RESUMEN
A dynamic mitigation is presented for sausage and kink instability growths of a z-current-driven magnetized plasma column. In this Rapid Communication we found that a wobbling motion of the z-current electron axis induces a phase-controlled perturbation, so that the growths of the sausage and kink instabilities are successfully and remarkably mitigated. In general, plasma instabilities emerge from perturbations, and the perturbation phase is normally unknown. However, if the perturbation phase is known or actively imposed by, for example, a designed driver wobbling behavior, the instability growth would be controlled and mitigated by a superimposition of the perturbations imposed. The results in this Rapid Communication demonstrate that the wobbling z-current electron beam would provide an improvement in the plasma column stability and uniformity.
RESUMEN
To investigate the chiral magnetic effect, 96Zr and 96Ru beams were accelerated at the relativistic heavy ion collider (RHIC) during Run-18 at Brookhaven National Laboratory. The 96Zr beam was provided from the electron beam ion source (EBIS) injector, which consists of a laser ion source, an EBIS high charge state ion breeder, a 300 keV/u radio frequency quadrupole, and a 2 MeV/u interdigital H type drift tube linear accelerator (IH-DTL). The natural abundance of 96Zr is only 2.8% with about 50% of 90Zr. To obtain a sufficient beam current, Zr material enriched to about 60% of 96Zr was used. The only available form of the enriched material was zirconium oxide (ZrO2) powder, which was not well suited for a laser ion source target. We studied and established a sintering technique of the ZrO2 powder to make a solid sample which could be installed into the laser ion source. The singly charged Zr was produced in a laser ablation plasma, extracted, and delivered to the EBIS to be ionized further to 96Zr16+. We optimized the laser irradiation condition, the EBIS confinement time, and transport through the RF linacs to maximize the performance of the injector. The total number of shots provided from the laser ion source for injection into the EBIS was 489 910. The EBIS facility provided a 192 MeV stable beam of 96Zr16+ ions to the booster ring of alternating gradient synchrotron (AGS) for further acceleration and stripping in the AGS/RHIC complex, allowing for successful data acquisition at the Solenoidal Tracker at the RHIC.
RESUMEN
AIM: To evaluate the effect of the saline flush (SF) technique on the depiction of lesions and the reduction of perivenous artefacts in the head and neck region using dual-energy computed tomography (CT) with virtual monochromatic imaging (VMI). MATERIALS AND METHODS: Fifty patients with head and neck cancer were divided into two groups: group A, without a SF and group B, with a 30-ml SF. All images were acquired using fast kilovolt-switching CT (Revolution HD, GE Healthcare, Milwaukee, WI, USA). Contrast-to-noise ratios (CNRs) of the lesions were calculated at VMI energy levels ranging from 40 to 80 keV. Subjective analysis of overall image quality, delineation of lesions, and perivenous artefacts was conducted by two reviewers at both VMI energy level 40 keV and the optimal energy level (which showed optimal CNR by objective analysis). RESULTS: Optimal energy level was 63 keV for group A and 61 keV for group B. At VMI energy levels ranging from 40 to 80 keV, the CNR was higher for group B. The highest subjective overall image quality was shown for group B at the optimal energy level (subjective image quality mean value, 3.40). Subjective delineation of lesions was comparable. The perivenous artefact score was significantly higher for group B (2.44 versus 2.74 [p<0.05] at 40 keV, 3.20 versus 3.46 [p<0.05] at the optimal energy level). CONCLUSION: The SF technique results in an improvement of lesion CNR and a reduction of perivenous artefacts in VMI using duel-energy CT, especially at 40 keV.
Asunto(s)
Carcinoma de Células Escamosas/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Aumento de la Imagen/métodos , Cloruro de Sodio/administración & dosificación , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Artefactos , Medios de Contraste , Femenino , Humanos , Yopamidol , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Ácidos TriyodobenzoicosRESUMEN
We have proposed a dynamic smoothing method based on a phase control to smooth plasma non-uniformities in perturbed plasma systems. In this paper, the dynamic smoothing method is applied to a spherical direct-driven fuel target implosion in heavy ion inertial confinement fusion. We found that the wobbling motion of each heavy ion beam (HIB) axis induces a phase-controlled HIBs energy deposition, and consequently the phase-controlled implosion acceleration is realized, so that the HIBs irradiation non-uniformity is successfully smoothed. HIB accelerators provide a well-established performance to oscillate a HIB axis at a high frequency. In inertial confinement fusion, a fuel implosion uniformity is essentially significant for achieving the DT fuel compression and for releasing the fusion energy, and the non-uniformity of the implosion acceleration should be less than a few %. The results in this paper demonstrate that the wobbling HIBs would provide an improvement in the fuel target implosion uniformity.
RESUMEN
We aimed to examine the relationship between renal dysfunction and anaemia that may develop during combination therapy involving pegylated interferon, ribavirin and telaprevir (PEG-IFN/RBV/TVR) for the treatment of chronic hepatitis C. Sixty-eight patients with genotype 1b high viral loads were treated with PEG-IFN/RBV/TVR. Peg-IFN and RBV doses were administered according to body weight. TVR was prescribed at 2250 mg/day for 44 patients and at 1500 mg/day for 24 patients who had low haemoglobin level (<12 g/dL). When anaemia had developed, the RBV dose was decreased. The serum TVR concentration at day 8 was measured, and the serum RBV concentration was measured serially. The estimated glomerular filtration rate (eGFR) was estimated to assess renal function. At week 1, serum TVR concentration was not correlated with a decrease in eGFR; however, the TVR dose, on a weight basis (mg/kg), and eGFR were correlated (r = 0.2691; P = 0.0265). Moreover, there was a negative correlation between eGFR and RBV serum concentration (r = −0.3694; P = 0.0025), and the serum RBV concentration and decrease in the haemoglobin were significantly correlated from week 1 to week 8. In triple therapy, the TVR dose per weight is correlated with a decline in renal function. Thus, the serum concentration of RBV increases, with a concomitant decrease in haemoglobin. It is important to adjust the doses of TVR and RBV to avoid excessive serum RBV levels and the development of severe anaemia, to achieve a good clinical effect.
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Antivirales/efectos adversos , Antivirales/farmacocinética , Hepatitis C Crónica/tratamiento farmacológico , Oligopéptidos/efectos adversos , Insuficiencia Renal/inducido químicamente , Ribavirina/farmacocinética , Adulto , Anciano , Anemia/inducido químicamente , Antivirales/uso terapéutico , Quimioterapia Combinada/efectos adversos , Quimioterapia Combinada/métodos , Femenino , Tasa de Filtración Glomerular , Humanos , Interferón-alfa/uso terapéutico , Masculino , Persona de Mediana Edad , Oligopéptidos/uso terapéutico , Ribavirina/uso terapéutico , Suero/químicaRESUMEN
AIM: In bypass-grafted arteries, anastomotic intimal hyperplasia develops more markedly at the distal junction than the proximal one. It is likely that it arises from the difference in flow patterns at these two sites. Therefore we have studied the relationship between the flow patterns and precise locations of wall thickening specific to the particular vessel. METHODS: In total 30 bypass-grafting procedures were carried out on the femoral arteries of dogs with 10 autologous common carotid arteries and 20 saphenous veins. The vessels were harvested at 3 months after operation, and precise locations of intimal thickening and characteristics of the flow such as flow patterns and distributions of fluid velocity and wall shear stress were studied in detail. RESULTS: At the proximal anastomosis, a large recirculation zone was formed only at the inlet of the partially or totally occluded host artery, whereas at the distal anastomosis, it was formed at both the floor of the host artery and the toe of the bypass in most vessels, and the former was connected to the latter, extending the region of disturbed flow to lateral walls of the host artery. Wall thickening was found mainly in these regions occupied with slow secondary and recirculation flows where wall shear stress was very low. CONCLUSION: The flow at the distal anastomosis is more disturbed and complex than that at the proximal anastomosis. This difference in flow pattern that determine the region of low wall shear stress might explain why intimal hyperplasia develop more markedly at the distal junction.
Asunto(s)
Arteria Carótida Común/trasplante , Arteria Femoral/cirugía , Vena Safena/trasplante , Túnica Íntima/patología , Injerto Vascular/efectos adversos , Animales , Arteria Carótida Común/patología , Arteria Carótida Común/fisiopatología , Proliferación Celular , Perros , Femenino , Arteria Femoral/patología , Arteria Femoral/fisiopatología , Hemodinámica , Hiperplasia , Masculino , Flujo Sanguíneo Regional , Factores de Riesgo , Vena Safena/patología , Vena Safena/fisiopatología , Trasplante AutólogoRESUMEN
A computational model of the fluid dynamics of intraventricular flow was used to investigate the importance of the effects of flow disturbances existing within the left ventricle (LV) at the onset of diastole on a diastolic flow field. The simulation started with a quiescent flow state; it continued for a number of cardiac cycles to obtain a cyclically repeatable flow. After the flow became periodic, the initial diastolic flow was not quiescent: flow disturbances, remnants of a systolic flow, were present within the LV. Nevertheless, they faded away during an acceleration phase of diastole and almost ceased by the end of this phase. Consequently, a flow field during a deceleration phase of diastole, characterised by the formation of a vortex ring, was hardly affected by the initial flow disturbances. The propagation velocity of a colour M-mode Doppler echocardiogram obtained by scanning velocity along the LV long axis was 0.58 m s(-1) in the case where diastolic flow was initially quiescent and 0.56 m s(-1) in the case where flow disturbances existed at the beginning of diastole. These results indicated that the colour M-mode Doppler echocardiographic technique captures flow dynamics produced purely by ventricular expansion, with little influence from initial diastolic flow disturbances.
Asunto(s)
Diástole/fisiología , Ecocardiografía Doppler en Color , Modelos Cardiovasculares , Simulación por Computador , Hemorreología , Humanos , Función Ventricular Izquierda/fisiologíaRESUMEN
A computational fluid dynamics study of intraventricular flow during early diastole was carried out using a 3D model of the human left ventricle (LV). It was found that a vortical flow formed under the aortic orifice and then grew in size and extended laterally along the ventricular wall towards the posterior side. With further expansion of the LV, it developed into an annular vortex asymmetrically enlarged on the side of the aortic orifice, narrowing the passage of blood inflow and thus causing a shift of the high-velocity portion of inflow towards the apex. This appeared as an elongation of the aliasing area when the velocity of the inflow was expressed as a spatiotemporal map in the same manner as a color M-mode Doppler (CMD) echocardiogram. Based on these findings, it was concluded that the shape of the aliasing area in a CMD echocardiogram shows the change in the velocity of blood inflow affected by the development of an annular vortex formed in the LV.
Asunto(s)
Diástole/fisiología , Ecocardiografía Doppler en Color/métodos , Ventrículos Cardíacos/diagnóstico por imagen , Interpretación de Imagen Asistida por Computador/métodos , Modelos Cardiovasculares , Función Ventricular Izquierda/fisiología , Función Ventricular , Velocidad del Flujo Sanguíneo/fisiología , Presión Sanguínea , Volumen Cardíaco/fisiología , Simulación por Computador , Humanos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
To elucidate the mechanisms of localisation of intimal hyperplasia in anastomosed arteries, the effects of flow disturbances on the transport of low-density lipoproteins (LDLs) from the flowing blood to the wall of end-to-end anastomosed arteries, with and without a moderate stenosis, were studied theoretically by means of a computer simulation under the condition of steady flow. In an artery with moderate stenosis at the anastomotic junction and intimal thickening distal to it, we found that, owing to the water-permeable nature of the arterial wall, the surface concentration of LDL was elevated up to 20% higher than that of the bulk flow distal to the stenosis, where a recirculation zone was formed and wall shear stresses were low. In contrast to this, no significant elevation of surface concentration of LDLs occurred in another anastomosed vessel in which no stenosis was formed and no intimal thickening was observed. These results suggest that flow-dependent concentration polarisation of LDLs plays a causative role in the localisation of anastomotic intimal hyperplasia in the human arterial system by locally elevating the surface concentration of LDLs, thus augmenting their uptake by endothelial cells.
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Anastomosis Quirúrgica , Hemorreología , Lipoproteínas LDL/sangre , Modelos Cardiovasculares , Animales , Perros , Hiperplasia/metabolismo , Túnica Íntima/patologíaRESUMEN
In June 2000, many cases with persistent cough were observed among inpatients and the staff of a ward for severely retarded. Some of them had symptoms suggestive of pertussis, such as whooping, post-tussive apnea. We performed a retrospective investigation to assess symptoms and serological findings suspicious of pertussis. There were a total of 14 cases of persistent cough over 3 weeks (4 to 9 weeks). 6 cases were inpatients and 8 were hospital staff. Of those, serological test for pertussis infection was performed in 10 cases and 6 cases were diagnosed as serologically confirmed pertussis. The other cases with persistent cough were also considered to be probable pertussis as they have had intensive contact with serologically confirmed cases. 12 cases were treated by antibiotics, but they all failed to respond. It was suggested that Bordetella pertussis must be considered as a causal organism of persistent cough even in adults. To prevent nosocomial transmission of pertussis, droplet precautions and macrolide treatment should be provided for patients with symptoms highly suggestive of pertussis.
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Infección Hospitalaria/epidemiología , Brotes de Enfermedades/estadística & datos numéricos , Discapacidad Intelectual/complicaciones , Tos Ferina/epidemiología , Adolescente , Adulto , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana EdadRESUMEN
To examine the involvement of p38 mitogen-activated protein kinase (p38 MAPK) and extracellular signal-regulated kinase (ERK) in the oxidative stress-induced increase of permeability in endothelial cells, the effects of a p38 MAPK inhibitor (SB203580) and ERK inhibitor (PD90859) on the H2O2-induced increase of permeability in bovine pulmonary artery endothelial cells (BPAEC) were investigated using a two-compartment system partitioned by a semi-permeable filter. H2O2 at 1 mM caused an increase of the permeation rate of fluorescein isothiocyanate (FITC)-labeled dextran 40 through BPAEC monolayers. SB203580 inhibited the H2O2-induced increase of permeability but PD98059 did not, though activation (phosphorylation) of both p38 MAPK and ERK was observed in H2O2-treated cells in Western blot analysis. An H2O2-induced increase of the intracellular Ca2+ concentration ([Ca2+]i) was also observed and an intracellular Ca2+ chelator (BAPTA-AM) significantly inhibited the H2O2-induced increase of permeability. However, it showed no inhibitory effects on the H2O2-induced phosphorylation of p38 MAPK and ERK. The H2O2-induced increase of [Ca2+]i was not influenced by SB203580 and PD98059. These results indicate that the activation of p38 MAPK and the increase of [Ca2+]i are essential for the H2O2-induced increase of endothelial permeability and that ERK is not.
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Calcio/metabolismo , Permeabilidad Capilar/efectos de los fármacos , Permeabilidad Capilar/fisiología , Ácido Egtácico/análogos & derivados , Endotelio Vascular/efectos de los fármacos , Endotelio Vascular/metabolismo , Peróxido de Hidrógeno/farmacología , Proteínas Quinasas Activadas por Mitógenos/metabolismo , Animales , Señalización del Calcio/efectos de los fármacos , Bovinos , Células Cultivadas , Quelantes/farmacología , Ácido Egtácico/farmacología , Inhibidores Enzimáticos/farmacología , Flavonoides/farmacología , Imidazoles/farmacología , Proteínas Quinasas Activadas por Mitógenos/antagonistas & inhibidores , Piridinas/farmacología , Proteínas Quinasas p38 Activadas por MitógenosRESUMEN
The aim of the study was to use an animal model to investigate the mechanisms by which tranexamic acid (TNA) increases ultrafiltration (UF) volume. Thirty Sprague-Dawley rats were studied in three groups (n = 10, each group). Group 1 was dialyzed with conventional dialysis solution, group 2 with conventional fluid plus low-dose TNA (300 mg/L), and group 3 with conventional fluid plus high-dose TNA (3000 mg/L). A PD catheter was inserted into each animal, and 25 mL of the designated dialysis fluid was injected twice daily for two weeks, starting seven days after surgery. Peritoneal transport properties (PTP) were measured by modified peritoneal equilibration test (PET), and transcapillary ultrafiltration (TCUF) and lymphatic absorption (LA) were determined by using dextran 70 weekly. Histological examinations of the peritoneum were performed at the end of the experiment. Drained dialysate volume (DDV) decreased in all groups; however, a lower reduction in DDV was seen in the TNA groups. PTP increased and TCUF decreased in all groups. LA increased in Group 1, but was unchanged in the other groups. No significant histological changes of the peritoneum were observed in any group. This study confirmed that, in rats, TNA maintained UF volume by reducing LA without serious adverse effects. We may safely use TNA as a "diuretic" for the peritoneal membrane.
Asunto(s)
Soluciones para Diálisis/metabolismo , Diálisis Peritoneal , Peritoneo/metabolismo , Ácido Tranexámico/farmacología , Absorción , Animales , Transporte Biológico/efectos de los fármacos , Nitrógeno de la Urea Sanguínea , Soluciones para Diálisis/química , Glucosa/metabolismo , Linfa/metabolismo , Masculino , Peritoneo/efectos de los fármacos , Ratas , Ratas Sprague-Dawley , UltrafiltraciónRESUMEN
A 26-year-old female was admitted because of multiple fractures in lower extremities. While in the hospital, she developed a high fever and generalized skin eruption. Physical examination revealed bilateral cervical lymphadenopathy and mild hepatosplenomegaly. The white cell count was 11,200 with 11% atypical lymphocytes. Serum GOT, GPT, LDH were markedly elevated. Infectious mononucleosis was suspected, but the serological test for EB virus did not show evidence of acute EB virus infection. Anti-HSV, CMV, hepatitis A virus antibody titers also did not show significant change during the coarse. The serological test for HHV-6 only showed increased titer of IgM and IgG antibodies. Rapidly elevated IgG antibody titer was indicative of reactivation of HHV-6. So, she was diagnosed as mononucleosis-like syndrome caused by HHV-6, probably reactivated infection. Her symptoms gradually disappeared during a month.
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Infecciones por Herpesviridae/diagnóstico , Herpesvirus Humano 6 , Mononucleosis Infecciosa/diagnóstico , Adulto , Diagnóstico Diferencial , Femenino , HumanosRESUMEN
A comparative study of 890 patients with community-acquired pneumonia requiring hospitalization in a community hospital was performed. The patients were divided into an elderly patient group and a non-elderly patient group. The elderly patients with community-acquired pneumonia exhibited frequent atypical symptoms such as dyspnea, consciousness disturbance and complication of shock, and also were frequently in a poor nutritional condition. The causative microorganism was isolated in 40.8% of the elderly patients and in 44.0% of the non-elderly patients. Polymicrobial agents were detected frequently in the elderly patients. Streptococcus pneumoniae (19.4%), MSSA (16.8%), Klebsiella pneumoniae (15.1%) and Haemophilus influenzae (15.0%) were frequently isolated from the sputum of the elderly patients, while Mycoplasma pneumoniae (25.2%), H. influenzae (15.0%), S. pneumoniae (12.2%) and MSSA (10.2%) were frequently isolated from that of the non-elderly patients. Regarding treatment with antibiotics, therapy with a single antibiotic therapy, such as cephem or carbapenem was carried out for the elderly patients, while new quinolone or tetracycline was administered to the non-elderly patients. Although the treatment with antibiotics was adequate according to the guidelines of the American Thoracic Society, the prognosis was poor; i.e.) in the elderly patients an efficacy rate of 74.3% and a mortality rate of 9.5%. In the non-elderly patients, the prognosis was good; i.e.) an efficacy rate of 88.0% and a mortality rate of 1.7%. These results suggest that the most important factors affecting the prognosis were the general condition of elderly patients and delay in an adequate diagnosis and treatment because of atypical clinical findings.
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Infecciones Comunitarias Adquiridas , Neumonía , Anciano , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Neumonía/tratamiento farmacológico , Neumonía/microbiologíaRESUMEN
To substantiate the occurrence of flow-dependent concentration or depletion of atherogenic lipoproteins, which has been theoretically predicted to take place at a blood/endothelium boundary, we have studied the effects of perfusion pressure and wall shear rate on the accumulation and uptake of microspheres by cultured vascular endothelial cells in a monolayer. The study was carried out by flowing a cell culture medium containing fetal calf serum and fluorescent microspheres through a parallel-plate flow chamber having a cultured bovine aortic endothelial cell (BAEC) monolayer on one wall of the chamber. The microspheres had a nominal diameter of 19 nm, approximately the same as that of low-density lipoproteins, and thus served as models and tracers of plasma proteins and lipoproteins. Experiments were carried out in steady flow in the physiological range of wall shear rate and water filtration velocity at the monolayer, while monitoring the intensity of fluorescence of the spheres accumulated at and taken up by the endothelial cells. It was found that in a perfusate containing only fluorescent microspheres, due to increased phagocytic activity of the endothelial cells, the intensity of fluorescence which reflected the number of the microspheres taken up by the endothelial cells, increased almost linearly with time and independently of wall shear rate. However, with perfusates containing fetal calf serum, this abnormal phenomenon did not occur, and the intensity of fluorescence increased with increasing perfusion pressure and decreasing wall shear rate. It was also found that the number of fluorescent microspheres accumulated at and taken up by the BAEC monolayer was shear-dependent only at low wall shear rates, and increased sharply when the flow rate was reduced to zero. These results provided solid experimental evidence that flow-dependent concentration or depletion of macromolecules occurs at the luminal surface of the endothelium at physiological wall shear rates and water filtration velocities, and strongly supports the hypothesis that flow-dependent concentration polarization of lipoproteins plays an important role in the localization of atherosclerosis and intimal hyperplasia in man by facilitating the uptake of atherogenic lipoproteins by endothelial cells.
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Endotelio Vascular/fisiología , Hemorreología , Lipoproteínas/sangre , Animales , Presión Sanguínea/fisiología , Bovinos , Técnicas de Cultivo de Célula , Endotelio Vascular/citología , Sustancias Macromoleculares , Microscopía Fluorescente , Microesferas , Fagocitosis/fisiología , Estrés MecánicoRESUMEN
We experienced 530 elderly cases with pneumonia among 930 patients with pneumonia in Kawasaki Medical School Kawasaki Hospital between April 1986 and September 1998. Clinical analysis of all these patients and a comparison of one group consisting of 418 patients with community-acquired pneumonia and another group composed of 112 patients with nosocomial pneumonia were performed. In all of the elderly patients with pneumonia, respiratory symptoms and inflammatory findings were less frequent, but were frequent for those in poor general and nutritional condition. The causative microorganism was isolated in 42% of these patients. Streptococcus pneumoniae, MSSA and Klebsiella pneumoniae were frequently isolated from the sputum of the patients with community-acquired pneumonia, while Methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Methicillin-sensitive Staphylococcus aureus (MSSA) were frequently isolated from that of nosocomial pneumonia patients. Mycoplasma pneumoniae, Chlamydia pneumoniae and some viruses were less frequent for patients in both groups. Although many intravenous antibiotics, such as cephem or carbapenem were administered to patients in both groups, the prognosis was relatively good for those with community acquired pneumonia but was extremely poor for those with nosocomial pneumonia despite mechanical ventilation or steroid pulse therapy for many patients.
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Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/terapia , Infección Hospitalaria/microbiología , Infección Hospitalaria/terapia , Neumonía/microbiología , Neumonía/terapia , Anciano , Femenino , Humanos , MasculinoRESUMEN
To determine which factors are important in predicting the outcome of patients with severe pneumonia requiring mechanical ventilation, we compared 43 surviving pneumonic patients with 37 non-surviving pneumonic patients. The following results were obtained. The following characteristics were noted in the non-surviving patients as compared with surviving patients; 1. a worsening of performance status in the background, 2. presence of physical signs such as hypotension and trachycardia, 3. abnormal laboratory data such as leukocytosis, lymphocytopenia, hypoalbuminemia, hepatorenal dysfunction and metabolic acidosis, 4. presence of massive pulmonary infiltrations on chest roentgenograms, 5. a prevalence of resistant microorganisms for many antibiotics such as MRSA (Methicillin resistant Staphylococcus aureus). These results suggest that the most important factor affecting the prognosis of patients with severe pneumonia requiring mechanical ventilation may by the condition of the host and of the microorganisms rather than antibiotic treatment.
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Neumonía/mortalidad , Respiración Artificial , Anciano , Femenino , Humanos , Masculino , Neumonía/microbiología , Neumonía/fisiopatología , Neumonía/terapia , PronósticoRESUMEN
We reported three cases of pneumonia due to mixed infection of bacteria (2 cases: Streptococcus pneumoniae, 1 case: methicilline-sensitive Stapholococcus aureus) and Mycoplasma pneumoniae. Increased serum antibody titers of M. pneumoniae were noted in all cases. They were a 36-year-old-female with bronchial asthma, a 74-year-old-male with old pulmonary tuberculosis and a 82-year-old-male with chronic bronchitis. All cases had fever, productive cough with purulent sputum and coarse crackle by auscultation. Leukocytosis was noted in 2 cases. Chest X-ray films showed dense consolidation in all cases, 2 cases were cured by administration of cephems and 1 case was cured by administration of carbapenems and minocycline.
Asunto(s)
Neumonía por Mycoplasma/complicaciones , Neumonía Neumocócica/complicaciones , Neumonía Estafilocócica/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Resistencia a la MeticilinaRESUMEN
It is suspected that physical and fluid mechanical factors play important roles in the localization of atherosclerotic lesions and intimal hyperplasia in man by affecting the transport of cholesterol in flowing blood to arterial walls. Hence, we have studied theoretically the effects of various physical and fluid mechanical factors such as wall shear rate, diffusivity of low density lipoproteins (LDL), and filtration velocity of water at the vessel wall on surface concentration of LDL at an arterial wall by means of a computer simulation of convective and diffusive transport of LDL in flowing blood to the wall of a straight artery under conditions of a steady flow. It was found that under normal physiologic conditions prevailing in the human arterial system, due to the presence of a filtration flow of water at the vessel wall, flow-dependent concentration polarization (accumulation or depletion) of LDL occurs at a blood/endothelium boundary. The surface concentration of LDL at an arterial wall takes higher values than that in the bulk flow in that vessel, and it is affected by three major factors, that is, wall shear rate, gamma w, filtration velocity of water at the vessel wall, Vw, and the distance from the entrance of the artery, L. It increases with increasing Vw and L, and decreasing gamma w hence the flow rate. Thus, under certain circumstances, the surface concentration of LDL could rise locally to a value which is several times higher than that in the bulk flow, or drop locally to a value even lower than a critical concentration for the maintenance of normal functions and survival of cells forming the vessel wall. These results suggest the possibility that all the vascular phenomena such as the localization of atherosclerotic lesions and intimal hyperplasia, formation of cerebral aneurysms, and adaptive changes of lumen diameter and wall structure of arteries and veins to certain changes in hemodynamic conditions in the circulation are governed by this flow-dependent concentration polarization of LDL which carry cholesterol.
Asunto(s)
Arteriosclerosis/etiología , Simulación por Computador , Endotelio Vascular , Hemorreología , Lipoproteínas LDL , Arterias , Velocidad del Flujo Sanguíneo , LDL-Colesterol , Difusión , Filtración , HumanosRESUMEN
Flow-dependent concentration or depletion of atherogenic low density lipoproteins which has been theoretically predicted to occur at a blood/endothelium boundary may play an important role in the genesis, progression, and regression of atherosclerosis in man and intimal hyperplasia in vascular grafts implanted in the arterial system in man and experimental animals. Hence to explore such a possibility, we have studied the effect of a steady shear flow on concentration polarization of plasma proteins and lipoproteins at the luminal surface of a cultured bovine aortic endothelial cell (BAEC) monolayer which served as a model of the vessel wall of an artery or an implanted vascular graft. The study was carried out by circulating a cell culture medium containing fetal calf serum or bovine plasma lipoproteins in steady flow through a parallel-plate flow cell in which a cultured BAEC monolayer was installed, over the physiologic ranges of wall shear rate and water filtration velocity at the BAEC monolayer. The water (cell culture medium) filtration velocity at the BAEC monolayer was determined to provide a measure of the change in concentration of plasma protein particles at the luminal surface of the BAEC monolayer. It was found that for perfusates containing plasma proteins and/or lipoproteins, water filtration velocity varied as a function of flow rate, being lowest in the absence of flow. Water filtration velocity increased or decreased as flow rate increased or decreased from an arbitrarily set non-zero value, indicating that surface concentration of protein particles varied as a direct function of flow rate, and the process was reversible. It was also found that at particle concentrations equivalent to those found in a culture medium containing serum at 20% by volume, plasma lipoproteins which were much smaller in number and lower in concentration but larger in size than albumin, showed almost the same effect as observed with serum which contained both lipoproteins and albumin, indicating that the substance responsible for this phenomenon is not albumin but lipoprotein whose diffusivity is much smaller than that of albumin. The results strongly support our hypothesis that flow-dependent concentration polarization of lipoproteins occurs at a blood endothelium boundary, and this in turn promote the localization of various vascular diseases which develop in our arterial system.