Patterns of home mechanical ventilation use in Europe: results from the Eurovent survey

The study was designed to assess the patterns of use of home mechanical ventilation (HMV) for patients with chronic respiratory failure across Europe. A detailed questionnaire of centre details, HMV user characteristics and equipment choices was sent to carefully identified HMV centres in 16 European countries. A total of 483 centres treating 27,118 HMV users were identified. Of these, 329 centres completed surveys between July 2001 and June 2002, representing up to 21,526 HMV users and a response rate of between 62% and 79%. The estimated prevalence of HMV in Europe was 6.6 per 100,000 people. The variation in prevalence between countries was only partially related to the median year of starting HMV services. In addition, there were marked differences between countries in the relative proportions of lung and neuromuscular patients using HMV, and the use of tracheostomies in lung and neuromuscular HMV users. Lung users were linked to a HMV duration of <1 yr, thoracic cage users with 6-10 yrs of ventilation and neuromuscular users with a duration of > or =6 yrs. In conclusion, wide variations exist in the patterns of home mechanical ventilation provision throughout Europe. Further work is needed to monitor its use and ensure equality of provision and access.

Quality control of equipment in home mechanical ventilation: a European survey

Quality control of the equipment used in home mechanical ventilation is necessary in order to ensure that patients safely and accurately receive the prescribed ventilatory support. The aim of this study was to carry out a survey on the quality-control procedures in different centres and countries. The survey was carried out in the context of a European Commission Concerted Action covering 16 European countries. The study was extensive and detailed, involving 326 centres, which provided home ventilation to >20,000 patients. The survey showed that: 1) ventilator servicing was mainly carried out by external companies (62% of centres), with a servicing frequency ranging 3-12 months; 2) interaction between servicing companies and prescribers was limited (only 61% of centres were always informed of major incidents); 3) participation of centres in equipment quality control was poor (only 56% of centres assessed that patients/caregivers correctly cleaned/maintained the ventilator); and 4) centres were insufficiently aware of vigilance systems (only 23% of centres). Moreover, the data showed considerable inter- and intra-country differences. The size of the centre was an important determinant of many of these quality-control aspects. This survey provides information that will enable the European Commission Concerted Action to formulate recommendations on procedures for home-ventilator quality control.

Power gain exhibited by motile mechanosensory neurons in Drosophila ears

In insects and vertebrates alike, hearing is assisted by the motility of mechanosensory cells. Much like pushing a swing augments its swing, this cellular motility is thought to actively augment vibrations inside the ear, thus amplifying the ear's mechanical input. Power gain is the hallmark of such active amplification, yet whether and how much energy motile mechanosensory cells contribute within intact auditory systems has remained uncertain. Here, we assess the mechanical energy provided by motile mechanosensory neurons in the antennal hearing organs of Drosophila melanogaster by analyzing the fluctuations of the sound receiver to which these neurons connect. By using dead WT flies and live mutants (tilB(2), btv(5P1), and nompA(2)) with defective neurons as a background, we show that the intact, motile neurons do exhibit power gain. In WT flies, the neurons lift the receiver's mean total energy by 19 zJ, which corresponds to 4.6 times the energy of the receiver's Brownian motion. Larger energy contributions (200 zJ) associate with self-sustained oscillations, suggesting that the neurons adjust their energy expenditure to optimize the receiver's sensitivity to sound. We conclude that motile mechanosensory cells provide active amplification; in Drosophila, mechanical energy contributed by these cells boosts the vibrations that enter the ear.

Surgical implications of sentinel node with micrometastatic disease in invasive breast cancer

AIM

To assess the rate of positive axillary clearance (AC) when the sentinel node biopsy (SNB) contains micrometastatic disease in invasive breast cancer and to evaluate the factors that could predict positivity.

PATIENTS AND METHODS

This is a prospective study carried out on 542 successive women undergoing SNB for unifocal T0-T1 N0 invasive breast cancer without previous treatment.

RESULTS

Five hundred and twenty-five sentinel nodes (SN) were found, 142 contained metastases. Fifty-five of the positive SN contained micrometastatic disease only. Of them, 40 patients underwent completion of AC. Six out of 40 patients who had micrometastatic SN had a positive AC, five for micrometastasis between 0.2 and 2 mm (5/34), one for isolated cells in the SN (1/6). None of the studied factors (age, histological tumour size, histological grade, estradiol receptor (ER), histological tumour type, size and method of micrometastasis detection) could significantly predict the status of the AC.

CONCLUSION

As long as the results of ongoing prospective randomised studies are unknown, it remains necessary to perform AC when the SNB contains micrometastatic disease, whatever the size or the detection mode of the metastasis.

The relation between preprocedural C-reactive protein levels and early and late complications in patients with acute myocardial infarction undergoing interventional coronary angioplasty

BACKGROUND

Inflammation is an important feature of arteriosclerotic disease, and the vulnerability of coronary plaques in acute myocardial infarction (AMI) may be related to the levels of serum C-reactive proteins (CRP). While some risk factors for early and late complications have been suggested, an accurate and definitive preprocedural risk stratification of patients undergoing percutaneous transluminal coronary angioplasty (PTCA) is still lacking.

HYPOTHESIS

The study was undertaken to investigate whether early and late complications after PTCA could be predicted by evaluation of baseline serum CRP levels in patients with AMI.

METHODS

Levels of serum CRP were measured in a total of 230 patients with AMI undergoing PTCA and provisional stent. They were divided into two groups: Group 1 (n = 48) with elevated CRP levels (> or = 5 mg/l) and Group 2 (n = 182) with normal CRP levels (< 5 mg/l).

RESULTS

There were no significant differences in baseline clinical, angiographic, and procedural characteristics between the two groups. However, the incidence of in-hospital adverse coronary events (reinfarction, coronary reocclusion, target vessel revascularization, and death) and severe left ventricular dysfunction was significantly higher in Group 1 (18.3 vs. 6.1%, p < 0.05 and 20.9 vs. 6.1%, p < 0.05, respectively). In addition, bailout stenting was performed more frequently in Group 1 than in Group 2 (60.4 vs. 36.3%, p < 0.005). No significant late complications were noted. The serum levels of CRP were the only independent predictors of early adverse events.

CONCLUSIONS

Preprocedural serum CRP level might be considered a powerful predictor of early but not late complications in patients undergoing PTCA/stent procedures.

Context-dependent stimulus presentation to freely moving animals in 3D

The presentation of controllable, dynamic sensory stimuli provides a powerful experimental paradigm, which has been extensively applied to explore sensory processing in walking and tethered flying insects. Recent advances in computer hardware and software technology provide the opportunity to track the 3D flight path of free-flying insects and process these data in real-time, opening up the possibility to present dynamic stimuli to free-flying animals. To accommodate for the increased complexity relating to 3D space, we partitioned experimental design, real-time data acquisition and stimulus control into multiple self-contained modules. 3D experimental scenarios were created in a stand-alone application by forging multiple 3D space-stimulus relationships. The use of dynamic cues is illustrated by an experiment, in which dynamic acoustic cues were presented to a free-flying parasitoid fly in a large 3D environment. The combination of loosely coupled modules provides robust and flexible solutions, allowing new paradigms to be readily implemented based on existing technologies. We demonstrate this with a test system that displayed a complex visual stimulus, controlled in real-time by the 2D position and orientation of a test object. The presented methods are applicable in a variety of novel experimental paradigms, including learning paradigms, for various sensory modalities in walking, swimming and flying animals.

Fatal Microascus trigonosporus (anamorph Scopulariopsis) pneumonia in a bone marrow transplant recipient

Over the past decade, an increasing number of opportunistic mycelial fungal infections have been reported in immunocompromised patients. Presented here is the first reported case of Microascus trigonosporus pneumonia, which occurred in a 24-year-old-man with a history of allogenic bone marrow transplantation with graft-versus-host disease. Despite the administration of effective antifungal treatment, the patient died after uncontrollable respiratory failure and multiorgan failure developed. This report confirms the results of previous studies that suggested a very poor outcome for bone marrow transplant recipients with non-Aspergillus mould infections.

C-reactive protein levels and arterial abnormalities in the offspring of patients with premature myocardial infarction

AIMS

To determine whether high C-reactive protein (CRP) levels and increased intima-media thickness of the common carotid arteries are coexistent in adolescents and young adults with a family history (FH) of premature myocardial infarction (MI).

METHODS

50 healthy young subjects whose parents had had premature MI and 50 control matched subjects were enrolled in the study. CRP levels and the intima-media thickness of the distal common carotid arteries were evaluated in all subjects.

RESULTS

As compared with the control subjects, the offspring of patients with premature MI had a higher CRP concentration (mean +/- SD 8.8 +/- 2.6 versus 3.9 +/- 0.6 mg/l, p < 0.02) and greater intima-media thickness of the common carotid arteries (values for combined sides, mean +/- SD 0.48 +/- 0.02 versus 0.43 +/- 0.02 mm, p < 0.03).

CONCLUSION

High serum levels of CRP and arterial structural changes are coexistent at an early age in subjects with an FH of premature MI.

[Non-linear model of glottic vibration. Potential clinical implications]

Glottic vibration is governed by a certain number of physical laws which in general correspond, as far as myo-elastic theory is concerned, with the laws of passive vibration of an elastic body under the influence of the expired air. Some of these laws are non-linear, especially those that deal with the exchange of energy between the expired air and the vocal folds. This non-linearity is specially important when it comes to the key concepts of the phonatory threshold and the passive synchronisation of the vocal cords. Based on their experimental work, which has been presented previously, the authors propose a mixed model, which is both linear and non-linear, like the oscillators of Van der Pool. This model is known as Slip-Stick.

Motion generation by Drosophila mechanosensory neurons

In Drosophila melanogaster, hearing is supported by mechanosensory neurons transducing sound-induced vibrations of the antenna. It is shown here that these neurons additionally generate motions that mechanically drive the antenna and tune it to relevant sounds. Motion generation in the Drosophila auditory system is betrayed by the auditory mechanics; the antenna of the fly nonlinearly alters its tuning as stimulus intensity declines and oscillates spontaneously in the absence of sound. The susceptibility of auditory motion generation to mechanosensory mutations shows that motion is generated by mechanosensory neurons. Motion generation depends on molecular components of the mechanosensory transduction machinery (NompA, NompC, Btv, and TilB), apparently involving mechanical activity of ciliated dendrites and microtubule-dependent motors. Hence, in analogy to vertebrate hair cells, the mechanosensory neurons of the fly serve dual, transducing, and actuating roles, documenting a striking functional parallel between the vertebrate cochlea and the ears of Drosophila.