The assessment of the peak of reflex cough in subjects with acquired brain injury and tracheostomy and healthy controls

Introduction: There is no standard procedure to evaluated the peak of reflex cough flow (PCF-reflex) in the literature, which is important assessment in subjects with acquired brain injury and tracheostomy cannula. The present study aims to investigate the PCF of the reflex cough in a broad sample of healthy controls and, furthermore, the presence and the strength of voluntary and reflex cough in subjects with ABI with tracheostomy cannula.Materials and methods: We recruited 147 participants including the healthy subjects (n = 105) and acquired brain injury subjects (n = 43), who underwent respiratory assessment: the Tidal Volume, Forced Vital Capacity, PCF of voluntary cough (PCF-voluntary) and PCF-reflex (using a spirometer connected with a nebulizer by a bidirectional).Results: The PCF-reflex of controls and subjects was significant lower than the PCF-voluntary (P < 0.01). The PCF-voluntary was not assessed in 26 (60.5 %) subjects due to severe cognitive deficit. In subjects without cognitive deficits (n = 17; 39.5 %), it was significantly lower than in healthy controls (p < 0.01). In contrast, the PCF-reflex was completed in all subjects and it was not significantly different from healthy controls. Furthermore, the strength of the PCF-reflex decreased with increasing inhalation numbers of nebulised air.Conclusion: Reflex cough behaviour differs largely from voluntary cough and the PCF results reflect this great discrepancy. PCF-reflex could be useful parameter for assessing the airway protection whereas PCF-voluntary for measuring airway clearance

Modelos matemáticos predador-presa e aplicações ao manejo integrado de pragas

Mathematical modeling of predator-prey and host-parasitoid systems is an important tool for describing the interactions among pests and natural enemies in biological control programs. Predator-prey models developed by Lotka and Volterra have been improved with the insertion of relevant parameters for each type of study. Among the insertions made in models, approaches directed towards the integrated pest management have been implemented to evaluate the effect of insecticides in the predator-prey dynamics. It is possible to infer the effects of insecticide application and evaluate the dynamic behavior resultant of this application in prey, predator or host and parasitoid. One could also add stochasticity to the models’ parameters, in order to obtain dynamic behavior simulations which are closer to reality, with the non-controllable variation effects taken into account. The development of new models is encouraged in this review, so as to the effects of the main factors which influence the dynamics in agroecosystems are more precisely modeled

Efficacy of BoNT-A and swallowing treatment for oropharyngeal dysphagia recovery in a patient with Lateral Medullary Syndrome: a case study

Abstract BACKGROUND: Wallenberg's syndrome (WS) is known as posterior inferior cerebellar artery syndrome. Dysphagia has been reported from 51% to 94% of the patients, ranging from mild to severe. CASE PRESENTATION: We reported a case of a patient (Male; 52yrs) with WS. MRI showed an intense hypodense area in the dorsolateral part of the ponto-medullary junction. The clinical signs were severe dysphagia, fed by PEG (FOIS 1; PAS 7), sialorrhea, trismus and ataxia. CLINICAL REHABILITATION IMPACT: Dysphagia was treated by botulinum toxin tipe A (BoNT-A), which was injected into the parotid and submandibular salivary glands, temporalis and masseter muscles, cricopharyngeal muscle associated with specific swallowing exercise and food trails. The 3-months follow-up showed significant saliva reduction and improvement of swallowing to from PEG feeding to consistent oral intake of food (FOIS 3, PAS 5). The treatment with BoNT-A combined with swallowing rehabilitation was fundamental in order to restore the swallowing functions

Status of the nuclear measurement stations for theprocess control of spent fuel reprocessing at AREVA NC/La Hague

International audienceNuclear measurements are used at AREVA NC/La Hague for the monitoring of spent fuel reprocessing. The process control is based on gamma-ray spectrometry, passive neutron counting and active neutron interrogation, and gamma transmission measurements. The main objectives are criticality-safety, online process monitoring, and the determination of the residual fissile mass and activities in the metallic waste remaining after fuel shearing and dissolution (empty hulls, grids, end pieces), which are put in radioactive waste drums before compaction in stainless steel containers. The whole monitoring system is composed of eight measurement stations which will be described in this paper. The main measurement stations n°1, 3 and 7 are needed for criticality control. Before fuel element shearing for dissolution, station n°1 allows determining the burn-up of the irradiated fuel by gamma-ray spectrometry with HP Ge (high purity germanium) detectors. The burn-up is correlated to the $^{137}$Cs and $^{134}$Cs gamma emission rates. The fuel maximal mass which can be loaded in one bucket of the dissolver is estimated from the lowest burn-up fraction of the fuel element. Station n°3 is dedicated to the control of the correct fuel dissolution, which is performed with a $^{137}$Cs gamma ray measurement with a HP Ge detector. Station n°7 allows estimating the residual fissile mass in the drums filled with the metallic residues, especially the hulls, from passive neutron counting (spontaneous fission and alpha-n reactions) and active interrogation (fission prompt neutrons induced by a pulsed neutron generator) with proportional $^3$He detectors. So far, large campaigns of reprocessing of the UOX fuels with a burn-up rate up to 60 GWd/t have been performed at AREVA/La Hague. This paper presents a brief overview of the current status of the nuclear measurement station

Clinical criteria for tracheostomy deccanulation in subjects with acquired brain injury

none12noBACKGROUND: Patients with acquired brain injury (ABI) often require long periods of having a tracheostomy tube for airway protection and prolonged mechanical ventilation. It has been recognized that fast and safe decannulation improves outcomes and facilitates the recovery process. Nevertheless, few studies have provided evidence for decannulation criteria, despite the high prevalence of ABI subjects with tracheostomies. The aim of our study was to assess which clinical parameters are the best predictors for decannulation in subjects with ABI. METHODS: In this cross-sectional study, we recruited 74 consecutive ABI subjects (mean age 51.52 ± 16.76) with tracheostomy tubes. First, the subjects underwent the original decannulation assessment for cannula removal. Second, they underwent our experimental decannulation protocol. The experimental protocol included: voluntary cough (cough peak flow >160 L/min), reflex cough, tracheostomy tube capping (>72 h), swallowing instrumental assessment (penetration aspiration scale <5), blue dye test, number of trachea suctions, endoscopic assessment of airway patency (lumen diameter >50%), saturation (SpO2 >95%), and level of consciousness evaluation (Glasgow coma scale >8). The reference standard was clinical removal of the tracheostomy tube within 48 h. RESULTS: Parameters showing the highest values of sensitivity and specificity, respectively, were tracheostomy tube capping (80%, 100%), endoscopy assessment of airway patency (100%, 30%), swallowing instrumental assessment (85%, 96%), and the blue dye test (65%, 85%). All these were combined in a clinical cluster parameter, which had higher sensitivity (100%) and specificity (82%). CONCLUSION: These results suggest that the best clinical prediction rule for decannulation in acquired brain injury subjects is a combination of the following assessments: (1) tracheostomy tube capping, (2) endoscopic assessment of patency of airways, (3) swallowing instrumental assessment, and (4) blue dye test.mixedEnrichi C.; Battel I.; Zanetti C.; Koch I.; Ventura L.; Palmer K.; Meneghello F.; Piccione F.; Rossi S.; Lazzeri M.; Sommariva M.; Turolla A.Enrichi C.; Battel I.; Zanetti C.; Koch I.; Ventura L.; Palmer K.; Meneghello F.; Piccione F.; Rossi S.; Lazzeri M.; Sommariva M.; Turolla A