Bronchoalveolar Activation of Coagulation and Inhibition of Fibrinolysis during Ventilator-Associated Lung Injury

Background and Objective. Bronchoalveolar coagulopathy is a characteristic feature of pulmonary inflammation. We compared bronchoalveolar and systemic levels of coagulation in patients who did and patients who did not develop ventilator-associated lung injury (VALI). Methods. Secondary analysis of a randomized controlled trial evaluating the effect of lower tidal volumes versus conventional tidal volumes in patients without acute lung injury or acute respiratory distress syndrome at the onset of mechanical ventilation. Results. Ten patients with VALI and 10 random control patients without lung injury during the course of mechanical ventilation, but all ventilated with conventional tidal volumes, were compared. Patients who developed VALI showed both bronchoalveolar activation of coagulation (increase in thrombin–antithrombin complex levels P < 0.001 versus baseline) and inhibition of fibrinolysis (decline in plasminogen activator activity P < 0.001 versus baseline). The later seemed to be dependent on higher levels of plasminogen activator inhibitor type 1 (P = 0.001 versus baseline). Patients who developed VALI also showed elevated systemic thrombin-antithrombin complex levels and decreased systemic plasminogen activator activity levels. Conclusions. VALI is characterized by bronchoalveolar coagulopathy. Systemic and bronchoalveolar coagulopathy at the onset of mechanical ventilation may be a risk factor for developing VALI in patients ventilated with conventional tidal volumes

On "many black hole" space-times

We analyze the horizon structure of families of space times obtained by evolving initial data sets containing apparent horizons with several connected components. We show that under certain smallness conditions the outermost apparent horizons will also have several connected components. We further show that, again under a smallness condition, the maximal globally hyperbolic development of the many black hole initial data constructed by Chrusciel and Delay, or of hyperboloidal data of Isenberg, Mazzeo and Pollack, will have an event horizon, the intersection of which with the initial data hypersurface is not connected. This justifies the "many black hole" character of those space-times.Comment: several graphic file

Distributional versions of Littlewood's Tauberian theorem

We provide several general versions of Littlewood's Tauberian theorem. These versions are applicable to Laplace transforms of Schwartz distributions. We apply these Tauberian results to deduce a number of Tauberian theorems for power series where Ces\`{a}ro summability follows from Abel summability. We also use our general results to give a new simple proof of the classical Littlewood one-sided Tauberian theorem for power series.Comment: 15 page

Interference by new-generation mobile phones on critical care medical equipment

GPRS, UMTS en medische apparatuur in het ziekenhui

Closed geodesics in Alexandrov spaces of curvature bounded from above

In this paper, we show a local energy convexity of $W^{1,2}$ maps into $CAT(K)$ spaces. This energy convexity allows us to extend Colding and Minicozzi's width-sweepout construction to produce closed geodesics in any closed Alexandrov space of curvature bounded from above, which also provides a generalized version of the Birkhoff-Lyusternik theorem on the existence of non-trivial closed geodesics in the Alexandrov setting.Comment: Final version, 22 pages, 2 figures, to appear in the Journal of Geometric Analysi

Regularity of higher codimension area minimizing integral currents

This lecture notes are an expanded version of the course given at the ERC-School on Geometric Measure Theory and Real Analysis, held in Pisa, September 30th - October 30th 2013. The lectures aim to explain the main steps of a new proof of the partial regularity of area minimizing integer rectifiable currents in higher codimension, due originally to F. Almgren, which is contained in a series of papers in collaboration with C. De Lellis (University of Zurich).Comment: This text will appear in "Geometric Measure Theory and Real Analysis", pp. 131--192, Proceedings of the ERC school in Pisa (2013), L. Ambrosio Ed., Edizioni SNS (CRM Series

Homomorphisms from functional equations: the Goldie equation

The theory of regular variation, in its Karamata and Bojani´c-Karamata/de Haan forms, is long established and makes essential use of the Cauchy functional equation. Both forms are subsumed within the recent theory of Beurling regular variation, developed elsewhere. Various generalizations of the Cauchy equation, including the Gołab–Schinzel functional equation (GS) and Goldie's equation (GBE) below, are prominent there. Here we unify their treatment by algebraicization: extensive use of group structures introduced by Popa and Javor in the 1960s turn all the various (known) solutions into homomorphisms, in fact identifying them 'en passant', and show that (GS) is present everywhere, even if in a thick disguise

Entropic Fluctuations in Statistical Mechanics I. Classical Dynamical Systems

Within the abstract framework of dynamical system theory we describe a general approach to the Transient (or Evans-Searles) and Steady State (or Gallavotti-Cohen) Fluctuation Theorems of non-equilibrium statistical mechanics. Our main objective is to display the minimal, model independent mathematical structure at work behind fluctuation theorems. Besides its conceptual simplicity, another advantage of our approach is its natural extension to quantum statistical mechanics which will be presented in a companion paper. We shall discuss several examples including thermostated systems, open Hamiltonian systems, chaotic homeomorphisms of compact metric spaces and Anosov diffeomorphisms.Comment: 72 pages, revised version 12/10/2010, to be published in Nonlinearit

Cytokine treatment optimises the immunotherapeutic effects of umbilical cord-derived MSC for treatment of inflammatory liver disease

Background: Mesenchymal stromal cells (MSC) possess immunomodulatory properties and low immunogenicity, both crucial properties for their development into an effective cellular immunotherapy. They have shown benefit in clinical trials targeting liver diseases; however the efficacy of MSC therapy will benefit from improvement of the immunomodulatory and immunogenic properties of MSC. Methods: MSC derived from human umbilical cords (ucMSC) were treated for 3 days in vitro with various inflammatory factors, interleukins, vitamins and serum deprivation. Their immunogenicity and immunomodulatory capacity were examined by gene-expression analysis, surface-marker expressions, IDO activity, PGE2 secretion and inhibition of T cell proliferation and IFNγ production. Furthermore, their activation of NK cell cytotoxicity was investigated via CD107a expre

Chest radiography practice in critically ill patients: a postal survey in the Netherlands

BACKGROUND: To ascertain current chest radiography practice in intensive care units (ICUs) in the Netherlands. METHODS: Postal survey: a questionnaire was sent to all ICUs with > 5 beds suitable for mechanical ventilation; pediatric ICUs were excluded. When an ICU performed daily-routine chest radiographs in any group of patients it was considered to be a "daily-routine chest radiography" ICU. RESULTS: From the number of ICUs responding, 63% practice a daily-routine strategy, in which chest radiographs are obtained on a daily basis without any specific reason. A daily-routine chest radiography strategy is practiced less frequently in university-affiliated ICUs (50%) as compared to other ICUs (68%), as well as in larger ICUs (> 20 beds, 50%) as compared to smaller ICUs (< 20 beds, 65%) (P > 0.05). Remarkably, physicians that practice a daily-routine strategy consider daily-routine radiographs helpful in guiding daily practice in less than 30% of all performed radiographs. Chest radiographs are considered essential for verification of the position of invasive devices (81%) and for diagnosing pneumothorax, pneumonia or acute respiratory distress syndrome (82%, 74% and 69%, respectively). On demand chest radiographs are obtained after introduction of thoracic drains, central venous lines and endotracheal tubes in 98%, 84% and 75% of responding ICUs, respectively. Chest films are also obtained in case of ventilatory deterioration (49% of responding ICUs), and after cardiopulmonary resuscitation (59%), tracheotomy (58%) and mini-tracheotomy (23%). CONCLUSION: There is notable lack of consensus on chest radiography practice in the Netherlands. This survey suggests that a large number of intensivists may doubt the value of daily-routine chest radiography, but still practice a daily-routine strategy