Articles: function.
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This study investigates the change of endothelial cell morphology and function at the rabbit basilar bifurcations in response to sustained high blood flow after bilateral common carotid artery ligation. ⋯ This study is the first to present endothelial cell changes of basilar artery bifurcation in response to sustained high blood flow in rabbits. Endothelial cell impairment possibly initiates aneurysm formation.
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Respiratory Support PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: COPD is a major cause of morbidity and mortality worldwide, representing a major public health problem due to the high health and economic resource consumption. Pulmonary rehabilitation is a standard care recommendation for these patients, in order to control the symptoms and optimize the functional capacity, reducing healthcare costs associated with exacerbations and activity limitations and participation. However, in patients with severe COPD exercise performance can be difficult, due to extreme dyspnea, decreased muscle strength and fatigue. In addition, hypoxemia and dyspnea during efforts and daily activities may occur, limiting their quality of life. Thus, NIV have been used as adjunct to exercise, in order to improve exercise capacity in these patients. However, there is no consensus for this technique recommendation. Our objective was to verify whether the use of NIV during exercise is effective than exercise without NIV in dyspnea, walked distance, blood gases and health status in COPD patients, through a systematic review and meta-analysis. ⋯ Sara Correia: Employee: salary The following authors have nothing to disclose: Teresa Tomás, Elisabete CarolinoNo Product/Research Disclosure Information.
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Critical Care Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: First described in 1950, cerebral salt wasting syndrome (CSW) is defined by development of extracellular volume depletion due to renal sodium transport abnormality in patients with intracranial disease and normal adrenal and thyroid function [1]. The entity has been controversial and its existence debatable. ⋯ This case illustrates the need for CSW recognition as a separate entity from SIADH. Failure to make this distinction in a patient with hyponatremia who has cranial conditions could lead to unbefitting and dangerous therapy with water restriction resulting in fatal outcomes.Reference #1: Peters JP, et al. A salt-wasting syndrome associated with cerebral disease. Trans Assc Am Phys. 1950, 63:57-64Reference #2: Schwartz WB, et al. A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 1957 Oct 23(4):529-42DISCLOSURE: The following authors have nothing to disclose: Anita Rajagopal, John LuciaNo Product/Research Disclosure Information.
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Critical CareSESSION TYPE: Slide PresentationPRESENTED ON: Saturday, March 22, 2014 at 04:15 PM - 05:15 PMPURPOSE: This QI intervention is aimed at reducing delirium,increasing implementation of goal directed sedation and improving patient's functional status by early physical therapy (PT) in CCU. Based on current data, this can effectively decrease delirium and neuromuscular deconditioning in intensive care patients. Our goals are to: 1) Increase delirium recognition by consistent implementation of Confusion Assessment Measurement (CAM-ICU), 2) reduce deep sedation by goal directed sedation protocols, 3)improve patients' functional mobility by increasing the number and earlier timing of PT treatments. ⋯ The following authors have nothing to disclose: Jasleen Pannu, Sarah Lee, Dereddi Raja Reddy, Pramod Guru, Mazen Al-Qadi, Bernardo SelimNo Product/Research Disclosure Information.
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Pleural CasesSESSION TYPE: Case ReportsPRESENTED ON: Sunday, March 23, 2014 at 09:00 AM - 10:00 AMINTRODUCTION: Patients with large pleural effusions often experience dramatic relief from dyspnea after thoracentesis. While this is well-recognized, the physiological basis for such relief remains poorly understood. One commonly held belief is that thoracentesis allows for lung reexpansion, ventilation of previously atelectatic lung, and improved ventilation-perfusion matching, subsequently leading to dyspnea relief. This contrasts with the concept of "length-tension inappropriateness," which posits chest wall mechanics best explain dyspnea relief. ⋯ Our case established that dyspnea relief after thoracentesis likely results from changes in chest wall mechanics and/or work of breathing. This observation has direct clinical implications and could inform therapeutic decisions.Reference #1: Brown NE et al. Changes in pulmonary mechanics and gas exchange following thoracentesis. Chest. 1978; 74: 540-42Reference #2: Estenne M et al. Mechanism of relief of dyspnea after thoracentesis in patients with large pleural effusions. Am J Med. 1983; 74(5):813-9Reference #3: Wang LM et al. Improved lung function after thoracentesis in patients with paradoxical movement of a hemidiaphragm secondary to a large pleural effusion. Respirology. 2007; 12(5):719-23DISCLOSURE: The following authors have nothing to disclose: Mary Klecka, Fabien MaldonadoNo Product/Research Disclosure Information.