Mounier-Kuhn Syndrome in an Elderly Female with Pulmonary Fibrosis

Mounier-Kuhn syndrome (MKS), or tracheobronchomegaly, is a rare clinical and radiologic condition characterized by pronounced tracheobronchial dilation and recurrent lower respiratory tract infections. Tracheobronchomegaly presents when the defect extends to the central bronchi. MKS can be diagnosed in adult women when the transverse and sagittal diameters of the trachea, right mainstem bronchus, and left mainstem bronchus exceed 21, 23, 19.8, and 17.4 mm, respectively. Its diagnosis is based on chest radiograph and chest computed tomography (CT). Patients, usually middle-aged men, may be asymptomatic or present with clinical manifestations ranging from minimal symptoms with preserved lung function to severe respiratory failure. Pulmonary function tests (PFTs) typically reveal a restrictive pattern. This report presents an elderly woman with previously diagnosed pulmonary fibrosis with symptoms of increased sputum production and haemoptysis. High-resolution chest CT showed tracheal and main stem bronchi dilatation along with bronchial diverticulosis. PFTs indicated a restrictive pattern characteristic of the underlying pulmonary fibrosis. The patient is the oldest, referred to the female gender, at presentation of MKS hitherto reported. This case highlights the need to include MKS in the differential diagnosis of recurrent lower respiratory tract infections, even in older subjects

Road Upgrading in Terms of Geometric and Functional Characteristics

The road network plays a vital role in the economy of any country and maintaining the infrastructure at a level that serves the current traffic needs is a critical element. Road maintenance directly affects road users. If it is not adequate or if it is not done in time, the damage that will occur, in a national and provincial network, may be unmanageable and will affect the increased operating costs of vehicles, delays in travel, increase in the accident index and generally reduce the reliability of transport services. When corrective interventions can no longer be postponed or cancelled, extensive restoration and reconstruction work takes place, which costs much more than the simple / preventive maintenance that can be planned and carried out in a timely manner. The protection of the existing road network is necessary and its maintenance in good condition is a dominant issue for a Management Body and often precedes as a priority even a new investment in the field of road infrastructure. This paper focuses on road network management from the point of view of upgrading and maintenance. An optimization methodology is proposed depending on the condition of the road, so that the choice of operation is optimal for the current situation. In this way, unnecessary expenses, which are brought about by the usual maintenance works, are avoided, while the street cannot serve modern traffic needs efficiently

Well-defined homopolypeptides, copolypeptides, and hybrids of Poly(l-proline)

l-Proline is the only, out of 20 essential, amino acid that contains a cyclized substituted α-amino group (is formally an imino acid), which restricts its conformational shape. The synthesis of well-defined homo- and copolymers of l-proline has been plagued either by the low purity of the monomer or the inability of most initiating species to polymerize the corresponding N-carboxy anhydride (NCA) because they require a hydrogen on the 3-N position of the five-member ring of the NCA, which is missing. Herein, highly pure l-proline NCA was synthesized by using the Boc-protected, rather than the free amino acid. The protection of the amine group as well as the efficient purification method utilized resulted in the synthesis of highly pure l-proline NCA. The high purity of the monomer and the use of an amino initiator, which does not require the presence of the 3-N hydrogen, led for the first time to well-defined poly(l-proline) (PLP) homopolymers, poly(ethylene oxide)-b-poly(l-proline), and poly(l-proline)-b-poly(ethylene oxide)-b-poly(l-proline) hybrids, along with poly(γ-benzyl-l-glutamate)-b-poly(l-proline) and poly(Boc-l-lysine)-b-poly(l-proline) copolypeptides. The combined characterization (NMR, FTIR, and MS) that results for the l-proline NCA revealed its high purity. In addition, all synthesized polymers exhibit high molecular and compositional homogeneity

Implementation of On-Line Data Reduction Algorithms in the CMS Endcap Preshower Data Concentrator Card

The CMS Endcap Preshower (ES) sub-detector comprises 4288 silicon sensors, each containing 32 strips. The data are transferred from the detector to the counting room via 1208 optical fibres running at 800Mbps. Each fibre carries data from 2, 3 or 4 sensors. For the readout of the Preshower, a VME-based system - the Endcap Preshower Data Concentrator Card (ES-DCC) is currently under development. The main objective of each readout board is to acquire on-detector data from up to 36 optical links, perform on-line data reduction (zero suppression) and pass the concentrated data to the CMS event builder. This document presents the conceptual design of the Reduction Algorithms as well as their implementation into the ES-DCC FPGAs. The algorithms implemented into the ES-DCC resulted in a reduction factor of ~20

Effect and Safety of Mycophenolate Mofetil or Sodium in Systemic Sclerosis-Associated Interstitial Lung Disease: A Meta-Analysis

Background. Interstitial lung disease (ILD) is the most common complication of systemic sclerosis (SSc) with treatment ineffective. Objective: The aim of this meta-analysis was to provide an estimate of the safety and efficacy profile of Mycophenolate Mofetil (MMF) or sodium (MMS) in SSc-ILD patients. Materials and Methods. All studies were reviewed systematically. The main end-points were safety and efficacy profile as estimated by forced vital capacity (FVC)% and diffusion capacity of the lung for carbon monoxide (DLCO)% of the predicted normal value (%pred.) before and after treatment in patients with SSc-ILD. Quality assessment and data extraction were performed independently by two reviewers. Results. Seventeen studies were reviewed systematically. Six studies, one prospective, were eligible for analysis encompassing 69 patients, including 10 subjects from our, yet unpublished, retrospective study. There was no statistically significant difference in both efficacy outcomes of interest, including FVC% pred. (weighted mean difference 1.48, 95% confidence interval (CI): −2.77 to 5.72, P = 0.49) and DLCO % pred. (weighted mean difference −0.83, 95% CI: −4.75 to 3.09, P = 0.93). No cases of clinically significant side effects were documented. Conclusions. Meta-analysis data suggest that MMF is a safe therapeutic modality which was associated with functional stabilization in patients with SSc-ILD

How does Nogo receptor influence demyelination and remyelination in the context of multiple sclerosis?

Multiple sclerosis (MS) can progress with neurodegeneration as a consequence of chronic inflammatory mechanisms that drive neural cell loss and/or neuroaxonal dystrophy in the central nervous system. Immune-mediated mechanisms can accumulate myelin debris in the disease extracellular milieu during chronic-active demyelination that can limit neurorepair/plasticity and experimental evidence suggests that potentiated removal of myelin debris can promote neurorepair in models of MS. The myelin-associated inhibitory factors (MAIFs) are integral contributors to neurodegenerative processes in models of trauma and experimental MS-like disease that can be targeted to promote neurorepair. This review highlights the molecular and cellular mechanisms that drive neurodegeneration as a consequence of chronic-active inflammation and outlines plausible therapeutic approaches to antagonize the MAIFs during the evolution of neuroinflammatory lesions. Moreover, investigative lines for translation of targeted therapies against these myelin inhibitors are defined with an emphasis on the chief MAIF, Nogo-A, that may demonstrate clinical efficacy of neurorepair during progressive MS