The diagnostic accuracy attained with the use of transbronchial fine needle aspiration biopsy, aspiration of bronchial secretion, bronchial washing, brush biopsy and forceps biopsy via a flexible fiberoptic bronchoscope was compared in patients with carcinoma of the lung. In endoscopic visible tumours the sensitivity of forceps biopsy was higher than that of the other methods. When forceps biopsy was combined with bronchial washing the overall diagnostic accuracy was significantly higher than that of any of the single methods, while no appreciable increase was obtained by adding additional methods. Selective brush biopsy from every segment bronchus has been established as a method in the search for occult bronchial carcinoma. The extent of respiratory mucosal damage and wound healing after brush biopsy was therefore studied in rabbits. Large differences in the extension and depth of the damage was observed. The basement membrane was often penetrated. Regeneration started during the first day after brush biopsy and a normal ciliated epithelium was restored within three weeks. To determine if the bronchoscope itself damaged the respiratory epithelium, bronchial mucosa was studied in the pig after examination with a flexible fiberoptic bronchoscope. The columnar epithelial cells were torn off in areas where the bronchoscope had rubbed against the airway wall but the basement membrane was not damaged. Since the function of the respiratory epithelium is to remove inhaled particles from the airways, mucociliary clearance was studied in man after fiberoptic bronchoscopy. The study suggests that the tracheobronchial clearance system has a large reserve for mechanical trauma. Mucociliary clearance can however be decreased after fiberoptic bronchoscopy in some patients. An increasing number of patients with impaired cardiopulmonary function are today subjected to examination with flexible fiberoptic broncoscopy. The haemodynamic effects of fiberoptic bronchoscopy performed under topical anaesthesia were therefore studied in patients with restrictive lung disease. The procedure induced marked haemodynamic changes during passage of the larynx and during suctioning. A slight fall in arterial oxygen tension was observed during bronchial suctioning and in the post-bronchoscopic period. Three of ten patients developed ST-T-segment changes during bronchial suctioning. / <p>S. 1-48: sammanfattning, s. 49-126: 5 uppsatser</p> / digitalisering@umu.se

Nedsatt motilitet i esophagus kan vara en orsak till dysphagi. Högupplöst esophagusmanometri (HRM) är "golden standard" för att utvärdera esophagus motilitet. Defekter av motiliteten kan ses som avbrott i den isobariska konturen (IBC). Det finns ett samband mellan avbrott och inkomplett bolus clearance. Referensvärdena för HRM är utformade för att patienten ska ligga ner och svälja under undersökningen. Kroppens läge påverkar esophagus och värdena för HRM ändras signifikant beroende på om patienten ligger ned eller sitter upp. Det pågår diskussioner kring om undersökningen borde innefatta sväljningar i både liggande och sittande position för att öka den diagnostiska säkerheten. Denna studie innefattade 12 stycken patienter som frivilligt genomgick 10 extra sväljningar sittande utöver de i liggande position. En jämförelse i antalet avbrott i IBC gjordes mellan sväljningarna sittandes och liggandes. Resultatet visade att 24 av 118 sväljningar liggande hade avbrott i IBC och 94 var utan avbrott. När patienterna satt upp hade 68 av 120 sväljningar avbrott i IBC och 52 sväljningar utan avbrott. Hypotesen bekräftades då det föreligger en signifikant skillnad i antalet avbrott mellan sittande och liggande position. Det förekom fler avbrott i sittande position och avbrotten blev också längre i sittande position. Fortsatta studier med större urval erfordras. / Reduced motility in the esophagus can be a cause of dysphagia. High-resolution esophagus manometry (HRM) is the golden standard for evaluating esophageal motility. Defects of the motility can be seen as disruptions in the isobaric contour (IBC). There is a correlation between disruptions and incomplete bolus clearance. The references for HRM are made for the patient to lie down and swallow for the examination. The position of the body affects the esophagus and the values for HRM changes significantly depending on whether the patients is lying down or sitting up. There are discussions about whether the procedure should include both supine and sitting position to increase diagnostic reliability. This study included 12 patients who voluntarily underwent 10 additional swallows sitting up in addition to the supine position. A comparison of the disruptions in IBC was made between the swallows sitting and supine. The results showed that 24 out of 118 supine swallows had disruptions in IBC and 94 were without. When the patients sat up, 68 out of 120 swallows had disruptions in IBC and 52 were without. The hypothesis was confirmed as there were more disruptions in the sitting position and the disruptions were longer. Further studies are required.

During last decade there has been developed concept of so-called ecosystem services (e.g. Millennium Ecosystem Assessment, 2005) in matured countries. This concept focus especially on identification of benefits resulting from intact ecosystem and also on various ways of taking all those benefits into account when dealing with decision-making process of market economy. Goal of this concept (among other things) is to keep currently freely available ecosystem services in nature as they are and also to ensure natural conditions for life won't be becoming worse. Landscape of eastern Ore Mountain has its specific character especially because of few unique ecosystems which don't occur in other locations at all; or they are presented there but not in such high volume. We can consider mountain meadows, natural streams and clearance cairns at the most important local unique ecosystems. Main goal of diploma thesis is to analyze recreational and mainly aesthetic values of clearance cairns. Even though clearance cairns are important biotopes there was quite small attention dedicated to them in existing analyses made in Czech Republic. That is in heavy contrast to attention dedicated to those biotopes in other areas, e.g. in eastern part of Ore Mountain belonging to Saxony where local inhabitants appreciate clearance cairns so much that every single section of them is completely documented (resulting into 1.000 kilometers of documented clearance cairns). Diploma thesis is based on methodology using analysis of primary data obtained from empirical research. Research was realized in eastern Ore Mountain during summer 2013 and author of this thesis was actively participated both in preparation phase and also in realization phase. Thesis also uses random utility theory, discrete choice models and also stated preferences methods (e.g. Bateman et al., 2002). Multinominal logit model and random parameter logic model are used for values estimation. Based on performed analysis thesis verifies or disproves hypothesis saying that willingness to pay for clearance cairns is statistically insignificant (i.e. people don't consider this landscape element as having significant value). Diploma thesis results will be used as a suggestion for obtaining clearance cairns management.

Chez les patients avec maladies neuromusculaires (MNM) ou lésions médullaires, les modifications musculaires et squelettiques perturbent le mécanisme de toux. Les in-exsufflations mécaniques (IE-M) et les hyper-insufflations (H-I) constituent une aide instrumentale pour avoir une toux plus efficace. En France, ces dispositifs médicaux (DM) sont remboursés via des forfaits de location avec prestations de services. Cette thèse a pour objectif d'étudier le bénéfice clinique des IE-M et H-I par l'évaluation : 1) du niveau de preuve disponible via une revue systématique, 2) de leurs modalités de remboursement en France, via la constitution d'un groupe de travail, puis à l'international, via une enquête auprès du réseau international des agences d'évaluation, et, 3) des populations éligibles à ces DM via l'exploitation des bases administratives. Notre revue systématique souligne l'absence de donnée fiable disponible sur les IE-M utilisées chez les patients avec MNM. Elle rend compte de la particularité française d'utiliser des H-I. Malgré le faible niveau de preuves, le contraste avec la pratique des professionnels de santé qui considèrent ces DM efficaces et souhaitent le maintien du remboursement, peut s'expliquer par le peu d'alternatives disponibles et la possibilité d'utiliser ces DM non invasifs à domicile. Il s'agit de la seule évaluation de ces DM menée par une agence. La population éligible aux IE-M et H-I a été estimée à 3 100 par an. Ce travail encourage d'autres recherches pour assurer le meilleur traitement pour les patients comme les essais contrôlés randomisés (bien que difficiles en population rare) ou d'explorer d'autres modèles (essais randomisés par groupes) / Patients with neuromuscular disease (NMD) or spinal cord injury suffered from muscle and skeletal changes which impair cough mechanism. Mechanical in-exsufflations (MI-E) and Intermittent Positive Pressure Breathing (IPPB) are instrumental methods used for having a more effective cough. In France, theses medical devices (MD) are available to rent on a weekly fee schedule including associated services.This thesis aimed to study the clinical benefit of MI-E and IPPB by assessing: 1) the level of evidence available through a systematic review, 2) reimbursement arrangements in France, through the set-up of a multidisciplinary working group, and then internationally, through a survey of the International Network of Agencies for Health Technology Assessment, and, 3) the patient population treated with these MD through public databases’ queries.Our systematic review points lack of reliable data available on the use of MI-E in patients with NMD. It highlights the French particularity of using IPPB. The scientific evidence does not support the use of these MD but healthcare professionals are faced with the reality of medical practice. They consider these MD effective and want to keep their refund. This can be explained by the few available alternatives and the home-used possibility of these non-invasive MD. This is the only assessment of these MD conducted by an agency. The patient population treated with MI-E and IPPB has been estimated at 3 100 per year.This work stresses the need for further research to ensure best treatment for the patients such as randomized controlled trials (although difficult in a rare population) or explore other designs (cluster randomized trials).

The project elaborated in frame of engineering studies branch Manufacturing Technology (N2307-00) is submitting design of technology production of the latch claw. The latch claw is a component of a car side-door latch assembly and can be used for different car models. The part is made of sheetmetal 4 mm thick. The material for the part is 15CrMo5, alloy steel for case-hardening purposes. Pursuant of the literary pursuit was designed several options of the part manufacture. With regard to required dimensional accuracy, cut-edge quality and expected production run (800 000 pcs. per year) was proposed manufacturing the part by fineblanking technology. Fineblanking is a cost-effective manufacturing method for accurate sheetmetal parts. For manufacturing parts was chosen Feintool hydraulic fineblanking press HFA 3200plus with total force 3200 kN. The press is coupled to a coil reel a strip straighter. Both units of Feintool feeding line FBA 8/300 are very compact, reducing space requirement. For the fineblanking tool design is used a moving-punch system because these tool systems are compact and economical to make and use. The tool make use of standardized cast iron fineblanking die set made by Fibro company. At the conclusion was compared the cost-effectiveness between two production methods – fineblanking with that of laser beam cutting.

Master thesis is focused on the research of influence of selected substantial parameters on stress – strain states in the deep groove radial ball bearing. The influence of radial load is analyzed, such as the influence of size of the bearing and row of the bearing, also influence of radial clearance is quantified. Next, the influence of thermal distribution in the bearing is analyzed for different combinations of thermal distributions and radial clearances. Conclusions from analyses are then used in the last task – suggestion of radial clearance for customer – specified assembly. Problem is solved using the finite element method (FEM) in pre/post processor MSC.Patran and solver MSC.Marc. To make analyses faster the substantial parameters are implemented in the algorithm for automatic generation of the bearing calculation (batch file).The theme of this thesis was commissioned by ZKL - Research and development, a. s.

The aim of the thesis is to design a manufacturing technology of a part of the universal opener with an innovated design. The component is made of stainless steel 17 240 (X5CrNi18-10). The blank is 2 mm thick sheet metal. Within the literary study the comparison of the possible technologies of manufacturing has been carried out. With respect to the batch size (200 000 pieces) and to the required quality of the component the fineblanking technology has been selected. For the manufacturing of the component a triple action hydraulic press HFA 3200plus has been chosen. This press will be coupled in production line with a feeding line FBA 8/300. The main point of the thesis is to design a cutting tool and to create a drawing documentation. Another part of the project is the technical and economical evaluation of the designed manufacturing process.

Bakgrund: Cystisk fibros påverkar lungornas funktion och individens hälsorelaterade livskvalitet. Behandlingen är krävande både fysiskt och psykiskt, och en tidskrävande del av den fysioterapeutiska behandlingen är andningsgymnastik inklusive sekretmobiliserande tekniker (airway clearance techniques/ACT).  Syfte: Att undersöka vilken effekt fysisk träning har på lungfunktion och hälsorelaterad livskvalitet. Metod: Systematisk litteraturstudie. Sökning gjordes i databaserna PubMed och Cochrane, åtta studier inkluderades. Tre studier undersökte konditionsträning, en undersökte styrketräning, tre undersökte kombinerad konditions- och styrketräning, och en undersökte både kondition- och styrketräning i två olika interventionsgrupper jämfört med kontrollgrupp. Kvalitetsgranskning gjordes med PEDro-skalan, evidensgradering med GRADEstud. Resultat: Litteraturstudien visade motstridiga resultat gällande valda träningsformers effekt på lungfunktion och hälsorelaterad livskvalitet. Fyra studier visade signifikanta effekter på ett eller flera lungfunktionsmått, två studier visade signifikanta effekter gällande hälsorelaterad livskvalitet. Studierna var indelade i tre kategorier utifrån träningsform. Evidensen bedömdes som begränsad gällande konditionsträning, och otillräcklig för både styrketräning och kombinerad konditions- och styrketräning. Konklusion: Granskning av studierna visade motstridiga resultat vilket gav låg evidensgrad, och utifrån denna referensram kan inga säkra slutsatser dras gällande vilken effekt fysisk träning har på lungfunktion och hälsorelaterad livskvalitet vid CF. / Background: Cystic fibrosis affects the pulmonary function and health related quality of life (HRQoL). The treatment is physically and mentally demanding, and a time-consuming part is chest physiotherapy, which contains airway clearance techniques (ACT). Study purpose: investigate the effects of exercise on pulmonary function and HRQoL, and provide a basis for future research regarding whether exercise could substitute for chest physiotherapy.  Method: Systematic review. Search conducted in PubMed and Cochrane; eight studies included. Three examined aerobic exercise, one weight training, three a combination of aerobic- and weight training, one aerobic- and weight training divided in two intervention groups. Assessment of study quality was made with PEDro-scale. Strength of evidence assessed by GRADEstud.  Results: Studies were divided into three categories based on exercise form. Contradicting results regarding the effects of exercise on pulmonary function and HRQoL were found in all categories. Four studies presented significant effects on pulmonary function measures, two showed significant effects on HRQoL. Strength of evidence: limited for aerobic training, insufficient for both weight training and a combination of aerobic- and weight training.  Conclusion: This review presented contradicting results which eventuated in low strength of evidence, therefor no definite conclusions can be made regarding the effect of exercise on pulmonary function and HRQoL.

Background: Glomerular filtration rate (GFR) is a clinically important measurement of kidney function and estimating the GFR is of great importance in healthcare. Methods available today either lack in precision or are overly time consuming. Proenkephalin (PENK) has been shown to correlate well with the GFR and has therefore been proposed as a novel biomarker for kidney function. Aim: To evaluate a new point-of-care test for measuring PENK in blood and to assess its correlation to GFR measured by iohexol plasma clearance (mGFRiohexol). Materials and methods: Blood was collected from 21 patients with varying indications for the iohexol plasma clearance test. PENK was measured with IB10 Sphingotest penKid in whole blood, plasma and serum respectively. The concentration was correlated to the mGFRiohexol and results were compared to those from measurement of the routine markers for kidney function, i.e. creatinine and cystatin C. Results: Fourteen men and seven women were included. The median age was 57 years. PENK in plasma correlated weakly with mGFRiohexol (R2=0.22, p=0.042). No significant correlation was shown for PENK in whole blood or serum. Creatinine also showed a weak correlation with mGFRiohexol (R2=0.35, p=0.0046). In contrast, cystatin C was strongly correlated with mGFRiohexol (R2= 0.87, p&lt;0.0001). Conclusion: Our results indicate that PENK is a biomarker of low clinical value for estimating the GFR. However, further studies are needed before this can be assured. Cystatin C, on the contrary, seems to be an accurate biomarker for estimating the GFR.

No description available.