Current Issue : April - June Volume : 2012 Issue Number : 2 Articles : 7 Articles
Introduction: Analysis of exhaled breath condensate (EBC) is a noninvasive method to access the epithelial lining fluid of\r\nthe lungs. Due to standardization problems the method has not entered clinical practice. The aim of the study was to assess\r\nthe comparability for two commercially available devices in healthy controls. In addition, we assessed different breathing\r\npatterns in healthy controls with protein markers to analyze the source of the EBC.\r\nMethods: EBC was collected from ten subjects using the RTube and ECoScreen Turbo in a randomized crossover design,\r\ntwice with every device - once in tidal breathing and once in hyperventilation. EBC conductivity, pH, surfactant protein A,\r\nClara cell secretory protein and total protein were assessed. Bland-Altman plots were constructed to display the influence of\r\ndifferent devices or breathing patterns and the intra-class correlation coefficient (ICC) was calculated. The volatile organic\r\ncompound profile was measured using the electronic nose Cyranose 320. For the analysis of these data, the linear\r\ndiscriminant analysis, the Mahalanobis distances and the cross-validation values (CVV) were calculated.\r\nResults: Neither the device nor the breathing pattern significantly altered EBC pH or conductivity. ICCs ranged from 0.61 to\r\n0.92 demonstrating moderate to very good agreement. Protein measurements were greatly influenced by breathing\r\npattern, the device used, and the way in which the results were reported. The electronic nose could distinguish between\r\ndifferent breathing patterns and devices, resulting in Mahalanobis distances greater than 2 and CVVs ranging from 64% to\r\n87%.\r\nConclusion: EBC pH and (to a lesser extent) EBC conductivity are stable parameters that are not influenced by either the\r\ndevice or the breathing patterns. Protein measurements remain uncertain due to problems of standardization. We conclude\r\nthat the influence of the breathing maneuver translates into the necessity to keep the volume of ventilated air constant in\r\nfurther studies....
The optimal diagnostic approach and yield for gastrointestinal bleeding (GIB) in patients with ventricular assist devices (VAD)\r\nare unknown. We explored the etiology of bleeding and yield of upper and lower endoscopy, balloon-assisted enteroscopy, and\r\nvideo capsule endoscopy in the evaluation of GIB in patients with VADs. Methods. All VAD patients with overt gastrointestinal\r\nbleeding and drop in hematocrit from April 1, 2000 to July 31, 2008 were retrospectively reviewed. The endoscopic evaluation\r\nof each episode was recorded. Overall yield of EGD, colonoscopy, balloon-assisted, and video capsule endoscopy were evaluated.\r\nResults. Thirty-six bleeding episodes occurred involving 20 patients. The site of GIB was identified in 32/36 episodes (88.9%), and\r\nthe etiology of bleeding was determined in 30/36 cases (83.3%). Five VAD patients underwent VCE. The VCE exams demonstrated\r\na high yield with 80% of exams identifying the etiology of GIB. Endoscopic intervention was successful in 8/9 attempts. No\r\nadverse events were recorded. Two patients required surgical intervention for GIB. Conclusion. Upper, lower, video capsule, and\r\nballoon-assisted enteroscopies are safe and demonstrate a high yield in the investigation of gastrointestinal bleeding in VAD\r\npatients. Medical centers caring for VAD patients should employ a standardized protocol to optimize endoscopic evaluation and\r\nintervention....
We challenge the hypothesis of enhanced myocardial reperfusion after implanting a left ventricular assist device\r\ntogether with bone marrow mononuclear stem cells in patients with end-stage ischemic cardiomyopathy.\r\nIrreversible myocardial loss observed in ischemic cardiomyopathy leads to progressive cardiac remodelling and\r\ndysfunction through a complex neurohormonal cascade. New generation assist devices promote myocardial\r\nrecovery only in patients with dilated or peripartum cardiomyopathy. In the setting of diffuse myocardial ischemia\r\nnot amenable to revascularization, native myocardial recovery has not been observed after implantation of an\r\nassist device as destination therapy. The hybrid approach of implanting autologous bone marrow stem cells during\r\nassist device implantation may eventually improve native cardiac function, which may be associated with a better\r\nprognosis eventually ameliorating the need for subsequent heart transplantation. The aforementioned hypothesis\r\nhas to be tested with well-designed prospective multicentre studies....
Here we describe field trials designed to standardize tools for the control of Glossina tachinoides, G. palpalis gambiensis and\r\nG.morsitans submorsitans in West Africa based on existing trap/target/bait technology. Blue and black biconical and\r\nmonoconical traps and 1 m2 targets were made in either phthalogen blue cotton, phthalogen blue cotton/polyester or\r\nturquoise blue polyester/viscose (all with a peak reflectance between 450ââ?¬â??480 nm) and a black polyester. Because targets\r\nwere covered in adhesive film, they proved to be significantly better trapping devices than either of the two trap types for\r\nall three species (up to 14 times more for G. tachinoides, 10 times more for G. palpalis gambiensis, and 6.5 times for G.\r\nmorsitans submorsitans). The relative performance of the devices in the three blue cloths tested was the same when\r\nunbaited or baited with a mixture of phenols, 1-octen-3-ol and acetone. Since insecticide-impregnated devices act via\r\ncontact with flies, we enumerated which device (traps or targets) served as the best object for flies to land on by also\r\ncovering the cloth parts of traps with adhesive film. Despite the fact that the biconical trap proved to be the best landing\r\ndevice for the three species, the difference over the target (20ââ?¬â??30%) was not significant. This experiment also allowed an\r\nestimation of trap efficiency, i.e. the proportion of flies landing on a trap that are caught in its cage. A low overall efficiency\r\nof the biconical or monoconical traps of between 11ââ?¬â??24% was recorded for all three species. These results show that targets\r\ncan be used as practical devices for population suppression of the three species studied. Biconical traps can be used for\r\npopulation monitoring, but a correction factor of 5ââ?¬â??10 fold needs to be applied to captures to compensate for the poor\r\ntrapping efficiency of this device for the three species....
Purpose: Pluripotent cells residing in the periosteum, a bi-layered membrane enveloping all bones, exhibit a remarkable\r\nregenerative capacity to fill in critical sized defects of the ovine femur within two weeks of treatment. Harnessing the\r\nregenerative power of the periosteum appears to be limited only by the amount of healthy periosteum available. Here we\r\nuse a substitute periosteum, a delivery device cum implant, to test the hypothesis that directional delivery of endogenous\r\nperiosteal factors enhances bone defect healing.\r\nMethods: Newly adapted surgical protocols were used to create critical sized, middiaphyseal femur defects in four groups of\r\nfive skeletally mature Swiss alpine sheep. Each group was treated using a periosteum substitute for the controlled addition\r\nof periosteal factors including the presence of collagen in the periosteum (Group 1), periosteum derived cells (Group 2), and\r\nautogenic periosteal strips (Group 3). Control group animals were treated with an isotropic elastomer membrane alone. We\r\nhypothesized that periosteal substitute membranes incorporating the most periosteal factors would show superior defect\r\ninfilling compared to substitute membranes integrating fewer factors (i.e. Group 3.Group 2.Group 1.Control).\r\nResults: Based on micro-computed tomography data, bone defects enveloped by substitute periosteum enabling\r\ndirectional delivery of periosteal factors exhibit superior bony bridging compared to those sheathed with isotropic\r\nmembrane controls (Group 3.Group 2.Group 1, Control). Quantitative histological analysis shows significantly increased\r\nde novo tissue generation with delivery of periosteal factors, compared to the substitute periosteum containing a collagen\r\nmembrane alone (Group 1) as well as compared to the isotropic control membrane. Greatest tissue generation and maximal\r\ndefect bridging was observed when autologous periosteal transplant strips were included in the periosteum substitute.\r\nConclusion: Periosteum-derived cells as well as other factors intrinsic to periosteum play a key role for infilling of critical\r\nsized defects....
Background: Acute lateral ankle ligament injuries are very common problems in present health care. Still there is\r\nno hard evidence about which treatment strategy is superior. Current evidence supports the view that a functional\r\ntreatment strategy is preferable, but insufficient data are present to prove the benefit of external support devices in\r\nthese types of treatment. The hypothesis of our study is that external ankle support devices will not result in better\r\noutcome in the treatment of acute ankle sprains, compared to a purely functional treatment strategy. Overall\r\nobjective is to compare the results of three different strategies of functional treatment for acute ankle sprain,\r\nespecially to determine the advantages of external support devices in addition to functional treatment strategy,\r\nbased on balance and coordination exercises.\r\nMethods/design: This study is designed as a randomised controlled multi-centre trial with one-year follow-up.\r\nAdult and healthy patients (N = 180) with acute, single sided and first inversion trauma of the lateral ankle\r\nligaments will be included. They will all follow the same schedule of balancing exercises and will be divided into 3\r\ntreatment groups, 1. pressure bandage and tape, 2. pressure bandage and brace and 3. no external support.\r\nPrimary outcome measure is the Karlsson scoring scale; secondary outcomes are FAOS (subscales), number of\r\nrecurrent ankle injuries, Visual Analogue Scales of pain and satisfaction and adverse events. They will be measured\r\nafter one week, 6 weeks, 6 months and 1 year.\r\nDiscussion: The ANKLE TRIAL is a randomized controlled trial in which a purely functional treated control group,\r\nwithout any external support is investigated. Results of this study could lead to other opinions about usefulness of\r\nexternal support devices in the treatment of acute ankle sprain....
Background: Gait and balance impairments lead to frequent falls and injuries in individuals with Huntington�s disease (HD).\r\nAssistive devices (ADs) such as canes and walkers are often prescribed to prevent falls, but their efficacy is unknown. We\r\nsystematically examined the effects of different types of ADs on quantitative gait measures during walking in a straight path\r\nand around obstacles.\r\nMethods: Spatial and temporal gait parameters were measured in 21 subjects with HD as they walked across a GAITRite\r\nwalkway under 7 conditions (i.e., using no AD and 6 commonly prescribed ADs: a cane, a weighted cane, a standard walker,\r\nand a 2, 3 or 4 wheeled walker). Subjects also were timed and observed for number of stumbles and falls while walking\r\naround two obstacles in a figure-of-eight pattern.\r\nResults: Gait measure variability (i.e., coefficient of variation), an indicator of fall risk, was consistently better when using the\r\n4WW compared to other ADs. Subjects also walked the fastest and had the fewest number of stumbles and falls when using\r\nthe 4WW in the figure-of-eight course. Subjects walked significantly slower using ADs compared to no AD both across the\r\nGAITRite and in the figure-of-eight. Measures reflecting gait stability and safety improved with the 4WW but were made\r\nworse by some other ADs....
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