung or liver cancers. The dosimetric parameters were assessed by comparing free breathing CT plan and 4 DCT-based 30-70% maximal intensity projection (MIP) plan. The use of complex system-guided breathing showed significantly less variation in respiratory amplitude and period compared to the free or audio-guided breathing regarding the root mean square errors (RMSE) of full inspiration (P = 0.031), full expiration (P = 0.007), and period (P = 0.007). The dosimetric parameters including V(5 Gy), V(10 Gy), V(20 Gy), V(30 Gy), V(40 Gy), and V(50 Gy) of normal liver or lung in 4 DCT MIP plan were superior over free breathing CT plan. The reproducibility and regularity of respiratory amplitude and period were significantly improved with the complex system-guided breathing compared to the free or the audio-guided breathing. In addition, the treatment plan based on the 4D CT-based MIP images acquired with the complex system guided breathing showed better normal tissue sparing than that on the free breathing CT.

  9. Verification and compensation of respiratory motion using an ultrasound imaging system

    SciTech Connect

    Chuang, Ho-Chiao Hsu, Hsiao-Yu; Chiu, Wei-Hung; Tien, Der-Chi; Wu, Ren-Hong; Hsu, Chung-Hsien

    2015-03-15

    Purpose: The purpose of this study was to determine if it is feasible to use ultrasound imaging as an aid for moving the treatment couch during diagnosis and treatment procedures associated with radiation therapy, in order to offset organ displacement caused by respiratory motion. A noninvasive ultrasound system was used to replace the C-arm device during diagnosis and treatment with the aims of reducing the x-ray radiation dose on the human body while simultaneously being able to monitor organ displacements. Methods: This study used a proposed respiratory compensating system combined with an ultrasound imaging system to monitor the compensation effect of respiratory motion. The accuracy of the compensation effect was verified by fluoroscopy, which means that fluoroscopy could be replaced so as to reduce unnecessary radiation dose on patients. A respiratory simulation system was used to simulate the respiratory motion of the human abdomen and a strain gauge (respiratory signal acquisition device) was used to capture the simulated respiratory signals. The target displacements could be detected by an ultrasound probe and used as a reference for adjusting the gain value of the respiratory signal used by the respiratory compensating system. This ensured that the amplitude of the respiratory compensation signal was a faithful representation of the target displacement. Results: The results show that performing respiratory compensation with the assistance of the ultrasound images reduced the compensation error of the respiratory compensating system to 0.81–2.92 mm, both for sine-wave input signals with amplitudes of 5, 10, and 15 mm, and human respiratory signals; this represented compensation of the respiratory motion by up to 92.48%. In addition, the respiratory signals of 10 patients were captured in clinical trials, while their diaphragm displacements were observed simultaneously using ultrasound. Using the respiratory compensating system to offset, the diaphragm

  10. Verification and compensation of respiratory motion using an ultrasound imaging system.

    PubMed

    Chuang, Ho-Chiao; Hsu, Hsiao-Yu; Chiu, Wei-Hung; Tien, Der-Chi; Wu, Ren-Hong; Hsu, Chung-Hsien

    2015-03-01

    The purpose of this study was to determine if it is feasible to use ultrasound imaging as an aid for moving the treatment couch during diagnosis and treatment procedures associated with radiation therapy, in order to offset organ displacement caused by respiratory motion. A noninvasive ultrasound system was used to replace the C-arm device during diagnosis and treatment with the aims of reducing the x-ray radiation dose on the human body while simultaneously being able to monitor organ displacements. This study used a proposed respiratory compensating system combined with an ultrasound imaging system to monitor the compensation effect of respiratory motion. The accuracy of the compensation effect was verified by fluoroscopy, which means that fluoroscopy could be replaced so as to reduce unnecessary radiation dose on patients. A respiratory simulation system was used to simulate the respiratory motion of the human abdomen and a strain gauge (respiratory signal acquisition device) was used to capture the simulated respiratory signals. The target displacements could be detected by an ultrasound probe and used as a reference for adjusting the gain value of the respiratory signal used by the respiratory compensating system. This ensured that the amplitude of the respiratory compensation signal was a faithful representation of the target displacement. The results show that performing respiratory compensation with the assistance of the ultrasound images reduced the compensation error of the respiratory compensating system to 0.81-2.92 mm, both for sine-wave input signals with amplitudes of 5, 10, and 15 mm, and human respiratory signals; this represented compensation of the respiratory motion by up to 92.48%. In addition, the respiratory signals of 10 patients were captured in clinical trials, while their diaphragm displacements were observed simultaneously using ultrasound. Using the respiratory compensating system to offset, the diaphragm displacement resulted in

  11. Optimizing the programation of cardiac resynchronization therapy devices in patients with heart failure and left bundle branch block.

    PubMed

    Vidal, Bàrbara; Sitges, Marta; Marigliano, Alba; Delgado, Victoria; Díaz-Infante, Ernesto; Azqueta, Manel; Tamborero, David; Tolosana, José María; Berruezo, Antonio; Pérez-Villa, Félix; Paré, Carles; Mont, Lluís; Brugada, Josep

    2007-09-15

    This study was conducted to investigate the clinical impact of cardiac resynchronization device optimization. A series of 100 consecutive patients received cardiac resynchronization therapy. In the first 49 patients, an empirical atrioventricular delay of 120 ms was set, with simultaneous biventricular stimulation (interventricular [VV] interval=0 ms). In the next 51 patients, systematic atrioventricular optimization was performed. VV optimization was also performed, selecting 1 VV delay: right or left ventricular preactivation (+30 or -30 ms) or simultaneous (VV interval=0 ms), according to the best synchrony obtained by tissue Doppler-derived wall displacement. At follow-up, patients who were alive without cardiac transplantation and showed improvement of >or=10% in the distance walked in the 6-minute walking test were considered responders. There were no differences between the 2 groups at baseline. Left ventricular ejection fraction improved in the 2 groups, but left ventricular cardiac output improved only in the optimized group. At 6 months, patients with optimized devices walked slightly further in the 6-minute walking test (497+/-167 vs 393+/-123 m, p<0.01), with no differences in New York Heart Association functional class or quality of life compared with nonoptimized patients. Overall, the number of nonresponders were similar in the 2 groups (27% vs 23%, p=NS). In conclusion, the echocardiographic optimization of cardiac resynchronization devices provided a slight incremental clinical benefit at midterm follow-up. Simple and rapid methods to routinely optimize the devices are warranted.

  12. A beam-splitting device for use with fiber-coupled laser light sources for photodynamic therapy.

    PubMed

    Wood, Leroy M; Bellnier, David A; Oseroff, Allan R; Potter, William R

    2002-12-01

    A device that divides light into eight, four or two beams of equivalent power with only minor total power loss was designed, built and tested. The apparatus accepts light from a 200 microm diameter, 0.16 numerical aperture, silica-silica multimode optical fiber connected to one of several laser light sources for photodynamic therapy (PDT) of cancer. The incorporation of a variable iris diaphragm into the optical couplers allows the power of the beams to be independently set. Each of the beams can be coupled to a 400 or 600 microm diameter optical fiber to deliver the therapeutic light to the patient. This device is used in our institute for PDT of patients with either numerous small malignant tumors or single tumors with large surface area.

  13. Reversible Motor Paralysis and Early Cardiac Rehabilitation in Patients With Advanced Heart Failure Receiving Left Ventricular Assist Device Therapy.

    PubMed

    Amao, Rie; Imamura, Teruhiko; Nakahara, Yasuo; Noguchi, Satoko; Kinoshita, Osamu; Yamauchi, Haruo; Ono, Minoru; Haga, Nobuhiko

    2016-12-02

    Advanced heart failure (HF) is sometimes complicated with brain impairment because of a microthrombosis caused by decreased left ventricular contraction or reduced brain circulation. Some patients may recover after left ventricular assist device (LVAD) implantation. However, little is known about the perioperative therapeutic strategy in patients suffering from such complications, particularly from a cardiac rehabilitation viewpoint. We report on a 58-year-old male patient with a previous history of poliomyelitis and a light paralysis in the left upper extremity, who suffered left hemiplegia with no evidence of stroke after hemodynamic deterioration. The combination therapy of perioperative cardiac rehabilitation and LVAD therapy improved his left hemiplegia as well as activities of daily living, and the patient was discharged on foot on postoperative day 72 after briefing the family on LVAD home management. Early initiation of cardiac rehabilitation before LVAD implantation may be a key for the smooth discharge and resocialization of patients suffering from brain impairment complicated with advanced HF.

  14. Acupuncture therapy for fever induced by viral upper respiratory tract infection (URTI) in military medical service: a case series.

    PubMed

    Kwon, SeungWon; Shin, KyoungHo; Jung, WooSang; Moon, SangKwan; Cho, KiHo

    2014-12-01

    We report the cases of eight military patients with fever (≥38°C) induced by viral upper respiratory tract infection (URTI) who requested treatment wi