Craniocervical manual lymphatic drainage and its impact on intracranial pressure - a pilot study.

BACKGROUND AND PURPOSE: Theoretical considerations and the results of animal studies indicate that manual lymphatic drainage (MLD) might have an impact on intracranial pressure (ICP). There is a lack of clinically qualitative investigations on patients with severe cerebral diseases. METHODS: Between April 2013 and January 2015 a prospective observational study was performed on patients who were undergoing intracranial pressure measurement and treatment with MLD. ICP, cerebral perfusion pressure, mean arterial pressure (MAP), heart rate and oxygen saturation were recorded continuously 15 min before the procedure, during MLD (22 min) and for 15 min after the procedure. For analysis the data treatment units were divided into two groups: patients with a mean baseline ICP <15 mmHg (group 1) and patients with a mean ICP ≥15 mmHg before MLD (group 2). RESULTS: A total of 133 treatment units (61 patients) were analysed (group 1 n = 99; group 2 n = 34). The mean baseline ICP was 10.4 mmHg overall, and 8.3 mmHg and 18.6 mmHg respectively in group 1 and group 2; ICP significantly decreased during therapy with MLD and this persisted during the follow-up period in group 2. MAP did not show any significant differences between the different periods. CONCLUSIONS: Our data showed a significant reduction of ICP during therapy with craniocervical MLD in patients with severe cerebral diseases.

Intracranial Pressure Changes During Intrahospital Transports of Neurocritically Ill Patients.

BACKGROUND: Intrahospital transport is associated with a high rate of complications. Investigations of this problem using neuromonitoring remain scarce. METHODS: This is a monocentric, prospective observational study. Patients with severe brain diseases and intracranial pressure (ICP) monitoring were included. Continuous monitoring of ICP, cerebral perfusion pressure (CPP), oxygen saturation (SpO2), heart rate, and mean arterial pressure was measured during seven different periods of intrahospital transport (baseline for 30 min, I = preparation, II = transport I, III = CT scan, IV = transport II, V = postprocessing, and follow-up for another 30 min). All complications were documented. RESULTS: Between July 2013 and December 2013, a total number of 56 intrahospital transports of 43 patients were performed from ICU to CT. Data recording was incomplete in six cases. Fifty transports have been taken into account for statistical analysis. Forty-two percent were emergency transports. Mean duration of the procedure was 17' (preparation), 6' (transport I), 9' (CT scan), 6' (transport II), and 15' (postprocessing), respectively. Mean ICP at baseline was 8.53 mmHg. Comparing all periods of intrahospital transport and the follow-up period to the baseline showed a significant increase of ICP only during CT scan (15.83 mmHg, p < 0.01), not during the transport to and from the radiology department. An overall complication rate of 36 % (n = 18) was observed. In 26 % (n = 13), additional ICP therapy was necessary due to an elevation of ICP above 20 mmHg. CONCLUSION: There is a considerable rate of complications during intrahospital transport of critically ill patients with severe brain diseases, with a significant increase of ICP during transport and CT scan. In one-fifth of all patients, additional therapy was necessary. From our point of view, transport of critically ill patients should only be performed by trained staff and under monitoring of ICP and CPP.

Photocatalytic abatement results from a model street canyon.

During the European Life+ project PhotoPAQ (Demonstration of Photocatalytic remediation Processes on Air Quality), photocatalytic remediation of nitrogen oxides (NOx), ozone (O3), volatile organic compounds (VOCs), and airborne particles on photocatalytic cementitious coating materials was studied in an artificial street canyon setup by comparing with a colocated nonactive reference canyon of the same dimension (5 × 5 × 53 m). Although the photocatalytic material showed reasonably high activity in laboratory studies, no significant reduction of NOx, O3, and VOCs and no impact on particle mass, size distribution, and chemical composition were observed in the field campaign. When comparing nighttime and daytime correlation plots of the two canyons, an average upper limit NOx remediation of ≤2% was derived. This result is consistent only with three recent field studies on photocatalytic NOx remediation in the urban atmosphere, whereas much higher reductions were obtained in most other field investigations. Reasons for the controversial results are discussed, and a more consistent picture of the quantitative remediation is obtained after extrapolation of the results from the various field campaigns to realistic main urban street canyon conditions.

Intracranial pressure and cerebral perfusion pressure during apnoea testing for the diagnosis of brain death - an observational study.

BACKGROUND AND PURPOSE: Some authors have suggested a rise of intracranial pressure (ICP) during apnoea testing and the possibility of harm to patients. Data, however, have yet to be obtained. METHODS: Between October 2012 and May 2014 an observational study was performed on patients who received ICP measurements and who underwent brain death diagnosis. ICP, cerebral perfusion pressure (CPP), mean arterial blood pressure (MAP) and heart rate were recorded continuously from 15 min before the start of brain death diagnosis (baseline), during clinical examination including apnoea testing, until 15 min after this procedure. RESULTS: A total of 16 clinical examinations for brain death including apnoea testing were performed on 13 patients. All patients had primary brain lesions. Mean ICP and mean CPP during the examination were 95 ± 27.7 mmHg and 13.5 ± 20.7 mmHg, respectively. ICP and MAP showed a strong and statistically significant correlation, with Pearson's correlation coefficients of more than +0.6 or less than -0.6 in 13 of the 15 examinations. CONCLUSION: Mean ICP even before brain death determination is increased excessively. Changes of ICP during apnoea show a clear correlation to the changes of MAP. Furthermore, CPP during the condition of brain death may not equal zero but may be positive thereby indicating some minor net influx of blood into the brain in some patients.

Combustion Processes as a Source of High Levels of Indoor Hydroxyl Radicals through the Photolysis of Nitrous Acid.

Hydroxyl radicals (OH) are known to control the oxidative capacity of the atmosphere but their influence on reactivity within indoor environments is believed to be of little importance. Atmospheric direct sources of OH include the photolysis of ozone and nitrous acid (HONO) and the ozonolysis of alkenes. It has been argued that the ultraviolet light fraction of the solar spectrum is largely attenuated within indoor environments, thus, limiting the extent of photolytic OH sources. Conversely, the ozonolysis of alkenes has been suggested as the main pathway of OH formation within indoor settings. According to this hypothesis the indoor OH radical concentrations span in the range of only 10(4) to 10(5) cm(-3). However, recent direct OH radical measurements within a school classroom yielded OH radical peak values at moderate light intensity measured at evenings of 1.8 × 10(6) cm(-3) that were attributed to the photolysis of HONO. In this work, we report results from chamber experiments irradiated with varying light intensities in order to mimic realistic indoor lighting conditions. The exhaust of a burning candle was introduced in the chamber as a typical indoor source causing a sharp peak of HONO, but also of nitrogen oxides (NOx). The photolysis of HONO yields peak OH concentration values, that for the range of indoors lightning conditions were estimated in the range 5.7 ×· 10(6) to 1.6 × 10(7) cm(-3). Excellent agreement exists between OH levels determined by a chemical clock and those calculated by a simple PSS model. These findings suggest that significant OH reactivity takes place at our dwellings and the consequences of this reactivity-that is, formation of secondary oxidants-ought to be studied hereafter.

Construction of a photocatalytic de-polluting field site in the Leopold II tunnel in Brussels.

Within the framework of the European Life+-funded project PhotoPAQ (Demonstration of Photocatalytic remediation Processes on Air Quality), which was aimed at demonstrating the effectiveness of photocatalytic coating materials on a realistic scale, a photocatalytic de-polluting field site was set up in the Leopold II tunnel in Brussels, Belgium. For that purpose, photocatalytic cementitious materials were applied on the side walls and ceiling of selected test sections inside a one-way tunnel tube. This article presents the configuration of the test sections used and the preparation and implementation of the measuring campaigns inside the Leopold II tunnel. While emphasizing on how to implement measuring campaigns under such conditions, difficulties encountered during these extensive field campaigns are presented and discussed. This included the severe de-activation observed for the investigated material under the polluted tunnel conditions, which was revealed by additional laboratory experiments on photocatalytic samples that were exposed to tunnel air. Finally, recommendations for future applications of photocatalytic building materials inside tunnels are given.

[Mimikry of herpes encephalitis by glioblastoma multiforme]. / Mimikry einer Herpes-Enzephalitis durch Glioblastoma multiforme.

Herpes encephalitis (HSE) is an acute illness. Imaging is an important part of the diagnostic work-up of HSE. In early stages one can see a manifestation in the insular cortex as well as in the fornix. These MRI findings are rather typical for HSE. We present three cases treated in our hospital over the past ten years. In these cases the clinical symptoms and signs as well as the morphological findings were compatible with the HSE diagnostic criteria. Later on, a glioblastoma multiforme was found in all three cases.

Photoenhanced uptake of gaseous NO2 on solid organic compounds: a photochemical source of HONO?

In several recent field campaigns the existence of a strong daytime source of nitrous acid was demonstrated. The mechanism of this source remains unclear. Accordingly, in the present laboratory study, the effect of light (in the range 300-500 nm) on the uptake kinetics of NO2 on various surfaces taken as proxies for organic surfaces encountered in the troposphere (as organic aerosol but also ground surfaces) was investigated. In this collaborative study, the uptake kinetics and product formation rate were measured by different flow tube reactors in combination with a sensitive HONO instrument. Uptake on light absorbing aromatic compounds was significantly enhanced when irradiated with light of 300-420 nm, and HONO was formed with high yield when the gas was humidified. Especially organic substrates containing a combination of electron donors, such as phenols, and of compounds yielding excited triplet states, such as aromatic ketones, showed a high reactivity towards NO2. Based on the results reported a mechanism is suggested, in which photosensitised electron transfer is occurring. The results show that HONO can be efficiently formed during the day in the atmosphere at much longer wavelengths compared to the recently proposed nitrate photolysis.

Absolute nu(2) Line Intensities of HOCl by Simultaneous Measurements in the Infrared with a Tunable Diode Laser and Far-Infrared Region Using a Fourier Transform Spectrometer.

We have measured absolute line intensities in the nu(2) fundamental band at 1238 cm(-1) of both isotopomers of hypochlorous acid, HOCl. To obtain the partial pressure of the species in the sample mixture, unavailable through direct measurement since HOCl exists only in equilibrium with H(2)O and Cl(2)O and may decay by secondary reactions, we relied on known absolute line intensities in the pure rotational far-infrared (FIR) spectrum determined from Stark effect measurements. We have thus recorded simultaneously the FIR pure rotation spectrum of HOCl using a Bruker IFS120HR interferometer and the spectrum of a few vibration-rotation lines in the infrared (IR) nu(2) band using a tunable diode laser spectrometer. The absolute intensities of these IR lines thus determined allowed us to "calibrate" the intensities of vibration-rotation lines in the whole nu(2) band, measured previously using Fourier transform spectroscopy. The treatment of the data took into account the blackbody emission contribution in the FIR and the evolution of the HOCl amount during the recording of the spectra. The latter was found to be almost constant over hours after conditioning of the cell. The square of the nu(2) band vibrational transition dipole moment was determined to be 0.013947(23) D(2) and 0.013870(51) D(2) for HO(35)Cl and HO(37)Cl, respectively, that is, 29 to 73% lower than previous measurements. A linear Herman-Wallis factor was also determined for both isotopomers. Finally, the line intensities were least-squares fitted using a model that takes into account a weak resonance between the (010) and (002) levels. Copyright 2000 Academic Press.