Can we improve outcome of congenital diaphragmatic hernia?

This review gives an overview of the disease spectrum of congenital diaphragmatic hernia (CDH). Etiological factors, prenatal predictors of survival, new treatment strategies and long-term morbidity are described. Early recognition of problems and improvement of treatment strategies in CDH patients may increase survival and prevent secondary morbidity. Multidisciplinary healthcare is necessary to improve healthcare for CDH patients. Absence of international therapy guidelines, lack of evidence of many therapeutic modalities and the relative low number of CDH patients calls for cooperation between centers with an expertise in the treatment of CDH patients. The international CDH Euro-Consortium is an example of such a collaborative network, which enhances exchange of knowledge, future research and development of treatment protocols

Overexpression of extracellular superoxide dismutase reduces acute radiation induced lung toxicity

BACKGROUND: Acute RT-induced damage to the lung is characterized by inflammatory changes, which proceed to the development of fibrotic lesions in the late phase of injury. Ultimately, complete structural ablation will ensue, if the source of inflammatory / fibrogenic mediators and oxidative stress is not removed or attenuated. Therefore, the purpose of this study is to determine whether overexpression of extracellular superoxide dismutase (EC-SOD) in mice ameliorates acute radiation induced injury by inhibiting activation of TGFβ1 and downregulating the Smad 3 arm of its signal transduction pathway. METHODS: Whole thorax radiation (single dose, 15 Gy) was delivered to EC-SOD overexpressing transgenic (XRT-TG) and wild-type (XRT-WT) animals. Mice were sacrificed at 1 day, 1 week, 3, 6, 10 and 14 weeks. Breathing rates, right lung weights, total/differential leukocyte count, activated TGFβ1 and components of its signal transduction pathway (Smad 3 and p-Smad 2/3) were assessed to determine lung injury. RESULTS: Irradiated wild-type (XRT-WT) animals exhibited time dependent increase in breathing rates and right lung weights, whereas these parameters were significantly less increased (p < 0.05) at 3, 6, 10 and 14 weeks in irradiated transgenic (XRT-TG) mice. An inflammatory response characterized predominantly by macrophage infiltration was pronounced in XRT-WT mice. This acute inflammation was significantly attenuated (p < 0.05) in XRT-TG animals at 1, 3, 6 and 14 weeks. Expression of activated TGFβ1 and components of its signal transduction pathway were significantly reduced (p < 0.05) at later time-points in XRT-TG vs. XRT-WT. CONCLUSION: This study shows that overexpression of EC-SOD confers protection against RT-induced acute lung injury. EC-SOD appears to work, in part, via an attenuation of the macrophage response and also decreases TGFβ1 activation with a subsequent downregulation of the profibrotic TGFβ pathway

Utilizing heat regeneration within hydraulic pressure accumulator

Tekniikan kehittyessä toimilaitteiden ja järjestelmien suunnittelussa ja toteutuksessa laitteiden ja koneiden energia- ja kustannustehokkuus nousevat jatkuvasti tärkeämpään rooliin. Hydraulisilla toimilaitteilla saavutetaan korkea tehotiheys, mutta järjestelmien kokonaishyötysuhde on usein heikko. Hyötysuhdetta voidaan nostaa lisäämällä järjestelmiin energian talteenotto, jolloin työkierroista voidaan normaalisti hukkaan menevää energiaa varastoida ja käyttää uudelleen seuraavassa työkierrossa. Hydraulisissa energian talteenottojärjestelmissä energiaa varastoidaan tyypillisesti hydraulipaineakkuihin. Paineakuissa energia varastoituu puristamalla paineakun kaasutilavuudessa olevaa kaasua. Puristusvaiheen aikana kaasun lämpötila nousee ja lämpö alkaa virrata paineakusta ympäristöön. Tämä energian virtaaminen ympäristöön muodostaa merkittävimmän yksittäisen paineakun hyötysuhdetta laskevan tekijän. Tämän työn tavoitteena oli nostaa mäntäpaineakun hyötysuhdetta hyödyntämällä lämmön regenerointia. Lämmön regeneroinnilla pyritään varastoimaan kaasussa puristusvaiheessa syntyvä lämpöenergia lämpöregeneraattoriin ja luovuttamaan energia takaisin kaasuun paineakun purkusyklin aikana. Työssä suunniteltu lämpöregeneraattori perustui faasimuutosmateriaalien hyödyntämiseen energiavarastona. Faasimuutosmateriaalit soveltuvat erinomaisesti lämpövarastoiksi, sillä ne kykenevät sitomaan suuren määrän energiaa faasimuutoksen aikana, jolloin työssä suunniteltu lämpöregeneraattori saatiin mahdutettua mäntäpaineakun sisälle. Työssä saatujen mittaustuloksien perusteella pääteltiin, että lämpöregeneraattorin dynamiikan merkitys nousi merkittävämmäksi kuin lämpöregeneraattorin kyky varastoida lämpöenergiaa. Lämpöregeneraattorin hidas dynamiikka ei mahdollista tehokasta energian talteenottoa nopeista puristus- tai purkusykleistä, ja tämän takia lämpöregeneraattorista saatava hyöty jäi pieneksi. Työssä toteutetulla lämpöregeneraattorilla saavutettiin parhaimmillaan 3 prosenttiyksikön hyötysuhteen nousu verrattaessa samaan mäntäpaineakkuun ilman lämmön regenerointia.As new technological advances are made the importance of energy efficiency and cost effective solutions are even more important when designing and producing new machine systems. Hydraulic systems offer great performance in different actuators, but the general efficiency of the whole hydraulic systems is usually low. Energy efficiency can be improved by utilizing energy recovery systems. With energy recovery some of the normally wasted energy can be recovered and used in the next work cycle. Hydraulic energy recovery systems usually store energy in hydraulic pressure accumulators. Within the hydraulic pressure accumulator, energy is stored by compressing gas inside the accumulator’s gas volume. When compressing gas, heat builds up within the gas and temperature difference between the gas and its surroundings causes heat energy to flow out of the gas. This energy flow is the single most significant factor lowering energy efficiency of the accumulator. The goal of this study was to increase the efficiency of piston type hydraulic pressure accumulator by utilizing heat regeneration. With heat regeneration, heat energy that is generated in the gas during compression cycle is stored in the heat regenerator to be released during the following decompression cycle. Heat regenerator designed in this study utilizes phase change materials to store heat energy. Phase change materials absorb a lot of energy during phase change and thus they are commonly used as heat storages. The results obtained in this study indicate that the dynamic properties of the heat regenerator are more important than the capability to store heat energy. Low dynamic properties prevent the heat regenerator from storing and releasing energy effectively during fast compression and decompression cycles. With the heat regenerator designed in this study the energy efficiency of the accumulator increased by maximum of 3 percentage units when compared to the same accumulator without heat regeneration

Pancreatic trauma in children.

We identified two distinct groups of patients in the 91 documented cases of pancreatic trauma (median age 8.0 years, range 0.6-15.8 years; M:F 2.5:1.0): 59 had a history of abdominal trauma and elevated serum lipase but no CT or ultrasound evidence of pancreatic injury (Group A); 32 had a history of abdominal trauma, elevated serum lipase but also had CT scan and/or ultrasound evidence of pancreatic injury (Group B). Patients with "less severe" injury based on normal imaging had a lower initial lipase level [Group A, median 651 U/L (interquartile range 520-1,324) vs. Group B, 1,608 U/L (interquartile range 680-3,526); p = 0.005] and shorter admission time [Group A, 9.0 days (interquartile range 5.5-15.5) vs. Group B, 13.4 days (interquartile range 6.8-23.8); p = 0.04]. There were no differences with respect to mortality (Group A, 13.5% vs. Group B, 12.5%), but patients with evidence of injury on imaging were more likely to have surgical intervention (p = 0.0001). The single most important overall cause of pancreatic trauma was involvement in a motor vehicle accident as a passenger or pedestrian. However, in children with high-grade ductal injury, bicycle handlebar injuries were most common. Associated injuries were common in both groups