Failure of a repeat course of cyclooxygenase inhibitor to close a PDA is a risk factor for developing chronic lung disease in ELBW infants

<p>Abstract</p> <p>Background</p> <p>The optimal treatment regimen or protocol for managing a persistent patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants has not been well established. This study was aimed at evaluating the failure rate of a cyclooxygenase (COX) inhibitor (COI) for PDA closure and to determine the incidence of a PDA requiring ligation in ELBW infants. We examined the clinical characteristics and risk factors that may predict the clinical consequences of failure of PDA closure by COI.</p> <p>Methods</p> <p>Medical information on 138 infants with birth weight (BW) < 1000 gm who survived for > 48 hours was retrieved. Clinical characteristics and outcomes of patients whose PDAs closed with COI were compared with those who did not close.</p> <p>Results</p> <p>Of the 138 patients, 112 survived to discharge. Eighty (71.4%) of those who survived received 1-3 courses of COI treatment for a symptomatic PDA. A total of 32 (40%) failed COI treatment and underwent PDA ligation. Multivariable logistic regression analysis suggests that the observed differences in the outcomes in infants with or without symptomatic PDA can be explained by the babies with symptomatic PDA being more immature and sicker. No significant difference was seen in the incidence of chronic lung disease (CLD) in infants whose PDA was treated medically versus those who failed medical treatment and then underwent ligation. However, after adjusting for disease severity and other known risk factors, the odds ratio of developing CLD for surviving babies with a persistent PDA compared to those whose PDA was successfully closed with 1-2 courses of COI is 3.24 (1.07-9.81; p = 0.038).</p> <p>Conclusions</p> <p>When successfully treated, PDA in ELBW infants did not contribute significantly to the adverse outcomes such as CLD, retinopathy of prematurity (ROP) and age at discharge. This suggests that it is beneficial for a hemodynamically significant PDA to be closed. The failure of a repeat course of COI to close a PDA is a major risk factor for developing CLD in ELBW infants.</p

Van der Pol and the history of relaxation oscillations: Toward the emergence of a concept

International audienceRelaxation oscillations are commonly associated with the name of Balthazar van der Pol via his eponymous paper (Philosophical Magazine, 1926) in which he apparently introduced this terminology to describe the nonlinear oscillations produced by self-sustained oscillating systems such as a triode circuit. Our aim is to investigate how relaxation oscillations were actually discovered. Browsing the literature from the late 19th century, we identified four self-oscillating systems in which relaxation oscillations have been observed: i) the series dynamo machine conducted by Gérard-Lescuyer (1880), ii) the musical arc discovered by Duddell (1901) and investigated by Blondel (1905), iii) the triode invented by de Forest (1907) and, iv) the multivibrator elaborated by Abraham and Bloch (1917). The differential equation describing such a self-oscillating system was proposed by Poincaré for the musical arc (1908), by Janet for the series dynamo machine (1919), and by Blondel for the triode (1919). Once Janet (1919) established that these three self-oscillating systems can be described by the same equation, van der Pol proposed (1926) a generic dimensionless equation which captures the relevant dynamical properties shared by these systems. Van der Pol's contributions during the period of 1926-1930 were investigated to show how, with Le Corbeiller's help, he popularized the "relaxation oscillations" using the previous experiments as examples and, turned them into a concept