L'hyperréactivité bronchique et son importance pour le clinician [Bronchial hyperresponsiveness and its importance for the clinician].

Asthma is a chronic inflammatory airway disease, characterised by bronchial hyperresponsiveness causing bronchoconstriction, and thereby provoking typical symptoms (dyspnoea, cough, wheezing). Bronchial hyperres- ponsiveness indicates a temporary airflow limitation when exposed to a bronchoconstricting stimulus. Its measurement by challenge tests can be a valuable tool for confirming or excluding asthma, as well as for evaluating the efficacy of treatment. However, the origin of bronchial hyperresponsiveness is multifactorial and the different challenge tests are not equivalent. Direct challenge tests, like methacholine, mainly reflect chronic airway remo- delling, whereas indirect tests, like mannitol, better reflect bronchial inflammation.

Development of the BG-Malaria trap as an alternative to human-landing catches for the capture of Anopheles darlingi

Although the human-landing catch (HLC) method is the most effective for collecting anthropophilic anophelines, it has been increasingly abandoned, primarily for ethical considerations. The objective of the present study was to develop a new trap for the collection of Anopheles darlingi . The initial trials were conducted using the BG-Sentinel trap as a standard for further trap development based on colour, airflow direction and illumination. The performance of the trap was then compared with those of the CDC, Fay-Prince, counterflow geometry trap (CFG) and HLC. All trials were conducted outdoors between 06:00 pm-08:00 pm. Female specimens of An. darlingi were dissected to determine their parity. A total of 8,334 anophelines were captured, of which 4,945 were identified as An. darlingi . The best trap configuration was an all-white version, with an upward airflow and no required light source. This configuration was subsequently named BG-Malaria (BGM). The BGM captured significantly more anophelines than any of the other traps tested and was similar to HLC with respect to the number and parity of anophelines. The BGM trap can be used as an alternative to HLC for collecting anophelines.

Capacité de travail en cas d'affections pulmonaires

This short review begins by defining some basic medico-legal concepts such as "impairment" and "disability" and gives the corresponding terms in French and German. It is then shown how, in stable obstructive and restrictive respiratory diseases such as COPD and lung fibrosis, the degree of impairment can be assessed on the basis of FEV1 and indices of gas exchange. In the case of bronchial asthma, however, with its typically variable degree of airflow limitation, the amount of reversibility and treatment necessary to achieve optimum bronchodilatation must be taken into account. This can best be done using a score system. Impairment represents a base but in no way equals the final percentage of disability pension or compensation, which are always assessed by the competent administrative authority. However, it is the physician who specifies the amount and type of work an individual patient, with his or her particular degree of disability, can or cannot be expected to do.

Non-invasive monitoring of diaphragmatic timing by means of surface contact sensors: an experimental study in dogs

Background: Non-invasive monitoring of respiratory muscle function is an area of increasing research interest, resulting in the appearance of new monitoring devices, one of these being piezoelectric contact sensors. The present study was designed to test whether the use of piezoelectric contact (non-invasive) sensors could be useful in respiratory monitoring, in particular in measuring the timing of diaphragmatic contraction.Methods: Experiments were performed in an animal model: three pentobarbital anesthetized mongrel dogs. The motion of the thoracic cage was acquired by means of a piezoelectric contact sensor placed on the costal wall. This signal is compared with direct measurements of the diaphragmatic muscle length, made by sonomicrometry. Furthermore, to assess the diaphragmatic function other respiratory signals were acquired: respiratory airflow and transdiaphragmatic pressure. Diaphragm contraction time was estimated with these four signals. Using diaphragm length signal as reference, contraction times estimated with the other three signals were compared with the contraction time estimated with diaphragm length signal.Results: The contraction time estimated with the TM signal tends to give a reading 0.06 seconds lower than the measure made with the DL signal (-0.21 and 0.00 for FL and DP signals, respectively), with a standard deviation of 0.05 seconds (0.08 and 0.06 for FL and DP signals, respectively). Correlation coefficients indicated a close link between time contraction estimated with TM signal and contraction time estimated with DL signal (a Pearson correlation coefficient of 0.98, a reliability coefficient of 0.95, a slope of 1.01 and a Spearman's rank-order coefficient of 0.98). In general, correlation coefficients and mean and standard deviation of the difference were better in the inspiratory load respiratory test than in spontaneous ventilation tests.Conclusion: The technique presented in this work provides a non-invasive method to assess the timing of diaphragmatic contraction in canines, using a piezoelectric contact sensor placed on the costal wall.

Small airways function declines after allogeneic haematopoietic stem cell transplantation.

Bronchiolitis obliterans (BO) following allogeneic haematopoietic stem cell transplantation (HSCT) affects peripheral airways. Detection of BO is presently delayed by the low sensitivity of spirometry. We examined the relationship between peripheral airway function and time since HSCT, and compared it with spirometry and clinical indices in 33 clinically stable allogeneic HSCT recipients. The following measurements were performed: lung function, exhaled nitric oxide, forced oscillatory respiratory system resistance and reactance, acinar (S(acin)) and conductive airways ventilation heterogeneity and lung clearance index (LCI) measured by multiple breath nitrogen washout. 22 patients underwent repeat visits from which short-term changes were examined. Median time post HSCT was 12 months. Eight patients were clinically diagnosed as having BO. In multivariate analysis, time since HSCT was predicted by S(acin) and forced expiratory volume in 1 s % predicted. 20 patients had abnormal S(acin) with normal spirometry, whereas none had airflow obstruction with normal S(acin). S(acin) and LCI were the only measures to change significantly between two visits, with both worsening. Change in S(acin) was the only parameter to correlate with change in chronic graft-versus-host disease grade. In conclusion, peripheral airways ventilation heterogeneity worsens with time after HSCT. S(acin) may be more sensitive than spirometry in detecting BO at an early stage, which needs confirmation in a prospective study.

Spirometric abnormalities in patients with Fabry disease and effect of enzyme replacement therapy

Aim: Fabry disease is an X-linked genetic disorder due to deficiency of the lysosomal enzyme a-galactosidase A, which leads to the accumulation of neutral glycosphingolipids within the lysosomes of almost all tissues. Clinical manifestations usually include acroparaesthesia, renal insufficiency and cardiomyopathy. Recently, pulmonary manifestations consisting of progressive obstructive airway disease have been reported. The aim of this study was to analyse the cross-sectional prevalence of airflow obstruction in a Swiss cohort of patients, and in selected cases, to evaluate the impact of enzyme replacement therapy (ERT) with agalsidase alfa (ReplagalTM; TKT - 5S). Methods: Forty-four patients (27 men, 17 women) were included in the study and received pulmonary function testing. Fifteen patients underwent spirometry after ERT. Results: Twelve patients (nine men) had chronic obstructive pulmonary disease according to the Global Obstructive Lung Disease (GOLD) initiative criteria: forced expiratory volume (FEV1)/forced vital capacity (FVC) 50.7), but only one was an active smoker and one a previous smoker. FEV1/ FVC as percentage predicted was weakly correlated with age (r=0.42, p=0.005, calculated by Pearson product-moment correlation), demonstrating that airway obstruction occurs in the late stages of the disease. Median FEV1 in patients with obstruction was 67% of predicted (range, 45-90%). Reversibility of FEV1 after b2-agonist inhalation never exceeded 8% of predicted. Diffusing capacity of the lung for carbon monoxide (DLCO) was measured in 13 individuals with a median of 88% of predicted (range, 39-125%). After 15+9 months of ERT, spirometry measurements were recorded in 15 patients. Decline in FEV1 was -2+5% of predicted. (p40.05, measured by the Wilcoxon signed-rank test). Median change in DLCO was -10% of predicted (-40 to +25%, p40.05). High resolution computed tomography scans demonstrated a moderate thickening of the bronchial wall in affected individuals, without evidence of emphysema. Conclusion: We conclude that Fabry disease can be complicated by significant airway obstruction, particularly in patients in the advanced stages of the disease, and that in the period studied, ERT had no demonstrable impact on pulmonary function.

Sniff nasal inspiratory pressure in patients with chronic obstructive pulmonary disease.

In subjects with normal lung mechanics, inspiratory muscle strength can be reliably and easily assessed by the sniff nasal inspiratory pressure (SNIP), which is the pressure measured in an occluded nostril during a maximal sniff performed through the contralateral nostril. The aim of this study was to assess the validity of the SNIP in patients with chronic obstructive pulmonary disease (COPD), where pressure transmission from alveoli to upper airways is likely to be dampened. Twenty eight patients with COPD were studied (mean forced expiratory volume in one second (FEV1) = 36% of predicted). The SNIP and the sniff oesophageal pressure (sniff Poes) were measured simultaneously during maximal sniffs, and were compared to the maximal inspiratory pressure obtained against an occlusion (MIP). All measurements were performed from functional residual capacity in the sitting position. The ratio SNIP/sniff Poes was 0.80, and did not correlate with the degree of airflow limitation. The ratio MIP/sniff Poes was 0.87, and the ratio SNIP/MIP was 0.97. Inspiratory muscle weakness, as defined by a low sniff Poes, was present in 17 of the 28 patients. A false diagnosis of weakness was made in eight patients when MIP was considered alone, in four when SNIP was considered alone, and in only three patients when MIP and SNIP were combined. We conclude that both the sniff nasal inspiratory pressure and the maximal inspiratory pressure moderately underestimate sniff oesophageal pressure in chronic obstructive pulmonary disease. Although suboptimal in this condition, the sniff nasal inspiratory pressure appears useful to complement the maximal inspiratory pressure for assessing inspiratory muscle strength in patients with chronic obstructive pulmonary disease.

Diagnosis of periprosthetic joint infections.

Advances in implant design, surgical technique, peri-operative antimicrobial prophylaxis and laminar airflow operating room environment have made total joint arthroplasty one of the most successful surgical procedures of all times. Orthopaedic implants, however, remain prone to microbial contamination resulting in persistent risk of implant-associated infection. Treatment of infections associated with orthopaedic devices usually requires appropriate surgical intervention combined with a prolonged antimicrobial therapy. The choice of the best possible treatment regimen depends on duration and pathogenesis of infection, stability of the implant, antimicrobial susceptibility of the pathogen and condition of the surrounding soft tissue. In addition towell known diagnostic procedures new promising tools for rapid and correct microbial diagnosis are being developed as correct diagnosis of the responsible micro-organism and this is paramount for successful treatment of prosthetic joint infection.

Solid-phase microextraction as short-term sampling technique for BTEX occupational exposure

Solid phase microextraction (SPME) has been widely used for many years in various applications, such as environmental and water samples, food and fragrance analysis, or biological fluids. The aim of this study was to suggest the SPME method as an alternative to conventional techniques used in the evaluation of worker exposure to benzene, toluene, ethylbenzene, and xylene (BTEX). Polymethylsiloxane-carboxen (PDMS/CAR) showed as the most effective stationary phase material for sorbing BTEX among other materials (polyacrylate, PDMS, PDMS/divinylbenzene, Carbowax/divinylbenzene). Various experimental conditions were studied to apply SPME to BTEX quantitation in field situations. The uptake rate of the selected fiber (75 μm PDMS/CAR) was determined for each analyte at various concentrations, relative humidities, and airflow velocities from static (calm air) to dynamic (>200 cm/s) conditions. The SPME method also was compared with the National Institute of Occupational Safety and Health method 1501. Unlike the latter, the SPME approach fulfills the new requirement for the threshold limit value-short term exposure limit (TLV-STEL) of 2.5 ppm for benzene (8 mg/m3).

Identification and prospective validation of clinically relevant chronic obstructive pulmonary disease (COPD) subtypes.

Background Chronic obstructive pulmonary disease (COPD) is increasingly considered a heterogeneous condition. It was hypothesised that COPD, as currently defined, includes different clinically relevant subtypes. Methods To identify and validate COPD subtypes, 342 subjects hospitalised for the first time because of a COPD exacerbation were recruited. Three months after discharge, when clinically stable, symptoms and quality of life, lung function, exercise capacity, nutritional status, biomarkers of systemic and bronchial inflammation, sputum microbiology, CT of the thorax and echocardiography were assessed. COPD groups were identified by partitioning cluster analysis and validated prospectively against cause-specific hospitalisations and all-cause mortality during a 4 year follow-up. Results Three COPD groups were identified: group 1 (n ¼ 126, 67 years) was characterised by severe airflow limitation (postbronchodilator forced expiratory volume in 1 s (FEV 1 ) 38% predicted) and worse performance in most of the respiratory domains of the disease; group 2 (n ¼ 125, 69 years) showed milder airflow limitation (FEV 1 63% predicted); and group 3 (n ¼ 91, 67 years) combined a similarly milder airflow limitation (FEV 1 58% predicted) with a high proportion of obesity, cardiovascular disorders, iabetes and systemic inflammation. During follow-up, group 1 had more frequent hospitalisations due to COPD (HR 3.28, p < 0.001) and higher all-cause mortality (HR 2.36, p ¼ 0.018) than the other two groups, whereas group 3 had more admissions due to cardiovascular disease (HR 2.87, p ¼ 0.014). Conclusions In patients with COPD recruited at their first hospitalisation, three different COPD subtypes were identified and prospectively validated:"severe respiratory COPD","moderate respiratory COPD", and"systemic COPD'

Ilmavirtausten laskennallinen mallinnus

Diplomityössä tutkitaan kolmea erilaista virtausongelmaa CFD-mallinnuksella. Yhteistä näille ongelmille on virtaavana aineena oleva ilma. Lisäksi tapausten perinteinen mittaus on erittäin vaikeaa tai mahdotonta. Ensimmäinen tutkimusongelma on tarrapaperirainan kuivain, jonka tuotantomäärä halutaan nostaa kaksinkertaiseksi. Tämä vaatii kuivatustehon kaksinkertaistamista, koska rainan viipymäaika kuivausalueella puolittuu. Laskentayhtälöillä ja CFD-mallinnuksella tutkitaan puhallussuihkun nopeuden ja lämpötilan muutoksien vaikutusta rainan pinnan lämmön- ja massansiirtokertoimiin. Tuloksena saadaan varioitujen suureiden sekä massan- ja lämmönsiirtokertoimien välille riippuvuuskäyrät, joiden perusteella kuivain voidaan säätää parhaallamahdollisella tavalla. Toinen ongelma käsittelee suunnitteilla olevan kuparikonvertterin sekundaarihuuvan sieppausasteen optimointia. Ilman parannustoimenpiteitä käännetyn konvertterin päästöistä suurin osa karkaa ohi sekundaarihuuvan. Tilannetta tutkitaan konvertterissa syntyvän konvektiivisen nostevirtauksen eli päästöpluumin sekä erilaisten puhallussuihkuratkaisujen CFD-mallinnuksella. Tuloksena saadaan puhallussuihkuilla päästöpluumia poikkeuttava ilmaverho. Suurin osa nousevasta päästöpluumista indusoituu ilmaverhoon ja kulkeutuu poistokanavaan. Kolmas tutkittava kohde on suunnitteilla oleva kuparielektrolyysihalli, jossa ilmanvaihtoperiaatteena on luonnollinen ilmanvaihto ja mekaaninen happosumun keräysjärjestelmä. Ilmanvaihtosysteemin tehokkuus ja sisäilman virtaukset halutaan selvittää ennen hallin rakentamista. CFD-mallinnuksella ja laskentayhtälöillä tutkitaan lämpötila- ja virtauskentät sekä hallin läpi virtaava ilmamäärä ja ilmanvaihtoaste. Tulo- ja poistoilma-aukkojen mitoitukseen ja sijoitukseen liittyvät suunnitteluarvot varmennetaan sekä löydetään ilmanvaihdon ongelmakohdat. Ongelmakohtia tutkitaan ja niille esitetään parannusehdotukset.

LTO- laitteiden vuosihyötysuhteiden vertailututkimus

Tämän työn tavoitteena oli laskea ja vertailla eroja lämmön talteenottolaitteistojen vuosihyötysuhteissa. Tavoitteena oli erityisesti löytää selkeät perusteet Suomen Rakennusmääräyskokoelman osassa D2 esitetyille arvoille vuosihyötysuhdetta laskettaessa. Työn kirjallisuusosassa on käsitelty yleisellä tasolla erityyppisten lämmön talteenottolaitteistojen teoriaa, toimintaperiaatteita ja soveltuvuutta erilaisiin käyttöolosuhteisiin. Työn empiirisessä osassa selvitettiin laboratorio-olosuhteissa virtauksessa mitattujen lämpötila- ja kosteusolosuhteiden vaikutusta lämmön talteenottolaitteiden toimintaan. Lisäksi työssä esitellään yleisellä tasolla mittauksissa käytettyjen mittalaitteiden toimintaa. Suoritettujen mittausten ja laskennan perusteella havaittiin, että laitteistojen vuosihyötysuhteiden välille saatiin odotetunlaisia eroja. Parhaimpiin tuloksiin päästiin regeneratiivisella lämmön talteenottolaitteella.

Ilmakehan hiukkasmaisten ioniyhdisteiden online-mittaus

Ilmakehän hiukkaset aiheuttavat merkittäviä ympäristö- ja terveyshaittoja, joihin vaikuttaa hiukkasten kemiallinen koostumus. Hiukkasten kemiallisesta koostumuksesta voidaan hankkia tietoa hiukkasmittauksilla. Työn tavoitteena oli rakentaa jatkuvatoiminen mittausjärjestelmä, jolla voidaan mitata ilmakehän aerosolihiukkasten ionipitoisuuksia. Mittausjärjestelmä koostuu virtuaali-impaktorista, denuderputkista, PILS-laitteesta ja ionikromatografista. Näyteilmavirtaus kulkee ensin esierottimena toimivan virtuaali-impaktorm lävitse, joka poistaa aerodynaamiselta halkaisijaltaan 1,3 um:a suuremmat hiukkaset ilmavirtauksesta. Näyte, joka sisältää 1,3 um:a pienemmät hiukkaset kulkee virtuaali-impaktorin jälkeen kahden 1 % KOH-liuoksella käsitellyn denuderputken lävitse, joilla poistetaan hiukkasmääritystä häiritsevät happamat kaasut näytevirtauksesta. Denuderputkien jälkeen ilmavirtaus saapuu PILS-laitteeseen, jossa hiukkaset kasvatetaan vesihöyryn avulla aerosolipisaroiksi, törmäytetään keräyslevyyn ja sekoitetaan sen jälkeen sisäistä standardiainetta (NaBr) sisältavään kuljetusliuokseen. Kuljetusliuoksen ja aerosolipisaroiden seoksesta koostuva näyteliuos johdetaan PILS-laitteesta ionikromatografille analysoitavaksi. Mittausjärjestelmään liitetyllä ionikromatografilla voidaan analysoida neljä näytetta tunnissa. Näytteistä määritettävät anionit olivat sulfaatti, nitraatti ja kloridi. PILS-mittausjärjestelmää testattiin keräämällä hiukkasnäytteitä samanaikaisesti PILS-laitteella sekä virtuaali-impaktorilla tai suodatinkeräimellä ja vertaamalla saatuja aerosolihiukkasten sulfaattipitoisuuksia keskenään. Testeissa kerättiin joko VOAG-laitteella tuotettuja ammoniumsulfaattihiukkasia tai laboratorion huoneilmaa. PILS-mittausjärjestelmällä mitatut sulfaattipitoisuudet olivat 2-20 % pienempia kuin suodatinkeraimella mitatut, kun kerättiin keinotekoisesti tuotettuja ammoniumsulfaattihiukkasia. Huoneilmaa kerättäessä PILS-mittausjärjestelmällä saadut pitoisuudet olivat noin 10 % pienempiä kuin suodatinkeräystulokset. Koetulokset osoittivat, että mittausjärjestelmällä saadaan analysoiduksi luotettavasti hiukkasten sulfaattipitoisuudet.

Viilukuivurin suunnittelu kuivaustehon ja -laadun parantamiseksi

Työn tarkoitus tutkia viilukuivurin ilmankiertoa. Tietojen pohjalta suunnitellaan alustava 6-kerroskuivuri. Lisäksi diplomityössä tutkitaan erilaisten kuivausparametrien vaikutusta kuivaustapahtumaan. Viilunkuivauksessa on tärkeää tasainen kuivaustulos. Kuivaustapahtumaan vaikuttavat monet parametrit, joista yksi tärkeimmistä on kuivausilman nopeus suuttimissa. Kun viilukuivurin kuivausilman kierto on tasapainossa, saadaan kuivurin jokaisen kerroksen suutinnopeus yhtäläiseksi. Työ tarkastelee kuivurin kennon eri osien: puhaltimen, patterin, kanavien ja suutinlaatikoiden vaikutusta kuivausilman virtaamiin. Tietojen perusteella on tarkoitus optimoida kuivausolosuhteet kennon eri osissa. Teorian lisäksi työssä on tarkasteltu erilaisten virtausmallien avulla kuivausilman kiertoa kennossa. Eri kuivausparametrien vaikutusta on tutkittu viilun kuivumista simuloivalla ohjelmalla. Kuivurin konstruktion kuormituskestävyyttä on arvioitu FEM-malleilla. Lopputuloksena on saatu alustava malli VTS6x6200 kuivurille.

Laivan ilmastointijärjestelmän perussuunnittelu ja mitoitus

Diplomityön tavoitteena on tarkastella risteilyaluksen ilmastointijärjestelmän suunnittelua ilmamäärien mitoituksen kannalta esisuunnitteluvaiheessa ja lopullisia laskelmia tehtäessä. Teoriaosassa tutustutaan hyvän sisäilmaston tekijöihin ja tarkastellaan ilmankäsittelyä laivoissa yleensä. Tilakohtaisia mitoituksia varten työssä esitellään perusteita, joita suunnittelijan on tunnettava ja huomioitava. Työn tuloksena esitellään laskentaohjelma, joka luo pohjaa tarkempaan ilmamäärälaskentaan standardin ISO 7547 mukaisesti. Ohjelman avulla ilmastoitavaan tilaan saadaan raitisilmamäärään, ilmanvaihtokertoimeen tai lämpökuormiin perustuva ilmamäärä. Esisuunnitteluvaiheessa alustavia ilmamäärälaskelmia tarvitaan tilavarausten riittävyyden tarkasteluun sekä tarjouskeskustelujen aloittamiseen toimittajien kanssa. Ilmamäärän arviointi perustuu vertailulaivoista määritettyihin eri tilatyyppien ja tilojen keskimääräisiin ilmanvaihtokertoimiin. Tilatyyppeihin perustuvilla kertoimilla saadaan tietokoneen avulla nopeasti karkea kuva ilmamäärien suuruusluokasta, tilabudjetin nimityksiin perustuvalla menetelmällä saadaan tarkempia arvioita ilmamääristä.