Association Between Use of Lung-Protective Ventilation With Lower Tidal Volumes and Clinical Outcomes Among Patients Without Acute Respiratory Distress Syndrome A Meta-analysis

Context Lung-protective mechanical ventilation with the use of lower tidal volumes has been found to improve outcomes of patients with acute respiratory distress syndrome (ARDS). It has been suggested that use of lower tidal volumes also benefits patients who do not have ARDS. Objective To determine whether use of lower tidal volumes is associated with improved outcomes of patients receiving ventilation who do not have ARDS. Data Sources MEDLINE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials up to August 2012. Study Selection Eligible studies evaluated use of lower vs higher tidal volumes in patients without ARDS at onset of mechanical ventilation and reported lung injury development, overall mortality, pulmonary infection, atelectasis, and biochemical alterations. Data Extraction Three reviewers extracted data on study characteristics, methods, and outcomes. Disagreement was resolved by consensus. Data Synthesis Twenty articles (2822 participants) were included. Meta-analysis using a fixed-effects model showed a decrease in lung injury development (risk ratio [RR], 0.33; 95% CI, 0.23 to 0.47; I-2, 0%; number needed to treat [NNT], 11), and mortality (RR, 0.64; 95% CI, 0.46 to 0.89; I-2, 0%; NNT, 23) in patients receiving ventilation with lower tidal volumes. The results of lung injury development were similar when stratified by the type of study (randomized vs nonrandomized) and were significant only in randomized trials for pulmonary infection and only in nonrandomized trials for mortality. Meta-analysis using a random-effects model showed, in protective ventilation groups, a lower incidence of pulmonary infection (RR, 0.45; 95% CI, 0.22 to 0.92; I-2, 32%; NNT, 26), lower mean (SD) hospital length of stay (6.91 [2.36] vs 8.87 [2.93] days, respectively; standardized mean difference [SMD], 0.51; 95% CI, 0.20 to 0.82; I-2, 75%), higher mean (SD) PaCO2 levels (41.05 [3.79] vs 37.90 [4.19] mm Hg, respectively; SMD, -0.51; 95% CI, -0.70 to -0.32; I-2, 54%), and lower mean (SD) pH values (7.37 [0.03] vs 7.40 [0.04], respectively; SMD, 1.16; 95% CI, 0.31 to 2.02; I-2, 96%) but similar mean (SD) ratios of PaO2 to fraction of inspired oxygen (304.40 [65.7] vs 312.97 [68.13], respectively; SMD, 0.11; 95% CI, -0.06 to 0.27; I-2, 60%). Tidal volume gradients between the 2 groups did not influence significantly the final results. Conclusions Among patients without ARDS, protective ventilation with lower tidal volumes was associated with better clinical outcomes. Some of the limitations of the meta-analysis were the mixed setting of mechanical ventilation (intensive care unit or operating room) and the duration of mechanical ventilation. JAMA. 2012;308(16):1651-1659 www.jama.com

A new genus and species of cavernicolous Pomatiopsidae (Mollusca, Caenogastropoda) in Bahia, Brazil

Spiripockia punctatais a new genus and species of Pomatiopsidae found in a cave from Serra Ramalho, SW Bahia, Brazil. The taxon is troglobiont (restricted to subterranean realm), and is characterized by the shell weakly elongated, fragile, translucent, normally sculptured by pustules with periostracum hair on tip of pustules; peristome highly expanded; umbilicus opened; radular rachidian with 6 apical and 3 pairs of lateral cusps; osphradium short, arched; gill filaments with rounded tip; prostate flattened, with vas deferens inserting subterminally; penis duct narrow and weakly sinuous; pallial oviduct simple anteriorly, possessing convoluted bypass connecting base of bulged portion of transition between visceral and pallial oviducts with base of seminal receptacle; spermathecal duct complete, originated from albumen gland. The description of this endemic species may raise protective environmental actions to that cave and to the Serra Ramalho Karst area.

Crenicichla chicha, a new species of pike cichlid (Teleostei: Cichlidae) from the rio Papagaio, upper rio Tapajós basin, Mato Grosso, Brazil

Crenicichla chicha, new species, occurs in clear, fast-running waters with rocky substrates in the rio Papagaio and tributaries. It is distinguished from all other Crenicichla species by the combination of two character states: infraorbitals 3 and 4 co-ossified (vs. separated) and 66-75 scales in the row immediately above to that containing the lower lateral line (E1 row scales). Crenicichla chicha shares a smooth preopercular margin, co-ossification of infraorbitals 3 and 4, and some color features with C. hemera from the adjacent rio Aripuanã drainage, rio Madeira basin. It differs from Crenicichla hemera in more E1 scales (66-75 vs. 58-65) and presence of a conspicuous black narrow stripe running from infraorbital 3 obliquely caudoventrad toward the preopercular margin vs. a rounded and faint suborbital marking present on infraorbitals 3-4. Examination of the type series and additional material from the rio Aripuanã confirms that Crenicichla guentheri Ploeg, 1991 is a junior subjective synonym of C. hemera Kullander, 1990.

Three new species of Lebiasina (Characiformes: Lebiasinidae) from the Brazilian shield border at Serra do Cachimbo, Pará, Brazil

Lebiasina marilynae n. sp., L. melanoguttata n. sp., and L. minuta n. sp. are described from the headwaters of the rio Curuá, in Serra do Cachimbo, Pará, Brazil, and represent the only members of the Lebiasininae in the Brazilian Shied, so far. A close relationship among these species is proposed based on: 1) the presence of a pair of foramina through which the ramus palatinus of the facial nerve passes, a modification unique in Lebiasinidae and apparently in the Characiformes, 2) the enlargement of the extrascapular bone, 3) the absence of the secondary stripe, and 4) the nearly equal length of caudal-fin lobes. Lebiasina marilynae additionally differs from all congeners in having the primary stripe extending from the tip of the snout to the distal border of the caudal-fin peduncle, the possession of two series of dark blotches parallel to the primary stripe, and a rounded dorsal surface of the mesethmoid. Lebiasina melanoguttata and Lebiasina minuta additionally differ from all congeners in the absence of the primary stripe and the caudal blotch, and the presence of three longitudinal series of dark blotches at the base of the scales of series 3-5. Lebiasina melanoguttata differs from Lebiasina minuta in the absence of a dark blotch at the base of the median rays of the dorsal fin, second infrapharyngobranchial bearing conical teeth, the reddish overall coloration of the eye and fins, and the dark blotches never coalescing (vs. dark dorsal-fin blotch present; the second infrapharyngobranchial being edentulous; dark, olive green eyes, and the yellowish overall color of body and fins; and the dark blotches of longitudinal series 3 and 4 coalescing where scales of adjacent longitudinal series overlap). The occurrence of species of the Lebiasininae on the Brazilian Shield is discussed, and the distribution pattern of the species described herein is compared to that of other endemic species of the Serra do Cachimbo, a highly biodiverse area isolated from the rest of the Amazon basin.

Seven new species of Cerambycidae (Coleoptera) from South America with the proposal of three new genera

The following new species are described - Cerambycinae, Sydacini: Sydax flechtmanni sp. nov. from Brazil (São Paulo); Eburiini: Ebrodacrys biffipradorum sp. nov. from Brazil (Roraima); - Lamiinae, Pteropliini: Ataxia piauiensis sp. nov. from Brazil (Piuaí); Calliini: Amucallia carbonaria sp. nov. from French Guiana; A. citrina sp. nov. from Guiana. Also in Lamiinae, two new genera of Onciderini are proposed. Ubytyra gen. nov., type species U. tuberosa sp. nov. from Peru (Junin) e Japi gen. nov., type species J. duartei sp. nov., from Brazil (São Paulo); Ubytyra gen. nov. can be distinguished by the sides of prothorax with long central spine rounded at apex, and this new feature among Onciderini is discussed. Japi gen. nov., is characterized by a fringe of long hairs on the inner side of antennomere III, present only in species from North and Central America, and gender comparison of these species is done and discussed. In Hemilophini, Pseudotacocha gen. nov., type species P. magnifica sp. nov. from Peru (Cuzco), are described. The new genera can be distinguished by eyes well developed, elytra with two carinae and the apices outer with short spine; a comparison with related genera is done.

Biphasic positive airway pressure minimizes biological impact on lung tissue in mild acute lung injury independent of etiology

Abstract Introduction Biphasic positive airway pressure (BIVENT) is a partial support mode that employs pressure-controlled, time-cycled ventilation set at two levels of continuous positive airway pressure with unrestricted spontaneous breathing. BIVENT can modulate inspiratory effort by modifying the frequency of controlled breaths. Nevertheless, the optimal amount of inspiratory effort to improve respiratory function while minimizing ventilator-associated lung injury during partial ventilatory assistance has not been determined. Furthermore, it is unclear whether the effects of partial ventilatory support depend on acute lung injury (ALI) etiology. This study aimed to investigate the impact of spontaneous and time-cycled control breaths during BIVENT on the lung and diaphragm in experimental pulmonary (p) and extrapulmonary (exp) ALI. Methods This was a prospective, randomized, controlled experimental study of 60 adult male Wistar rats. Mild ALI was induced by Escherichia coli lipopolysaccharide either intratracheally (ALIp) or intraperitoneally (ALIexp). After 24 hours, animals were anesthetized and further randomized as follows: (1) pressure-controlled ventilation (PCV) with tidal volume (Vt) = 6 ml/kg, respiratory rate = 100 breaths/min, PEEP = 5 cmH2O, and inspiratory-to-expiratory ratio (I:E) = 1:2; or (2) BIVENT with three spontaneous and time-cycled control breath modes (100, 75, and 50 breaths/min). BIVENT was set with two levels of CPAP (Phigh = 10 cmH2O and Plow = 5 cmH2O). Inspiratory time was kept constant (Thigh = 0.3 s). Results BIVENT was associated with reduced markers of inflammation, apoptosis, fibrogenesis, and epithelial and endothelial cell damage in lung tissue in both ALI models when compared to PCV. The inspiratory effort during spontaneous breaths increased during BIVENT-50 in both ALI models. In ALIp, alveolar collapse was higher in BIVENT-100 than PCV, but decreased during BIVENT-50, and diaphragmatic injury was lower during BIVENT-50 compared to PCV and BIVENT-100. In ALIexp, alveolar collapse during BIVENT-100 and BIVENT-75 was comparable to PCV, while decreasing with BIVENT-50, and diaphragmatic injury increased during BIVENT-50. Conclusions In mild ALI, BIVENT had a lower biological impact on lung tissue compared to PCV. In contrast, the response of atelectasis and diaphragmatic injury to BIVENT differed according to the rate of spontaneous/controlled breaths and ALI etiology.

Numerical simulation of an ethanol turbulent spray flame with RANS and diffusion combustion model

A detailed numerical simulation of ethanol turbulent spray combustion on a rounded jet flame is pre- sented in this article. The focus is to propose a robust mathematical model with relatively low complexity sub- models to reproduce the main characteristics of the cou- pling between both phases, such as the turbulence modulation, turbulent droplets dissipation, and evaporative cooling effect. A RANS turbulent model is implemented. Special features of the model include an Eulerian– Lagrangian procedure under a fully two-way coupling and a modified flame sheet model with a joint mixture fraction– enthalpy b -PDF. Reasonable agreement between measured and computed mean profiles of temperature of the gas phase and droplet size distributions is achieved. Deviations found between measured and predicted mean velocity profiles are attributed to the turbulent combustion modeling adopted

Estimación del movimiento de objetos en secuencias de imágenes de intensidad y profundidad

Máster Universitario en Sistemas Inteligentes y Aplicaciones Numéricas en Ingeniería (SIANI)

Discontinuity preserving in TV-L1 optical flow methods

[EN] We analyze the discontinuity preserving problem in TV-L1 optical flow methods. This type of methods typically creates rounded effects at flow boundaries, which usually do not coincide with object contours. A simple strategy to overcome this problem consists in inhibiting the diffusion at high image gradients. In this work, we first introduce a general framework for TV regularizers in optical flow and relate it with some standard approaches. Our survey takes into account several methods that use decreasing functions for mitigating the diffusion at image contours. Consequently, this kind of strategies may produce instabilities in the estimation of the optical flows. Hence, we study the problem of instabilities and show that it actually arises from an ill-posed formulation. From this study, it is possible to come across with different schemes to solve this problem. One of these consists in separating the pure TV process from the mitigating strategy. This has been used in another work and we demonstrate here that it has a good performance. Furthermore, we propose two alternatives to avoid the instability problems: (i) we study a fully automatic approach that solves the problem based on the information of the whole image; (ii) we derive a semi-automatic approach that takes into account the image gradients in a close neighborhood adapting the parameter in each position. In the experimental results, we present a detailed study and comparison between the different alternatives. These methods provide very good results, especially for sequences with a few dominant gradients. Additionally, a surprising effect of these approaches is that they can cope with occlusions. This can be easily achieved by using strong regularizations and high penalizations at image contours.

Experimental study on Carbon FRP-confined elliptical concrete columns

It is well recognized that the technique of strengthening reinforced concrete (RC) using fiber-reinforced polymer (FRP) jackets is more effective for circular sections, but less effective for rectangular sections. Indeed the presence of angular corners does not permit a uniform confinement to be provided by the FRP jackets to the columns. While rounded corners can enhance the effectiveness of FRP confinement, it will be more efficient to modify the rectangular section into an elliptical section. In addition to the better confinement effectiveness, from an aesthetical point of view, the shape modification would be a surprise to the built environment. This paper presents an experimental study on the behavior of FRP-confined concrete columns with elliptical section. Thirty-two short columns, divided in eight batches, were tested under axial compression. Each batch presents four specimens with different elliptical sections, determined by the aspect ratio a/b, that is the ratio between the minor and mayor axis. By varying this value from 1.0 to 2.0 (1.0, 1.3., 1.7, 2.0), the section becomes more and more elliptical starting from a circular shape. In this way it is possible to study the trend of effectiveness of FRP confinement for different section geometries. It is also interesting to study how the confinement effectiveness may vary by changing the cylinder strength of concrete and the number of the layers of CFRP. For this reason, a cylinder strength of concrete of 25 and 45 MPa have been used for the present research work, and half of the specimens were wrapped by one layer of CFRP, while the remaining specimens were wrapped with two layers. A simple analysis of the results has been carried out for evaluating the experimental work described in the present document. Further studies and analysis on this work should help to achieve a new and more accurate stress-strain model for CFRP-confined concrete columns with an elliptical section.

Inflammatory myofibroblastic tumour of the lung in a five-year-old girl

The inflammatory myofibroblastic tumour of the lung is considered a rare diagnosis of lung masses. We report the case of a five-year-old girl who presented with recurrent pyrexia, dry cough, and shortness of breath. Chest X-ray and computed tomography showed a total atelectasis of the left lower lobe and a segmental atelectasis of the left upper lobe. The mass was removed in toto, histopathology revealed the diagnosis of an inflammatory myofibroblastic tumour of the lung. The patient is without any signs of relapse 30 months after surgery.

Influence of fluid and volume state on PaO(2) oscillations in mechanically ventilated pigs

ABSTRACT Varying pulmonary shunt fractions during the respiratory cycle cause oxygen oscillations during mechanical ventilation. In artificially damaged lungs, cyclical recruitment of atelectasis is responsible for varying shunt according to published evidence. We introduce a complimentary hypothesis that cyclically varying shunt in healthy lungs is caused by cyclical redistribution of pulmonary perfusion. Administration of crystalloid or colloid infusions would decrease oxygen oscillations if our hypothesis was right. Therefore, n = 14 mechanically ventilated healthy pigs were investigated in 2 groups: crystalloid (fluid) versus no-fluid administration. Additional volume interventions (colloid infusion, blood withdrawal) were carried out in each pig. Intra-aortal PaO(2) oscillations were recorded using fluorescence quenching technique. Phase shift of oxygen oscillations during altered inspiratory to expiratory (I:E) ventilation ratio and electrical impedance tomography (EIT) served as control methods to exclude that recruitment of atelectasis is responsible for oxygen oscillations. In hypovolemia relevant oxygen oscillations could be recorded. Fluid and volume state changed PaO(2) oscillations according to our hypothesis. Fluid administration led to a mean decline of 105.3 mmHg of the PaO(2) oscillations amplitude (P < 0.001). The difference of the amplitudes between colloid administration and blood withdrawal was 62.4 mmHg in pigs not having received fluids (P = 0.0059). Fluid and volume state also changed the oscillation phase during altered I:E ratio. EIT excluded changes of regional ventilation (i.e., recruitment of atelectasis) to be responsible for these oscillations. In healthy pigs, cyclical redistribution of pulmonary perfusion can explain the size of respiratory-dependent PaO(2) oscillations.

The Clearing Storm: A Re-Assessment of the Climate for Collaboration between Academic and Student Affairs

There is increasing recognition among those in higher education that it is no longer adequate to train students in a specific field or industry. Instead, the push is more towards producing well-rounded students. In order to do so, all of a university’s resources must come together and the climate on campus must be one that supportscollaboration. This report is a re-examination of the climate for collaboration on the campus of a private liberal arts university in the Mid-Atlantic region of the United States. It is a follow up to a similar investigation conducted on the same campus by Victor Arcelus(2008) five years earlier. In the interim, the university had re-configured its organizational structure, combining separate academic and student affairs divisions into a single unit overseen by the Provost. Additionally, the university had experienced turnover in several key leadership positions, including those of the President and the chief academic and student affairs officers. The purpose of this investigation, therefore, was to gauge the immediate impact of these changes on conditions for collaboration, which when present, advance student learning and development. Through interviews with six men and women, information was collected on the perceived climate for collaboration between academic and student affairs personnel.Analysis of the interview transcripts revealed that, depending on the position of the interviewee within the university, conditions on campus were seen as either improved or largely unchanged as a result of the transition in leadership and the structural merger of the two divisions.

Respiratory function during anesthesia: effects on gas exchange

Anaesthesia causes a respiratory impairment, whether the patient is breathing spontaneously or is ventilated mechanically. This impairment impedes the matching of alveolar ventilation and perfusion and thus the oxygenation of arterial blood. A triggering factor is loss of muscle tone that causes a fall in the resting lung volume, functional residual capacity. This fall promotes airway closure and gas adsorption, leading eventually to alveolar collapse, that is, atelectasis. The higher the oxygen concentration, the faster will the gas be adsorbed and the aleveoli collapse. Preoxygenation is a major cause of atelectasis and continuing use of high oxygen concentration maintains or increases the lung collapse, that typically is 10% or more of the lung tissue. It can exceed 25% to 40%. Perfusion of the atelectasis causes shunt and cyclic airway closure causes regions with low ventilation/perfusion ratios, that add to impaired oxygenation. Ventilation with positive end-expiratory pressure reduces the atelectasis but oxygenation need not improve, because of shift of blood flow down the lung to any remaining atelectatic tissue. Inflation of the lung to an airway pressure of 40 cmH2O recruits almost all collapsed lung and the lung remains open if ventilation is with moderate oxygen concentration (< 40%) but recollapses within a few minutes if ventilation is with 100% oxygen. Severe obesity increases the lung collapse and obstructive lung disease and one-lung anesthesia increase the mismatch of ventilation and perfusion. CO2 pneumoperitoneum increases atelectasis formation but not shunt, likely explained by enhanced hypoxic pulmonary vasoconstriction by CO2. Atelectasis may persist in the postoperative period and contribute to pneumonia.

Differential roles of Rho-kinase and myosin light chain kinase in regulating shape, adhesion, and migration of HT1080 fibrosarcoma cells

We present evidence for differential roles of Rho-kinase and myosin light chain kinase (MLCK) in regulating shape, adhesion, migration, and chemotaxis of human fibrosarcoma HT1080 cells on laminin-coated surfaces. Pharmacological inhibition of Rho-kinase by Y-27632 or inhibition of MLCK by W-7 or ML-7 resulted in significant attenuation of constitutive myosin light chain phosphorylation. Rho-kinase inhibition resulted in sickle-shaped cells featuring long, thin F-actin-rich protrusions. These cells adhered more strongly to laminin and migrated faster. Inhibition of MLCK in contrast resulted in spherical cells and marked impairment of adhesion and migration. Inhibition of myosin II activation with blebbistatin resulted in a morphology similar to that induced by Y-27632 and enhanced migration and adhesion. Cells treated first with blebbistatin and then with ML-7 also rounded up, suggesting that effects of MLCK inhibition on HT1080 cell shape and motility are independent of inhibition of myosin activity.