Acute lung injury (ALI) and its severe form, known as acute respiratory distress syndrome (ARDS), are caused by direct pulmonary insults and indirect systemic inflammatory responses that result from ...conditions such as sepsis, trauma, and major surgery. The reciprocal influences between pulmonary and systemic inflammation augments the inflammatory process in the lung and promotes the development of ALI. Emerging evidence has revealed that alveolar macrophage (AM) death plays important roles in the progression of lung inflammation through its influence on other immune cell populations in the lung. Cell death and tissue inflammation form a positive feedback cycle, ultimately leading to exaggerated inflammation and development of disease. Pharmacological manipulation of AM death signals may serve as a logical therapeutic strategy for ALI/ARDS. This review will focus on recent advances in the regulation and underlying mechanisms of AM death as well as the influence of AM death on the development of ALI.
The modelling of volumetric errors of machine tools has been widely used by the method of Homogeneous Transformation Matrix (HTM) based on rigid body kinematics analysis for a long time. Without ...spindle induced errors and thermal errors, to establish a closed-loop HTM for a three-axis machine tool, the total of 21 geometric errors are the primary elements to be known. It is well known that the measured points of translational errors are directly related to the volumetric error at the tool cutting point through rigid body kinematics. In the generalized HTM method, however, this relationship is missing. This report, therefore, proposes a new comprehensive approach to formulate the volumetric errors based on the famous Abbe principle in order to derive the error term in the motion direction, and Bryan principle to derive the error terms in orthogonal to the motion direction. The proposed methodology is simple in concept, rational in physical meaning and easy in implementation. Experimental results, including faster multi-degree-of-freedom error measurements, volumetric error analysis and compensation on a testbed of small machine tool, validate the correctness and effectiveness of this method.
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•This new method is more physically reasonable than the popular Homogeneous Transformation Matrix method.•An embedded sensor system for detecting 5-DOF geometric errors of a linear stage has been developed and equipped into an investigated small NC machine tool.•Through error measurement and compensation experiments, the correctness and feasibility of this new model have been verified.
Domestic violence continues to be a global public health issue, and facial injuries in these cases are common with a reported incidence of up to 94%. Our aims were to identify patients with facial ...injuries caused by domestic violence, and to find out how confident members of the oral and maxillofacial surgical (OMFS) team were at assessing them. In this 18-month retrospective study of patients seen at King’s College Hospital we identified 18 and obtained details on sex, age, nature of maxillofacial injury, mechanism of injury, time to presentation, and alleged assailant, from their electronic records. Most of the patients were female and the mean (range) age was 28 (16-44) years. In 10 cases, the alleged assailant was the patient’s current partner. A total of 15 patients presented on the same day as their injury, and only 3 the following day. Punching was the most common mechanism (n=13) followed by use of a weapon. We also circulated a questionnaire among the OMFS team to gain an insight into their attitudes regarding screening for domestic violence. Most OMFS clinicians were only “somewhat confident” at recognising and asking about domestic violence, and few were “very” or “extremely confident”. Targeted training for frontline staff in OMFS teams is likely to increase their confidence to identify and manage these patients, and to refer them appropriately.
A systematic review and meta-analysis of the entire COVID-19 Tracheostomy cohort was conducted to determine the cumulative incidence of complications, mortality, time to decannulation and ventilatory ...weaning. Outcomes of surgical versus percutaneous and outcomes relative to tracheostomy timing were also analysed. Studies reporting outcome data on patients with COVID-19 undergoing tracheostomy were identified and screened by 2 independent reviewers. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Outcome data were analysed using a random-effects model. From 1016 unique studies, 39 articles reporting outcomes for a total of 3929 patients were included for meta-analysis. Weighted mean follow-up time was 42.03±26 days post-tracheostomy. Meta-analysis showed that 61.2% of patients were weaned from mechanical ventilation 95%CI 52.6%–69.5%, 44.2% of patients were decannulated 95%CI 33.96%–54.67%, and cumulative mortality was found to be 19.23% 95%CI 15.2%–23.6% across the entire tracheostomy cohort. The cumulative incidence of complications was 14.24% 95%CI 9.6%–19.6%, with bleeding accounting for 52% of all complications. No difference was found in incidence of mortality (RR1.96; p=0.34), decannulation (RR1.35, p=0.27), complications (RR0.75, p=0.09) and time to decannulation (SMD 0.46, p=0.68) between percutaneous and surgical tracheostomy. Moreover, no difference was found in mortality (RR1.57, p=0.43) between early and late tracheostomy, and timing of tracheostomy did not predict time to decannulation. Ten confirmed nosocomial staff infections were reported from 1398 tracheostomies. This study provides an overview of outcomes of tracheostomy in COVID-19 patients, and contributes to our understanding of tracheostomy decisions in this patient cohort.
Radiation therapy (RT) and concurrent chemotherapy RT (CCRT) generate radiation‐induced oral mucositis (OM) and lower quality of life (QOL). This study assessed the impact of a saline mouth rinse ...regimen and education programme on radiation‐induced OM symptoms, and QOL in oral cavity cancer (OCC) patients receiving RT or CCRT. Ninety‐one OCC patients were randomly divided into a group that received saline mouth rinses and an education programme and a control group that received standard care. OM symptoms and QOL were assessed with the WHO Oral Toxicity Scale, MSS‐moo and UW‐QOL. Data were collected at the first postoperative visit to the radiation department (T0) and at 4 weeks and 8 weeks after beginning RT or CCRT. Patients in both groups had significantly higher levels of physical and social‐emotional QOL at 8 weeks after beginning RT or CCRT compared to the first visit. Patients in the saline rinse group had significantly better physical and social‐emotional QOL as compared to the standard care group at 8 weeks. Radiation‐induced OM symptoms and overall QOL were not different between the groups. We thus conclude the saline rinse and education programme promote better physical and social‐emotional QOL in OCC patients receiving RT/CCRT.
A cross-sectional survey of
prevalence was conducted among senior primary school pupils of Siphofaneni area, Eswatini. This area is devoid of potable water, with a newly constructed Lubovane dam and ...an LUSIP irrigation scheme. The objective of the study was to investigate the distribution of urinary schistosomiasis among Siphofaneni senior primary school pupils. Using simple random sampling, 200 partcipants were enroled from four of six schools in the area. Ten millimetres (10 ml) of urine samples were obtained from each participant and examined for
eggs. The intensity of the infection was estimated by calculating the total number of
eggs present in 10 ml urine. Out of 200 participants, 45% (n = 91) were males, and 55% (n = 109) were females. The mean age for participants was 13 years, and almost half (47%, n = 94) were in Grade 5. Overall, the prevalence of
infection was 16% (32/200). More than half (59%, 19/32) of the Schistosomiasis cases were from females. Positive and significant associations were observed between the number of eggs (χ
=170.9) and the presence of red blood cells (χ
=49.2) at
= 0.001. In conclusion, the prevalence of Schistosomiasis is high among pupils enrolled in Siphofaneni area primary schools that needs comprehensive treatment and education to prevent from
infection.
The rapid global spread of SARS-CoV-2, the causative agent of COVID-19, has dominated healthcare services, with exponential numbers requiring mechanical ventilation in the intensive care unit (ICU). ...Tracheostomy facilitates respiratory and sedative weaning but risks potential viral transmission. This study reviewed the tracheostomy provision, techniques, and outcomes for a single-centre prospective cohort during the resource-pressured COVID-19 period. Seventy-two of 176 patients underwent tracheostomy at a median 17 days: 44 surgical (open), 28 percutaneous. Their median age was 58 years, the male to female ratio was 2.4:1, 75.1% were of BAME backgrounds, 76% had a BMI≥25kg/m2, and 65% had ≥2 major co-morbidities. Seventy-nine percent of patients were weaned from sedation at a median 2 days, 61% were weaned from mechanical ventilation at a median 10 days, 39% were discharged from the ICU at a median 11.5 days, and 19.4% were discharged home at a median 24 days. All patients survived the procedure. The mortality rate was 9.7% at a median 12 days. No clinician reported COVID-19 symptoms within 14 days of the procedure. The role of tracheostomy in COVID-19 is currently unclear. Delivery of tracheostomy by maxillofacial surgeons relieved the workload pressure from ICU clinicians. The choice of technique was influenced by the patient and resource factors, resulting in a mixed cohort of open and percutaneous tracheostomy in COVID-19 patients. Preliminary data suggest that open tracheostomy is as favourable as percutaneous tracheostomy for COVID-19 patients, and is safe for clinicians.
Patients with severe refractory asthma pose a major healthcare problem. Over the last decade it has become increasingly clear that, for the development of new targeted therapies, there is an urgent ...need for further characterisation and classification of these patients. The Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED) consortium is a pan-European public-private collaboration funded by the European Commission Innovative Medicines Initiative of the European Union. U-BIOPRED aims to subphenotype patients with severe refractory asthma by using an innovative systems biology approach. This paper presents the U-BIOPRED international consensus on the definition and diagnosis of severe asthma, aligning the latest concepts in adults as well as in children. The consensus is based on existing recommendations up to 2010 and will be used for the selection of patients for the upcoming U-BIOPRED study. It includes the differentiation between 'problematic', 'difficult' and 'severe refractory' asthma, and provides a systematic algorithmic approach to the evaluation of patients presenting with chronic severe asthma symptoms for use in clinical research and specialised care.
We demonstrate reconfigurable anisotropic metamaterials at terahertz frequencies where artificial "atoms" reorient within unit cells in response to an external stimulus. This is accomplished by ...fabricating planar arrays of split ring resonators on bimaterial cantilevers designed to bend out of plane in response to a thermal stimulus. We observe a marked tunability of the electric and magnetic response as the split ring resonators reorient within their unit cells. Our results demonstrate that adaptive metamaterials offer significant potential to realize novel electromagnetic functionality ranging from thermal detection to reconfigurable cloaks or absorbers.
New targets for drug development in asthma Adcock, Ian M, Prof; Caramori, Gaetano, MD; Chung, K Fan, Prof
The Lancet (British edition),
09/2008, Letnik:
372, Številka:
9643
Journal Article
Recenzirano
Summary Asthma is a chronic inflammatory disease that affects about 300 million people worldwide, a total that is expected to rise to about 400 million over the next 15–20 years. Most asthmatic ...individuals respond well to the currently available treatments of inhaled corticosteroids and β-adrenergic agonists; however, 5–10% have severe disease that responds poorly. Improved knowledge of asthma mechanisms has led to the recognition of different asthma phenotypes that might reflect distinct types of inflammation, explaining the effectiveness of anti-leucotrienes and the anti-IgE monoclonal antibody omalizumab in some patients. However, more knowledge of the inflammatory mechanisms within the airways is required. Improvements in available therapies—such as the development of fast-onset, once-a-day combination drugs with better safety profiles—will occur. Other drugs, such as inhaled p38 MAPK inhibitors and anti-oxidants, that target specific pathways or mediators could prove useful as monotherapies, but could also, in combination with corticosteroids, reduce the corticosteroid insensitivity often seen in severe asthma. Biological agents directed against the interleukin-13 pathway and new immunoregulatory agents that modulate functions of T-regulatory and T-helper-17 cells are likely to be successful. Patient-specific treatments will depend on the development of discriminatory handprints of distinct asthma subtypes and are probably over the horizon. Although a cure is unlikely to be developed in the near future, a greater understanding of disease mechanisms could bring such a situation nearer to reality.
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