356 research outputs found
DIPOL - ein Reformcurriculum: problemorientiertes Lernen in der Dresdner Medizin
Im Reformcurriculum DIPOL (Dresdner Integratives Problem/Praxis/Patienten Orientiertes Lernen) werden zukünftige Ärzte früher und intensiver auf ihre spätere praktische Tätigkeit vorbereitet. DIPOL ist ein Hybridcurriculum, bestehend aus traditionellen Lehrformen (Vorlesungen, Seminare, Praktika) und neuen Elementen (problem- bzw. fallorientiertes Lernen, Kleingruppen, Tutorien, Unterricht an Simulatoren und im Skills Lab)
Gesundheitsrisiken inhalierter Partikel
Although not all hazardous effects on human health have been clearly defined so far, the health risks of particulate matter can be considered evident. Pulmonary and cardiovascular diseases, in particular, are caused or aggravated by inhaled particulate matter. The aim of this article is to describe the incorporation and the effects on organ function of inhaled particles. Furthermore, the potential risks of de novo synthesised nanoparticles are discussed in the context of the public controversy regarding environmental particulate matter pollution.Obwohl die schädlichen Auswirkungen inhalierbarer Partikel auf unseren Organismus bisher noch nicht vollständig geklärt sind, kann eine Gesundheitsgefährdung durch Feinstäube als erwiesen angesehen werden. Insbesondere pulmonale und kardiovaskuläre Erkrankungen werden durch Feinstaubexposition ausgelöst oder verschlimmert. Dieser Artikel stellt Aufnahme und Auswirkungen inhalierter Partikel im menschlichen Organismus dar und erörtert potenzielle Gefahren de novo synthetisierter Nanopartikel im Kontext der auch in der breiten Öffentlichkeit kontrovers geführten Feinstaubdiskussion
Estimating inert gas bubbling from simple SCUBA diving parameters
Inert gas bubbles frequently occur in SCUBA divers' vascular systems, eventually leading to decompression accidents. Only in professional settings, dive profiles can be adjusted on individual basis depending on bubble grades detected through ultrasonography. A total of 342 open-circuit air dives following sports diving profiles were assessed using echocardiography. Subsequently, (Eftedal-Brubakk) bubble grades were correlated with dive and individual parameters. Post-dive cardiac bubbles were observed in 47% of all dives and bubble grades were significantly correlated with depth (r=0.46), air consumption (r=0.41), age (r=0.25), dive time (r=0.23), decompression diving (r=0.19), surface time (r=- 0.12). Eftedal-Brubakk categorical bubble grades for sports diving with compressed air can be approximated by bubble grade = (age*50-1 - surface time*150-1+maximum depth*45-1+air consumption*4500-1)2 (units in years, hours, meter, and bar*liter; R2=0.31). Thus, simple dive and individual parameters allow reasonable estimation of especially relevant medium to higher bubble grades for information on relevant decompression stress after ascent. Echo bubble grade 0 is overestimated by the formula derived. However, echo might fail to detect minor bubbling only. The categorical prediction of individual decompression stress with simple bio and dive data should be evaluated further to be developed towards dive computer included automatic ex-post information for decision-making on individual safety measures.info:eu-repo/semantics/publishedVersio
Regional lung aeration and ventilation during pressure support and biphasic positive airway pressure ventilation in experimental lung injury
INTRODUCTION:
There is an increasing interest in biphasic positive airway pressure with spontaneous breathing (BIPAP+SBmean), which is a combination of time-cycled controlled breaths at two levels of continuous positive airway pressure (BIPAP+SBcontrolled) and non-assisted spontaneous breathing (BIPAP+SBspont), in the early phase of acute lung injury (ALI). However, pressure support ventilation (PSV) remains the most commonly used mode of assisted ventilation. To date, the effects of BIPAP+SBmean and PSV on regional lung aeration and ventilation during ALI are only poorly defined.
METHODS:
In 10 anesthetized juvenile pigs, ALI was induced by surfactant depletion. BIPAP+SBmean and PSV were performed in a random sequence (1 h each) at comparable mean airway pressures and minute volumes. Gas exchange, hemodynamics, and inspiratory effort were determined and dynamic computed tomography scans obtained. Aeration and ventilation were calculated in four zones along the ventral-dorsal axis at lung apex, hilum and base.
RESULTS:
Compared to PSV, BIPAP+SBmean resulted in: 1) lower mean tidal volume, comparable oxygenation and hemodynamics, and increased PaCO2 and inspiratory effort; 2) less nonaerated areas at end-expiration; 3) decreased tidal hyperaeration and re-aeration; 4) similar distributions of ventilation. During BIPAP+SBmean: i) BIPAP+SBspont had lower tidal volumes and higher rates than BIPAP+SBcontrolled; ii) BIPAP+SBspont and BIPAP+SBcontrolled had similar distributions of ventilation and aeration; iii) BIPAP+SBcontrolled resulted in increased tidal re-aeration and hyperareation, compared to PSV. BIPAP+SBspont showed an opposite pattern.
CONCLUSIONS:
In this model of ALI, the reduction of tidal re-aeration and hyperaeration during BIPAP+SBmean compared to PSV is not due to decreased nonaerated areas at end-expiration or different distribution of ventilation, but to lower tidal volumes during BIPAP+SBspont. The ratio between spontaneous to controlled breaths seems to play a pivotal role in reducing tidal re-aeration and hyperaeration during BIPAP+SBmean
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Reduced pulmonary blood flow in regions of injury 2 hours after acid aspiration in rats
Background: Aspiration-induced lung injury can decrease gas exchange and increase mortality. Acute lung injury following acid aspiration is characterized by elevated pulmonary blood flow (PBF) in damaged lung areas in the early inflammation stage. Knowledge of PBF patterns after acid aspiration is important for targeting intravenous treatments. We examined PBF in an experimental model at a later stage (2 hours after injury). Methods: Anesthetized Wistar-Unilever rats (n = 5) underwent unilateral endobronchial instillation of hydrochloric acid. The PBF distribution was compared between injured and uninjured sides and with that of untreated control animals (n = 6). Changes in lung density after injury were measured using computed tomography (CT). Regional PBF distribution was determined quantitatively in vivo 2 hours after acid instillation by measuring the concentration of [68Ga]-radiolabeled microspheres using positron emission tomography. Results: CT scans revealed increased lung density in areas of acid aspiration. Lung injury was accompanied by impaired gas exchange. Acid aspiration decreased the arterial pressure of oxygen from 157 mmHg [139;165] to 74 mmHg [67;86] at 20 minutes and tended toward restoration to 109 mmHg [69;114] at 110 minutes (P < 0.001). The PBF ratio of the middle region of the injured versus uninjured lungs of the aspiration group (0.86 [0.7;0.9], median [25%;75%]) was significantly lower than the PBF ratio in the left versus right lung of the control group (1.02 [1.0;1.05]; P = 0.016). Conclusions: The PBF pattern 2 hours after aspiration-induced lung injury showed a redistribution of PBF away from injured regions that was likely responsible for the partial recovery from hypoxemia over time. Treatments given intravenously 2 hours after acid-induced lung injury may not preferentially reach the injured lung regions, contrary to what occurs during the first hour of inflammation. Please see related article: http://dx.doi.org/10.1186/s12871-015-0014-z
Influence of anatomic conditions on efficacy and safety of combined intermediate cervical plexus block and perivascular infiltration of internal carotid artery in carotid endarterectomy: a prospective observational trial
Systematisches Risikomanagement für eine geplante Gasabschaltung im High-Care-Bereich eines Universitätsklinikums
Rationale and study design of ViPS - variable pressure support for weaning from mechanical ventilation: study protocol for an international multicenter randomized controlled open trial
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