275 research outputs found
sj-pdf-2-prf-10.1177_02676591211042563 – Supplemental material for International survey of neuromonitoring and neurodevelopmental outcome in children and adults supported on extracorporeal membrane oxygenation in Europe
No full textSupplemental material, sj-pdf-2-prf-10.1177_02676591211042563 for International survey of neuromonitoring and neurodevelopmental outcome in children and adults supported on extracorporeal membrane oxygenation in Europe by Mirjana Cvetkovic, Giovanni Chiarini, Mirko Belliato, Thijs Delnoij, Paolo Zanatta, Fabio Silvio Taccone, Dinis dos Reis Miranda, Mark Davidson, Nashwa Matta, Carl Davis, Hanneke IJsselstijn, Matthieu Schmidt, Lars Mikael Broman, Dirk W Donker, Dirk Vlasselaers, Piero David, Matteo Di Nardo, Ralf M Muellenbach, Thomas Mueller, Nicholas A Barrett, Roberto Lorusso, Jan Belohlavek and Aparna Hoskote in Perfusion</p
sj-pdf-1-prf-10.1177_02676591211042563 – Supplemental material for International survey of neuromonitoring and neurodevelopmental outcome in children and adults supported on extracorporeal membrane oxygenation in Europe
No full textSupplemental material, sj-pdf-1-prf-10.1177_02676591211042563 for International survey of neuromonitoring and neurodevelopmental outcome in children and adults supported on extracorporeal membrane oxygenation in Europe by Mirjana Cvetkovic, Giovanni Chiarini, Mirko Belliato, Thijs Delnoij, Paolo Zanatta, Fabio Silvio Taccone, Dinis dos Reis Miranda, Mark Davidson, Nashwa Matta, Carl Davis, Hanneke IJsselstijn, Matthieu Schmidt, Lars Mikael Broman, Dirk W Donker, Dirk Vlasselaers, Piero David, Matteo Di Nardo, Ralf M Muellenbach, Thomas Mueller, Nicholas A Barrett, Roberto Lorusso, Jan Belohlavek and Aparna Hoskote in Perfusion</p
Clinical and experimental aspects of lung development and injury in congenital diaphragmatic hernia
Full text linkCongenital anomalies are expressions of abnormal growth and development. They presently form the second most frequent cause of death, after immaturity, in the perinatal period. Congenital diaphragmatic hernia (CDH) is a congenital anomaly manifesting itself in about one in 3,000 total births or one in 2,700 live births. More than 95% of the diaphragmatic defects are posterolateral ones.
For a long time CDH was considered as a purely anatomical defect of the diaphragm. But it has become clear that in many cases (ranging from 39 to 47%) it is associated with other anomalies, especially cardiac defects.
Despite improved neonatal intensive care, the overall survival rate does still not exceed 55 to 58%, and is even less in patients with associated anomalies. However, higher survival rates have been reported: Wung and coworkers reported a survival rate of 94% in a group of CDH patients who were treated with very delayed surgery and a respiratory care strategy that avoids pulmonary overdistension.
The studies reported in this thesis were conducted to investigate various, related aspects of lung development and lung injury in CDH
Morbidity and Long-Term Follow-Up in CDH Patients
No full textOverall survival of congenital diaphragmatic hernia (CDH) patients has increased since the widespread implementation of delayed operative repair with extracorporeal membrane oxygenation/gentle ventilation strategies starting in the mid-1990s. With the improvements in survival, CDH survivorship has been marked by increased morbidity with a greater need for monitoring and supportive interventions in infancy and early childhood. The multisystem morbidity and complexity of care for these patients mandate the dedicated resources and focus of medical specialties to ensure that the neurodevelopmental, cardiopulmonary, nutritional, and surgical sequelae of CDH are properly addressed. In this article, we will discuss the experience of CDH centers that offer long-term CDH follow-up as well as the patients' morbidities that require active monitoring until transition to adult care
Cardiopulmonary Morbidity in Adults Born With Congenital Diaphragmatic Hernia
No full textOBJECTIVES: Studies concerning cardiopulmonary outcomes of adults born with congenital diaphragmatic hernia (CDH) are sparse. Moreover, they don't include participants who have been treated with extracorporeal membrane oxygenation (ECMO) during the neonatal period. This study evaluated the cardiopulmonary morbidities in young adults born with CDH.METHODS: We assessed 68 participants between the ages of 18 and 30 years. The assessment included auxology assessment, lung function tests, pulmonary imaging, cardiopulmonary exercise testing, and echocardiography.RESULTS: Lung function parameters in the overall group were significantly worse than normal values. Mean (SD) scores postbronchodilator forced expiratory volume in 1 second were -2.91 (1.38) in the ECMO-treated and -1.20 (1.53) in the non-ECMO-treated participants. Chest computed tomography scans showed mild to moderate abnormal lung structure in all ECMO-treated participants, and to a lesser extent in non-ECMO treated participants. A recurrent diaphragmatic defect was observed in 77% of the ECMO-treated group and in 43% of the non-ECMO-treated group. Except for 2 cases with acute symptoms, no clinical problems were noted in cases of recurrence. Cardiopulmonary exercise testing revealed mean (SD) percentage predicted peak oxygen consumption per kilogram of 73 (14)% and 88 (16)% in ECMO-treated and non-ECMO-treated participants, respectively. The mean (SD) workload was normal in the non-ECMO-treated group (111 [25]% predicted); in the ECMO-treated group, it was 89 (23)%. Cardiac evaluation at rest revealed no signs of pulmonary hypertension.CONCLUSIONS: In young adults who survived treatment of CDH, significant pulmonary morbidity, reduced exercise capacity, and frequent hernia recurrence should be anticipated. Lifelong follow-up care, with the emphasis on prevention of further decline, is to be recommended.</p
Clinical and experimental aspects of lung development and injury in congenital diaphragmatic hernia
Full text linkCongenital lung malformations
Full text linkCongenital lung malformations (CLMs) are rare developmental anomalies of the lung, including congenital pulmonary airway malformations (CPAM), bronchopulmonary sequestration, congenital lobar overinflation, bronchogenic cyst and isolated congenital bronchial atresia. CLMs occur in 4 out of 10,000 live births. Postnatal presentation ranges from an asymptomatic infant to respiratory failure. CLMs are typically diagnosed with antenatal ultrasonography and confirmed by chest CT angiography in the first few months of life. Although surgical treatment is the gold standard for symptomatic CLMs, a consensus on asymptomatic cases has not been reached. Resection, either thoracoscopically or through thoracotomy, minimizes the risk of local morbidity, including recurrent infections and pneumothorax, and avoids the risk of malignancies that have been associated with CPAM, bronchopulmonary sequestration and bronchogenic cyst. However, some surgeons suggest expectant management as the incidence of adverse outcomes, including malignancy, remains unknown. In either case, a planned follow-up and a proper transition to adult care are needed. The biological mechanisms through which some CLMs may trigger malignant transformation are under investigation. KRAS has already been confirmed to be somatically mutated in CPAM and other genetic susceptibilities linked to tumour development have been explored. By summarizing current progress in CLM diagnosis, management and molecular understanding we hope to highlight open questions that require urgent attention.<br/
Modelling morphodynamic development in the presence of immobile sediment
No full textPredicting the formation and break-up of immobile layers is of crucial importance for river management, as these processes greatly affect the morphodynamic evolution of the river bed. Two models are currently available for studying these processes: Struiksma's and Hirano's model. In this paper, we show that both models present limitations. This is done by numerical modelling of a laboratory experiment and two thought experiments. Struiksma's model does not predict break-up and Hirano's model yields unrealistic results when part of the sediment is immobile. We propose two alternatives that overcome these limitations: the ILSE and HANNEKE models. They differ in the interpretation of the top part of the bed interacting with the flow. Moreover, only the HANNEKE model explicitly predicts the formation of coarse layers, at the expenses of a more limited application range.Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Rivers, Ports, Waterways and Dredging Engineerin
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