A neglected etiology of bronchiectasis: External compression due to hiatal hernia.

AIM: To investigate the incidence of bronchiectasis supposed to be made by the external compression of hiatal hernia (HH) to bronchi. MATERIALS AND METHODS: The thorax computed tomography (CT) scans of patients which were carried out in Duzce University Hospital between February 2014 and August 2015 were retrospectively evaluated. The repeated scans in the same patient were excluded. RESULTS: A total of 4388 patients were included in the study. A total of 98 HH cases were detected of which 58 (59.2%) were female. The mean age was 73.30 ± 9.14 (45-90). The rate of HH according to small, moderate and large size was 45 (45.9%), 9 (9.2%), 44 (44.9%), respectively. The rate of hiatal hernia accompanied by bronchiectasis were similar in both males and females (P = 0.078). The prevalence of bronchiectasis was significantly high in large hernias with 81.4% rate (P = 0.009). Bronchiectasis rate was 12.343 times (OR: 12.343, 95% CI: 1.479-103.027, P = 0.009) higher in the large HH group compared to small and moderate HH groups. Hiatal hernia accompanied by bronchiectasis was 88.1% anatomically near to HH. CONCLUSIONS: Thus, hiatal hernia may cause bronchiectasis due to external compression rather than lymphadenopathy or the tumor as an etiology of bronchiectasis and should be considered in the differential diagnosis.

[PRESSURE ULCER AS THE PRINCIPAL INDICATOR OF HEALTH CARE QUALITY AT NEUROLOGY DEPARTMENT].

According to the European Pressure Ulcer Advisory Panel (EPUAP) definition, pressure ulcer is a local skin or subcutaneous tissue damage due to the force of pressure or friction or their combination. Pressure ulcers have accompanied humans since the beginning and respective descriptions are found in the 19th century literature. Pressure ulcer is a major medical, social and health-economic problem because it is associated with a number of complications that require multidisciplinary approach in care and treatment. In affected patients, pressure ulcer causes quality of life reduction, discomforts, pain, emotional problems and social isolation. If the process of tissue decay is not halted, tissue damage will spread involving deep and wider structures, thus seriously compromising the patient general condition. Pressure ulcer usually develops at the sites of protrusions formed by lumbar spine, ischium, hip, ankle, knee or elbow, as well as in the areas with less developed adipose tissue. Any temporary or permanent immobility should be perceived as a milieu favoring the onset of pressure ulcer. Advances in medicine and standards of living in general have prolonged life expectancy, thus also increasing the population at risk of chronic diseases including pressure ulcer. The aim of the study was to determine the relationship between the length of bed-ridden condition and the occurrence of pressure ulcers in patients treated at Department of Cerebrovascular Diseases and Intensive Neurology from January 1, 2012 until December 31, 2015. The study included patients with pressure ulcer verified on admission and those having developed pressure ulcer during hospital stay. Clinical picture of severe stroke predominated in the majority of study patients. Patients were divided into groups according to health care requirements as classified by the Croatian Chamber of Nurses. Preliminary results indicated the length of bed-ridden condition to be associated with the occurrence of chronic wounds, and thus with increased cost and length of hospital treatment. Therefore, health care methods and procedures should be focused on reduction of pressure ulcer development, quality health care, implementation of preventive measures, and continuous education of health care professionals.

[Multidisciplinary Management and Neurorehabilitation of Patients with Amyotrophic Lateral Sclerosis].

Patients with amyotrophic lateral sclerosis require comprehensive care with a multidisciplinary approach, which is individually adjusted to each patient. The goals of neurorehabilitation should be adjusted to the stage of disease. In early stages, physical therapy is focused on preserving and optimizing motor and respiratory function. At this stage, family should be involved to partake in desired activities and be informed regarding the natural course of the disease. In late stages, physical therapy is focused on preventing respiratory complications and contractures, and orthotics may also be recommended. The onset of dysarthria should trigger swallowing and pulmonary function testing. Swallowing maneuvers should be tried at the onset of symptoms, later feeding tubes or percutaneous gastrostomy tube is necessary. Noninvasive mechanical ventilation may delay the need of tracheostomy and invasive mechanical ventilation. The key objectives of multidisciplinary teams are to optimize medical care, facilitate communication, and thus to improve the quality of care and quality of life.

Silicon detector dark matter results from the final exposure of CDMS II.

We report results of a search for weakly interacting massive particles (WIMPS) with the silicon detectors of the CDMS II experiment. This blind analysis of 140.2 kg day of data taken between July 2007 and September 2008 revealed three WIMP-candidate events with a surface-event background estimate of 0.41(-0.08)(+0.20)(stat)(-0.24)(+0.28)(syst). Other known backgrounds from neutrons and 206Pb are limited to <0.13 and <0.08 events at the 90% confidence level, respectively. The exposure of this analysis is equivalent to 23.4 kg day for a recoil energy range of 7-100 keV for a WIMP of mass 10 GeV/c2. The probability that the known backgrounds would produce three or more events in the signal region is 5.4%. A profile likelihood ratio test of the three events that includes the measured recoil energies gives a 0.19% probability for the known-background-only hypothesis when tested against the alternative WIMP+background hypothesis. The highest likelihood occurs for a WIMP mass of 8.6 GeV/c2 and WIMP-nucleon cross section of 1.9×10(-41) cm2.

Results from a low-energy analysis of the CDMS II germanium data.

We report results from a reanalysis of data from the Cryogenic Dark Matter Search (CDMS II) experiment at the Soudan Underground Laboratory. Data taken between October 2006 and September 2008 using eight germanium detectors are reanalyzed with a lowered, 2 keV recoil-energy threshold, to give increased sensitivity to interactions from weakly interacting massive particles (WIMPs) with masses below ∼10 GeV/c(2). This analysis provides stronger constraints than previous CDMS II results for WIMP masses below 9 GeV/c(2) and excludes parameter space associated with possible low-mass WIMP signals from the DAMA/LIBRA and CoGeNT experiments.

Unobtrusive, Continuous LIDAR-Based Measurement of Gait Characteristics at Home.

This paper describes a novel approach to the unobtrusive assessment of a subset of gait characteristics using a light detection and ranging (LIDAR) device. The developed device is poised to enable unobtrusive, nearly continuous monitoring and inference of patients' gait characteristics to assess physical and cognitive states. The device provides a rapidly sampled signal representing the distance of a participant's body from the LIDAR device. The densely sampled distance estimation is processed by custom algorithms that can potentially be used to estimate various gait characteristics such as step size, cadence, double support, and even step-size symmetry.Clinical Relevance- Since gait is a complex behavior that requires seamless cooperation of multiple systems, including sensation, perception, muscular synergies, and even cognition. Subtle changes in gait may, therefore, indicate issues with physical and mental functionality. In addition to the walking speed, the gait monitoring results can provide inferences about the physical and cognitive states of the unobtrusively monitored individuals using their own data as a baseline.

Pulse wave velocity predicts mortality in renal transplant patients.

BACKGROUND: measuring arterial stiffness using pulse wave velocity (PWV) has become an important tool to assess vascular function and cardiovascular mortality. For subject with hypertension, end-stage renal disease and diabetes, PWV has been shown to predict cardiovascular and all-cause mortality. We hypothesize that PWV would also predict mortality in subjects who have undergone kidney transplantation. METHODS: a cohort of 330 patients with renal transplantation was studied with a mean age at entry 51.4 ± 0.75 years. Mean follow-up was 3.8 years (± 0.7 years); 16 deaths occurred during follow-up. At entry, together with standard clinical and biochemical parameters, PWV was determined from pressure tracing over carotid and femoral arteries. RESULTS: with increasing PWV, there was a significant increase in age, systolic blood pressure and pulse pressure. In addition, subjects with higher PWV also exhibited more frequently the presence of coronary heart disease. On the basis of Cox analyses, PWV and systolic blood pressure emerged as predictors of all-cause mortality. CONCLUSION: these results provide evidence that PWV is a strong predictor of all-cause mortality in the population of renal transplant recipients.

Mucoadhesion on urinary bladder mucosa: the influence of sodium, calcium, and magnesium ions.

The aim of the present work was to establish if different cations present in the lumen of the urinary bladder at the time of application affect the mucoadhesion strength of cationic chitosan, anionic sodium carboxymethyl cellulose (NaCMC), and nonionic hydroxypropyl cellulose (HPC). The mucoadhesion strength of polymeric films was determined on pig urinary bladder mucosa. Sodium, calcium, and magnesium ions decreased the mucoadhesion strength of all three polymers except NaCMC, whose detachment forces were not influenced by the presence of sodium. Lower mucoadhesion strength in the presence of cations should be considered when drug delivery systems, for example microspheres, containing the tested mucoadhesive polymers are applied intravesically. In the majority of the experiments, cations decreased the mucoadhesion strength of the polymers already in concentrations normally present in urine. For stronger mucoadhesion, application of microspheres into the empty urinary bladder would be recommended. Additionally, the mucoadhesion properties of the tested polymers could be controlled by the selection of a proper medium for the suspension of microspheres. Namely, for all three polymers bivalent calcium and magnesium had stronger influence on mucoadhesion compared to univalent sodium, and with increasing concentrations of cations mucoadhesion strength of the polymers decreased.

[Have we made progress in the development of a vestibular implant?]. / Queues avancées cette année dans le développement d'un implant vestibulaire?

The concept of a vestibular implant to restore balance in patients suffering from bilateral loss of function is similar to that of a cochlear implant. Motion sensors will capture head movements and this information will be transmitted to the central nervous system via electrodes implanted in the vestibular system. However, several key questions must be answered before such prosthesis could be used in humans. One is to restore a baseline neural activity in the system that can be then adequately modulated by the prosthesis, without causing unbearable symptoms. We showed that this is possible in human. This is an important prerequisite for the feasibility of a vestibular implant.

Search for axions with the CDMS experiment.

We report on the first axion search results from the Cryogenic Dark Matter Search (CDMS) experiment at the Soudan Underground Laboratory. An energy threshold of 2 keV for electron-recoil events allows a search for possible solar axion conversion into photons or local galactic axion conversion into electrons in the germanium crystal detectors. The solar axion search sets an upper limit on the Primakov coupling g(agammagamma) of 2.4x10(-9) GeV-1 at the 95% confidence level for an axion mass less than 0.1 keV/c2. This limit benefits from the first precise measurement of the absolute crystal plane orientations in this type of experiment. The galactic axion search analysis sets a world-leading experimental upper limit on the axioelectric coupling g(aee) of 1.4x10(-12) at the 90% confidence level for an axion mass of 2.5 keV/c2.

Immuno-detection of Staphylococcus aureus biofilm on a cochlear implant.

CASE PRESENTATION: A 46-year-old man suffering from progressive deafness since childhood received a Clarion 90 K cochlear implant with the HiRes preformed electrode in his left ear in October 2006. A persistent Staphylococcus aureus infection failed to be treated with corticoids, amoxicillin/ clavulanate, ciprofloxaxin, and rifampin. The processor was removed on July 2007. INTERVENTIONS: The removed cochlear implant processor was treated with different reagents, with the aim of detecting a S. aureus and S. aureus biofilm: (1) fluorescein-coupled Fc of anti-human serum, (2) polyclonal anti-polysaccharide intercellular adhesion antibodies coupled to Alexa Fluor 568 goat anti-rabbit immunoglobulin (Ig)G, (3) crystal violet, (4) methylene blue, (5) acridine orange, (6) Gram stain, and (7) live/dead fluorescent stain. RESULTS: S. aureus and the major constituent of the S. aureus biofilm, the polysaccharide intercellular adhesion, were detected on the surface of the implant. S. aureus was isolated after a simple contact between the implant and a solid growth medium. The ability of the isolated S. aureus strain to produce biofilm in vitro was confirmed. INTERPRETATION: S. aureus biofilm was documented on the implant. Initial bacterial colonization could be related to the pocket of the removable magnet. Colonies of S. aureus without biofilm were found attached to the electrode wire. CONCLUSION: We report one case of a S. aureus biofilm infection documented on a cochlear implant, as assessed by immuno-microscopy. The biofilm was likely responsible for the persistent infection which manifested for many months after the implant surgery and could explain the unusual bacterial phenotypic resistance against administered antimicrobial agents.

Enhanced permeability of the urinary bladder wall: the role of polymer charge.

The urothelium is usually impermeable to substances present in the urine. In the current work the possibility of using different absorption enhancers in the development of intravesical drug delivery systems was explored. To establish the role of the polymer charge on its ability to improve bladder wall permeability, cationic poly-L-arginine, anionic NaCMC and alginate as well as nonionic HPC and HPMC were tested. The permeability experiments were performed on isolated pig urinary bladders. We established that the charge of the polymer affects its ability to enhance the permeability of the urinary bladder wall, but to a limited extent. Positively charged polymers were the most promising absorption enhancers for the urinary bladder wall. In order to significantly enhance the permeability of the bladder wall, higher concentrations of poly-L-arginine were needed compared to chitosan. Moreover, chitosan reached the plateau of its absorption enhancement effect after 60 min, while poly-L-arginine increased the permeability continuously over 90 min. In contrast to polycarbophil, two other anionic polymers, NaCMC and alginate, did not significantly enhance the permeation of pipemidic acid into the tissue. Interactions between the polymers and the drug might prevail over the potential effect of NaCMC and alginate on tissue permeability. Furthermore, for the nonionic polymers HPMC and HPC an insignificant influence on bladder wall permeability was determined. Therefore, the selection of absorption enhancers for intravesical drug delivery systems is limited and cannot be done only on the basis of polymer charge.

Comparative study of the ''Misgav Ladach'' and traditional Pfannenstiel surgical techniques for cesarean section.

AIM: The aim of this study was to evaluate the advantages of the Misgav Ladach surgical technique compared to traditional cesarean section. METHODS: A prospective randomized trial of 111 women undergoing cesarean section was carried out in the Pula General Hospital. Forty-nine operations were performed using the Pfannenstiel method of cesarean section, 55 by the Misgav Ladach method and 7 by lower midline laparotomy. RESULTS: It was proved that the cases where the Misgav Ladach method was implemented, compared to the Pfannenstiel method, showed a significantly shorter delivery/extraction and operative time (P=0.0009), the incision pain on the second postoperative day was significantly lower (0.021), we recorded a quicker stand up and walking time (P=0.013), significantly fewer analgesic injections and a shorter duration of analgesia were required (P=0.0009) and the bowel function was restored to normal sooner (P=0.001). CONCLUSION: The Misgav Ladach method of cesarean section has advantages over the Pfannenstiel method in so far as it is significantly quicker to perform, with diminished postoperative pain and less use of postoperative analgesics. The recovery of physiologic function is faster. No differences were found in intraoperative bleeding, maternal morbidity, scar appearance, uterus postoperative involution and the assessment of the inflammation response to the operative technique.

[Otitis externa, a self-inflicted disease?]. / Otites externes: une maladie auto-infligée?

Otitis externa, an inflammation of the external auditory canal is the most frequent cause of ENT consultation all over the world. It can be caused by viral, bacterial or fungal infections. In most of the cases it is provoked by anatomical causes and, even more frequently inadvertently, by the patient himself. Typically, otitis externa is an isolated episode of short duration, easily treated with topical medication. It evolves rarely to the atypical forms of chronic otitis externa and malignant otitis externa. It is important to search for an allergy, eczema or immunodepression in cases of chronic otitis externa and for diabetes in cases of malignant otitis externa.

Renal artery changes in patients with primary renal cell carcinoma.

Arterial fibromuscular dysplasia (FMD) is a noninflammatory, nonatherosclerotic, occlusive condition of the systemic arteries, most frequently affecting renal arteries. Renal cell carcinoma (RCC) might be associated with arterial hypertension; however, there are no data in the literature regarding the relationship between RCC and associated renal artery changes. We analyzed a consecutive series of 57 (35 male and 22 female) patients aging from 35 to 79 years (mean 58.9 years) who underwent nephrectomy due to RCC in the year 2003. The patients had RCC measuring from 2 to 16 cm (mean 7.1 cm). Specimens were routinely fixed, embedded in paraffin, cut, and stained with hematoxylin and eosin, Mallory trichrome method, and orcein. Renal arteries of 26 patients (20 male, 6 female) showed no changes. In these patients, RCC measured 2.5-11 cm in largest diameter (mean 6.6 cm). In 24 patients (10 male, 14 female), renal arteries showed FMD. RCCs in these patients measured between 2 and 16 cm (mean 8.0 cm). Seven patients had atherosclerotic changes in renal arteries. In this series, FMD was found in a significant proportion of patients with RCC, mainly in women. The cause of such changes and their relationship with RCC and systemic hypertension should be further analyzed.

Carbon dioxide differentially affects the cytokine release of macrophage subpopulations exclusively via alteration of extracellular pH.

BACKGROUND: The improved outcome after endoscopic surgery has been attributed to less surgical trauma. However, the underlying mechanisms are not fully understood, and direct effects of CO2 used for pneumoperitoneum, cellular acidification, and/or the lack of air contamination have been postulated to additionally modulate immune functions during endoscopic surgery. We investigated the effects of CO2 incubation, extracellular acidification, and air contamination on the inflammatory response of two distinct macrophage populations. METHODS: R2 and NR 8383 rat macrophage cell lines were used. Interleukin-6 (IL-6) and nitric oxide after lipopolysaccharide (LPS) stimulation were determined in these sets of experiments: incubation in 100% CO2, 5% CO2, and room air for 2h; incubation at pH 7.4, 6.5, and 5.5 for 2 h in 5% CO2; and incubation in 100% CO2, 5% CO2 and room air in fixed pH 6.3. The extracellular pH was monitored during incubation. We determined the alteration of intracellular pH in cells subjected to extracellular acidification by fluorescence microscopy. RESULTS: Extracellular pH decreased to 6.3 during 100% CO2 incubation. IL-6 release was reduced after CO2 incubation in NR 8383 cells and increased in R2 cells (p < 0.05). It was not altered by air incubation. Decreasing the extracellular pH to 6.5 mimicked the effects of CO2 and a decrease to 5.5 suppressed IL-6 release in both cell lines. In fixed pH at 6.3, CO2 and air incubation had no effect. CO2 and pH had no impact on nitric oxide release and vitality. Intracellular pH decreased with extracellular acidification without significant difference between the two cell lines. CONCLUSIONS: A decrease in extracellular pH during incubation in CO2 differentially affects IL-6 release in macrophage subpopulations. This may explain contradictory results in the literature. Moreover, we demonstrated that air contamination does not affect macrophage cytokine release. The decrease in extracellular pH is the primary underlying mechanism of the alteration of macrophage cytokine release after CO2 incubation, and it appears that the ability to maintain intracellular pH is not determined by the effects of CO2 or extracellular acidification.

Insitu bioaugmentation of nitrification in the regeneration zone: practical application and experiences at full-scale plants.

Nitrification is the rate-limiting process in the design of activated sludge process. It is especially unstable during the winter season (when the temperature of activated sludge mixed liquor drops below 13 degrees C). It is therefore difficult to meet the ammonia effluent standards in winter. The common way to compensate for low nitrification rates at low temperatures is to increase sludge retention time (SRT). However, the increase of SRT is accompanied by negative factors such as elevated sludge concentration, higher sludge loading of secondary clarifiers, formation of unsettleable microflocs, etc. The low performance of nitrification at low temperatures can also be compensated for by enhancing the nitrification population in activated sludge. This paper describes such a method called bioaugmentation of nitrification in situ. This procedure takes place in a so-called regeneration tank, which is situated in the return activated sludge stream. The results of the operation of two wastewater treatment plants with regeneration zones are described in this paper, together with some economic evaluation of the bioaugmentation method.

Drug-induced apoptosis is associated with enhanced Fas (Apo-1/CD95) ligand expression but occurs independently of Fas (Apo-1/CD95) signaling in human T-acute lymphatic leukemia cells.

Induction of apoptosis is considered to be the underlying mechanism that accounts for the efficiency of chemotherapeutic drugs. It has recently been proposed that induction of Fas ligand (FasL) expression with subsequent autocrine and/or paracrine induction of cell death through binding to the Fas (Apo-1/CD95) membrane accounts for chemotherapy-associated apoptosis. In the present study, we analyzed the significance of FasL expression in the mediation of drug-induced apoptosis in the T-acute lymphatic leukemia model CEM. In particular, we examined the potential of the tumor drugs fludarabine, doxorubicin, and cisplatin to induce FasL expression. We also raised the question of whether apoptosis induced by these drugs occurs through the Fas pathway and hence can be blocked by the cowpox virus protein CrmA, a specific inhibitor of this pathway. All tumor drugs examined led to an increase in FasL protein. However, overexpression of CrmA had no effect on drug-induced apoptosis. Moreover, neither incubation with inhibitory monoclonal antibodies against Fas that completely prevented Fas-induced apoptosis in these cells nor pretreatment with a monoclonal antibody to FasL affected drug-induced cell death. Our observations suggest a Fas/FasL-independent mechanism for drug-induced apoptosis and exclude the involvement of caspase 1 and caspase 8 in this process in T-acute lymphatic leukemia cells.

The predictive effect of initial complete blood count of intensive care unit patients on mortality, length of hospitalization, and nosocomial infections.

OBJECTIVE: The mean platelet volume (MPV) can be used as an indicator of platelet activation. However, it has been shown that the platelet/lymphocyte ratio (PLR) can provide useful predictive information about inflammation and aggregation pathways. The neutrophil/lymphocyte ratio (NLR) may also be helpful as a marker of systemic or local inflammation. The main objective of this study evaluated to unselected critically ill patients the relationship of initial MPV, NLR, and PLR with mortality, length of hospitalization, and the risk of developing nosocomial infections in ICU patients. PATIENTS AND METHODS: In this retrospective study, we evaluated consecutive patients at our tertiary nine-bed ICU. One hundred seventy-three patients who were followed up during a 1-year period were included. RESULTS: MPV levels were found to be higher in patients who died in the hospital (p = 0.05). In addition, there was a significant positive correlation between expected mortality rate and MPV among non-survivors (p = 0.009). NLR levels were higher among non-survivors, but this difference was not statistically significant (p = 0.435). PLR levels were similar between non-survivors and survivors (p = 0.173). The initial NLR and PLR were significantly higher in patients with nosocomial infections. NLR and PLR had a significant positive correlation with length of hospitalization (p = 0.006 and p = 0.027, respectively). CONCLUSIONS: In our study, we found that high PLR and NLR may be indicators for the development of nosocomial infections. Moreover, the length of hospitalization may be prolonged in patients with high PLR and NLR.