BackgroundSivelestat, a neutrophil elastase inhibitor, was previously approved in Japan for the treatment of acute lung injury associated with systemic inflammatory response syndrome. However, sivelestat produced inconsistent therapeutic benefits. This study aimed to identify factors predicting the therapeutic effects of sivelestat.MethodsWe enrolled 53 mechanically ventilated patients who received sivelestat. The patients were classified as effective (n = 28) if they were weaned from the ventilator within 28 days, or as ineffective groups (n = 25). Patient characteristics were compared between these groups and multivariate logistic regression analysis was used to identify predictive factors. A validation study was then conducted in sivelestat-free patients.ResultsA high red blood cell count and low hydrogen ion concentration were significantly associated with a higher ventilator weaning rate in patients receiving sivelestat. The validation study revealed that the hydrogen ion concentration value also significantly associated with ventilator weaning in patients who did not receive sivelestat.ConclusionsAlthough hydrogen ion concentration was inversely associated with the ventilator weaning rate, it did not predict sivelestat efficacy. This study indicated that acute lung injury patients with a high red blood cell count would derive the most benefit from sivelestat administration.
This paper discusses the operational characteristics of two emulsified blends of aqueous ethanol and diesel fuel in a DI diesel engine with supercharging and cooled EGR. Two emulsified blends: one with 25 vol% aqueous ethanol (E20W5, Ethanol: 20 vol%, Water: 5 vol%) and the other with 50 vol% aqueous ethanol (E40W10, Ethanol: 40 vol%, Water: 10 vol%) were examined. Silent, low NOx, and smokeless combustion was realized over a wide load range with the emulsified fuel, E40W10 when the quantity of pilot injection and the intake oxygen content were optimized. The results show that smokeless operation can be established with low pressure injection and low intake oxygen content. The degree of constant volume heat release and the indicated thermal efficiency with the emulsified fuels improved over a wide load range as the pilot injection quantity was increased and the heat release with the pilot injection was retarded to near TDC. The degree of constant volume heat release with the emulsified fuel also improved, mainly due to the reduction in afterburning with smaller quantities of the main injection.
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