Electron microscopic demonstration of centrifugal nerve fibers in the human optic nerve

Electron microscopic views of centrifugal nerve fibers in the optic nerve stump of a 56-year-old man are presented. These nerve fibers had survived for 16 days after removal of the corresponding eyeball and exhibited terminal swellings pointing in a distal direction and indicating axoplasmic flow towards the removed eye. The centrifugal nerves in this adult lack any evidence of attempted regeneration that has earlier been observed under similar conditions in the optic nerve stump of a child. Zentrifugale (antidrome, efferente) Nervenfasern sind hier zum ersten Mal mit dem Elektronenmikroskop im menschlichen Sehnerven dargestellt worden. Diese Nervenfasern wurden in dem Sehnervenstumpf eines 56jährigen Mannes 16 Tage nach der Entfernung des dazugehörigen Auges gefunden. Endschwellungen dieser Nervenfasern waren distal ausgerichtet und deuteten damit einen Axoplasmafluß in Richtung des entfernten Auges an. Während deutliche Regenerationsversuche an den distalen Enden unterbrochener zentrifugaler Nervenfasern im Sehnervenstumpf eines Kindes früher beobachtet worden sind, fanden sich im Sehnerven dieses Erwachsenen keinerlei Zeichen von Regeneration der zentrifugalen Fasern.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47369/1/417_2004_Article_BF00414787.pd

Immunocompromised patients with acute respiratory distress syndrome : Secondary analysis of the LUNG SAFE database

The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013