Biologic validation of diagnoses of depression

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24517/1/0000796.pd

Expiratory resistances prevent expiratory diaphragm contraction, flow limitation, and lung collapse

Rationale: Tidal expiratory flow limitation (tidal-EFL) is not completely avoidable by applying positive end-expiratory pressure and may cause respiratory and hemodynamic complications in ventilated patients with lungs prone to collapse. During spontaneous breathing, expiratory diaphragmatic contraction counteracts tidal-EFL. We hypothesized that during both spontaneous breathing and controlled mechanical ventilation, external expiratory resistances reduce tidal-EFL. Objectives: To assess whether external expiratory resistances 1) affect expiratory diaphragmatic contraction during spontaneous breathing, 2) reduce expiratory flow and make lung compartments more homogeneous with more similar expiratory time constants, and 3) reduce tidal atelectasis, preventing hyperinflation. Methods: Three positive end-expiratory pressure levels and four external expiratory resistances were tested in 10 pigs after lung lavage. We analyzed expiratory diaphragmatic electric activity and respiratory mechanics. On the basis of computed tomography scans, four lung compartments-not inflated (atelectasis), poorly inflated, normally inflated, and hyperinflated-were defined. Measurements and Main Results: Consequently to additional external expiratory resistances, and mainly in lungs prone to collapse (at low positive end-expiratory pressure), 1) the expiratory transdiaphragmatic pressure decreased during spontaneous breathing by .10%, 2) expiratory flow was reduced and the expiratory time constants became more homogeneous, and 3) the amount of atelectasis at end-expiration decreased from 24% to 16% during spontaneous breathing and from 32% to 18% during controlled mechanical ventilation, without increasing hyperinflation. Conclusions: The expiratory modulation induced by external expiratory resistances preserves the positive effects of the expiratory brake while minimizing expiratory diaphragmatic contraction. External expiratory resistances optimize lung mechanics and limit tidal-EFL and tidal atelectasis, without increasing hyperinflation

Relatively hyperbolic groups

In this paper we develop some of the foundations of the theory of relatively hyperbolic groups as originally formulated by Gromov. We prove the equivalence of two definitions of this notion. One is essentially that of a group admitting a properly discontinuous geometrically finite action on a proper hyperbolic space, that is, such that every limit point is either a conical limit point or a bounded parabolic point. The other is that of a group which admits a cofinite action on a connected fine hyperbolic graph. We define a graph to be "fine" if there are only finitely many circuits a given length containing any given edge, and we develop some of the properties of this notion. We show how a relatively hyperbolic group can be assumed to act on a proper hyperbolic space of a particular geometric form. We define the boundary of a relatively hyperbolic group, and show that the limit set of any geometrically finite action of the group is equivariantly homeomorphic to this boundary. This generalizes a result of Tukia for geometrically finite kleinian groups. We also describe when the boundary is connected. © 2012 World Scientific Publishing Compan