Long-term persistence of hemopoietic chimerism following sex-mismatched bone marrow transplantation

Wegener's granulomatosis is a distinct clinicopathologic entity characterized by granulomatous vasculitis of the upper and lower respiratory tract and glomerulonephritis. This disease can present as a clinical picture which resembles sepsis and adult respiratory distress syndrome (ARDS). Wegener's disease requires immunosuppression which can have detrimental consequences when used in sepsis. The following case report illustrates the diagnostic difficulties encountered by intensive care physicians treating severe pulmonary failure and multiple organ dysfunction in Wegener's granulomatosis appearing as ARDS with sepsis. CASE REPORT: A 19-year-old female patient had developed acute respiratory and renal failure after a prolonged period (many months) of antibiotic resistant otitis, sinusitis and mastoiditis. The patient had required intubation at another hospital and there was a history of tension pneumothorax and cardiopulmonary resuscitation during mechanical ventilation. Emergency extracorporeal membrane oxygenation (ECMO) for acute hypercapnic and hypoxic respiratory failure was instituted and the patient was transported to our institution while on ECMO. The patient was treated empirically for suspected pulmonary and systemic infection and received hydrocortisone (0.18 mg/kg/h) as part of a protocol-driven treatment of septic shock in addition to antibiotic and antimycotic regime. The use of ECMO was required for 10 and mechanical ventilation for another 50 days after admission. After successful extubation, central nervous system dysfunction became evident with a somnolent and generally unresponsive patient. When the hydrocortisone dose was gradually tapered, the clinical status of the patient further deteriorated, pulmonary gas exchange worsened and she developed renal failure with proteinura and hematuria. A renal biopsy was performed demonstrating vasculitis and focal segmental glomerulonephritis, a systemic granulomatous vasculitis was suspected; the serum was tested for anti-proteinase 3 antibodies (PR3-ANCA) and turned out to be positive (17.5 U/ml; normal range < 7 U/ml). The morphologic findings from renal biopsy, the positive test for antiproteinase 3 antibodies and the pulmonary-renal involvement with evidence of multisystem disease established the diagnosis of Wegener's granulomatosis. Immunosuppressive therapy with cyclophosphamide and prednisolone was instituted resulting in rapid improvement with recovery of pulmonary, renal and central nervous system function within two weeks. The use of ECMO in this patient served as a life-saving immediate measure usefull to "buy time" until a definite diagnosis could be established. ARDS represents an uniform pulmonary reaction to a large number of different noxious stimuli and disease entities. This case demonstrates that intensive care physicians caring for critically ill patients with ARDS should include even rare causes of pulmonary injury into their differential diagnosis.     

Identifying time-dependent changes in the morphology of an individual aerosol particle from its light scattering pattern

The physical, chemical, and biological properties of an aerosol droplet/particle are dependent on the morphology of the droplet/particle itself; for example, a liquid droplet will be processed by oxidants in the gas phase in a fundamentally different way than a solid particle. Additionally, given their small size, aerosol droplets may change phase over timescales in the order of milliseconds (e.g., deliquescence or crystallisation). Thus, ability to rapidly and easily estimate the morphology of a droplet/particle is critical, especially in the interpretation of complex aerosol processes such as spray drying and dissolution. To be reported here is a novel method that uses the forward scattered light (～32° < θ < ～58°) passed through a droplet to determine the droplet/particles morphology. The algorithm was developed through the qualitative analysis of over one million individual phase functions of various particle morphologies. The algorithm can differentiate between four different morphologies: homogeneous, core/shell, with inclusions, and non-spherical/inhomogeneous. The algorithm is applicable to droplets between ～5 to ～30 microns in radius. The rate of phase analysis is dependent on the rate in which the light scatter can be collected, in the data presented here a particle’s morphology is reported every 10 milliseconds. The accuracy of the phase identification with the algorithm proposed in this work is very high (>90%); its utility is strengthened by the high frequency of the collection of scattered light, which allows an individual droplet to be probed upwards of over 100 times per second. Although not absolute on every phase function analysis, when coupled with repetition and high throughput, the algorithm presented here can be a valuable tool to easily and readily determine particle morphology in dynamic aerosol systems.

Copyright © 2019 American Association for Aerosol Research     

Prevalence and correlates of echocardiographic determined left ventricular hypertrophy in 2318 asymptomatic middle-aged men: the ECCIS project. Epidemiolgia e Clinica della Cardiopatia Ischemica Silente

BACKGROUND: Serum levels of eosinophil cationic protein are an indirect measure of airway inflammation in asthma. It is proposed that the extent to which broncho-constriction or airway inflammation contributes to airflow obstruction in acute asthma may determine responsiveness to bronchodilator therapy. OBJECTIVE: To test the hypothesis that subjects with acute asthma exacerbations who respond poorly to inhaled bronchodilator treatment may have more marked airway inflammation than those who respond well to identical therapy. METHODS: Forty-eight asthmatic children who visited the emergency room due to acute exacerbations were studied. Serum levels of eosinophil cationic protein were measured at the time of acute exacerbations and of clinical remissions. At acute exacerbation, FEV1 was assessed before and after the administration of aerosolized salbutamol. RESULTS: The mean serum level of eosinophil cationic protein at acute exacerbation (41.1 +/- 12.8 micrograms/L) was significantly higher (P < .01) than that at clinical remission (30.0 +/- 8.5 micrograms/L) in the study population. The level at acute exacerbation was even higher in group A (n = 18: postbronchodilator FEV1 < 75% predicted) than in group B (n = 30: postbronchodilator FEV1 > or = 75% predicted), whereas both groups showed similar levels at clinical remission. The level at acute exacerbation correlated positively with severity of exacerbation (r = .47, P < .01) and negatively with bronchodilator responses (r = -.56, P < .01). This negative correlation was valid among subjects with a similar degree of exacerbation. CONCLUSION: A higher level of eosinophil cationic protein at acute asthma exacerbation was associated not only with more severe exacerbation but also with a lower degree of bronchodilator responsiveness. This suggests that degree of airway inflammation may be one determinant of degree of responsiveness to initial bronchodilator therapy at acute asthma exacerbation.     

Physiopathology of IL-12 in human solid neoplasms: blood levels of IL-12 in early or advanced cancer patients, and their variations with surgery and immunotherapy

Working with psychotraumatized war veterans we perceived their extremely regressive position, which is accompanied by several destructive and autodestructive compulsions. Facing the multiple traumatic experiences which they lived through, a certain degree of regression has been appearing, since even a satisfying "nourishing-indulgence of their needs" cannot completely make up for their pre-war position. In this way occurred the splitting between ideal (introjected) object and real object, in which were projected all bad experiences, and which is still persecuting and wants to destroy. Through interactions between all group members of traumatized patients we analyzed the phenomena and the specificities of these groups-particularly their regressive position. The aim of the group psychotherapy was to enable progressive overcoming of regressive position and transition into a more mature stage of development, thus creating a favorable climate for growing up and independence.     

MINIT: A new gas detector for very low threshold particle identification

We report on the first results of in-beam tests performed with the MINIT detection technique. Its modular structure of multilayer ionization chamber with proportional avalanche multiplication allows to detect and identify heavy ions with a very low energy threshold. Its simple mechanical structure, based on a glass microstrip plate, should allow the realization of cheap large-area arrays of similar detectors, in view of the next generation of experiments with radioactive ion beams.