Physiological and lipidomic response of exogenous choline chloride alleviating salt stress injury in Kentucky bluegrass (Poa pratensis)

Introduction

Choline participates in plant stress tolerance through glycine betaine (GB) and phospholipid metabolism. As a salt-sensitive turfgrass species, Kentucky bluegrass (Poa pratensis) is the main turfgrass species in cool-season areas.

Methods

To improve salinity tolerance and investigate the effects of choline on the physiological and lipidomic responses of turfgrass plants under salinity stress conditions, exogenous choline chloride was applied to Kentucky bluegrass exposed to salt stress.

Results

From physiological indicators, exogenous choline chloride could alleviate salt stress injury in Kentucky bluegrass. Lipid analysis showed that exogenous choline chloride under salt-stress conditions remodeled the content of phospholipids, glycolipids, and lysophospholipids. Monogalactosyl diacylglycerol, digalactosyl diacylglycerol, phosphatidylcholine, phosphatidylethanolamine, phosphatidylserine, and lysophosphatidylcholine content were increased and phosphatidic acid content were decreased in plants after exogenous choline chloride under salt treatment. Plant leaf choline content increased, but GB was not detected in exogenous choline chloride treatment plants under nonstress or salt-stress conditions.

Discussion

GB synthesis pathway related genes showed no clear change to choline chloride treatment, whereas cytidyldiphosphate-choline (CDP-choline) pathway genes were upregulated by choline chloride treatment. These results reveal that lipid remodeling through choline metabolism plays an important role in the salt tolerance mechanism of Kentucky bluegrass. Furthermore, the lipids selected in this study could serve as biomarkers for further improvement of salt-sensitive grass species.

Identification and pharmacological characterization of histamine-gated chloride channels in the fall armyworm, Spodoptera frugiperda

Histamine-gated chloride channels (HACls) mediate fast inhibitory neurotransmission in invertebrate nervous systems and have important roles in light reception, color processing, temperature preference and light-dark cycle. The fall armyworm, Spodoptera frugiperda is a main destructive pest of grain and row crops. However, the pharmacological characterization of HACls in S. frugiperda remain unknown. In this study, we identified two cDNAs encoding SfHACl1 and SfHACl2 in S. frugiperda. They had similar expression patterns and were most abundantly expressed in the head of larvae and at the egg stage. Electrophysiological analysis with the two-electrode voltage clamp method showed that histamine (HA) and γ-aminobutyric acid (GABA) activated inward currents when SfHACls were singly or collectively expressed with different ratios in Xenopus laevis oocytes. These channels were ≥2000-fold more sensitive to HA than to GABA. They were anion-selective channels, which were highly dependent on changes in external chloride concentrations, but insensitive to changes in external sodium concentrations. The insecticides abamectin (ABM) and emamectin benzoate (EB) also activated these channels with the EC₅₀ to SfHACl1 lower than that to SfHACl2. And the EC_50s of ABM and EB to the co-expressed channels gradually increased with increase in the injection ratio of SfHACl2 cRNA. Homology models and docking simulations revealed that HA bound to the large amino-terminal extracellular domain of SfHACl1 and SfHACl2 by forming 4 and 2 hydrogen bonds, respectively. The docking simulations of ABM and EB had similar binding sites in the transmembrane regions. Overall, these findings indicated that HACls act as targets for macrolide, and this study provides theoretical guidance for further derivatization of abamectin insecticides.

An ultra-sensitive and selective nitrogen dioxide sensor based on a novel P2C2 monolayer from a theoretical perspective

The sensing properties of an α phase black phosphorus carbide (P2C2) monolayer for the adsorption of CO2, H2, H2O, N2, H2S, NH3, O2 and NO2 gases are theoretically investigated using first-principles calculations. We calculate the adsorption energy, equilibrium distance, Mulliken charge transfer, electron localization function, and work function to explore whether P2C2 is suitable for detecting NO2 gas. The results demonstrate that the P2C2 monolayer is highly sensitive and selective to NO2 gas molecules with robust adsorption energy and superior charge transfer due to the existence of strong orbital hybridization between the NO2 molecule and monolayer P2C2. In addition, the results of the work function calculations indicate that field effect transistor type NO2 gas sensors based on P2C2 monolayers are also feasible. Furthermore, the current-voltage curves reveal that the adsorption of NO2 can greatly modify the resistance of the P2C2 monolayer. Our results show that gas sensors based on P2C2 monolayers could be better than those based on black phosphorene (BP) for detecting NO2 molecules in an air mixture. In addition, the recovery time of the P2C2 sensor at T = 300 K was estimated to be short (and even shorter at higher temperatures) for NO2 which satisfies the demands for sustainable use.

CYP4A in tumor-associated macrophages promotes pre-metastatic niche formation and metastasis

Tumor-associated macrophages (TAMs) play an essential role in metastasis. However, what enables TAMs to have a superior capacity to establish pre-metastatic microenvironment in distant organs is unclear. Here we have begun to uncover the effects of cytochrome P450 (CYP) 4A in TAMs on lung pre-metastatic niche formation and metastasis. CYP4A⁺ TAM infiltration was positively associated with metastasis, pre-metastatic niche formation and poor prognosis in breast cancer patients. The pharmacological inhibition of CYP4A reduced lung pre-metastatic niche formation (evidenced by a decrease in vascular endothelial growth factor receptor 1 positive (VEGFR1⁺) myeloid cell recruitment and pro-metastatic protein expression) and metastatic burden, accompanied with TAM polarization away from the M2 phenotype in spontaneous metastasis models of 4T1 breast cancer and B16F10 melanoma. Co-implantation of 4T1 cells with CYP4A10^high macrophages promoted lung pre-metastatic niche formation and metastasis. Depletion of TAMs disrupted lung pre-metastatic niches and thereby prevented metastasis. Treatment with the CM from CYP4A10^high M2 macrophages (M2) increased pre-metastatic niche formation and metastatic burden in the lungs, whereas CYP4A inhibition attenuated these effects. In vitro TAM polarization away from the M2 phenotype induced by CYP4A inhibition decreased VEGFR1⁺ myeloid cell migration and fibronectin expression, accompanied with downregulation of STAT3 signaling. Conversely, overexpression of CYP4A or exogenous addition of 20-hydroxyeicosatetraenoic acid promoted M2 polarization and cytokine production of macrophages and thereby enhanced migration of VEGFR1⁺ myeloid cells, which were reversed by siRNA or pharmacological inhibition of STAT3. Importantly, a combined blocking M2 macrophage-derived factors TGF-β, VEGF and SDF-1 abolished VEGFR1⁺ myeloid cell migration and fibroblast activation induced by CYP4A. In summary, CYP4A in TAMs is crucial for lung pre-metastatic niche formation and metastasis, and may serve as a potential therapeutic target in human cancer.

Total arch repair with open triple-branched stent graft placement for acute type A aortic dissection: experience with 122 patients

OBJECTIVE

To summarize the clinical experiences and midterm follow-up results of total arch repair with open triple-branched stent graft placement for acute type A aortic dissection.

METHODS

From June 2008 to March 2013, 122 patients (95 men and 27 women; mean age, 50.9 ± 10.4 years) with acute type A aortic dissection underwent total arch repair with open placement of a triple-branched stent graft under hypothermic cardiopulmonary bypass and selective cerebral perfusion. During the follow-up period, enhanced computed tomography and echocardiography were performed at 3 months postoperatively and annually thereafter.

RESULTS

Placement of the triple-branched stent graft into the true lumen of the descending aorta, arch, and 3 arch vessels was technically successful in 121 patients. The cardiopulmonary bypass time was 186.50 ± 38.23 minutes, and the selective antegrade cerebral perfusion time was 31.97 ± 10.08 minutes. The in-hospital mortality was 4.93%. No permanent neurologic dysfunction or paraplegia was observed. Three patients were lost to follow-up. The mean follow-up period was 30.24 ± 12.35 months. After hospital discharge, 3 patients died. On the 3-month postoperative scans, complete thrombus formation around the triple-branched stent graft was observed in 89.38% of the patients. Endoleaks were detected in 12 patients; 8 patients refused any management for the endoleaks, but they maintained a good quality of life. The other 4 patients were successfully treated by additional surgery.

CONCLUSIONS

Total arch repair with open triple-branched stent graft placement is an effective technique with satisfactory early and midterm results. This technique could be an attractive alternative to conventional total arch replacement.

Total Arch Repair for Acute Type A Aortic Dissection With 2 Modified Techniques: Open Single-Branched Stent Graft Placement and Reinforcement of the Dissected Arch Vessel Stump With Stent Graft

Background—

In total arch replacement for patients with acute type A aortic dissection, anastomoses of the graft to the left subclavian artery and descending aorta are often difficult, and the arch vessel anastomosis is frequently performed at the site of dissection. To make this procedure easier and safer, we developed 2 modified techniques: open single-branched stent graft placement into the left subclavian artery and the descending aorta and reinforcement of the dissected arch vessel stump with a stent graft neointima. The feasibility and initial clinical results of these 2 new techniques are reported.

Methods and Results—

Total arch repair with the 2 new techniques was performed in 26 patients with acute Stanford type A aortic dissection. Most patients had an uneventful postoperative course, and there were no surgical deaths. All implanted stent grafts were fully opened and not kinked, and there was no space or blood flow surrounding any of the stent grafts. The false lumen of the descending thoracic aorta closed with thrombus formation in 22 of 26 patients. Disappearance of the false lumen and recovery of the true lumen was observed in all of the dissected arch vessels.

Conclusions—

Open single-branched stent graft placement into the left subclavian artery and the descending aorta and reinforcement of the dissected arch vessel stump with a stent graft neointima are 2 simple and effective techniques that should make total arch repair an easier and safer procedure for acute type A aortic dissection.

CT and ultrasound findings of metanephric adenoma: a report of two cases and literature review

Metanephric adenoma (MA) of the kidney is an uncommon benign epithelial tumour that can present at any age. The histology of the lesion is well established, but imaging findings have been described in only a few cases. We report the CT and ultrasound appearance of MA in two females to increase the awareness of this entity among radiologists. Its recognition may facilitate nephron-sparing surgery.

Incidence of anomalous origin of coronary artery in 1879 Chinese adults on dual-source CT angiography

Background and Objective. Dual-source CT (DSCT) has been used to detect coronary artery anomalies. The purpose of this study was to assess the incidence of anomalous origin of the coronary artery in Chinese adults. Methods. We summarised all patients who underwent DSCT coronary angiography (CTCA) from December 2006 to February 2008, and data of anomalous origin of the coronary artery in Chinese adults were recorded. Results. 1879 patients underwent CTCA during that period; 24 patients with an anomalous origin of the coronary artery were detected, giving an incidence of 1.3%. Fifteen patients had an anomalous origin of the right coronary artery (12 from left coronary sinus, 3 high takeoff), eight patients had an anomalous origin of the left coronary artery (LCA from posterior sinus of Valsalva in three cases, LCX from the right coronary sinus, LCX from RCA, high takeoff, LCA from right coronary sinus, and single coronary artery in one case, respectively), and one patient had an anomalous origin of both coronary arteries (high takeoff). Conclusion. The incidence of anomalous origin of the coronary artery in Chinese adults in this study is 1.3%. DSCT can clearly visualise the anomalous origin and course of the coronary artery and is a useful screening modality. (Neth Heart J 2010;18:466-70.).

Cell cycle-related kinase supports ovarian carcinoma cell proliferation via regulation of cyclin D1 and is a predictor of outcome in patients with ovarian carcinoma

Our previous study has suggested that the cell cycle-related kinase (CCRK) is a putative candidate oncogene in glioblastoma tumorigenesis. The potential oncogenic role of CCRK and its clinical/prognostic significance, however, in ovarian carcinoma are unclear. In this study, CCRK expression was examined by immunohistochemistry in a series of ovarian carcinoma tissues. Overexpression of CCRK was detected in 53% of the ovarian carcinomas, and it was positively correlated with an ascending histological grade and/or advanced clinical stage of the disease (p < 0.05). In addition, overexpression of CCRK in ovarian carcinoma was determined to be a strong and an independent predictor of short overall survival (p < 0.05). In ovarian carcinoma cells, CCRK knockdown by RNAi led to a G1 phase cell cycle arrest, while CCRK overexpression by stable transfection of CCRK-containing plasmid pcDNA-CCRK promoted cell proliferation in vitro and tumor growth in vivo. In addition, CCRK knockdown was found to reduce cyclin D1 expression. Consistently, CCRK overexpression increased cyclin D1 expression, and furthermore, a significant correlation between expression of CCRK and cyclin D1 in ovarian carcinomas was observed (p < 0.001). These findings suggest a potential important role of CCRK in the control of cell proliferation via regulation of cyclin D1 expression, and the overexpression of CCRK, as detected by immunohistochemistry, is an independent molecular marker for shortened survival time of patients with ovarian carcinoma.

Thermal stability and spectroscopic properties of Er3+-doped antimony-borosilicate glasses

This paper reports on the optical spectroscopic properties and thermal stability of Er3+-doped antimony-borosilicate glasses for developing 1.5 microm optical amplifiers. Upon excitation at 980 nm laser diode, an intense 1.5 microm infrared fluorescence has been observed with the maximum full width at half maximum (FWHM) of 90 nm for Er3+-doped antimony-borosilicate glasses. The emission cross-section and the lifetime of the 4I13/2 level of Er3+ ions are 6.3 x 10(-21) cm2 and 0.30 ms, respectively. It is noted that the product of the emission cross-section and FWHM of the glass studied is as great as 567 x 10(-21) cm2 nm, which is comparable or higher than that of bismuthate and tellurite glasses.

Laser-diode-excited intense luminescence and green-upconversion in erbium-doped bismuth-germanate-lead glasses

We investigate the spectroscopic properties of the 1.5-microm emission from the (4)I(13/2)-->(4)I(15/2) transition of Er(3+) ions in bismuth-germanate-lead glasses for applications in broadband fiber amplifiers. The emission peak locates at 1532nm with a full width at half-maximum (FWHM) of approximately 65nm. The measured lifetime and the calculated emission cross-section of this transition are 3.3ms and 8.66x10(-21)cm(2), respectively. IR-to-green-upconversion occurs simultaneously upon excitation of the 1.5-microm emission with a commercially available 980nm laser diode. Effects of PbF(2) content on the thermal stability, structure and spectroscopic properties of Er(3+)-doped bismuth-germanate-lead glasses have been examined. We find that the substitution with PbF(2) provides a couple of potentials: shortening the UV cutoff band and decreasing the phonon energy of host glasses. Codoping of Yb(3+) significantly enhances both the green-upconversion and 1.5-microm emission intensity by means of a nonradiative Yb(3+)-->Er(3+) energy transfer. Energy transfer processes and nonradiative phonon-assisted decays could account for the population of the (2)H(11/2) level, which is an emitting level of the green-upconversion of Er(3+). The results indicate the possibility towards the development of bismuth-germanate-lead based glasses as photonics devices.

Spectroscopic Properties of Er3+/Yb3+-codoped PbO–Bi2O3–Ga2O3–GeO2 Glasses

We investigate the spectroscopic properties of the 1.5-microm emission from the (4)I(13/2)-->(4)I(15/2) transition of Er(3+) ions in PbO-Bi(2)O(3)-Ga(2)O(3)-GeO(2) glasses for applications in broadband fiber amplifiers. The measured emission peak locates at 1,532 nm with a full width at half-maximum of approximately 45 nm. The glasses exhibit a large stimulated emission cross-section of 0.89 x 10(-20) cm(2) and a large FWHM x sigma(e)(peak) product of 40.0. Infrared-to-green upconversion occurs simultaneously upon excitation of the 1.5-microm emission with a commercially available 980 nm laser diode. The green-upconversion intensity has a quadratic dependence on incident pump laser power, indicating a two-photon process. Energy transfer processes and nonradiative phonon-assisted decays could account for the population of the (2)H(11/2) of Er(3+). The results indicate the possibility towards the development of lead-bismuth-gallate-germanate based glasses as photonics devices.

Renal artery aneurysm: diagnosis and surveillance with multidetector-row computed tomography

PURPOSE

To investigate the prevalence of renal artery aneurysms, and to assess the value of multidetector-row computed tomography (MDCT) in diagnosing renal artery aneurysms.

MATERIAL AND METHODS

Altogether, 862 patients underwent arterial-phase contrast-enhanced CT scan of the abdomen in the period November 2003 to October 2005. A search for renal artery aneurysms was performed in our reporting system and revealed six patients with renal artery aneurysm (RAA).

RESULTS

The incidence of RAA was 0.7%. All renal artery aneurysms were solitary, located in the main trunk or the first branch of the renal artery, with sizes from 1.5 cm to 3.4 cm. Five aneurysms were saccular, one fusiform. No underlying thrombosis was seen. Extensive calcification was found in one aneurysm. Three aneurysms were diagnosed using axial images, while three aneurysms were only displayed by volume rendering and maximum-intensity projection images.

CONCLUSION

This study demonstrates a 0.7% incidence of renal artery aneurysms in a total of 862 patients. MDCT has an important role in detecting and assessing renal artery aneurysms. Some aneurysms can only be displayed by post-processing techniques such as volume rendering and maximum-intensity projection.

Mid-infrared emission characteristic and energy transfer of Ho3+-doped tellurite glass sensitized by Tm 3+

We report on 2.0-microm emission characteristic and energy transfer of Ho3+-doped tellurite glass sensitized by Tm3+ upon excitation of a conventional 808 nm laser diode. The Judd-Ofelt strength parameters, spontaneous radiative transition probabilities and radiative lifetime of Ho3+ have been calculated from the absorption spectra by using the Judd-Ofelt theory. Significant enhancement of 2.0-microm emission of Ho3+ has been observed with increasing Tm3+ doping up to 0.7 mol%. The energy transfer coefficient of the forward Tm3+-->Ho3+ is approximately 17 times larger than that of the backward Tm3+<--Ho3+ energy transfer. Our result indicates that the maximum gain of 2.0-microm emission, assigned to the transition of (5)I7-->(5)I8 of Ho3+, might be achieved from the tellurite glass at the concentration of 0.5 mol% of Tm2O3 and 0.15 mol% of Ho2O3. The high gain coefficient and quantum efficiency (1.16) along with the large value of the product of the stimulated emission cross-section and the measured radiative lifetime (4.12 x 10(-27) m(2)s) of the Ho3+/Tm3+-codoped tellurite glasses might find potential applications in efficient 2.0-microm laser.

Polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs) and heavy metals (HMs) as well as their genotoxicity in soil after long-term wastewater irrigation

A study was carried out on the residue level of major concern pollutants (PAHs, PCBs and HMs) and the assessment of their genotoxicity in soils obtained from Shenyang, northeast of China which had been subjected to wastewater irrigation for more than 40 years. Topsoils (0-20cm) in paddy fields were sampled along the upper, middle and lower reaches of the wastewater disposal channel. Sixteen USEPA PAHs were determined by High Performance Liquid Chromatography (HPLC) with fluorescence detector, eight PCBs were detected by Gas Chromatography (GC) with electron capture detector, and six heavy metals (Cd, Cu, Pb, Zn, Ni, and Cr) were measured by Atomic Absorption Spectrophotometer (AAS). The genotoxicity effect of soils was examined by Vicia faba micronucleus (MN) test. Archived soils that had undergone a similar history of wastewater irrigation provided by Technical University of Berlin, Germany were subjected to analysis of the above pollutants and Vicia faba/MN test for comparison. Results indicated elevated residues of the studied pollutants (PAHs, especially benzo (a) pyrene, the eight PCB congeners and heavy metals) in both tested and archived soils. The MN frequencies were 2.2-48.4 times higher compared with the control. However, there was no correlation between the MN frequencies and the concentration of pollutants detected. This investigation suggested a potential ecological risk even with a lower level of residual pollutants in soil matrix after long-term wastewater irrigation.

[Significance and mechanisms of overexpression of PAK1 gene in epithelial ovarian neoplasms]

OBJECTIVE

To investigate the significance and mechanisms of overexpression of p21-activated kinase 1 gene (PAK1) in epithelial ovarian neoplasms.

METHODS

Immunohistochemistry, fluorescence in situ hybridization and terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling methods were used to examine the protein expression and amplification of PAK1 and cell apoptosis in 30 benign ovarian adenomas, 20 borderline tumors and 80 ovarian carcinomas by tissue microarray.

RESULTS

In immunohistochemistry study, overexpression of PAK1 protein was observed in 7 (25.9%) informative benign ovarian adenomas, 7 (36.8%) borderline tumors and 53 (68.8%) ovarian carcinomas. A significant inverse correlation of PAK1 overexpression and cell apoptosis was observed in these epithelial ovarian neoplasm cohorts (P = 0.002). In addition, 27/31 (87.1%) poorly differentiated (G3) carcinomas showed overexpression of PAK1, the frequency was significantly higher than that in tumors of G1 - G2 (26/46, 56.5% , P =0.01). In fluorescence in situ hybridization study, only 2 (4.7%) informative ovarian carcinomas showed amplification of PAK1 gene. None of the borderline and benign ovarian tumors showed PAK1 amplification.

CONCLUSION

Overexpression of PAK1 protein may be involved in the tumorigenesis of epithelial ovarian neoplasms and it is associated closely with the malignant histological phenotype of ovarian carcinomas. Mechanism other than gene amplification of PAK1 may play a more important role in the regulation of protein expression of PAK1 in ovarian tumors.

Imaging of primary adrenal lymphoma: case report and literature review

Primary adrenal lymphoma is very rare, and correct preoperative diagnosis is difficult because of its nonspecific imaging findings. We report a case of bilateral primary adrenal lymphoma, with the largest dimension of 18 cm, which is the largest one reported so far, to our knowledge. Computed tomography (CT) and magnetic resonance (MR) findings were not specific enough to establish a correct diagnosis, but positron emission tomography/CT (PET/CT) showed high fluorodeoxyglucose (FDG) uptake, indicating its malignant nature. We describe the imaging findings and review the related literature to highlight this uncommon entity.

Genetic diversity of cattle in south China as revealed by blood protein electrophoresis

Genetic variation of 31 blood protein loci in 236 cattle from eight South China populations (including mithan, Bos frontalis) and a Holstein population was investigated by means of horizontal starch gel electrophoresis. Thirteen loci (ALB, CAR, Hb-b, Np, PGM, Amy-I, PEP-B, AKP, 6PGD, Cp, Pa, EsD, and TF) were found to be polymorphic. The comparison of average heterozygosities (H) shows that all the native cattle embrace a rich genetic diversity. Our results on protein polymorphism suggest that cattle in China originated mainly from Bos indicus and Bos taurus; Xuwen, Hainan, Wenshan, and Dehong cattle and the Dehong zebu are close to zebu-type cattle, and Diqing and Zhaotong cattle are close to the taurine. The mithan was very different from other native cattle, and we suggest that its origin was complicated and may be influenced by other cattle species.

Survival of individuals with spinal muscular atrophy on ventilatory support

Six ventilator-assisted individuals (VAIs) with spinal muscular atrophy (SMA) are described. All six survived by using intermittent positive pressure ventilation via an indwelling tracheostomy for a mean of 11.7 +/- 17.7 yr despite frequent episodes of mucus plugging and pneumonia. Four of the VAIs also received all nutrition via indwelling gastrostomy tubes because of severe bulbar muscle weakness. Four VAIs used tracheostomy intermittent positive pressure ventilation with their tracheostomy cuffs deflated and could communicate verbally. Five of the six VAIs remained institutionalized from the onset of ventilatory use. Two SMA VAIs survived for 15 and 4 yr, respectively, despite need for ventilatory support since early infancy. All four SMA VAIs who could communicate remained socially active and one, gainfully employed. We conclude that for patients with advanced SMA markedly prolonged survival is possible with ventilatory assistance despite severe respiratory and bulbar muscle dysfunction.

Chronic ventilator use in osteogenesis imperfecta congenita with basilar impression: a case report

Osteogenesis imperfecta, a rare connective tissue disorder, is known to be associated sometimes with the invagination of the basilar skull. This deformity may disturb respiratory function secondary to brain stem compression and hydrocephalus. In addition, the deformed thoracic cage and fragile ribs make pulmonary care more complicated. A case of 24-year-old man is presented with brain stem compression syndrome secondary to osteogenesis imperfecta congenita with basilar impression. He developed respiratory failure and became tracheostomy positive-pressure ventilator dependent at the age of 21 years. He also suffered multiple skeletal abnormalities and mental retardation, and following the brain stem compression, severe quadriparesis. The patient's condition is stable since he has been using the ventilator and he is currently living in the community.

Pneumobelt for sleep in the ventilator user: clinical experience

A pneumobelt with a positive pressure respirator was used for sleep for three patients with chronic respiratory insufficiency secondary to syringomyelia, poliomyelitis, and Friedreich's ataxia respectively. This device was found to be effective in improving and maintaining their daily functioning in the community or institute.

Respiratory rehabilitation in severe restrictive lung disease secondary to tuberculosis

There is a need for portable and less expensive devices for patients with chronic respiratory insufficiency. The case of a 44-year-old Hispanic woman is illustrative. The patient had severe restrictive lung disease secondary to right phrenic nerve crush/pneumoperitoneum and left pneumonectomy/decortication for bilateral lower lobe tuberculosis. In 1969, 12 years after her last operation, she developed dyspnea, coryza, and somnolence. She was hospitalized with a PaO2 of 30mmHg; PaCO2 of 77mmHg and a pH of 7.28. Pulmonary function tests showed alveolar hypoventilation and her resting ventilation was between 2.26 to 3.74L/min. Her vital capacity was 1130cc (37% of predicted value) and maximum breathing capacity was 36L/min (44% of predicted value). From 1969, she used a poncho (wraparound) ventilator for her long-term respiratory care and modified the poncho suit to meet her personal needs. In 1971, she discovered that a mouth intermittent positive pressure ventilation (MIPPV) method, often used by patients with neuromuscular disorders, was easier to apply. Since then, she has continued to use a Bantam Respirator with MIPPV and a lipguard/mouthpiece during the night, and the respirator with a mouthpiece for a few hours during the days. However, when she has an upper respiratory infection or feels tired, she finds that she needs the greater rest and comfort that the poncho provides. With the assistance of these two respiratory devices, she has been able to complete her education, marry, and lead a fulfilling life in the community. This patient is considered the first person with severe lung pathology to utilize MIPPV for sleep.