Background: Comprehensive endoscopic scoring of the upper and lower airways for inflammation has not been critically assessed among a large population of horses. The relationship between upper and lower airways described in humans by the "one airway, one disease" concept might also apply to horses.Hypothesis/Objectives: To evaluate if an association exists between endoscopic inflammatory scores and mucus scores of upper and lower airways and to investigate if endoscopic findings correlate with the lower airway inflammation measured by bronchoalveolar lavage (BAL) cytology.Methods: Prospective field study. Pharyngitis, pharyngeal mucus, tracheal mucus, tracheal septum thickness, and bronchial mucus were scored using new and previously described scoring systems on a convenience sample of 128 horses with and without lung inflammation. Based on BAL fluid cytology, horses were categorized as having normal, moderate, or severe inflammation of the lower airways.Results: All 5 endoscopy scores showed excellent interobserver agreement. Tracheal mucus (P < .001), tracheal septum thickness (P = .036), and bronchial mucus (P = .037) were significantly increased in horses with severe inflammation BALs and were correlated among themselves but not with upper airways scores. BAL neutrophils percentage was correlated with tracheal mucus (r s = 0.41, P < .001), bronchial mucus (r s = 0.27, P = .003), and had a weak negative correlation with pharyngitis (r s = À0.25, P = .004).Conclusions and Clinical Importance: Lower airway endoscopy scores are reflective of lower airway inflammation; however, upper and lower airways are independent in terms of severity of inflammation. Therefore, observing upper airway inflammation is not an indication to test for lower airway inflammation.

Effect of early, individualised and intensified follow-up after open heart valve surgery on unplanned cardiac hospital readmissions and all-cause mortality

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We discuss the maximal analytic extension along an axis where O,+ = constant of the solution to Einstein's field equations with cosmological constant with a charged point-mass source.Einstein's field equations with cosmological conthe cosmological constant may well be important stant, in understanding the global properties of our actual space-time, and (c) because metric (3) provides Rub -% g a p + Agab = -K T ,~ , another example which illustrates that the global have solutions with line elements nature of solutions to nonlinear field equations Taking for Tub the energy-momentum tensor a s s ociated with the electric field surrounding a charged point m a s s , one obtains for @ ( r ) in Eq. (2) Here w i and e a r e the m a s s and charge of the central body. The solution (3) can be obtained by anintegrationprocedure illustrated in textbooksfor the Reissner-Nordstram solution [A = 0 in Eq. (3)11 o r the Schwarzschild solution with o r without cosmological constant [e = 0 in Eq. (3)].2 Solution (3) i s containedin a more general solution mentionedby Carter.3 A metric of the f o r m (2) h a s singularities where @ vanishes o r becomes infinite. However, s o m e of these singularities a r e pseudosingularities, caused by a n inappropriate coordinate system. Graves and rill^ have shown how to extend a metric of the f o r m (2) a c r o s s a pseudosingularity by means of a coordinate transformation of the Kruskal type. They illustrated the procedure f o r the Reissner-, Nordstrijm c a s e with e 2 < m 2 . The resulting maximally extended analytic manifold turned out to be a world infinitely repeated in a timelike direction with a timelike singularity a t r = 0. It is best r e presented by means of a P e n r o s e diagram a s in some m o r e recent t e~t b o o k s .~~' The method was also used by c a r t e r 7 to find the maximal analytic extension of the K e r r solution a s well a s that of the Reissner-Nordstrijm solution f o r the special c a s e of e2=wz2. Here we do the s a m e for the metric (3). This i s an interesting exercise (a) because it i s important, in trying to understand the physical significance of Eq. (1) to study the qualitative properties of all exact solutions in idealized situations, (b) because may depend drastically on s m a l l perturbations of the equations. Since the technique of analytic extension a c r o s s pseudosingularities is well understood,' we quote h e r e only the results. It is convenient and interesting in itself to consider first the c a s e when e = 0 in metric (3), i.e., the c a s e of the Schwarzschild solution with cosmological constant. It will be easy a t the end to piece together the result f o r e = 0 with the result for A = 0 (~e i s s n e r -N o r d s t r i j m ) to obtain the result f o r the general c a s e (3).F o r e = 0, O < A < l/9tn2, @(Y) has two positive roots r, > r,, and one negative root r,. The two positive roots a r e pseudosingularities. The negative unphysical root cannot be reached because of the singularity a t r = 0 and will not concern us further...

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The diagnosis of Hydrops fetalis still carries a grave prognosis with reported mortality ranging from 50 to 100%. With the advent of more aggressive therapy, improvement of survival is undetermined. The study population of this outcome case series was gathered from all cases of hydrops fetalis admitted to our Loyola University Medical Center Neonatal Intensive Care Unit (NICU) from 1990 to 1997. Forty-one patients were eligible for inclusion. Only four had a diagnosis of immune hydrops fetalis, while the remainder had varied nonimmune causes. Models predicting survival were constructed with various neonatal and maternal factors as explanatory variables using Cox proportional Hazards technique. Kaplan-Meier estimates of median survival times for different stratifying variables were likewise computed. The overall mortality rate was 49% with an overall median survival time of 15 days (95% CI 8-38). Median survival time estimates differed significantly between patients who had (a) proven infection or not and (b) had less than or greater than two fluid-filled cavities. The use of steroids, surfactant, or high-frequency ventilation did not improve survival. Stratifying the study base into those treated in early or late 1990s likewise failed to show difference in survival times. Infection remains a significant problem (46%). In our series of 41 infants with hydrops fetalis, survival rates remain comparable to those reported in the literature, despite aggressive therapy. Although the use of surfactant, steroids, and high-frequency ventilation appear to prolong survival times, these treatments failed to alter overall survival outcome.

Objective: To gather information regarding the efficacy of early minimal enteral nutrition on overall feeding tolerance in extremely low birth weight infants.Study Design: Prospective randomized controlled trial comparing the early use of minimal enteral nutrition in extremely low birth weight infants from day 2 to day 7 vs control infants. On day 8, feeding volume in both groups were advanced by 10 ml kg À1 day À1 until full enteral feedings were reached. Time to full feeds, number of intolerance episodes, anthropometric measurements, peak total bilirubin levels, incidence of necrotizing enterocolitis and incidence of sepsis were compared between the two groups with t-test and w 2 test.Result: Eighty-four infants were enrolled in the study but only 61 infants completed the feeding protocol. No statistically significant differences were found between the groups with regards to growth patterns, feeding tolerance, mortality, length of hospital stay and incidence of sepsis and necrotizing enterocolitis. Conclusion:Early minimal enteral nutrition use in extremely low birth weight infants did not improve feeding tolerance.

There is a long-held belief that preterm newborns lack sufficient arteriolar musculature to maintain a prolonged elevated pulmonary vascular resistance (PVR) after birth. Net ductal flow is thought to be minimal, with the developing pulmonary circulation incapable of significant vasoconstriction. We identified retrospectively 15 premature newborns over a 10-year period weighing < or = 1500 g and with a gestational age of < or = 30 weeks with documented persistent pulmonary hypertension of the newborn (PPHN) in the first 24 hours after birth. We matched 36 newborns of similar weight and gestation with no clinical evidence of shunting. The control group weaned to an FiO2 < or = 0.50 by 12 hours after birth. Despite similar gestational ages, the PPHN group (n = 15) had significantly higher birth weights than the control group (n = 36). The duration of ruptured membranes, maternal tobacco use, and use of antenatal steroids were significantly higher in the PPHN group. We speculate that these three factors might act in a synergistic relationship with which to accelerate pulmonary vascular smooth muscle development in premature newborns.