Pulmonary endothelium activity in mechanically ventilated patients

Acute Lung Injury (ALI) is a common pathologic continuum in critically ill patients witch represents with an acute, diffuse, and severe alteration of lung structure and functions that occurs after exposure to noxious external or endogenous agents. The extreme and most severe part of this continuum is the Acute Respiratory Distress Syndrome (ARDS), an overt non-cardiogenic pulmonary edema that carries high morbidity and mortality. The ICU management of these patients remains complex, as not only there is not an effective drug treatment but also mechanical ventilation per se may induce lung injury.Extensive research over the past 25 years has confirmed that pulmonary endothelium is not only a major structural component of the alveolar-capillary unit. It is also a highly specialized metabolically active organ possessing numerous physiological, immunological, and synthetic functions.Among these ectoenzymes pulmonary capillary endothelium-bound (PCEB) angiotensin converting enzyme (ACE) has been extensively studied. In humans, endothelium-bound ACE is expressed in significantly higher amounts than serum ACE. It is responsible for the hydrolysis of angiotensin I and bradykinin, and thus is a major regulator of vascular tone in health and disease.In humans without lung disease, there is evidence that bedside assessment of pulmonary endothelial ACE activity provides a reliable and quantifiable index of dynamically perfused capillary surface area (DPCSA). In a previous study, on critically ill patients with various degrees of ALI, we demonstrated that PCEB ACE activity is inversely related to lung injury and disease severity (APACHE II score).Purpose: in the present study we sought a/ to monitor PCEB ACE activity with time in ALI/ARDS patients and b/ to investigate if any early alteration of PCEB ACE activity occurs in patients without confirmed ALI/ARDS but vulnerable to the disease.Conclusions: •PCEB-ACE activity is higher in mechanically-ventilated patients without ALI as compared to patients with ALI/ARDS •PCEB-ACE activity: i. decreases with time both in the presence and absence of ALI, ii. is inversely related to the degree of lung injury even when the latter is very mild•PCEB-ACE activity reduction appears to be mostly related to: i. time in patients without ALI, and ii. the severity of lung injury in patients with ALI/ARDSThe aforementioned PCEB-ACE activity reduction in the absence of ALI probably suggests the presence of subtle endothelial injury associated, at least in part, with ventilator-induced sub-clinical lung injuryΤο ALI είναι μια πολύ συχνή παθολογική οντότητα στις ΜΕΘ και πολύ συχνά είτε οδηγεί τους ασθενείς στη ΜΕΘ, είτε επιπλέκει τη νοσηλεία τους αυξάνοντας το κόστος και κυρίως τη θνητότητά τους.Το ARDS αποτελεί τη σοβαρότερη και πιο επικίνδυνη έκφρασή του αυτού του συνδρόμου προσθέτοντας αξιοσημείωτα μεγάλη θνητότητα αλλά και ιδιαίτερες δυσκολίες καθώς οι χειρισμοί που απαιτούνται για τον μηχανικό αερισμό του ενδέχεται να έχουν και οι ίδιοι βλαπτική επίδραση στους πνεύμονες. Το συνδεδεμένο στο πνευμονικό ενδοθήλιο μετατρεπτικό ένζυμο (PCEB-ACE) είναι ένα από τα ένζυμα που έχουμε τη δυνατότητα να τα μελετήσουμε με ειδικές τεχνικές «αραίωσης του δείκτη» και μέσω συγκεκριμένων δεικτών (υδρόλυσης και Amax/Km) να βγάλουμε χρήσιμα συμπεράσματα για τη λειτουργικότητα του ίδιου του πνευμονικού ενδοθηλίου. Σκοπός της μελέτης ήταν να διαπιστώσουμε -αν και πως επηρεάζεται το PCEB-ACE, άρα και το πνευμονικό ενδοθήλιο, σε ασθενείς ΜΕΘ υπό μηχανική αναπνοή, με ή χωρίς ALI .-Αν, πως, και από ποιούς παράγοντες μεταβάλλεται η δραστικότητα του ενζύμου -Με διαδοχικές μετρήσεις αν και πως μεταβάλλεται στην πορεία του χρόνου σε κάθε άρρωστο. -Επιπλέον αν θα μπορούσε να είναι χρήσιμη η παρακολούθησή του σαν δείκτη πρόβλεψης της εξέλιξης του ALI/ARDS. Μέθοδος και Αποτελέσματα . Εφαρμόζοντας μεθόδους αραίωσης του δείκτη ( indicator-dilution techniques) μετρήσαμε την διαπνευμονική υδρόλυση του ACE υποστρώματος ,το 3H-benzoyl-Phe-Ala-Pro (BPAP) σε 20 ασθενείς υπό μηχανικό αερισμό και με σκορ πνευμονικής βλάβης (Lung Injury Score- LIS) κυμαινόμενο από 0 (μη πνευμονική βλάβη) έως 3.7( σοβαρή πνευμονική βλάβη). Επίσης μετρήθηκε η παράμετρος Amax/Km. Συγκρίναμε τη δραστικότητα του ενζύμου σε 2 ομάδες εκ των οποίων την ομάδα 1 αποτελούσαν ασθενείς δίχως ALI/ARDS ενώ την ομάδα 2 ασθενείς με ALI/ARDS Αποτελέσματα της μελέτης μας:α/ η δραστικότητα του ενζύμου RCEB-ACE είναι μειωμένη στους ασθενείς με ALI/ARDS και μάλιστα είναι ανάλογη της βαρύτητας του ALI/ARDSβ/ Η δραστικότητα του ενζύμου είναι μεγαλύτερη στους ασθενείς υπό μηχανική αναπνοή δίχως ALI σε σύγκριση με τους ασθενείς που έχουν ALI/ARDSγ/ ακόμα και σε διασωληνωμένους ασθενείς δίχως εμφανές ALI η λειτουργικότητα του ενζύμου όμως εμφανίζεται μειωμένη με την πάροδο του χρόνου

A Review of Sensors Used on Fabric-Handling Robots

While in most industries, most processes are automated and human workers have either been replaced by robots or work alongside them, fewer changes have occurred in industries that use limp materials, like fabrics, clothes, and garments, than might be expected with today’s technological evolution. Integration of robots in these industries is a relatively demanding and challenging task, mostly because of the natural and mechanical properties of limp materials. In this review, information on sensors that have been used in fabric-handling applications is gathered, analyzed, and organized based on criteria such as their working principle and the task they are designed to support. Categorization and related works are presented in tables and figures so someone who is interested in developing automated fabric-handling applications can easily get useful information and ideas, at least regarding the necessary sensors for the most common handling tasks. Finally, we hope this work will inspire researchers to design new sensor concepts that could promote automation in the industry and boost the robotization of domestic chores involving with flexible materials

A Review of Sensors Used on Fabric-Handling Robots

While in most industries, most processes are automated and human workers have either been replaced by robots or work alongside them, fewer changes have occurred in industries that use limp materials, like fabrics, clothes, and garments, than might be expected with today’s technological evolution. Integration of robots in these industries is a relatively demanding and challenging task, mostly because of the natural and mechanical properties of limp materials. In this review, information on sensors that have been used in fabric-handling applications is gathered, analyzed, and organized based on criteria such as their working principle and the task they are designed to support. Categorization and related works are presented in tables and figures so someone who is interested in developing automated fabric-handling applications can easily get useful information and ideas, at least regarding the necessary sensors for the most common handling tasks. Finally, we hope this work will inspire researchers to design new sensor concepts that could promote automation in the industry and boost the robotization of domestic chores involving with flexible materials

Reduced bone mineral density in adult patients with Langerhans cell histiocytosis

This retrospective study evaluated bone mineral density (BMD) and bone turnover in adults with LCH. Twenty-five adult patients and 25 matched controls were evaluated with BMD measurement and indices of bone metabolism. A BMD value below the expected range for age (Z-score <==-2.0) was found in 20% of patients; in particular, all postmenopausal women and men over 50-years had either osteoporosis or osteopenia. Patients with active disease had significantly lower Z-scores compared to patients with inactive disease and controls. Reduced bone turnover was found in all 14 patients treated with chemotherapy. No fractures due to osteoporosis were identified during 305.15 patient-years of follow-up. Pediatr Blood Cancer 2012; 58: 819822. (C) 2011 Wiley Periodicals, Inc

Advances on systemic treatment for lung neuroendocrine neoplasms

Lung well-to-moderately differentiated neuroendocrine tumors (also known as carcinoids) and large cell neuroendocrine lung carcinoma (poorly differentiated neuroendocrine tumor) are rare neuroendocrine neoplasms, which account for less than 4% of all lung neoplasms. Due to their low incidence, their systemic treatment is greatly influenced by therapeutic evidence derived from the more frequent gastroenteropancreatic neuroendocrine neoplasms and/or small cell lung carcinoma leading to significant bias. Currently, employed systemic therapies for lung carcinoids, aiming at controlling tumor growth include long acting somatostatin analogues (SSAs), peptide receptor radionuclide therapy, chemotherapy and molecular-targeted therapy. In this review, each of those treatments is presented based upon available clinical evidence from retrospective and prospective studies particularly focused on the role of everolimus in the advanced setting and on ongoing clinical trials reflecting our expectations in the near future. In addition, we critically analyse currently employed treatment of large cell neuroendocrine carcinoma where the appropriate chemotherapeutic regimen is still a matter of debate

Hospital Resources May Be an Important Aspect of Mortality Rate among Critically Ill Patients with COVID-19: The Paradigm of Greece

For critically ill patients with coronavirus disease 2019 (COVID-19) who require intensive care unit (ICU) admission, extremely high mortality rates (even 97%) have been reported. We hypothesized that overburdened hospital resources by the extent of the pandemic rather than the disease per se might play an important role on unfavorable prognosis. We sought to determine the outcome of such patients admitted to the general ICUs of a hospital with sufficient resources. We performed a prospective observational study of adult patients with COVID-19 consecutively admitted to COVID—designated ICUs at Evangelismos Hospital, Athens, Greece. Among 50 patients, ICU and hospital mortality was 32% (16/50). Median PaO2/FiO2 was 121 mmHg (interquartile range (IQR), 86–171 mmHg) and most patients had moderate or severe acute respiratory distress syndrome (ARDS). Hospital resources may be an important aspect of mortality rates, since severely ill COVID-19 patients with moderate and severe ARDS may have understandable mortality, provided that they are admitted to general ICUs without limitations on hospital resources