Effect of external PEEP in patients under controlled mechanical ventilation with an auto-PEEP of 5 cmH2O or higher.

In some patients with auto-positive end-expiratory pressure (auto-PEEP), application of PEEP lower than auto-PEEP maintains a constant total PEEP, therefore reducing the inspiratory threshold load without detrimental cardiovascular or respiratory effects. We refer to these patients as complete PEEP-absorbers. Conversely, adverse effects of PEEP application could occur in patients with auto-PEEP when the total PEEP rises as a consequence. From a pathophysiological perspective, all subjects with flow limitation are expected to be complete PEEP-absorbers, whereas PEEP should increase total PEEP in all other patients. This study aimed to empirically assess the extent to which flow limitation alone explains a complete PEEP-absorber behavior (i.e., absence of further hyperinflation with PEEP), and to identify other factors associated with it.One hundred patients with auto-PEEP of at least 5 cmH2O at zero end-expiratory pressure (ZEEP) during controlled mechanical ventilation were enrolled. Total PEEP (i.e., end-expiratory plateau pressure) was measured both at ZEEP and after applied PEEP equal to 80 % of auto-PEEP measured at ZEEP. All measurements were repeated three times, and the average value was used for analysis.Forty-seven percent of the patients suffered from chronic pulmonary disease and 52 % from acute pulmonary disease; 61 % showed flow limitation at ZEEP, assessed by manual compression of the abdomen. The mean total PEEP was 7 ± 2 cmH2O at ZEEP and 9 ± 2 cmH2O after the application of PEEP (p < 0.001). Thirty-three percent of the patients were complete PEEP-absorbers. Multiple logistic regression was used to predict the behavior of complete PEEP-absorber. The best model included a respiratory rate lower than 20 breaths/min and the presence of flow limitation. The predictive ability of the model was excellent, with an overoptimism-corrected area under the receiver operating characteristics curve of 0.89 (95 % CI 0.80-0.97).Expiratory flow limitation was associated with both high and complete PEEP-absorber behavior, but setting a relatively high respiratory rate on the ventilator can prevent from observing complete PEEP-absorption. Therefore, the effect of PEEP application in patients with auto-PEEP can be accurately predicted at the bedside by measuring the respiratory rate and observing the flow-volume loop during manual compression of the abdomen

Ökologische Saatgutvermehrung von Festuca nigrescens Lam. (Festuca rubra subsp. commutata Gaud.)

The seed of Festuca nigrescens, an alpine species with wide ecological amplitude which is successfully used for the revegetation of eroded areas in mountain regions, is already conventionally propagated and currently available on the market. The organic seed propagation of this species was studied in a two-factorial field experiment (factor 1: weed control method, factor 2: harvesting method) in lowlands (220 m a.s.l., Hebenshausen, Hesse, D). Concerning the effectiveness of the mechanical weed control methods, hoeing and brush weeding allowed the achievement of satisfactory seed yields around 700 kg ha–1 (average of two harvest years), but exhibited a relatively low seed purity (91%). Combine harvesting proved to be as effective as hand-harvesting, although a poor seed quality was obtained (82% pure seed, 13% other seeds on average). The use of a stripping/vacuum device (prototype) for harvesting resulted in high seed losses (around 50%), but allowed better seed quality (92% seed purity, 4% other seeds). The results indicate that, under the present conditions, the achievement of a satisfactory seed purity is the major problem of the organic seed propagation of Festuca nigrescens in lowlands.Das Saatgut von Festuca nigrescens, einer alpenländischen Art mit breiter ökologischer Amplitude, die für die Begrünung erodierter Flächen in Bergregionen verwendet wird, wird bereits konventionell vermehrt und ist im Handel erhältlich. Die ökologische Saatgutvermehrung dieser Art wurde in einem zweifaktoriellen Feldversuch in Kleinparzellen (Faktor 1: Methode der Unkrautbekämpfung, Faktor 2: Erntemethode) im Flachland (220 m NN, Hebenshausen, Hessen, D) untersucht. Bezüglich des Wirkungsgrads der untersuchten mechanischen Methoden der Unkrautbekämpfung erzielten Hacken und Hackbürsten mit etwa 700 kg ha–1 (Mittelwert von zwei Erntejahren) befriedigende Saatguterträge, wiesen aber eine relativ niedrige Reinheit (91%) auf. Der Mähdrusch erwies sich als genauso effektiv wie die Handernte, obwohl eine dürftige Saatgutqualität (82% reines Saatgut, 13% Fremdbesatz im Durchschnitt) erreicht wurde. Die Anwendung eines Saugbürstgerätes (Prototyp) für die Ernte führte zu starken Saatgutverlusten (etwa 50%), erlaubte aber eine bessere Saatgutqualität (92% reines Saatgut, 4% Fremdbesatz). Die Ergebnisse zeigen, dass das Erreichen einer befriedigenden Saatgutreinheit das Hauptproblem der ökologischen Saatgutvermehrung von Festuca nigrescens im Flachland unter den untersuchten Bedingungen ist

Reescrituras del negativo. Variaciones en las modernas teodiceas, entre Leibniz y Rosmini

La presente contribución se propone investigar las variaciones que se han producido en la elaboración teórica de la teodicea – entendida en sentido clásico como el tratamiento del problema del mal frente a la bondad y la justicia de Dios – en la filosofía moderna, desde Leibniz hasta Rosmini. Para la comprensión de la teodicea leibniziana resulta de importancia fundamental la evolución moderna de la ontología de la posibilidad, en relación con el ser real. El cuadro teórico es ingeniosamente reconsiderado por Rosmini sobre el fondo de su metafísica de las tres formas categoriales del ser, gracias a la cual el filósofo roveretano puede dar mayor solidez a las perspectivas delineadas, superando algunos puntos críticos de la concepción leibniziana

Tablas rápidas : método sencillísimo para efectuar con la mayor brevedad, por medio de una sola operación de sumar, toda clase de cálculos relativos al importe de los algodones en rama, desde el precio de un diez y seisavo de peso, hasta ochenta pesos sencillos el quinto catalán

Copia digital. España : Ministerio de Cultura. Subdirección General de Coordinación Bibliotecaria, d2024Rústica.Registro de la Propiedad Intelectual: Ley de 1847: [sin número]; n. de solicitud de ingreso: "6570"; firma del depositante: "Amancio Peratoner

_Par sentiment de cœur_. Polisemia di un luogo etico-antropologico pascaliano

The ‘heart’, an object of misunderstanding in a sentimentalist sense, condenses in Pascal’s thought a plurality of meanings that make it, in several respects, an anthropologically pregnant and fundamental ‘place’ for the understanding of his philosophy. The apparent opposition between heart and reason should be overcome in a complementary understanding, in which the former represents the intellectual-intuitive moment of the apprehension of principles that precedes the discursive development of reason and its foundation and condition of practice. In the heart, however, there is also the significance of the biblical-patristic tradition, familiar to Pascal, of the moral and spiritual barycentre of the person and, from there, the common root of the intellectual and volitional powers, where the unity of experience firmly unites the knowing and the loving of being, so that authentic knowledge is revealed as the love of the intended reality and, vice versa, this alone guarantees the cognitive relationship as the experience of truth. In this way, we find in the heart the place and expression of a sentimental dimension that is also profoundly human and harmoniously united to the rationality proper to the thinking nature of man

3,5-Dibenzoyl-2,6-dimethyl-1-pentyl-4-pyridone

In the crystal structure of the title compound, C26H27NO3, a one-dimensional network of C—H⋯O hydrogen bonds and π-ring inter­actions is responsible for crystal stabilization. Inter­molecular hydrogen bonds and C—H⋯ π inter­actions produce R 2 2(10), R 4 4(27) and R 4 4(29) rings

Comparison of Noninvasive Ventilation by Sequential Use of Mask and Helmet versus Mask in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Preliminary Study

Background:Noninvasive positive pressure ventilation (NPPV) using a face mask is the ventilatory mode of choice in selected patients experiencing acute exacerbation of chronic obstructive pulmonary disease (COPD). A high incidence of intolerance limits the use of this approach. Objective: To evaluate the sequential use of mask and helmet during NPPV in patients with severe exacerbation of COPD in order to reduce the intolerance to these devices. Methods: Fifty-three patients ventilated for the first 2 h with NPPV by mask were studied. If gas exchange and clinical status improved, they were randomized to continue on NPPV by mask or helmet.Physiological parameters were measured at admission, after the first 2 h on NPPV by mask, 4 h after randomization and at discharge. Need for intubation, ventilatory assistance, length of stay (LOS) and complications were recorded. Results: After the first 2 h of NPPV, gas exchange and clinical parameters improved in 40 patients. Four hours after randomization, PaCO2 was lower in the mask group than in the helmet group. Nine patients in the mask group and 2 in the helmet group failed NPPV, 8 and 1, respectively, owing to intolerance. Time of noninvasive ventilation and LOS were lower in the mask than in the helmet group. Conclusions: In patients with acute exacerbation of COPD and undergoing NPPV, the sequential use of a mask and helmet diminished the incidence of failure. Under the present experimental conditions, the use of a helmet increased LOS and the duration of artificial ventilation

Impact of patient delay in a modern real world STEMI network

Background: The impact of patient delay on left ventricular ejection fraction (LVEF), when system delay has performance that meets the current recommended guidelines, is poorly investigated. Methods: We evaluated a cohort of STEMI patients treated with primary percutaneous coronary intervention (pPCI) and with an ECG STEMI diagnosis to wire crossing time (ETW) 64120 min. Independent predictors of pre-discharge decreased LVEF ( 6445%) were analyzed. Results: 490 STEMI patients with both ETW time 64120 min and available pre-discharge LVEF were evaluated. Mean age was 64.2 \ub1 12 years, 76.2% were male, 19.5% were diabetics, 42.7% had and anterior myocardial infarction (MI), and 9.8% were in Killip class III\u2013IV. Median time of patient's response to initial symptoms (patient delay) was 58,5 (IQR 30;157) minutes and median ETW time was 78 (IQR 62\u201395) minutes. 115 patients (23.4%) had pre-discharge LVEF 6445%. At multivariable analysis independent predictors of decreased LVEF ( 6445%) were anterior MI (OR 4,659, 95% CI 2,618-8,289, p < 0,001), Killip class (OR 1,449, 95% CI 1,090-1,928, p = 0,011) and patients delay above the median (OR 2,030, 95% CI 1,151\u20133.578, p = 0,014). These independent predictors were confirmed in patients with ETW time 6490 min. Conclusions: When system delay meets the recommended criteria for pPCI, patient delay becomes an independent predictor of pre-discharge LVEF. These findings provide further insights into the potential optimization of STEMI management and identify a target that needs to be improved, considering that still a significant proportion of patients continue to delay seeking medical care