Percutaneous Endovascular Salvage Techniques for Implanted Venous Access Device Dysfunction.

PURPOSE: Implanted venous access devices (IVADs) are often used in patients who require long-term intravenous drug administration. The most common causes of device dysfunction include occlusion by fibrin sheath and/or catheter adherence to the vessel wall. We present percutaneous endovascular salvage techniques to restore function in occluded catheters. The aim of this study was to evaluate the feasibility, safety, and efficacy of these techniques. METHODS AND MATERIALS: Through a femoral or brachial venous access, a snare is used to remove fibrin sheath around the IVAD catheter tip. If device dysfunction is caused by catheter adherences to the vessel wall, a new "mechanical adhesiolysis" maneuver was performed. IVAD salvage procedures performed between 2005 and 2013 were analyzed. Data included clinical background, catheter tip position, success rate, recurrence, and rate of complication. RESULTS: Eighty-eight salvage procedures were performed in 80 patients, mostly women (52.5 %), with a mean age of 54 years. Only a minority (17.5 %) of evaluated catheters were located at an optimal position (i.e., cavoatrial junction ±1 cm). Mechanical adhesiolysis or other additional maneuvers were used in 21 cases (24 %). Overall technical success rate was 93.2 %. Malposition and/or vessel wall adherences were the main cause of technical failure. No complications were noted. CONCLUSION: These IVAD salvage techniques are safe and efficient. When a catheter is adherent to the vessel wall, mechanical adhesiolysis maneuvers allow catheter mobilization and a greater success rate with no additional risk. In patients who still require long-term use of their IVAD, these procedures can be performed safely to avoid catheter replacement.

Thoracocervicofacial Emphysema after Heimlich's Maneuvre.

We report an extremely rare example of a thoracocervicofacial subcutaneous emphysema after Heimlich maneuver case.

Application of intravoxel incoherent motion perfusion imaging to shoulder muscles after a lift-off test of varying duration.

Intravoxel incoherent motion (IVIM) MRI is a method to extract microvascular blood flow information out of diffusion-weighted images acquired at multiple b-values. We hypothesized that IVIM can identify the muscles selectively involved in a specific task, by measuring changes in activity-induced local muscular perfusion after exercise. We tested this hypothesis using a widely used clinical maneuver, the lift-off test, which is known to assess specifically the subscapularis muscle functional integrity. Twelve shoulders from six healthy male volunteers were imaged at 3 T, at rest, as well as after a lift-off test hold against resistance for 30 s, 1 and 2 min respectively, in three independent sessions. IVIM parameters, consisting of perfusion fraction (f), diffusion coefficient (D), pseudo-diffusion coefficient D* and blood flow-related fD*, were estimated within outlined muscles of the rotator cuff and the deltoid bundles. The mean values at rest and after the lift-off tests were compared in each muscle using a one-way ANOVA. A statistically significant increase in fD* was measured in the subscapularis, after a lift-off test of any duration, as well as in D. A fD* increase was the most marked (30 s, +103%; 1 min, +130%; 2 min, +156%) and was gradual with the duration of the test (in 10(-3) mm(2) /s: rest, 1.41 ± 0.50; 30 s, 2.86 ± 1.17; 1 min, 3.23 ± 1.22; 2 min, 3.60 ± 1.21). A significant increase in fD* and D was also visible in the posterior bundle of the deltoid. No significant change was consistently visible in the other investigated muscles of the rotator cuff and the other bundles of the deltoid. In conclusion, IVIM fD* allows the demonstration of a task-related microvascular perfusion increase after a specific task and suggests a direct relationship between microvascular perfusion and the duration of the effort. It is a promising method to investigate non-invasively skeletal muscle physiology and clinical perfusion-related muscular disorders.

Liikesodankäynti Julian S. Corbettin kirjoituksissa

Tämän strategian perustutkimukseen kuuluvan tutkimuksen tarkoituksena on selvittää liikesodan periaatteiden kuvautumista merisodan teoreetikon Sir Julian S. Corbettin kirjoituksissa. Tutkimuksen näkökulma on luonteeltaan teoreettinen ja perustuu Merivoimien tarpeeseen tutkia liikesodankäyntiä merisodassa. Tutkimuksen pääongelmana on: miten liikesodankäynnin periaatteet kuvautuvat J. S. Corbettin kirjoituksissa? Tutkimuksen alaongelmat ovat: mitä tarkoittaa liikesodankäynti? Mitkä ovat liikesodankäynnin keskeiset periaatteet ja teoriat? Mitkä ovat Corbettin merisodan teorian keskeisimmät opit? Mitä merisota on Corbettin mukaan? Tutkimuksen päälähteenä on Julian Corbettin merisodan teorian pääteos ”Some Principles of Maritime Strategy” vuodelta 1911. Liikesodan teorian päälähteenä on Robert Leonhardin teos ”The Art of Maneuver – Maneuver-Warfare Theory and AirLand Battle” vuodelta 1991. Tutkimusmenetelmänä on kuvaileva kvalitatiivinen tapaustutkimus. Tutkimuksessa kuvaillaan tutkimuskohteena olevan merisotateoreetikon, J. S. Corbettin merisodan teoriaa ja tarkastellaan sitä liikesodankäynnin teorian näkökulmasta. Liikesodankäynnin erottaa muista sodankäynnin muodoista sillä, miten liikesodassa määritetään voittoon tähtäävät keinot. Liikesodan teorian keskeisiin periaatteisiin kuuluvat vihollisen vahvuuksien välttäminen, vihollisen harhauttaminen, vihollisen haavoittuvuuksien tunnistaminen ja niitä vastaan hyökkääminen. Leonhard on jalostanut nämä edelleen kolmeksi toimintamalliksi: ennakoinniksi, dislokaatioksi sekä hajaannukseksi. Merisota on Corbettin mukaan taistelua meren ja meriyhteyksien hallinnasta. Laivaston tavoitteena tulee olla merenherruuden saavuttaminen. Saavuttamalla ja ylläpitämällä merenherruus kyetään toteuttamaan muut merivoimien tehtävät. Corbettia voidaan pitää yhteisoperaatio-ajattelun edelläkävijänä, sillä Corbettin mukaan sodassa operaatioihin tulee käyttää sekä maa- että merivoimia yhdessä. Corbett luokittelee merelliset operaatiot kolmeen kategoriaan: 1) merenherruuden varmistaminen, 2) merenherruuden kiistäminen, 3) merenherruuden hyödyntäminen. Tutkimuksen johtopäätöksenä havaittiin, että Sir Julian Stafford Corbettin kirjoituksissa esiintyvät näkemykset merisodasta ja merisodan teoriasta noudattavat pitkälti liikesodankäynnin periaatteita. Liikesodan perusperiaatteet vihollisen vahvuuksien välttämisestä, harhautukseen pyrkimisestä sekä vihollisen haavoittuvuuksien tunnistamisesta ja niitä vastaan hyökkäämisestä ovat voimakkaasti läsnä corbettiaanisessa merisodan teoriassa.

Suomen Ilmavoimien johtamisjärjestelmän evoluutio ilmasotateorian, kansallisten instituutioiden ja johtamisjärjestelmän ulkomaisen kehityksen näkökulmasta

Ilmavoimien johtamisjärjestelmä on osa Ilmavoimien järjestelmäkokonaisuutta, jonka kaksi muuta osaa ovat taistelujärjestelmä ja tukeutumisjärjestelmä. Ilmavoimien materiaalista suorituskykyä rakennetaan tämän järjestelmäajattelun pohjalta. tässä tutkimuksessa Ilmavoimien johtamisjärjestelmää tutkitaan kolmen kokonaisuuden, ilmavalvontajärjestelmän, ilmatilannekuvan muodostamisjärjestelmän ja tulenkäytön johtamisjärjestelmän, näkökulmasta. Ilmavoimien johtamisjärjestelmän laajuuden vuoksi tutkimusaluetta on jouduttu rajaamaan. Tutkimus perustuu evoluutioparadigmaan, jonka mukaisesti kaikki olevainen on evolutionaarista. Mikään tässä ajassa oleva ilmiö ei ole historiaton. Jokaisella ilmiöllä on nykyisyytensä lisäksi historia ja tulevaisuus. Evoluutioparadigman avulla laajennetaan Ilmavoimien johtamisjärjestelmän nykyisyyden ymmärtämistä kuvaamalla ja analysoimalla sen evoluutiota. Tutkimusaineistoa analysoidaan käyttäen hyväksi polkuriippuvuutta evolutionaarisena mallina. tätä mallia on käytetty uusinstitutionaalisessa ja evolutionaarisessa taloustieteessä ja taloushistoriassa tutkittaessa yritysten, toimialojen tai tuotteiden pysyvyyttä markkinoilla sekä erilaisten innovaatioiden vaikuttavuutta menestymiseen eri markkinatilanteissa. Tutkimusasetelman lähtökohtana on Ilmavoimien johtamisjärjestelmäevoluution kuvaaminen kolmen tekijän tasapainoasetelman suhteen, joita ovat instituutiot, ilmasotateoria ja kansainvälinen ilmavoimien johtamisjärjestelmän kehitys. tutkimuksen tavoitteena on löytää institutionaalinen logiikka Ilmavoimien johtamisjärjestelmän evoluutiolle sekä sen eri kehitysprosesseihin liittyvä mahdollinen polkuriippuvuuden logiikka. Tutkittavina instituutioina ovat kansallinen poliittinen päätöksenteko, joka ilmentyy erilaisina komiteamietintöjä, raportteina ja selontekoina. Sotilaallista instituutiota edustavat eri operatiiviset ohjeet, ohjesäännöt ja doktriinit, jotka ovat ohjanneet johtamisjärjestelmäkehitystä. Ilmasotateorian vaikuttavuuden analyysiä varten tutkimuskohteiksi on valittu seitsemän merkittävää ilmasotateoreetikkoa. Kenraalimajuri Giulio douhet, ilmamarsalkka Hugh Trenchard ja kenraalimajuri William Mitchell edustavat ilmasotateorian varhaista kautta. Kansallista ilmasotateorian kehitystä edustavat eversti Richard Lorentz ja kenraalimajuri Gustaf Erik Magnusson. Yhdysvaltalaiset everstit John Boyd ja John Warden III ovat uuden ajan ilmasotateoreetikkoja. Näiden henkilöiden tuottamien teorioiden avulla voidaan piirtää kuva muutoksesta, jota ilmasodankäynnin teoreetti- sessa ajattelussa on tapahtunut. Ilmavoimien johtamisjärjestelmän evoluutiolle haetaan vertailua kehityksestä, jota on tapahtunut Yhdysvalloissa, Isossa-Britanniassa ja Saksassa. Ilmavoimat on saanut vaikutteita muistakin maista, mutta näiden maiden kehityksen avulla voidaan selittää Suomessa tapahtunutta kehitystä. Tutkimuksessa osoitetaan, että kansainvälisellä johtamisjärjestelmäevoluutiolla on ollut merkittävä vaikutus suomalaiseen kehitykseen. Tämä tutkimus laajentaa prosessuaalista tutkimusteoriaa ja polkuriippuvuusmallin käyttöä sotatieteelliseen tutkimuskenttään. tutkimus yhdistää toisiinsa aivan uudella tavalla sotilasorganisaation institutionaalisia tekijöitä pitkässä evoluutioketjussa. Tutkimus luo pohjaa prosessuaaliseen, havaintoihin perustuvaan evoluutioajatteluun, jossa eri tekijöiden selitysmalleja ja kausaalisuutta eri periodien aikana voidaan kuvata. Tutkimuksen tuloksena ilmavoimien johtamisjärjestelmäevoluutiossa paljastui merkittäviä piirteitä. Teknologia on ollut voimakas katalysaattori ilmapuolustuksen evoluutiossa. Uusien teknologisten innovaatioiden ilmestyminen taistelukentälle on muuttanut oleellisesti taistelun kuvaa. Sodankäynnin revoluutiosta huolimatta sodankäynnin tai operaatiotaidon ja taktiikan perusperiaatteissa ei ole tapahtunut perustavanlaatuista muutosta. Ilmavoimien johtamisjärjestelmän kehitys on voimakkaasti linkittynyt ulkomaiseen johtamisjärjestelmäkehitykseen, jossa teknologiaimplementaatiot perustuvat usean eri ilmiön paljastumiseen ja hyväksikäyttöön. Sotilas- ja siviili-instituutiot ovat merkittävästi vaikuttaneet Ilmavoimien johtamisjärjestelmän kansalliseen kehitykseen. Ne ovat antaneet poliittisen ohjauksen, taloudellisten resurssien ja strategis-operatiivisten käskyjen ja suunnitelmien avulla perusteet, joiden pohjalta johtamisjärjestelmää on kehitetty. Tutkimus osoittaa, että Suomen taloudellisten resurssien rajallisuus on ollut merkittävin institutionaalinen rajoite Ilmavoimien johtamisjärjestelmää kehitettäessä. Useat poliittiset ohjausasiakirjat ovat korostaneet, ettei Suomella pienenä kansakuntana ole taloudellisia resursseja seurata kansainvälistä sotilasteknologiakehitystä. Lisäksi ulko- ja turvallisuuspoliittinen liikkumavapaus on vaikuttanut kehittämismahdollisuuksiin. Ilmasotateorian evoluutio on luonut johtamisjärjestelmän kehitykselle välttämättömän konseptuaalisen viitekehyksen, jotta ilmasota on voitu viedä käytännön tasolle. Teoria, doktriini ja instituutiot toimivat vuorovaikutuksessa, jossa ne interaktiivisesti vaikuttavat toinen toisiinsa. Tutkimus paljasti kuusi merkittävää sokkia, jotka saivat aikaan radikaaleja muutoksia johtamisjärjestelmän evoluutiopolulla. tutkimuksen perusteella vaikuttavimmat muutoksia aiheuttavat sokit olivat radikaalit turvallisuuspoliittiset muutokset kuten sota ja voimakkaat kansantalouden muutokset kuten lama. Sokkeja aiheuttaneet kuusi ajankohtaa olivat: 1. Puolustusvoimien rakentamisen aloittaminen vapaussodan jälkeen 1918 2. Maailmanlaajuinen lama 1929–1933 ja eurooppalainen rauhanaate 1928–1933 3. Talvi- ja jatkosota 1939–1944 4. Uusi alku Pariisin rauhansopimuksen 1947 ja YYA-sopimuksen 1948 varjossa 5. Kylmän sodan päättyminen ja Suomen lama 1990–1993 6. Maailmanlaajuinen lama 2008- Tutkimuksen perusteella voidaan todeta, että Suomen ilmavoimien johtamisjärjestelmän kehittäminen on perustunut rationaalisiin päätöksiin, jotka ovat saaneet vaikutteita ulkomaisesta ilmasotateorian ja -doktriinien kehityksestä sekä kansainvälisestä johtamisjärjestelmäkehityksestä. Johtamisjärjestelmän evoluutioon on vaikuttanut globaali konvergenssi, johon on tehty kansallisen tason ratkaisuja järjestelmien adaptaation ja implementaation yhteydessä.

Protecting the skin during thyroidectomy

In this note we describe the standard technical maneuver used in our department to protect the skin during thyroidectomy in order to get the best aesthetic result. We use surgical gloves to protect the skin during these operations to reduce the negative impact of thermal trauma and mechanical retractors and energy delivery devices at the edges of the skin incised. This practice is effective, inexpensive, rapid, reproducible and showed no complication in our experience of over 2,500 thyroidectomies.

Pulmonar recruitment in acute respiratory distress syndrome. What is the best strategy?

Supporting patients with acute respiratory distress syndrome (ARDS), using a protective mechanical ventilation strategy characterized by low tidal volume and limitation of positive end-expiratory pressure (PEEP) is a standard practice in the intensive care unit. However, these strategies can promote lung de-recruitment, leading to the cyclic closing and reopening of collapsed alveoli and small airways. Recruitment maneuvers (RM) can be used to augment other methods, like positive end-expiratory pressure and positioning, to improve aerated lung volume. Clinical practice varies widely, and the optimal method and patient selection for recruitment maneuvers have not been determined, considerable uncertainty remaining regarding the appropriateness of RM. This review aims to discuss recent findings about the available types of RM, and compare the effectiveness, indications and adverse effects among them, as well as their impact on morbidity and mortality in ARDS patients. Recent developments include experimental and clinical evidence that a stepwise extended recruitment maneuver may cause an improvement in aerated lung volume and decrease the biological impact seen with the traditionally used sustained inflation, with less adverse effects. Prone positioning can reduce mortality in severe ARDS patients and may be an useful adjunct to recruitment maneuvers and advanced ventilatory strategies, such noisy ventilation and BIVENT, which have been useful in providing lung recruitment.

The impact of a new partnership outsourcing arrangement: a routine-based case study in detail engineering

This thesis investigated the contemporary phenomenon of detail engineering outsourcing. The case organization had pursued a new outsourcing approach with a trusted partner. The goal of this empirical study was to examine the impact of the consequential partnership outsourcing arrangement. Particularly, the beneficence of the arrangement was evaluated based on the underlying organizational routine and the long-term economic implications of its performance outcome. The case study was needed, as the unit will likely have to rely on such distance outsourcing arrangements more and more in the future, and understanding on the impact of such operations is needed. The main findings revealed that the new outsourcing arrangement is not currently a very attractive strategic option for organizing production. The benefits which stem from the emerged, unique engineering project routine are not significant enough to make the arrangement an advantageous one, especially since increasing partnering costs are being met. This conclusion was drawn via the extended transaction cost view. Benchmarking was done in reliance to an old arrangement from which the new pursuit was a departure from. The case study then enlightened the engineering unit on the impact of its strategic maneuver by combining the routines-theory framework with contemporary methods of governance structure evaluation. Through this, it was shown that greater efforts are needed to make the new outsourcing approach a more beneficial one. However, the studied arrangement was seen to inhold potential for better results. The findings can be used to capitalize on this.

Anatomical and functional characteristics of the pelvic floor in nulliparous women submitted to three-dimensional endovaginal ultrasonography: case control study and evaluation of interobserver agreement

PURPOSE: To determine anatomical and functional pelvic floor measurements performed with three-dimensional (3-D) endovaginal ultrasonography in asymptomatic nulliparous women without dysfunctions detected in previous dynamic 3-D anorectal ultrasonography (echo defecography) and to demonstrate the interobserver reliability of these measurements. METHODS: Asymptomatic nulliparous volunteers were submitted to echo defecography to identify dynamic dysfunctions, including anatomical (rectocele, intussusceptions, entero/sigmoidocele and perineal descent) and functional changes (non-relaxation or paradoxical contraction of the puborectalis muscle) in the posterior compartment and assessed with regard to the biometric index of levator hiatus, pubovisceral muscle thickness, urethral length, anorectal angle, anorectal junction position and bladder neck position with the 3-D endovaginal ultrasonography. All measurements were compared at rest and during the Valsalva maneuver, and perineal and bladder neck descent was determined. The level of interobserver agreement was evaluated for all measurements. RESULTS: A total of 34 volunteers were assessed by echo defecography and by 3-D endovaginal ultrasonography. Out of these, 20 subjects met the inclusion criteria. The 14 excluded subjects were found to have posterior dynamic dysfunctions. During the Valsalva maneuver, the hiatal area was significantly larger, the urethra was significantly shorter and the anorectal angle was greater. Measurements at rest and during the Valsalva maneuver differed significantly with regard to anorectal junction and bladder neck position. The mean values for normal perineal descent and bladder neck descent were 0.6 cm and 0.5 cm above the symphysis pubis, respectively. The intraclass correlation coefficient ranged from 0.62-0.93. CONCLUSIONS: Functional biometric indexes, normal perineal descent and bladder neck descent values were determined for young asymptomatic nulliparous women with the 3-D endovaginal ultrasonography. The method was found to be reliable to measure pelvic floor structures at rest and during Valsalva, and might therefore be suitable for identifying dysfunctions in symptomatic patients.

Predictive factors for voiding dysfunction after transobturator slings

PURPOSE: To identify the predictive factors for voiding dysfunction after transobturator slings. METHODS: We retrospectively reviewed the records of all patients who underwent a transobturator sling between March 2003 and December 2008. A total of 514 women had available data with at least a six-week follow-up. Patients' demographics, preoperative symptoms, urodynamic testing including multichannel voiding studies and surgical variables were tabulated. Voiding dysfunction was defined by a catheterized or ultrasonographic postvoid residual greater than 100 cc (≥six weeks after the procedure) associated with any complaints of abnormal voiding. Univariate logistic regression analysis was performed with respect to postoperative voiding dysfunction. RESULTS: The patient population had a mean age of 58.5±12.9 years. Thirty-three out of 514 patients (6.4%) had postoperative voiding dysfunction according to our definition, and 4 (0.78%) required sling transection. No differences were observed between normal and dysfunctional voiders in age, associated prolapse surgery, preoperative postvoid residual, preoperative urinary flow rate, prior pelvic surgery, and menopausal status. Valsalva efforts during the preoperative pressure flow study was the only predictive factor for postoperative voiding dysfunction, 72.4% dysfunctional versus 27.6% normal (p<0.001). CONCLUSION: Preoperative Valsalva maneuver during the micturition could identify those at risk for voiding dysfunction after transobturator sling, and it should be noted during preoperative counseling.

Standardization of a computerized method for calculating autonomic function test responses in healthy subjects and patients with diabetes mellitus

The objectives of the present study were 1) to compare results obtained by the traditional manual method of measuring heart rate (HR) and heart rate response (HRR) to the Valsalva maneuver, standing and deep breathing, with those obtained using a computerized data analysis system attached to a standard electrocardiograph machine; 2) to standardize the responses of healthy subjects to cardiovascular tests, and 3) to evaluate the response to these tests in a group of patients with diabetes mellitus (DM). In all subjects (97 healthy and 143 with DM) we evaluated HRR to deep breathing, HRR to standing, HRR to the Valsalva maneuver, and blood pressure response (BPR) to standing up and to a sustained handgrip. Since there was a strong positive correlation between the results obtained with the computerized method and the traditional method, we conclude that the new method can replace the traditional manual method for evaluating cardiovascular responses with the advantages of speed and objectivity. HRR and BPR of men and women did not differ. A correlation between age and HRR was observed for standing (r = -0.48, P<0.001) and deep breathing (r = -0.41, P<0.002). Abnormal BPR to standing was usually observed only in diabetic patients with definite and severe degrees of autonomic neuropathy.

Efficacy of the FEV1/FEV6 ratio compared to the FEV1/FVC ratio for the diagnosis of airway obstruction in subjects aged 40 years or over

The present cross-sectional, population-based study was designed to evaluate the performance of the FEV1/FEV6 ratio for the detection of airway-obstructed subjects compared to the FEV1/FVC <0.70 fixed ratio test, as well as the lower limit of normality (LLN) for 1000 subjects ³40 years of age in the metropolitan area of São Paulo, SP, Brazil. After the exclusion of 37 (3.7%) spirometries, a total of 963 pre-bronchodilator (BD) and 918 post-BD curves were constructed. The majority of the post-BD curves (93.1%) were of very good quality and achieved grade A (762 curves) or B (93 curves). The FEV1/FEV6 and FEV1/FVC ratios were highly correlated (r² = 0.92, P < 0.000). Two receiver operator characteristic curves were constructed in order to express the imbalance between the sensitivity and specificity of the FEV1/FEV6 ratio compared to two FEV1/FVC cut-off points for airway obstruction: equal to 70 (area under the curve = 0.98, P < 0.0001) and the LLN (area under the curve = 0.97, P < 0.0001), in the post-BD curves. According to an FEV1/FVC <0.70, the cut-off point for the FEV1/FEV6 ratio with the highest sum for sensitivity and specificity was 0.75. The FEV1/FEV6 ratio can be considered to be a good alternative to the FEV1/FVC ratio for the diagnosis of airway obstruction, both using a fixed cut-off point or below the LLN as reference. The FEV1/FEV6 ratio has the additional advantage of being an easier maneuver for the subjects and for the lung function technicians, providing a higher reproducibility than traditional spirometry maneuvers.

Correlations between pulse oximetry and peak expiratory flow in acute asthma

Few studies are available concerning correlations between pulse oximetry and peak expiratory flow in children and adolescents with acute asthma. Although the Global Initiative for Asthma states that measurements of lung function and oximetry are critical for the assessment of patients, it is not clear if both methods should necessarily be included in their evaluation. Since there is a significant difference in cost between pulse oximetry equipment and peak expiratory flow devices, we determined whether clinical findings and peak expiratory flow measurements are sufficient to determine the severity of acute asthma. The present prospective observational study was carried out to determine if there is correlation between pulse oximetry and peak expiratory flow determination in 196 patients with acute asthma aged 4 to 15 years diagnosed according to the Global Initiative for Asthma criteria. Patients experiencing their first or second wheezing episode, with fever, related acute or chronic diseases, and unable to perform the peak expiratory flow maneuver were excluded. Measurements of peak expiratory flow and pulse oximetry were performed at admission and after 15 min of each inhaled salbutamol cycle. Correlations obtained by linear regression using the Pearson correlation coefficients (r) were 0.41 (P < 0.0001), 0.53 (P < 0.0001), 0.51 (P < 0.0001), and 0.61 (P < 0.0001) at admission and after the first, second and third cycles of salbutamol, respectively. These correlations showed that one measure cannot substitute the other (Pearson's coefficient <0.7), probably because they evaluate different aspects in the airways, suggesting that peak expiratory flow should not be used alone in the assessment of acute asthma in children and adolescents.

Lung hyperinflation stimulates the release of inflammatory mediators in spontaneously breathing subjects

Lung hyperinflation up to vital capacity is used to re-expand collapsed lung areas and to improve gas exchange during general anesthesia. However, it may induce inflammation in normal lungs. The objective of this study was to evaluate the effects of a lung hyperinflation maneuver (LHM) on plasma cytokine release in 10 healthy subjects (age: 26.1 ± 1.2 years, BMI: 23.8 ± 3.6 kg/m²). LHM was performed applying continuous positive airway pressure (CPAP) with a face mask, increased by 3-cmH2O steps up to 20 cmH2O every 5 breaths. At CPAP 20 cmH2O, an inspiratory pressure of 20 cmH2O above CPAP was applied, reaching an airway pressure of 40 cmH2O for 10 breaths. CPAP was then decreased stepwise. Blood samples were collected before and 2 and 12 h after LHM. TNF-α, IL-1β, IL-6, IL-8, IL-10, and IL-12 were measured by flow cytometry. Lung hyperinflation significantly increased (P < 0.05) all measured cytokines (TNF-α: 1.2 ± 3.8 vs 6.4 ± 8.6 pg/mL; IL-1β: 4.9 ± 15.6 vs 22.4 ± 28.4 pg/mL; IL-6: 1.4 ± 3.3 vs 6.5 ± 5.6 pg/mL; IL-8: 13.2 ± 8.8 vs 33.4 ± 26.4 pg/mL; IL-10: 3.3 ± 3.3 vs 7.7 ± 6.5 pg/mL, and IL-12: 3.1 ± 7.9 vs 9 ± 11.4 pg/mL), which returned to basal levels 12 h later. A significant correlation was found between changes in pro- (IL-6) and anti-inflammatory (IL-10) cytokines (r = 0.89, P = 0.004). LHM-induced lung stretching was associated with an early inflammatory response in healthy spontaneously breathing subjects.

Understanding round-tripping phenomenon in Russian context – case Cyprus

Russian FDI has a few peculiarities. One of them is round-tripping. Round-tripping is defined as transfer of funds abroad, usually to offshore financial centers (OFCs), and then bringing all or some of the investment back as foreign investment. Russian context was chosen for this study because the share of round-tripping investments from country’s total FDI is extensive. However, it needs to be addressed that this is not just a Russian phenomenon. Round-tripping is used by many developed and developing countries, and most of the countries have their own designated destinations for this kind of capital, much like Cyprus is the main destination for Russian capital. It is important to study this phenomenon further, since it falsifies FDI statistics and can lead to poor decisions on state level. Theoretical part of the study tries to determine weather traditional FDI and internationalization theories fit to explain the Russian round-tripping phenomenon. Traditional FDI and internationalization theories are first introduced in general terms, and then further examined in Russian context. In traditional endogenic FDI theories, when the capital is formed in one country it goes abroad to find better profits. At a first glance, this seemed not to be the case in round-tripping. However, during the study it became rather clear that with few adjustments and changes in perspective, traditional theories could be used to explain round-tripping phenomenon. For example, OLI paradigm can be further developed into OLIH paradigm with ‘H’ representing the important home country institutions. Transaction based view and resource seeking theories were also seen well equipped to explain round-tripping with a change in perspective. The latter part of the study focused on holistic understanding of Russian –Cyprian investment relationship. Study aims to shed light into the determinants and consequences of this phenomenon for both countries involved. The two share historical, cultural and political ties, but most importantly common financial interests. Russian companies seek security and financial knowledge to maneuver their assets and Cyprian economy largely is dependent on their disproportionally large financial sector. Consequences for Cyprian economy were seen in current economic crisis, when the need for their financial services diminished. Russian government on the other hand is losing vast amounts of tax money due to this phenomenon. A rather extreme view was also introduced in this study. Round-tripping phenomenon and OFCs are an important reason why corruption exists, since if one does not have a way to make ill-gained money legitimate why try to ill-gain the money at the first place. The most important finding of the study is that round-tripping companies are in a better competitive position than genuine and purely domestic investor due to their institutional knowledge.