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

Resolved versus confirmed ARDS after 24 h: insights from the LUNG SAFE study

Purpose: To evaluate patients with resolved versus confirmed ARDS, identify subgroups with substantial mortality risk, and to determine the utility of day 2 ARDS reclassification. Methods: Our primary objective, in this secondary LUNG SAFE analysis, was to compare outcome in patients with resolved versus confirmed ARDS after 24\ua0h. Secondary objectives included identifying factors associated with ARDS persistence and mortality, and the utility of day 2 ARDS reclassification. Results: Of 2377 patients fulfilling the ARDS definition on the first day of ARDS (day 1) and receiving invasive mechanical ventilation, 503 (24%) no longer fulfilled the ARDS definition the next day, 52% of whom initially had moderate or severe ARDS. Higher tidal volume on day 1 of ARDS was associated with confirmed ARDS [OR 1.07 (CI 1.01\u20131.13), P = 0.035]. Hospital mortality was 38% overall, ranging from 31% in resolved ARDS to 41% in confirmed ARDS, and 57% in confirmed severe ARDS at day 2. In both\ua0resolved and confirmed\ua0ARDS, age, non-respiratory SOFA score, lower PEEP and P/F ratio, higher peak pressure and respiratory rate were each\ua0associated with mortality. In confirmed ARDS, pH and the presence of immunosuppression or neoplasm were also associated\ua0with mortality. The increase in area under the receiver operating curve for ARDS reclassification on day 2 was marginal. Conclusions: ARDS, whether resolved or confirmed at day 2, has a high mortality rate. ARDS reclassification at day 2 has limited predictive value for mortality. The substantial mortality risk in severe confirmed ARDS suggests that complex interventions might best be tested in this population. Trial Registration: ClinicalTrials.gov NCT02010073. \ua9 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM