Asthma and asthma-like disorders

AbstractBronchial asthma is defined as a chronic inflammatory disease resulting in a reversible and variable bronchial obstruction. For the clinical diagnosis of the disease there are some key indicators but as there is no ‘gold standard’ a correct diagnosis will sometimes not be obtained. Examples are patients in a symptom-free stage, current medication interfering with the methods used, patients with asthma-like symptoms reporting lack of effect of bronchodilators and patients who are unable to perform a forced expiration in an airway function test. The prevalence of asthma is reported to be 5–10%. The prevalence of asthma-like symptoms may be double this.The term ‘asthma-like’ has been used to an increasing extent during the last few years, which may indicate an increasing awareness of the fact that asthma-like symptoms are not always classical asthma. In this overview some disorders with asthma-like symptoms, especially in adults, are presented. The spectrum of differential diagnoses in a clinic may depend on which doctor/specialist the patient is consulting. In an asthma and allergy clinic it has been found that the most common differential diagnoses are chronic obstructive pulmonary disease (COPD), non-asthmatic cough and sensory hyper-reactivity (SHR), a disorder which is sometimes mixed up with asthma due to similar symptoms (heavy breathing, cough, increased secretion, difficulty in getting air etc.) and similar trigger factors (smoke, strong scents, exercise, cold air etc.). Recently it has been suggested that a capsaicin inhalation test may be an objective test for identifying patients with SHR. In asthma effective treatment is available today but in asthma-like disorders, such as SHR, no effective therapy is available, underlining the need of further research for understanding the pathophysiological mechanisms

Exercise-induced respiratory symptoms are not always asthma

AbstractEighty-eight patients with a history of exercise-induced respiratory symptoms performed a maximal exercise test in order to study the reasons for stopping the test. There was a wide range of percentage maximal fall in peak expiratory flow (PEF), from minus 3% to 63%, mean 11%, recorded 0–30 min, mean 12 min after the break. In the controls the maximal decrease was 0–16%, mean 6%. Diagnostic criteria for asthma were fulfilled by 48 patients (55%). Of these patients 42% had a fall in PEF ≥ 15% (exercise-induced asthma). Of the non-asthma patients 10% had a fall ≥ 15%. The most common reason for stopping the exercise in the asthma group was breathing troubles (46%), the most common reason in the non-asthma group was chest pain/discomfort (35%). In about 20% of the patients dizziness and/or pricking sensations in arms or legs indicated hyperventilation as an additional reason for stopping the exercise. It is concluded that other kinds of reaction, than bronchial obstruction such as breathing troubles not directly related to bronchial obstruction and chest pain, may be important factors that can restrict physical capacity in patients with exercise-induced respiratory symptoms

Установка для измерения деформируемости смеси под нагрузкой

Полезная модель относится к области испытаний материалов и может быть использована в литейном производстве, промышленности строительных материало

Stable isotopes of oxygen and hydrogen in meteoric water during the Cryogenian Period

We measured δ18O and δ2H values of muscovite and carbonate mineral separates from metamorphosed carbonate-bearing mudstone layers in late Tonian to early Cryogenian strata, including Sturtian glacial deposits, which were deposited in a coastal setting at an approximate paleolatitude of 30-35°S and now crop out on Islay and the Garvellach Islands, Scotland. From these values, we calculated δ18O and δ2H values of meteoric water that equilibrated with clay at diagenetic conditions which we infer were reached shortly after deposition (i.e. before the end of the Cryogenian Period) because sediment accumulation was rapid due to fast subsidence at that time. This calculation required removal of the effects of exchange with reservoir rocks, metamorphic volatilization and mixing with metamorphic fluids on δ18O and δ2H values. The values we calculated for meteoric water fall within the 2σ ranges δ18O = -1 to -4 ‰ and δ2H = 0 to -23 ‰, respectively. These ranges are similar to present day values at equivalent latitudes. This finding is consistent with sediment accumulation in the Cryogenian Period having occurred in a climate similar to present day (Ice Age) conditions. This conclusion is not at odds with the Snowball Earth hypothesis because one of its predictions is that sediment accumulation occurred as the climate warmed at the end of panglaciation, a prediction supported by sedimentological evidence of multiple glacial advances and retreats in our study area and elsewhere

Prediction of Outcome After Endovascular Embolectomy in Anterior Circulation Stroke Using Biomarkers

Stroke is a major public health problem that can cause a long-term disability or death due to brain damage. Serious stroke is frequently caused by a large vessel occlusion in the anterior circulation, which should be treated by endovascular embolectomy if possible. In this study, we investigated the use of the brain damage biomarkers tau, NFL, NSE, GFAp, and S100B to understand the progression of nervous tissue damage and their relationship to outcome in such stroke after endovascular treatment. Blood samples were taken from 90 patients pre-treatment and 2 h, 24 h, 48 h, 72 h and 3 months after endovascular treatment. Stroke-related neurological deficit was estimated using the National Institute of Health Stroke Scale (NIHSS) at admission and at 24 h. Neurological outcome was evaluated at 3 months. After stroke, tau, NFL, GFAp and S100B increased in a time dependent manner, while NSE remained constant over time. At 3 months, tau and GFAp levels were back to normal whereas NFL was still high. Tau, NFL and GFAp correlated well to outcome, as well as to infarct volume and NIHSS at 24 h. The best time for prediction of poor outcome was different for each biomarker. However, the combination of NIHSS at 24 h with either tau, NFL or GFAp at 48 h gave the best prediction. The use of biomarkers in the early setting after endovascular treatment of stroke will lead to a simplified and standardized way to estimate the nervous tissue damage and possibly complement the clinical judgement in foreseeing the need of rehabilitation measures

Anaplastic thyroid carcinoma: three protocols combining doxorubicin, hyperfractionated radiotherapy and surgery

Patients with anaplastic thyroid carcinoma can rarely be cured, but every effort should be made to prevent death due to suffocation. Between 1984 and 1999, 55 consecutive patients with anaplastic thyroid carcinoma were prospectively treated according to a combined regimen consisting of hyperfractionated radiotherapy, doxorubicin, and when feasible surgery. Radiotherapy was carried out for 5 days a week. The daily fraction until 1988 was 1.0 Gy×2 (A) and 1989–92 1.3 Gy×2 (B) . Thereafter 1.6 Gy×2 (C) was administered. Radiotherapy was administered to a total target dose of 46 Gy; of which 30 Gy was administered preoperatively in the first two protocols (A and B), while the whole dose was given preoperatively in the third protocol (C). The therapy was otherwise identical. Twenty mg doxorubicin was administered intravenously weekly. Surgery was possible in 40 patients. No patient failed to complete the protocol due to toxicity. In only 13 cases (24%) was death attributed to local failure. Five patients (9%) ‘had a survival’ exceeding 2 years. No signs of local recurrence were seen in 33 patients (60%); 5 out of 16 patients in Protocol A, 11 out of 17 patients in Protocol B, 17 out of 22 patients in Protocol C (P=0.017). In the 40 patients undergoing additional surgery, no signs of local recurrence were seen in 5 out of 9 patients, 11 out of 14 patients and 17 out of 17 patients, respectively (P=0.005)

Decision-Makers behind Effective Crisis Management : An industry comparison of a crisis prepared approach among Small and Medium-Sized Enterprises

Master Thesis within Business Administration Title: Decision-Makers behind Effective Crisis Management: An industry comparison of a crisis prepared approach among Small and Medium-Sized Enterprises Author: Renée Löwhagen Tutor: Angelika Löfgren Date: May, 2015 Key words: Crises, Crisis Management, Crisis preparedness, SME, Managerial decision-making Abstract Problem. The world is in an era with technological advancements, shorter business cycles and a growing competition that requires constant organizational changes in order for or-ganizations to stay on track. Uncertainty in the business world is therefore higher than ev-er. With respect to Small and Medium-Sized Enterprises (SMEs) and their central role in the European economy, it is of high relevance of today’s researchers to adopt the perspec-tive of these businesses to take on a more crisis prepared approach. Purpose. The focus of this study is to investigate the perception of the concepts of crisis and crisis management among SMEs’ managers in different industries in Sweden. Moreover, this study intends to develop an understanding of the decision-making behind a crisis pre-pared approach of different industries of SMEs. Method. This research employs a multi-methodical qualitative research approach in which, in-depth interviews with owner-managers of SMEs and a crisis expert have been conduct-ed. Results. This study indicates that there may be a lack of insight regarding the core meaning of crises and crisis management among the SMEs’ managers studied. Crises and crisis management was found to be perceived in a similar way among all the managers in the study. Crises were perceived as involving the personnel and safety issues of the business-es. Crisis Management, was understood as the management of an already occurred crisis, rather than the preparation for potential crises. A deficiency was found among the busi-nesses regarding crisis preparations. This seemed to be related to resource restrictions and a general lack of research about this topic in the context of SMEs. The study indicates that SME managers do not always make formal decisions regarding crisis preparations. In the cases where the SME managers of the study had prepared plans and strategies for how to handle crises, these had emerged as a gradual process rather than from decisions taken in this matter