A Rare Case of Adult Acute Disseminated Encephalomyelitis Associated with Primary Epstein-Barr Virus Infection.

We report a rare case of acute disseminated encephalomyelitis (ADEM) secondary to a primary Epstein-Barr (EBV) infection, in a 22-year-old male. Symptomatic infectious mononucleosis and ADEM are both quite uncommon conditions in this age group. LEARNING POINTS: ADEM is a very rare CNS disorder; it is more common in childhood but can also be described in adults.The clinical evaluation must focus on the presence of recent signs of infection or vaccination.A normal cerebral scan does not rule out the disease and MRI must be performed to confirm the diagnoses.

Pre-ejection period, the reason why the electrocardiogram Q-wave is an unreliable indicator of pulse wave initialization.

OBJECTIVE: Pulse wave velocity measurements are an indicator of arterial stiffness and possible cardiovascular dysfunction. It is usually calculated by measuring the pulse transit time (PTT) over a known distance through the arteries. In animal studies, reliable PTT measures can be obtained using two pressure catheters. However, such direct, invasive methods are undesirable in clinical settings. A less invasive alternative measure of PTT is pulse arrival time (PAT), the time between the Q-wave of an electrocardiogram (ECG) and the arrival of the foot of the beats pressure waveform at one pressure catheter. Since the Q-wave signifies the start of ventricular contraction, PAT includes the pre-ejection period (PEP), a time where no blood is ejected. Thus, inter- or intra- subject variation in PEP could result in poor correlation between pulse arrival time (PAT) and the desired pulse transit time (PTT). APPROACH: This study looks at the relationship between PAT and PTT, over a range of common critical care therapies and determines the effect of PEP on PAT as a possible surrogate of PTT in a critical care environment. The analysis uses data from five porcine experiments, where ECG, aortic arch and abdominal aortic pressure were measured simultaneously, over a range of induced hemodynamic conditions. RESULTS: The resulting correlations of PAT verse PTT varied within pigs and across interventions (r 2 = 0.32-0.69), and across pigs (r 2 = 0.05-0.60). Variability was due to three main causes. First, the interventions themselves effect PEP and PTT differently, second, pig specific response to the interventions, and third, inter- and intra- pig variability in PEP, independent of PTT. SIGNIFICANCE: The overall analysis shows PAT is an unreliable measure of PTT and a poor surrogate under clinical interventions common in a critical care setting, due to intra- and inter- subject variability in PEP.

Minimally invasive estimation of ventricular dead space volume through use of Frank-Starling curves.

This paper develops a means of more easily and less invasively estimating ventricular dead space volume (Vd), an important, but difficult to measure physiological parameter. Vd represents a subject and condition dependent portion of measured ventricular volume that is not actively participating in ventricular function. It is employed in models based on the time varying elastance concept, which see widespread use in haemodynamic studies, and may have direct diagnostic use. The proposed method involves linear extrapolation of a Frank-Starling curve (stroke volume vs end-diastolic volume) and its end-systolic equivalent (stroke volume vs end-systolic volume), developed across normal clinical procedures such as recruitment manoeuvres, to their point of intersection with the y-axis (where stroke volume is 0) to determine Vd. To demonstrate the broad applicability of the method, it was validated across a cohort of six sedated and anaesthetised male Pietrain pigs, encompassing a variety of cardiac states from healthy baseline behaviour to circulatory failure due to septic shock induced by endotoxin infusion. Linear extrapolation of the curves was supported by strong linear correlation coefficients of R = 0.78 and R = 0.80 average for pre- and post- endotoxin infusion respectively, as well as good agreement between the two linearly extrapolated y-intercepts (Vd) for each subject (no more than 7.8% variation). Method validity was further supported by the physiologically reasonable Vd values produced, equivalent to 44.3-53.1% and 49.3-82.6% of baseline end-systolic volume before and after endotoxin infusion respectively. This method has the potential to allow Vd to be estimated without a particularly demanding, specialised protocol in an experimental environment. Further, due to the common use of both mechanical ventilation and recruitment manoeuvres in intensive care, this method, subject to the availability of multi-beat echocardiography, has the potential to allow for estimation of Vd in a clinical environment.

Visualisation of time-varying respiratory system elastance in experimental ARDS animal models.

BACKGROUND: Patients with acute respiratory distress syndrome (ARDS) risk lung collapse, severely altering the breath-to-breath respiratory mechanics. Model-based estimation of respiratory mechanics characterising patient-specific condition and response to treatment may be used to guide mechanical ventilation (MV). This study presents a model-based approach to monitor time-varying patient-ventilator interaction to guide positive end expiratory pressure (PEEP) selection. METHODS: The single compartment lung model was extended to monitor dynamic time-varying respiratory system elastance, Edrs, within each breathing cycle. Two separate animal models were considered, each consisting of three fully sedated pure pietrain piglets (oleic acid ARDS and lavage ARDS). A staircase recruitment manoeuvre was performed on all six subjects after ARDS was induced. The Edrs was mapped across each breathing cycle for each subject. RESULTS: Six time-varying, breath-specific Edrs maps were generated, one for each subject. Each Edrs map shows the subject-specific response to mechanical ventilation (MV), indicating the need for a model-based approach to guide MV. This method of visualisation provides high resolution insight into the time-varying respiratory mechanics to aid clinical decision making. Using the Edrs maps, minimal time-varying elastance was identified, which can be used to select optimal PEEP. CONCLUSIONS: Real-time continuous monitoring of in-breath mechanics provides further insight into lung physiology. Therefore, there is potential for this new monitoring method to aid clinicians in guiding MV treatment. These are the first such maps generated and they thus show unique results in high resolution. The model is limited to a constant respiratory resistance throughout inspiration which may not be valid in some cases. However, trends match clinical expectation and the results highlight both the subject-specificity of the model, as well as significant inter-subject variability.

Model-based respiratory mechanics to titrate PEEP and monitor disease state for experimental ARDS subjects.

Modelling the respiratory mechanics of mechanically ventilated (MV) patients can provide useful information to guide MV therapy. Two model-based methods were evaluated based on data from three experimental acute respiratory distress syndrome (ARDS) induced piglets and validated against values available from ventilators. A single compartment lung model with integral-based parameter identification was found to be effective in capturing fundamental respiratory mechanics during inspiration. The trends matched clinical expectation and provided better resolution than clinically derived linear model metrics. An expiration time constant model also captured the same trend in respiratory elastance. However, the assumption of constant resistance and a slightly higher fitting error results in less insight than the single compartment model. Further research is required to confirm its application in titrating to optimal MV settings.

Expiratory model-based method to monitor ARDS disease state.

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

Assessment of ventricular contractility and ventricular-arterial coupling with a model-based sensor.

Estimation of ventricular contractility and ventricular arterial coupling is clinically important in diagnosing and treating cardiac dysfunction in the critically ill. However, experimental assessment of indexes of ventricular contractility, such as the end-systolic pressure-volume relationship, requires a highly invasive maneuver and measurements that are not typical in an intensive care unit (ICU). This research describes the use of a previously validated cardiovascular system model and parameter identification process to evaluate the right ventricular arterial coupling in septic shock. Model-based ventricular arterial coupling is defined by the ratio of the end systolic right ventricular elastance (E(esrvf)) over the pulmonary artery elastance (E(pa)) or the mean pulmonary inflow resistance (R(pulin)). Results are compared to the clinical gold-standard assessment (conductance catheter method). Six anesthetized healthy pigs weighing 20-30kg received a 0.5mg kg(-1) endotoxin infusion over a period of 30min from T0 to T30, to induce septic shock and veno-venous hemofiltration was used from T60 onward. The results show good agreement with the gold-standard experimental assessment. In particular, the model-based right ventricular elastance (E(esrvf)) correlates well with the clinical gold standard (R(2)=0.69) and the model-based non-invasive coupling (E(esrvf)/R(pulin)) follow the same trends and dynamics (R(2)=0.37). The overall results show the potential to develop a model-based sensor to monitor ventricular-arterial coupling in clinical real-time.

Physiological relevance and performance of a minimal lung model: an experimental study in healthy and acute respiratory distress syndrome model piglets.

BACKGROUND: Mechanical ventilation (MV) is the primary form of support for acute respiratory distress syndrome (ARDS) patients. However, intra- and inter- patient-variability reduce the efficacy of general protocols. Model-based approaches to guide MV can be patient-specific. A physiological relevant minimal model and its patient-specific performance are tested to see if it meets this objective above. METHODS: Healthy anesthetized piglets weighing 24.0 kg [IQR: 21.0-29.6] underwent a step-wise PEEP increase manoeuvre from 5cmH2O to 20cmH2O. They were ventilated under volume control using Engström Care Station (Datex, General Electric, Finland), with pressure, flow and volume profiles recorded. ARDS was then induced using oleic acid. The data were analyzed with a Minimal Model that identifies patient-specific mean threshold opening and closing pressure (TOP and TCP), and standard deviation (SD) of these TOP and TCP distributions. The trial and use of data were approved by the Ethics Committee of the Medical Faculty of the University of Liege, Belgium. RESULTS AND DISCUSSIONS: 3 of the 9 healthy piglets developed ARDS, and these data sets were included in this study. Model fitting error during inflation and deflation, in healthy or ARDS state is less than 5.0% across all subjects, indicating that the model captures the fundamental lung mechanics during PEEP increase. Mean TOP was 42.4cmH2O [IQR: 38.2-44.6] at PEEP = 5cmH2O and decreased with PEEP to 25.0cmH2O [IQR: 21.5-27.1] at PEEP = 20cmH2O. In contrast, TCP sees a reverse trend, increasing from 10.2cmH2O [IQR: 9.0-10.4] to 19.5cmH2O [IQR: 19.0-19.7]. Mean TOP increased from average 21.2-37.4cmH2O to 30.4-55.2cmH2O between healthy and ARDS subjects, reflecting the higher pressure required to recruit collapsed alveoli. Mean TCP was effectively unchanged. CONCLUSION: The minimal model is capable of capturing physiologically relevant TOP, TCP and SD of both healthy and ARDS lungs. The model is able to track disease progression and the response to treatment.

Effects of large-pore hemofiltration in a swine model of fulminant hepatic failure.

Among the different potential mechanisms that could lead to brain edema and intracranial hypertension in fulminant hepatic failure (FHF), the inflammatory hypothesis implies that systemic inflammation might be in part responsible for an increase in cerebral blood flow (CBF) and brain water content. In this study, the authors used a validated ischemic FHF swine model to evaluate the effects of 80 kDa large-pore membrane hemofiltration (LPHF) on intracranial pressure (ICP) and CBF, in relation with the clearance of proinflammatory cytokines and blood liver tests, as primary end points. Fifteen pigs were randomized into one of three groups: SHAM, FHF, and FHF + LPHF. All experiments lasted 6 h. In the FHF groups, liver failure was induced by liver ischemia. After 2 h, the FHF + LPHF group underwent 4 h of a zero-balance continuous veno-venous hemofiltration using a 0.7-m(2), large-pore (78 Å) membrane with a cutoff of 80 kDa. ICP, CBF, mean arterial pressure, central venous pressure, and heart rate were continuously monitored and recorded. Arterial aspartate aminotransferase, total bilirubin, creatinine, international normalized ratio, glucose, lactate and serum cytokines interleukin (IL)-6, IL-10, and tumor necrosis factor-α were measured at T0, T120, and T360. Over the 6 h following liver ischemia, the FHF group developed a significant increase in ICP. This ICP rise was not observed in the SHAM group and was attenuated in the FHF + LDHF group. However, the ICP levels were not different at T360 in the FHF + LDHF group compared to the FHF group. No significant effect of LPHF on liver tests or levels of proinflammatory cytokines could be demonstrated. In this model, 80 kDa LPHF was not efficient to control FHF intracranial hypertension and to decrease serum cytokine levels.

Arterial dP/dtmax accurately reflects left ventricular contractility during shock when adequate vascular filling is achieved.

BACKGROUND: Peak first derivative of femoral artery pressure (arterial dP/dtmax) derived from fluid-filled catheter remains questionable to assess left ventricular (LV) contractility during shock. The aim of this study was to test if arterial dP/dtmax is reliable for assessing LV contractility during various hemodynamic conditions such as endotoxin-induced shock and catecholamine infusion. METHODS: Ventricular pressure-volume data obtained with a conductance catheter and invasive arterial pressure obtained with a fluid-filled catheter were continuously recorded in 6 anaesthetized and mechanically ventilated pigs. After a stabilization period, endotoxin was infused to induce shock. Catecholamines were transiently administrated during shock. Arterial dP/dtmax was compared to end-systolic elastance (Ees), the gold standard method for assessing LV contractility. RESULTS: Endotoxin-induced shock and catecholamine infusion lead to significant variations in LV contractility. Overall, significant correlation (r=0.51; p<0.001) but low agreement between the two methods were observed. However, a far better correlation with a good agreement were observed when positive-pressure ventilation induced an arterial pulse pressure variation (PPV)≤11% (r=0.77; p<0.001). CONCLUSION: While arterial dP/dtmax and Ees were significantly correlated during various hemodynamic conditions, arterial dP/dtmax was more accurate for assessing LV contractility when adequate vascular filling, defined as PPV≤11%, was achieved.

On the utility of diagnostic instruments for pediatric delirium in critical illness: an evaluation of the Pediatric Anesthesia Emergence Delirium Scale, the Delirium Rating Scale 88, and the Delirium Rating Scale-Revised R-98.

PURPOSE: Delirium is a poor-prognosis neuropsychiatric disorder. Pediatric delirium (PD) remains understudied, particularly at pediatric intensive care units (PICU). Although the Pediatric Anesthesia Emergence Delirium (PAED) scale, the Delirium Rating Scale (DRS-88), and the Delirium Rating Scale-Revised (DRS-R-98) are available, none have been validated for use in PICU settings. The aim of the present study was to investigate the use of the DRS/PAED instruments as diagnostic tools for PD in the PICU. METHODS: A prospective panel study was conducted, under circumstances of routine clinical care, investigating the diagnostic properties of the PAED, DRS-88, and DRS-R-98 in PICU patients at a tertiary university medical center. A total of 182 non-electively admitted, critically ill pediatric patients, aged 1-17 years, were included between November 2006 and February 2010. Sensitivity, specificity, and receiver operating characteristic (ROC) curves were calculated. Three psychometric properties were analyzed: (1) internal consistency (2) proportion of items not rateable, and (3) discriminative ability. RESULTS: The PAED could be completed in 144 (93.5%) patients, much more frequently than either the DRS-88 (66.9%) or the DRS-R-98 (46.8%). Compared with the clinical gold standard diagnosis of delirium, the PAED had a sensitivity of 91% and a specificity of 98% (AUC 0.99). The optimal PAED cutoff score as a screening instrument in this PICU setting was 8. Cronbach's alpha was 0.89; discriminative ability was high. CONCLUSIONS: The PAED is a valid instrument for PD in critically ill children, given its reliance on routinely rateable observational signs and symptoms.

Changes in working time arrangements over time as a consequence of work-family conflict.

Existing longitudinal studies on the relationship between working time arrangements (WTA) and work-family conflict have mainly focused on the normal causal relationship, that is, the impact of WTA on work-family conflict over time. So far, however, the reversed relationship, that is, the effect of work-family conflict on adjustments in WTA over time, has hardly been studied. Because work-family conflict is highly prevalent in the working population, further insight in this reverse relationship is invaluable to gain insight into secondary selection processes. The aim of this study is to investigate whether work-family conflict is prospectively related to adjustments in work schedules, working hours, and overtime work, and to explore sex differences and different time lags in this relation. Data of the prospective Maastricht Cohort Study were used. To study the effect of work-family conflict on a change from shift- to day work over 32 months of follow-up, male three-shift (n = 727), five-shift (n = 932), and irregular-shift (n = 451) workers were selected. To study effects of work-family conflict on reduction of working hours over 12 and 24 months of follow-up, respectively, only day workers (males and females) were selected, capturing 5809 full-time workers (> or =36 h/wk) and 1387 part-time workers (<36 h/wk) at baseline. To examine effects of work-family conflict on refraining from overtime work over 12 months of follow-up, only day workers reporting frequent overtime work at baseline were selected (3145 full-time and 492 part-time workers). Cox regression analyses were performed with adjustments for age, educational level, and presence of a long-term illness. Work-family conflict was associated with a significantly increased risk of changing from shift- to day work over 32 months of follow-up in three-shift workers (relative risk [RR] = 1.77, 95% confidence interval [CI] 1.19-2.63) but not in five-shift workers (RR = 1.32, 95% CI 0.78-2.24) and irregular-shift workers (RR = 0.81, 95% CI 0.50-1.31). Within day workers, work-family conflict among full-time workers was associated with a significantly increased risk of reducing working hours during 1 yr of follow-up in women (RR = 2.80, 95% CI 1.42-5.54) but not men (RR = 1.34, 95% CI 0.81-2.22). In part-time workers, work-family conflict was associated with a significantly increased risk of reducing working hours during 1 yr of follow-up both in women (RR = 1.99, 95% CI 1.04-3.82) and men (RR = 4.03, 95% CI 1.28-12.68). Whereas the effects of work-family conflict on a reduction of working hours somewhat decreased among female full-time workers after 2 yr of follow-up (RR = 2.13, 95% CI 1.24-3.66), among male full-time workers the effects increased and reached statistical significance (RR = 1.53, 95% CI 1.05-2.21). Work-family conflict was not significantly associated with refraining from overtime work over 1 yr of follow-up. This study shows that work-family conflict has important consequences in terms of adjustments in work schedules and working hours over time, with considerable sex differences. The study thereby clearly illustrates secondary selection processes both in shift- and day workers, with significant implications for labor force participation, emphasizing the need for prevention of work-family conflict.

Gender differences in return to work patterns among sickness absentees and their associations with health: a prospective cohort study in The Netherlands.

This article describes (i) gender differences in initial return to work (RTW) and lasting return to work (LRTW); (ii) health characteristics that predicted the observed gender differences in LRTW; and (iii) associations between health characteristics and (L)RTW in men and women separately. A 13-month prospective cohort study was performed with 119 employees (54 women and 65 men) who had reported sick for more than 1 month because of mental or musculoskeletal complaints. These employees were interviewed bimonthly about their work status and health. The health characteristics included were self-rated health, the reason for reporting sick, the presence of at least one long-term disease, early improvement in health and a change in diagnosis. Cox regression analyses on the time to (L)RTW were performed. No gender differences were found regarding RTW. Women, however, did report a longer time to LRTW than men. This was predicted by their reason for reporting sick, the presence of at least one long-term disease, lack of early improvement in health and change in diagnosis. Women who experienced no early improvement and/or whose diagnosis changed during their sickness absence had lower chances of attaining a LRTW than other women. Men who were absent owing to mental complaints were less likely to RTW than men with musculoskeletal complaints. Men who had at least one long-term disease were also less likely to RTW than men who had no long-term diseases. The findings showed a delayed LRTW for women when compared with men, as predicted by health characteristics. The health characteristics, however, that predicted LRTW in women differed from those that predicted LRTW in men. Clearly, the findings support a gender-specific approach to sickness absence guidance. The results also suggest that women are misdiagnosed more often than men. This requires further investigation.

Comparison of functional residual capacity and static compliance of the respiratory system during a positive end-expiratory pressure (PEEP) ramp procedure in an experimental model of acute respiratory distress syndrome.

INTRODUCTION: Functional residual capacity (FRC) measurement is now available on new ventilators as an automated procedure. We compared FRC, static thoracopulmonary compliance (Crs) and PaO2 evolution in an experimental model of acute respiratory distress syndrome (ARDS) during a reversed, sequential ramp procedure of positive end-expiratory pressure (PEEP) changes to investigate the potential interest of combined FRC and Crs measurement in such a pathologic state. METHODS: ARDS was induced by oleic acid injection in six anesthetised pigs. FRC and Crs were measured, and arterial blood samples were taken after induction of ARDS during a sequential ramp change of PEEP from 20 cm H2O to 0 cm H2O by steps of 5 cm H2O. RESULTS: ARDS was responsible for significant decreases in FRC, Crs and PaO2 values. During ARDS, 20 cm H2O of PEEP was associated with FRC values that increased from 6.2 +/- 1.3 to 19.7 +/- 2.9 ml/kg and a significant improvement in PaO2. The maximal value of Crs was reached at a PEEP of 15 cm H2O, and the maximal value of FRC at a PEEP of 20 cm H2O. From a PEEP value of 15 to 0 cm H2O, FRC and Crs decreased progressively. CONCLUSION: Our results indicate that combined FRC and Crs measurements may help to identify the optimal level of PEEP. Indeed, by taking into account the value of both parameters during a sequential ramp change of PEEP from 20 cm H2O to 0 cm H2O by steps of 5 cm H2O, the end of overdistension may be identified by an increase in Crs and the start of derecruitment by an abrupt decrease in FRC.

Alteration of right ventricular-pulmonary vascular coupling in a porcine model of progressive pressure overloading.

In acute pulmonary embolism, right ventricular (RV) failure may result from exceeding myocardial contractile resources with respect to the state of vascular afterload. We investigated the adaptation of RV performance in a porcine model of progressive pulmonary embolism. Twelve anesthetized pigs were randomly divided into two groups: gradual pulmonary arterial pressure increases by three injections of autologous blood clot (n=6) or sham-operated controls (n=6). Right ventricular pressure-volume (PV) loops were recorded using a conductance catheter. Right ventricular contractility was estimated by the slope of the end-systolic PV relationship (Ees). After load was referred to as pulmonary arterial elastance (Ea) and assessed using a four-element Windkessel model. Right ventricular-arterial coupling (Ees/Ea) and efficiency of energy transfer (from PV area to external mechanical work [stroke work]) were assessed at baseline and every 30 min for 4 h. Ea increased progressively after embolization, from 0.26+/-0.04 to 2.2+/-0.7 mmHg mL(-1) (P<0.05). Ees increased from 1.01+/-0.07 to 2.35+/-0.27 mmHg mL(-1) (P<0.05) after the first two injections but failed to increase any further. As a result, Ees/Ea initially decreased to values associated with optimal SW, but the last injection was responsible for Ees/Ea values less than 1, decreased stroke volume, and RV dilation. Stroke work/PV area consistently decreased with each injection from 79%+/-3% to 39%+/-11% (P<0.05). In response to gradual increases in afterload, RV contractility reserve was recruited to a point of optimal coupling but submaximal efficiency. Further afterload increases led to RV-vascular uncoupling and failure.

Large-pore membrane hemofiltration increases cytokine clearance and improves right ventricular-vascular coupling during endotoxic shock in pigs.

Hemodynamic improvement in patients suffering from both septic shock and renal failure who received hemofiltration suggested that an extrarenal epuration technique could be of interest in patients with septic shock alone. However, most of the studies using continuous venovenous hemofiltration (CVVH) in this setting evidenced neither cytokine clearance nor significant reduction in their plasma level. Lack of significant clearance was explained in part by the small size of the membrane pores. Therefore, we investigated the effects of large-pore membrane hemofiltration (LPHF) during endotoxic shock in pigs on interleukin 6 (IL-6) and interleukin 10 (IL-10) clearances, and on right ventricular (RV)-vascular coupling. Thirteen anesthetized healthy pigs weighing 20-30 kg were divided into two groups. In the Endo group (n = 6), the pigs received a 0.5-mg/kg endotoxin infusion over a period of 30 mins from T0 to T30. In the EndoHF group (n = 7), LPHF (cutoff = 80 kDa) and an ultrafiltration rate of 45 mL/kg/h were started 30 mins after the end of the endotoxin infusion, from T60 to T240. In this model of porcine endotoxic shock, LPHF was responsible for a significant clearance of IL-6 (20 mL/min) and Il-10 (14 mL/min), and for an improvement in RV-vascular coupling.

Associations between positive changes in perceived work characteristics and changes in fatigue.

Little is known about the natural course of fatigue among employees. An adequate understanding of its development and risk factors is important to prevent chronic health complaints and absenteeism. This longitudinal study investigated associations between positive changes in perceived work characteristics (ie, a decrease in job demands, an increase in decision latitude, and an increase in social support) and changes in fatigue by performing hierarchical regression analyses. The work characteristics of the demand-control-support model were selected as predictors. The outcome measures emotional exhaustion and psychologic distress were investigated as secondary outcomes. The results showed that, compared with a stable work situation, positive changes in perceived social support, decision latitude, and psychologic job demands went together with a decrease in fatigue. Similar results were found for the secondary outcomes emotional exhaustion and psychologic distress.