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Sample records for ett massabruks sodapanna

  1. The ABC-F protein EttA gates ribosome entry into the translation elongation cycle

    PubMed Central

    Boël, Grégory; Smith, Paul C.; Ning, Wei; Englander, Michael T.; Chen, Bo; Hashem, Yaser; Testa, Anthony J.; Fischer, Jeffrey J.; Wieden, Hans-Joachim; Frank, Joachim; Gonzalez, Ruben L.; Hunt, John F.

    2014-01-01

    ABC-F proteins have evaded functional characterization even though they comprise one of the most widely distributed branches of the ATP-binding cassette (ABC) superfamily. Herein, we demonstrate that YjjK, the most prevalent eubacterial ABC-F protein, gates ribosome entry into the translation elongation cycle through a nucleotide-dependent interaction sensitive to ATP/ADP ratio. Accordingly, we rename this protein Energy-dependent Translational Throttle A (EttA). We determined the crystal structure of Escherichia coli EttA and used it to design mutants for biochemical studies, including enzymological assays of the initial steps of protein synthesis. These studies suggest that EttA may regulate protein synthesis in energy-depleted cells, which have a low ATP/ADP ratio. Consistent with this inference, ΔettA cells exhibit a severe fitness defect in long-term stationary phase. These studies demonstrate that an ABC-F protein regulates protein synthesis via a novel mechanism sensitive to cellular energy status. PMID:24389466

  2. The ABC-F protein EttA gates ribosome entry into the translation elongation cycle.

    PubMed

    Boël, Grégory; Smith, Paul C; Ning, Wei; Englander, Michael T; Chen, Bo; Hashem, Yaser; Testa, Anthony J; Fischer, Jeffrey J; Wieden, Hans-Joachim; Frank, Joachim; Gonzalez, Ruben L; Hunt, John F

    2014-02-01

    ABC-F proteins have evaded functional characterization even though they compose one of the most widely distributed branches of the ATP-binding cassette (ABC) superfamily. Herein, we demonstrate that YjjK, the most prevalent eubacterial ABC-F protein, gates ribosome entry into the translation elongation cycle through a nucleotide-dependent interaction sensitive to ATP/ADP ratio. Accordingly, we rename this protein energy-dependent translational throttle A (EttA). We determined the crystal structure of Escherichia coli EttA and used it to design mutants for biochemical studies including enzymological assays of the initial steps of protein synthesis. These studies suggest that EttA may regulate protein synthesis in energy-depleted cells, which have a low ATP/ADP ratio. Consistently with this inference, EttA-deleted cells exhibit a severe fitness defect in long-term stationary phase. These studies demonstrate that an ABC-F protein regulates protein synthesis via a new mechanism sensitive to cellular energy status.

  3. Comparison of the effect of LMA and ETT on ventilation and intragastric pressure in pediatric laparoscopic procedures.

    PubMed

    Ozdamar, D; Güvenç, B H; Toker, K; Solak, M; Ekingen, G

    2010-08-01

    The aim of our study was to compare classic laryngeal mask airway (LMA-C) with the endotracheal tube (ETT) in pediatric laparoscopic surgery to evaluate the intragastric pressures (IGP) using intragastric pressure monitoring. We also sought to investigate the related influence on respiratory parameters. The Ethics Committee of the Health Institution approved the study protocol. A total of 40 patients, ASA I-II, three and a half months to 12 years old were included in this randomized study. Two study groups were formed: the ETT group and the LMA-C group. A nasogastric tube was inserted following induction to evacuate any intragastric gas and fluid before application of either LMA-C or ETT. The change in IGP was measured with a transducer, which was attached to the nasogastric tube. IGP, peak airway pressures (PAP), SPO2 and ETCO2 were recorded. Repeated ANOVA measures were used to evaluate the change in IGP, PAP, SPO2 and ETCO2 times in both groups. The change in IGP was not significant among the groups except at 15 and 30 minutes (P<0.05). The changes in PAP, SPO2, and ETCO2 levels were not significant. The perioperative intragastric pressure evaluation failed to show any significant change in intragastric pressures and ventilation parameters due to the application of LMA-C in this study. We advocate LMA-C application as a feasible anesthetic device in pediatric laparoscopic surgery.

  4. EttA regulates translation by binding to the ribosomal E site and restricting ribosome-tRNA dynamics

    PubMed Central

    Chen, Bo; Boël, Grégory; Hashem, Yaser; Ning, Wei; Fei, Jingyi; Wang, Chi; Gonzalez, Ruben L.; Hunt, John F.; Frank, Joachim

    2014-01-01

    Cells express many ribosome-interacting factors whose functions and molecular mechanisms remain unknown. Here, we elucidate the mechanism of a newly characterized regulatory translation factor, Energy-dependent Translational Throttle A (EttA), which is an Escherichia coli representative of the ATP-binding cassette F (ABC-F) protein family. Using cryo-EM, we demonstrate that the ATP-bound form of EttA binds to the ribosomal tRNA exit (E) site, where it forms bridging interactions between the ribosomal L1 stalk and the tRNA bound in the peptidyl-tRNA binding (P) site. Using single-molecule fluorescence resonance energy transfer (smFRET), we show that the ATP-bound form of EttA restricts ribosome and tRNA dynamics required for protein synthesis. This work represents the first example, to our knowledge, where the detailed molecular mechanism of any ABC-F family protein has been determined and establishes a framework for elucidating the mechanisms of other regulatory translation factors. PMID:24389465

  5. Transition from two to one integument in Prunus species: expression pattern of INNER NO OUTER (INO), ABERRANT TESTA SHAPE (ATS) and ETTIN (ETT).

    PubMed

    Lora, Jorge; Hormaza, José I; Herrero, Maria

    2015-10-01

    While gymnosperm ovules have one integument, in most angiosperms two integuments surround the ovules. Unitegmic ovules have arisen independently several times during the evolution of angiosperms, but the ultimate genetic cause of the presence of a single integument remains elusive. We compared species of the genus Prunus that have different numbers of integuments: bitegmic species, such as Prunus armeniaca (apricot) and Prunus persica (peach), and unitegmic species, such as Prunus incisa, analyzing the expression pattern of genes that are involved in integument development in Arabidopsis thaliana: INNER NO OUTER (INO), ABERRANT TESTA SHAPE (ATS) and ETTIN (ETT). Bitegmic and unitegmic species showed similar INO expression patterns, indicative of the conservation of an outer integument. However, expression of ETT, which occurs in the boundary of the outer and inner integuments, was altered in unitegmic ovules, which showed lack of ETT expression. These results strongly suggest that the presence of a single integument could be attributable to the amalgamation of two integuments and support the role of ETT in the fusion of the outer and inner integuments in unitegmic ovules, a situation that could be widespread in other unitegmic species of angiosperms.

  6. Distributed Denial of Service Attack Source Detection Using Efficient Traceback Technique (ETT) in Cloud-Assisted Healthcare Environment.

    PubMed

    Latif, Rabia; Abbas, Haider; Latif, Seemab; Masood, Ashraf

    2016-07-01

    Security and privacy are the first and foremost concerns that should be given special attention when dealing with Wireless Body Area Networks (WBANs). As WBAN sensors operate in an unattended environment and carry critical patient health information, Distributed Denial of Service (DDoS) attack is one of the major attacks in WBAN environment that not only exhausts the available resources but also influence the reliability of information being transmitted. This research work is an extension of our previous work in which a machine learning based attack detection algorithm is proposed to detect DDoS attack in WBAN environment. However, in order to avoid complexity, no consideration was given to the traceback mechanism. During traceback, the challenge lies in reconstructing the attack path leading to identify the attack source. Among existing traceback techniques, Probabilistic Packet Marking (PPM) approach is the most commonly used technique in conventional IP- based networks. However, since marking probability assignment has significant effect on both the convergence time and performance of a scheme, it is not directly applicable in WBAN environment due to high convergence time and overhead on intermediate nodes. Therefore, in this paper we have proposed a new scheme called Efficient Traceback Technique (ETT) based on Dynamic Probability Packet Marking (DPPM) approach and uses MAC header in place of IP header. Instead of using fixed marking probability, the proposed scheme uses variable marking probability based on the number of hops travelled by a packet to reach the target node. Finally, path reconstruction algorithms are proposed to traceback an attacker. Evaluation and simulation results indicate that the proposed solution outperforms fixed PPM in terms of convergence time and computational overhead on nodes.

  7. Meta-analyses of microarrays of Arabidopsis asymmetric leaves1 (as1), as2 and their modifying mutants reveal a critical role for the ETT pathway in stabilization of adaxial-abaxial patterning and cell division during leaf development.

    PubMed

    Takahashi, Hiro; Iwakawa, Hidekazu; Ishibashi, Nanako; Kojima, Shoko; Matsumura, Yoko; Prananingrum, Pratiwi; Iwasaki, Mayumi; Takahashi, Anna; Ikezaki, Masaya; Luo, Lilan; Kobayashi, Takeshi; Machida, Yasunori; Machida, Chiyoko

    2013-03-01

    It is necessary to use algorithms to analyze gene expression data from DNA microarrays, such as in clustering and machine learning. Previously, we developed the knowledge-based fuzzy adaptive resonance theory (KB-FuzzyART), a clustering algorithm suitable for analyzing gene expression data, to find clues for identifying gene networks. Leaf primordia form around the shoot apical meristem (SAM), which consists of indeterminate stem cells. Upon initiation of leaf development, adaxial-abaxial patterning is crucial for lateral expansion, via cellular proliferation, and the formation of flat symmetric leaves. Many regulatory genes that specify such patterning have been identified. Analysis by the KB-FuzzyART and subsequent molecular and genetic analyses previously showed that ASYMMETRIC LEAVES1 (AS1) and AS2 repress the expression of some abaxial-determinant genes, such as AUXIN RESPONSE FACTOR3 (ARF3)/ETTIN (ETT) and ARF4, which are responsible for defects in leaf adaxial-abaxial polarity in as1 and as2. In the present study, genetic analysis revealed that ARF3/ETT and ARF4 were regulated by modifier genes, BOBBER1 (BOB1) and ELONGATA3 (ELO3), together with AS1-AS2. We analyzed expression arrays with as2 elo3 and as2 bob1, and extracted genes downstream of ARF3/ETT by using KB-FuzzyART and molecular analyses. The results showed that expression of Kip-related protein (KRP) (for inhibitors of cyclin-dependent protein kinases) and Isopentenyltransferase (IPT) (for biosynthesis of cytokinin) genes were controlled by AS1-AS2 through ARF3/ETT and ARF4 functions, which suggests that the AS1-AS2-ETT pathway plays a critical role in controlling the cell division cycle and the biosynthesis of cytokinin around SAM to stabilize leaf development in Arabidopsis thaliana.

  8. Greenhouse Gas-ette Fall 1988, Spring, Fall 1989, Winter, Spring, Fall 1990.

    ERIC Educational Resources Information Center

    Greenhouse Gas-ette, 1990

    1990-01-01

    This newsletter is for educators interested in developing lessons related to global climate change. The newsletter contains sample lessons, news items involving global climate change on an international scale, and background information on issues related to global climate change. (CW)

  9. Greenhouse Gas-ette Fall 1988, Spring, Fall 1989, Winter, Spring, Fall 1990.

    ERIC Educational Resources Information Center

    Greenhouse Gas-ette, 1990

    1990-01-01

    This newsletter is for educators interested in developing lessons related to global climate change. The newsletter contains sample lessons, news items involving global climate change on an international scale, and background information on issues related to global climate change. (CW)

  10. Propulsion Velocity and ETT on Biomagnetic Assessment of the Human Esophagus

    NASA Astrophysics Data System (ADS)

    Cordova-Fraga, T.; Cano, E.; Bravo-Miranda, C.; Huerta, R.; De la Roca-Chiapas, J. M.; Bernal, J. J.; Sosa, M.

    2008-08-01

    Esophagus transit time measurement is a common clinical practical. Biomagnetic techniques and modern instrumentation can perform non invasive and functional assessments of the gastrointestinal tract. This study presents the evaluation of the esophagus transit time and propulsion velocity of a magnetic marker from the mouth to stomach using water vs. a swallow easy substance recently patented. A group of ten healthy subjects from 45 to 55 years, were evaluated in identical conditions for two times, they ingested randomly a magnetic marker in an anatomical body position of 45°, one times with water and the other one with a patented substance developed in order to help the subjects to swallow pills. The esophagus transit time was shorter when the subjects ingested the magnetic marker with the swallow easy substance than they ingested the magnetic marker with same quantity of water

  11. Description and modelling of the solar-hydrogen-biogas-fuel cell system in GlashusEtt

    NASA Astrophysics Data System (ADS)

    Hedström, L.; Wallmark, C.; Alvfors, P.; Rissanen, M.; Stridh, B.; Ekman, J.

    The need to reduce pollutant emissions and utilise the world's available energy resources more efficiently has led to increased attention towards e.g. fuel cells, but also to other alternative energy solutions. In order to further understand and evaluate the prerequisites for sustainable and energy-saving systems, ABB and Fortum have equipped an environmental information centre, located in Hammarby Sjöstad, Stockholm, Sweden, with an alternative energy system. The system is being used to demonstrate and evaluate how a system based on fuel cells and solar cells can function as a complement to existing electricity and heat production. The stationary energy system is situated on the top level of a three-floor glass building and is open to the public. The alternative energy system consists of a fuel cell system, a photovoltaic (PV) cell array, an electrolyser, hydrogen storage tanks, a biogas burner, dc/ac inverters, heat exchangers and an accumulator tank. The fuel cell system includes a reformer and a polymer electrolyte fuel cell (PEFC) with a maximum rated electrical output of 4 kW el and a maximum thermal output of 6.5 kW th. The fuel cell stack can be operated with reformed biogas, or directly using hydrogen produced by the electrolyser. The cell stack in the electrolyser consists of proton exchange membrane (PEM) cells. To evaluate different automatic control strategies for the system, a simplified dynamic model has been developed in MATLAB Simulink. The model based on measurement data taken from the actual system. The evaluation is based on demand curves, investment costs, electricity prices and irradiation. Evaluation criteria included in the model are electrical and total efficiencies as well as economic parameters.

  12. Propulsion Velocity and ETT on Biomagnetic Assessment of the Human Esophagus

    SciTech Connect

    Cordova-Fraga, T.; Cano, E.; Bravo-Miranda, C.; De la Roca-Chiapas, J. M.; Bernal, J. J.; Sosa, M.; Huerta, R.

    2008-08-11

    Esophagus transit time measurement is a common clinical practical. Biomagnetic techniques and modern instrumentation can perform non invasive and functional assessments of the gastrointestinal tract. This study presents the evaluation of the esophagus transit time and propulsion velocity of a magnetic marker from the mouth to stomach using water vs. a swallow easy substance recently patented. A group of ten healthy subjects from 45 to 55 years, were evaluated in identical conditions for two times, they ingested randomly a magnetic marker in an anatomical body position of 45 deg., one times with water and the other one with a patented substance developed in order to help the subjects to swallow pills. The esophagus transit time was shorter when the subjects ingested the magnetic marker with the swallow easy substance than they ingested the magnetic marker with same quantity of water.

  13. Avoid falling for a jerk(ette): Effectiveness of the Premarital Interpersonal Choices and Knowledge Program among Emerging Adults.

    PubMed

    Bradford, Kay; Stewart, J Wade; Pfister, Roxane; Higginbotham, Brian J

    2016-10-01

    Premarital education may help emerging adults form healthy relationships, but evaluation research is needed, particularly with community samples. We studied emerging adults in the Premarital Interpersonal Choices and Knowledge (PICK) program, using a pre- to post- and a posttest-then-retrospective-pretest design to examine change in perceived relationship skills, partner selection, relational patterns, and relationship behaviors and attitudes. Mixed models analyses showed that scores for the treatment group (n = 682) increased from pre to post on all four outcomes. Changes in scores for the nonequivalent comparison group (n = 462) were nonsignificant. In addition, significant differences between pre- and retrospective prescores demonstrated evidence for response shift bias. The results suggest that the PICK program helps participants increase their knowledge regarding the components of healthy relationship formation. © 2016 American Association for Marriage and Family Therapy.

  14. Experimental Test Results of Energy Efficient Transport (ETT) High-Lift Airfoil in Langley Low-Turbulence Pressure Tunnel-Supplement

    NASA Technical Reports Server (NTRS)

    Morgan, Harry L., Jr.

    2002-01-01

    This report describes the results of an experimental study conducted in the Langley Low-Turbulence Pressure Tunnel to determine the effects of Reynolds number and Mach number on the two-dimensional aerodynamic performance of the Langley Energy Efficient Transport (EET) High-Lift Airfoil. The high-lift airfoil was a supercritical-type airfoil with a thickness-to-chord ratio of 0.12 and was equipped with a leading-edge slat and a double-slotted trailing-edge flap. The leading-edge slat could be deflected 30deg, 40deg, 50deg, and 60deg, and the trailing-edge flaps could be deflected to 15deg, 30deg, 45deg, and 60deg. The gaps and overlaps for the slat and flaps were fixed at each deflection resulting in 16 different configurations. All 16 configurations were tested through a Reynolds number range of 2.5 to 18 million at a Mach number of 0.20. Selected configurations were also tested through a Mach number range of 0.10 to 0.35. The plotted and tabulated force, moment, and pressure data are available on the CD-ROM supplement L-18221.

  15. Micropatterned Endotracheal Tubes Reduce Secretion-Related Lumen Occlusion.

    PubMed

    Mann, Ethan E; Magin, Chelsea M; Mettetal, M Ryan; May, Rhea M; Henry, MiKayla M; DeLoid, Heather; Prater, Justin; Sullivan, Lauren; Thomas, John G; Twite, Mark D; Parker, Albert E; Brennan, Anthony B; Reddy, Shravanthi T

    2016-12-01

    Tracheal intubation disrupts physiological homeostasis of secretion production and clearance, resulting in secretion accumulation within endotracheal tubes (ETTs). Novel in vitro and in vivo models were developed to specifically recapitulate the clinical manifestations of ETT occlusion. The novel Sharklet™ micropatterned ETT was evaluated, using these models, for the ability to reduce the accumulation of both bacterial biofilm and airway mucus compared to a standard care ETT. Novel ETTs with micropattern on the inner and outer surfaces were placed adjacent to standard care ETTs in in vitro biofilm and airway patency (AP) models. The primary outcome for the biofilm model was to compare commercially-available ETTs (standard care and silver-coated) to micropatterned for quantity of biofilm accumulation. The AP model's primary outcome was to evaluate accumulation of artificial airway mucus. A 24-h ovine mechanical ventilation model evaluated the primary outcome of relative quantity of airway secretion accumulation in the ETTs tested. The secondary outcome was measuring the effect of secretion accumulation in the ETTs on airway resistance. Micropatterned ETTs significantly reduced biofilm by 71% (p = 0.016) compared to smooth ETTs. Moreover, micropatterned ETTs reduced lumen occlusion, in the AP model, as measured by cross-sectional area, in distal (85%, p = 0.005), middle (84%, p = 0.001) and proximal (81%, p = 0.002) sections compared to standard care ETTs. Micropatterned ETTs reduced the volume of secretion accumulation in a sheep model of occlusion by 61% (p < 0.001) after 24 h of mechanical ventilation. Importantly, micropatterned ETTs reduced the rise in ventilation peak inspiratory pressures over time by as much as 49% (p = 0.005) compared to standard care ETTs. Micropatterned ETTs, demonstrated here to reduce bacterial contamination and mucus occlusion, will have the capacity to limit complications occurring during mechanical ventilation and

  16. Epinephrine delivery during neonatal resuscitation: comparison of direct endotracheal tube vs catheter inserted into endotracheal tube administration.

    PubMed

    Rehan, Virender K; Garcia, Maricela; Kao, Justin; Tucker, Christina M; Patel, Satish M

    2004-11-01

    The optimal method for epinephrine administration during neonatal resuscitation is not known. We hypothesized that epinephrine will be delivered more efficiently when administered via a feeding catheter inserted into the endotracheal tube (C-ETT) vs when administered directly into the ETT (D-ETT). Our objectives were to (1) compare the delivery of epinephrine to the distal end of the ETT when administered via D-ETT vs C-ETT; (2) measure the retention of epinephrine within the ETT vs the feeding catheter used for the drug delivery; and (3) compare the delivery of the drug with and without an air flush after administration via C-ETT. All experiments were performed in vitro, simulating epinephrine administration during neonatal resuscitation, according to the standard guidelines. Radiolabeled epinephrine, diluted to 1 microCi/ml, was used and experiments were repeated at least 4 times. Epinephrine administration via D-ETT was followed by one manual breath via a self-inflating bag attached to the ETT. Epinephrine delivery via C-ETT was followed by 1 ml saline flush, and in some experiments, this was also followed by a 1 cm(3) air flush. Epinephrine delivery and retention were assessed by measuring the radioactive content of the effluent fluid and that of the ETT or of the feeding catheter used for drug delivery. Significantly higher dosage of the drug was delivered when administered via D-ETT vs C-ETT, if air flush following C-ETT method was not used. However, with an air flush following the saline flush after the drug instillation, there was no difference in the amount of epinephrine delivered between the two methods. Retention in the ETT wall or the catheter was <7.5% of the administered dose with either method. Without an air flush following C-ETT method of epinephrine delivery, higher dosage of the drug is delivered via D-ETT vs C-ETT method. An air flush following the saline flush during C-ETT method improves drug delivery. Given that the C-ETT method is more

  17. The supine-to-prone position change induces modification of endotracheal tube cuff pressure accompanied by tube displacement.

    PubMed

    Minonishi, Toshiyuki; Kinoshita, Hiroyuki; Hirayama, Michiko; Kawahito, Shinji; Azma, Toshiharu; Hatakeyama, Noboru; Fujiwara, Yoshihiro

    2013-02-01

    To determine whether the supine-to-prone position change displaced the endotracheal tube (ETT) and, if so, whether the displacement related to this change modified ETT cuff pressure. Prospective study. Operating room of a university hospital. 132 intubated, adult, ASA physical status 1, 2, and 3 patients undergoing lumbar spine surgery. After induction of anesthesia, each patient's trachea was intubated. The insertion depth of each ETT was 23 cm for men and 21 cm for women at the upper incisors. In the supine position and after the supine-to-prone position change with the head rotated to the right, the length from the carina to ETT tip and ETT cuff pressure were measured. After the supine-to-prone position change, 91.7% patients had ETT tube displacement. Of these, 48% of patients' ETT moved ≥ 10 mm, whereas 86.3% of patients had changes in tube cuff pressure. There was a slight but significant correlation between ETT movement and change in cuff pressure. Depending on the position change, ETT cuff pressure decreased and the ETT tended to withdraw. After the supine-to-prone position change, patients had ETT tube displacement. Such ETT movement may be accompanied by a decrease in cuff pressure. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Prevention of airway fires: testing the safety of endotracheal tubes and surgical devices in a mechanical model.

    PubMed

    Roy, Soham; Smith, Lee P

    2015-01-01

    This study was designed to assess the ability of carbon dioxide (CO2) lasers and radiofrequency ablation devices (Coblator) (ArthoCare Corporation, Sunnyvale, CA) to ignite either a non-reinforced (polyvinylchloride) endotracheal tube (ETT) or an aluminum and fluoroplastic wrapped silicon ("laser safe") ETT at varying titrations of oxygen in a mechanical model of airway surgery. Non-reinforced and laser safe ETTs were suspended in a mechanical model imitating endoscopic airway surgery. A CO2 laser set at 5-30 watts was fired at the ETT at oxygen concentrations ranging from 21% to 88%. The process was repeated using a radiofrequency ablation (RFA) device. All trials were repeated to ensure accuracy. The CO2 laser ignited a fire when contacting a non-reinforced ETT in under 2 seconds at oxygen concentrations as low as 44%. The CO2 laser could not ignite a laser safe ETT under any conditions, unless it struck the non-reinforced distal tip of the ETT. With the RFA, a fire could not be ignited with either reinforced or non-reinforced ETTs. RFA presents no risk of ignition in simulated airway surgery. CO2 lasers should be utilized with a reinforced ETT or no ETT, as fires can easily ignite when lasers strike a non-reinforced ETT. Decreasing the fraction of inspired oxygen reduces the risk of fire. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Insights on the role of antimicrobial cuffed endotracheal tubes in preventing transtracheal transmission of VAP pathogens from an in vitro model of microaspiration and microbial proliferation.

    PubMed

    Rosenblatt, Joel; Reitzel, Ruth; Jiang, Ying; Hachem, Ray; Raad, Issam

    2014-01-01

    We developed an in vitro model to evaluate the effect of different cuffed endotracheal tubes (ETTs) on transtracheal transmission of ventilator-associated pneumonia (VAP) pathogens along external surfaces of ETTs. The model independently assessed the relative contributions of microbial proliferation to the distal tip and microaspiration of contaminated secretions past the cuff by testing in three modes: microaspiration only, microbial proliferation only, and simultaneous microaspiration and microbial proliferation. We evaluated transmission of methicillin resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa (PA) in the presence of a standard ETT; a soft, tapered cuff ETT with subglottic suctioning; and a novel antimicrobial gendine (combination of gentian violet and chlorhexidine) ETT in the model. In the microaspiration only mode, when leakage past the cuff occurred quickly, no ETT prevented transmission. When microaspiration was delayed, the gendine ETT was able to completely disinfect the fluid above the cuff and thereby prevent transmission of pathogens. In microbial proliferation only mode, the gendine ETT was the sole ETT that prevented transmission. With both mechanisms simultaneously available, transmission was dependent on how long microaspiration was delayed. Potent antimicrobial ETTs, such as a gendine ETT, can make unique contributions to prevent VAP when microaspiration is gradual.

  20. Incremental change in cross sectional area in small endotracheal tubes: A call for more size options.

    PubMed

    Mortelliti, Caroline L; Mortelliti, Anthony J

    2016-08-01

    To elucidate the relatively large incremental percent change (IPC) in cross sectional area (CSA) in currently available small endotracheal tubes (ETTs), and to make recommendation for lesser incremental change in CSA in these smaller ETTs, in order to minimize iatrogenic airway injury. The CSAs of a commercially available line of ETTs were calculated, and the IPC of the CSA between consecutive size ETTs was calculated and graphed. The average IPC in CSA with large ETTs was applied to calculate identical IPC in the CSA for a theoretical, smaller ETT series, and the dimensions of a new theoretical series of proposed small ETTs were defined. The IPC of CSA in the larger (5.0-8.0 mm inner diameter (ID)) ETTs was 17.07%, and the IPC of CSA in the smaller ETTs (2.0-4.0 mm ID) is remarkably larger (38.08%). Applying the relatively smaller IPC of CSA from larger ETTs to a theoretical sequence of small ETTs, starting with the 2.5 mm ID ETT, suggests that intermediate sizes of small ETTs (ID 2.745 mm, 3.254 mm, and 3.859 mm) should exist. We recommend manufacturers produce additional small ETT size options at the intuitive intermediate sizes of 2.75 mm, 3.25 mm, and 3.75 mm ID in order to improve airway management for infants and small children. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Ultrasonography for endotracheal tube position in infants and children.

    PubMed

    Jaeel, Pooja; Sheth, Mansi; Nguyen, Jimmy

    2017-03-01

    Ultrasonography (US) has been shown to be effective for verifying endotracheal tube (ETT) position in adults but has been less studied in infants and children. We review the literature regarding US for ETT positioning in the pediatric population. A literature search was conducted using the Ovid and MEDLINE databases with search terms regarding US relating to ETT intubation and positioning in infants and children. Most studies in neonates and infants used the midsagittal suprasternal view. Studies reported >80% visualization of the ETT tip by US, and US interpretation of the ETT position correlated with the XR position in 73-100% of cases. Studies of older children used the suprasternal views, substernal views, and mid-axillary intercostal views. US appears comparable to XR and capnography in determining ETT position in this population.

  2. Randomised trial of estimating oral endotracheal tube insertion depth in newborns using weight or vocal cord guide.

    PubMed

    Gill, Irwin; Stafford, Aisling; Murphy, Madeleine C; Geoghegan, Aisling R; Crealey, Miranda; Laffan, Eoghan; O'Donnell, Colm Patrick Finbarr

    2017-09-07

    When intubating newborns, clinicians aim to position the endotracheal tube (ETT) tip in the midtrachea. The depth to which ETTs should be inserted is often estimated using the infant's weight. ETTs are frequently incorrectly positioned in newborns, most often inserted too far. Using the vocal cord guide (a mark at the distal end of the ETT) to guide insertion depth has been recommended. To determine whether estimating ETT insertion depth using the vocal cord guide rather than weight results in more correctly positioned ETT tips. Single-centre randomised controlled trial. Level III neonatal intensive care unit (NICU) at a university maternity hospital (National Maternity Hospital, Dublin, Ireland). Newborn infants without congenital anomalies intubated in the NICU. Participants were randomised to have ETT insertion depth estimated using weight [insertion depth (cm) = weight (kg) +6] or vocal cord guide. Correct ETT position, that is, tip between the upper border of the first thoracic vertebra (T1) and the lower border of the second thoracic vertebra (T2) on a chest X-ray as determined by one paediatric radiologist masked to group assignment. 136 participants were randomised. The proportion of correctly positioned ETTs was similar in both groups (weight 30/69 (44%) vs vocal cord guide 27/67 (40%), p=0.731). Most incorrectly positioned ETT (69/79, 87%) were too low. Estimating ETT insertion depth using the vocal cord guide did not result in more correctly positioned ETT tips. ISRCTN39654846. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Effect of 90° counterclockwise rotation of the endotracheal tube on its advancement through the larynx during nasal fiberoptic intubation in children: a randomized and blinded study.

    PubMed

    Choudhry, Dinesh K; Brenn, B Randall; Lutwin-Kawalec, Malgorzata; Sacks, Karen; Nesargi, Susmita; He, Zhaoping

    2016-04-01

    Resistance to the passage of the endotracheal tube (ETT) is frequently encountered in children as it is advanced over the fiberoptic scope for placement into the trachea because it gets hung up at the laryngeal inlet. Literature in adults indicates that a 90° counterclockwise rotation (CCR) of the ETT before advancing results in smooth passage. We found no literature in children. Our aim was to study if a 90° counterclockwise rotation (CCR) of the ETT before advancement leads to smooth passage of the ETT into the larynx in children. Following IRB approval, we performed this study in two parts: Part 1: An unblinded, observational, pilot study on 20 children scheduled for oral rehabilitation where we concurrently used a fiberoptic scope nasally and GlideScope orally. We visualized the ETT path and observed that 90° CCR allowed smooth passage without hang up. Part 2: A blinded and randomized study on 40 children to confirm if 90° CCR from the outset would improve passage of the ETT during nasal intubation with a fiberoptic scope in children. All children were divided into two groups: group S, ETT bevel facing left; group R, ETT bevel facing down. In Part 1, we observed that the ETT got hung up in 57% of children with standard bevel direction (facing left) and in 0% of children when prerotated. In Part 2, efficacy of prerotation was confirmed; the ETT got hung up in 50% of children in group S but in only 10.5% of children in group R. A change in ETT tip orientation from bevel facing left to facing down by 90° CCR, leads to a significantly higher first-attempt success rate by nasal approach in children. We believe the ETT should be rotated before insertion into the nostril to ensure that full 90° CCR of the tip has been accomplished. © 2016 John Wiley & Sons Ltd.

  4. Laryngeal resistance before and after minor surgery: endotracheal tube versus Laryngeal Mask Airway.

    PubMed

    Tanaka, Atsuko; Isono, Shiroh; Ishikawa, Teruhiko; Sato, Jiro; Nishino, Takashi

    2003-08-01

    The placement of an endotracheal tube (ETT) may promote laryngeal swelling, which is an important cause of upper airway obstruction after extubation. The authors hypothesized that laryngeal swelling after ETT placement increases laryngeal resistance and tested that hypothesis by comparing postoperative laryngeal patency between patients with ETT placement and those with a Laryngeal Mask Airway trade mark (LMA). Fourteen adult patients who underwent elective minor surgeries were randomly allocated to two groups whose airway would be managed through ETTs (the ETT group) or LMAs (the LMA group) during the surgery. While maintaining at sevoflurane 1 minimum alveolar concentration, the authors measured laryngeal resistance before and after surgery, during both spontaneous breathing and mechanical ventilation under complete paralysis. In addition, they endoscopically measured the vocal cord angle under complete paralysis. In association with marked swelling of the vocal cords, the vocal cord angle significantly decreased after surgery in the ETT group, whereas the angle did not change in the LMA group. Laryngeal resistance during mechanical ventilation significantly increased only in the ETT group. Laryngeal resistance during spontaneous breathing significantly increased after surgeries in both groups. Postoperative laryngeal resistance increases at least in part because of laryngeal swelling in patients with ETT placement, whereas alteration of laryngeal neural control mechanisms has been also indicated. The use of the LMA trade mark has an advantage over ETT placement in order to avoid postoperative laryngeal swelling.

  5. Endotracheal tube resistance and inertance in a model of mechanical ventilation of newborns and small infants-the impact of ventilator settings on tracheal pressure swings.

    PubMed

    Hentschel, Roland; Buntzel, Julia; Guttmann, Josef; Schumann, Stefan

    2011-09-01

    Resistive properties of endotracheal tubes (ETTs) are particularly relevant in newborns and small infants who are generally ventilated through ETTs with a small inner diameter. The ventilation rate is also high and the inspiratory time (ti) is short. These conditions effectuate high airway flows with excessive flow acceleration, so airway resistance and inertance play an important role. We carried out a model study to investigate the impact of varying ETT size, lung compliance and ventilator settings, such as peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP) and inspiratory time (ti) on the pressure-flow characteristics with respect to the resistive and inertive properties of the ETT. Pressure at the Y piece was compared to direct measurement of intratracheal pressure (P(trach)) at the tip of the ETT, and pressure drop (ΔP(ETT)) was calculated. Applying published tube coefficients (Rohrer's constants and inertance), P(trach) was calculated from ventilator readings and compared to measured P(trach) using the root-mean-square error. The most relevant for ΔP(ETT) was the ETT size, followed by (in descending order) PIP, compliance, ti and PEEP, with gas flow velocity being the principle in common for all these parameters. Depending on the ventilator settings ΔP(ETT) exceeded 8 mbar in the smallest 2.0 mm ETT. Consideration of inertance as an additional effect in this setting yielded a better agreement of calculated versus measured P(trach) than Rohrer's constants alone. We speculate that exact tracheal pressure tracings calculated from ventilator readings by applying Rohrer's equation and the inertance determination to small size ETTs would be helpful. As an integral part of ventilator software this would (1) allow an estimate of work of breathing and implementation of an automatic tube compensation, and (2) be important for gentle ventilation in respiratory care, especially of small infants, since it enables the physician to estimate

  6. Decreased Staphylococcus aureus biofilm formation on nanomodified endotracheal tubes: a dynamic airway model

    PubMed Central

    Machado, Mary C; Tarquinio, Keiko M; Webster, Thomas J

    2012-01-01

    Ventilator-associated pneumonia (VAP) is a serious and costly clinical problem. Specifically, receiving mechanical ventilation for over 24 hours increases the risk of VAP and is associated with high morbidity, mortality, and medical costs. Cost-effective endotracheal tubes (ETTs) that are resistant to bacterial infections could help prevent this problem. The objective of this study was to determine differences in the growth of Staphylococcus aureus on nanomodified and unmodified polyvinyl chloride (PVC) ETTs under dynamic airway conditions simulating a ventilated patient. PVC ETTs were modified to have nanometer surface features by soaking them in Rhizopus arrhisus, a fungal lipase. Twenty-four-hour experiments (supported by computational models) showed that airflow conditions within the ETT influenced both the location and the concentration of bacterial growth on the ETTs, especially within areas of tube curvature. More importantly, experiments revealed a 1.5 log reduction in the total number of S. aureus on the novel nanomodified ETTs compared with the conventional ETTs after 24 hours of airflow. This dynamic study showed that lipase etching can create nanorough surface features on PVC ETTs that suppress S. aureus growth, and thus may provide clinicians with an effective and inexpensive tool to combat VAP. PMID:22904622

  7. Decreased Staphylococcus aureus biofilm formation on nanomodified endotracheal tubes: a dynamic airway model.

    PubMed

    Machado, Mary C; Tarquinio, Keiko M; Webster, Thomas J

    2012-01-01

    Ventilator-associated pneumonia (VAP) is a serious and costly clinical problem. Specifically, receiving mechanical ventilation for over 24 hours increases the risk of VAP and is associated with high morbidity, mortality, and medical costs. Cost-effective endotracheal tubes (ETTs) that are resistant to bacterial infections could help prevent this problem. The objective of this study was to determine differences in the growth of Staphylococcus aureus on nanomodified and unmodified polyvinyl chloride (PVC) ETTs under dynamic airway conditions simulating a ventilated patient. PVC ETTs were modified to have nanometer surface features by soaking them in Rhizopus arrhisus, a fungal lipase. Twenty-four-hour experiments (supported by computational models) showed that airflow conditions within the ETT influenced both the location and the concentration of bacterial growth on the ETTs, especially within areas of tube curvature. More importantly, experiments revealed a 1.5 log reduction in the total number of S. aureus on the novel nanomodified ETTs compared with the conventional ETTs after 24 hours of airflow. This dynamic study showed that lipase etching can create nanorough surface features on PVC ETTs that suppress S. aureus growth, and thus may provide clinicians with an effective and inexpensive tool to combat VAP.

  8. Computer-aided detection of malpositioned endotracheal tubes in portable chest radiographs

    NASA Astrophysics Data System (ADS)

    Huo, Zhimin; Mao, Hongda; Zhang, Jane; Sykes, Anne-Marie; Munn, Samson; Wandtke, John

    2014-03-01

    Portable chest radiographic images play a critical role in examining and monitoring the condition and progress of critically ill patients in intensive care units (ICUs). For example, portable chest images are acquired to ensure that tubes inserted into the patients are properly positioned for effective treatment. In this paper, we present a system that automatically detects the position of an endotracheal tube (ETT), which is inserted into the trachea to assist patients who have difficulty breathing. The computer detection includes the detections of the lung field, spine line, and aortic arch. These detections lead to the identification of regions of interest (ROIs) used for the subsequent detection of the ETT and carina. The detection of the ETT and carina is performed within the ROIs. Our ETT and carina detection methods were trained and tested on a large number of images. The locations of the ETT and carina were confirmed by an experienced radiologist for the purpose of performance evaluation. Our ETT detection achieved an average sensitivity of 85% at less than 0.1 false-positive detections per image. The carina approach correctly identified the carina location within a 10 mm distance from the truth location for 81% of the 217 testing images. We expect our system will assist ICU clinicians to detect malpositioned ETTs and reposition malpositioned ETTs more effectively and efficiently.

  9. Ventilator associated pneumonia and endotracheal tube repositioning: an underrated risk factor.

    PubMed

    McGovern Murphy, F; Raymond, M; Menard, P-A; Bejar-Ardiles, K-R; Carignan, A; Lesur, O

    2014-12-01

    Aspiration of secretions toward lower airways potentially occurs during endotracheal tube (ETT) repositioning in mechanically ventilated patients in the intensive care unit and may be a risk factor for developing ventilator-associated pneumonia (VAP). This case-control study confirms that repositioning of the ETT is an independent risk factor for VAP.

  10. Preventing cuff rupture during tracheostomy: importance of endotracheal tube positioning.

    PubMed

    Sood, Amit; Taheri, M Reza; Joshi, Arjun S

    2014-09-01

    The objective of our study is to describe the technique of distal endotracheal tube (ETT) positioning for avoiding cuff rupture and validate the technique in a virtual tracheostomy model. A prospective nonrandomized case series of 129 patients who had undergone tracheostomy using the senior author's technique were evaluated. Primary outcome was ETT cuff rupture. One hundred normal patient computed tomography (CT) scans were used to generate a virtual tracheostomy model, and the probability of cuff rupture, among other values, was obtained. One hundred twenty-three of 129 patients underwent tracheostomy without cuff rupture when the distal tip of the ETT was placed just proximal to the carina. After analysis of 100 3-dimensional CT scans, the average distance from the tracheotomy to the superior aspect of the cuff was 54.6 mm in men and 39.87 mm in women when a 6.5-size ETT was used, and 44.8 mm in men and 30.07 mm in women when a 7.5-size ETT was used. Virtual tracheotomy between the second and third tracheal rings resulted in no probability of inadvertent ETT cuff rupture. Distal ETT positioning during tracheostomy should be considered for avoiding inadvertent ETT cuff rupture. © The Author(s) 2014.

  11. Effective Teaching Training. Program Evaluation.

    ERIC Educational Resources Information Center

    Vanderburg, Arne S.; Shainline, Michael

    Workshops for teachers given under the Effective Teaching Training (ETT) program of the Albuquerque (New Mexico) Public Schools were evaluated. Based on the Upland Model of Effective Teaching, ETT will be extended to all teachers and administrators in the district by the end of the 1988-89 school year. Interviews, workshop ratings, and…

  12. Studenters fritids--och motionsvanor i Umea och Madison. Ett bidrag till forstaelsen av Pierre Bourdieus vetenskapliga metodologi. Akademiska avhanlingar, Pedagogiska institutionen Nr. 58 (Leisure and Exercise Habits among Students in Umea and Madison. A Contribution to the Understanding of Pierre Bourdieu's Scientific Methodology. Academic Dissertation, Faculty of Social Sciences No. 58).

    ERIC Educational Resources Information Center

    Lofgren, Kent

    This study, presented in Swedish with an English summary, analyzed differences between student groups at Umea University, Sweden, and the University of Wisconsin-Madison in terms of study situations, experiences of the university environment, exercise and sports activities, and the connections between study and leisure time activities. The study…

  13. [Final report for DOE contract FG03-88ER13882

    SciTech Connect

    1999-04-30

    The female reproductive organ, the gynoecium, is the most complex structure that plants produce. The molecular mechanisms that coordinate its development are unknown, but can be dissected by molecular genetics. The ettin (ett) mutation provides a remarkable window for viewing gynoecium development. ett induced alterations result from misinterpretation of positional information along longitudinal and transverse gynoecial axes. Molecular cloning revealed the ETT encoded amino acid sequence is homologous to transcriptional factors involved in signaling by the plant hormone auxin. Early ETT gene expression marks the site of the future outgrowth of the gynoecium. The primary gene sequence and pattern of expression of ETT fits with a role in hormone mediated signaling for regional development in the female organ.

  14. Comparison of rest and exercise radionuclide angiocardiography and exercise treadmill testing for diagnosis of anatomically extensive coronary artery disease

    SciTech Connect

    Campos, C.T.; Chu, H.W.; D'Agostino, H.J. Jr.; Jones, R.H.

    1983-06-01

    The accuracy of rest and exercise radionuclide angiocardiography (RNA) and exercise treadmill testing (ETT) for diagnosis of three-vessel or left main coronary artery disease (extensive CAD) was determined in 544 patients. ETT and RNA sensitivities were similar (88% vs 92%, NS), but ETT was more specific than RNA (46% vs 34%, p less than 0.01). The prevalence of extensive CAD in patients with a positive treadmill (41%) increased only 3% when the RNA was also positive. However, in the 292 patients with a negative or indeterminate ETT, a positive RNA increased this prevalence from 16% to 23%, while a negative RNA decreased this prevalence to 5%. These results support the initial use of ETT followed by RNA if the treadmill is negative or indeterminate for diagnosis in a population with a high prevalence of extensive CAD. This approach separates patients into subgroups with a high or low probability of extensive CAD.

  15. Securing endotracheal tubes: does NeoBar availability improve tube position?

    PubMed

    Brinsmead, Tammy Lee; Davies, Mark William

    2010-05-01

    To assess if neonatal endotracheal tube (ETT) position improved with introduction of the NeoBar. This retrospective study compared two cohorts of intubated neonates and their x-rays. During the first 2-month study period, ETTs were secured with tape only--the 'Tape-only' period; during the second study period, they were secured with a NeoBar (or tape if the NeoBar was unsuitable)--the 'NeoBar' period. ETT tip position was assessed subjectively as very high, high, OK, low, or very low; and objectively by vertebral body position and the ETT-tip-to-T1 distance. During the Tape-only period, 59 babies had 275 x-rays with an ETT visible. During the NeoBar period, 67 babies had 331 x-rays with an ETT visible. There were 160 (58.2%) and 193 (58.3%) assessed as OK during the Tape-only and NeoBar periods, respectively (Fisher's Exact Test, P= 1.0). There were more very high tubes during the NeoBar period, and more low and very low tubes during the Tape-only period (Chi-squared test, P= 0.011). A similar trend was observed with the distribution of the ETT-tip-to-T1 distance (difference not statistically significant, Mann-Whitney test, P= 0.079). During both time periods, less than two-thirds of ETTs were located in an acceptable position. For ETTs in unacceptable positions, there were more tubes in the higher positions during the NeoBar period, and more tubes in the lower positions during the Tape-only period. Further investigation is necessary to clarify if the differences in ETT position on x-ray correlate with relevant clinical outcomes.

  16. Comparison of intubation performance by junior emergency department doctors using gum elastic bougie versus stylet reinforced endotracheal tube insertion techniques.

    PubMed

    Brazil, Victoria; Grobler, Catharina; Greenslade, Jaimi; Burke, John

    2012-04-01

    Endotracheal intubation is a challenging procedure in emergency medicine. Junior doctors lack experience and confidence in this task. The use of a gum elastic bougie (GEB) to facilitate intubation may improve success rates, especially in difficult situations. Junior doctors working in the ED were studied. Endotracheal intubation was simulated using part-task trainers in "easy" positioning and "difficult" positioning modes. Intubation was attempted in both positions using either an endotracheal tube, with re-enforcing stylet (ETT-S), or insertion of a gum elastic bougie (GEB), with subsequent passage of the endotracheal tube over the bougie. Success rates and time to complete intubation were measured with GEB, and with ETT-S. Participants were asked to record the perceived ease of intubation. One hundred and four intubations were performed by 26 study subjects. Overall, mean time to intubation with ETT-S technique was 16.14 s (14.49-17.98 95% CI), and was faster than with GEB 24.18 (21.45-27.25 95% CI) in both airway difficulty grades (P < 0.01). The success rate for intubation using the GEB was 100%, compared with 92.9% with ETT-S. This difference was not statistically significant. Perceived ease of intubation was similar for GEB and ETT-S (VAS 6.808 vs 6.904). The use of a GEB marginally increases the time taken to perform endotracheal intubation. Success rates for junior doctors attempting endotracheal intubation were not significantly different between the two techniques. Success rates for novice practitioners using a GEB were high after even limited instruction and practice. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  17. Resistance of pediatric and neonatal endotracheal tubes: influence of flow rate, size, and shape.

    PubMed

    Manczur, T; Greenough, A; Nicholson, G P; Rafferty, G F

    2000-05-01

    The aim of this study was to determine the resistances of endotracheal tubes (ETTs) commonly used in neonatal and pediatric intensive care units and the relationship of resistance to flow rate, size, and shape of ETT. Laboratory-based measurements. We examined straight tubes with inner diameters between 2.5 and 6 mm and shouldered (Cole) tubes with inner diameter/outer diameter between 2.5/4 and 3.5/5 mm. We assessed ETT resistance at standard and "appropriate for patient use" lengths at flow rates from 0 L/min to 30 L/min. We used calibrated rotameters to control the flow of gas and proximal static pressure measured by using either an industrial draft gauge or a differential pressure transducer. The ETT resistance was calculated by dividing the proximal ETT pressure by the measured flow and expressed as the mean of three measurements at each flow rate. Resistance increased as ETT diameter decreased; at flows of 5 L/min and 10 L/min, the resistances of the 6 mm inner diameter ETT were 3.1 H2O/L/sec and 4.6 cm H20/L/ sec, respectively, and the resistances of the 2.5 mm inner diameter ETT were 81.2 H2O/L/sec and 139.4 cm H20/L/sec, respectively. Shortening an ETT to a length appropriate for patient use (e.g., a 4.0 mm inner diameter, from 20.7 to 11.3 cm) reduced its resistance on average by 22%. The resistance of a Cole tube was approximately 50% lower than that of a straight tube with an inner diameter corresponding to the narrow part of the shouldered tube. Our results suggest that the use of a small-diameter, straight ETT will significantly increase the work of breathing.

  18. Prompt correction of endotracheal tube positioning after intubation prevents further inappropriate positions.

    PubMed

    Rigini, Nugzar; Boaz, Mona; Ezri, Tiberiu; Evron, Shmuel; Trigub, Dimitry; Jackobashvilli, Simon; Izakson, Alexander

    2011-08-01

    To determine whether the timely correction of endotracheal tube (ETT) positioning prevents further inappropriate positions. Prospective crossover study. University-affiliated hospital. 44 adult, ASA physical status 1, 2, and 3 patients undergoing open or laparoscopic abdominal procedures. ETT positioning was verified by both auscultation and fiberoptic bronchoscopy (FOB), after intubation, and before extubation. In laparoscopic procedures, two additional measurements were performed: after maximal abdominal gas insufflation and with head-down position. An ETT in the bronchus or at the carina was considered an inappropriate placement. An ETT ≤ one cm from the carina was considered a critical placement. The frequency of inappropriate and critical ETT positioning with both auscultation and FOB and the number of ETTs that remained in an incorrect position despite repositioning. FOB detected 5 inappropriately positioned ETTs, 4 of which were also detected by chest auscultation (P = 0.99). Critical positioning was detected by FOB in 6 patients, three of which were also detected by auscultation (P = 0.24). There were 15 other "out-of-desired range" positions (out of the 3-5 cm range) - one placed too high and 14 placed too low, while 18 were placed within the range of positions. All patients with inappropriate ETT positioning were women (P = 0.005). Age, body mass index, Mallampati grade > 3, thyromental distance < 6 cm, or laryngoscopy grade ≥ 2 were not associated with either inappropriate or critical placement. No episodes of inappropriate or critical positioning were detected by FOB or auscultation at the end of surgery. Early detection and prompt correction of inappropriate ETT positioning after intubation prevented further ETT migration into undesired positions. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. Factors Associated with Misplaced Endotracheal Tubes During Intubation in Pediatric Patients.

    PubMed

    Miller, Kelsey A; Kimia, Amir; Monuteaux, Michael C; Nagler, Joshua

    2016-07-01

    Correct positioning of the endotracheal tube (ETT) during emergent pediatric intubations can be challenging, and incorrect placement may be associated with higher rates of complications. The aims of this study are to: 1) assess the prevalence of clinically undetected misplaced ETTs after intubation in the pediatric emergency department; 2) identify predictors of ETT misplacement; and 3) evaluate for any association between intubation-related complications and ETT position. In this retrospective cross-sectional study, the primary outcome was rate of unrecognized low or high ETTs detected on confirmatory chest radiographs. The secondary outcome was frequency of complications (i.e., hypoxemia, difficult ventilation, atelectasis, pneumothorax, pneumomediastinum, and aspiration) associated with misplaced ETTs. Multivariable analyses were used to evaluate the associations between patient and procedural characteristics and misplaced ETTs and between ETT position and complications. Seventy-seven of 201 (38.3%) intubations performed in the emergency department resulted in clinically unrecognized misplaced ETTs. Of the misplaced tubes, 45 of 77 (58%) were identified as low and 32 (42%) were high. In multivariable analyses, female sex and decreasing age were associated with increased risk of low tube placement (odds ratio for female sex, 2.4 [95% confidence interval, 1.1-5.1]; odds ratio of decreasing age, 1.16 [95% confidence interval, 1.0-1.3]). Low tube misplacement was associated with an increased risk of intubation-related complications compared to both correct and high tube placement (p < 0.05, Chi-square). Clinically unrecognized ETT misplacement occurs frequently in the pediatric emergency department, with low placement being most common, particularly in girls and younger children. Measures to improve clinical or radiographic recognition of incorrect tube position should be considered. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Prevalence, diagnosis and management of ectopic thyroid glands.

    PubMed

    Santangelo, Giuseppe; Pellino, Gianluca; De Falco, Nadia; Colella, Giuseppe; D'Amato, Salvatore; Maglione, M Grazia; De Luca, Roberto; Canonico, Silvestro; De Falco, Massimo

    2016-04-01

    Ectopic thyroid tissue (ETT) is an uncommon entity that may be found anywhere along the line of the obliterated thyroglossal duct, usually from the tongue to the diaphragm. We performed a retrospective analysis of patients undergoing surgical treatment for thyroid disease between January 2000 and December 2013, seeking for ETT All patients with prior neck surgery or trauma were excluded. The clinic-pathologic features, prevalence and diagnosis of the lesions were collected and analyzed. Out of 3092 included patients, 28 ETT were identified (0.9%). The anatomical site of ETT was as follows: lateral cervical in 6 (21.4%), along the thyroglossal duct in 6 (21.4%), mediastinal in 5 (17.9%), lingual in 5 (17.9%), sublingual in 3 (10.7%), and submandibular in 3 (10.7%). Histopathology revealed 27 benign lesions and 1 (3.6%) papillary carcinoma. ETT is found in less than 1% of patients receiving thyroid surgery. Diagnosis of ETT requires clinical imaging. Surgery is a prudent choice due to the potential of malignant evolution of ETT.

  1. Effects of anatomical position on esophageal transit time: A biomagnetic diagnostic technique

    PubMed Central

    Cordova-Fraga, Teodoro; Sosa, Modesto; Wiechers, Carlos; la Roca-Chiapas, Jose Maria De; Moreles, Alejandro Maldonado; Bernal-Alvarado, Jesus; Huerta-Franco, Raquel

    2008-01-01

    AIM: To study the esophageal transit time (ETT) and compare its mean value among three anatomical inclinations of the body; and to analyze the correlation of ETT to body mass index (BMI). METHODS: A biomagnetic technique was implemented to perform this study: (1) The transit time of a magnetic marker (MM) through the esophagus was measured using two fluxgate sensors placed over the chest of 14 healthy subjects; (2) the ETT was assessed in three anatomical positions (at upright, fowler, and supine positions; 90º, 45º and 0º, respectively). RESULTS: ANOVA and Tuckey post-hoc tests demonstrated significant differences between ETT mean of the different positions. The ETT means were 5.2 ± 1.1 s, 6.1 ± 1.5 s, and 23.6 ± 9.2 s for 90º, 45º and 0º, respectively. Pearson correlation results were r = -0.716 and P < 0.001 by subjects’ anatomical position, and r = -0.024 and P > 0.05 according the subject’s BMI. CONCLUSION: We demonstrated that using this biomagnetic technique, it is possible to measure the ETT and the effects of the anatomical position on the ETT. PMID:18837088

  2. ETTIN (ARF3) physically interacts with KANADI proteins to form a functional complex essential for integument development and polarity determination in Arabidopsis.

    PubMed

    Kelley, Dior R; Arreola, Alexandra; Gallagher, Thomas L; Gasser, Charles S

    2012-03-01

    KANADI (KAN) transcription factors promote abaxial cell fate throughout plant development and are required for organ formation during embryo, leaf, carpel and ovule development. ABERRANT TESTA SHAPE (ATS, or KAN4) is necessary during ovule development to maintain the boundary between the two ovule integuments and to promote inner integument growth. Yeast two-hybrid assays identified ETTIN (ETT, or AUXIN RESPONSE FACTOR 3) as a transcription factor that could physically interact with ATS. ATS and ETT were shown to physically interact in vivo in transiently transformed tobacco epidermal cells using bimolecular fluorescence complementation. ATS and ETT were found to share an overlapping expression pattern during Arabidopsis ovule development and loss of either gene resulted in congenital fusion of the integuments and altered seed morphology. We hypothesize that in wild-type ovules a physical interaction between ATS and ETT allows these proteins to act in concert to define the boundary between integument primordia. We further show protein-protein interaction in yeast between ETT and KAN1, a paralog of ATS. Thus, a direct physical association between ETT and KAN proteins underpins their previously described common role in polarity establishment and organogenesis. We propose that ETT-KAN protein complex(es) constitute part of an auxin-dependent regulatory module that plays a conserved role in a variety of developmental contexts.

  3. Comparative effectiveness of exercise electrocardiography with or without myocardial perfusion single photon emission computed tomography in women with suspected coronary artery disease: results from the What Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) trial.

    PubMed

    Shaw, Leslee J; Mieres, Jennifer H; Hendel, Robert H; Boden, William E; Gulati, Martha; Veledar, Emir; Hachamovitch, Rory; Arrighi, James A; Merz, C Noel Bairey; Gibbons, Raymond J; Wenger, Nanette K; Heller, Gary V

    2011-09-13

    There is a paucity of randomized trials regarding diagnostic testing in women with suspected coronary artery disease (CAD). It remains unclear whether the addition of myocardial perfusion imaging (MPI) to the standard ECG exercise treadmill test (ETT) provides incremental information to improve clinical decision making in women with suspected CAD. We randomized symptomatic women with suspected CAD, an interpretable ECG, and ≥5 metabolic equivalents on the Duke Activity Status Index to 1 of 2 diagnostic strategies: ETT or exercise MPI. The primary end point was 2-year incidence of major adverse cardiac events, defined as CAD death or hospitalization for an acute coronary syndrome or heart failure. A total of 824 women were randomized to ETT or exercise MPI. For women randomized to ETT, ECG results were normal in 64%, indeterminate in 16%, and abnormal in 20%. By comparison, the exercise MPI results were normal in 91%, mildly abnormal in 3%, and moderate to severely abnormal in 6%. At 2 years, there was no difference in major adverse cardiac events (98.0% for ETT and 97.7% for MPI; P=0.59). Compared with ETT, index testing costs were higher for exercise MPI (P<0.001), whereas downstream procedural costs were slightly lower (P=0.0008). Overall, the cumulative diagnostic cost savings was 48% for ETT compared with exercise MPI (P<0.001). In low-risk, exercising women, a diagnostic strategy that uses ETT versus exercise MPI yields similar 2-year posttest outcomes while providing significant diagnostic cost savings. The ETT with selective follow-up testing should be considered as the initial diagnostic strategy in symptomatic women with suspected CAD. http://www.clinicaltrials.gov. Unique identifier: NCT00282711.

  4. The use of a novel cleaning closed suction system reduces the volume of secretions within the endotracheal tube as assessed by micro-computed tomography: a randomized clinical trial.

    PubMed

    Coppadoro, Andrea; Bellani, Giacomo; Bronco, Alfio; Lucchini, Alberto; Bramati, Simone; Zambelli, Vanessa; Marcolin, Roberto; Pesenti, Antonio

    2015-12-01

    Early after intubation, a layer of biofilm covers the inner lumen of the endotracheal tube (ETT). Cleaning the ETT might prevent airways colonization by pathogens, reduce resistance to airflow, and decrease sudden ETT obstruction. We investigated the effectiveness of a cleaning closed suction system in maintaining the endotracheal tube free from secretions. We conducted a single center, randomized controlled trial, in the general intensive care unit of a tertiary-level university hospital. We enrolled 40 adult critically ill patients expected to remain intubated for more than 48 h, within 24 h from intubation. Patients were randomized to receive three ETT cleaning maneuvers/day using a novel device (Airway Medix Closed Suction System™, cleaning group) or to standard care (no ETT cleaning, standard closed suction, control group). After extubation, the amount of secretions in the ETTs was measured by micro-computed tomography. The volume of secretions in the ETTs from the cleaning group was lower than controls (0.081 [0.021-0.306] vs. 0.568 [0.162-0.756] mL, p = 0.001), corresponding to a cross-sectional area reduction six times lower (1[0-3] vs. 6 [2-10] %, p = 0.001). In a subset of 16 patients, the resistance to airflow tended to be lower after 1 day of treatment (p = 0.063) and was lower after 2 days (0.024), while no difference was present at enrollment (p = 0.922). ETT colonization did not differ between the two groups. The use of a novel cleaning closed suction system proved to be effective in reducing secretions present in the ETT after extubation, possibly reducing resistance to airflow during intubation. clinicaltrials.gov NCT01912105.

  5. In search of the false-negative exercise treadmill testing evidence-based use of exercise echocardiography.

    PubMed

    Southard, Jeffrey; Baker, Larry; Schaefer, Saul

    2008-01-01

    Controversy exists regarding the role of exercise treadmill testing (ETT) versus exercise stress echocardiography (ESE) as the appropriate initial noninvasive test to risk-stratify patients with chest pain. The majority of studies to date that evaluated these methodologies included patients with poor functional status and baseline electrocardiogram (ECG) abnormalities, potentially limiting the sensitivity of ETT. We examined the hypothesis that given stringent standards of exercise duration and ECG interpretability, the ETT would have a high diagnostic sensitivity for the presence of significant coronary artery disease (CAD). Results of concurrent ETT and ESE in 3,098 patients were examined, and the subset of patients with a negative ETT and positive ESE (-ETT/ + ESE) were reviewed for the presence of CAD as a function of exercise duration (< or > or = 6 min) and baseline ECG normality. In those patients with a - ETT/ + ESE who exercised > or = 6 min, 54 had a normal baseline ECG, 22 underwent angiography and 6 had CAD (all of whom had either small, grafted or collateralized vessels). Patients with a - ETT/ + ESE who were incapable of exercising 6 min were more frequently older and female. Mortality was significantly greater in the < 6 min exercise duration group (31.4 versus 3.1%). These findings support the use of the ETT without imaging as the initial test in patients with chest pain who have a normal baseline ECG and are able to exercise 6 min. Using these criteria, false negative findings are generally seen in patients without critical large vessel epicardial disease. The ESE should be reserved as the initial test for patients with an abnormal baseline ECG or reduced functional capacity. 2007 Wiley Periodicals, Inc

  6. Evaluation of a new circuit configuration for the VDR-4 high-frequency percussive ventilator.

    PubMed

    Jones, Samuel W; Short, Kathy A; Hanson, William J; Hendrix, Laura; Charles, Anthony G; Cairns, Bruce A

    2010-01-01

    High-frequency percussive ventilation (HFPV) by the VDR-4(R) has been a successful mode of ventilation in the management of inhalation injuries for nearly 20 years. A limitation of the standard VDR-4 ventilator circuit is that the sliding venturi manifold is heavy in weight and is normally connected directly to the patient's endotracheal tube (ETT), resulting in potentially hazardous torque on the ETT. In this study, we evaluate the mechanics of a new circuit for the VDR-4 that relocates the sliding venturi manifold portion of the circuit away from the ETT into the ventilator proper. This new VDR-4 circuit configuration may have an important impact on patient safety.

  7. Comparison of the cuff pressure of a TaperGuard endotracheal tube and a cylindrical endotracheal tube after lateral rotation of head during middle ear surgery: A single-blind, randomized clinical consort study.

    PubMed

    Choi, Eunkyung; Park, Yongmin; Jeon, Younghoon

    2017-03-01

    Positional change affects the cuff pressure of an endotracheal tube (ETT) in treacheally intubated patients. We compared the cuff pressure of a TaperGuard ETT and a cylindrical ETT after lateral rotation of head during middle ear surgery. Fifty-two patients aged 18-70 years underwent a tympanomastoidectomy under general anesthesia were randomly allocated to receive endotracheal intubation with cylindrical (group C, n = 26) or TaperGuard ETTs (group T, n = 26). After endotracheal intubation, the ETT cuff pressure was set at 22 cmH2O in the neutral position of head. After lateral rotation of head, the cuff pressure was measured again and readjusted to 22 cmH2O. In addition, the change of distance from the carina to the tip of the ETT was measured before and after the positional change. The incidence of cough, sore throat, and hoarseness was assessed at 30 minutes, 6 hours, and 24 hours after surgery. There was no difference in demographic data between groups. After lateral rotation of head, the cuff pressure significantly increased in group T (11.9 ± 2.3 cmH2O) compared with group C (6.0 ± 1.9 cmH2O) (P < 0.001). The incidence of a cuff pressure >30 cmH2O was higher in group T (96.2%) than in group C (30.8%) (P < 0.001). In addition, the degree of displacement of an ETT was greater in group T (11.0 ± 1.7 mm) than in group C (7.2 ± 2.6 mm) (P < 0.001). The overall incidences of postoperative sore throat, hoarseness, and cough at 30 minutes, 6 hours, and 24 hours after surgery were comparable between two groups. The cuff pressure was higher in the TaperGuard ETT than in the cylindrical ETT after positional change of head from neutral to lateral rotation. In addition, after a positional change, the extent of displacement of ETT was greater in the TaperGuard ETT than in the cylindrical ETT.

  8. Comparison of the cuff pressure of a TaperGuard endotracheal tube and a cylindrical endotracheal tube after lateral rotation of head during middle ear surgery

    PubMed Central

    Choi, Eunkyung; Park, Yongmin; Jeon, Younghoon

    2017-01-01

    Abstract Background: Positional change affects the cuff pressure of an endotracheal tube (ETT) in treacheally intubated patients. We compared the cuff pressure of a TaperGuard ETT and a cylindrical ETT after lateral rotation of head during middle ear surgery. Methods: Fifty-two patients aged 18–70 years underwent a tympanomastoidectomy under general anesthesia were randomly allocated to receive endotracheal intubation with cylindrical (group C, n = 26) or TaperGuard ETTs (group T, n = 26). After endotracheal intubation, the ETT cuff pressure was set at 22 cmH2O in the neutral position of head. After lateral rotation of head, the cuff pressure was measured again and readjusted to 22 cmH2O. In addition, the change of distance from the carina to the tip of the ETT was measured before and after the positional change. The incidence of cough, sore throat, and hoarseness was assessed at 30 minutes, 6 hours, and 24 hours after surgery. Results: There was no difference in demographic data between groups. After lateral rotation of head, the cuff pressure significantly increased in group T (11.9 ± 2.3 cmH2O) compared with group C (6.0 ± 1.9 cmH2O) (P < 0.001). The incidence of a cuff pressure >30 cmH2O was higher in group T (96.2%) than in group C (30.8%) (P < 0.001). In addition, the degree of displacement of an ETT was greater in group T (11.0 ± 1.7 mm) than in group C (7.2 ± 2.6 mm) (P < 0.001). The overall incidences of postoperative sore throat, hoarseness, and cough at 30 minutes, 6 hours, and 24 hours after surgery were comparable between two groups. Conclusion: The cuff pressure was higher in the TaperGuard ETT than in the cylindrical ETT after positional change of head from neutral to lateral rotation. In addition, after a positional change, the extent of displacement of ETT was greater in the TaperGuard ETT than in the cylindrical ETT. PMID:28272230

  9. Discordance of exercise thallium testing with coronary arteriography in patients with atypical presentations

    SciTech Connect

    Bungo, M.W.; Leland, O.S. Jr.

    1983-01-01

    Eighty-one patients with diagnostically difficult clinical presentations suggesting coronary disease underwent symptom-limited maximal-exercise treadmill testing (ETT) and exercise radionuclide scanning with /sup 201/Tl. Results of these tests were in agreement in only 47 percent of the cases. Either exercise thallium or ETT was positive in 94 percent of patients with disease. Among a population with a disease prevalence of 67 percent, agreement between exercise thallium an ETT predicted disease in 92 percent of instances or excluded disease in 82 percent of instances. Frequent discordance between these two tests in 53 percent of the cases unfortunately limits this usefulness.

  10. Audit of Endotracheal Tube Suction in a Pediatric Intensive Care Unit.

    PubMed

    Davies, Kylie; Bulsara, Max K; Ramelet, Anne-Sylvie; Monterosso, Leanne

    2017-02-01

    We report outcomes of a clinical audit examining criteria used in clinical practice to rationalize endotracheal tube (ETT) suction, and the extent these matched criteria in the Endotracheal Suction Assessment Tool(ESAT)©. A retrospective audit of patient notes ( N = 292) and analyses of criteria documented by pediatric intensive care nurses to rationalize ETT suction were undertaken. The median number of documented respiratory and ventilation status criteria per ETT suction event that matched the ESAT© criteria was 2 [Interquartile Range (IQR) 1-6]. All criteria listed within the ESAT© were documented within the reviewed notes. A direct link was established between criteria used for current clinical practice of ETT suction and the ESAT©. The ESAT©, therefore, reflects documented clinical decision making and could be used as both a clinical and educational guide for inexperienced pediatric critical care nurses. Modification to the ESAT © requires "preparation for extubation" to be added.

  11. Intratracheal ectopic thyroid tissue: a case report and literature review.

    PubMed

    Byrd, Michael C; Thompson, Lester D R; Wieneke, Jacqueline A

    2003-07-01

    We discuss a case of intratracheal ectopic thyroid tissue (ETT) that was retrieved from the files of the Otorhinolaryngic--Head and Neck Pathology Registry at the Armed Forces Institute of Pathology. The patient was a 54-year-old man who had a history of papillary thyroid carcinoma, which had been treated with a subtotal thyroidectomy. During routine follow-up 4 years later, the patient's primary care physician detected an elevated thyroglobulin level. Further referrals and evaluations revealed that the patient had intratracheal ETT. The patient refused to undergo surgical excision and remains without evidence of recurrent carcinoma. In a MEDLINE literature review, we found only 13 other well-documented cases of intratracheal ETT since 1966; in all but two cases, patients had benign disease. Once the possibility of thyroid carcinoma has been eliminated by histologic examination, intratracheal ETT can be managed by complete surgical excision with the prospect of an excellent long-term clinical outcome.

  12. Respiratory mechanics during high-frequency oscillatory ventilation: a physical model and preterm infant study.

    PubMed

    Singh, Rachana; Courtney, Sherry E; Weisner, Michael D; Habib, Robert H

    2012-04-01

    Accurate mechanics measurements during high-frequency oscillatory ventilation (HFOV) facilitate optimizing ventilator support settings. Yet, these are influenced substantially by endotracheal tube (ETT) contributions, which may dominate when leaks around uncuffed ETT are present. We hypothesized that 1) the effective removal of ETT leaks may be confirmed via direct comparison of measured vs. model-predicted mean intratracheal pressure [mPtr (meas) vs. mPtr (pred)], and 2) reproducible respiratory system resistance (Rrs) and compliance (Crs) may be derived from no-leak oscillatory Ptr and proximal flow. With the use of ETT test-lung models, proximal airway opening (Pao) and distal (Ptr) pressures and flows were measured during slow-cuff inflations until leaks are removed. These were repeated for combinations of HFOV settings [frequency, mean airway pressure (Paw), oscillation amplitudes (ΔP), and inspiratory time (%t(I))] and varying test-lung Crs. Results showed that leaks around the ETT will 1) systematically reduce the effective distending pressures and lung-delivered oscillatory volumes, and 2) derived mechanical properties are increasingly nonphysiologic as leaks worsen. Mean pressures were systematically reduced along the ventilator circuit and ETT (Paw > Pao > Ptr), even for no-leak conditions. ETT size-specific regression models were then derived for predicting mPtr based on mean Pao (mPao), ΔP, %t(I), and frequency. Next, in 10 of 11 studied preterm infants (0.77 ± 0.24 kg), no-to-minimal leak was confirmed based on excellent agreement between mPtr (meas) and mPtr (pred), and consequently, their oscillatory respiratory mechanics were evaluated. Infant resistance at the proximal ETT (R(ETT); resistance airway opening = R(ETT) + Rrs; P < 0.001) and ETT inertance (P = 0.014) increased significantly with increasing ΔP (50%, 100%, and 150% baseline), whereas Rrs showed a modest, nonsignificant increase (P = 0.14), and Crs was essentially unchanged (P = 0

  13. Application of a flexible lightwand in percutaneous dilatational tracheotomy.

    PubMed

    Zhao, Zhuang; Pan, Shu; Wang, Dunwei; Wang, Chengyu; Li, Zhiwen

    2017-06-23

    By comparing flexible lightwand-assisted and conventional endotracheal tube (ETT) withdrawal in percutaneous dilatational tracheotomy (PDT), this paper aims to provide guidance for precise ETT withdrawal by anesthesiologists and accurate determination of the incision site by surgeons. Sixty patients who underwent PDT in our hospital were randomly divided into the lightwand group (Group L, n=30) and the withdrawal group (Group W, n=30) using the envelope method. For Group L patients, a flexible lightwand was inserted into an ETT (based on the patient's size), the light source was positioned at the root of the cuff, and the depth from the root of the cuff to the end of the ETT was marked. The flexible lightwand was inserted into the patient's ETT to the marked depth. The ETT along with the flexible lightwand was withdrawn until the highlighted spot was located at the level of the thyroid cartilage. The incision site was approximately 3 finger widths (approximately 4.8cm) below the highlighted spot. For Group W patients, the ETT was withdrawn to a tube depth of 17cm at the upper incisors in males and 15cm in females, and surgeons determined incision sites without assistance. The following metrics were recorded for the two groups: occurrences of inadvertent extubation, ETT puncture and cuff rupture; success rate of first puncture; hypoxia rate; SpO2 at the time of tracheostomy cannula intubation (T1); and postoperative hemorrhage rate. Inadvertent extubation, ETT puncture and cuff rupture occurred significantly less frequently in Group L than in Group W, and the success rate of first puncture and SpO2 at T1 were markedly higher in Group L than in Group W. Moreover, significant between-group differences in hypoxia rate and postoperative hemorrhage rate were observed. The use of a flexible lightwand in PDT is a safe and effective approach. This approach can effectively and directly guide precise ETT repositioning and provide incision site confirmation with few intra- and

  14. Heart Rate Variability, Catecholamine and Hemodynamic Responses During Rest and Stress in Coronary Artery Disease Patients: The PIMI Study

    DTIC Science & Technology

    2007-01-31

    Chierchia, S. L. (1997). Angina pectoris and the personality factor: the relevance of psychosocial factors in myocardial ischaemia. Eur Heart J, 18(6), 892...25 ischemic events were asymptomatic (no angina ) and the decreases in HRV (HF and LF) were correlated with high levels of...angioplasty (PTCA) within 6 months of qualifying ETT, cardiac surgery requiring thoracotomy, unstable angina within 4 weeks of qualifying ETT

  15. Influence of Low Peak Respiratory Exchange Ratio on Cardiac Rehabilitation in Patients With Coronary Artery Disease

    PubMed Central

    2016-01-01

    Objective To compare and analyze the effects of cardiac rehabilitation (CR) in two groups based on the peak respiratory exchange ratio (RERpeak) 1.1 values using the exercise tolerance test (ETT) results, and to investigate the reasons for early termination of ETT. Methods Patients with acute coronary syndrome who participated in CR exercise training were selected and all subjects underwent 6 weeks of CR exercise training. ETT was performed on a treadmill using a Modified Bruce Protocol before and after CR exercise training. According to the result of the first ETT, the subjects were divided into two groups: those with an RERpeak≥1.1 (n=33) and those with an RERpeak<1.1 (n=22). We investigated the reasons for ETT termination and compared the effect of CR between the groups. Results The reasons for the early termination of the first ETT in the RERpeak<1.1 group were subjective dyspnea, abnormal cardiovascular responses, leg fatigue and other problems. After a 6-week CR, the peak oxygen consumption (VO2peak) and ETT time increased, and the rate of perceived exertion (RPE) and RPP (rate pressure product) at stage 3 decreased in both the RERpeak<1.1 and RERpeak≥1.1 groups. Conclusion CR exercise training improved exercise capacity, not only in the RERpeak≥1.1 group, but also in the RERpeak<1.1 group. This means that patients with a lower exercise tolerance could also benefit from the effects of CR. Thoughtful consideration to identify the direct and indirect causes for the early termination of ETT would be necessary to improve the efficiency of CR. PMID:28119843

  16. ProSeal Laryngeal Mask Airway as an Alternative to Standard Endotracheal Tube in Securing Upper Airway in the Patients Undergoing Beating-heart Coronary Artery Bypass Grafting

    PubMed Central

    Shah, Kalpana

    2017-01-01

    Background: ProSeal laryngeal mask airways (PLMAs) are routinely used after failed tracheal intubation as airway rescue, facilitating tracheal intubation by acting as a conduit and to secure airway during emergencies. In long duration surgeries, use of endotracheal tube (ETT) is associated with various hemodynamic complications, which are minimally affected during PLMA use. However, except for few studies, there are no significant data available that promote the use of laryngeal mask during cardiac surgery. This prospective study was conducted with the objective of demonstrating the advantages of PLMA over ETT in the patients undergoing beating-heart coronary artery bypass graft (CABG). Methodology: This prospective, interventional study was carried out in 200 patients who underwent beating-heart CABG. Patients were randomized in equal numbers to either ETT group or PLMA group, and various hemodynamic and respiratory parameters were observed at different time points. Results: Patients in PLMA group had mean systolic blood pressure 126.10 ± 5.31 mmHg compared to the patients of ETT group 143.75 ± 6.02 mmHg. Pulse rate in the PLMA group was less (74.52 ± 10.79 per min) (P < 0.05) compared to ETT group (81.72 ± 9.8). Thus, hemodynamic changes were significantly lower (P < 0.05) in PLMA than in ETT group. Respiratory parameters such as oxygen saturation, pressure CO2 (pCO2), peak airway pressure, and lung compliance were similar to ETT group at all evaluation times. The incidence of adverse events was also lower in PLMA group. Conclusion: In experience hand, PLMA offers advantages over the ETT in airway management in the patients undergoing beating-heart CABG. PMID:28074798

  17. Incidence of endotracheal tube colonization with the use of PneuX endotracheal tubes in patients following cardiac surgery.

    PubMed

    Senanayake, E L; Giri, R; Gopal, S; Nevill, A; Luckraz, H

    2017-01-01

    Ventilator-associated pneumonia (VAP) develops in up to 25% of patients following cardiac surgery. Colonization of the endotracheal tube (ETT) contributes to VAP. The PneuX ETT has been shown to halve VAP in high-risk patients undergoing cardiac surgery. This article reports on the secondary analysis of bacterial colonization in relation to VAP between the PneuX and standard ETTs. In this randomized controlled trial, patients were randomized on a 1:1 basis to Group A (PneuX ET, N=120) or Group B (standard ETT, N=120). Patients aged >70 years with or without impaired left ventricular function (<50%) undergoing elective and urgent cardiac surgery were included in this study. Incidence of postoperative VAP and analysis of bacterial colonization within the ETT (N=234) were measured for patients requiring <24 h, 24-48 h and >48 h of intubation. Baseline patient demographics were comparable. VAP was lower in Group A compared with Group B (10.8% vs 21%; P=0.03). The incidence of VAP was lower at each time point for Group A. There was a lower incidence of ETT colonization in Group A for patients needing >48 h of intubation. There was no difference in the type of bacterial colonization (P=0.5) or the mean number of colony-forming units [4.35x10(7) (1.18x10(8)) and 2.16x10(8) (1.24x10(9)) in Groups A and B, respectively (P=0.8)]. Colonization of the ETT does not seem to play an important role in early-onset VAP. There is a tendency for reduced colonization in the PneuX ETT with longer intubation times. This may have an impact on reducing the incidence of late-onset VAP. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  18. Predicting endotracheal tube size by length in newborns.

    PubMed

    Luten, Robert; Kahn, Nagma; Wears, Robert; Kissoon, Niranjan

    2007-05-01

    The objective of this study was to determine the relationship of length to endotracheal tube (ETT) size in newborns and to use this relationship to develop a tool for predicting ETT size. The study, a prospective derivation, and validation of a predictive model, took place in the neonatal intensive care units (NICUs) in two urban teaching hospitals. Subjects included: ETT derivation set - 39 intubated neonates admitted to the NICU; Validation set - 69 intubated newborns from the same NICU. Leak percentages were measured in intubated neonates where the actual ETT size did not correlate with the tape-determined ETT size. Interventions were length, weight, and leak measurements. A prototype tape was developed using the derivation set and published anthropometric studies. The accuracy of the tape was validated on a separate set of newborns. The average relative difference between tape-predicted weight and actual weight was 9.5% (confidence interval [CI] = 8.3-10.6%) and was evenly distributed throughout all the weight groups. The tape predicted actual ETT size in 96% of cases (CI 86.3-99.5%) and was correct within 1 tube size (1/2 mm) in 100% (CI 94.8-100%). The only error in prediction of ETT size was in underestimation. Length-based weight estimations were tested on 100 subjects and predicted actual weight within 20% in 94% of cases. We concluded that length is an accurate predictor of ETT size and weight in term and preterm newborns and may be useful in situations in which weights are unobtainable, such as emergency resuscitation.

  19. Decreased Pseudomonas aeruginosa biofilm formation on nanomodified endotracheal tubes: a dynamic lung model

    PubMed Central

    Machado, Mary C; Webster, Thomas J

    2016-01-01

    Ventilator-associated pneumonia (VAP) is a serious complication of mechanical ventilation that has been shown to be associated with increased mortality rates and medical costs in the pediatric intensive care unit. Currently, there is no cost-effective solution to the problems posed by VAP. Endotracheal tubes (ETTs) that are resistant to bacterial colonization and that inhibit biofilm formation could provide a novel solution to the problems posed by VAP. The objective of this in vitro study was to evaluate differences in the growth of Pseudomonas aeruginosa on unmodified polyvinyl chloride (PVC) ETTs and on ETTs etched with a fungal lipase, Rhizopus arrhizus, to create nanoscale surface features. These differences were evaluated using an in vitro model of the pediatric airway to simulate a ventilated patient in the pediatric intensive care unit. Each experiment was run for 24 hours and was supported by computational models of the ETT. Dynamic conditions within the ETT had an impact on the location of bacterial growth within the tube. These conditions also quantitatively affected bacterial growth especially within the areas of tube curvature. Most importantly, experiments in the in vitro model revealed a 2.7 log reduction in the number (colony forming units/mL) of P. aeruginosa on the nanoroughened ETTs compared to the untreated PVC ETTs after 24 hours. This reduction in total colony forming units/mL along the x-axis of the tube was similar to previous studies completed for Staphylococcus aureus. Thus, this dynamic study showed that lipase etching can create surface features of nanoscale roughness on PVC ETTs that decrease bacterial attachment of P. aeruginosa without the use of antibiotics and may provide clinicians with an effective and inexpensive tool to combat VAP. PMID:27563242

  20. Decreased Pseudomonas aeruginosa biofilm formation on nanomodified endotracheal tubes: a dynamic lung model.

    PubMed

    Machado, Mary C; Webster, Thomas J

    2016-01-01

    Ventilator-associated pneumonia (VAP) is a serious complication of mechanical ventilation that has been shown to be associated with increased mortality rates and medical costs in the pediatric intensive care unit. Currently, there is no cost-effective solution to the problems posed by VAP. Endotracheal tubes (ETTs) that are resistant to bacterial colonization and that inhibit biofilm formation could provide a novel solution to the problems posed by VAP. The objective of this in vitro study was to evaluate differences in the growth of Pseudomonas aeruginosa on unmodified polyvinyl chloride (PVC) ETTs and on ETTs etched with a fungal lipase, Rhizopus arrhizus, to create nanoscale surface features. These differences were evaluated using an in vitro model of the pediatric airway to simulate a ventilated patient in the pediatric intensive care unit. Each experiment was run for 24 hours and was supported by computational models of the ETT. Dynamic conditions within the ETT had an impact on the location of bacterial growth within the tube. These conditions also quantitatively affected bacterial growth especially within the areas of tube curvature. Most importantly, experiments in the in vitro model revealed a 2.7 log reduction in the number (colony forming units/mL) of P. aeruginosa on the nanoroughened ETTs compared to the untreated PVC ETTs after 24 hours. This reduction in total colony forming units/mL along the x-axis of the tube was similar to previous studies completed for Staphylococcus aureus. Thus, this dynamic study showed that lipase etching can create surface features of nanoscale roughness on PVC ETTs that decrease bacterial attachment of P. aeruginosa without the use of antibiotics and may provide clinicians with an effective and inexpensive tool to combat VAP.

  1. Epistaxis during nasotracheal intubation: a randomized trial of the Parker Flex-Tip™ nasal endotracheal tube with a posterior facing bevel versus a standard nasal RAE endotracheal tube.

    PubMed

    Earle, Rosie; Shanahan, Enda; Vaghadia, Himat; Sawka, Andrew; Tang, Raymond

    2017-04-01

    Nasotracheal intubation is a widely performed technique to facilitate anesthesia induction during oral, dental, and maxillofacial surgeries. The technique poses several risks not encountered with oropharyngeal intubation, most commonly epistaxis due to nasal mucosal abrasion. The purpose of this study was to test whether the use of the Parker Flex-Tip™ (PFT) nasal endotracheal tube (ETT) with a posterior facing bevel reduces epistaxis when compared with the standard nasal RAE ETT with a leftward facing bevel. Sixty American Society of Anesthesiologists physical status I and II patients undergoing oral or maxillofacial surgery with nasotracheal intubation were recruited. Patients were randomized to either a standard nasal RAE ETT or a PFT nasal ETT. The ETT was thermosoftened and lubricated for both study groups prior to insertion, and the size of the tube was chosen at the discretion of the attending anesthesiologist. The primary outcome was the incidence of epistaxis, with a secondary outcome of epistaxis severity (scored as none, mild, moderate, or severe). An investigator measured both outcomes five minutes after intubation was completed. Mild or moderate epistaxis was experienced by 22 of 30 (73%) patients in the PFT group compared with 21 of 30 (70%) patients in the standard nasal RAE ETT group (absolute risk reduction, 3%; 95% confidence interval, -19 to 25; P = 0.78). There were no occurrences of severe epistaxis in either group. There was no difference in the incidence or severity of epistaxis following nasal intubation using the Parker Flex-Tip nasal ETT when compared with a standard nasal RAE ETT. This trial was registered at ClinicalTrials.gov, identifier: NCT02315677.

  2. Predictors of postoperative sore throat in intubated children.

    PubMed

    Calder, Alyson; Hegarty, Mary; Erb, Thomas O; von Ungern-Sternberg, Britta S

    2012-03-01

    The incidence of postoperative sore throat (POST) following intubation is not well defined in the pediatric population. The etiology is multifactorial and includes impairment of subglottic mucosal perfusion and edema as a result of the pressures exerted by cuffed or uncuffed tubes. To determine the incidence of, and risk factors for, POST in intubated children undergoing elective day-case surgery. Five hundred patients aged 3-16 years were studied prospectively. Endotracheal tube (ETT) choice (cuffed or uncuffed) was left to the anesthetist. The cuff was inflated either until loss of audible leak or to a determined pressure using a cuff manometer. The research team then measured the cuff pressure (CP). POST incidence and intensity was determined by interviewing patients prior to discharge from the same day procedure unit. Chi-square testing and stepwise logistic regression were used to determine the predictors of POST. Of the 111 (22%) children developed a sore throat, 19 (3.8%) a sore neck, and 5 (1%) a sore jaw. 19% of patients with cuffed ETTs complained of sore throat compared with 37% of those intubated with an uncuffed ETT. The incidence of POST increased with CP; 0-10% at 0 cmH(2)O, 4% at 11-20 cmH(2)O, 20% at 21-30 cmH(2)O, 68% at CP 31-40 cmH(2)O, and 96% at CP >40 cmH(2)O. The ETT CP and use of uncuffed ETTs were univariate predictors of POST. Children intubated with uncuffed ETTs are more likely to have POST. ETT CP is positively correlated with the incidence of POST. When using cuffed ETTs, CP should be routinely measured intraoperatively. © 2011 Blackwell Publishing Ltd.

  3. Parallel structural evolution of auxin response factors in the angiosperms.

    PubMed

    Finet, Cédric; Fourquin, Chloé; Vinauger, Marion; Berne-Dedieu, Annick; Chambrier, Pierre; Paindavoine, Sandrine; Scutt, Charles P

    2010-09-01

    Here we analyze the structural evolution of the paralogous transcription factors ETTIN (ETT/ARF3) and AUXIN RESPONSE FACTOR 4 (ARF4), which control the development of floral organs and leaves in the model angiosperm Arabidopsis. ETT is truncated at its C terminus, and consequently lacks two regulatory domains present in most other ARFs, including ARF4. Our analysis indicates ETT and ARF4 to have been generated by the duplication of a non-truncated ARF gene prior to the radiation of the extant angiosperms. We furthermore show that either ETT or ARF4 orthologs have become modified to encode truncated ARF proteins, lacking C-terminal regulatory domains, in representatives of three groups that separated early in angiosperm evolution: Amborellales, Nymphaeales and the remaining angiosperm clade. Interestingly, the production of truncated ARF4 transcripts in Amborellales occurs through an alternative splicing mechanism, rather than through a permanent truncation, as in the other groups studied. To gain insight into the potential functional significance of truncations to ETT and ARF4, we tested the capacity of native, truncated and chimeric coding sequences of these genes to restore a wild-type phenotype to Arabidopsis ett mutants. We discuss the results of this analysis in the context of the structural evolution of ARF genes in the angiosperms.

  4. Digital palpation of endotracheal tube tip as a method of confirming endotracheal tube position in neonates: an open-label, three-armed randomized controlled trial.

    PubMed

    Saboo, Ashwin R; Dutta, Sourabh; Sodhi, Kushaljit Singh

    2013-10-01

    To compare the malposition rates of endotracheal tubes (ETTs) when the insertional length (IL) is determined by a weight-based nomogram versus when IL is determined by palpation of the ETT tip. Open-label, randomized controlled trial (RCT). Level III neonatal intensive care unit (NICU). All newborn babies admitted in NICU requiring intubation. Subjects were randomly allocated to one of three groups, wherein IL was determined by (i) weight-based nomogram alone, (ii) weight-based nomogram combined with suprasternal palpation of ETT tip performed by specially trained neonatology fellows, or (iii) combination of weight-based and suprasternal methods by personnel not specially trained. Rate of malposition of ETT as judged on chest X-ray (CXR). Fifty seven babies were randomized into group 1(n = 15), group 2 (n = 20), and group 3 (n = 22). The proportion of correct ETT placement was highest in group 2, being 66.7%, 83.3%, and 66.7% in groups 1 through 3, respectively (P value = 0.58). No complication was attributable to palpation technique. Suprasternal palpation shows promise as a simple, safe, and teachable method of confirming ETT position in neonates. © 2013 John Wiley & Sons Ltd.

  5. The Arabidopsis STV1 Protein, Responsible for Translation Reinitiation, Is Required for Auxin-Mediated Gynoecium PatterningW⃞

    PubMed Central

    Nishimura, Taisuke; Wada, Takuji; Yamamoto, Kotaro T.; Okada, Kiyotaka

    2005-01-01

    Ribosomal protein L24 (RPL24) is implicated in translation reinitiation of polycistronic genes. A newly isolated Arabidopsis thaliana short valve1 (stv1) mutant, in which one of the RPL24-encoding genes, RPL24B, is deleted, shows specific defects in the apical-basal patterning of the gynoecium, in addition to phenotypes induced by ribosome deficiency. A similar gynoecium phenotype is caused by mutations in the auxin response factor (ARF) genes ETTIN (ETT) and MONOPTEROS (MP), which have upstream open reading frames (uORFs) in their 5′-transcript leader sequences. Gynoecia of a double mutant of stv1 and a weak ett mutant allele are similar to those of a strong ett allele, and transformation with a uORF-eliminated ETT construct partially suppressed the stv1 gynoecium phenotype, implying that STV1 could influence ETT translation through its uORFs. Analyses of 5′-leader-reporter gene fusions showed that the uORFs of ETT and MP negatively regulate the translation of the downstream major ORFs, indicating that translation reinitiation is an important step for the expression of these proteins. Taken together, we propose that perturbation of translation reinitiation of the ARF transcripts causes the defects in gynoecium patterning observed in the stv1 mutant. PMID:16227452

  6. Endotracheal tube size selection guidelines for Chinese children: prospective study of 533 cases.

    PubMed

    Wang, T K; Wu, R S; Chen, C; Chang, T C; Hseih, F S; Tan, P P

    1997-05-01

    Appropriate selection of the size of an endotracheal tube (ETT) for use in children is important both in general anesthesia and critical care practice. Past published data on guidelines for selecting ETT size in children are based on Caucasian measurements. As body build is generally different in Chinese children compared with Caucasians of the same age group, guidelines for Chinese children are needed. The aim of this study was to determine guidelines for ETT size selection by recording and comparing age, body weight, length, head girth and circumference of the right fifth finger of the child. Correlations between internal diameter (ID) of the chosen ETT and the child's data were calculated and compared. In this study, 533 Chinese children. American Society of Anesthesiolgists class I or II, aged from 3 months to 6 years, undergoing oral intubation for general anesthesia for minor pediatric surgery were enrolled. Our results showed that body length (height) had the best correlation to the size of an uncuffed oral ETT. Through stepwise regression, a formula. ETT ID = 2 + (body length (cm)/30), was obtained.

  7. Extrauterine epithelioid trophoblastic tumor in hysterectomized woman.

    PubMed

    Kim, Ji-Hye; Lee, Sun Kyung; Hwang, Soo Hyun; Kim, Jung-Sun; Yoon, Gun; Lee, Yoo-Young; Kim, Tae-Joong; Choi, Chel Hun; Kim, Byoung-Gie; Bae, Duk-Soo; Lee, Jeong-Won

    2017-01-01

    Epithelioid trophoblastic tumor (ETT) is a very rare variant of gestational trophoblastic disease (GTD) which arises in reproductive age women with prior gestational history. Although abnormal vaginal bleeding is the most common symptom of ETT, there are no reported pathognomonic symptoms of ETT because of its rarity. ETT is similar to placental site trophoblastic tumor in terms of its slow growing characteristic and microscopic findings. Therefore, it could be misdiagnosed as placental site trophoblastic tumor or other types of GTD. Unlike other types of GTD, primary treatment of ETT is surgical resection because of its chemo-resistant nature. Accordingly, immunohistochemical staining is essential for accurate diagnosis and appropriate treatment. Here, we report a case of a 42-year-old hysterectomized woman with pelvic masses who suffered from abdominal pain. Through laparotomy, tumors were resected completely and they were diagnosed as ETT through immunohistochemical stain. This report provides more evidence about its clinical features, diagnosis, and treatment including a brief review of the literature.

  8. ST elevation in the lead aVR during exercise treadmill testing may indicate left main coronary artery disease.

    PubMed

    Ozmen, Namik; Yiginer, Omer; Uz, Omer; Kardesoglu, Ejder; Aparci, Mustafa; Isilak, Zafer; Cingozbay, Bekir Yilmaz; Cebeci, Bekir Sitki; Kocum, Halil Tolga

    2010-10-01

    exercise treadmill testing (ETT) is the most widely used method for evaluating patients with coronary artery disease. Predicting the left main coronary artery (LMCA) disease before invasive procedures is very important in risk assessment because of its severe clinical outcome. To examine whether ST elevation in lead aVR during ETT may suggest LMCA disease since the lead aVR is the reciprocal lead of LMCA. in this study, 61 patients with positive ETT were included. The study group consisted of 21 patients with ST elevation in lead aVR. Forty patients, also having positive ETT, but without ST elevation in lead aVR comprised the control group. All patients underwent coronary angiography. coronary angiography in the study group revealed significant LMCA stenosis in 16 (76%) patients, whereas LMCA disease was present in only 3 (8%) patients from the control group. There was no significant coronary artery stenosis in 5 patients in the study group and 12 patients in the control group. Of the 16 patients who had LMCA stenosis, 9 had isolated LMCA disease and 7 had additional stenotic lesions in LAD or circumflex coronary arteries. The sensitivity and specificity of ST segment elevation in lead aVR during ETT was 84% and 88%, respectively. The values of positive and negative predictive value of this finding in diagnosing the presence of LMCA were 76% and 93%, respectively. ST segment elevation in lead aVR during ETT may point to a high probability of the presence of LMCA disease.

  9. Extrauterine epithelioid trophoblastic tumor in hysterectomized woman

    PubMed Central

    Kim, Ji-Hye; Lee, Sun Kyung; Hwang, Soo Hyun; Kim, Jung-Sun; Yoon, Gun; Lee, Yoo-Young; Kim, Tae-Joong; Choi, Chel Hun; Kim, Byoung-Gie; Bae, Duk-Soo

    2017-01-01

    Epithelioid trophoblastic tumor (ETT) is a very rare variant of gestational trophoblastic disease (GTD) which arises in reproductive age women with prior gestational history. Although abnormal vaginal bleeding is the most common symptom of ETT, there are no reported pathognomonic symptoms of ETT because of its rarity. ETT is similar to placental site trophoblastic tumor in terms of its slow growing characteristic and microscopic findings. Therefore, it could be misdiagnosed as placental site trophoblastic tumor or other types of GTD. Unlike other types of GTD, primary treatment of ETT is surgical resection because of its chemo-resistant nature. Accordingly, immunohistochemical staining is essential for accurate diagnosis and appropriate treatment. Here, we report a case of a 42-year-old hysterectomized woman with pelvic masses who suffered from abdominal pain. Through laparotomy, tumors were resected completely and they were diagnosed as ETT through immunohistochemical stain. This report provides more evidence about its clinical features, diagnosis, and treatment including a brief review of the literature. PMID:28217684

  10. The insecure airway: a comparison of knots and commercial devices for securing endotracheal tubes.

    PubMed

    Lovett, Paris B; Flaxman, Alexander; Stürmann, Kai M; Bijur, Polly

    2006-05-24

    Endotracheal Tubes (ETTs) are commonly secured using adhesive tape, cloth tape, or commercial devices. The objectives of the study were (1) To compare degrees of movement of ETTs secured with 6 different commercial devices and (2) To compare movement of ETTs secured with cloth tape tied with 3 different knots (hitches). A 17 cm diameter PVC tube with 14 mm "mouth" hole in the side served as a mannequin. ETTs were subjected to repeated jerks, using a cable and pulley system. (1) Total movement of ETTs relative to "mouth" (measure used for devices) (2) Slippage of ETT through securing knot (measure used for knots). Among commercial devices, the Dale showed less movement than other devices, although some differences between devices did not reach significance. Among knots, Magnus and Clove Hitches produced less slippage than the Cow Hitch, but these differences did not reach statistical significance. Among devices tested, the Dale was most secure. Within the scope offered by the small sample sizes, there were no statistically significant differences between the knots in this study.

  11. Fructose-enhanced reduction of bacterial growth on nanorough surfaces.

    PubMed

    Durmus, Naside Gozde; Taylor, Erik N; Inci, Fatih; Kummer, Kim M; Tarquinio, Keiko M; Webster, Thomas J

    2012-01-01

    Patients on mechanical ventilators for extended periods of time often face the risk of developing ventilator-associated pneumonia. During the ventilation process, patients incapable of breathing are intubated with polyvinyl chloride (PVC) endotracheal tubes (ETTs). PVC ETTs provide surfaces where bacteria can attach and proliferate from the contaminated oropharyngeal space to the sterile bronchoalveolar area. To overcome this problem, ETTs can be coated with antimicrobial agents. However, such coatings may easily delaminate during use. Recently, it has been shown that changes in material topography at the nanometer level can provide antibacterial properties. In addition, some metabolites, such as fructose, have been found to increase the efficiency of antibiotics used to treat Staphylococcus aureus (S. aureus) infections. In this study, we combined the antibacterial effect of nanorough ETT topographies with sugar metabolites to decrease bacterial growth and biofilm formation on ETTs. We present for the first time that the presence of fructose on the nanorough surfaces decreases the number of planktonic S. aureus bacteria in the solution and biofilm formation on the surface after 24 hours. We thus envision that this method has the potential to impact the future of surface engineering of biomaterials leading to more successful clinical outcomes in terms of longer ETT lifetimes, minimized infections, and decreased antibiotic usage; all of which can decrease the presence of antibiotic resistant bacteria in the clinical setting.

  12. Comparison of 2 techniques of laryngeal tube exchange in a randomized controlled simulation study.

    PubMed

    Budde, Arne O; Schwarz, Adam; Dalal, Priti G; Sinz, Elizabeth H; Vaida, Sonia J

    2015-02-01

    Laryngeal tubes (LT) are often used as rescue airway devices. Among prehospital medical personnel, the success rates are high and significantly faster compared to an endotracheal tube (ETT). Therefore, LTs are increasingly used in the prehospital setting. The exchange of an LT for an ETT may often be desirable. Two fiberoptic bronchoscope-facilitated techniques have been described to exchange an LT for an ETT: an intraluminal technique using an Aintree intubating catheter and an extraluminal technique using a nasal route alongside the LT. In this randomized cross-over mannequin study, we compared the intraluminal with the extraluminal exchange technique. The primary outcome was time to achieve an effective airway through an ETT. We hypothesized that the intraluminal technique would be significantly faster. Thirty anesthesia providers were recruited to the study. Each participant attempted both techniques in an intubation simulation model. The tube exchange time was recorded from picking up the fiberoptic bronchoscope until confirmation of ventilation with the ETT. Four participants in each group had a failed attempt at intubation. Time to establish an endotracheal intubation was significantly shorter with the intraluminal technique vs the extraluminal technique (77.5 vs 140 seconds; P=.03). Based on the results of our study, we suggest that the intraluminal technique may be a suitable alternative for a fiberoptic-guided rapid exchange of an LT for an ETT to establish an effective airway in a challenging situation. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Comparison of endoscopic transcanal myringoplasty and endoscopic type I tympanoplasty in repairing medium-sized tympanic perforations.

    PubMed

    Tseng, Chih-Chieh; Lai, Ming-Tang; Wu, Chia-Che; Yuan, Sheng-Po; Ding, Yi-Fang

    2017-12-01

    The tympanomeatal flap elevation technique has been used in tympanoplasty for decades; however, this procedure has disadvantages. In recent years, endoscopic transcanal myringoplasty (ETM) has been increasingly practiced and has yielded positive results.This study compares the efficacy of ETM and endoscopic type I tympanoplasty (ETT) in repairing medium-sized perforations of the tympanic membrane. This retrospective medical record review included patients undergoing surgery for medium-sized perforations of the tympanic membrane from January 1, 2013 to August 1, 2015. We divided our patients into 2 groups: the ETM group and ETT group. The main outcome measure was comparison of the graft take rates and hearing results between ETM and ETT. A total of 113 patients were enrolled in this study; of these patients, 64 underwent ETM and 49 received ETT. The overall graft take rates and improvement of air-bone gaps were comparable between the groups. However, the patients in the ETM group had shorter operative times and fewer follow-up visits over 3 months than those in the ETT group did. We recommend that ETM (instead of ETT) be used for repairing medium-sized perforations of the tympanic membrane. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Agreement between lower esophageal and nasopharyngeal temperatures in children ventilated with an endotracheal tube with leak.

    PubMed

    Snoek, Aarjan P; Saffer, Emily

    2016-02-01

    A temperature probe placed in the lower third of the esophagus accurately reflects core temperature in anesthetized children. Temperature probes are commonly placed in the nasopharynx in children, but when utilizing an uncuffed endotracheal tube (ETT) with a softly audible leak, ventilated gases from the trachea can escape upwards toward the nasopharynx, thereby potentially causing a cooling effect in the nasopharynx. We sought to establish if nasopharyngeal and lower esophageal temperatures are in agreement in children undergoing general anesthesia, both in scenarios of ventilation with a cuffed ETT that has minimal or no leak (cuff up), as well as an ETT with leak (cuff down). A prospective, crossover agreement study was performed on anesthetized children. Children were intubated with a MicroCuff(®) ETT and had temperature probes inserted into both the nasopharynx and lower esophagus. Under standardized ventilator and gas flow settings, temperatures were recorded with the ETT cuff inflated, and with the cuff deflated. Bland-Altman plots were utilized to assess agreement of temperatures. Fifty patients successfully completed this study. The mean difference between esophageal and nasopharyngeal temperature was found to be -0.03°C in the presence of minimal or no leak around the ETT (cuff up), with 95% limits of agreement (LOA) of -0.22 to 0.15°C. The mean difference between esophageal and nasopharyngeal temperature was found to be 0.1°C when a larger leak existed around the ETT (cuff down), with LOA of -0.31 to 0.51°C. Nasopharyngeal temperature accurately reflects lower esophageal temperature when there is minimal or no ETT leak. When a larger ETT leak is present, nasopharyngeal temperature is on average 0.1°C cooler than lower esophageal temperature. As the nasopharyngeal temperature probe site confers the advantage of simplicity of accurate placement compared to its esophageal counterpart, our findings support the use of nasopharyngeal temperature probes

  15. Effect of cuffed and uncuffed endotracheal tubes on the oropharyngeal oxygen and volatile anesthetic agent concentration in children.

    PubMed

    Raman, Vidya; Tobias, Joseph D; Bryant, Jason; Rice, Julie; Jatana, Kris; Merz, Meredith; Elmaraghy, Charles; Kang, D Richard

    2012-06-01

    Over the past 5 years, there has been a change in the clinical practice of pediatric anesthesiology with a transition to the use of cuffed instead of uncuffed endotracheal tubes (ETTs) in infants and children. As the trachea is sealed, one advantage is to eliminate the contamination of the oropharynx with oxygen which should be advantageous during adenotonsillectomy where there is a risk of airway fire. The current study prospectively assesses the oropharyngeal oxygen and volatile anesthetic agent concentration during adenotonsillectomy in infants and children. Following the induction of general anesthesia in patients scheduled for adenoidectomy, tonsillectomy or adenotonsillectomy, the trachea was intubated. The use of a cuffed or uncuffed ETT and the use of spontaneous (SV) or positive pressure ventilation (PPV) were at the discretion of the anesthesia team. The oxygen concentration was kept at 100% oxygen until the study was completed. Following placement of the mouth gag, the otolaryngolist placed into the oropharynx a small bore catheter, which was attached to a standard anesthesia gas monitoring device which sampled the gas at 150mL/min. The concentration of the oxygen and the concentration of the anesthetic agent in the oropharynx were measured for 5 breaths. The cohort for the study included 200 patients ranging in age from 1 to 18 years. With the use of a cuffed ETT and either SV or PPV, the oxygen concentration in the oropharynx was 20-21% and the volatile agent concentration was 0% in all 118 patients. With the use of an uncuffed ETT and the administration of 100% oxygen, there was significant contamination of the oropharynx noted during both PPV and SV. The mean oxygen concentration was 71% during PPV with an uncuffed ETT and 65% during SV with an uncuffed ETT. In these patients, the oropharyngeal oxygenation concentration exceeded 30% in 73 of the 82 patients (89%). The oropharyngeal oxygen and agent concentration was greater when the leak around the

  16. The pressure drop across the endotracheal tube in mechanically ventilated pediatric patients.

    PubMed

    Spaeth, Johannes; Steinmann, Daniel; Kaltofen, Heike; Guttmann, Josef; Schumann, Stefan

    2015-04-01

    During mechanical ventilation, the airway pressure (Paw) is usually monitored. However, Paw comprises the endotracheal tube (ETT)-related pressure drop (∆PETT ) and thus does not reflect the pressure in the patients' lungs. Therefore, monitoring of mechanical ventilation should be based on the tracheal pressure (Ptrach ). We systematically investigated potential factors influencing ∆PETT in pediatric ETTs. In this study, the flow-dependent pressure drop across pediatric ETTs from four manufacturers [2.0-4.5 mm inner diameter (ID)] was estimated in a physical model of the upper airways. Additionally, ∆PETT was examined with the ETTs shortened to 75% of their original length and at different curvatures. In nine healthy mechanically ventilated children (aged between 9 days and 29 months), Ptrach was compared to Paw . ∆PETT was nonlinearly flow dependent. Low IDs corresponded to high ∆PETT . Differences between ETTs from different manufacturers were identified. Shortening of the ETTs' length by 25% reduced ∆PETT on average by 14% of the value at original length. Ventilation frequency and tube curvature did not influence ∆PETT to a relevant extent. In the pediatric patients, the root mean square deviation between Paw and Ptrach was 2.3 cm H2O. Paw and Ptrach differ considerably (by ∆PETT ) during mechanical ventilation of pediatric patients. The ETTs' ID, tube length, and manufacturer type are significant factors for ∆PETT and should be taken into account when Paw is valuated. For this purpose, Ptrach can be continuously calculated with good precision by means of the Rohrer approximation. © 2014 John Wiley & Sons Ltd.

  17. Ultrasonographic Measurement of Subglottic Diameter for Paediatric Cuffed Endotracheal Tube Size Selection: Feasibility Report

    PubMed Central

    Altun, Demet; Sungur, Mukadder Orhan; Ali, Achmet; Bingül, Emre Sertaç; Seyhan, Tülay Özkan; Çamcı, Emre

    2016-01-01

    Objective The aim of this feasibility study was to investigate the first attempt success of ultrasonography (USG) in paediatric patients in predicting an appropriate cuffed endotracheal tube (ETT) size. Methods Fifty children who were 1–10 years of age and who received general anaesthesia with endotracheal intubation for adenoidectomy or adenotonsillectomy were enrolled in the study. In all participants, the transverse diameter of the subglottic airway was measured with USG at the cricoid level without ventilation. The outer diameter (OD) of the maximum allowable ETT was chosen according to the measured subglottic airway diameter. In the presence of resistance to passage of the tube into the trachea or in the absence of an audible leak at airway pressure of >25 cm H2O, the ETT was replaced with a tube whose internal diameter (ID) was 0.5 mm smaller. If a leak was audible at airway pressures of <10 cm H2O, if a seal could not be achieved with a cuff pressure of >25 cm H2O or if a peak airway pressure of >25 cm H2O was observed during ventilation, the tube was changed to a tube one size larger. The OD of the best-fit ETT was converted to the ID. The best-fit ID, the requirement for ETT replacement, the duration of airway diameter measurement by USG and the peak airway pressure were recorded. Results The success rate of the first attempt with USG was 86%; the ETT was replaced in five patients with a tube one size larger and in two patients with a tube one size smaller. Conclusion Our findings show the subglottic diameter measured by USG to be a reliable predictor in estimating the appropriate paediatric ETT size. PMID:28058141

  18. Radiological evaluation of tube depth and complications of prehospital endotracheal intubation in pediatric trauma: a descriptive study.

    PubMed

    Simons, T; Söderlund, T; Handolin, L

    2017-01-27

    Pediatric prehospital endotracheal intubation (PHETI) is a difficult and rarely performed procedure that remains the gold standard for prehospital airway management when ventilation and/or anesthesia is required, but high complications rates, including malposition continue to concern. We reviewed the experience in our institution of pediatric intubations with particular emphasis on the position of the endotracheal tube (ETT) tip within the trachea and related complications. Intubated pediatric patients presenting directly from the scene to our level 1 trauma center, between 2006 and 2014, were included in our study. Patient records and radiographs were retrospectively reviewed to identify the ETT tip-to-carina distance and possible intubation-related complications. ETT tips identified beyond the carina on radiographs or by clinical diagnosis were defined as misplaced. Because head movement causes a significant ETT movement within the trachea, which is age related, we also defined ETT tip placement (1) less than 2 cm above the carina in children younger than 8 and (2) less than 3 cm above the carina in children 8 years or older as "near miss" intubations. From a total of 34 cases, ETT misplacement was identified in seven cases. Diagnosis was made radiologically in five cases and clinically in two cases. Four of these patients had left lung atelectasis due to tube misplacement. Tube thoracotomy was performed in two of these patients without concurrent evidence of chest injury. "Near miss" intubations accounted for 7/9 and 9/25 in children <8 years and ≥8 years old, respectively, totaling 16/34, with two of these leading to late displacements. Pediatric endotracheal tube intubation carries a high rate of tube malposition and left lung atelectasis in our experience of pediatric trauma patients, with less than a third of ETTs placed in a safe position.

  19. Airway management with endotracheal tube versus Combitube during parabolic flights.

    PubMed

    Rabitsch, Werner; Moser, Doris; Inzunza, Michelle R; Niedermayr, Monika; Köstler, Wolfgang J; Staudinger, Thomas; Locker, Gottfried J; Schellongowski, Peter; Wulkersdorfer, Beatrix; Rich, James M; Meyer, Brigitte; Benumof, Jonathan L; Frass, Michael

    2006-10-01

    Training of National Aeronautics and Space Administration space shuttle astronauts revealed difficult airway management with endotracheal tubes (ETTs) under microgravity conditions. The authors performed a randomized comparative study of ETT and Combitube (ETC; Tyco Healthcare, Pleasanton, CA). The aim of the study was to evaluate ease, time of insertion, and success rates during normogravity and parabolic flights using mannequins. After normogravity experiments, four flyers performed intubation on a mannequin during the flights. Sixty-two intubation attempts were performed using the ETC (normogravity, 29; microgravity, 33), and 58 intubation attempts were performed using the ETT (each 29 attempts, both conditions). Time to completion of the intubation procedure, success rate, and ease of insertion were recorded. The ETC performed equally well between normogravity (median, 18 s; range, 17-25 s) and microgravity (median, 18.5 s; range, 17-28 s), whereas the ETT performed significantly slower under microgravity (median, 20 s; range, 17-27 s) as compared with normogravity (median, 18 s; range, 16-22 s; P = 0.019). One hundred nine of 120 (90%) were successful. The ETT and ETC were comparable with respect to successful intubations, under normogravity or microgravity, respectively. Both the ETC and ETT perform comparably well. Slight differences could be found with respect to time of insertion in favor of the ETC. Because this is the first experiment using the ETC on the KC-135, it is shown that there is enough time to perform the insertion procedure. Because the ETC airway requires less training and is easier to insert than an ETT, it is recommended for further study as an alternative airway to what is currently on the shuttle.

  20. I-gel as an alternative to endotracheal tube in adult laparoscopic surgeries: A comparative study

    PubMed Central

    Badheka, Jigisha Prahladrai; Jadliwala, Rashida Mohammedi; Chhaya, Vrajeshchandra Amrishbhi; Parmar, Vandana Surendrabhai; Vasani, Amit; Rajyaguru, Ajay Maganlal

    2015-01-01

    BACKGROUND: The tracheal tube is always considered to be the gold standard for laparoscopic surgeries. As conventional laryngoscopy guided endotracheal intubation evokes significant hypertension and tachycardia, we have used I-gel, second generation extraglottic airway device, in an attempt to overcome these drawbacks. We conducted this study to compare haemodynamic changes during insertion, efficacy of ventilation, and complications with the use of I-gel when compared with endotracheal tube (ETT) in laparoscopic surgeries. MATERIALS AND METHODS: A total of 60 American Society of Anaesthesiologists physical status I and II adult patients undergoing elective laparoscopic surgeries were randomly allocated to one of the two groups of 30 patients each: Group-A (I-gel) in which patients airway was secured with appropriate sized I-gel, and Group-B (ETT) in which patients airway was secured with laryngoscopy - guided endotracheal intubation. Ease, attempts and time for insertion of airway device, haemodynamic and ventilatory parameters at different time intervals, and attempts for gastric tube insertion, and perioperative complications were recorded. RESULTS: There was significant rise in pulse rate and mean blood pressure during insertion with use of ETT when compared to I-gel. Furthermore, time required for I-gel insertion was significantly less when compared with ETT. However ease and attempts for airway device insertion, attempts for gastric tube insertion and efficacy of ventilation were comparable between two groups. CONCLUSION: We concluded that I-gel requires less time for insertion with minimal haemodynamic changes when compared to ETT. I-gel also provides adequate positive-pressure ventilation, comparable with ETT. Hence I-gel can be a safe and suitable alternative to ETT for laparoscopic surgeries. PMID:26622115

  1. Significance of a clean-tip catheter closed suctioning system in a high-setting ventilated, super morbidly obese patient with profuse respiratory secretions.

    PubMed

    Mazlan, Mohd Zulfakar; Mohd Zaini, Rhendra Hardy; Hassan, Shamsul Kamalrujan; Ali, Saedah; Che Omar, Sanihah; Wan Hassan, Wan Mohd Nazaruddin

    2017-01-01

    Closed suctioning is commonly used in the context of high-setting mechanical ventilation (MV), given its ability to prevent lung volume loss that otherwise accompanies open suctioning. However, closed suctioning systems (CSS) are not equivalent regarding components and capabilities, and thus this technique may be differentially effective to adequately clear patient secretions from an endotracheal tube (ETT), which is of paramount importance when the tube size makes the ETT particularly vulnerable to block by patient secretions. A 25-year-old super morbidly obese female (body mass index = 55 kg/meter(2)) presented with worsening shortness of breath. For MV, pairing of a 6 mm (mm) diameter ETT to accommodate the patient's vocal cord edema, with a CSS not designed to maintain a clean catheter tip, precipitated ETT blockage and respiratory acidosis. Replacement of these devices with a 6.5 mm ETT and a CSS designed to keep the catheter tip clean resolved the complications. After use of the different ETT and CSS for approximately one week, the patient was discharged to home. The clean-tip catheter CSS enabled a more patent airway than its counterpart device that did not have this feature. Use of a clean-tip catheter CSS was an important care development for this patient, because this individual's super morbidly obese condition minimized tolerance for MV complications that would exacerbate her pre-existing tenuous respiratory health status. Special attention should be given to the choices of ETT size and CSS to manage super morbidly obese patients who have a history of difficult airway access.

  2. Tactile sensitivity of vital and endodontically treated teeth.

    PubMed

    Schneider, Birte-Juliane; Freitag-Wolf, Sandra; Kern, Matthias

    2014-11-01

    Endodontically treated teeth (ETT) used as abutments for removable partial dental prostheses (RPDPs) have an increased fracture risk as compared to vital abutments. One suggested explanation is that ETT exhibit a lower threshold level for tactile sensitivity than vital teeth. Therefore, this study compared the threshold for tactile sensitivity of vital teeth and ETT in the same individuals. Forty participants with double crown-retained RPDPs fixed to vital teeth and ETT were included in the study. Each subject had at least one vital and one corresponding contralateral endodontically treated abutment tooth in the same jaw. After removal of the RPDP, an increasing centric force (0cN to max. 2000cN) was separately applied axially to both free-standing abutment teeth using a force gauge while the patient was asked to give three acoustic signals: (1) when noticing the first contact, (2) when noticing pressure and (3) when the pressure became displeasing. Afterwards, the same trial was performed with an eccentric force applied parallel to the tooth axis. Statistical analysis revealed no significant differences in the threshold of tactile sensitivity of vital teeth and ETT to either centric or eccentric loading (p>0.05). Eccentric loading showed lower mean threshold values compared to centric loading. A large variability of tactile sensitivity between individuals was noted. However, there were no gender-related significant differences in tactile sensitivity (p>0.05). The tactile sensitivity of vital and non-vital teeth seems comparable. The assumption that a lower threshold level for tactile sensitivity in ETT than in vital teeth is responsible for their increased fracture risk could not be confirmed. Therefore, other reasons, e.g. loss of hard tissue due to root canal treatment, have to be considered responsible for the increased fracture risk of ETT. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. Comparison of clinical efficacy and cost of a cardiac imaging strategy versus a traditional exercise test strategy for the investigation of patients with suspected stable coronary artery disease.

    PubMed

    Demir, Ozan M; Bashir, Abdullah; Marshall, Kathy; Douglas, Martina; Wasan, Balvinder; Plein, Sven; Alfakih, Khaled

    2015-06-15

    We evaluated the clinical efficacy and cost of a cardiac imaging strategy versus a traditional exercise tolerance test (ETT) strategy for the investigation of suspected stable coronary artery disease (CAD). We retrospectively collected data of consecutive patients seen in rapid access chest pain clinics at 2 UK hospitals for a period of 12 months. Hospital A investigated patients by performing ETT. Hospital B investigated patients using cardiac imaging test; 483 patients from hospital A and 295 from hospital B were included. In hospital A, 209 patients (43.3%) had contraindication to ETT. Of those who had ETT, 151 (55.1%) had negative ETT, 68 (24.8%) had equivocal ETT, and 55 (20.1%) had positive ETT, of which 53 (96.4%) had invasive coronary angiography (ICA), and of these 23 (43.4%) had obstructive CAD. In hospital B, 26 patients (8.8%) with low pretest probability had calcium score and 3 (11.5%) were positive leading to computed tomography coronary angiography; 98 patients (33.2%) with intermediate pretest probability had computed tomography coronary angiography and 5 (5.1%) were positive; 77 patients (26.1%) had stress echocardiogram and 6 (7.8%) were positive; and 57 patients (19.3%) had myocardial perfusion scintigraphy and 11 (19.3%) were positive. Hospital A performed 127 ICA (26.3% of population) and 52 (40.9%) had obstructive CAD. Hospital B performed 63 ICA (21.4% of population) and 32 (50.8%) had obstructive CAD. The average cost per patient in hospital A was £566.6 ± 490.0 ($875 ± 758) and in hospital B was £487.9 ± 469.6 ($750 ± 725) (p <0.001). In conclusion, our results suggest that a cardiac imaging pathway leads to fewer ICA and a higher yield of obstructive CAD at lower cost per patient. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. How much force is required to dislodge an alternate airway?

    PubMed

    Carlson, Jestin N; Mayrose, James; Wang, Henry E

    2010-01-01

    Endotracheal tube (ETT) dislodgment is a potentially catastrophic adverse event. Newer alternate airway devices-esophageal-tracheal Combitube (ETC), King laryngeal tube disposable airway (King LT), and laryngeal mask airway (LMA)-are easier to insert, but their relative extubating forces remain unknown. To examine the applied forces required to dislodge an ETC, King LT, LMA, and ETT. We used five recently deceased adult unembalmed cadavers. In random order, we sequentially inserted an ETC, King LT, LMA, and standard ETT. Because commercial tube holders are not designed for all alternate airways, we secured the devices with a standard adhesive tape method. Using a precision digital force measuring device, we measured the minimum manually applied axial force (lb) that dislodged each airway device at least 4 cm. We compared required dislodgment forces between airway devices using a mixed-effects regression model, adjusting for cadaver height, weight, neck circumference, and thyromental distance. Characteristics of the cadavers were as follows (median, interquartile range [IQR]): height 172 cm (167-177), weight 98 kg (84-120), neck circumference 46.5 cm (41-52), and thyromental distance 7.5 cm (7.5-8). Required axial dislodgment forces for each airway device were as follows (median, IQR): ETC 28.3 lb (19.0-28.6), King LT 12.5 lb (11.7-13.3), LMA 18.3 lb (14.0-21.9), and ETT 14.4 lb (13.5-22.1). The ETC required twice as much dislodgment force as the ETT (adjusted difference 16.7 lb, 95% confidence interval [CI]: 8.3 to 25.1). The King LT and LMA dislodgment forces were similar to that of the ETT (King LT vs. ETT adjusted difference 5.9 lb, 95% CI: -2.4 to 14.2; LMA vs. ETT 8.1 lb, 95% CI: -0.2 to 16.5). In a cadaver model of unintended airway dislodgment, the ETC required the most force for dislodgment. The King LT and LMA performed similarly to a standard ETT.

  5. Adult intensive care patients' perception of endotracheal tube-related discomforts: a prospective evaluation.

    PubMed

    Samuelson, Karin A M

    2011-01-01

    This study was designed to investigate adult patients' perceptions of endotracheal tube (ETT)-related discomfort at 5 days and 2 months after discharge from the intensive care unit (ICU). This prospective cohort study in 2 general ICUs included 250 intubated, mechanically ventilated adults admitted for more than 24 hours. Patients were interviewed 5 days and 2 months after discharge from the ICU about their ETT-related discomfort, using a modified Swedish ETT version of the ICU Stressful Experience Questionnaire that comprises 14 items. Of 116 patients describing their ETT experience during their ICU stay, 88% rated their discomfort as moderately to extremely stressful. At 2 months after discharge from the ICU, 23% (51/226) reported bothersome discomfort, vs. 46% (104/226) 5 days after discharge from the ICU, and 10 patients suffered from severe, persistent hoarseness. The incidence of bothersome subjective complaints after tracheal intubation in the intensive-care setting is high, and severe ETT-related problems may persist several months after extubation. Copyright © 2011 Elsevier Inc. All rights reserved.

  6. A multifaceted quality improvement program improves endotracheal tube confirmation documentation in the emergency department.

    PubMed

    Phelan, Michael P; Hustey, Fredric M; Glauser, Jonathan M; Bena, James

    2015-01-01

    Confirmation of endotracheal tube (ETT) position is an essential part of emergency department (ED) airway care. The study team evaluated the effect of a multifaceted quality improvement initiative on improving confirmation documentation rates. Rates of documentation of appropriate methods of ETT position confirmation were better for patients undergoing ETT placement in the study site ED than for those arriving already intubated (103/127 [81.1%] vs 19/71 [26.8%]; relative risk [RR] = 3.03; 95% confidence interval [CI] = 2.04 to 4.49). Overall rates of documentation of appropriate methods of ETT position confirmation were higher after the intervention (557/758 [73.5%] vs 122/198 [61.6%]; RR = 1.19; 95% CI = 1.06 to 1.34), with a greater increase among the group presenting to the ED with an ETT already placed (116/259 [44.8%] vs 19/71 [26.8%]; RR = 1.67; 95% CI = 1.11 to 2.51) compared with those intubated in the study site ED (103/127 [81.1%] vs 441/499 [88.4%]; RR = 0.92; 95% CI = 0.8389 to 1.0039).

  7. Community analysis of dental plaque and endotracheal tube biofilms from mechanically ventilated patients.

    PubMed

    Marino, Poala J; Wise, Matt P; Smith, Ann; Marchesi, Julian R; Riggio, Marcello P; Lewis, Michael A O; Williams, David W

    2017-06-01

    Mechanically ventilated patients are at risk for developing ventilator-associated pneumonia, and it has been reported that dental plaque provides a reservoir of respiratory pathogens that may aspirate to the lungs and endotracheal tube (ETT) biofilms. For the first time, metataxonomics was used to simultaneously characterize the microbiome of dental plaque, ETTs, and non-directed bronchial lavages (NBLs) in mechanically ventilated patients to determine similarities in respective microbial communities and therefore likely associations. Bacterial 16S rRNA gene sequences from 34 samples of dental plaque, NBLs, and ETTs from 12 adult mechanically ventilated patients were analyzed. No significant differences in the microbial communities of these samples were evident. Detected bacteria were primarily oral species (e.g., Fusobacterium nucleatum, Streptococcus salivarius, Prevotella melaninogenica) with respiratory pathogens (Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcuspneumoniae, and Haemophilus influenzae) also in high abundance. The high similarity between the microbiomes of dental plaque, NBLs, and ETTs suggests that the oral cavity is indeed an important site involved in microbial aspiration to the lower airway and ETT. As such, maintenance of good oral hygiene is likely to be highly important in limiting aspiration of bacteria in this vulnerable patient group. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. False-positive colorimetric capnometry after ingestion of carbonated beverages.

    PubMed

    Keller, William Ryan; Biehler, Jefrey; Linares, Marc Yves-Rene; Garcia-Pena, Barbara M

    2009-02-01

    To investigate the potential for false-positive colorimetric capnometric readings during esophageal intubation after ingestion of carbonated beverages. The study was conducted in the human patient simulation laboratory of a tertiary care pediatric hospital. The sole outcome measurement was the capnometric indicator membrane color after expiration for 10 breaths. Readings were recorded for scenarios simulating 8 different models. For all carbonated beverage trials with a cuffed endotracheal tube (ETT) and those with 2 and 6 oz of beverage in the gastric sac with an uncuffed ETT, a false-positive result was observed on the capnometer's indicator for breaths 1 through 10. The sensitivity of the capnometer for the detection of CO2 after full exhalation of breath 6 for these trials was 100%. For trials containing 12 oz in the gastric sac and an uncuffed ETT, yellow was observed on the capnometer indicator for breaths 1 through 3, tan for breaths 4 through 6, and purple for breath 7. The sensitivity of the capnometer for the detection of adequate CO2 after full exhalation of breath 6 for these trials was 0%. The overall sensitivity of the capnometer for the carbonated beverage models with a cuffed ETT was 100%, whereas the combined sensitivity for the trials with an uncuffed ETT was 67%. Under proper circumstances, a significant potential exists for false-positive colorimetric capnometric results in the presence of even small amounts of carbonated beverages.

  9. Placental site trophoblastic tumors and epithelioid trophoblastic tumors: Biology, natural history, and treatment modalities.

    PubMed

    Horowitz, Neil S; Goldstein, Donald P; Berkowitz, Ross S

    2017-01-01

    Placental site (PSTT) and epithelioid trophoblastic tumor (ETT) are rare types of gestational trophoblastic neoplasia (GTN) that arise from intermediate trophoblast. Given that this cell of origin is different from other forms of GTN, it is not surprising that the clinical presentation, tumor marker profile, and treatment paradigm for PSTT and ETT are quite different as well. The mainstay for therapy for stage I PSTT and ETT is hysterectomy with adjuvant chemotherapy reserved for those presenting greater than four years from the antecedent pregnancy. Surgery is also important for metastatic disease. There is no standardized chemotherapy regimen for advanced stage disease but often consists of a platinum-containing combination therapy, usually EMA-EP or TE/TP. Despite its rarity, PSTT and ETT account for a disproportionate percentage of mortality from GTN likely resulting from their relative chemotherapy resistance. Novel therapeutic modalities therefore are needed to improve the outcomes of women with advanced stage or resistant PSTT and ETT. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Lung recruitment and endotracheal suction in ventilated preterm infants measured with electrical impedance tomography.

    PubMed

    Hough, Judith L; Shearman, Andrew D; Liley, Helen; Grant, Caroline A; Schibler, Andreas

    2014-11-01

    Although suctioning is a standard airway maintenance procedure, there are significant associated risks, such as loss of lung volume due to high negative suction pressures. This study aims to assess the extent and duration of change in end-expiratory level (EEL) resulting from endotracheal tube (ETT) suction and to examine the relationship between EEL and regional lung ventilation in ventilated preterm infants with respiratory distress syndrome. A prospective observational clinical study of the effect of ETT suction on 20 non-muscle-relaxed preterm infants with respiratory distress syndrome (RDS) on conventional mechanical ventilation was conducted in a neonatal intensive care unit. Ventilation distribution was measured with regional impedance amplitudes and EEL using electrical impedance tomography. ETT suction resulted in a significant increase in EEL post-suction (P < 0.01). Regionally, anterior EEL decreased and posterior EEL increased post-suction, suggesting heterogeneity. Tidal volume was significantly lower in volume-guarantee ventilation compared with pressure-controlled ventilation (P = 0.04). ETT suction in non-muscle-relaxed and ventilated preterm infants with RDS results in significant lung volume increase that is maintained for at least 90 min. Regional differences in distribution of ventilation with ETT suction suggest that the behaviour of the lung is heterogeneous in nature. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  11. Clinical indicators for the initiation of endotracheal suction in children: An integrative review.

    PubMed

    Davies, K; Monterosso, L; Bulsara, M; Ramelet, A S

    2015-02-01

    Critical decisions and interpretation of observations by the nurse caring for the paediatric intensive care (PIC) patient can have dramatic and potential adverse impact on the clinical stability of the patient. A common PIC procedure is endotracheal tube (ETT) suction, however there is inconsistent evidence regarding the clinical indicators to guide and support nursing action. Justification for performing this procedure is not clearly defined within the literature. Further, a review of the literature has failed to establish clear standards for determining if the procedure is warranted, especially for paediatric patients. The objective of the review is to identify current clinical indicators used in practice to determine why ETT suction should be performed. An integrative review using a systematic approach to summarise the empirical and theoretical evidence within the literature as it relates to clinical practice was used. Consensus of opinion indicates that ETT suctioning should only be performed when clinically indicated. There is no general consensus regarding which clinical indicators should be measured and used to guide the decision to perform ETT suctioning. Research is required to identify the clinical indicators that could be used to design a valid and clinically appropriate tool to use to assist in the decision making process to perform ETT suction. Copyright © 2014. Published by Elsevier Ltd.

  12. Ventilator-associated pneumonia or endotracheal tube-associated pneumonia? An approach to the pathogenesis and preventive strategies emphasizing the importance of endotracheal tube.

    PubMed

    Pneumatikos, Ioannis A; Dragoumanis, Christos K; Bouros, Demosthenes E

    2009-03-01

    Ventilator-associated pneumonia is the most common nosocomial infection in the intensive care unit, and it is associated with prolonged hospitalization, increased health care costs, and high attributable mortality. During the past several decades, numerous studies focused on the crucial role of the endotracheal tube (ETT) in the pathogenesis of ventilator-associated pneumonia. Tracheal intubation thwarts the cough reflex, compromises mucocilliary clearance, injures the tracheal epithelial surface, provides a direct conduit for rapid access of bacteria from upper into the lower respiratory tract, and allows the formation of biofilm on the ETT surface. The combination of these factors puts the mechanically ventilated patient at great jeopardy of developing ventilator-associated pneumonia. Many preventive strategies have arisen from this understanding: control of intracuff pressure, aspiration of subglottic secretions, decontamination of subglottic area, use of antiseptic impregnated ETTs, and elimination or prevention of the ETT biofilm formation. The authors review the role of ETT management for the prevention of the ventilator-associated pneumonia.

  13. Bactericidal effects of silver plus titanium dioxide-coated endotracheal tubes on Pseudomonas aeruginosa and Staphylococcus aureus.

    PubMed

    Tarquinio, Keiko M; Kothurkar, Nikhil K; Goswami, Dharendra Y; Sanders, Ronald C; Zaritsky, Arno L; LeVine, Ann Marie

    2010-04-07

    Ventilator-associated pneumonia (VAP) is a nosocomial infection resulting in significant morbidity and mortality. Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus) are pathogens associated with VAP. Silver (Ag) coating of endotracheal tubes (ETTs) reduces bacterial colonization, however titanium dioxide (TiO(2)) coating has not been studied. Five types of ETT coatings were applied over silica layer: Ag, solgel TiO(2), solgel TiO(2) with Ag, Degussa P25 TiO(2) (Degussa TiO(2)), and Degussa TiO(2) with Ag. After ETTs were incubated with P. aeruginosa or S. aureus; colonization was determined quantitatively. Pseudomonas aeruginosa and S. aureus grew for 5 days on standard ETTs. Compared to standard ETTs, P. aeruginosa growth was significantly inhibited by solgel TiO(2) with Ag at 24 hours, and by Degussa TiO(2) with Ag at 24 and 48 hours after inoculation. No significant difference in S. aureus growth was observed between the control and any of the five coatings for 5 days. In vitro, solgel TiO(2) with Ag and Degussa TiO(2) with Ag both attenuated P. aeruginosa growth, but demonstrated no effect on S. aureus colonization. Further studies using alternative coating and incorporating UV light exposure are needed to identify their potential utility in reducing VAP.

  14. Intraoperative atelectasis due to endotracheal tube cuff herniation: a case report.

    PubMed

    Moazeni Bitgani, Mohammad; Madineh, Hossein

    2012-01-01

    Endotracheal tube (ETT) cuff herniation is a rare, and often difficult to diagnose, cause of bronchial obstruction. We present a case of outside cuff herniation of an endotracheal tube that caused pulmonary right lung atelectasis. A 29-year-old man ,a case of car accident with multiple fractures, was admitted to the emergency ward and transferred to the operating room(OR) for open reduction and internal fixation (ORIF) of all fractures .The procedures were done under general anesthesia (G/A). The past medical history of the patient did not indicate any problem. Anesthesia was induced with thiopental, atracurium and then maintained by propofol and remifentanyl infusions and 100% O2 via orally inserted ETT. The patient was positioned in left lateral decubitus position for operation. Two hours after induction of anesthesia, the oxygen saturation level dropped to 85 % and the breath sounds in the right side of the chest were weakened. The chest x-ray images showed right lung atelectasis especially in the upper lobe. The problem was disappeared after removal of the ETT. In this case, we observed that an ETT cuff herniation can be a cause of airway obstruction. If there is a decreased unilateral breath sounds, we recommend replacement or repositioning of ETT.

  15. Intonation and expressivity: a single case study of classical western singing.

    PubMed

    Sundberg, Johan; Lã, Filipa M B; Himonides, Evangelos

    2013-05-01

    Previous studies have shown that singers tend to sharpen phrase-peak tones as compared with equally tempered tuning (ETT). Here we test the hypothesis that this can serve the purpose of musical expressivity. Data were drawn from earlier recordings, where a professional baritone sang excerpts as void of musical expression as he could (Neutral) and as expressive as in a concert (Concert). Fundamental frequency averaged over tones was examined and compared with ETT. Phrase-peak tones were sharper in excited examples, particularly in the Concert versions. These tones were flattened to ETT using the Melodyne software. The manipulated and original versions were presented pairwise to a musician panel that was asked to choose the more expressive version. By and large, the original versions were perceived as more expressive, thus supporting the common claim that intonation is a means for adding expressivity to a performance.

  16. Endocrowns: review

    PubMed Central

    Sevimli, Gaye; Cengiz, Seda; Oruc, M. Selcuk

    2015-01-01

    The ideal restoration of endodontically treated teeth (ETT) has been widely and controversially discussed in the literature. Prevention of healthy dental structure is essential to help mechanical stabilization of tooth-restoration integrity, increase the amount of suitable surfaces for adhesion and thus positively affect the long-term success. ETT are affected by a higher risk of biomechanical failure than vital teeth. With the development of adhesive systems, the need for post-core restorations is also reduced. Especially for restoration of excessively damaged ETT, endocrowns have been used as an alternative to the conventional post-core and fixed partial dentures. Compared to conventional methods, good aesthetics, better mechanical performance, and less cost and clinic time are the advantages of endocrowns. PMID:28955538

  17. Discordance of exercise thallium testing with coronary arteriography in patients with atypical presentations

    NASA Technical Reports Server (NTRS)

    Bungo, M. W.; Leland, O. S., Jr.

    1983-01-01

    Eighty-one patients with diagnostically difficult clinical presentations suggesting coronary artery disease underwent symptom-limited maximal-exercise treadmill testing (ETT) and exercise radionuclide scanning with thallium-201 followed by coronary angiography. Results showed that in nearly half of the patients (47%) these tests were in agreement, while either exercise thallium or ETT was positive in 94% of patients with coronary artery disease. It was found that agreement between exercise thallium and ETT tests predicted disease in 92% of the instances or excluded disease in 82% of the instances. It is concluded that despite frequent discord between these two tests in 53% of the cases, a significant gain in exclusive diagnostic capability is realized when applied to a patient population anticipated to have a disease prevalence equal to the 67% encountered in this study.

  18. Nitrous oxide pollution in the operating room. A comparison of two modes of ventilation.

    PubMed

    Noorddin, Y; Raha, A R; Jaafar, M Z; Rozaidi, S H W; Muraly, S; Marlizan, M Y

    2007-06-01

    The use of laryngeal mask airway (LMA) as an alternative to the endotracheal tube (ETT) is becoming more popular in the practice of anesthesia. It is undeniable that this device has numerous advantages over endotracheal tube, however it does not provide an airtight seal between the airway and atmospheric gases. This may lead to pollution of the operating room environment with nitrous oxide. One hundreds adult patients undergoing general anaesthesia were divided into two groups. The airway in Group I was maintained with LMA with spontaneous ventilation and ETT with intermittent positive pressure ventilation (IPPV) was used for Group II. The result demonstrated that the ETT group recorded concentrations of nitrous oxide that were well above the NIOSH recommended eight hour time weighted average of 25ppm throughout the duration of surgery when compared to patients using LMA.

  19. Discordance of exercise thallium testing with coronary arteriography in patients with atypical presentations

    NASA Technical Reports Server (NTRS)

    Bungo, M. W.; Leland, O. S., Jr.

    1983-01-01

    Eighty-one patients with diagnostically difficult clinical presentations suggesting coronary artery disease underwent symptom-limited maximal-exercise treadmill testing (ETT) and exercise radionuclide scanning with thallium-201 followed by coronary angiography. Results showed that in nearly half of the patients (47%) these tests were in agreement, while either exercise thallium or ETT was positive in 94% of patients with coronary artery disease. It was found that agreement between exercise thallium and ETT tests predicted disease in 92% of the instances or excluded disease in 82% of the instances. It is concluded that despite frequent discord between these two tests in 53% of the cases, a significant gain in exclusive diagnostic capability is realized when applied to a patient population anticipated to have a disease prevalence equal to the 67% encountered in this study.

  20. The unusual amino acid l-ergothioneine is a physiologic cytoprotectant

    PubMed Central

    Paul, BD; Snyder, SH

    2010-01-01

    Ergothioneine (ET) is an unusual sulfur-containing derivative of the amino acid, histidine, which is derived exclusively through the diet. Although ET was isolated a century ago, its physiologic function has not been clearly established. Recently, a highly specific transporter for ET (ETT) was identified in mammalian tissues, which explains abundant tissue levels of ET and implies a physiologic role. Using RNA interference, we depleted cells of its transporter. Cells lacking ETT are more susceptible to oxidative stress, resulting in increased mitochondrial DNA damage, protein oxidation and lipid peroxidation. ETT is concentrated in mitochondria, suggesting a specific role in protecting mitochondrial components such as DNA from oxidative damage associated with mitochondrial generation of superoxide. In combating cytotoxic effects of pyrogallol, a known superoxide generator, ET is as potent as glutathione. Because of its dietary origin and the toxicity associated with its depletion, ET may represent a new vitamin whose physiologic roles include antioxidant cytoprotection. PMID:19911007

  1. Are specialized endotracheal tubes and heat-and-moisture exchangers cost-effective in preventing ventilator associated pneumonia?

    PubMed

    Gentile, Michael A; Siobal, Mark S

    2010-02-01

    Ventilator-associated pneumonia (VAP) is a common and serious complication of mechanical ventilation via an artificial airway. As with all nosocomial infections, VAP increases costs, morbidity, and mortality in the intensive care unit (ICU). VAP prevention is a multifaceted priority of the intensive care team, and can include the use of specialized artificial airways and heat-and-moisture exchangers (HME). Substantial evidence supports the use of endotracheal tubes (ETTs) that allow subglottic suctioning; silver-coated and antiseptic-impregnated ETTs; ETTs with thin-walled polyurethane cuffs; and HMEs, but these devices also can have adverse effects. Controversy still exists regarding the evidence, cost-effectiveness, and disadvantages and risks of these devices.

  2. Subglottic stenosis: another challenge for intubation and potential mechanism of airway obstruction in Pierre Robin Sequence.

    PubMed

    Knapp, Kolin; Powitzky, Rosser; Digoy, Paul

    2011-09-01

    To determine the endotracheal tube (ETT) size and presence of subglottic narrowing in children less than 1 year old with Pierre Robin Sequence (PRS). We performed a retrospective review from 2005 to 2009 of infants with PRS who underwent diagnostic laryngoscopy (DL) and intubation. Fifteen children with a median age of 25 days were reviewed. All patients, except one, were born full term. Subglottic narrowing was visualized in 5 patients (33%). 73% of all patients required an ETT size smaller than what is recommended by intubation guidelines in the literature in regards to normative data based on age and weight. Infants with PRS may have a higher incidence of subglottic stenosis and require a smaller ETT compared to the normal population. This pilot study warrants a larger prospective investigation to validate these findings. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  3. A semi-Dirac point and an electromagnetic topological transition in a dielectric photonic crystal.

    PubMed

    Wu, Ying

    2014-01-27

    Accidental degeneracy in a photonic crystal consisting of a square array of elliptical dielectric cylinders leads to both a semi-Dirac point at the center of the Brillouin zone and an electromagnetic topological transition (ETT). A perturbation method is deduced to affirm the peculiar linear-parabolic dispersion near the semi-Dirac point. An effective medium theory is developed to explain the simultaneous semi-Dirac point and ETT and to show that the photonic crystal is either a zero-refractive-index material or an epsilon-near-zero material at the semi-Dirac point. Drastic changes in the wave manipulation properties at the semi-Dirac point, resulting from ETT, are described.

  4. Perioperative and anesthetic management of complete tracheal rupture in one dog and one cat.

    PubMed

    Morath, Ute; Gendron, Karine; Revés, Nuria Vizcaíno; Adami, Chiara

    2015-01-01

    The authors describe two animals (one dog and one cat) that were presented with severe respiratory distress after trauma. Computerized tomographic imaging under general anesthesia revealed, in both cases, complete tracheal transection. Hypoxic episodes during anesthesia were relieved by keeping the endotracheal tube (ETT) positioned in the cranial part of the transected trachea and by allowing spontaneous breathing. Surgical preparation was performed quickly, and patients were kept in a sternal position to improve ventilation and oxygenation, and were only turned into dorsal recumbency shortly before surgical incision. A sterile ETT was guided into the distal part of the transected trachea by the surgeon, at which point mechanical ventilation was started. Both animals were successfully discharged from hospital a few days after surgery. Rapid and well-coordinated teamwork seemed to contribute to the good outcome. Precise planning and communication between anesthetists, surgeons, and technicians, as well as a quick course of action prior to correct ETT positioning helped to overcome critical phases.

  5. Neonatal outcomes based on mode and intensity of delivery room resuscitation.

    PubMed

    Bashir, A; Bird, B; Wu, L; Welles, S; Taylor, H; Anday, E; Bhandari, V

    2017-10-01

    To examine outcomes of neonates based on the mode and intensity of resuscitation received in the delivery room (DR). A retrospective study of 439 infants with birth weight ⩽1500 g receiving DR resuscitation at two hospital centers in Philadelphia, Pennsylvania. Of 439 infants, 22 (5%) received routine care, 188 (43%) received noninvasive positive pressure ventilation (PPV) and 229 (52%) received endotracheal tube (ETT) intubation in the DR. Adjusted odds for respiratory distress syndrome was associated with lower rates in infants requiring lower intensity of DR resuscitation (P<0.001). Noninvasive PPV vs ETT was associated with decreased odds of developing intraventricular hemorrhage and retinopathy of prematurity (P<0.05). Routine vs noninvasive PPV or ETT had decreased odds of developing bronchopulmonary dysplasia (P<0.05). Decreased intensity of DR resuscitation was associated with a decreased risk of specific morbidities.

  6. Aerosolized KL4 surfactant improves short-term survival and gas exchange in spontaneously breathing newborn pigs with hydrochloric acid-induced acute lung injury.

    PubMed

    Lampland, Andrea L; Wolfson, Marla R; Mazela, Jan; Henderson, Christopher; Gregory, Timothy J; Meyers, Patricia; Plumm, Brenda; Worwa, Cathy; Mammel, Mark C

    2014-05-01

    Surfactant therapy may be beneficial in acute lung injury (ALI). In spontaneously breathing newborn pigs with ALI supported with continuous positive airway pressure (CPAP), we evaluated the hypothesis that aerosolized KL4 surfactant (AERO KL4 S) would provide a similar therapeutic effect as intratracheal KL4 surfactant (ETT KL4 S) when compared to controls. We randomized pigs with HCl-induced ALI to: (1) 175 mg/kg KL4 surfactant via endotracheal tube (ETT); (2) AERO KL4 S (22.5 mg/min phospholipid) for 60 min via continuous positive airway pressure (CPAP); or (3) sham procedure on CPAP. We obtained physiologic data and arterial blood gases throughout the 3-hr study. At study end, lungs were excised for analysis of interleukin-8 (IL-8), myeloperoxidase (MPO) levels and histomorphometric data. Pigs treated with ETT KL4 S and AERO KL4 S had improved survival and sustained pO2 compared to controls. The AERO KL4 S group had higher pH compared to controls. Lung IL-8 levels were lower in the AERO KL4 S group compared to controls. Histomorphometric analysis showed less hemorrhage in the ETT and AERO KL4 S groups compared to controls. The AERO KL4 S group had more open lung units per fixed-field than the ETT KL4 S or controls. AERO KL4 S produced similar improvements in survival, physiology, inflammatory markers, and morphology as ETT KL4 S in an ALI model. © 2013 Wiley Periodicals, Inc.

  7. Flow resistance, work of breathing of humidifiers, and endotracheal tubes in the hyperbaric chamber.

    PubMed

    Arieli, Ran; Daskalovic, Yohanan; Ertracht, Ofir; Arieli, Yehuda; Adir, Yohai; Abramovich, Amir; Halpern, Pinchas

    2011-09-01

    Humidification of inspired gas is critical in ventilated patients, usually achieved by heat and moisture exchange devices (HMEs). HME and the endotracheal tube (ETT) add airflow resistance. Ventilated patients are sometimes treated in hyperbaric chambers. Increased gas density may increase total airway resistance, peak pressures (PPs), and mechanical work of breathing (WOB). We tested the added WOB imposed by HMEs and various sizes of ETT under hyperbaric conditions. We mechanically ventilated 4 types of HMEs and 3 ETTs at 6 minute ventilation volumes (7-19.5 L/min) in a hyperbaric chamber at pressures of 1 to 6 atmospheres absolute (ATA). Peak pressure increased with increasing chamber pressure with an HME alone, from 2 cm H₂O at 1 ATA to 6 cm H(2)O at 6 ATA. Work of breathing was low at 1 ATA (0.2 J/L) and increased to 1.2 J/L at 6 ATA at minute ventilation = 19.5 L/min. Connecting the HME to an ETT increased PP as a function of peak flow and chamber pressure. Reduction of the ETT diameter (9 > 8 > 7.5 mm) and increase in chamber pressure increased the PP up to 27.7 cm H₂O, resistance to 33.2 cmH₂O*s/L, and WOB to 3.76 J/L at 6 ATA with a 7.5-mm EET. These are much greater than the usually accepted critical peak pressures of 25 cm H₂O and WOB of 1.5 to 2.0 J/L. Endotracheal tubes less than 8 mm produce significant added WOB and airway pressure swings under hyperbaric conditions. The hyperbaric critical care clinician is advised to use the largest possible ETT. The tested HMEs add negligible resistance and WOB in the chamber. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. Tracheal rapid ultrasound saline test (T.R.U.S.T.) for confirming correct endotracheal tube depth in children.

    PubMed

    Tessaro, Mark O; Salant, Evan P; Arroyo, Alexander C; Haines, Lawrence E; Dickman, Eitan

    2015-04-01

    We evaluated the accuracy of tracheal ultrasonography of a saline-inflated endotracheal tube (ETT) cuff for confirming correct ETT insertion depth. We performed a prospective feasibility study of children undergoing endotracheal intubation for surgery. Tracheal ultrasonography at the suprasternal notch was performed during transient endobronchial intubation and inflation of the cuff with saline, and with the ETT at a correct endotracheal position. Ultrasound videos were recorded at both positions, which were confirmed by fiberoptic bronchoscopy. These videos were shown to two independent blinded reviewers, who determined the presence or absence of a saline-inflated cuff. The primary outcome was accuracy of tracheal ultrasonography for appropriate ETT insertion depth. Forty-two patients were enrolled. For correct endotracheal versus endobronchial positioning, pooled results from the reviewers revealed a sensitivity of 98.8% (95% CI=90-100%), a specificity of 96.4% (95% CI=87-100%), a PPV of 96.5% (95% CI=87-100%), a NPV of 98.8% (95% CI=89-100%), a positive likelihood ratio of 32 (95% CI=6-185), and a negative likelihood ratio of 0.015 (95% CI=0.004-0.2). Agreement between reviewers was high (kappa co-efficient=0.93; 95% CI=0.86 to 1). The mean duration of the ultrasound exam was 4.0s (range 1.0-15.0s). Sonographic visualization of a saline-inflated ETT cuff at the suprasternal notch is an accurate and rapid method for confirming correct ETT insertion depth in children. Copyright © 2015. Published by Elsevier Ireland Ltd.

  9. Gender differences in sore throat and hoarseness following endotracheal tube or laryngeal mask airway: a prospective study

    PubMed Central

    2014-01-01

    Background Postoperative sore throat and hoarseness are common minor complications following airway manipulation. This study was primarily done to determine gender differences in the incidence of these symptoms and the location of POST after laryngeal mask airway (LMA) and endotracheal tube (ETT). Methods A total of 112 men and 185 women were included during a four month period. All patients were evaluated postoperatively and after 24 hours about the occurrence of sore throat, its location and hoarseness. If the patients had any symptom, they were followed-up at 48, 72 and 96 hours until the symptoms resolved. Results There was no significant gender difference in postoperative sore throat (POST) and postoperative hoarseness (PH) when analyzing both airway devices together. The incidence of sore throat and hoarseness were higher postoperatively after an ETT than an LMA (32% vs. 19%, p = 0.012) and 57% vs. 33% (p < 0.001) respectively. Significantly more women than men had POST after an LMA (26% vs. 6%, p = 0.004). No significant gender difference was found in either POST or PH after an ETT or in the incidence of PH after an LMA. More patients located their pain below the larynx after an ETT vs. an LMA (24% vs. 4%). Pain above the larynx was more common after an LMA than an ETT (52% vs. 37%). Conclusions In a clinical setting where women are intubated with a smaller size ETT than men, there were no significant differences in POST or PH between genders. Additionally, more women than men have POST when an LMA is used. Awareness of POST and PH may help streamline patients in whom the best airway device could be used during anesthesia and surgery. PMID:25061426

  10. Examining the relationship between exercise tolerance and isoproterenol-based cardiac reserve in murine models of heart failure.

    PubMed

    Richards, Daniel A; Bao, Weike; Rambo, Mary V; Burgert, Mark; Jucker, Beat M; Lenhard, Stephen C

    2013-05-01

    The loss of cardiac reserve is, in part, responsible for exercise intolerance in late-stage heart failure (HF). Exercise tolerance testing (ETT) has been performed in mouse models of HF; however, treadmill performance and at-rest cardiac indexes determined by magnetic resonance imaging (MRI) rarely correlate. The present study adopted a stress-MRI technique for comparison with ETT in HF models, using isoproterenol (ISO) to evoke cardiac reserve responses. Male C57BL/6J mice were randomly subjected to myocardial infarction (MI), transverse aortic constriction (TAC), or sham surgery under general anesthesia. Mice underwent serial ETT on a graded treadmill with follow-up ISO stress-MRI. TAC mice showed consistent exercise intolerance, with a 16.2% reduction in peak oxygen consumption vs. sham at 15-wk postsurgery (WPS). MI and sham mice had similar peak oxygen consumption from 7 WPS onward. Time to a respiratory exchange ratio of 1.0 correlated with ETT distance (r = 0.64; P < 0.001). The change in ejection fraction under ISO stress was reduced in HF mice at 4 WPS [10.1 ± 3.9% change (Δ) and 8.9 ± 3.5%Δ in MI and TAC, respectively, compared with 32.0 ± 3.5%Δ in sham; P < 0.001]. However, cardiac reserve differences between surgery groups were not observed at 16 WPS in terms of ejection fraction or cardiac output. In addition, ETT did not correlate with cardiac indexes under ISO stress. In conclusion, ISO stress was unable to reflect consistent differences in ETT between HF and healthy mice, suggesting cardiac-specific indexes are not the sole factors in defining exercise intolerance in mouse HF models.

  11. The Prevalence of Oral Flora in the Biofilm Microbiota of the Endotracheal Tube.

    PubMed

    Bardes, James M; Waters, Christopher; Motlagh, Hamed; Wilson, Alison

    2016-05-01

    The endotracheal tube (ETT) is recognized as an independent factor for infection in intubated patients. The presence of biofilm contributes to the development of pneumonia. Standard culturing techniques are inadequate to detect many of the bacteria present in a biofilm. Delineation of the microbiota in the ETT is needed to further understand infections in ventilated patients. A prospective, observational study was performed at a university, Level I trauma center. Twenty ETT were collected at extubation. Bioluminal accretions were removed and quantified. DNA was extracted and 16S ribosomal RNA gene analysis performed using the Human Oral Microbe Identification Microarray. Twenty ETT were evaluated. Mean age was 47.5 years (19-82). Five were smokers. Mean ventilator days was 3.6 ± 3.1. Mean intensive care unit days was 7.8 ± 6.3. In those ETT, 87 different bacterial species were identified. Mean number of bacterial species identified was 16 ± 9 (3-35). There was no relationship between duration of intubation and number of species (P = 0.5). Nonsmokers had a greater variety of bacteria than smokers (P = 0.03). Patients with pneumonia did not have a greater variety of bacteria (P = 0.14). Parvimonas micra presence was associated with reintubation (P = 0.01). The most common species in smokers were different from nonsmokers. There is a wide variety of bacteria present in an ETT, many of which cannot be cultured by standard means. Variation is not correlated to duration of intubation or accretion volume. Studies to evaluate these bacteria and their interaction with the biofilm may further delineate factors in development of infections.

  12. Is I-gel airway a better option to endotracheal tube airway for sevoflurane-fentanyl anesthesia during cardiac surgery?

    PubMed Central

    Elgebaly, Ahmed Said; Eldabaa, Ahmed Ali

    2014-01-01

    Background: Anesthetists used lower doses of fentanyl, successfully with hemodynamic control by titrating volatile anesthetic agents or vasodilators for fast-tracking in cardiac surgery. Hypothesis: Lower total doses of anesthetics and fentanyl could be required with hemodynamic control by use of supraglottic devices than endotracheal tube (ETT) and helps in fast-tracking. Design: A prospective randomized observational clinical trial study. Aims: The authors compared the utility of I-gel airway with a conventional ETT during the induction and maintenance of anesthesia with sevoflurane and fentanyl in adults undergoing cardiac surgery. Patients and Methods: A total of 49 adult patients underwent cardiac surgery were randomized into two groups according to the airway management: I-gel group (n = 23) and ETT group (n = 26). Doses of fentanyl and hemodynamic parameters (heart rate [HR], mean arterial pressure [MAP] central venous pressure [CVP], pulmonary artery pressure [PAP], and pulmonary capillary wedge pressure [PCWP]) were recorded preoperative, 5 min following tracheal intubation or I-gel airway insertion, after skin incision, after stenotomy, and after weaning off bypass. Results: None of the patients in the I-gel group required additional doses of fentanyl during the I-gel insertion, compared with 74% of the patients during laryngoscopy and endotracheal insertion in the ETT group, for an average total dose of 22.6 ± 0.6 μg/kg. The MAP and HR did not significantly differ from the baseline values at any point of measurement in either group. Furthermore, CVP, PAP, and PCWP measured during the procedure were significantly lower in I-gel group than ETT group. Extubation required more amount of time in ETT than I- gel group. Conclusion: The I-gel airway is well-tolerated by adult patients undergoing cardiac surgery, and requires lower total doses of anesthetics than endotracheal intubation with hemodynamic control and helps in fast-tracking. PMID:25886229

  13. Manual ventilation and open suction procedures contribute to negative pressures in a mechanical lung model

    PubMed Central

    Nakstad, Espen Rostrup; Opdahl, Helge; Heyerdahl, Fridtjof; Borchsenius, Fredrik; Skjønsberg, Ole Henning

    2017-01-01

    Introduction Removal of pulmonary secretions in mechanically ventilated patients usually requires suction with closed catheter systems or flexible bronchoscopes. Manual ventilation is occasionally performed during such procedures if clinicians suspect inadequate ventilation. Suctioning can also be performed with the ventilator entirely disconnected from the endotracheal tube (ETT). The aim of this study was to investigate if these two procedures generate negative airway pressures, which may contribute to atelectasis. Methods The effects of device insertion and suctioning in ETTs were examined in a mechanical lung model with a pressure transducer inserted distal to ETTs of 9 mm, 8 mm and 7 mm internal diameter (ID). A 16 Fr bronchoscope and 12, 14 and 16 Fr suction catheters were used at two different vacuum levels during manual ventilation and with the ETTs disconnected. Results During manual ventilation with ETTs of 9 mm, 8 mm and 7 mm ID, and bronchoscopic suctioning at moderate suction level, peak pressure (PPEAK) dropped from 23, 22 and 24.5 cm H2O to 16, 16 and 15 cm H2O, respectively. Maximum suction reduced PPEAK to 20, 17 and 11 cm H2O, respectively, and the end-expiratory pressure fell from 5, 5.5 and 4.5 cm H2O to –2, –6 and –17 cm H2O. Suctioning through disconnected ETTs (open suction procedure) gave negative model airway pressures throughout the duration of the procedures. Conclusions Manual ventilation and open suction procedures induce negative end-expiratory pressure during endotracheal suctioning, which may have clinical implications in patients who need high PEEP (positive end-expiratory pressure). PMID:28725445

  14. Manual ventilation and open suction procedures contribute to negative pressures in a mechanical lung model.

    PubMed

    Nakstad, Espen Rostrup; Opdahl, Helge; Heyerdahl, Fridtjof; Borchsenius, Fredrik; Skjønsberg, Ole Henning

    2017-01-01

    Removal of pulmonary secretions in mechanically ventilated patients usually requires suction with closed catheter systems or flexible bronchoscopes. Manual ventilation is occasionally performed during such procedures if clinicians suspect inadequate ventilation. Suctioning can also be performed with the ventilator entirely disconnected from the endotracheal tube (ETT). The aim of this study was to investigate if these two procedures generate negative airway pressures, which may contribute to atelectasis. The effects of device insertion and suctioning in ETTs were examined in a mechanical lung model with a pressure transducer inserted distal to ETTs of 9 mm, 8 mm and 7 mm internal diameter (ID). A 16 Fr bronchoscope and 12, 14 and 16 Fr suction catheters were used at two different vacuum levels during manual ventilation and with the ETTs disconnected. During manual ventilation with ETTs of 9 mm, 8 mm and 7 mm ID, and bronchoscopic suctioning at moderate suction level, peak pressure (PPEAK) dropped from 23, 22 and 24.5 cm H2O to 16, 16 and 15 cm H2O, respectively. Maximum suction reduced PPEAK to 20, 17 and 11 cm H2O, respectively, and the end-expiratory pressure fell from 5, 5.5 and 4.5 cm H2O to -2, -6 and -17 cm H2O. Suctioning through disconnected ETTs (open suction procedure) gave negative model airway pressures throughout the duration of the procedures. Manual ventilation and open suction procedures induce negative end-expiratory pressure during endotracheal suctioning, which may have clinical implications in patients who need high PEEP (positive end-expiratory pressure).

  15. The minimal leak test technique for endotracheal cuff maintenance.

    PubMed

    Harvie, D A; Darvall, J N; Dodd, M; De La Cruz, A; Tacey, M; D'Costa, R L; Ward, D

    2016-09-01

    Endotracheal tube (ETT) cuff pressure management is an essential part of airway management in intubated and mechanically ventilated patients. Both under- and over-inflation of the ETT cuff can lead to patient complications, with an ideal pressure range of 20-30 cmH2O defined. A range of techniques are employed to ensure adequate ETT cuff inflation, with little comparative data. We performed an observational cross-sectional study in a tertiary metropolitan ICU, assessing the relationship between the minimal leak test and cuff manometry. Forty-five mechanically ventilated patients, over a three-month period, had ETT cuff manometry performed at the same time as their routine cuff maintenance (minimal leak test). Bedside nurse measurements were compared with investigator measurements. At the endpoint of cuff inflation, 20 of 45 patients (44%) had cuff pressures between 20 and 30 cmH2O; 11 of 45 patients (24%) had cuff pressures <20 cmH2O; 14 of 45 patients (31%) had cuff pressures ≥30 cmH2O. Univariate analysis demonstrated an association between both patient obesity and female gender requiring less ETT cuff volume (P=0.008 and P <0.001 respectively), though this association was lost on multivariate analysis. No association was demonstrated between any measured variables and cuff pressures. Inter-operator reliability in performing the minimal leak test showed no evidence of bias between nurse and investigators (Pearson coefficient = 0.897). We conclude the minimal leak test for maintenance of ETT cuffs leads to both over- and under-inflation, and alternative techniques, such as cuff manometry, should be employed.

  16. Survey on restoration of endodontically treated anterior teeth: a questionnaire based study.

    PubMed

    Ratnakar, P; Bhosgi, Rashmi; Metta, Kiran Kumar; Aggarwal, Kanika; Vinuta, S; Singh, Navneet

    2014-01-01

    The aim of endodontic and restorative dentistry is the conservation of natural tooth structure. Endodontically treated tooth (ETT) undergoes loss of tooth structure and changes in physical characteristics. Therefore, proper selection of restoration for ETT is mandatory. The clinical approach of restoring ETT needs taking into considerations several issues. However, the best way to restore teeth after root canal treatment has long been and still a controversial subject to debate. Therefore, this study was carried out to detect the frequency of preferred methods of restoring ETT under different conditions. A questionnaire was framed and distributed among prosthodontists, endodontist and general practitioners of north India region to find out the frequency of best suitable material and method regarding restoration of ETT. 220 questionnaires were sent by electronic mail out of which 110 were received back. The questionnaire contained different methods of restoration of endodontically treated anterior teeth at different conditions (percentages) of remaining sound tooth structure. Respondents were asked to indicate their preferred method of restoration of those teeth. Results showed that majority of respondents (51.82%) preferred to restore the tooth only with a tooth-color restorative material in condition A. In condition B, majority of respondents preferred to use tooth colored crown (44.55%) and prefabricated post and tooth colored restoration (24.5%). Whereas in condition C, most of the respondents preferred to use a cast post and core/crown (80.91%). From the findings of the present study, it can be concluded that the unrestored ETT is susceptible to fracture, which could lead to loss of tooth and that the maximum preservation of healthy tooth structure and use of restorative materials with mechanical properties similar to dental structure favor greater longevity of tooth restoration complex.

  17. Measurement of endotracheal tube cuff pressure: Instrumental versus conventional method

    PubMed Central

    Khan, Mueen Ullah; Khokar, Rashid; Qureshi, Sadia; Al Zahrani, Tariq; Aqil, Mansoor; Shiraz, Motasim

    2016-01-01

    Objective: To evaluate the conventional practice of endotracheal tube (ETT) cuff inflation and pressure measurement as compared to the instrumental method. Study Design: Prospective observational study. Place and Duration of Study: Department of Anaesthesia, King Saud University Hospital, Riyadh, Saudi Arabia (June 2014–July 2014). Methods: A total of 100 adult patients were observed according to the syringe size used Group-1 (10 ml) and Group-2 (20 ml) for ETT cuff inflation in general anesthesia. Patients with anticipated difficult intubation, risk for aspiration, known anatomical laryngotracheal abnormalities, and emergency cases were excluded. Trachea was intubated with size 8 or 8.5 mm and 7.0 or 7.5 mm ETT in male and female patients respectively. The ETT cuff was inflated with air by one of the anesthesia technician. Cuff pressures were measured using aneroid manometer. ETT cuff pressure of 20–30 cm of water was considered as standard. Results: In 69% of the patients, the cuff pressure measurements were above the standard. Age (P = 0.806), weight (P = 0.527), height (P = 0.850), and gender (P = 1.00) were comparable in both groups. The mean cuff pressure in Group-1 and Group-2 was 32.52 ± 6.39 and 38.90 ± 6.60 cm of water (P = 0.001). The cuff inflation with 20 ml syringe resulted in higher cuff pressure as compared to 10cc syringe 37.73 ± 4.23 versus 40.74 ± 5.01 (86% vs. 52%, P = 0.013). Conclusion: The conventional method for ETT cuff inflation and pressure measuring is unreliable. As a routine instrumental cuff pressure, monitoring is suggested. PMID:27833487

  18. Detection of endobronchial intubation by monitoring the CO2 level above the endotracheal cuff.

    PubMed

    Efrati, Shai; Deutsch, Israel; Weksler, Nathan; Gurman, Gabriel M

    2015-02-01

    Early detection of accidental endobronchial intubation (EBI) is still an unsolved problem in anesthesia and critical care daily practice. The aim of this study was to evaluate the ability of monitoring above cuff CO2 to detect EBI (the working hypothesis was that the origin of CO2 is from the unventilated, but still perfused, lung). Six goats were intubated under general anesthesia and the ETT positioning was verified by a flexible bronchoscope. The AnapnoGuard system, already successfully used to detect air leak around the ETT cuff, was used for continuous monitoring of above-the-cuff CO2 level. When the ETT distal tip was located in the trachea, with an average cuff pressure of 15 mmHg, absence of CO2 above the cuff was observed. The ETT was then deliberately advanced into one of the main bronchi under flexible bronchoscopic vision. In all six cases the immediate presence of CO2 above the cuff was identified. Further automatic inflation of the cuff, up to a level of 27 mmHg, did not affect the above-the-cuff measured CO2 level. Withdrawal of the ETT and repositioning of its distal tip in mid-trachea caused the disappearance of CO2 above the cuff in a maximum of 3 min, confirming the absence of air leak and the correct positioning of the ETT. Our results suggest that measurement of the above-the-cuff CO2 level could offer a reliable, on-line solution for early identification of accidental EBI. Further studies are planned to validate the efficacy of the method in a clinical setup.

  19. Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport

    PubMed Central

    Tennyson, Joseph; Ford-Webb, Tucker; Weisberg, Stacy; LeBlanc, Donald

    2016-01-01

    Introduction Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS) transportation. Measurement of endotracheal tube (ETT) cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH2O impede mucosal capillary blood flow. Multiple prior studies have recommended 30 cmH2O as the maximum safe cuff inflation pressure. This study sought to evaluate the inflation pressures in ETT cuffs of patients presenting to HEMS. Methods We enrolled a convenience sample of patients presenting to UMass Memorial LifeFlight who were intubated by the sending facility or emergency medical services (EMS) agency. Flight crews measured the ETT cuff pressures using a commercially available device. Those patients intubated by the flight crew were excluded from this analysis as the cuff was inflated with the manometer to a standardized pressure. Crews logged the results on a research form, and we analyzed the data using Microsoft Excel and an online statistical analysis tool. Results We analyzed data for 55 patients. There was a mean age of 57 years (range 18–90). The mean ETT cuff pressure was 70 (95% CI= [61–80]) cmH2O. The mean lies 40 cmH2O above the maximum accepted value of 30 cmH2O (p<0.0001). Eighty-four percent (84%) of patients encountered had pressures above the recommended maximum. The most frequently recorded pressure was >120 cmH2O, the maximum pressure on the analog gauge. Conclusion Patients presenting to HEMS after intubation by the referral agency (EMS or hospital) have ETT cuffs inflated to pressures that are, on average, more than double the recommended maximum. These patients are at risk for tracheal mucosal injury and scarring from decreased mucosal capillary blood flow

  20. Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport.

    PubMed

    Tennyson, Joseph; Ford-Webb, Tucker; Weisberg, Stacy; LeBlanc, Donald

    2016-11-01

    Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS) transportation. Measurement of endotracheal tube (ETT) cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH2O impede mucosal capillary blood flow. Multiple prior studies have recommended 30 cmH2O as the maximum safe cuff inflation pressure. This study sought to evaluate the inflation pressures in ETT cuffs of patients presenting to HEMS. We enrolled a convenience sample of patients presenting to UMass Memorial LifeFlight who were intubated by the sending facility or emergency medical services (EMS) agency. Flight crews measured the ETT cuff pressures using a commercially available device. Those patients intubated by the flight crew were excluded from this analysis as the cuff was inflated with the manometer to a standardized pressure. Crews logged the results on a research form, and we analyzed the data using Microsoft Excel and an online statistical analysis tool. We analyzed data for 55 patients. There was a mean age of 57 years (range 18-90). The mean ETT cuff pressure was 70 (95% CI= [61-80]) cmH2O. The mean lies 40 cmH2O above the maximum accepted value of 30 cmH2O (p<0.0001). Eighty-four percent (84%) of patients encountered had pressures above the recommended maximum. The most frequently recorded pressure was >120 cmH2O, the maximum pressure on the analog gauge. Patients presenting to HEMS after intubation by the referral agency (EMS or hospital) have ETT cuffs inflated to pressures that are, on average, more than double the recommended maximum. These patients are at risk for tracheal mucosal injury and scarring from decreased mucosal capillary blood flow. Hospital and EMS providers should use ETT cuff

  1. Risk of aspiration during anesthesia in patients with congenital insensitivity to pain with anhidrosis: case reports and review of the literature.

    PubMed

    Zlotnik, Alexander; Gruenbaum, Shaun E; Rozet, Irene; Zhumadilov, Agzam; Shapira, Yoram

    2010-10-01

    Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive disease, characterized by episodes of unexplained fever, anhidrosis, pain insensitivity despite intact tactile perception, self-mutilating behavior, mental retardation, and autonomic nervous system (ANS) abnormalities. We present a case series of three patients with CIPA who underwent semielective orthopedic surgery under general anesthesia complicated by intraoperative regurgitation, and subsequent aspiration in two of the three cases. All three patients were nil per os (NPO) for at least 8 h prior to surgery. Two patients had their airways maintained with a laryngeal mask airway (LMA), and one patient had an endotracheal tube (ETT). The patients with an LMA suffered aspiration of gastric contents and subsequently developed hypoxic cardiac arrest. Although the patient with an ETT in situ regurgitated intraoperatively, the presence of the ETT prevented aspiration and any further potential complications. We review the perioperative complications typically observed in patients with CIPA and discuss the risks of using an LMA in these patients. We recommend that patients with CIPA always should be considered as having a "full stomach", regardless of the duration of their NPO status, due to their coexisting ANS abnormalities. Therefore, rapid-sequence induction with an ETT should be utilized for the anesthetic management in every patient with CIPA.

  2. Strategic Requirements for the Army to the Year 2000. Volume II. The World Environment to the Year 2000.

    DTIC Science & Technology

    1982-11-01

    masses to sur- vive Khomeini’s death. Nevertheless, the problems facing the post-Khomeini leadership will be monumental. A significant and vocal ...the next two decades. Saud Ar1big A n tbh ett " oesf lba now e Gu.l Saudi Arabia is increasingly assuming a leadership role in the area. After the Iran

  3. Physiological Responses During the Lower Body Positive Pressure Supported Treadmill Test

    PubMed Central

    2016-01-01

    Objective To quantify changes in cardiopulmonary function using a lower body positive pressure supported (LBPPS) treadmill during the exercise tolerance test (ETT) in healthy subjects before applying the LBPPS treadmill in patients with gait problems. Methods We evaluated 30 healthy subjects who were able to walk independently. The ETT was performed using the Modified Bruce Protocol (stages 1–5) at four levels (0%, 40%, 60%, and 80%) of LBPPS. The time interval at each level of the LBPPS treadmill test was 20 minutes to recover to baseline status. We measured systolic blood pressure, diastolic blood pressure, peak heart rate (PHR), rating of perceived exertion (RPE), metabolic equivalents (METs), and oxygen consumption rate (VO2) during each LBPPS condition. Results Systolic blood pressure increased as the LBPPS level was increased (40% to 80%). PHR, RPE, METs, and VO2 were negatively associated with the LBPPS condition, although they were not always significant different among the LBPPS levels. The equation from a random effect linear regression model was as follows: VO2 (mL/kg/min)=(2.75×stage)+(–0.14×LBPPS level)+11.9 (r2=0.69). Conclusion Detection of the changes in physiological parameters during a submaximal ETT using the LBPPS system may be helpful for applying the LBPPS treadmill in patients who cannot perform the ETT due to gait problems, even at submaximal intensity. PMID:27847722

  4. Coexisting epithelioid trophoblastic tumor and placental site trophoblastic tumor of the uterus following a term pregnancy: report of a case and review of literature.

    PubMed

    Zhang, Xiaofei; Zhou, Caiyun; Yu, Minghua; Chen, Xiaoduan

    2015-01-01

    Gestational trophoblastic neoplasms are a group of fetal trophoblastic tumors including choriocarcinomas, epithelioid trophoblastic tumors (ETTs), and placental site trophoblastic tumors (PSTTs). Mixed gestational trophoblastic neoplasms are extremely rare. The existence of mixed gestational trophoblastic neoplasms that were composed of choriocarcinoma and/or PSTT and/or ETT was also reported. Herein, we present a case of uterine mixed gestational trophoblastic neoplasm which is ETT admixed with PSTT, and reviewed 9 cases of mixed gestational trophoblastic neoplasms reported in English literature available. The most common combination was a choriocarcinoma admixed with an ETT and/or PSTT. Mixed gestational trophoblastic neoplasms present in women of reproductive age and rare in postmenopausal, Abnormal vaginal bleeding is the most common presenting symptom, serum β-HCG levels are elevated, mostly below 2500 mIU/ml, the tumor was limited to uterus in 7 cases, the rest of 3 with pulmonary metastases at the time of diagnosis. Mixed gestational trophoblastic neoplasms have more similar clinical features with intermediate trophoblastic tumors (ITTs). Total hysterectomy with lymph node dissection is recommended treatment for mixed gestational trophoblastic neoplasms, and chemotherapy should be used in patients with metastatic disease and with nonmetastatic disease who have adverse prognostic factors.

  5. Coexisting epithelioid trophoblastic tumor and placental site trophoblastic tumor of the uterus following a term pregnancy: report of a case and review of literature

    PubMed Central

    Zhang, Xiaofei; zhou, Caiyun; Yu, Minghua; Chen, Xiaoduan

    2015-01-01

    Gestational trophoblastic neoplasms are a group of fetal trophoblastic tumors including choriocarcinomas, epithelioid trophoblastic tumors (ETTs), and placental site trophoblastic tumors (PSTTs). Mixed gestational trophoblastic neoplasms are extremely rare. The existence of mixed gestational trophoblastic neoplasms that were composed of choriocarcinoma and/or PSTT and/or ETT was also reported. Herein, we present a case of uterine mixed gestational trophoblastic neoplasm which is ETT admixed with PSTT, and reviewed 9 cases of mixed gestational trophoblastic neoplasms reported in English literature available. The most common combination was a choriocarcinoma admixed with an ETT and/or PSTT. Mixed gestational trophoblastic neoplasms present in women of reproductive age and rare in postmenopausal, Abnormal vaginal bleeding is the most common presenting symptom, serum β-HCG levels are elevated, mostly below 2500 mIU/ml, the tumor was limited to uterus in 7 cases, the rest of 3 with pulmonary metastases at the time of diagnosis. Mixed gestational trophoblastic neoplasms have more similar clinical features with intermediate trophoblastic tumors (ITTs). Total hysterectomy with lymph node dissection is recommended treatment for mixed gestational trophoblastic neoplasms, and chemotherapy should be used in patients with metastatic disease and with nonmetastatic disease who have adverse prognostic factors. PMID:26261623

  6. Endotracheal Tube Cuff Pressure Following Intubation

    DTIC Science & Technology

    2005-09-08

    inflated ETT cuff. This method may lead to erroneous cuff pressures. Fernandez, Blanch, Mancebo, Bonsoms, and Artigas studied the accuracy of...Laryngologica, 345, suppl: 1-71. 10. Fernandez, R., Blanch, L., Mancebo, J., Bonsoms, N., Artigas , A. (1990). Endotracheal tube cuff pressure assessment

  7. Ease of intubation with the Parker Flex-Tip or a standard Mallinckrodt endotracheal tube using a video laryngoscope (GlideScope).

    PubMed

    Radesic, Brian P; Winkelman, Chris; Einsporn, Richard; Kless, Jack

    2012-10-01

    Two endotracheal tubes (ETTs) are available for use in operative suites for intubation: the Parker Flex-Tip (PFT, Parker Medical) and the standard Mallinckrodt (Covidien). To the authors' knowledge, no study has compared these 2 ETTs with each other when the anesthesia provider uses the GlideScope video laryngoscope (Verathon) for intubation. The purpose of the study was to determine if there are differences related to ease of intubation reported by anesthesia providers who use the PFT tube compared with the standard tube while using the GlideScope. The study was a randomized block intervention design. The sample consisted of 58 observed intubations in an operating room setting. Data analysis was completed with a 2-factor analysis of covariance using 2 covariates. The PFT tube in suboptimal conditions demonstrated a significantly greater ease of intubation, as measured by decreased time for ETT insertion and greater ease of ETT insertion score. The number of redirections at the glottis to intubate the trachea once the glottis was visualized was not statistically different. Based on the findings from this study, anesthesia providers may want to consider the use of the PFT tube when using the GlideScope to promote ease of intubation.

  8. The effect of lidocaine jelly on a taper-shaped cuff of an endotracheal tube on the postoperative sore throat: a prospective randomized study: A CONSORT compliant article.

    PubMed

    Lee, Jiwon; Lee, Yong-Cheol; Son, Je-Do; Lee, Jae-Yoon; Kim, Hyun-Chang

    2017-09-01

    Postoperative sore throat (POST) following general anesthesia with endotracheal intubation is a common complication. We hypothesized that lidocaine jelly applied to the tapered cuff of the endotracheal tube (ETT) might decrease the incidence of POST most commonly arising from endotracheal intubation. A total of 208 patients under general anesthesia were randomly assigned into 1 of 2 groups. In the lidocaine group (n = 104), the distal part of ETTs with tapered-shaped cuff was lubricated with lidocaine jelly. In the control group (n = 104), the distal part of ETTs with tapered-shaped cuff was lubricated with normal saline. The incidence of POST, hoarseness, and cough in the postanesthesia patients was compared. The overall incidence of POST was higher in the lidocaine group than in the normal saline group [60 (58%) vs 40 (39%), P = .006]. The incidence of POST at 1 hour postoperatively was higher in the lidocaine group than in the normal saline group [53 (51%) vs 32 (31%), P = .003]. The overall incidence of hoarseness for 24 hours postoperatively was comparable (P = .487). The overall incidence of cough for 24 hours postoperatively is higher in the lidocaine group (P = .045). The lidocaine jelly applied at the distal part of ETT with tapered-shaped cuff increased the overall incidence of POST in patients undergoing general anesthesia.

  9. 2011 North Plains research field 12-200 limited irrigation corn production study

    USDA-ARS?s Scientific Manuscript database

    The North Plains Water Conservation District started a water conservation project in 2010 on corn irrigation aimed at using just 12 inches of irrigation and producing 200 bu/ac of corn. This report is for 2011, the second year of the study, conducted at the North Plains Research Field (NPRF) in Ett...

  10. European Training Thesaurus: A Multilingual Synopsis

    ERIC Educational Resources Information Center

    Cedefop - European Centre for the Development of Vocational Training, 2012

    2012-01-01

    Education and training issues are similar across Europe, but how can we ensure we mean the same things with the same terms? The new format of the European training thesaurus (ETT) is a multilingual synopsis. It is an online tool enabling those working in education, training and employment to have a common understanding of terms. It helps…

  11. Interprocessor Communication Issues in Fat-Tree Architectures,

    DTIC Science & Technology

    1985-10-01

    34 CAMBRIDGE MASSA CHUS ETTS 0 2 1 3 9 VLSI Memo No. 85-268 October 1985 Interprocessor Communication Issues in Fat-Tree Architectures* Alexander Toichl...8217 + - .. ’ .’ .’+ .’ ’. . . . -. - ., ’. . . . .’’ .- . . - .’ . .. -, . .’% .. ’ .. +. ’ - " . , . ’. - .- . .°, ’ - . " ’ . ’ . .. . ,’ . -.... . .. ... ° ..ool Interprocessor Communication Issues in Fat-Tree

  12. Feasibility of a Novel Optoacoustic Device to Precisely Localize Endotracheal Tube Positioning in a Cadaver Model

    DTIC Science & Technology

    2016-11-02

    extubations are especially disastrous during casualty transport when clinical expertise and resources are limited. In the intensive care unit, at least 20% of...of inadvertent tube dislodgement. Physical examination has relatively low sensitivity for determining ETT position (primarily trachea vs. esophagus...of optical tomography (high optical contrast) and ultrasound imaging (minimal scattering of acoustic waves) to yield high contrast, sensitivity, and

  13. The effect of lidocaine jelly on a taper-shaped cuff of an endotracheal tube on the postoperative sore throat: a prospective randomized study

    PubMed Central

    Lee, Jiwon; Lee, Yong-Cheol; Son, Je-Do; Lee, Jae-Yoon; Kim, Hyun-Chang

    2017-01-01

    Abstract Background: Postoperative sore throat (POST) following general anesthesia with endotracheal intubation is a common complication. We hypothesized that lidocaine jelly applied to the tapered cuff of the endotracheal tube (ETT) might decrease the incidence of POST most commonly arising from endotracheal intubation. Methods: A total of 208 patients under general anesthesia were randomly assigned into 1 of 2 groups. In the lidocaine group (n = 104), the distal part of ETTs with tapered-shaped cuff was lubricated with lidocaine jelly. In the control group (n = 104), the distal part of ETTs with tapered-shaped cuff was lubricated with normal saline. The incidence of POST, hoarseness, and cough in the postanesthesia patients was compared. Results: The overall incidence of POST was higher in the lidocaine group than in the normal saline group [60 (58%) vs 40 (39%), P = .006]. The incidence of POST at 1 hour postoperatively was higher in the lidocaine group than in the normal saline group [53 (51%) vs 32 (31%), P = .003]. The overall incidence of hoarseness for 24 hours postoperatively was comparable (P = .487). The overall incidence of cough for 24 hours postoperatively is higher in the lidocaine group (P = .045). Conclusion: The lidocaine jelly applied at the distal part of ETT with tapered-shaped cuff increased the overall incidence of POST in patients undergoing general anesthesia. PMID:28906414

  14. Efficacy of benzydamine hydrochloride dripping at endotracheal tube cuff for prevention of postoperative sore throat.

    PubMed

    Nimmaanrat, Sasikaan; Chokkijchai, Kedsirin; Chanchayanon, Thavat

    2013-10-01

    Postoperative sore throat (POST) is a frequent consequence following ETT intubation, which may negatively affect the postoperative course and patient satisfaction. Benzydamine hydrochloride is a topically-applied non-steroidal anti-inflammatory drug (NSAID). The authors evaluated the analgesic effect of benzydamine hydrochloride dripping on the ETT cuff on POST. Eighty-six patients participated in this randomized controlled trial. They were assigned into either the benzydamine hydrochloride or the control group. The whole ETT cuff was dripped either with 3 ml (4.5 mg) of benzydamine hydrochloride or nothing five minutes prior to anesthesia induction. The incidence and severity of POST at 0, 2, 4, 6, 12 and 24 hours postoperatively were assessed. The potential adverse effects of benzydamine hydrochloride (throat numbness throat burning sensation, dry mouth, and thirst) were also evaluated. Twenty-five patients (58.14%) in each group had POST (p-value = 1). The severity of POST (calculated from affected patients) in both groups at different time points was not significantly different. Patients in the benzydamine hydrochloride group did not have a higher incidence of adverse effects. We found that dripping benzydamine hydrochloride on the ETT cuff neither reduced the incidence of POST nor increased the incidence of adverse effects in comparison with no intervention.

  15. Technologic advances in endotracheal tubes for prevention of ventilator-associated pneumonia.

    PubMed

    Fernandez, Juan F; Levine, Stephanie M; Restrepo, Marcos I

    2012-07-01

    Ventilator-associated pneumonia (VAP) is associated with high morbidity, mortality, and costs. Interventions to prevent VAP are a high priority in the care of critically ill patients requiring mechanical ventilation (MV). Multiple interventions are recommended by evidence-based practice guidelines to prevent VAP, but there is a growing interest in those related to the endotracheal tube (ETT) as the main target linked to VAP. Microaspiration and biofilm formation are the two most important mechanisms implicated in the colonization of the tracheal bronchial tree and the development of VAP. Microaspiration occurs when there is distal migration of microorganisms present in the secretions accumulated above the ETT cuff. Biofilm formation has been described as the development of a network of secretions and attached microorganisms that migrate along the ETT cuff polymer and inside the lumen, facilitating the transfer to the sterile bronchial tree. Therefore, our objective was to review the literature related to recent advances in ETT technologies regarding their impact on the control of microaspiration and biofilm formation in patients on MV, and the subsequent impact on VAP.

  16. The endotracheal tube microbiome associated with Pseudomonas aeruginosa or Staphylococcus epidermidis

    PubMed Central

    Hotterbeekx, An; Xavier, Basil B.; Bielen, Kenny; Lammens, Christine; Moons, Pieter; Schepens, Tom; Ieven, Margareta; Jorens, Philippe G; Goossens, Herman; Kumar-Singh, Samir; Malhotra-Kumar, Surbhi

    2016-01-01

    Ventilator-associated pneumonia (VAP) is one of the commonest hospital-acquired infections associated with high mortality. VAP pathogenesis is closely linked to organisms colonizing the endotracheal tube (ETT) such as Staphylococcus epidermidis and Pseudomonas aeruginosa, the former a common commensal with pathogenic potential and the latter a known VAP pathogen. However, recent gut microbiome studies show that pathogens rarely function alone. Hence, we determined the ETT microbial consortium co-colonizing with S. epidermidis or P. aeruginosa to understand its importance in the development of VAP and for patient prognosis. Using bacterial 16S rRNA and fungal ITS-II sequencing on ETT biomass showing presence of P. aeruginosa and/or S. epidermidis on culture, we found that presence of P. aeruginosa correlated inversely with patient survival and with bacterial species diversity. A decision tree, using 16S rRNA and patient parameters, to predict patient survival was generated. Patients with a relative abundance of Pseudomonadaceae <4.6% and of Staphylococcaceae <70.8% had the highest chance of survival. When Pseudomonadaceae were >4.6%, age of patient <66.5 years was the most important predictor of patient survival. These data indicate that the composition of the ETT microbiome correlates with patient prognosis, and presence of P. aeruginosa is an important predictor of patient outcome. PMID:27812037

  17. Predictors of Posterior Glottic Stenosis: A Multi-Institutional Case-Control Study.

    PubMed

    Hillel, Alexander T; Karatayli-Ozgursoy, Selmin; Samad, Idris; Best, Simon R A; Pandian, Vinciya; Giraldez, Laureano; Gross, Jennifer; Wootten, Christopher; Gelbard, Alexander; Akst, Lee M; Johns, Michael M

    2016-03-01

    To assess intrinsic and extrinsic risk factors in the development of posterior glottic stenosis (PGS) in intubated patients. Patients diagnosed with PGS between September 2012 and May 2014 at 3 tertiary care university hospitals were included. Patient demographics, comorbidities, duration of intubation, endotracheal tube (ETT) size, and indication for intubation were recorded. Patients with PGS were compared to control patients represented by patients intubated in intensive care units (ICU). Thirty-six PGS patients were identified. After exclusion, 28 PGS patients (14 male, 14 female) and 112 (65 male, 47 female) controls were studied. Multivariate analysis demonstrated ischemia (P < .05), diabetes (P < .01), and length of intubation (P < .01) were significant risk factors for the development of PGS. Fourteen of 14 (100%) males were intubated with a size 8 or larger ETT compared to 47 of 65 (72.3%) male controls (P < .05). Posterior glottic stenosis (P < .01), length of intubation (P < .001), and obstructive sleep apnea (P < .05) were significant risk factors for tracheostomy. Duration of intubation, ischemia, diabetes mellitus, and large ETT size (8 or greater) in males were significant risk factors for the development of PGS. Reducing the use of size 8 ETTs and earlier planned tracheostomy in high-risk patients may reduce the incidence of PGS and improve ICU safety. © The Author(s) 2015.

  18. Electronic topological transition in zinc metal? A 67Zn-Mössbauer investigation

    NASA Astrophysics Data System (ADS)

    Potzel, Walter

    2000-11-01

    The question concerning the existence of an electronic topological transition (ETT) in Zn metal under quasi-hydrostatic pressure at ˜6.6 GPa caused a considerable controversy in the literature. We briefly review low-temperature 67Zn-Mössbauer data and scalar-relativistic augmented plane wave calculations and give a consistent interpretation in terms of an ETT. To highlight some important aspects of the controversy two theoretical and two experimental publications will be discussed in more detail. At present the existence of an ETT in Zn metal is disputed both from an experimental and from a theoretical point of view. The suggestion of a transition to a commensurate spin-density wave at ˜6.6 GPa instead of an ETT may reconcile the seemingly contradictory results of 67Zn-Mössbauer experiments at 4.2 K and of room temperature inelastic neutron scattering measurements. However, it does not explain the anomalies found in theoretical calculations performed for Zn metal in this pressure range. Considerable experimental and theoretical efforts are required to confirm - or rule out - a spin-density-wave transition.

  19. Measurements of endotracheal tube cuff contact pressure using fibre Bragg gratings

    NASA Astrophysics Data System (ADS)

    Hernandez, F. U.; Correia, R.; Korposh, S.; Morgan, S. P.; Hayes-Gill, B. R.; James, S. W.; Evans, D.; Norris, A.

    2015-09-01

    An optical fibre Bragg grating (FBG) was used to measure local strain (due to contact pressure) at the interface of a cuffed endotracheal tube (ETT) tested in a tracheal model. The tracheal model consisted of a corrugated tube. Two FBG sensors written in a single optical fibre were attached to the outside wall of the cuff of the ETT. Intracuff endotracheal pressure was measured using a digital manometer, while the contact pressure between the model trachea and the ETT was measured using Flexiforce sensors. Changes in the Bragg wavelengths in response to the inflation of the cuff of the ETT, and concomitant pressure increase, were observed to be dependent on the location of the FBGs at the corrugations, i.e., the annular peaks and troughs of the corrugated tube. The performance of both contact pressure sensors FBG and Flexiforce suggests that FBG technology is better suited to this application as it allows the measurement of contact pressures on non-uniform surfaces such as in the tracheal model.

  20. Review of multiple endocrine neoplasia type 2A in children: therapeutic results of early thyroidectomy and prognostic value of codon analysis.

    PubMed

    Szinnai, Gabor; Meier, Christian; Komminoth, Paul; Zumsteg, Urs W

    2003-02-01

    The aim of this study was first to investigate whether early total thyroidectomy (ETT; 1-5 years of age) can prevent medullary thyroid carcinoma with persistent or recurrent disease (PRD) in pediatric patients with multiple endocrine neoplasia type 2A (MEN-2A) and second, to evaluate the strength of codon analysis in children with MEN-2A as prognostic parameter. Case reports and review of the literature for pediatric patients with MEN-2A were conducted. Inclusion criteria were age (0-20 years) and histologic degree of C-cell disease (normal = N, C-cell hyperplasia = CCH, medullary thyroid carcinoma = MTC, metastatic MTC = MMTC). To evaluate therapeutic results of ETT (1-5 years) versus late total thyroidectomy (LTT; 6-20 years), age-dependent histologic stages of C-cell disease and postoperative occurrence of PRD were compared. Prognostic value of specific codons, age-dependent histologic distribution, and long-term outcome were analyzed. In a total of 260 cases, 42 (16%) underwent ETT, and 218 (84%) underwent LTT. Histologic analysis showed significant difference between ETT versus LTT (57% vs 76%) regarding malignant stage of C-cell disease (of combined rate of MTC and MMTC). Long-term outcome was documented in 74 patients (28%). During a median follow-up period of 2 years (range: 0-15 years), 21 of 65 of the LTT group versus 0 of 9 of the ETT group suffered PRD. Information about codon analysis was available in 150 patients (58%). Mutated codons were c634 (63%), c618 (19%), c620 (9%), and c804 (6%). Codon-related histologic analysis resulted in prognostic differences: 81% of patients with c634-mutation had MCT or MMTC in contrast to c804 (44%), c618 (34%), and c620 (7%). Fifteen of 17 MMTC and 7 of 9 PRD occurred in patients with c634-mutation. 1) ETT until 5 years of age in MEN-2A gene carriers results in significant reduction of MTC and MMTC in favor of CCH and improved disease-free long-term outcome. 2) Codon analysis is an important prognostic factor. Timing

  1. Effect of Endotracheal Tube Size on Vocal Outcomes After Thyroidectomy: A Randomized Clinical Trial.

    PubMed

    Mehanna, Rania; Hennessy, Anthony; Mannion, Stephen; O'Leary, Gerard; Sheahan, Patrick

    2015-08-01

    The optimum size of endotracheal tube (ETT) for general anesthesia remains unresolved. Choice of ETT size may be of particular relevance to thyroid surgery because of the increased risk of laryngeal trauma and concerns regarding postoperative vocal outcomes. To test our hypothesis that intubation with a smaller ETT would lead to reduced postoperative vocal impairment and associated reduced laryngoscopic evidence of laryngeal trauma compared with intubation with a standard-size ETT. This double-blind randomized clinical trial studied patients 18 years and older undergoing elective thyroidectomy at an academic teaching hospital from October 15, 2012, through June 13, 2013. Patients were randomized to group 1 (standard-size ETT, 8.0 mm for men and 7.5 mm for women; n = 24) or group 2 (small ETT, 7.0 mm for men and 6.5 mm for women; n = 25). Patients were assessed preoperatively and at 24 hours and 3 weeks postoperatively. Fiberoptic videolaryngoscopy with modified scoring system, voice assessment using the GRBAS (grade, roughness, breathiness, asthenia, strain) rating scale, vocal self-assessment using the 30-item Voice Handicap Index, and subjective pain score. At 24 hours, no significant differences were found between patients in groups 1 and 2 in change in GRBAS scores, change in laryngoscopic score (1.71 vs 1.76, P = .90), or postoperative pain score (3.3 vs 3.2, P = .91). At 3 weeks, no significant differences were found in changes in the 30-item Voice Handicap Index score (-2.2 vs -1.3, P = .74), GRBAS scores, or laryngoscopic score (0.25 vs 0.16, P = .67). We did not find evidence that smaller ETT size for thyroidectomy has any significant effect on postoperative vocal outcomes, incidence of laryngeal trauma as assessed by laryngoscopy, or pain scores. However, because of the small sample size, our study may have been underpowered to detect small differences. clinicaltrials.gov Identifier: NCT02136459.

  2. Conventional Versus Video Laryngoscopy for Tracheal Tube Exchange: Glottic Visualization, Success Rates, Complications, and Rescue Alternatives in the High-Risk Difficult Airway Patient.

    PubMed

    Mort, Thomas C; Braffett, Barbara H

    2015-08-01

    Tracheal tube exchange is a simple concept but not a simple procedure because hypoxemia, esophageal intubation, and loss of airway may occur with life-threatening ramifications. Combining laryngoscopy with an airway exchange catheter (AEC) may lessen the exchange risk. Laryngoscopy is useful for a pre-exchange examination and to open a pathway for endotracheal tube (ETT) passage. Direct laryngoscopy (DL) is hampered by a restricted "line of sight"; thus, airway assessment and exchange may proceed blindly and contribute to difficulty and complications. We hypothesized that video laryngoscopy (VL), when compared with DL, will improve glottic viewing for airway assessment, and the VL-AEC method of ETT exchange will result in a reduction in airway and hemodynamic complications in high-risk patients when compared with a historical group of patients who underwent DL + AEC-assisted exchange. Critically ill patients requiring an ETT exchange underwent DL-assisted pre-exchange airway assessment. If the DL-assisted pre-exchange assessment rendered a "poor view," these patients underwent a VL-based airway assessment followed by a VL-assisted ETT exchange procedure. The DL and VL pre-exchange assessments were compared. The attempts, complications, and rescue devices required for ETT exchange were analyzed. These exchange results were then compared with a historical control group of patients who (1) were classified as a poor view on DL-assisted pre-exchange airway assessment; and (2) underwent a DL + AEC-assisted exchange. The airway assessment and ETT exchange were performed by a board-certified anesthesiologist from the Department of Anesthesiology alone or with anesthesia resident assistance. Three hundred twenty-eight patients with a poor view on initial DL examination underwent a subsequent VL with comparison of views with the 337 patients in the historical control group (DL + AEC). A majority (88%) had a "full or near-full view" on VL examination. The first-pass success

  3. Evaluating Risk Factors for Pediatric Post-extubation Upper Airway Obstruction Using a Physiology-based Tool

    PubMed Central

    Hotz, Justin; Morzov, Rica; Flink, Rutger; Kamerkar, Asavari; Ross, Patrick A.; Newth, Christopher J. L.

    2016-01-01

    Rationale: Subglottic edema is the most common cause of pediatric extubation failure, but few studies have confirmed risk factors or prevention strategies. This may be due to subjective assessment of stridor or inability to differentiate supraglottic from subglottic disease. Objectives: Objective 1 was to assess the utility of calibrated respiratory inductance plethysmography (RIP) and esophageal manometry to identify clinically significant post-extubation upper airway obstruction (UAO) and differentiate subglottic from supraglottic UAO. Objective 2 was to identify risk factors for subglottic UAO, stratified by cuffed versus uncuffed endotracheal tubes (ETTs). Methods: We conducted a single-center prospective study of children receiving mechanical ventilation. UAO was defined by inspiratory flow limitation (measured by RIP and esophageal manometry) and classified as subglottic or supraglottic based on airway maneuver response. Clinicians performed simultaneous blinded clinical UAO assessment at the bedside. Measurements and Main Results: A total of 409 children were included, 98 of whom had post-extubation UAO and 49 (12%) of whom were subglottic. The reintubation rate was 34 (8.3%) of 409, with 14 (41%) of these 34 attributable to subglottic UAO. Five minutes after extubation, RIP and esophageal manometry better identified patients who subsequently received UAO treatment than clinical UAO assessment (P < 0.006). Risk factors independently associated with subglottic UAO included low cuff leak volume or high preextubation leak pressure, poor sedation, and preexisting UAO (P < 0.04) for cuffed ETTs; and age (range, 1 mo to 5 yr) for uncuffed ETTs (P < 0.04). For uncuffed ETTs, the presence or absence of preextubation leak was not associated with subglottic UAO. Conclusions: RIP and esophageal manometry can objectively identify subglottic UAO after extubation. Using this technique, preextubation leak pressures or cuff leak volumes predict subglottic UAO in

  4. Improving aerosol drug delivery during invasive mechanical ventilation with redesigned components.

    PubMed

    Longest, P Worth; Azimi, Mandana; Golshahi, Laleh; Hindle, Michael

    2014-05-01

    Patients receiving invasive mechanical ventilation with an endotracheal tube (ETT) can often benefit from pharmaceutical aerosols; however, drug delivery through the ventilator circuit is known to be very inefficient. The objective of this study was to improve the delivery of aerosol through an invasive mechanical ventilation system by redesigning circuit components using a streamlining approach. Redesigned components were the T-connector interface between the nebulizer and ventilator line and the Y-connector leading to the ETT. The streamlining approach seeks to minimize aerosol deposition and loss by eliminating sharp changes in flow direction and tubing diameter that lead to flow disruption. Both in vitro experiments and computational fluid dynamic (CFD) simulations were applied to analyze deposition and emitted dose of drug for multiple droplet size distributions, flows, and ETT sizes used in adults. The experimental results demonstrated that the streamlined components improved delivery through the circuit by factors ranging from 1.3 to 1.5 compared with a commercial system for adult ETT sizes of 8 and 9 mm. The overall delivery efficiency was based on the bimodal aspect of the aerosol distributions and could not be predicted by median diameter alone. CFD results indicated a 20-fold decrease in turbulence in the junction region for the streamlined Y resulting in a maximum 9-fold decrease in droplet deposition. The relative effectiveness of the streamlined designs was found to increase with increasing particle size and increasing flow, with a maximum improvement in emitted dose of 1.9-fold. Streamlined components can significantly improve the delivery of pharmaceutical aerosols during mechanical ventilation based on an analysis of multiple aerosol generation devices, ETT sizes, and flows.

  5. End-tidal capnography and upper airway ultrasonography in the rapid confirmation of endotracheal tube placement in patients requiring intubation for general anaesthesia.

    PubMed

    Abhishek, Chintamani; Munta, Kartik; Rao, S Manimala; Chandrasekhar, C N

    2017-06-01

    Confirmation of correct endotracheal tube placement is essential immediately after intubation for general anaesthesia. In this study, we have compared upper airway ultrasonography (USG) with reference to capnography for rapid confirmation of endotracheal tube placement after general anaesthesia. A prospective, single centre, observational study was conducted on 100 patients requiring tracheal intubation for general anaesthesia. Both capnography and upper airway USG were performed immediately after intubation to confirm the endotracheal tube (ETT) placement. Sensitivity, specificity, and positive and negative predictive values of upper airway USG were determined against capnography as the reference method. Agreement between the methods and time required to determine ETT placement by the two methods were assessed with kappa statistics and Student's t-test. Upper airway USG detected all five cases of oesophageal intubation, but could not detect five patients with correct tracheal intubation. Upper airway USG had a sensitivity of 96.84% (95% confidence interval [CI]: 94.25%-96.84%), specificity of 100% (95% CI: 50.6%-100%), positive predictive value of 100% (95% CI: 97.3%-100%) and negative predictive value of 62.5% (95% CI: 31.6%-62.5%). Kappa value was found to be 0.76, indicating a good agreement between upper airway USG and capnography for confirmation of ETT placement. Time taken for confirmation of ETT by capnography was 8.989 ± 1.043 s vs. 12.0 ± 1.318 s for upper airway USG (P < 0.001). Both capnography and upper airway USG may be used as primary procedures for the confirmation of ETT placement.

  6. Tracheal tube cuff inflation guided by pressure volume loop closure associated with lower postoperative cuff-related complications: Prospective, randomized clinical trial

    PubMed Central

    Almarakbi, Waleed A.; Kaki, Abdullah M.

    2014-01-01

    Background: The main function of an endotracheal tube (ETT) cuff is to prevent aspiration. High cuff pressure is usually associated with postoperative complications. We tried to compare cuff inflation guided by pressure volume loop closure (PV-L) with those by just to seal technique (JS) and assess the postoperative incidence of sore throat, cough and hoarseness. Materials and Methods: In a prospective, randomized clinical trial, 100 patients’ tracheas were intubated. In the first group (n = 50), ETT cuff inflation was guided by PV-L, while in the second group (n. = 50) the ETT cuff was inflated using the JS technique. Intracuff pressures and volumes were measured. The incidence of postoperative cuff-related complications was reported. Results: Demographic data and durations of intubation were comparable between the groups. The use of PV-L was associated with a lesser amount of intracuff air [4.05 (3.7-4.5) vs 5 (4.8-5.5), P < 0.001] and lower cuff pressure than those in the JS group [18.25 (18-19) vs 33 (32-35), P ≤ 0.001]. The incidence of postextubation cuff-related complications was significantly less frequent among the PV-L group patients as compared with the JS group patients (P ≤ 0.009), except for hoarseness of voice, which was less frequent among the PV-L group, but not statistically significant (P ≤ 0.065). Multiple regression models for prediction of intra-cuff pressure after intubation and before extubation revealed a statistically significant association with the technique used for cuff inflation (P < 0.0001). Conclusions: The study confirms that PV-L-guided ETT cuff inflation is an effective way to seal the airway and associates with a lower ETT cuff pressure and lower incidence of cuff-related complications. PMID:25191181

  7. The effect of intracuff alkalinized 2% lidocaine on emergence coughing, sore throat, and hoarseness in smokers.

    PubMed

    Navarro, Laís Helena Camacho; Lima, Rodrigo Moreira e; Aguiar, Andressa Simões; Braz, José Reinaldo Cerqueira; Carness, Jeffrey M; Módolo, Norma Sueli Pinheiro

    2012-01-01

    We evaluated whether endotracheal tube (ETT) intracuff alkalinized lidocaine was superior to saline in blunting emergence coughing, postoperative sore throat, and hoarseness in smokers. In our prospective, double-blind trial, we enrolled 50 smoking patients undergoing surgery under general anesthesia including nitrous oxide (N2O). Patients were randomly allocated to receive either ETT intracuff 2% lidocaine plus 8.4% sodium bicarbonate (L group), or ETT intracuff 0.9% saline (S group). The ETT cuff was inflated to achieve a cuff pressure that prevented air leak during positive pressure ventilation. Incidence of emergence coughing, sore throat, and hoarseness were analyzed. The volume of inflation solution, the intracuff pressure, the duration of anesthesia, the time elapsed to extubation after discontinuation of anesthesia, and the volume of the inflation solution and the air withdrawn from the ETT cuff were also recorded. Intracuff alkalinized 2% lidocaine was superior to saline in blunting emergence coughing (p < 0.001). The incidence of sore throat was significantly lower in the L group at the post-anesthesia care unit (PACU) (p = 0.02). However, at 24 hours after extubation, sore throat incidence was similar in both groups (p = 0.07). Incidence of hoarseness was similar in both groups. Intracuff pressure in the saline group increased with time while the intracuff pressure in the lidocaine group remained constant. The present study demonstrated that the intracuff alkalinized 2% lidocaine was superior to saline in decreasing the incidence of emergence coughing and sore throat during the postoperative period in smokers.

  8. Does sealing endotracheal tube cuff pressure diminish the frequency of postoperative laryngotracheal complaints after nitrous oxide anesthesia?

    PubMed

    Braz, José Reinaldo Cerqueira; Volney, Alexandre; Navarro, Laís Helena Camacho; Braz, Leandro Gobbo; Nakamura, Giane

    2004-08-01

    To study endotracheal tube (ETT) cuff pressures during nitrous oxide (N2O) anesthesia when the cuffs are inflated with air to achieve sealing pressure, and to evaluate the frequency of postoperative laryngotracheal complaints. Prospective, randomized, blind study. Metropolitan teaching hospital. 50 ASA physical status I and II patients scheduled for elective abdominal surgery. Patients received standard general anesthesia with 66% N2O in oxygen. In 25 patients, the ETT cuff was inflated with air to achieve a sealing pressure (Pseal group). In 25 patients, the ETT cuff was inflated with air to achieve a pressure of 25 cm H2O (P25 group). ETT intracuff pressures were recorded before (control) and at 30, 60, 90, 120, and 150 minutes during N2O administration. We investigated the frequency and intensity of sore throat, hoarseness, and dysphagia in patients in the Post-Anesthesia Care Unit (PACU) and 24 hours following tracheal extubation. The cuff pressures in the Pseal group were significantly lower than in the P25 group at all time points studied (p < 0.001), with a significant increase with time in both groups (p < 0.001). The cuff pressures exceeded the critical pressure of 30 cm H2O only after 90 minutes in the Pseal group and already by 30 minutes in the P25 group. The frequency and intensity of sore throat, hoarseness, and dysphagia were similar in both groups in the PACU and 24 hours after tracheal extubation (p > 0.05). Minimum ETT sealing cuff pressure during N2O anesthesia did not prevent, but instead attenuated, the increase in cuff pressure and did not decrease postoperative laryngotracheal complaints. Copyright 2004 Elsevier Inc.

  9. Clinical evaluation of C-MAC videolaryngoscope with or without use of stylet for endotracheal intubation in patients with cervical spine immobilization.

    PubMed

    Gupta, Nidhi; Rath, Girija Prasad; Prabhakar, Hemanshu

    2013-10-01

    This study was carried out to evaluate the relative efficacy of the C-MAC videolaryngoscope as compared to the conventional Macintosh laryngoscope using both styletted and non-styletted endotracheal tube (ETT) in patients undergoing elective cervical spine surgery with head and neck stabilized by manual in-line stabilization. We randomized 120 consenting adults into four groups (30 each) to undergo tracheal intubation using either the Macintosh laryngoscope or C-MAC videolaryngoscope with styletted and non-styletted ETT. There was no significant difference between the C-MAC videolaryngoscope and Macintosh laryngoscope in Intubation Difficulty Scale (IDS) score using either styletted [median (IQR) 2 (1, 3) vs. 3 (2, 4); p = 0.58] or non-styletted ETT [median (IQR) 4 (2, 6) vs. 3 (2, 8); p = 1.00]. Similarly, when using a similar ETT-stylet assembly, the duration of successful intubation attempt, first attempt success rate, complications, use of airway optimization maneuvers, and adjuncts to facilitate intubation were comparable. The Cormack-Lehane view of the glottis was better with the C-MAC videolaryngoscope (p < 0.001). The use of stylet significantly reduced the IDS score [median (IQR) 2 (1, 3) vs. 4 (2, 6); p = 0.02], intubation time [median (IQR) 27 s (23, 31) vs. 52 s (28, 76); p < 0.001], and use of gum elastic bougie (3.3% vs. 43.3%, p < 0.001) with the C-MAC videolaryngoscope whereas no such effect was observed with the Macintosh laryngoscope. Use of the C-MAC videolaryngoscope and Macintosh laryngoscope resulted in similar levels of intubation difficulty during cervical immobilization when used with a similar ETT-stylet assembly. The inclusion of the stylet significantly reduced the intubation difficulty experienced with the C-MAC videolaryngoscope.

  10. Development and evaluation of a treadmill-based exercise tolerance test in cardiac rehabilitation

    PubMed Central

    Adams, Jenny; Cheng, Dunlei; Barton, Stephanie; Bigej-Cerqua, Janet; Mims, Lisa; Molden, Jennifer; Anderson, Valerie

    2013-01-01

    Cardiac rehabilitation exercise prescriptions should be based on exercise stress tests; however, limitations in performing stress tests in this setting typically force reliance on subjective measures like the Duke Activity Status Index (DASI). We developed and evaluated a treadmill-based exercise tolerance test (ETT) to provide objective physiologic measures without requiring additional equipment or insurance charges. The ETT is stopped when the patient's Borg scale rating of perceived exertion (RPE) reaches 15 or when any sign/symptom indicates risk of an adverse event. Outcomes of the study included reasons for stopping; maximum heart rate, systolic blood pressure, and rate pressure product; and adverse events. We tested equivalence to the DASI as requiring the 95% confidence interval for the mean difference between DASI and ETT metabolic equivalents (METs) to fall within the range (–1, 1). Among 502 consecutive cardiac rehabilitation patients, one suffered a panic attack; no other adverse events occurred. Most (80%) stopped because they reached an RPE of 15; the remaining 20% were stopped on indications that continuing risked an adverse event. Mean maximum systolic blood pressure, heart rate, and rate pressure product were significantly (P < 0.001) below thresholds of the American Association of Cardiovascular and Pulmonary Rehabilitation. Two patients’ heart rates exceeded 150 beats per minute, but their rate pressure products remained below 36,000. The mean difference between DASI and ETT METs was −0.8 (−0.98, −0.65), indicating equivalence at our threshold. In conclusion, the ETT can be performed within cardiac rehabilitation, providing a functional capacity assessment equivalent to the DASI and objective physiologic measures for developing exercise prescriptions and measuring progress. PMID:23814381

  11. [Kinking of the endotracheal tube in a prone patient associated with the inadequate withdrawal maneuver of the Pentax-AWS Airway Scope].

    PubMed

    Ohata, Hiroto; Iida, Yuko; Kito, Kazuhiro; Kawamura, Michika; Yamashita, Mika; Ohta, Shuichiro; Ueda, Norio; Iida, Hiroki

    2013-06-01

    We report a case of intraoperative kinking of an endotracheal tube (ETT) in a prone patient during spine surgery. We postulate that one of the risk factors involved with kinking was the inadequate withdrawal maneuver of Pentax-AWS Airway Scope (AWS). Patient was a 69-year-old woman with hypertension, diabetes mellitus, and rheumatoid arthritis, undergoing C4-6 laminoplasty under general anesthesia in the prone position. A 7.0-mm polyvinyl endotracheal tube (Paker Flex-Tip Tube) was placed to 21 cm at the right angle of the mouse without difficulty using the AWS. Both peak inspiratory pressure (PIP) and partial pressure of end-tidal carbon dioxide began to rise gradually from 24 to 28 cmH2O and 38 to 44 mmHg, respectively. Although over 30 cmH2O in PIP repeatedly appeared after that, we did not find any remarkable change of ventilation except for weak breath sound. Thereafter, when we checked the tube with a flexible fiberoptic bronchoscope, it could not pass through the tube. At first, we asked the surgeon to release neck flexion as much as possible. This procedure could not correct the kink completely but allowed the passage of bronchoscope in the ETT. Then, we tried to reposition the ETT by inserting the bronchoscope beyond the point of kinking for maintaining luminal patency and adequate ventilation. The subsequent anesthetic course was uneventful. Kinking of the ETT in the oral cavity is an uncommon problem but we must keep in mind as one of the differential diagnoses. When using the AWS for endotracheal intubation, we recommend the confirmation of the position of the ETT to be normal in the oral cavity by direct laryngoscopy.

  12. Discovery of the ergothioneine transporter

    PubMed Central

    Gründemann, Dirk; Harlfinger, Stephanie; Golz, Stefan; Geerts, Andreas; Lazar, Andreas; Berkels, Reinhard; Jung, Norma; Rubbert, Andrea; Schömig, Edgar

    2005-01-01

    Variants of the SLC22A4 gene are associated with susceptibility to rheumatoid arthritis and Crohn's disease. SLC22A4 codes for an integral membrane protein, OCTN1, that has been presumed to carry organic cations like tetraethylammonium across the plasma membrane. Here, we show that the key substrate of this transporter is in fact ergothioneine (ET). Human OCTN1 was expressed in 293 cells. A substrate lead, stachydrine (alias proline betaine), was identified by liquid chromatography MS difference shading, a new substrate search strategy. Analysis of transport efficiency of stachydrine-related solutes, affinity, and Na+ dependence indicates that the physiological substrate is ET. Efficiency of transport of ET was as high as 195 μl per min per mg of protein. By contrast, the carnitine transporter OCTN2 from rat did not transport ET at all. Because ET is transported >100 times more efficiently than tetraethylammonium and carnitine, we propose the functional name ETT (ET transporter) instead of OCTN1. ET, all of which is absorbed from food, is an intracellular antioxidant with metal ion affinity. Its particular purpose is unresolved. Cells with expression of ETT accumulate ET to high levels and avidly retain it. By contrast, cells lacking ETT do not accumulate ET, because their plasma membrane is virtually impermeable for this compound. The real-time PCR expression profile of human ETT, with strong expression in CD71+ cells, is consistent with a pivotal function of ET in erythrocytes. Moreover, prominent expression of ETT in monocytes and SLC22A4 polymorphism associations suggest a protective role of ET in chronic inflammatory disorders. PMID:15795384

  13. Pressure attenuation during high-frequency airway clearance therapy across different size endotracheal tubes: An in vitro study.

    PubMed

    Smallwood, Craig D; Bullock, Kevin J; Gouldstone, Andrew

    2016-08-01

    High-frequency airway clearance therapy is a positive pressure secretion clearance modality used in pediatric and adult applications. However, pressure attenuation across different size endotracheal tubes (ETT) has not been adequately described. This study quantifies attenuation in an in vitro model. The MetaNeb® System was used to deliver high-frequency pressure pulses to 3.0, 4.0, 6.0 and 8.0mm ID ETTs connected to a test lung during mechanical ventilation. The experimental setup included a 3D-printed trachea model and imbedded pressure sensors. The pressure attenuation (Patt%) was calculated: Patt%=[(Pproximal-Pdistal)/Pproximal]x100. The effect of pulse frequency on Pdistal and Pproximal was quantified. Patt% was inversely and linearly related to ETT ID and (y=-7.924x+74.36; R(2)=0.9917, P=.0042 for 4.0Hz pulse frequency and y=-7.382+9.445, R(2)=0.9964, P=.0018 for 3.0Hz pulse frequency). Patt% across the 3.0, 4.0, 6.0 and 8.0mm I.D. ETTs was 48.88±10.25%, 40.87±5.22%, 27.97±5.29%, and 9.90±1.9% respectively. Selecting the 4.0Hz frequency mode demonstrated higher Pproximal and Pdistal compared to the 3.0Hz frequency mode (P=.0049 and P=.0065). Observed Pdistal was <30cmH2O for all experiments. In an in vitro model, pressure attenuation was linearly related to the inner diameter of the endotracheal tube; with decreasing attenuation as the ETT size increased. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Comparative efficiency of exercise stress testing with and without stress-only myocardial perfusion imaging in patients with low-risk chest pain.

    PubMed

    Amirian, Jossef; Javdan, Omid; Misher, Jason; Diamond, Joseph; Raio, Christopher; Rudolph, Gary; Druz, Regina S

    2017-01-12

    To compare major adverse cardiac event (MACE), downstream resource utilization, and direct cost of care for low-risk chest pain patients observed in the clinical decision unit (CDU) with exercise treadmill testing (ETT) and with stress-only myocardial perfusion imaging (sMPI). CDUs are poised to increase efficiency and resource utilization. However, the optimal testing strategy that would assure favorable outcomes while decreasing cost is not defined. 1016 subjects from 2 locations were propensity score-matched (PSM) by age, gender, pre-test likelihood, Duke treadmill score, and test results. Outcomes were length of stay >24 hours, MACE (acute coronary syndrome, revascularization, cardiac death), downstream resource use (admission for chest pain, repeat testing, angiography), and mean direct cost per patient. PSM yielded 680 patients (340 matches). 98% of all tests were normal. 96.6% of patients were discharged from the CDU within 24 hours but twice as many exceeded 24 hours in the sMPI group. There were no cardiac deaths. MACE rate was 1.47% at 72 hours and 1% at 1 year. Downstream resource use was 4.82% at 72 hours, and 7.69% at 1 year. The sMPI group was event-free longer than the ETT group reflecting less repeat testing. The mean direct cost was 30% higher for sMPI ($3168.70) vs. ETT ($2226.96). Low-risk chest pain patients in the observation unit had low MACE rate, not different for ETT vs. sMPI. The majority of ETT and sMPI tests were normal. The sMPI reduced additional testing, but resulted in greater expense and longer stay.

  15. Lipase degradation of plasticized polyvinyl chloride endotracheal tube surfaces to create nanoscale features.

    PubMed

    Machado, Mary C; Webster, Thomas J

    2017-01-01

    Polyvinyl chloride (PVC) endotracheal tubes (ETTs) nanoetched with a fungal lipase have been shown to reduce bacterial growth and biofilm formation and could be an inexpensive solution to the complex problem of ventilator-associated pneumonia (VAP). Although bacterial growth and colonization on these nanoetched materials have been well characterized, little is known about the mechanism by which the fungal lipase degrades the PVC and, thus, alters its properties to minimize bacteria functions. This study used X-ray photoelectron spectroscopy (XPS) and attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) to better describe the surface chemistry of both unetched and lipase nanoetched PVC ETT. ATR-FTIR analysis of the unetched and treated surfaces showed a similar presence of a plasticizer. This was confirmed by XPS analysis, which showed an increase of carbon and the presence of oxygen on both unetched and nanoetched surfaces. A quantitative comparison of the FTIR spectra revealed significant correlations (Pearson's correlation, R=0.997 [R(2)=0.994, P<0.001]) between the unetched and nanomodified PVC ETT spectra, demonstrating similar surface chemistry. This analysis showed no shifting or widening of the bands in the spectra and no significant changes in the intensity of the infrared peaks due to the degradation of the plasticizer by the fungal lipase. In contrast, results from this study did demonstrate significantly increased nanoscale surface features on the lipase etched compared to non-etched PVC ETTs. This led to a change in surface energetics, which altered ion adsorption to the ETTs. Thus, these results showed that PVC surfaces nanoetched with a 0.1% lipase solution for 48 hours have no significant change on surface chemistry but do significantly increase nanoscale surface roughness and alters ion adsorption, which suggests that the unique properties of these materials, including their previously reported ability to decrease

  16. Impact of endotracheal tube size on preextubation respiratory variables.

    PubMed

    Mehta, Sangeeta; Heffer, Matthew J; Maham, Nava; Nelson, David L; Klinger, James R; Levy, Mitchell M

    2010-09-01

    Many parameters have been evaluated to predict successful extubation. These are all affected by extrapulmonary variables. The purpose of this study was to evaluate the effect of endotracheal tube (ETT) size on preextubation predictors of successful extubation. Twenty-two intubated and mechanically ventilated subjects were recruited when ready for extubation. Subjects were ventilated with T-piece, continuous positive airway pressure (CPAP) of 5 cm H(2)O, and pressure support ventilation (PSV) of 5 cm H(2)O in randomized order for 15 minutes each. Pulmonary mechanics-including respiratory frequency (f), tidal volume (V(T)), f/V(T) ratio, negative change in esophageal pressure, pressure time product (PTP), work of breathing, and the airway occlusion pressure 100 milliseconds after the onset of inspiratory flow-were measured using a microprocessor-based monitor at the end of each interval. After extubation, measurement of pulmonary mechanics was repeated at 15 and 60 minutes. In patients with 7.0- or 7.5-mm ETT compared with patients with 8.0-mm ETT, (1) f was significantly higher during all ventilatory modes and 15 minutes after extubation; (2) V(T) during PSV and CPAP was significantly lower; (3) mean f/V(T) was significantly higher (122 ± 57 vs 69 ± 35, P = .026); and (4) PTP was significantly higher during CPAP, PSV, and 15 minutes after extubation. There was a nonsignificant trend toward increased negative change in esophageal pressure, work of breathing, and airway occlusion pressure 100 milliseconds after the onset of inspiratory flow in the smaller-ETT group. The ETT size has a significant impact on f, V(T), f/V(T) ratio, and PTP. Copyright © 2010 Elsevier Inc. All rights reserved.

  17. Exercise-induced ischemia initiates the second window of protection in humans independent of collateral recruitment.

    PubMed

    Lambiase, Pier D; Edwards, Richard J; Cusack, Michael R; Bucknall, Clifford A; Redwood, Simon R; Marber, Michael S

    2003-04-02

    This study was designed to examine if exercise-induced ischemia initiated late preconditioning in humans that becomes manifest during subsequent exercise and serial balloon occlusion of the left anterior descending coronary artery (LAD). The existence of late preconditioning in humans is controversial. We therefore compared myocardial responses to exercise-induced and intracoronary balloon inflation-induced ischemia in two groups of patients subjected to different temporal patterns of ischemia. Thirty patients with stable angina secondary to single-vessel LAD disease underwent percutaneous coronary intervention (PCI) after two separate exercise tolerance test (ETT) protocols designed to investigate isolated early preconditioning (IEP) alone or the second window of protection (SWOP). The IEP subjects underwent three sequential ETTs at least two weeks before PCI. The SWOP subjects underwent five sequential ETTs commencing 24 h before PCI. During PCI there was no significant difference in intracoronary pressure-derived collateral flow index (CFI) between groups (IEP = 0.15 +/- 0.13, SWOP = 0.19 +/- 0.15). In SWOP patients, compared with the initial ETT, the ETT performed 24 h later had a 40% (p < 0.001) increase in time to 0.1-mV ST depression and a 60% (p < 0.05) decrease in ventricular ectopic frequency. During the first balloon inflation, peak ST elevation was reduced by 49% (p < 0.05) in the SWOP versus the IEP group, and the dependence on CFI observed in the IEP group was abolished (analysis of covariance, p < 0.05). The significant attenuation of ST elevation (47%, p < 0.005) seen at the time of the second inflation in the IEP patients was not seen in the SWOP patients. Exercise-induced ischemia triggers late preconditioning in humans, which becomes manifest during exercise and PCI. This is the first evidence that ischemia induced by coronary occlusion is attenuated in humans by a late preconditioning effect induced by exercise.

  18. Exercise testing in asymptomatic gene carriers exposes a latent electrical substrate of arrhythmogenic right ventricular cardiomyopathy.

    PubMed

    Perrin, Mark J; Angaran, Paul; Laksman, Zachary; Zhang, Hanfei; Porepa, Liane F; Rutberg, Julie; James, Cynthia; Krahn, Andrew D; Judge, Daniel P; Calkins, Hugh; Gollob, Michael H

    2013-11-05

    The aim of this study was to determine if exercise testing could expose a latent electrical substrate of arrhythmogenic right ventricular cardiomyopathy (ARVC) in asymptomatic gene carriers. Management of asymptomatic ARVC gene carriers is challenging because of variable penetrance of disease and the recognition that sudden cardiac death may be the first clinical manifestation. Exercise-induced abnormalities during exercise treadmill testing (ETT) were initially compared in 60 subjects: 30 asymptomatic ARVC gene carriers and 30 healthy controls. In phase 2 of the study, ETT results of 25 patients with ARVC with histories of sustained ventricular arrhythmia or cardiac arrest were evaluated to determine if ETT abnormalities in asymptomatic gene carriers were common to patients with a malignant electrical form of the disease. Depolarization abnormalities during ETT were found to develop more frequently in asymptomatic gene carriers compared with healthy controls: epsilon waves appeared in 4 of 28 (14%) compared with 0 of 30 (0%) (p = 0.048), premature ventricular contractions in 17 of 30 (57%) compared with 3 of 30 (10%) (p = 0.0003), and new QRS terminal activation duration ≥ 55 ms in 7 of 22 (32%) compared with 2 of 29 (7%) (p = 0.03). Superior axis premature ventricular contractions occurred only in gene carriers. In the second phase of the study, the frequency of these abnormalities was found to be high in patients with symptomatic ARVC: new epsilon waves appeared in 3 of 18 (17%), superior axis premature ventricular contractions in 21 of 25 (84%), and new terminal activation duration ≥ 55 ms in 8 of 12 (67%). Exercise testing exposes a latent electrical substrate in asymptomatic ARVC gene carriers that is shared by patients with ARVC with histories of ventricular arrhythmia. ETT may be useful in guiding treatment decisions, exercise prescription, and prioritizing medical surveillance in asymptomatic ARVC gene carriers. Copyright © 2013 American College of

  19. Is Neuromuscular Blocker Necessary in Pediatric Patients Undergoing Laparoscopic Inguinal Hernia Repair with Percutaneous Internal Ring Suturing?

    PubMed

    Ahiskalioglu, Ali; İnce, İlker; Ahiskalioglu, Elif Oral; Oral, Akgun; Aksoy, Mehmet; Yiğiter, Murat; Celikkaya, Mehmet Emin; Salman, Ahmet Bedii

    2017-06-01

    Purpose The aim of this study is to evaluate operating conditions during general anesthesia with or without neuromuscular blocker (NMB) in patients undergoing percutaneous internal ring suturing (PIRS). Materials and Methods In this study, 40 patients, with American Society of Anesthesiologists I and II between the ages of 1 and 12 years, were randomly assigned to two groups to receive muscle relaxant with endotracheal tube (ETT) (ETT group) or without muscle relaxant with supreme laryngeal mask airway (sLMA) (LMA group). Anesthesia was maintained with sevoflurane in oxygen (Fio 2 0.3-0.5), thiopental sodium, fentanyl, and rocuronium in ETT group. In LMA group, same protocol was used without rocuronium. Heart rate, blood pressure, peak airway pressure, end-tidal carbon dioxide (EtCO2), and Spo 2 were recorded before and during pneumoperitoneum maintained at a pressure of 8 to 10 mm Hg. Duration of surgery, recovery time, anesthetic time, and grade of quality view were also recorded. Airway problems (cough, hoarseness, laryngospasm, and aspiration) were recorded. Results In LMA group, there was a statistically significant reduction in recovery time versus ETT group (11.6 ± 4.08 vs. 17.15 ± 5.32 minutes; p = 0,001). There were no statistically significant differences grade of quality view between the two groups (p = 0.548). There were no statistically significant differences in oxygen saturation (Spo 2), peak airway pressure, and EtCO2 between the two groups before or during insufflation (p > 0.05). Postoperative airway complications were significantly more prevalent in the ETT group. There was no case of inadequate ventilation, regurgitation, or aspiration recorded. Conclusion sLMA is safe and suitable alternative to ETT and NMB is not necessary in general anesthesia with sLMA, pediatric patients undergoing laparoscopic hernia repair with PIRS. Georg Thieme Verlag KG Stuttgart · New York.

  20. Effects of intrapulmonary percussive ventilation on airway mucus clearance: A bench model

    PubMed Central

    Fernandez-Restrepo, Lorena; Shaffer, Lauren; Amalakuhan, Bravein; Restrepo, Marcos I; Peters, Jay; Restrepo, Ruben

    2017-01-01

    AIM To determine the ability of intrapulmonary percussive ventilation (IPV) to promote airway clearance in spontaneously breathing patients and those on mechanical ventilation. METHODS An artificial lung was used to simulate a spontaneously breathing patient (Group 1), and was then connected to a mechanical ventilator to simulate a patient on mechanical ventilation (Group 2). An 8.5 mm endotracheal tube (ETT) connected to the test lung, simulated the patient airway. Artificial mucus was instilled into the mid-portion of the ETT. A filter was attached at both ends of the ETT to collect the mucus displaced proximally (mouth-piece filter) and distally (lung filter). The IPV machine was attached to the proximal end of the ETT and was applied for 10-min each to Group 1 and 2. After each experiment, the weight of the various circuit components were determined and compared to their dry weights to calculate the weight of the displaced mucus. RESULTS In Group 1 (spontaneously breathing model), 26.8% ± 3.1% of the simulated mucus was displaced proximally, compared to 0% in Group 2 (the mechanically ventilated model) with a P-value of < 0.01. In fact, 17% ± 1.5% of the mucus in Group 2 remained in the mid-portion of the ETT where it was initially instilled and 80% ± 4.2% was displaced distally back towards the lung (P < 0.01). There was an overall statistically significant amount of mucus movement proximally towards the mouth-piece in the spontaneously breathing (SB) patient. There was also an overall statistically significant amount of mucus movement distally back towards the lung in the mechanically ventilated (MV) model. In the mechanically ventilated model, no mucus was observed to move towards the proximal/mouth piece section of the ETT. CONCLUSION This bench model suggests that IPV is associated with displacement of mucus towards the proximal mouthpiece in the SB patient, and distally in the MV model. PMID:28828301

  1. [A new bite block also serving as an endotracheal tube holder for infants].

    PubMed

    Kitamura, S; Fukumitsu, K; Taniguchi, A; Kinouchi, K; Tamai, H

    1999-08-01

    We developed a new type of bite block with a combined function as an endotracheal tube (ETT) holder for infants and small children to prevent airway troubles caused by tube kinking, dislodging, extubation and oral membrane trauma. One mm thick plastic plate sized 3.5 x 2 cm was curved to make an open roll. The outer surface of the roll was covered and glued with soft plastic tube (5.0 mm ID endotracheal tube), cut in 3.5 cm length to give an elastic outer surface for the patient's comfort. The rolled ends were diagonally cut to make an oblique slit of 3 mm width. A t-shaped flange made of soft vinyl plate was fixed at a third of the length of the roll to maintain the block's position relative to the lips and to make the fixation of the tube easier. In practical use, after endotracheal intubation is performed as usual, this bite block is put into the mouth and positioned at the oral angle with the flange on the patient's skin. The ETT is fit into the slit of the roll. The skin-facing surface of the flange is pasted to the skin with the double stick material usually used for colostomy stoma. The ETT and the bite block are fixed en bloc with fixing tapes around the mouth. Our bite block has following advantages over other types of bite blocks and tube holders especially for children; 1) the volume of foreign bodies (ETT and bite block) occupying the oral cavity can be reduced and this attenuates the patient's discomfort, 2) good holding of the ETT can prevent its dislodging and decrease the incidence of accidental extubation and 3) suctioning is easier because of wide oral space. The four sizes of the bite block suitable for 4.0, 4.5, 5.0, 5.5 and 6.0 mm ID ETTs are manufactured. We applied this device to several ICU patients and found its use practical and safe.

  2. Clinical value and severity of myocardial perfusion defects in asymptomatic diabetic patients with negative or weakly positive exercise treadmill test

    PubMed Central

    Zakavi, Seyed Rasoul; Taherpour, Mehdi; Moossavi, Zohreh; Sadeghi, Ramin; Kakhki, Vahidreza Dabbagh; Rokni, Haleh

    2013-01-01

    Objective: Although coronary artery disease (CAD) is the leading cause of death in type 2 diabetic patients, it is frequently asymptomatic. Myocardial perfusion imaging (MPI) is reported to show ischemia in a significant number of asymptomatic diabetic patients. We studied the prevalence and severity of myocardial perfusion defects in asymptomatic diabetic patients and its clinical impact. Methods and patients: One hundred thirty consecutive asymptomatic patients, aged 35-65 years with type 2 diabetes mellitus and with no history of CAD and no cardiac symptoms were recruited in the study. Echocardiography, electrocardiography (ECG), routine laboratory tests and exercise treadmill test (ETT) were performed and patients with weakly positive or negative ETT underwent Dipyridamole MPI. Patients with positive ETT were referred to coronary angiography. Patients were followed for at least 17 months (mean 21.7 months) and any cardiac event was recorded. Results: We studied 81 female and 49 male patients with mean age of 51.8 years. Negative, weakly positive and positive ETT result was noted in 74.3%, 15% and 10.7% respectively. 75% of patients with positive ETT had coronary artery disease in angiography. Gated myocardial perfusion SPECT was done in 106 patients. MPI showed reversible defect in 26.9% of the patients with a mean summed stress score of 3.3±1.8. Follow up completed in 112 patients and only one patient with abnormal MPI underwent coronary angiography followed by PTCA. No cardiac death, MI, UA or hospital admission occurred among our patients during follow up (17-26 months). Mean stress end diastolic volume (EDV) was significantly higher in patients with reversible defect compared to patients without reversible defect based on MPI findings (62.0±31.6 Vs 48.5±18.4 ml, P=0.04). Blood glucose and HbA1c were significantly higher in patients with ischemia compared to patients without ischemia (P<0.05). Meanwhile the ratio of TG to HDL was 6.06±3.2 in ischemic

  3. Survival time of endodontically treated teeth: a 7-year retrospective clinical study

    NASA Astrophysics Data System (ADS)

    Baldea, Bogdan; Canjau, Silvana; Popescu, Dragos; Tudor, Anca; Todea, Carmen

    2014-01-01

    The aim of this retrospective clinical study was to examine the survival time of endodontically treated teeth (ETT) and the factors that may influence the failure risk, over a period of up to 7 years. The files of 67 patients that received metal free post and core restorations using a standardized technique were analyzed. The survival probability was assessed using Kaplan-Meyer analysis and Log Rank (Matel-Cox). Cox regression was used to assess the risk of failure and to identify possible covariates. The average survival time of the ETT was 6.6 Years. The cumulative failure rate was 5.82% for all type of the restored endodontically treated teeth. The main failure type was encountered in the cervical area of the teeth, and due to the extensive hard tissue loss, the teeth were extracted.

  4. Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes

    PubMed Central

    Xu, Rui; Lian, Ying; Li, Wen Xian

    2016-01-01

    Objective Flexible laryngeal mask airways (FLMAs) have been widely used in thyroidectomy as well as cleft palate, nasal, upper chest, head and neck oncoplastic surgeries. This systematic review aims to compare the incidence of airway complications that occur during and after general anesthesia when using the FLMA and endotracheal intubation (ETT). We performed a quantitative meta-analysis of the results of randomized trials. Methods A comprehensive search of the PubMed, Embase and Cochrane Library databases was conducted using the key words "flexible laryngeal mask airway" and "endotracheal intubation". Only prospective randomized controlled trials (RCTs) that compared the FLMA and ETT were included. The relative risks (RRs) and the corresponding 95% confidence intervals (95% CIs) were calculated using a quality effects model in MetaXL 1.3 software to analyze the outcome data. Results Ten RCTs were included in this meta-analysis. There were no significant differences between the FLMA and ETT groups in the incidence of difficulty in positioning the airway [RR = 1.75, 95% CI = (0.70–4.40)]; the occurrence of sore throat at one hour and 24 hours postoperative [RR = 0.90, 95% CI = (0.13–6.18) and RR = 0.95, 95% CI = (0.81–1.13), respectively]; laryngospasms [RR = 0.58, 95% CI = (0.27–1.23)]; airway displacement [RR = 2.88, 95% CI = (0.58–14.33)]; aspiration [RR = 0.76, 95% CI = (0.06–8.88)]; or laryngotracheal soiling [RR = 0.34, 95% CI = (0.10–1.06)]. Patients treated with the FLMA had a lower incidence of hoarseness [RR = 0.31, 95% CI = (0.15–0.62)]; coughing [RR = 0.28, 95% CI = (0.15–0.51)] during recovery in the postanesthesia care unit (PACU); and oxygen desaturation [RR = 0.43, 95% CI = (0.26–0.72)] than did patients treated with ETT. However, the incidence of partial upper airway obstruction in FLMA patients was significantly greater than it was for ETT patients [RR = 4.01, 95% CI = (1.44–11.18)]. Conclusion This systematic review showed

  5. Laryngeal mask airways in ear, nose, and throat procedures.

    PubMed

    Mandel, Jeff E

    2010-09-01

    The use of laryngeal mask airway (LMA) and its variants in ear, nose, and throat procedures have been extensively described in case reports, retrospective reviews, and randomized clinical trials. The LMA has developed a considerable following because of its lack of tracheal stimulation, which can be a considerable advantage in ear, nose, and throat (ENT) procedures. The incidence of coughing on emergence has been shown to be lower with the LMA than with the endotracheal tube (ETT). Although other approaches to smooth emergence have been described, few would argue that it is as easy to achieve a smooth emergence with an ETT as with an LMA. Although patients certainly exist for whom the LMA is contraindicated, many will experience better results with the LMA because of the features delineated in this article.

  6. Ultrasonography of Extravaginal Testicular Torsion in Neonates

    PubMed Central

    Bombiński, Przemysław; Warchoł, Stanisław; Brzewski, Michał; Majkowska, Zofia; Dudek-Warchoł, Teresa; Żerańska, Maria; Panek, Małgorzata; Drop, Magdalena

    2016-01-01

    Summary Background Extravaginal testicular torsion (ETT), also called prenatal or perinatal, occurs prenatally and is present at birth or appears within the first month of life. It has different etiology than intravaginal torsion, which appears later in life. Testicular torsion must be taken into consideration in differential diagnosis of acute scrotum and should be confirmed or ruled out at first diagnostic step. Ultrasonography is a basic imaging modality, however diagnostic pitfalls are still possible. There is still wide discussion concerning management of ETT, which varies from immediate orchiectomy to conservative treatment resulting in testicle atrophy. Material/Methods In this article we present ultrasonographic spectrum of ETT in neonates, which were diagnosed and treated in our hospital during the last 8 years (2008–2015), in correlation with clinical and intraoperative findings. Results Thirteen neonates with ETT were enrolled in the study – 11 patients with a single testicle affected and 2 patients with bilateral testicular torsion. Most common signs on clinical examination were: hardened and enlarged testicle and discoloration of the scrotum. Most common ultrasonographic signs were: abnormal size or echostructure of the affected testicle and absence of the blood flow in Doppler ultrasonography. In 3 patients ultrasound elastography was performed, which appeared very useful in testicle structure assessment. Conclusions Testicular torsion may concern boys even in the perinatal period. Ultrasonographic picture of acute scrotum in young boys may be confused. Coexistence of the abnormal size or echostructure of the torsed testicle with absence of the blood flow in Doppler ultrasonography appear as very specific but late ultrasonographic sings. Ultrasound elastography may be a very useful tool for visualisation of a very common clinical sign – hardening of the necrotic testicle. PMID:27757176

  7. A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates.

    PubMed

    Barbosa, Rosilu F; Simões E Silva, Ana C; Silva, Yerkes P

    To compare the short-term efficacy of surfactant administration by laryngeal mask airway versus endotracheal tube. Preterm infants (28-35 weeks of gestational age), weighing 1kg or more, with respiratory distress syndrome, requiring nasal continuous positive airway pressure, with increased respiratory effort and/or fraction of inspired oxygen (FiO2)≥0.40 to maintain oxygen saturation 91-95%, were randomized to receive surfactant by LMA following nCPAP or by ETT following mechanical ventilation (MV). The primary outcome was a clinical response defined as FiO2≤0.30 three hours after surfactant. Secondary outcomes for LMA group were: need of surfactant retreatment during the first 24h, MV requirement, and presence of surfactant in gastric content. Forty-eight patients were randomized; 26 in the LMA group and 22 in the ETT group. Six of 26 patients (23%) in the LMA group and five of 22 patients (22.7%) in the ETT group did not meet the primary outcome (p=0.977). Fourteen (53.8%) of the LMA patients were not intubated nor ventilated; 12 (46.1%) were ventilated: for surfactant failure (23%), for nCPAP failure (11.5%), and for late complications (11.5%). Groups were similar regarding prenatal status, birth conditions, and adverse events. No significant gastric content was found in 61.5% of the LMA patients. Oxygen and second dose surfactant requirements, arterial/alveolar ratio, and morbidities were similar among groups. Surfactant administration by LMA showed short-term efficacy, with similar supplementary oxygen need compared to surfactant by ETT, and lower MV requirement. Further studies with larger sample size are necessary to confirm these results. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  8. Developments in Science and Technology

    DTIC Science & Technology

    1984-01-01

    rities to form the formyl (HCO) radical . Because fused silica is amorphous, the resulting electron spin resonance (ESR) spectrum of the HCO radical is...34Magnetophotoselective Pho- radical is not rigidly fixed in the silica host but executes tolysis of the Formyl Radical in Fused Silica," Chem. Phys. Lett...Photolysis of the Formyl Radical in Fused Silica," Cheat. pp. 74-78 (1984). Phs. 1.ett. 104, 413-417 (1984). W. G. Bath, F . W. )avid, and .. T. Miller

  9. Sequential Quadratic Programming Algorithms for Optimization

    DTIC Science & Technology

    1989-08-01

    series expansion for the activo constraints, -(X) = 0 = c(x*) + A*dkl1k - x*ll + O(ll.rk - X*I1I), 3.5. The penalty parameter 37 which implies that...sequence of Q P statiot ary miitts (no to that the sequence is bouinded). From the assumption that the correct activo ett ha been identified, it must hold

  10. C4 Software Technology Reference Guide - A Prototype.

    DTIC Science & Technology

    1997-01-10

    Baudoin, Claude & Hollowell , Glenn. Realizing the Object-Oriented Life- cycle. Englewood Cliffs, NJ: Prentice Hall, 1996. Embley, David W.; Jackson... Hollowell , Glenn. Realizing the Object-Oriented Life- cycle. Upper Saddle River, NJ: Prentice Hall, 1996. Ett, William. A Guide to Integration of...96] [Kamath 93] [Malan 95] ^ [Tokar 96] Author Baudoin, Claude & Hollowell , Glenn. Realizing the Object-Oriented Life- cycle. Upper Saddle River

  11. Visual Search in the Detection of Retinal Injury: A Feasibility Study

    DTIC Science & Technology

    2013-04-01

    D, Heyes A. et al. Mobility of people with retinitis pigmentosa as a function of vision and psychological variables. Optometry and Vision Science...AFRL-RH-FS-TR-2013-0019 Visual Search in the Detection of Retinal Injury: A Feasibility Study Thomas Kuyk TASC, Inc. Lei Liu The...Detection of Retinal Injury: A Feasibility Study" 2013 0019 LEON N. McLIN, JR., DR-III, DAF Work Unit Manager 711 HPW/ RHDO POLHAMUS.GARR ETT.D

  12. The air-leak test is not a good predictor of postextubation adverse events in children undergoing cardiac surgery.

    PubMed

    Suominen, Pertti K; Tuominen, Netta A; Salminen, Jukka T; Korpela, Reijo E; Klockars, Jaakko G M; Taivainen, Tomi R; Meretoja, Olli A

    2007-04-01

    The air-leak test is recommended as a method of assessing the appropriate size of an uncuffed endotracheal tube (ETT) in children. The authors' primary objective was to determine whether the air-leak test would predict adverse events and reintubations after the removal of the ETT in children who have undergone cardiac surgery. Prospective, observational, clinical study. University tertiary care hospital. Ninety-four children <10 years of age undergoing elective cardiac surgery requiring cardiopulmonary bypass surgery. The attending anesthesiologist assessed air-leak pressure after intubation in the operating room (OR). In addition, the air-leak test was performed in 42 patients before extubation in the pediatric intensive care unit (PICU). The incidence of adverse events and the number of failed extubations were recorded after removal of the ETT. Eleven of the 94 patients were excluded from the study. Four (4.3%) of the patients died in the PICU before extubation, and 7 patients were excluded for other reasons. The median age of the 83 children was 0.9 years (range 0.01-9.6 years). The total incidences of postextubation adverse events and failed extubations were 30.1% and 8.4%, respectively. An audible air leak < or =25 cmH(2)O airway pressure during the OR phase or before removal of the ETT during the PICU recovery phase had no significant predictive value for the incidence of adverse events (p = 0.63) or reintubations (p = 1.0). The patients undergoing simple and complete operations compared with more complex and incomplete operations had significantly fewer postextubation adverse events (p = 0.03). Neonates did not have a higher risk for postextubation adverse events (p = 0.64) or reintubations (p = 0.26) than older children. The air-leak test did not predict an increased risk for postextubation adverse events and reintubations in children undergoing elective congenital heart surgery.

  13. Friendly Extensible Transfer Tool Beta Version

    SciTech Connect

    Collins, William P.; Gutierrez, Kenneth M.; McRee, Susan R.; Sands, Daniel N.; Yaklin, Allan C.

    2016-04-15

    Often data transfer software is designed to meet specific requirements or apply to specific environments. Frequently, this requires source code integration for added functionality. An extensible data transfer framework is needed to more easily incorporate new capabilities, in modular fashion. Using FrETT framework, functionality may be incorporated (in many cases without need of source code) to handle new platform capabilities: I/O methods (e.g., platform specific data access), network transport methods, data processing (e.g., data compression.).

  14. Molecular genotyping of placental site and epithelioid trophoblastic tumours; female predominance.

    PubMed

    Zhao, Sihao; Sebire, Neil J; Kaur, Baljeet; Seckl, Michael J; Fisher, Rosemary A

    2016-09-01

    To investigate a large series of placental site trophoblastic tumours (PSTT) and epithelioid trophoblastic tumours (ETT) and determine the relationship between their development and the type and sex of both the immediately antecedent and causative pregnancies. The antecedent pregnancy was determined from patient records in 92 cases with a confirmed diagnosis of PSTT, ETT or mixed PSTT/ETT. In a subset of 57 cases, type and sex of the causative pregnancy was established by molecular genotyping of tumour tissue microdissected from formalin-fixed, paraffin-embedded blocks. The antecedent pregnancy was a normal live birth in 59 (64%) cases, a hydatidiform mole in 19 (21%) and other pregnancy loss in 14 (15%). Where the sex was recorded, 36 (78%) of 46 antecedent normal pregnancies were female, a significantly greater proportion than expected (p<0.0001). Genotyping of 57 cases found 15 (26%) to derive from hydatidiform moles while 42 (74%) arose in non-molar pregnancies. Where the causative pregnancy was non-molar, 38 (91%) tumours arose in female conceptions, significantly greater than expected (p<0.0001). Analysis of short tandem repeats on the X chromosome in three tumours with an XY chromosomal constitution confirmed that the X chromosome was maternal in origin. PSTT and ETT predominantly arise in female pregnancies but can develop in male pregnancies. A male derived X chromosome is not required for the development of these tumours. While these tumours are predominantly female it is not because most originate in complete hydatidiform moles. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. The Air Land Sea Bulletin. Issue No. 2008-3, September 2008

    DTIC Science & Technology

    2008-09-01

    artillery to improve, artillery mentors must know and teach consistently from year-to-year the same skills and crew drills across the entire ANA...English, and transliterated phonetically so mentors can use the proper words themselves and cut reliance on interpreters. TTP #3—Establish an...expect our ETTs to arrive in Afghanistan and begin coaching, teaching , and mentoring without first under- standing both the most fundamental issues

  16. Choices and Challenges: A Guide for the Battalion Commander’s Wife

    DTIC Science & Technology

    1991-05-28

    tradition you establish. 10 Take dance lessons; brush up nn your speaking skills; collect recipes for yroup gatherings; get ready for your first round of...8217 functions? Ideas? d. Annual dinner dance ? What rank? e. Hail and farewell ideas? f. Holiday parties: Christmas, Easter? g. As a group interested in...ettes! We wanted to tell you how excited we arc about our upcomi.; 19-91st Battalion Spring Dance on 10 June 1991 at the Embers and also to give you

  17. A prospective randomised comparison of the LMA ProSeal™ versus endotracheal tube on the severity of postoperative pain following gynaecological laparoscopy.

    PubMed

    Griffiths, J D; Nguyen, M; Lau, H; Grant, S; Williams, D I

    2013-01-01

    Pain and postoperative nausea and vomiting (PONV) are common problems after gynaecologic laparoscopy. Two recent studies have shown that morphine requirements and PONV are lower when an LMA ProSeal™ is used, rather than an endotracheal tube (ETT), for female patients undergoing breast and gynaecological surgery. We conducted a patient and observer-blinded randomised controlled trial, recruiting non-obese women without gastro-oesophageal reflux undergoing laparoscopic gynaecological surgery. Patients received a standardised relaxant general anaesthetic and then were randomised to receive either an LMA ProSeal or an endotracheal tube. Patients were assessed at two and 24 hours post-anaesthesia. The primary outcome was postoperative pain score and secondary endpoints included morphine consumption, postoperative emesis and adverse upper airway symptoms. We recruited 116 patients to the study, 57 patients in the ETT group and 59 patients in the LMA ProSeal group. The patients were similar in demographic and surgical characteristics. At two hours, the ETT group was similar to the LMA ProSeal group in regards to pain scores (Visual Analogue Scale 3.0 vs 3.5, P=0.86), morphine consumption (7.2 vs 7.4 mg, P=0.56) and PONV (47.4 vs 47.5%, P=0.99). After 24 hours, pain scores and PONV rates were also similar. No significant difference in rates of sore throat or dysphagia was observed between the ETT and LMA ProSeal groups. No significant complications were attributable to either airway device. The LMA ProSeal did not decrease pain or PONV in patients undergoing gynaecological laparoscopy when compared to endotracheal intubation.

  18. Approaches to Inflight Ear Oximetry.

    DTIC Science & Technology

    1980-10-01

    of arterial oxygen saturation. For centri- fuge experiments the floe,! ett-Packard ear oximeter, Model 47201A, has been successfully used both at...These difficulties are perhaps even more significant with respect to inflight experimental use. The difficulties are: 1. The bloodless ear is not truly...available (9), and a number of papers on both the clini- cal use (10-17) and the experimental use (1, 2, 18) of this equipment have been published since its

  19. Some Perspectives on Solution-Phase Electron-Transfer Processes

    DTIC Science & Technology

    1994-04-18

    bound media. 3 7 𔃾 1 A second, fundamentally different, approach to molecular solvent reorganization makes use of molecular-dynamics (ND) simulations ...see also the article in this issue by G. Voth). This group has successfully simulated the redox activation behavior of the well-known hexaaquo iron(IH...interactions abound in this highly charged/hydrogen-bonded system. On the other hand, model MD simulations for both dipole creation/annihilation 4 3 and ETT

  20. Alternative approaches to ventilator-associated pneumonia prevention.

    PubMed

    Berra, L; Sampson, J; Fumagalli, J; Panigada, M; Kolobow, T

    2011-03-01

    Ventilator-associated pneumonia (VAP), which develops in patients receiving mechanical ventilation, is the most common nosocomial infection in patients with acute respiratory failure. The major mechanism of lower respiratory tract colonization is aspiration of bacteria-colonized secretions from the oropharynx into the lower airways. The hydrostatic pressure of the secretions that collect in the subglottic space, which is the area above the endotracheal tube (ETT) cuff, or aerosolization of bacteria from the secretions collected within the respiratory tubing may facilitate the leakage into the lower airways. Ideally, the elimination of the mechanisms responsible for aspiration would decrease the incidence of VAP. Several preventive measures have been tested in clinical trials with little success.Here we present the results of our efforts to develop novel approaches for the prevention of VAP. Specifically, we found that keeping ventilated patients in a lateral position, which eliminates gravitational forces, is feasible and possibly advantageous. Additionally, several novel medical devices have been recently developed to prevent bacterial biofilm formation from the ETT and breathing tubing. These devices include coated ETTs, mucus shavers and mucus slurpers. Prevention of ETT bacterial colonization showed decreased bacterial colonization of the respiratory circuit and of the lower respiratory tract in laboratory studies and clinical trials. Future large studies should be designed to test the hypothesis that VAP can be prevented with these novel strategies. While there is a current focus on the use of respiratory devices to prevent biofilm formation and microaspiration, it is important to remember that lower respiratory tract colonization is multifactorial. Prevention of VAP cannot be achieved solely by eliminating bacterial biofilm on respiratory devices, and more comprehensive care of the intubated patient needs to be implemented.

  1. Tracheal size variability is associated with sex: implications for endotracheal tube selection.

    PubMed

    Karmakar, Arunabha; Pate, Mariah B; Solowski, Nancy L; Postma, Gregory N; Weinberger, Paul M

    2015-02-01

    Whereas selection of endotracheal tube (ETT) size in pediatric patients benefits from predictive nomograms, adult ETT sizing is relatively arbitrary. We sought to determine associations between cervical tracheal cross-sectional area (CTCSA) and clinical variables. One hundred thirty-two consecutive patients undergoing noncontrasted chest computed tomography (CT) at a single tertiary care institution from January 2010 to June 2011 were reviewed. Patients with improper CT technique, endotracheal intubation, and pulmonary/tracheal pathology were excluded. Tracheal luminal diameters in anteroposterior (D1) and transverse (D2) were measured 2 cm inferior to the cricoid and used to determine CTCSA = π*D1*D2*¼. The demographic variables of age, height, weight, and body mass index (BMI) were tested for association with CTCSA by Spearman correlation. Wilcoxon rank-sum test was used to compare CTCSA by race and sex. Multivariate linear regression was performed including all clinical variables. There were 91 patients who met inclusion criteria. There was no correlation between age, weight, or BMI and CTCSA. There was a significant positive correlation between patient height and CTCSA (P = .001, R = 0.35); however, this was confounded by sex. Female patients had significantly smaller CTCSA (mean = 241 mm(2)) compared to male patients (mean = 349 mm(2), P < .001). Multivariate linear regression stratified by sex revealed that height is correlated with CTCSA only in males (P = .028). Males also had more variability in CTCSA (SD 118.6) compared to females (SD 65.5). Our data suggest that selection of ETT size in male patients should include height as a predictive factor. For female patients, it may be appropriate to select a uniformly smaller diameter ETT size. © The Author(s) 2014.

  2. Atraumatic intubation: experience using a 5.0 endotracheal tube without a stylet for laryngeal surgery.

    PubMed

    Moore, Jaime E; Hu, Amanda; Rutt, Amy; Green, Parmis; Hawkshaw, Mary; Sataloff, Robert T

    2015-02-01

    Vocal fold injury is a well-know complication of intubation, with rates reported as high as 69%. Laryngology textbooks recommend the use of a small endotracheal tube (ETT) to help avoid these complications and optimize visualization. Case reports have suggested that the rigid stylet can lead to laryngeal injury. Given the additional risks, intubation without the stylet is our preferred practice. There is limited documentation in the literature regarding this viewpoint. Our study investigated the feasibility of and potential barriers to intubation using 5.0 ETT without a stylet. Prospective study. Consecutive adult patients undergoing laryngeal surgery were recruited for intubation with a 5.0 ETT without a stylet. Demographic data, specialty and training level of the intubator, and factors that would predict a difficult intubation were recorded. Descriptive statistical analysis was performed. Findings of the participants (n = 67) included average American Society of Anesthesiologists (ASA) physical status classification (2.2), average Mallampati score (1.7), average Cormack-Lehane grade (1.5), and average body mass index (28.0). Five patients (7.4%) required intubation using a stylet, and one of these five participants was intubated initially with a stylet. Of these five participants, 80% required use of a GlideScope (P < .001), and they had significantly higher ASA classification (P = .047) and number of intubation attempts (P = .042). One patient sustained an oropharyngeal injury during intubation with a stylet. No participants had laryngeal injury. Most patients can be intubated successfully using a 5.0 ETT without a stylet. There were no cases of laryngeal trauma with this technique. 2b. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  3. Endotracheal tubes for critically ill patients: an in vivo analysis of associated tracheal injury, mucociliary clearance, and sealing efficacy.

    PubMed

    Li Bassi, Gianluigi; Luque, Nestor; Martí, Joan Daniel; Aguilera Xiol, Eli; Di Pasquale, Marta; Giunta, Valeria; Comaru, Talitha; Rigol, Montserrat; Terraneo, Silvia; De Rosa, Francesca; Rinaudo, Mariano; Crisafulli, Ernesto; Peralta Lepe, Rogelio Cesar; Agusti, Carles; Lucena, Carmen; Ferrer, Miguel; Fernández, Laia; Torres, Antoni

    2015-05-01

    Improvements in the design of the endotracheal tube (ETT) have been achieved in recent years. We evaluated tracheal injury associated with ETTs with novel high-volume low-pressure (HVLP) cuffs and subglottic secretions aspiration (SSA) and the effects on mucociliary clearance (MCC). Twenty-nine pigs were intubated with ETTs comprising cylindrical or tapered cuffs and made of polyvinylchloride (PVC) or polyurethane. In specific ETTs, SSA was performed every 2 h. Following 76 h of mechanical ventilation, pigs were weaned and extubated. Images of the tracheal wall were recorded before intubation, at extubation, and 24 and 96 h thereafter through a fluorescence bronchoscope. We calculated the red-to-green intensity ratio (R/G), an index of tracheal injury, and the green-plus-blue (G+B) intensity, an index of normalcy, of the most injured tracheal regions. MCC was assessed through fluoroscopic tracking of radiopaque markers. After 96 h from extubation, pigs were killed, and a pathologist scored injury. Cylindrical cuffs presented a smaller increase in R/G vs tapered cuffs (P = .011). Additionally, cuffs made of polyurethane produced a minor increase in R/G (P = .012) and less G+B intensity decline (P = .022) vs PVC cuffs. Particularly, a cuff made of polyurethane and with a smaller outer diameter outperformed all cuffs. SSA-related histologic injury ranged from cilia loss to subepithelial inflammation. MCC was 0.9 ± 1.8 and 0.4 ± 0.9 mm/min for polyurethane and PVC cuffs, respectively (P < .001). HVLP cuffs and SSA produce tracheal injury, and the recovery is incomplete up to 96 h following extubation. Small, cylindrical-shaped cuffs made of polyurethane cause less injury. MCC decline is reduced with polyurethane cuffs.

  4. Prevalence and predictors of out-of-range cuff pressure of endotracheal and tracheostomy tubes: a prospective cohort study in mechanically ventilated patients.

    PubMed

    Alzahrani, Amer R; Al Abbasi, Shatha; Abahoussin, Othman Khalid; Al Shehri, Tariq Othman; Al-Dorzi, Hasan M; Tamim, Hani M; Sadat, Musharaf; Arabi, Yaseen M

    2015-10-15

    Maintaining the cuff pressure of endotracheal tubes (ETTs) within 20-30 cmH2O is a standard practice. The aim of the study was to evaluate the effectiveness of standard practice in maintaining cuff pressure within the target range. This was a prospective observational study conducted in a tertiary-care intensive care unit, in which respiratory therapists (RTs) measured the cuff pressure 6 hourly by a handheld manometer. In this study, a research RT checked cuff pressure 2-4 h after the clinical RT measurement. Percentages of patients with cuff pressure levels above and below the target range were calculated. We identified predictors of low-cuff pressure. We analyzed 2120 cuff-pressure measurements. The mean cuff pressure was 27 ± 2 cmH2O by the clinical RT and 21 ± 5 cmH2O by the research RT (p < 0.0001). The clinical RT documented that 98.0 % of cuff pressures were within the normal range. The research RT found the cuff pressures to be within the normal range in only 41.5 %, below the range in 53 % and above the range in 5.5 %. Low cuff pressure was found more common with lower ETT size (OR, 0.34 per 0.5 unit increase in ETT size; 95 % CI, 0.15-0.79) and with lower peak airway pressure (OR per one cm H2O increment, 0.93; 95 % CI, 0.87-0.99) on multivariate analysis. Cuff pressure is frequently not maintained within the target range with low-cuff pressure being very common approximately 3 h after routine measurements. Low cuff pressure was associated with lower ETT size and lower peak airway pressure. There is a need to redesign the process for maintaining cuff pressure within the target range.

  5. Predictors and outcome of early-onset pneumonia after out-of-hospital cardiac arrest.

    PubMed

    Pabst, Dirk; Römer, Sonja; Samol, Alexander; Kümpers, Philipp; Waltenberger, Johannes; Lebiedz, Pia

    2013-09-01

    Early-onset pneumonia (EOP) after out-of-hospital cardiac arrest is frequently observed. Causative factors are loss of airway protection during cardiac arrest, pulmonary contusion, and emergency airway management. We assessed the incidence, risk factors, and clinical course of EOP, and evaluated the impact of an early exchange of the prehospitally inserted endotracheal tube (ETT). In our retrospective analysis we included 104 consecutive subjects admitted to our ICU after out-of-hospital cardiac arrest between 2007 and 2012. All subjects underwent therapeutic hypothermia. We analyzed clinical course, inflammation indicators, Clinical Pulmonary Infection Score, occurrence of EOP, duration of ventilatory support, microbiological findings, and short-term outcome. Of the 104 subjects, 46.2% received an exchange of ETT directly after hospital admission. Neither ETT exchange nor observed aspiration were associated with elevated CPIS or EOP, nor with proof of microorganisms in respiratory secretions. We found no differences in duration of ventilatory support, P(aO2)/F(IO2), ICU days, or outcome. C-reactive protein was significantly higher in subjects with aspiration (P = .046). Sex, age, smoking status, aspiration, cause of cardiac arrest, first detected heart rhythm, and use of supraglottic airways devices were not associated with EOP. Subjects with EOP had a longer need for ventilatory support (P = .005), higher tracheotomy rate (P = .03), longer ICU stay (P = .005), higher C-reactive protein (P < .001), higher body temperature (P = .003), higher Clinical Pulmonary Infection Score (P < .001), and lower P(aO2)/F(IO2) (P = .008). The rate of EOP was not significantly influenced by the exchange of the preclinically inserted ETT, but was associated with longer need for mechanical ventilation and ICU stay.

  6. Impaired heart rate recovery is associated with new-onset atrial fibrillation: a prospective cohort study.

    PubMed

    Maddox, Thomas M; Ross, Colleen; Ho, P Michael; Magid, David; Rumsfeld, John S

    2009-03-12

    Autonomic dysfunction appears to play a significant role in the development of atrial fibrillation (AF), and impaired heart rate recovery (HRR) during exercise treadmill testing (ETT) is a known marker for autonomic dysfunction. However, whether impaired HRR is associated with incident AF is unknown. We studied the association of impaired HRR with the development of incident AF, after controlling for demographic and clinical confounders. We studied 8236 patients referred for ETT between 2001 and 2004, and without a prior history of AF. Patients were categorized by normal or impaired HRR on ETT. The primary outcome was the development of AF. Cox proportional hazards modeling was used to control for demographic and clinical characteristics. Secondary analyses exploring a continuous relationship between impaired HRR and AF, and exploring interactions between cardiac medication use, HRR, and AF were also conducted. After adjustment, patients with impaired HRR were more likely to develop AF than patients with normal HRR (HR 1.43, 95% confidence interval (CI) 1.06, 1.93). In addition, there was a linear trend between impaired HRR and AF (HR 1.05 for each decreasing BPM in HRR, 95% CI 0.99, 1.11). No interactions between cardiac medications, HRR, and AF were noted. Patients with impaired HRR on ETT were more likely to develop new-onset AF, as compared to patients with normal HRR. These findings support the hypothesis that autonomic dysfunction mediates the development of AF, and suggest that interventions known to improve HRR, such as exercise training, may delay or prevent AF.

  7. Prototype Concept Design for U.S. Army Type IIIA Air Traffic Control Tower (ATCT).

    DTIC Science & Technology

    1984-10-01

    Insulated cores will be provided in all exterior doors and in all interior doors at the tower support module level that lead into the kitchen- ette area... assembled in box modules, they would create shear walls that would provide lateral load resistance. The module’s major disadvantage is its weight, which...be eliminated by the "H" option illustrated in Figure 12. The module now becomes one floor/ceiling assembly with columns positioned to end at half

  8. Knowledge, Attitudes and Practice of Restoring Endodontically Treated Teeth by Dentists in North of Saudi Arabia

    PubMed Central

    Akbar, Iftikhar

    2015-01-01

    Objectives The aim of this study was to determine the knowledge, current approaches, techniques and practices for the restoration of endodontically treated teeth (ETT) among general dental practitioners and specialists in north of Saudi Arabia. Methodology A standard questionnaire based survey containing 16 multiple choice questions about techniques and treatment methods, frequency of post, type of post, choice of luting cement, core material, reason of failure of endodontic treatment was distributed by hand and through email among 255 general dentists and specialists. The data were processed by using SPSS statistical software. Results The majority of clinicians (54%) believed that post reinforces the remaining tooth structure and reduces fracture probability. The ferrule effect was considered an important factor in increasing fracture resistance of the ETT (72%). The preferred technique for restoring ETT was core material along with 1–2 mm of ferule (41%) followed by prefabricated post and core build up (25%). On the basis of post material, the most common was metal (43%) followed by fiber post (41%). 2/3rd length of the root canal for the post length (67%), 4–5mm apical seal of gutta percha after post placement (47%) and for the post diameter, 1/3rd of root diameter (51%) was agreed by most of the participants. Composite resin (61%) was the most popular material for core foundation followed by amalgam (23%). Conclusion The surveyed practitioners had a sound knowledge of the techniques and materials for restoring ETT with the exception that post reinforces the remaining tooth structure and reduces fracture probability. PMID:25901132

  9. Heart Rate Variability Correlates to Functional Aerobic Impairment in Hemodialysis Patients

    PubMed Central

    Carreira, Maria Angela Magalhães de Queiroz; Nogueira, André Barros; Pena, Felipe Montes; Kiuchi, Marcio Galindo; Rodrigues, Ronaldo Campos; Rodrigues, Rodrigo da Rocha; de Matos, Jorge Paulo Strogoff; Lugon, Jocemir Ronaldo

    2015-01-01

    Background Autonomic dysfunction (AD) is highly prevalent in hemodialysis (HD) patients and has been implicated in their increased risk of cardiovascular mortality. Objective To correlate heart rate variability (HRV) during exercise treadmill test (ETT) with the values obtained when measuring functional aerobic impairment (FAI) in HD patients and controls. Methods Cross-sectional study involving HD patients and a control group. Clinical examination, blood sampling, transthoracic echocardiogram, 24-hour Holter, and ETT were performed. A symptom-limited ramp treadmill protocol with active recovery was employed. Heart rate variability was evaluated in time domain at exercise and recovery periods. Results Forty-one HD patients and 41 controls concluded the study. HD patients had higher FAI and lower HRV than controls (p<0.001 for both). A correlation was found between exercise HRV (SDNN) and FAI in both groups. This association was independent of age, sex, smoking, body mass index, diabetes, and clonidine or beta-blocker use, but not of hemoglobin levels. Conclusion No association was found between FAI and HRV on 24-hour Holter or at the recovery period of ETT. Of note, exercise HRV was inversely correlated with FAI in HD patients and controls. PMID:26131705

  10. Randomized clinical study comparing metallic and glass fiber post in restoration of endodontically treated teeth.

    PubMed

    Gbadebo, Olaide S; Ajayi, Deborah M; Oyekunle, Oyekunle O Dosumu; Shaba, Peter O

    2014-01-01

    Post-retained crowns are indicated for endodontically treated teeth (ETT) with severely damaged coronal tissue. Metallic custom and prefabricated posts have been used over the years, however, due to unacceptable color, extreme rigidity and corrosion, fiber posts, which are flexible, aesthetically pleasing and have modulus of elasticity comparable with dentin were introduced. To compare clinical performance of metallic and glass fiber posts in restoration of ETT. 40 ETT requiring post retained restorations were included. These teeth were randomly allocated into 2 groups. Twenty teeth were restored using a glass fiber-reinforced post (FRP) and 20 others received stainless steel parapost (PP), each in combination with composite core buildups. Patients were observed at 1 and 6 months after post placement and cementation of porcelain fused to metal (PFM) crown. Marginal gap consideration, post retention, post fracture, root fracture, crown fracture, crown decementation and loss of restoration were part of the data recorded. All teeth were assessed clinically and radiographically. Fisher's exact test was used for categorical values while log-rank test was used for descriptive statistical analysis. One tooth in the PP group failed, secondary to decementation of the PFM crown giving a 2.5% overall failure while none in the FRP group failed. The survival rate of FRP was thus 100% while it was 97.5% in the PP group. This however was not statistically significant (log-rank test, P = 0.32). Glass FRPs performed better than the metallic post based on short-term clinical performance.

  11. Exercise-triggered transient R-wave enhancement and ST-segment elevation in II, III, and aVF ECG leads: a testament to the "plasticity" of the QRS complex during ischemia.

    PubMed

    Madias, John E; Attari, Mehran

    2004-04-01

    We describe a patient with coronary artery disease who showed transiently augmented R-waves in his electrocardiogram (ECG) during the course of an exercise treadmill test (ETT), an ECG pattern occasionally associated with the hyperacute phase of myocardial infarction and variant angina. This change in the R-waves was noted in II, III, and aVF ECG leads and was associated with ST-segment elevation; both changed gradually and were normalized during the recovery period. Cardiac enzymes after ETT were negative, and arteriography revealed 3-vessel coronary artery disease, with a completely occluded right coronary artery. The ventriculogram showed very mild hypokinesis of the inferior left ventricular wall, while the global ejection fraction was 75%. These ECG changes, noted previously during ETT in precordial ECG leads, are herein reported to occur also in II, III, and aVF ECG leads. The generation of these ECG changes, which hinges upon a late unopposed depolarization occurring in the course and at the site of severe ischemic injury, constitutes a transient focal ventricular conduction abnormality.

  12. Endotracheal tube displacement during head and neck movements. Observational clinical trial.

    PubMed

    Tailleur, Robert; Bathory, Istvan; Dolci, Mirko; Frascarolo, Philippe; Kern, Christian; Schoettker, Patrick

    2016-08-01

    Measure the displacements of endotracheal tube (ETT) tip displacement during head and neck movements. Observational study. Ear-nose-throat (ENT) and neurosurgery operating room. We performed a maximal head-neck movement trial on 50 adult patients, American Society of Anaesthesiologists 1 or 2. Patients with body mass index >35 kg · m(-2), height <150 cm, airway malformations, pulmonary diseases, difficulties in neck flexion or extension, previous ENT surgery or radiotherapy, gastroesophageal reflux, or dental instability were excluded from the study. ENT and neurosurgery. We measured the change in distance between the ETT tip and the carina, using a fiberscope through the ETT. After intubation, a wide disparity of tube tip distance to the carina in the neutral position was noted with a median of 5.0 (3.5-7.0) cm. Cephalad tube movement was documented following maximal head and neck extension in 34 (68%) patients and right head rotation in 25 patients (50%). Caudal tube displacement was due to maximal head and neck flexion in 38 patients (76%) and left head rotation in 25 patients (50%). Selective right main bronchus intubation was noted in 2 (4%) patients after maximal head extension. Maximal head and neck movements led to unpredictable tube displacements. Proper reassessment of tube positioning after head and neck movement of intubated patients is therefore mandatory. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Effects of aerobic conditioning in lupus fatigue: a pilot study.

    PubMed

    Robb-Nicholson, L C; Daltroy, L; Eaton, H; Gall, V; Wright, E; Hartley, L H; Schur, P H; Liang, M H

    1989-12-01

    Fatigue, a complex symptom, significantly affects the quality of life in many patients with systemic lupus erythematosus (SLE). To understand this phenomenon, 23 patients with SLE and fatigue were studied. Standardized tests of depression (NIMH), fatigue, exercise tolerance (ETT) on a bicycle ergometer, and SLE activity were obtained. At baseline, SLE patients had significantly lower maximum oxygen consumption (VO2 max) than normals (p less than 0.005). Adjusted for age and sex, SLE patients perform at 54% of their expected maximum VO2, which is similar to published data from patients with rheumatoid arthritis. Depression by NIMH was not correlated with VO2 max or length of time on ETT. Fatigue measured by Profile of Mood States (POMS) was correlated with ETT time (r = 0.476, p less than 0.025) and with VO2 max (r = -0.402, p less than 0.07). After an 8-week aerobic conditioning programme the experimental group increased their aerobic capacity by 19% in contrast to 8% in controls. This change correlated with decreased fatigue as measured by visual analogue scales. Exercise did not exacerbate disease, and only two of 16 experimental subjects experienced transient joint symptoms during exercise.

  14. Comparison of quantification methods illustrates reduced Pseudomonas aeruginosa activity on nanorough polyvinyl chloride.

    PubMed

    Seil, Justin T; Rubien, Nathan M; Webster, Thomas J; Tarquinio, Keiko M

    2011-07-01

    Patients on mechanical ventilators for extended periods of time are faced with a high probability of developing ventilator associated pneumonia. Although this has been mostly addressed through the re-engineering of endotracheal tubes (ETTs) with antimicrobial materials, such material coatings may easily delaminate during use. However, the potential exists to apply nanotechnology to the ETT to avoid delamination but implement antibacterial properties. Selecting a protocol to evaluate in vitro material for anti-infection is difficult, partially due to the existence of conflicting reported methods of analysis. In this study, the susceptibility of conventional and nanorough polymeric materials to bacterial biofilm growth were evaluated. After creating nanorough polyvinyl chloride (PVC) ETTs, Pseudomonas aeruginosa biofilms were then grown on sample surfaces during a 24-h culture. Biofilms were then removed and assayed from sample surfaces using a variety of techniques. Comparisons between the different techniques used for biofilm removal indicated that vortexing provided adequate removal of the biofilm from sample surfaces. Most importantly, a protocol following the vortexing method of biofilm and bacteria removal provided an ∼40% lower yield of colony forming units from nanorough PVC compared to conventional PVC. This suggests that Pseudomonas aeruginosa are less adherent on nanorough PVC than conventional PVC.

  15. Strain induced Z{sub 2} topological insulating state of β-As{sub 2}Te{sub 3}

    SciTech Connect

    Pal, Koushik; Waghmare, Umesh V.

    2014-08-11

    Topological insulators are non-trivial quantum states of matter which exhibit a gap in the electronic structure of their bulk form, but a gapless metallic electronic spectrum at the surface. Here, we predict a uniaxial strain induced electronic topological transition (ETT) from a band to topological insulating state in the rhombohedral phase (space group: R3{sup ¯}m) of As{sub 2}Te{sub 3} (β-As{sub 2}Te{sub 3}) through first-principles calculations including spin-orbit coupling within density functional theory. The ETT in β-As{sub 2}Te{sub 3} is shown to occur at the uniaxial strain ϵ{sub zz} = −0.05 (σ{sub zz} = 1.77 GPa), passing through a Weyl metallic state with a single Dirac cone in its electronic structure at the Γ point. We demonstrate the ETT through band inversion and reversal of parity of the top of the valence and bottom of the conduction bands leading to change in the ℤ{sub 2} topological invariant ν{sub 0} from 0 to 1 across the transition. Based on its electronic structure and phonon dispersion, we propose ultra-thin films of As{sub 2}Te{sub 3} to be promising for use in ultra-thin stress sensors, charge pumps, and thermoelectrics.

  16. Comparison of EtView™ tracheoscopic ventilation tube and video-assisted fiberoptic bronchoscopy during percutaneous dilatational tracheostomy.

    PubMed

    Umutoglu, Tarik; Bakan, Mefkur; Topuz, Ufuk; Yilmaz, Sinan; Idin, Kadir; Alver, Selcuk; Ozturk, Erdogan; Salihoglu, Ziya

    2017-06-01

    Fiberoptic bronchoscopy (FOB) via endotracheal tube (ETT) is the most frequent utilized technique for monitoring of percutaneous dilatational tracheostomy (PDT) procedure while maintaining mechanical ventilation. Endoscopic guidance has increased the safety of this procedure; nevertheless, the use of a bronchoscope via ETT potentially may deteriorate ventilation and lead to hypercarbia and/or hypoxia. EtView tracheoscopic ventilation tube (EtView TVT) is a standard endotracheal tube with a camera and light source embedded at the tip. The objectives of this study are to introduce EtView TVT as a monitoring tool during PDT and to compare it with video assisted FOB via ETT. We hypothesized that using EtView TVT during PDT may obtain similar visualization; also may have advantages regarding better mechanical ventilation conditions when compared with video-assisted FOB via ETT. Patients, 18-75 years of age requiring mechanical ventilation scheduled for PDT were randomly allocated into two groups for airway monitorization to guide PDT procedure either with FOB via ETT (Group FOB, n = 12) or EtView TVT (Group EtView, n = 12). After standard anesthesia protocol, alveolar recruitment maneuver was applied and all patients were mechanically ventilated at pressure-controlled ventilation mode with same pressure levels. The primary outcome variable was the reduction in arterial oxygen partial pressure (PaO2) values during the procedure. Other respiratory variables and the effectiveness (the visualization and identification of relevant airway structures) of two techniques were the secondary outcome variables. Patients in both groups were comparable with respect to demographic characteristics and initial respiratory variables. Visualization and identification of relevant airway structures in any steps of the PDT procedure were also comparable. The decrease in minute ventilation in Group FOB was higher when compared with Group EtView (51 ± 4 % vs. 12 ± 7.3 %, p < 0

  17. A comparison of a traditional endotracheal tube versus ETView SL in endotracheal intubation during different emergency conditions: A randomized, crossover cadaver trial.

    PubMed

    Truszewski, Zenon; Krajewski, Paweł; Fudalej, Marcin; Smereka, Jacek; Frass, Michael; Robak, Oliver; Nguyen, Bianka; Ruetzler, Kurt; Szarpak, Lukasz

    2016-11-01

    Airway management is a crucial skill essential to paramedics and personnel working in Emergency Medical Services and Emergency Departments: Lack of practice, a difficult airway, or a trauma situation may limit the ability of paramedics to perform direct laryngoscopy during cardiopulmonary resuscitation. Videoscope devices are alternatives for airway management in these situations. The ETView VivaSight SL (ETView; ETView Ltd., Misgav, Israel) is a new, single-lumen airway tube with an integrated high-resolution imaging camera. To assess if the ETView VivaSight SL can be a superior alternative to a standard endotracheal tube for intubation in an adult cadaver model, both during and without simulated CPR. ETView VivaSight SL tube was investigated via an interventional, randomized, crossover, cadaver study. A total of 52 paramedics participated in the intubation of human cadavers in three different scenarios: a normal airway at rest without concomitant chest compression (CC) (scenario A), a normal airway with uninterrupted CC (scenario B) and manual in-line stabilization (scenario C). Time and rate of success for intubation, the glottic view scale, and ease-of-use of ETView vs. sETT intubation were assessed for each emergency scenario. The median time to intubation using ETView vs. sETT was compared for each of the aforementioned scenarios. For scenario A, time to first ventilation was achieved fastest for ETView, 19.5 [IQR, 16.5-22] sec, when compared to that of sETT at 21.5 [IQR, 20-25] sec (p = .013). In scenario B, the time for intubation using ETView was 21 [IQR, 18.5-24.5] sec (p < .001) and sETT was 27 [IQR, 24.5-31.5] sec. Time to first ventilation for scenario C was 23.5 [IQR, 19-25.5] sec for the ETView and 42.5 [IQR, 35-49.5] sec for sETT. In normal airways and situations with continuous chest compressions, the success rate for intubation of cadavers and the time to ventilation were improved with the ETView. The time to glottis view, tube insertion

  18. Lipase degradation of plasticized polyvinyl chloride endotracheal tube surfaces to create nanoscale features

    PubMed Central

    Machado, Mary C; Webster, Thomas J

    2017-01-01

    Polyvinyl chloride (PVC) endotracheal tubes (ETTs) nanoetched with a fungal lipase have been shown to reduce bacterial growth and biofilm formation and could be an inexpensive solution to the complex problem of ventilator-associated pneumonia (VAP). Although bacterial growth and colonization on these nanoetched materials have been well characterized, little is known about the mechanism by which the fungal lipase degrades the PVC and, thus, alters its properties to minimize bacteria functions. This study used X-ray photoelectron spectroscopy (XPS) and attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) to better describe the surface chemistry of both unetched and lipase nanoetched PVC ETT. ATR-FTIR analysis of the unetched and treated surfaces showed a similar presence of a plasticizer. This was confirmed by XPS analysis, which showed an increase of carbon and the presence of oxygen on both unetched and nanoetched surfaces. A quantitative comparison of the FTIR spectra revealed significant correlations (Pearson’s correlation, R=0.997 [R2=0.994, P<0.001]) between the unetched and nanomodified PVC ETT spectra, demonstrating similar surface chemistry. This analysis showed no shifting or widening of the bands in the spectra and no significant changes in the intensity of the infrared peaks due to the degradation of the plasticizer by the fungal lipase. In contrast, results from this study did demonstrate significantly increased nanoscale surface features on the lipase etched compared to non-etched PVC ETTs. This led to a change in surface energetics, which altered ion adsorption to the ETTs. Thus, these results showed that PVC surfaces nanoetched with a 0.1% lipase solution for 48 hours have no significant change on surface chemistry but do significantly increase nanoscale surface roughness and alters ion adsorption, which suggests that the unique properties of these materials, including their previously reported ability to decrease

  19. Deep versus shallow suction of endotracheal tubes in ventilated neonates and young infants.

    PubMed

    Gillies, Donna; Spence, Kaye

    2011-07-06

    Mechanical ventilation is commonly used in Neonatal Intensive Care Units to assist breathing in a variety of conditions. Mechanical ventilation is achieved through the placement of an endotracheal tube (ETT) which is left in-situ. The ETT is suctioned to prevent a build-up of secretions and blockage of the airway. Methods of suctioning the endotracheal tube vary according to institutional practice and the individual clinician performing the task. The depth of suctioning is one of these variables. The catheter may be passed to the tip of the ETT or beyond the tip into the trachea or bronchi to facilitate removal of secretions. However, trauma to the lower airways may result from the suction catheter being passed into the airway beyond the tip of the endotracheal tube. To compare the effectiveness and complications of deep (catheter passed beyond the tip of the ETT) versus shallow (catheter passed to length of ETT only) suctioning of the endotracheal tube in ventilated infants. In this first update the searches were expanded to the Cochrane Central Register of Controlled Trials (The Cochrane Library, March 30), MEDLINE (from January 1966 to May 30 2011), CINAHL (from 1982 to May 30 2011) and EMBASE (1980 to May 2011) using text words and subject headings relevant to endotracheal suctioning. There were no language restrictions. Controlled trials using random or quasi-random allocation of neonates receiving ventilatory support via an endotracheal tube to either deep or shallow endotracheal suctioning. The updated search resulted in 149 potentially relevant references. Two of the studies from this search were identified as potentially relevant. We included one of the potentially relevant studies and the other was excluded because it did not fit the inclusion criteria. One small crossover trial (n = 27) of shallow versus deep suctioning met the criteria for inclusion in this review. The reported outcomes were oxygen saturation and heart rate, during and after suctioning

  20. Effect of fiber posts on the fracture resistance of endodontically treated anterior teeth with cervical cavities: An in vitro study.

    PubMed

    Abduljawad, Mohammed; Samran, Abdulaziz; Kadour, Jadalkareem; Al-Afandi, Mahmoud; Ghazal, Mohamad; Kern, Matthias

    2016-07-01

    How the placement of fiber posts affects the fracture resistance of endodontically treated maxillary central incisors with cervical cavities is not well documented. The purpose of this in vitro study was to evaluate the effect of fiber posts on the fracture resistance of endodontically treated maxillary central incisors with cervical cavities. Fifty extracted human maxillary central incisors were selected and divided into 5 test groups (n=10) according to the restoration strategy: GHT, control group; endodontically treated teeth (ETT) without endodontic posts; GCV, ETT with cervical cavities simulating coronal destruction; GCF, ETT with cervical cavities and carbon fiber posts; GGF, ETT with cervical cavities and glass fiber posts; and GCP, ETT with cervical cavities and composite resin posts. After the fiber posts had been cemented with a resin cement and the foundations had been placed, all specimens were quasi statically loaded at 45 degrees in a universal testing machine until fracture. All specimens were evaluated for fracture modes. The data were then analyzed by 1-way ANOVA, followed by multiple comparisons with the Tukey HSD test (α=.05). The mode of failure was determined by visual inspection. The mean ±SD failure loads for the groups ranged from 718.2 ±89.8 N to 943.8 ±93.1 N. In a 1-way ANOVA followed by post hoc testing, GGFs had a higher fracture strength than all other groups (P≤.05). However, GCPs had a lower fracture strength than all other groups. Statistically significant differences were observed among groups (P≤.05), except between the GHT group and the GCF and GGF groups (P=.075, P=.226). All groups except GHT showed complete favorable fracture mode within the cervical third of the roots. Within the limitations of this in vitro study, placement of glass fiber posts significantly improved the fracture resistance of endodontically treated maxillary central incisors with cervical cavities. Copyright © 2016 Editorial Council for the

  1. Achieving a Safe Endotracheal Tube Cuff Pressure in the Prehospital Setting: Is It Time to Revise the Standard Cuff Inflation Practice?

    PubMed

    Carhart, Elliot; Stuck, Logan H; Salzman, Joshua G

    2016-01-01

    Numerous studies have reported unsafe endotracheal tube (ETT) cuff pressures (CP) in the prehospital environment. The purpose of this study was to identify an optimal cuff inflation volume (CIV) to achieve a safe CP (20-30 cmH2O). This observational study utilized 30 recently harvested ovine tracheae, which were warmed from refrigeration in a water bath at 85°F prior to testing. Each trachea was intubated with five different ETT sizes (6.0-8.0 mm), and each size tube was tested with six cuff inflation volumes (5-10 cc). The order of ETT size for each trachea and CIV for each size ETT was randomly pre-assigned. Data were descriptively summarized and categorized before mixed-effects logistic regression was used to determine optimal CIV. Only 113 CP measurements (12.6%, N = 900) were within the optimal range (M = 54.75 cmH2O, SD = 38.52), all of which resulted from a CIV 6 or 7 cc (61% and 39%, respectively). CIVs of 5 cc (n = 150) resulted in underinflation (<20 cmH2O) in all instances, while CIVs of 8, 9, or 10 cc (n = 150 each) resulted in overinflation (>30 cmH2O) in all instances, regardless of ETT size. The odds of achieving a safe CP were greater with CIV of 6 cc for tube sizes 6.0 (OR = 15.9, 95% CI = 3.85-65.58, p < 0.01) and 6.5 mm (OR = 3.16, 95% CI = 1.06-9.39, p = 0.039); however, there was no significant difference in the odds of achieving a safe CP between CIV of 6 and 7 cc for tube sizes 7.0, 7.5, or 8.0 mm. Neither trachea circumference (M = 7.11 cm, SD = 0.40), nor tissue temperature (M = 81.32°F, SD = 0.93) were found to be significant predictors of CP (p = 0.20 and 0.81, respectively). Our study showed a high frequency of CP measurements outside of the desired norms. The CIV range of 6-7 cc resulted in the highest likelihood of achieving the desired cuff pressure range, while cuffs inflated with 8-10 cc resulted in dangerously high CPs in all instances. In the absence of a more ideal solution, the results of this study suggest that narrowing the

  2. Reduction of Endotracheal Tube Connector Dead Space Improves Ventilation: A Bench Test on a Model Lung Simulating an Extremely Low Birth Weight Neonate.

    PubMed

    Ivanov, Vadim A

    2016-02-01

    The reduction of instrumental dead space is a recognized approach to preventing ventilation-induced lung injury in premature infants. However, there are no published data regarding the effectiveness of instrumental dead-space reduction in endotracheal tube (ETT) connectors. We tested the impact of the Y-piece/ETT connector pairs with reduced instrumental dead space on CO2 elimination in a model of the premature neonate lung. The standard ETT connector was compared with a low-dead-space ETT connector and with a standard connector equipped with an insert. We compared the setups by measuring the CO2 elimination rate in an artificial lung ventilated via the connectors. The lung was connected to a ventilator via a standard circuit, a 2.5-mm ETT, and one of the connectors under investigation. The ventilator was run in volume-controlled continuous mandatory ventilation mode. The low-dead-space ETT connector/Y-piece and insert-equipped standard connector/Y-piece pairs had instrumental dead space reduced by 36 and 67%, respectively. With set tidal volumes (VT) of 2.5, 5, and 10 mL, in comparison with the standard ETT connector, the low-dead-space connector reduced CO2 elimination time by 4.5% (P < .05), 4.4% (P < .01), and 7.1% (not significant), respectively. The insert-equipped standard connector reduced CO2 elimination time by 13.5, 25.1, and 16.1% (all P < .01). The low-dead-space connector increased inspiratory resistance by 17.8% (P < .01), 9.6% (P < .05), and 5.0% (not significant); the insert-equipped standard connector increased inspiratory resistance by 9.1, 8.4, and 5.9% (all not significant). The low-dead-space connector decreased expiratory resistance by 6.8% (P < .01) and 1.8% (not significant) and increased it by 1.4% (not significant); the insert-equipped standard connector decreased expiratory resistance by 1.5 and 1% and increased it by 1% (all not significant). The low-dead-space connector increased work of breathing by 4.7% (P < .01), 3.8% (P < .01), and

  3. Swedish use and validation of Valpar work samples for patients with musculoskeletal neck and shoulder pain.

    PubMed

    Schult, M L; Söderback, I; Jacobs, K

    1995-01-01

    I studien beskrivs vad e bedömning av arbetskapacitet (BAK) innehåller Vid en bedömning av arbetskapacitet jämförs kraven för att utföra ett specifikt arbete, definierat i "The dictionary of Occupational Titles" (DOT), och patientens förmåga att utföra ett arbote vilket definieras med hjälp av sju variabler. Allmän utbildnings nivä. Speciella yrkesförberedelser. Anlag, Intresseområden, Personlig läggning. Fysiska drav och Miljöpåverkan. En bedömning av arbetskapaciteten kan ske antingen genom att observera patienten under arbete påarbetsplatsen eller under simulerat arbete tex genom att använda Valpar systemets arbetsprover.Vid Rehabiliteringsmedicinska kliniken, Karolinska Sjukhuset har tvä av de standardiserade arbetsprovema använts. VCWS 8 "Simulerad moontering" och VCWS 9 "Simulerade rorelser for hela kroppen" for att förbättra bedömningen av patientens arbetskapacitet. VCWS 8 mäter "en persons förmaga att utföra ett monteringsarbete som kräver repetetiva fysiska manipulationer" och VCWS 9 mäter "en persons formåga att röra på bålen, nacken, armarna, händerna och fingrama när de relaterar till funktionellt utförande av ett arbete". Valideringen av arbetsprovema för Svensk anvandning gjordes på en grupp patienter (n = 97) med muskuloskelettal nack- och skulder smärta som deltog i ett rehabiliteringsprogram. VCWS 9 utfördes av åttiofem patienter och VCWS 9 av sextionic patienter.Medelvärdet for patienterna som slutförde VCWS 8 var 83.1% av industriell standard nivå (mätt enligt MTM-Method-Time-Measurement) där den lä gsta gränsen är 87.5% för ett godkännt utförende. Detta innebär att de "inte moter" kraven för detta specifika arbete. I motsats till detta sä nädde patientema som utförde VCWS 9 ett medelvärde pä 108.6% vilket overstiger kravet (87.5%) för industriell standard. Det oväntade resultatet kan kanske förklaras av att patienternas intresseområden vad gäller arbetsfalt endast sammanfoll med

  4. Pilot study of dornase alfa (Pulmozyme) therapy for acquired ventilator-associated infection in preterm infants.

    PubMed

    Scala, Melissa; Hoy, Deborah; Bautista, Maria; Palafoutas, Judith Jones; Abubakar, Kabir

    2017-06-01

    Evaluate the feasibility, safety, and efficacy of adjunctive treatment with dornase alfa in preterm patients with ventilator-associated pulmonary infection (VAPI) compared to standard care. We hypothesize that therapy with dornase alfa will be safe and well tolerated in the preterm population with no worsening of symptoms, oxygen requirement, or need for respiratory support. Prospective, randomized, blinded, pilot study comparing adjunctive treatment with dornase alfa to sham therapy. In addition to standard care, infants were randomized to receive dornase alfa 2.5 mg nebulized via endotracheal tube (ETT) every 12 hr for 7 days or sham therapy. ETT secretion gram stain and culture and chest X-ray (CXR) findings were evaluated. Respiratory support data were downloaded from the ventilator. Fourteen infants developed VAPI between 2012 and 2014; 11 enrolled in the study. Six received dornase alfa and five received sham therapy. Average gestational age at birth was 25 weeks and age at study entry was 31 days. There were no differences in demographics, ETT white blood cell count (WBC), CXR, or mean airway pressure (MAP) between the two groups. There was a trend towards decreased oxygen requirement (FiO2) in the treatment group that did not reach statistical significance. No side effects were observed in the treatment group. Treatment with dornase alfa is safe and treated infants had some improvement in FiO2 requirement but no improvement in MAP. A larger randomized trial is needed to evaluate the efficacy of this therapy. Pediatr Pulmonol. 2017; 52:787-791. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  5. Neuro-otological findings in psychiatric patients with nystagmus.

    PubMed

    Kiyomizu, Kensuke; Matsuda, Keiji; Torihara, Koji; Nakayama, Meiho; Ishida, Yasushi; Yoshida, Kensei; Tono, Tetsuya

    2011-12-01

    To evaluate whether neuro-otological tests have clinical significance in psychiatric patients with nystagmus who have inner ear and/or brain dysfunction, we performed neuro-otological tests on 56 psychiatric patients with nystagmus (38 men, 18 women) (age range 40-97; mean age ± SD 61.6 ± 10.5 years). Patients were classified according to the underlying diseases: schizophrenia (25 cases), organic psychiatric disorders (14 cases), alcoholism (16 cases) and excited mental retardation (1 case). Caloric test results showed a normal response in 30 (75%) cases, right canal paresis (CP) in 4 (10%), left CP in 4 (10%) and bilateral CP in 2 (5%). Therefore, 10 (25%) cases had CP. The results of the eye tracking tests (ETT) were sorted into five categories: 4 (8.2%) cases smooth (normal), 8 (16.3%) slightly saccadic, 28 (57.1%) saccadic, 8 (16.3%) ataxic, and 1 (2%) no tracking ability. Therefore, 45 (91.8%) cases had abnormal ETT results. Pure tone audiometry showed normal hearing in 24 (47.1%) cases, right hearing loss (HL) in 3 (5.8%), left HL in 3 (5.8%) and bilateral HL in 21 (41.2%). Therefore, 27 (52.9%) cases had HL. The patients were classified as organic or functional groups. In ETT there was a significant difference between these two groups. These results indicate that neuro-otological tests with video-oculography are very important not only for neurological or neuro-otological patients with nystagmus, but also for psychiatric patients with nystagmus.

  6. The Diagnostic Value of Tc-99m MIBI Gated Myocardial Perfusion SPECT in Detection of Silent Myocardial Ischemia in Asymptomatic Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Ak, Coskun; Sahin, Ali; Capoglu, Ilyas

    2008-01-01

    Objective: In this study, we aimed to evaluate the diagnostic value of Technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) gated myocardial perfusion SPECT (MPS) in the detection of coronary artery disease (CAD) and silent myocardial ischemia (SMI) in patients with asymptomatic type 2 diabetes mellitus (DM). Materials and Methods: For this purpose, 35 patients with type 2 DM and 15 volunteers with no cardiac symptoms (control group) were included in this study. Exercise tolerance tests (ETT), echocardiography and Tc-99m MIBI gated MPS were performed in patients and volunteers. Computed tomography coronary angiography (CTCA) was performed in patients with coronary ischemia or infarct detected by Tc-99m MIBI gated MPS. The results were analyzed and compared visually and statistically. Results: The present study revealed a high rate of silent myocardial ischemia (25.71%, N=9) in 35 patients with type 2 DM. Severe CAD in CTCA was detected in four of nine patients with ischemia or infarct by Tc-99m MIBI gated MPS (44.4%). Left ventricular diastolic dysfunction, ischemic pattern and high risk of CAD were detected in the same four patients by echocardiography, ETT and biochemical analysis, respectively. At the end of the statistical evaluation, we found that Tc-99m MIBI gated MPS showed significant correlations with CTCA, echocardiography, ETT, Hba1c level, risk of CAD and diabetic age in diabetic patients with CAD. Conclusion: We propose that Tc-99m MIBI gated MPS is a reliable and non-invasive method that can be used to detect silent myocardial ischemia and CAD in patients with type 2 DM. PMID:25610029

  7. Frequency and distribution of early tooth loss and endodontic treatment needs of permanent first molars in a Turkish pediatric population

    PubMed Central

    Demirbuga, Sezer; Tuncay, Oznur; Cantekin, Kenan; Cayabatmaz, Muhammed; Dincer, Asiye Nur; Kilinc, Halil İbrahim; Sekerci, Ahmet Ercan

    2013-01-01

    Objectives: The objective of this study is to evaluate the frequency and distribution of early tooth loss and endodontic treatment needs of permanent first molars in a Turkish pediatric population. Materials and Methods: A total of 7,895 panoramic radiographs taken for routine dental examination at the Department of Oral Maxillofacial Radiology between 2008 and 2012 years were investigated. Two independent specialists evaluated early tooth loss and endodontic treatment needs of permanent first molars using panoramic radiography and patient anamnesis forms. The teeth were classified according to the following data: (a) Missing teeth, (b) teeth requiring extraction, (c) endodontically treated teeth (ETT), (d) teeth requiring endodontic therapy. The data also classified according to four factors: Age group (6-12 and 13-16), gender (boy and girl), jaw (mandible and maxilla) and side (right and left). A Chi-square test was used for statistical analyses. Results: A total of 19,488 and 12,092 teeth were evaluated in the child group and adolescent group respectively. All data were higher in adolescents than children (P < 0.001). For gender factor, only ETT was higher in girls than it was in boys (P < 0.001). For the jaw factor, all data were higher (P < 0.001) in mandible than in the maxilla. For the side factor, no statistical difference existed between right and left. Conclusions: Early tooth loss and endodontic treatment needs of permanent first molars showed variability according to age groups and jaws. When the results were compared according to the side and gender factors, no statistical difference was found (P > 0.05) except with the data of ETT in gender groups. PMID:24966738

  8. Hot water swallows improve symptoms and accelerate esophageal clearance in esophageal motility disorders.

    PubMed

    Triadafilopoulos, G; Tsang, H P; Segall, G M

    1998-06-01

    Cold liquid ingestion may precipitate episodes of dysphagia and chest pain in patients with spastic esophageal motility disorders. The effect of hot liquids on esophageal symptoms, esophageal peristalsis, and clearance and any potential therapeutic benefit in such patients has not been examined. Using esophageal scintigraphy and manometry, we have investigated the effects of hot water swallows on dysphagia, chest pain, and esophageal motility and clearance in patients with esophageal motility disorders. We studied 48 men and women with intermittent dysphagia to both solids and liquids, chest pain, and/or regurgitation. All patients underwent upper endoscopy, barium swallow, and esophageal manometry using standard techniques. Esophageal scintigraphy assessed esophageal transit time (ETT) and retrograde intraesophageal movement of bolus at baseline (22 degrees C) and after hot (60 degrees C) water swallows. Esophageal manometry assessed the amplitude and duration of esophageal contractions in response to baseline and hot water swallows. Patients were followed clinically for as long as 6 months to assess symptomatic response. We found that baseline esophageal scintigraphy revealed a mean ETT of 48.5 seconds; after hot water swallow, mean ETT was 27.8 seconds (p < 0.001). The number of secondary peaks at baseline was 3.5; after hot water swallow, it was 2.1 (p < 0.001). Baseline esophageal manometry showed a mean esophageal body contraction amplitude of 188 mm Hg (mean duration, 11.8 seconds) in response to wet swallows and 125 mm Hg (mean duration, 5.7 seconds) with hot water swallows (p < 0.001). Clinically, 28 (58%) of 48 patients noted significant (>50%) improvement of their symptoms and have been ingesting hot water or other hot liquids regularly with their meals. We conclude that hot water accelerates esophageal clearance, decreases the amplitude and duration of esophageal body contractions, and improves symptoms in patients with esophageal motility disorders

  9. Intracuff 160 mg alkalinized lidocaine reduces cough upon emergence from N2O-free general anesthesia: a randomized controlled trial.

    PubMed

    Souissi, Houssine; Fréchette, Yannick; Murza, Alexandre; Masse, Marie-Hélène; Marsault, Éric; Sarret, Philippe; D'Aragon, Frédérick; Parent, Alexandre J; Sansoucy, Yanick

    2016-07-01

    Chemical and mechanical irritation of the tracheal mucosa influences the incidence of cough at emergence from general anesthesia, potentially leading to significant postoperative complications. This study evaluates the benefits of endotracheal tube (ETT) intracuff alkalinized lidocaine during N2O-free general anesthesia by 1) assessing the in vitro effect of alkalinization on lidocaine diffusion kinetics across the cuff's membrane and 2) evaluating, in a randomized controlled clinical trial, the impact of 160 mg of intracuff alkalinized lidocaine on cough upon emergence from anesthesia for surgery lasting > 120 min. In the in vitro study, diffusion kinetics of various intracuff alkalinized lidocaine amounts (40, 80, and 160 mg) were compared to their non-alkalinized lidocaine controls. In the clinical trial, 80 adult patients (American Society of Anesthesiologists physical status I-III) undergoing urological or gynecological surgery expected to last > 120 min and scheduled for N2O-free general anesthesia were enrolled. The ETT cuffs (high-volume, low-pressure) were filled with either 160 mg of alkalinized lidocaine or a comparable volume of 0.9% saline. The primary outcome was the incidence of cough upon emergence from anesthesia. Sore throat, hoarseness, and postoperative nausea and vomiting were evaluated as secondary outcomes. Our in vitro study confirmed that alkalinization increases lidocaine diffusion across the membrane of ETT cuffs and suggested that the lidocaine diffusion rate is associated with the initial intracuff lidocaine quantity. Our clinical trial demonstrated that, compared with the saline group, 160 mg of intracuff alkalinized lidocaine reduced the incidence of cough upon emergence from N2O-free general anesthesia (76% vs 34%, respectively; difference 42%; 95% confidence interval, 21% to 62%; P < 0.001) while having no clinical impact on secondary outcomes. The use of 160 mg of intracuff alkalinized lidocaine is associated with a decreased

  10. Changes in intracuff pressure of cuffed endotracheal tubes while positioning for adenotonsillectomy in children.

    PubMed

    Olsen, Griffin H; Krishna, Senthil G; Jatana, Kris R; Elmaraghy, Charles A; Ruda, James M; Tobias, Joseph D

    2016-05-01

    When using cuffed endotracheal tubes (cETTs), changes in head and neck position can lead to changes in intracuff pressure. The aim of this study was to assess the combined effect of neck extension, shoulder roll placement, and Crowe-Davis retractor use during adenotonsillectomy on the intracuff pressure of cETTs in children. Patients <18 years of age undergoing adenotonsillectomy under general anesthesia following the placement of a cETT were included in the study. After inflation of the cuff to seal the trachea, using the leak test, baseline intracuff pressure was recorded and then continuously monitored. After neck extension, placement of a shoulder roll, insertion of the Crow-Davis retractor, suspension from a Mayo stand, and positioning for surgery, the intracuff pressure was recorded again. The study cohort included 84 patients, ranging in age from 0.9 to 17 years (5.7 ± 3.9 years). In 46 patients (54.8%), the intracuff pressure increased from baseline after positioning for adenotonsillectomy. In 12 of these patients (14.3%), the intracuff pressure was >30 cm H2O. The intracuff pressure decreased in 28 patients (33.3%), while no change was noted in 10 patients (11.9%). Overall, the general trend was an increase in intracuff pressure from 15.9 ± 7.8 cm H2O to 18.9 ± 11.6 cm H2O. Both increases and decreases in the intracuff pressure may occur following positioning of the pediatric patient for adenotonsillectomy. An increase in intracuff pressure may result in a higher risk of damage to the tracheal mucosa. A decrease in the intracuff pressure can result in an air leak resulting in inadequate ventilation, increased risk of aspiration, and even predispose to airway fire if oxygen-enriched gases are used. Continuous intracuff pressure monitoring or rechecking the intracuff pressure after positioning for adenotonsillectomy may be indicated. © 2016 John Wiley & Sons Ltd.

  11. Comparison of success rate of intubation through Air-Q with ILMA using two different endotracheal tubes.

    PubMed

    Malhotra, S K; Bharath, K V; Saini, Vikas

    2016-04-01

    Air-Q™ is a newly introduced airway device, which can be used to facilitate endotracheal intubation. The primary aim of this study was to assess whether use of two different endotracheal tubes (ETTs) (standard polyvinyl chloride [PVC] and reinforced PVC) increases the success rate of blind intubation through Air-Q™ (Group Q) when compared with intubating laryngeal mask airway (ILMA- Fastrach™) keeping ILMA as control (Group I). One hundred and twenty patients aged between 18 and 60 years with American Society of Anesthesiologists physical status I-II, undergoing elective surgery under general anaesthesia, were enrolled into this prospective, randomised, case-control study to compare the success rate of tracheal intubation between ILMA (Fastrach™) and Air-Q™ intubating laryngeal airway. Those patients with anticipated difficult airway were excluded from the study. All the recruited patients completed the study. Reinforced PVC ETT was used in both airway devices to secure intubation. Since standard PVC tube is recommended for use in Air-Q, when first intubation attempt failed, second or third attempt was made with standard PVC ETT. Total of three attempts were made for each procedure: Whereas in ILMA group, only reinforced tube was used in all three attempts. The overall success rate after three attempts was more with Air-Q (96.6%) in our study compared with ILMA (91.6%) but no significant difference was seen between the groups (P = 0.43). The present study shows that when intubation with reinforced tube fails, the success rate with use of conventional PVC tube is more with Air-Q when compared with ILMA.

  12. Effect of noble metal alloy post and core material on the fracture resistance of endodontically treated teeth.

    PubMed

    Toksavul, Suna; Toman, Muhittin; Sarikanat, Mehmet; Nergiz, Ibrahim; Schmage, Petra

    2010-03-01

    The aim of this study was to investigate the effect of one particular brand of post and core system (ER Post) consisted of different post and core materials on the fracture resistance of endodontically treated teeth. Fifty caries-free maxillary central incisors were randomly assigned to five groups (n=10). All teeth were sectioned at the cemento-enamel junction except for the teeth in the control group. Four experimental groups consisted of cast gold post-and-core group (GG), Heraplat post/cast gold core group (HG), titanium post/composite core (TC), and titanium post/cast gold core (TG). The control group (ETT) consisted of endodontically treated teeth without posts. All posts were cemented in the roots with zinc phosphate cement. Following thermal cycling (5000 cycles between 5 degrees C and 55 degrees C with a dwell time of 30 seconds) a static load was applied to 2 mm below the incisal edge on the palatal surface of each specimen until they were fractured. Fracture data obtained and statistically analyzed with one-way ANOVA and a Tukey's test (p<0.05). Means of the fracture resistance during static loading were: 423.76 N (GG), 529.46 N (HG), 389.08 N (TC), 408.7 N (TG), 404.4 N (ETT, control). Heraplat post with cast gold core exhibited the highest fracture load than the other groups (p<0.05). Specimens in groups HG and ETT (control) showed the most repairable failure. Heraplat post with cast gold core had the highest fracture resistance of endodontically treated teeth.

  13. Autoinducer-2 of Streptococcus mitis as a Target Molecule to Inhibit Pathogenic Multi-Species Biofilm Formation In Vitro and in an Endotracheal Intubation Rat Model

    PubMed Central

    Wang, Zhengli; Xiang, Qingqing; Yang, Ting; Li, Luquan; Yang, Jingli; Li, Hongong; He, Yu; Zhang, Yunhui; Lu, Qi; Yu, Jialin

    2016-01-01

    Streptococcus mitis (S. mitis) and Pseudomonas aeruginosa (P. aeruginosa) are typically found in the upper respiratory tract of infants. We previously found that P. aeruginosa and S. mitis were two of the most common bacteria in biofilms on newborns’ endotracheal tubes (ETTs) and in their sputa and that S. mitis was able to produce autoinducer-2 (AI-2), whereas P. aeruginosa was not. Recently, we also found that exogenous AI-2 and S. mitis could influence the behaviors of P. aeruginosa. We hypothesized that S. mitis contributes to this interspecies interaction and that inhibition of AI-2 could result in inhibition of these effects. To test this hypothesis, we selected PAO1 as a representative model strain of P. aeruginosa and evaluated the effect of S. mitis as well as an AI-2 analog (D-ribose) on mono- and co-culture biofilms in both in vitro and in vivo models. In this context, S. mitis promoted PAO1 biofilm formation and pathogenicity. Dual-species (PAO1 and S. mitis) biofilms exhibited higher expression of quorum sensing genes than single-species (PAO1) biofilms did. Additionally, ETTs covered in dual-species biofilms increased the mortality rate and aggravated lung infection compared with ETTs covered in mono-species biofilms in an endotracheal intubation rat model, all of which was inhibited by D-ribose. Our results demonstrated that S. mitis AI-2 plays an important role in interspecies interactions with PAO1 and may be a target for inhibition of biofilm formation and infection in ventilator-associated pneumonia. PMID:26903968

  14. Comparison between Two Endotracheal Tube Cuff Inflation Methods; Just-Seal Vs. Stethoscope-Guided

    PubMed Central

    Harde, Minal; Bhadade, Rakesh; Dave, Sona; Aswar, Swapnil Ganeshrao

    2017-01-01

    Introduction The Endotracheal Tube (ETT) cuff performs a critical function of sealing the airway during positive pressure ventilation. There is a narrow range of cuff pressure required to maintain a functionally safe seal without exceeding capillary blood pressure. Aim We aimed to compare Just-Seal (JS) and Stethoscope-Guided (SG) method of ETT cuff inflation with respect to the volume of air required to inflate the cuff, the manometric cuff pressure achieved and also to assess for the occurrence of postoperative sore throat after extubation in both the groups. Materials and Methods It was a prospective observational study done in a Tertiary Teaching Public Hospital over a period of 1½ years on 100 patients with 50 each in two groups; JS or SG method of cuff inflation. SPSS Version 17 was used for data analysis. Results Statistically significant difference (p-value of less than 0.05) was noted between the two methods based on the volume of air injected into the cuff {the mean volume injected in JS was 6.79 ml and in the SG was 4.95 ml with p=5.71E-16 (< 0.05)} and cuff pressure achieved {mean cuff pressure achieved was 38.80 cm H2O in the JS and 29.64 cm H2O in SG with p=2.29E-14 (< 0.05)}. The incidence of post extubation sore throat was 54% (27 in 50) in the JS group and only 12% (6 in 50) in the SG; p= 0.00000797. Conclusion ETT cuff inflation guided by a stethoscope is an effective technique for ensuring appropriate cuff pressures thus accomplishing the objective of providing safe and superior quality care of the patient both during and after anaesthesia and reducing the likelihood of even minimal risk complications that may still have legal implications. PMID:28764268

  15. Use of short tandem repeat analysis in unusual presentations of trophoblastic tumors and their mimics.

    PubMed

    Aranake-Chrisinger, John; Huettner, Phyllis C; Hagemann, Andrea R; Pfeifer, John D

    2016-06-01

    Gestational trophoblastic tumors can be difficult to distinguish from nongestational neoplasms. Somatic and germ cell tumors can mimic gestational choriocarcinoma, and epithelioid trophoblastic tumor (ETT) is known for its histologic, and sometimes clinical, resemblance to squamous cell carcinoma. Short tandem repeat (STR) analysis can separate gestational from nongestational neoplasms and can provide useful information about the type of causative conceptus. We present a series of cases which demonstrate the utility of STR analysis in the evaluation of gestational choriocarcinoma, epithelioid trophoblastic tumor, and their mimics. Samples from normal tissue and tumor were microdissected. DNA was extracted, and STR analysis was performed. Five cases were identified in which there was clinical and/or histologic concern for a gestational trophoblastic neoplasm. Case 1 is a choriocarcinoma presenting concurrently with a 16-week gestation. STR testing on the tumor, mother, and fetus showed that the tumor arose from a previous occult complete hydatidiform mole. Case 2 is an ETT presenting as multiple masses in bilateral kidneys, initially diagnosed as urothelial carcinoma. However, because of an elevated human chorionic gonadotropin, additional workup was performed which showed that the tumor was most likely an ETT. STR analysis showed that the tumor arose from a nonmolar pregnancy. Cases 3-5 illustrate somatic carcinomas mimicking gestational neoplasia. In those cases, STR confirmed a somatic origin. STR can be useful in distinguishing gestational from nongestational neoplasms, particularly in unusual settings. Also, STR analysis can add clinically useful information that is not available from clinical or histologic evaluation. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Epithelioid trophoblastic tumor: A single institution case series at the New England Trophoblastic Disease Center.

    PubMed

    Davis, M R; Howitt, B E; Quade, B J; Crum, C P; Horowitz, N S; Goldstein, D P; Berkowitz, R S

    2015-06-01

    Epithelioid trophoblastic tumor (ETT) is a rare form of gestational trophoblastic neoplasm which is distinct based on its development from intermediate trophoblast cells and nodular growth pattern. The aim of this study is to describe a case series from a single institution with a review of the literature to better understand the clinical characteristics and outcomes for patients with ETT. A retrospective review was performed using the IRB approved New England Trophoblastic Disease Center (NETDC) database from 1998 to 2014. Eight patients were identified of which seven had complete records. Follow-up data was obtained from the longitudinal medical records. Four (57.1%) patients presented with vaginal bleeding and two (28.6%) patients were asymptomatic at presentation. Three (42.9%) patients had extrauterine disease. All three patients with extrauterine disease who received chemotherapy had stable or progressive disease at follow-up. Only two (29%) patients who presented with non-metastatic disease and underwent hysterectomy were alive with no evidence of disease. The mean interval following antecedent pregnancy was 104months. All patients with an interval >4years demonstrated stable or progressive disease despite intensive chemotherapy. Two patients with non-metastatic disease who declined hysterectomy developed stable or progressive disease despite chemotherapy. This series highlights several features of ETT including the potential for asymptomatic presentation of extrauterine disease. The series also demonstrates chemoresistance, even with multi-agent therapy and a poor prognosis with extrauterine disease and an interval greater than 4years following the antecedent pregnancy suggesting that surgery remains critical in disease control. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Electrically heated simulator for relative evaluation of alternative infant incubator environments.

    PubMed

    Ultman, J S; Berman, S; Kirlin, P; Vreslovic, J M; Baer, C B; Marks, K H

    1988-02-01

    A 10.9-cm diameter, copper ellipsoid was electrically heated to provide a simulation of sensible heat transfer from a newborn infant. The use of this simulator to determine mean radiant temperature and convective heat-transfer coefficient was demonstrated in three commercial incubators: the Isolette (Model C-86, Narco/Air Shields); the Armstrong Care-ette (Ohio Medical Products); and the I. C. (Ohmeda). The relative performance of these environmental therapeutic devices in shielding an infant against radiant heat loss was judged by the deviation of mean radiant temperature from incubator air temperature, which was varied from 32-36 degrees C. Whereas the I. C. incubator exhibited a radiant temperature always 0.5 degrees C less than air temperature, the Care-ette incubator showed radiant temperatures of 4.0-5.5 degrees C below air temperature, and the Isolette displayed radiant temperatures of 2.7-4.7 degrees C (inner wall removed) and 2.0-3.8 degrees C (inner wall inserted) below air temperature. The relative performance of the incubators in preventing convective heat loss was judged from the magnitude of the convective heat-transfer coefficient, hv. The I. C. incubator had an hv = 4.52 W/m2/degrees C; the Care-ette, 5.55 W/m2/degrees C; and the Isolette 7.19 W/m2/degrees C (inner wall removed) and 6.23 W/m2/degrees C (inner wall inserted). Although an ellipsoid simulator is not an anatomically correct substitute for an infant, it does provide a reliable and convenient comparison of steady-state heat transfer characteristics of alternative environmental devices.

  18. Retrospective analysis of vocal cord-to-suprasternal notch distance

    PubMed Central

    Kim, Hyerim; Chang, Jee-Eun; Ryu, Jung-Hee; Jung, Haesun; Min, Seong-Won; Lee, Jung-Man; Hwang, Jin-Young

    2017-01-01

    Abstract Endotracheal tube (ETT) positioning using the cuff ballottement test, which confirms that the inflated cuff is positioned at the suprasternal notch with squeezing or inflating a pilot balloon, has been reported to be a simple and reliable method of preventing endobronchial intubation. However, in patients with a short vocal cord-to-suprasternal notch, ETT placement using the cuff ballottement test can cause vocal cord injury. In the present study, we assessed the distance from a point 15 mm below the vocal cord to the suprasternal notch (VSD-15), the safe position for ETT cuff placement above the suprasternal notch, and investigated variables for predicting VSD-15. We retrospectively examined neck computed tomography in 427 adult patients and measured VSD-15 and the distance from the thyroid notch to the suprasternal notch (TSD). Patient height, weight, sex, and age were also recorded. In total, 47 patients (11.0%) showed a VSD-15 shorter than 45 mm. VSD-15 significantly correlated with TSD (r = 0.778, P < 0.001) and height (r = 0.312, P < 0.001), and inversely correlated with age (r = −0.321, P < 0.001). In multiple linear regression models, a formula was obtained for VSD-15 (VSD-15 [mm] = −6.220 + 0.744 × TSD [mm] + 0.092 × height [cm] − 0.065 × age [years], R2 = 0.621). The cuff ballottement test should be used cautiously in patients with a predicted short VSD-15. VSD-15 can be predicted from TSD, height, and age. PMID:28207550

  19. Rescue Ventilation Through a Small-Bore Transtracheal Cannula in Severe Hypoxic Pigs Using Expiratory Ventilation Assistance

    PubMed Central

    Hamaekers, Ankie E.; van der Beek, Tim; Theunissen, Maurice

    2015-01-01

    BACKGROUND: Suction-generated expiratory ventilation assistance (EVA) has been proposed as a way to facilitate bidirectional ventilation through a small-bore transtracheal cannula (TC). In this study, we investigated the efficiency of ventilation with EVA for restoring oxygenation and ventilation in a pig model of acute hypoxia. METHODS: Six pigs (61–76 kg) were anesthetized and ventilated (intermittent positive pressure ventilation) via a cuffed endotracheal tube (ETT). Monitoring lines were placed, and a 75-mm long, 2-mm inner diameter TC was inserted. After the baseline recordings, the ventilator was disconnected. After 2 minutes of apnea, reoxygenation with EVA was initiated through the TC and continued for 15 minutes with the ETT occluded. In the second part of the study, the experiment was repeated with the ETT either partially obstructed or left open. Airway pressures and hemodynamic data were recorded, and arterial blood gases were measured. Descriptive statistical analysis was performed. RESULTS: With a completely or partially obstructed upper airway, ventilation with EVA restored oxygenation to baseline levels in all animals within 20 seconds. In a completely obstructed airway, Paco2 remained stable for 15 minutes. At lesser degrees of airway obstruction, the time to reoxygenation was delayed. Efficacy probably was limited when the airway was completely unobstructed, with 2 of 6 animals having a Pao2 <85 mm Hg even after 15 minutes of ventilation with EVA and a mean Paco2 increased up to 90 mm Hg. CONCLUSIONS: In severe hypoxic pigs, ventilation with EVA restored oxygenation quickly in case of a completely or partially obstructed upper airway. Reoxygenation and ventilation were less efficient when the upper airway was completely unobstructed. PMID:25565319

  20. Effect on postoperative sore throat of spraying the endotracheal tube cuff with benzydamine hydrochloride, 10% lidocaine, and 2% lidocaine.

    PubMed

    Hung, Nan-Kai; Wu, Ching-Tang; Chan, Shun-Ming; Lu, Chueng-He; Huang, Yuan-Shiou; Yeh, Chun-Chang; Lee, Meei-Shyuan; Cherng, Chen-Hwan

    2010-10-01

    Postoperative sore throat (POST) is a common complication after endotracheal intubation. We compared the effectiveness on POST of spraying the endotracheal tube (ETT) cuff with benzydamine hydrochloride, 10% lidocaine, and 2% lidocaine. Three hundred seventy-two patients were randomly allocated into 4 groups. The ETT cuffs in each group were sprayed with benzydamine hydrochloride, 10% lidocaine hydrochloride, 2% lidocaine hydrochloride, or normal saline before endotracheal intubation. After insertion, the cuffs were inflated to an airway leak pressure of 20 cm H(2)O. Anesthesia was maintained with propofol. The patients were examined for sore throat (none, mild, moderate, or severe) at 1, 6, 12, and 24 hours after extubation. The highest incidence of POST occurred at 6 hours after extubation in all groups. There was a significantly lower incidence of POST in the benzydamine group than 10% lidocaine, 2% lidocaine, and normal saline groups (P < 0.05) at each observation time point. At 6 hours after extubation, the incidence of POST was significantly lower in the benzydamine group (17.0%) compared with 10% lidocaine (53.7%), 2% lidocaine (37.0%), and normal saline (40.8%) groups (P < 0.05). The benzydamine group had significantly decreased severity of POST compared with the 10% lidocaine, 2% lidocaine, and normal saline groups (P < 0.05) at each observation time point. Compared with the 2% lidocaine and normal saline groups, the 10% lidocaine group had significantly increased severity of POST at 1, 6, and 12 hours after extubation. There were no significant differences among groups in local or systemic side effects. Spraying benzydamine hydrochloride on the ETT cuff is a simple and effective method to reduce the incidence and severity of POST.

  1. Comparison of success rate of intubation through Air-Q with ILMA using two different endotracheal tubes

    PubMed Central

    Malhotra, SK; Bharath, KV; Saini, Vikas

    2016-01-01

    Background and Aims: Air-Q™ is a newly introduced airway device, which can be used to facilitate endotracheal intubation. The primary aim of this study was to assess whether use of two different endotracheal tubes (ETTs) (standard polyvinyl chloride [PVC] and reinforced PVC) increases the success rate of blind intubation through Air-Q™ (Group Q) when compared with intubating laryngeal mask airway (ILMA- Fastrach™) keeping ILMA as control (Group I). Methods: One hundred and twenty patients aged between 18 and 60 years with American Society of Anesthesiologists physical status I-II, undergoing elective surgery under general anaesthesia, were enrolled into this prospective, randomised, case–control study to compare the success rate of tracheal intubation between ILMA (Fastrach™) and Air-Q™ intubating laryngeal airway. Those patients with anticipated difficult airway were excluded from the study. All the recruited patients completed the study. Reinforced PVC ETT was used in both airway devices to secure intubation. Since standard PVC tube is recommended for use in Air-Q, when first intubation attempt failed, second or third attempt was made with standard PVC ETT. Total of three attempts were made for each procedure: Whereas in ILMA group, only reinforced tube was used in all three attempts. Results: The overall success rate after three attempts was more with Air-Q (96.6%) in our study compared with ILMA (91.6%) but no significant difference was seen between the groups (P = 0.43). Conclusion: The present study shows that when intubation with reinforced tube fails, the success rate with use of conventional PVC tube is more with Air-Q when compared with ILMA. PMID:27141106

  2. Lifshitz topological transitions, induced by doping and deformation in single-crystal bismuth wires

    NASA Astrophysics Data System (ADS)

    Nikolaeva, A. A.; Konopko, L. A.; Huber, T. E.; Kobylianskaya, A. K.; Para, Gh. I.

    2017-02-01

    The features associated with the manifestation of Lifshitz electron topological transitions (ETT) in glass-insulated bismuth wires upon qualitative changes to the topology of the Fermi surface are investigated. The variation of the energy spectrum parameters was implemented by doping Bi with an acceptor impurity Sn and using elastic strain of up to 2%, relative to the elongation in the weakly-doped p-type Bi wires. Pure and doped glass-insulated single-crystal bismuth with different diameters and (1011) orientations along the axis were prepared by the Ulitovsky liquid phase casting method. For the first time, ETT-induced anomalies are observed along the temperature dependences of the thermoemf α(T) as triple-changes of the α sign (given heavy doping of Bi wires with an acceptor impurity Sn). The concentration and energy position of the Σ-band given a high degree of bismuth doping with Sn was assessed using the Shubnikov-de Haas effect oscillations, which were detected both from L-electrons and from T-holes in magnetic fields of up to 14 T. It is shown that the Lifshitz electron-topological transitions with elastic deformation of weakly-doped p-type Bi wires are accompanied by anomalies along the deformation dependences of the thermoemf at low temperatures. The effect is interpreted in terms of the formation of a selective scattering channel of L-carriers into the T-band with a high density of states, which is in good agreement with existing theoretical ETT models.

  3. Do physical examination and CT-scan measures of femoral neck anteversion and tibial torsion relate to each other?

    PubMed

    Sangeux, Morgan; Mahy, Jessica; Graham, H Kerr

    2014-01-01

    Informed clinical decision making for femoral and/or tibial de-rotation osteotomies requires accurate measurement of patient function through gait analysis and anatomy through physical examination of bony torsions. Validity of gait analysis has been extensively studied; however, controversy remains regarding the accuracy of physical examination measurements of femoral and tibial torsion. Comparison between CT-scans and physical examination measurements of femoral neck anteversion (FNA) and external tibial torsion (ETT) were retrospectively obtained for 98 (FNA) and 64 (ETT) patients who attended a tertiary hospital for instrumented gait analysis between 2007 and 2010. The physical examination methods studied for femoral neck anteversion were the trochanteric prominence angle test (TPAT) and the maximum hip rotation arc midpoint (Arc midpoint) and for external tibial torsion the transmalleolar axis (TMA). Results showed that all physical examination measurements statistically differed to the CT-scans (bias(standard deviation): -2(14) for TPAT, -10(12) for Arc midpoint and -16(9) for TMA). Bland and Altman plots showed that method disagreements increased with increasing bony torsions in all cases but notably for TPAT. Regression analysis showed that only TMA and CT-scan measurement of external tibial torsion demonstrated good (R(2)=57%) correlation. Correlations for both TPAT (R(2)=14%) and Arc midpoint (R(2)=39%) with CT-scan measurements of FNA were limited. We conclude that physical examination should be considered as screening techniques rather than definitive measurement methods for FNA and ETT. Further research is required to develop more accurate measurement methods to accompany instrumented gait analysis.

  4. Independent Review of Elemental Phosphorus Remediation at the Eastern Michaud Flats FMC Operable Unit near Pocatello, Idaho

    SciTech Connect

    Martino, L. E.; Jerden, J. J.; Kimmell, T. A.; Quinn, J.

    2016-01-01

    If, despite risks to workers and these potential impacts, stakeholders decide that P4 wastes need to be excavated and treated, the Review Team determined that a number of the ETTs examined warrant further consideration for the treatment of P4 waste that has been characterized (for example, P4 waste present in the historical ponds). Nevertheless, concerns about the health and safety of site investigation workers using then-available investigation approaches prevented the collection of subsurface samples containing P4 from large areas of the site (e.g., the railroad swale, the vadose zone beneath the Furnace Building, and the abandoned railcars), As a result, the contaminant CSM in those particular areas was not refined enough to allow the Review Team to draw conclusions about using some of the ETTs to treat P4 waste in those areas. The readiness of an ETT for implementation varies depending on many factors, including stakeholder input, permitting, and remedial action construction requirements. Technologies that could be ready for use in the near term (within 1 year) include the following: mechanical excavation, containment technologies, off-site incineration, and drying and mechanical mixing under a tent structure. Technologies that could be ready for use in the mid-term (1 to 2 years) include cutter suction dredging, thermal-hydraulic dredging, and underground pipeline cleaning technologies. Technologies requiring a longer lead time (2 to 5 years) include on-site incineration, a land disposal restriction waste treatment system, an Albright & Wilson batch mud still, post-treatment on-site disposal, and post-treatment off-site disposal.

  5. Nanoelectronics.

    DTIC Science & Technology

    1987-08-14

    Barrier Growth by Resonant Tunneling," M. A. Reed, J. W. Lee, R. K. Aldert, and A. E. Wetsel , J. Mat. Res. 1, 337 (1986). 37 G. "Excited State Resonant...effectively [51 M.A. Reed, J.W. Lee, R.K. Aldert, and A.E. Wetsel , narrower. The same effect probably explains why the "Investigation of Quantum Well and...Steckenborn, and 0. Weimann, Appi. Phys. ett, A. Wetsel , and J1. Williams for technical assistance. We Lett. 44, 84 (1984). J. Voo. SaL Todwal. 3, Vol. 4, Ito

  6. Micro-patterned surfaces reduce bacterial colonization and biofilm formation in vitro: Potential for enhancing endotracheal tube designs

    PubMed Central

    2014-01-01

    Background Ventilator-associated pneumonia (VAP) is a leading hospital acquired infection in intensive care units despite improved patient care practices and advancements in endotracheal tube (ETT) designs. The ETT provides a conduit for bacterial access to the lower respiratory tract and a substratum for biofilm formation, both of which lead to VAP. A novel microscopic ordered surface topography, the Sharklet micro-pattern, has been shown to decrease surface attachment of numerous microorganisms, and may provide an alternative strategy for VAP prevention if included on the surface of an ETT. To evaluate the feasibility of this micro-pattern for this application, the microbial range of performance was investigated in addition to biofilm studies with and without a mucin-rich medium to simulate the tracheal environment in vitro. Methods The top five pathogens associated with ETT-related pneumonia, Methicillin-Resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Klebsiella pneumonia, Acinetobacter baumannii, and Escherichia coli, were evaluated for attachment to micro-patterned and un-patterned silicone surfaces in a short-term colonization assay. Two key pathogens, MRSA and Pseudomonas aeruginosa, were evaluated for biofilm formation in a nutrient rich broth for four days and minimal media for 24 hours, respectively, on each surface type. P. aeruginosa was further evaluated for biofilm formation on each surface type in a mucin-modified medium mimicking tracheal mucosal secretions. Results are reported as percent reductions and significance is based on t-tests and ANOVA models of log reductions. All experiments were replicated at least three times. Results Micro-patterned surfaces demonstrated reductions in microbial colonization for a broad range of species, with up to 99.9% (p < 0.05) reduction compared to un-patterned controls. Biofilm formation was also reduced, with 67% (p = 0.12) and 52% (p = 0.05) reductions in MRSA and P. aeruginosa

  7. Micro-patterned surfaces reduce bacterial colonization and biofilm formation in vitro: Potential for enhancing endotracheal tube designs.

    PubMed

    May, Rhea M; Hoffman, Matthew G; Sogo, Melinda J; Parker, Albert E; O'Toole, George A; Brennan, Anthony B; Reddy, Shravanthi T

    2014-01-01

    Ventilator-associated pneumonia (VAP) is a leading hospital acquired infection in intensive care units despite improved patient care practices and advancements in endotracheal tube (ETT) designs. The ETT provides a conduit for bacterial access to the lower respiratory tract and a substratum for biofilm formation, both of which lead to VAP. A novel microscopic ordered surface topography, the Sharklet micro-pattern, has been shown to decrease surface attachment of numerous microorganisms, and may provide an alternative strategy for VAP prevention if included on the surface of an ETT. To evaluate the feasibility of this micro-pattern for this application, the microbial range of performance was investigated in addition to biofilm studies with and without a mucin-rich medium to simulate the tracheal environment in vitro. The top five pathogens associated with ETT-related pneumonia, Methicillin-Resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Klebsiella pneumonia, Acinetobacter baumannii, and Escherichia coli, were evaluated for attachment to micro-patterned and un-patterned silicone surfaces in a short-term colonization assay. Two key pathogens, MRSA and Pseudomonas aeruginosa, were evaluated for biofilm formation in a nutrient rich broth for four days and minimal media for 24 hours, respectively, on each surface type. P. aeruginosa was further evaluated for biofilm formation on each surface type in a mucin-modified medium mimicking tracheal mucosal secretions. Results are reported as percent reductions and significance is based on t-tests and ANOVA models of log reductions. All experiments were replicated at least three times. Micro-patterned surfaces demonstrated reductions in microbial colonization for a broad range of species, with up to 99.9% (p < 0.05) reduction compared to un-patterned controls. Biofilm formation was also reduced, with 67% (p = 0.12) and 52% (p = 0.05) reductions in MRSA and P. aeruginosa biofilm formation

  8. Factor analysis of laboratory and clinical measurements of dyspnea in patients with chronic obstructive pulmonary disease.

    PubMed

    Nguyen, Huong Q; Altinger, Julie; Carrieri-Kohlman, Virginia; Gormley, Jenny M; Stulbarg, Michael S

    2003-02-01

    The primary purpose of this study was to determine if there are three distinct factors representing ratings of dyspnea during laboratory exercise, clinical ratings of dyspnea, and pulmonary function in patients with moderate to severe chronic obstructive pulmonary disease (COPD) (n = 92) using factor analysis. Subjects (mean age 66 +/- 7 yrs; FEV1% predicted 44.7 +/- 14.0) were randomly assigned to one of three treatment groups to test the effects of three education and exercise training programs. Outcomes were evaluated at baseline and at 2 months after the intervention. Dyspnea ratings with laboratory exercise (SOB) were measured during incremental (ITT) and endurance (ETT) treadmill tests, and a six-minute walk (6MW) using the modified Borg scale. Clinical measures of dyspnea were measured with the Baseline and Transitional Dyspnea Index (BDI/TDI), UCSD Shortness of Breath Questionnaire (SOBQ), Medical Research Council Dyspnea Scale (MRC), Dyspnea subscale of the Chronic Respiratory Questionnaire (CRQ-D), and a global dyspnea question. Pulmonary function parameters included FEV1% predicted, FEV1/FVC, and RV/TLC. The factor analysis yielded three factors that accounted for 58.7% of the total variance in the data: Factor 1, "Dyspnea with Laboratory Exercise" comprised ETT SOB end, ETT SOB isotime, ITTSOB end, ITT SOB isotime, ITT SOB/Time and ETT SOB/Time. Factor 2, "Clinical Dyspnea," comprised 6MW SOB, 6MW SOB/Feet, BDI, SOBQ, MRC, Global SOB, CRQ-D. Measures of airway resistance (FEV1% predicted, FEV1/FVC) and hyperinflation (RV/TLC) loaded on a third factor, "Pulmonary Function." An additional post hoc factor analysis with post-intervention data provided similar results. The Global SOB question and ITT SOB isostage variables were relatively more sensitive to change compared to the other outcome variables. We conclude that pulmonary function, clinical ratings of dyspnea, and laboratory ratings of dyspnea are three separate and independent factors and should be

  9. Developing Tactical Commanders at CGSOC for the Future AirLand Battlefield

    DTIC Science & Technology

    1991-01-04

    and history. Airland BaLtLe Futr (ALB-F), sentor Army leaders and cu|rrent an thors ettIIaI sizL’ w LI tIpo rta|ce of these same c’ommniland cotlpoilets...that bring about an end or result."󈧖 Proper identification of the command process components could therefore form the basis of a command educational...doctrinal manual Truppenfuhrung (troop- 14 leading).39 For example, Truppenfuhrung specifically states: "The general intention is expressed, the end to

  10. Detailed Mutational Analysis of Vga(A) Interdomain Linker: Implication for Antibiotic Resistance Specificity and Mechanism

    PubMed Central

    Lenart, Jakub; Vimberg, Vladimir; Vesela, Ludmila; Janata, Jiri

    2014-01-01

    Detailed mutational analysis examines the roles of individual residues of the Vga(A) linker in determining the antibiotic resistance phenotype. It defines a narrowed region of residues 212 to 220 whose composition determines the resistance specificity to lincosamides, pleuromutilins, and/or streptogramins A. From the analogy with the recently described function of the homologous ABC-F protein EttA as a translational factor, we infer that the Vga(A) linker interacts with the ribosome and directly or indirectly affects the binding of the respective antibiotic. PMID:25512423

  11. Exercise-induced ST-segment elevation in ECG lead aVR is a useful indicator of significant left main or ostial LAD coronary artery stenosis.

    PubMed

    Uthamalingam, Shanmugam; Zheng, Hui; Leavitt, Marcia; Pomerantsev, Eugene; Ahmado, Imad; Gurm, Gagandeep S; Gewirtz, Henry

    2011-02-01

    The authors tested the hypothesis that exercise treadmill testing (ETT)-induced ST-segment elevation (STE) in electrocardiographic lead aVR is an important indicator of significant left main coronary artery (LMCA) or ostial left anterior descending coronary artery (LAD) stenosis. Although STE in lead aVR is an indicator of LMCA or very proximal LAD occlusion in acute coronary syndromes, its predictive power in the setting of ETT is uncertain. Rest and stress electrocardiograms, clinical and stress test parameters, and single photon-emission computed tomographic myocardial perfusion imaging (MPI) data, when available, were obtained in 454 subjects (378 with MPI) who underwent cardiac catheterization and standard Bruce ETT ≤ 6 months before catheterization. Patients were selected for LMCA or ostial LAD disease (≥ 50% stenosis) with or without other coronary artery disease (CAD), CAD (≥ 70% stenosis) without significant LMCA or ostial LAD, or no significant CAD. Univariate followed by multivariate logistic regression analyses of clinical, electrocardiographic, stress test, and single photon-emission computed tomographic MPI variables were used to identify significant correlates of LMCA or ostial LAD stenosis. Bayesian analysis of the data also was performed. LMCA (n = 38) or ostial LAD (n = 42) stenosis occurred in 75 patients (5 patients had both). The remainder had CAD without LMCA or ostial LAD stenosis (n = 276) or no CAD (n = 103). In multivariate analysis, the strongest predictor was stress-induced STE in lead aVR (p < 0.0001, area under the curve 0.82). Both left ventricular ejection fraction (after stress) and percent reversible LAD ischemia on single photon-emission computed tomographic MPI also contributed significantly in multivariate analysis (p < 0.005 and p < 0.05, respectively, areas under the curve 0.60 and 0.64, respectively). Although additional electrocardiographic, stress test, and MPI variables were significant univariate predictors, none

  12. Offutt AFB Nebraska. Revised Uniform Summary of Surface Weather Observations. Parts A-F

    DTIC Science & Technology

    1979-06-21

    C GLOBAL CLIMATOLUr-Y BRANCH ,’ USA FETAC PSYCH ROMETRICSUMR j14949 fMFUTT AFO NIF 0__________78_______ _ mAR...8217. 2 G LOOAL CLIMATULUr’Y B3RANCH USA Fr TAC PSYCHROMETRICSU M R AIR viATHER SERV!CF/iCSU M R 14940 rl(:ETT A~ NIF j-7k’N SAINSTATION NAME...Ar( 14949 [11FUTT AFI3 NIF ,_-76 JUN STATION STATION NAME YEARS MONTH PAGE I l00-2300 HOURS (L. S. T.) Temp. _ WET BULB TEMPERATURE DEPRESSION (F

  13. Regulation of Epidermal Growth Factor Receptor Signaling by cbl-b

    DTIC Science & Technology

    2001-01-18

    2367-2377. 4. Keane. M. M., Ett.enbe’l’ S. A., Nau, M. N., Banerjee, P., Cuello , M., Penainger, J., and Lipkowitz, S. (1999) OncogeM 1& 3365-3375. 5...DegradationoftheEpidermalGrowtbFactorReceptorSignaling Complex Seth A. Ettenberg*t, Alessandra Magnificot, Mauricio Cuello *, Marion M. Nau*, Yalfa R...Lopez. M.. Rosnet. 0 .. and Birnbaum. D. (1998) In’ J OncoI13(6), 1159-1161 7. Keane. M. M.. Ellenberg. S. A.. Nau. M. N.. Banerjee. P.. Cuello . M

  14. Complete Obstruction of Endotracheal Tube in an Infant with a Retropharyngeal and Anterior Mediastinal Abscess

    PubMed Central

    Greene, Nathaniel H.

    2017-01-01

    Intraoperative ventilatory failure is not an uncommon complication; however, acute endotracheal obstruction by a foreign body or blood clot can be difficult to quickly discriminate from other causes. Once the diagnosis is made, quick action is needed to restore ventilation. The ultimate solution is to exchange the endotracheal tube; however, there can be other ways of resolving this in situations where reintubation would be difficult or unsafe. This case report discusses such an event in an infant with multiple airway challenges including a retropharyngeal and anterior mediastinal abscess. We have also formulated a pathway based on various case reports involving complete ETT obstruction. PMID:28299222

  15. Cuffed endotracheal tubes in children: the effect of the size of the cuffed endotracheal tube on intracuff pressure.

    PubMed

    Krishna, Senthil G; Hakim, Mumin; Sebastian, Roby; Dellinger, Heather L; Tumin, Dmitry; Tobias, Joseph D

    2017-05-01

    In children, the size of the cuffed endotracheal tube is based on various age-based formulas. However, such formulas may over or underestimate the size of the cuffed endotracheal tube. There are no data on the impact of different-sized cuffed endotracheal tubes (ETT) on the intracuff pressure in children. The current study measures intracuff pressure with different-sized cuffed ETT. The study was conducted in an in vitro and in vivo phase. For the in vitro phase, 10 cuffed ETT of size 4.0, 4.5, and 5 mm internal diameter (ID) each were randomly placed inside a 1.0 cm ID plastic tube (mimicking the trachea), which was in turn connected to a 1 l test lung. After inflation of the cuff using the air leak test at a continuous positive airway pressure of 20 cmH2 O, the intracuff pressure was measured. The in vivo phase was conducted in 100 children (4-8 years) and were randomly divided into two groups to receive either a cuffed endotracheal tube based on the Khine formula (Group R) or a cuffed endotracheal tube that was a half-size (0.5 mm ID) smaller (Group S). Following the inflation of the cuff to seal the trachea, the intracuff pressure was measured. In the in vitro phase, the intracuff pressure was 45 ± 6, 23 ± 1, and 14 ± 6 cmH2 O with size 4.0, 4.5, and 5 mm ID cuffed ETT, respectively (F-test P < 0.001 for difference among three groups). In the in vivo phase, the mean intracuff pressure in Group R was 25 ± 19 cmH2 O vs 37 ± 35 cmH2 O in Group S (95% CI of difference: 1, 23; P = 0.039). If the cuffed endotracheal tube is too small, the trachea can still be sealed by inflating the cuff with additional air. However, this transforms the cuff from the intended high-volume, low-pressure cuff to an undesirable high-volume, high-pressure cuff. © 2017 John Wiley & Sons Ltd.

  16. A comparison of coronary CTA and stress testing using high-efficiency SPECT MPI for the evaluation of chest pain in the emergency department.

    PubMed

    Duvall, W Lane; Savino, John A; Levine, Elliot J; Baber, Usman; Lin, Jonathan T; Einstein, Andrew J; Hermann, Luke K; Henzlova, Milena J

    2014-04-01

    Recent studies have compared CTA to stress testing and MPI using older Na-I SPECT cameras and traditional rest-stress protocols, but are limited by often using optimized CTA protocols but suboptimal MPI methodology. We compared CTA to stress testing with modern SPECT MPI using high-efficiency CZT cameras and stress-first protocols in an ED population. In a retrospective, non-randomized study, all patients who underwent CTA or stress testing (ETT or Tc-99m sestamibi SPECT MPI) as part of their ED assessment in 2010-2011 driven by ED attending preference and equipment availability were evaluated for their disposition from the ED (admission vs discharge, length of time to disposition), subsequent visits to the ED and diagnostic testing (within 3 months), and radiation exposure. CTA was performed using a 64-slice scanner (GE Lightspeed VCT) and MPI was performed using a CZT SPECT camera (GE Discovery 530c). Data were obtained from prospectively acquired electronic medical records and effective doses were calculated from published conversion factors. A propensity-matched analysis was also used to compare outcomes in the two groups. A total of 1,458 patients underwent testing in the ED with 192 CTAs and 1,266 stress tests (327 ETTs and 939 MPIs). The CTA patients were a lower-risk cohort based on age, risk factors, and known heart disease. A statistically similar proportion of patients was discharged directly from the ED in the stress testing group (82% vs 73%, P = .27), but their time to disposition was longer (11.0 ± 5 vs 20.5 ± 7 hours, P < .0001). There was no significant difference in cardiac return visits to the ED (5.7% CTA vs 4.3% stress testing, P = .50), but more patients had follow-up studies in the CTA cohort compared to stress testing (14% vs 7%, P = .001). The mean effective dose of 12.6 ± 8.6 mSv for the CTA group was higher (P < .0001) than 5.0 ± 4.1 mSv for the stress testing group (ETT and MPI). A propensity score-matched cohort showed similar

  17. Nuclear Techniques for Plasma Diagnostics.

    DTIC Science & Technology

    1979-04-23

    ers ar e ’ usually u’~ett t o s ep ar a t e ’ t h e n eu t cons and x rays . In e x p e r i r n ’n t s w her e I ic x — r a \\ pu iso is Sn I S ic...DAViS EGSG , INC. ALBU QUER QUE D IV IS ION P.O. BOX 10218 ALBUQUERQUE, NM 87114 1 CV ATTN: TECHNICAL LIBRARY FORD AEROSPACE & COMMUNICATIONS CORP

  18. Endoscopic Appearance of Oropharyngeal and Upper GI Kaposi's Sarcoma in an Immunocompromised Patient.

    PubMed

    Darr, Umar; Renno, Anas; Khan, Zubair; Alkully, Turki; Moslim, Maitham A; Kamal, Sehrish; Nawras, Ali

    2017-01-01

    Introduction. Kaposi's sarcoma (KS) usually manifests as a cutaneous disease but GI manifestation is often rare. It is associated with human herpes virus-8 (HHV-8) and seen in immunocompromised patients. In the USA, use of highly active antiretroviral therapy (HAART) has drastically reduced incidence of KS in HIV patients. Case Presentation. A 65-year-old male with human immunodeficiency virus (HIV) was admitted to the intensive care unit (ICU) with cardiopulmonary arrest secondary to hyperkalemia of 7.5 meq/L. Following placement of orogastric and endotracheal tube (ETT), a significant amount of blood was noticed in the ETT. Hemoglobin trended down from 9.6 mg/dL to 6.7 mg/dL over five days. Stool guaiac was positive. Esophagogastroduodenoscopy (EGD) was performed and revealed multiple large hypervascularized violaceous submucosal nodular lesions with stigmata of bleeding seen on the soft palate and pharynx and within the cricopharyngeal area close to the vocal cords. Biopsy of the soft palate lesions showed proliferation of neoplastic spindle shaped cells arranged in bundles with slit-like capillary spaces containing erythrocytes consistent with Kaposi's sarcoma. Biopsy was positive for HHV-8. Colonoscopy was unremarkable. There were no cutaneous manifestations of the disease. Conclusion. GI involvement of Kaposi's sarcoma must be considered in immunocompromised patients and can be confirmed by endoscopic methods.

  19. Implementing a perpetual anesthesia setup standardized for the trauma room in a level I trauma center.

    PubMed

    Faircloth, Amanda C; Ford, Mary B

    2013-02-01

    The trauma room in a level I trauma center is a dynamic environment that provides little room for error. Significant variability can exist if anesthesia providers set up the room differently. Standardization provides a system that is consistent, reliable, and cost-effective. This study examines the process of creating and implementing a standardized anesthesia setup in the trauma room of a level I trauma center. As a result of this study, the medication cart and airway setups have been standardized. Providers are encouraged to only draw up medications that will be immediately used and to ensure that prefilled syringes have been incorporated into the pharmacy formulary. Using the EZ Endo prestyleted endotracheal tube (ETT) vs a regular ETT with stylet has yielded an annual cost savings of $2,673. Ensuring that items such as an esophageal temperature probe, humidifier, and nasogastric tube are available but unopened has provided a savings of $1,989.25 per year. The reservoir bag has been changed to a latex-free bag, and 3 central line kits including an arterial line kit are routinely stocked. An ultrasound machine dedicated for central line access, GlideScope, rapid fluid infuser, and Airtraq laryngoscope have all been incorporated into the permanent setup in the trauma room.

  20. Endoscopic Appearance of Oropharyngeal and Upper GI Kaposi's Sarcoma in an Immunocompromised Patient

    PubMed Central

    Renno, Anas; Khan, Zubair; Alkully, Turki; Kamal, Sehrish; Nawras, Ali

    2017-01-01

    Introduction. Kaposi's sarcoma (KS) usually manifests as a cutaneous disease but GI manifestation is often rare. It is associated with human herpes virus-8 (HHV-8) and seen in immunocompromised patients. In the USA, use of highly active antiretroviral therapy (HAART) has drastically reduced incidence of KS in HIV patients. Case Presentation. A 65-year-old male with human immunodeficiency virus (HIV) was admitted to the intensive care unit (ICU) with cardiopulmonary arrest secondary to hyperkalemia of 7.5 meq/L. Following placement of orogastric and endotracheal tube (ETT), a significant amount of blood was noticed in the ETT. Hemoglobin trended down from 9.6 mg/dL to 6.7 mg/dL over five days. Stool guaiac was positive. Esophagogastroduodenoscopy (EGD) was performed and revealed multiple large hypervascularized violaceous submucosal nodular lesions with stigmata of bleeding seen on the soft palate and pharynx and within the cricopharyngeal area close to the vocal cords. Biopsy of the soft palate lesions showed proliferation of neoplastic spindle shaped cells arranged in bundles with slit-like capillary spaces containing erythrocytes consistent with Kaposi's sarcoma. Biopsy was positive for HHV-8. Colonoscopy was unremarkable. There were no cutaneous manifestations of the disease. Conclusion. GI involvement of Kaposi's sarcoma must be considered in immunocompromised patients and can be confirmed by endoscopic methods. PMID:28261507

  1. Who gets admitted to the Chest Pain Unit (CPU) and how do we manage them? Improving the use of the CPU in Waikato DHB, New Zealand.

    PubMed

    Jade, Judith; Huggan, Paul; Stephenson, Douglas

    2015-01-01

    Chest pain is a commonly encountered presentation in the emergency department (ED). The chest pain unit at Waikato DHB is designed for patients with likely stable angina, who are at low risk of acute coronary syndrome (ACS), with a normal ECG and Troponin T, who have a history which is highly suggestive of coronary artery disease (CAD). Two issues were identified with patient care on the unit (1) the number of inappropriate admissions and (2) the number of inappropriate exercise tolerance tests. A baseline study showed that 73% of admissions did not fulfil the criteria and the majority of patients (72%) had an exercise tolerance test (ETT) irrespective of clinical picture. We delivered educational presentations to key stakeholders and the implementation of a new fast track chest pain pathway for discharging patients directly from the ED. There was an improvement in the number of patients inappropriately admitted, which fell to 61%. However, the number of inappropriate ETTs did not decrease, and were still performed on 76.9% of patients.

  2. Blood pressure morning surge, exercise blood pressure response and autonomic nervous system.

    PubMed

    Tanindi, Asli; Ugurlu, Murat; Tore, Hasan Fehmi

    2015-08-01

    We investigated blood pressure (BP) response to exercise with respect to BP morning surge (MS), and the association between MS, exercise treadmill test (ETT) and heart rate variability (HRV) indices. Eighty-four healthy subjects without hypertension were enrolled. Ambulatory BP monitoring and 24-hour Holter recordings were obtained for sleep-trough MS and HRV indices: low-frequency (LF) component, high-frequency (HF) component and LF/HF ratio. ETT was performed, and BPs were obtained at rest, end of each stage, and recovery. Third-minute heart rate recovery (HRR) and BP recovery ratio (BPRR) were calculated. When analysed in quartiles of MS, systolic BP at low workloads was higher in the highest than in the lowest quartile, although maximum BPs at maximum exercise were not significantly different. BPRR was highest in the highest quartile in contrast to HRR, which was lowest in the highest quartile. LF/HF was highest during both at daytime and night-time in the highest quartile. BPRR and LF/HF were positively, and HRR was inversely associated with MS. Subjects with a high MS have higher BP at low workloads, at which most daily activities are performed, and impairment in some indices, which indirectly reflect the autonomic nervous system.

  3. CO2 Absorption Using Fluorine Functionalized Ionic Liquids: Interplay of Hydrogen and σ-Hole Interactions.

    PubMed

    Rao, Soniya S; Gejji, Shridhar P

    2016-03-03

    Use of ionic liquids (ILs) for CO2 capture offers certain advantages over currently used methodologies and is of growing interest. With this perspective, ILs composed of S-ethyl-N,N,N',N'-tetramethylthiouronium ([ETT]) and 1-hexyl-3-methylimidazolium ([Hmim]) cations and tris(pentafluoroethyl)trifluorophosphate ([FEP]) anion have been investigated. The present work unravels the noncovalent interactions accompanying CO2 capture by these ILs. Electronic structure of ion pairs and their CO2 absorbed [ETT][FEP]·n(CO2) and [Hmim][FEP]·n(CO2) (n up to 30) complexes are derived. The anisotropy in molecular electrostatic potential dictates the binding of CO2 through the interplay of (i) halogen bonding (O···F) between electron deficient σ-holes on fluorines, (ii) electrostatic C···F interactions between electron deficient carbons of CO2 and the electron-rich fluorine atoms, and the (iii) hydrogen bonding (O···H) interactions from the cation. The manifestations of these interactions on binding energies, polarizabilities, and vibrational spectra of CO2 absorbed complexes are presented. Consequent "frequency shift" accompanying hydrogen and halogen bonding exhibit complementary characteristics in the infrared spectra of CO2 absorbed complexes. Correlation of binding energies to absorbed CO2 molecules further demonstrate that [Hmim] based ILs are more efficient for CO2 capture applications.

  4. A fibroid or cancer? A rare case of mixed choriocarcinoma and epithelioid trophoblastic tumour.

    PubMed

    Luk, Wan Yu; Friedlander, Michael

    2013-01-01

    Background. Gestational trophoblastic disease (GTD) is a rare complication of pregnancy which is characterised by abnormal growth of the trophoblasts at the placental site. It is categorised into benign and malignant forms, which include hydatidiform moles (HMs) and gestational trophoblastic neoplasia (GTN), respectively. A mixed choriocarcinoma (CC) and epithelioid trophoblastic tumour (ETT) is an extremely rare subgroup of GTN, which is a highly curable but aggressive form of malignancy. Case. We report a case of mixed CC and ETT in a 41-year-old patient who presented with a 2-year history of menorrhagia and fibroid uterus in the absence of previous history of molar pregnancy. She had a 12-year interval between the antecedent pregnancy and presentation. She was treated with intensive regimen of adjuvant chemotherapy, etoposide, methotrexate, and actinomycin-D with etoposide and cisplatin (EMA-EP). She has remained disease free for more than 5 years. Conclusion. This case highlights the importance of considering GTN as one of the differential diagnoses value of β -HCG in patients presented with menorrhagia and growing fibroids.

  5. Making whole blood available in austere medical environments: donor performance and safety.

    PubMed

    Eliassen, Håkon S; Aandstad, Anders; Bjerkvig, Christopher; Fosse, Theodor; Audun Hervig, Tor; Pidcoke, Heather F; Strandenes, Geir

    2016-04-01

    To provide whole blood on the battlefield can be a challenge, but a buddy system protocol is both an elegant and the only currently available means to supply blood to a Special Forces team in far-forward locations. Our aim was to investigate donor-safety associated with such a protocol. This study was a randomized, double-blinded, controlled trial that aimed to evaluate the immediate effects of a 450 cc blood donation on physical performance in fatigued and dehydrated Special Forces soldiers. The primary outcome variables were absolute and relative maximal oxygen uptake (VO2max ), exercise tolerance time (ETT) and heart rate (HR). Relative VO2max decreased by 7.1% in the donation group between pre and posttest, compared to no change in the control group. Absolute VO2max decreased by 11.2 and 3.6% between pre and posttest in the donation and control groups, respectively. Mean ETT in the donation group was on average 92 seconds shorter compared to baseline, which represents a decrease of 9.5%. Donating blood after a week of strenuous physical activity is feasible for Special Forces personnel. While the donation results in some diminishment of VO2max , a 3.6%-11.2% decrease in relative VO2max , and in elevation of submaximal HR levels highly trained personnel continue to perform well both at both sub-maximal and maximal effort levels. © 2016 AABB.

  6. Numerical investigation of pulmonary drug delivery under mechanical ventilation conditions

    NASA Astrophysics Data System (ADS)

    Banerjee, Arindam; van Rhein, Timothy

    2012-11-01

    The effects of mechanical ventilation waveform on fluid flow and particle deposition were studied in a computer model of the human airways. The frequency with which aerosolized drugs are delivered to mechanically ventilated patients demonstrates the importance of understanding the effects of ventilation parameters. This study focuses specifically on the effects of mechanical ventilation waveforms using a computer model of the airways of patient undergoing mechanical ventilation treatment from the endotracheal tube to generation G7. Waveforms were modeled as those commonly used by commercial mechanical ventilators. Turbulence was modeled with LES. User defined particle force models were used to model the drag force with the Cunningham correction factor, the Saffman lift force, and Brownian motion force. The endotracheal tube (ETT) was found to be an important geometric feature, causing a fluid jet towards the right main bronchus, increased turbulence, and a recirculation zone in the right main bronchus. In addition to the enhanced deposition seen at the carinas of the airway bifurcations, enhanced deposition was also seen in the right main bronchus due to impaction and turbulent dispersion resulting from the fluid structures created by the ETT. Authors acknowledge financial support through University of Missouri Research Board Award.

  7. Prediction of the mid-tracheal level using surface anatomical landmarks in adults

    PubMed Central

    Jang, Young-Eun; Kim, Eun-Hee; Song, In-Kyung; Lee, Ji-Hyun; Ryu, Ho-Geoul; Kim, Hee-Soo; Kim, Jin-Tae

    2017-01-01

    Abstract Endotracheal tube (ETT) should be placed at the optimal level to avoid single lung ventilation or accidental extubation. This study was performed to estimate the mid-tracheal level by using surface anatomical landmarks in adult patients. Neck computed tomography images of 329 adult patients between the ages of 16 and 79 years were reviewed. In the midline sagittal plane, the levels corresponding to the vocal cords, cricoid cartilage, suprasternal notch, manubriosternal junction, and carina were identified. The surface distances from the cricoid cartilage to the suprasternal notch (extCC-SSN) and that from the suprasternal notch to the manubriosternal junction (extSSN-MSJ) were measured. The relationship between mid-tracheal level and the surface distances was analyzed using Bland–Altman plot. The difference between the extCC-SSN and the mid-tracheal level was −6.6 (12.5) mm, and the difference between the extSSN-MSJ and the mid-tracheal level was −19.2 (6.1) mm. The difference between the extCC-SSN and the mid-tracheal level was smaller in females compared with males [−1.7 (11.7) mm vs −12.8 (10.7) mm; P < 0.001]. The mid-tracheal level, which is helpful in planning the insertion depth of an ETT, can be predicted by the surface distance between the cricoid cartilage and suprasternal notch in adults, especially in females. PMID:28328810

  8. The Effect of a Self Exercise Program in Cardiac Rehabilitation for Patients with Coronary Artery Disease

    PubMed Central

    Kim, Chul; Youn, Jo Eun

    2011-01-01

    Objective To investigate the effect of self exercise in cardiac rehabilitation on cardiopulmonary exercise capacity for selected patients with coronary artery disease. Method The subjects of this study were patients who received percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery and who participated in a cardiac rehabilitation program. The supervised exercise group participated in 6-8 weeks of aerobic exercise training with telemetry ECG monitoring in hospital. The self exercise group, whose exercise risk was low, was instructed to participiate in self exercise training in a community exercise environment according to the exercise tolerance test (ETT) using a modified Bruce protocol. Both groups underwent ETTs before and 6 months after initiation of the cardiac rehabilitation program. We compared the supervised group with the self exercise groups on exercise capacity. Results After 6 months, the supervised exercise group showed significant changes in maximum oxygen consumption, maximal heart rate, resting heart rate, and submaximal rate pressure product. The self exercise group also showed significant improvement of maximum oxygen consumption and submaximal rate pressure product. However, the changing rate of maximum oxygen consumption was significantly higher in the supervised exercise group than the self exercise group. Conclusion Both the supervised and self exercise groups showed similar improvement of cardiopulmonary exercise capacity after 6 months' participation in the cardiac rehabilitation program. However, the changing rate of maximum oxygen consumption, maximal heart rate, and resting heart rate were significantly higher in the supervised exercise group than the self exercise group. PMID:22506148

  9. Effect of nebulized eucalyptus on contamination of microbial plaque of endotracheal tube in ventilated patients

    PubMed Central

    Amini, Nazanin; Rezaei, Korosh; Yazdannik, Ahmadreza

    2016-01-01

    Background: Formation of biofilm and bacterial colonization within the endotracheal tube (ETT) are significant sources of airway contamination and play a role in the development of ventilator-associated pneumonia (VAP). This study was conducted to examine the effect of nebulized eucalyptus (NE) on bacterial colonization of ETT biofilm. Materials and Methods: We performed a randomized clinical trial in three intensive care units (ICUs) of an educational hospital. Seventy intubated patients were selected and randomly divided into intervention (n = 35) and control (n = 35) groups. The intervention group received 4 ml (5%) of eucalyptus in 6 ml normal saline every 8 h. The placebo group received only 10 ml of normal saline in the same way. On extubation, the interior of the tube was immediately sampled using a sterile swab for standard microbiological analysis. Chi-square and Fisher's exact tests were used for statistical analysis in SPSS. P values less than 0.05 were considered statistically significant. Results: In both samples, Klebsiella pneumoniae and Acinetobacter baumannii were the most frequently isolated bacteria. In the control group, heavy colonization was greater than in the intervention group (P = 0.002). The frequency of isolation of K. pneumoniae in the intervention group was lower than in the control group (P < 0.001). However, there was no difference between the two groups in other isolated bacteria. Conclusions: NE can reduce microbial contamination of the endotracheal tube biofilm in ventilated patients. Moreover, K. pneumoniae was the most sensitive to NE. PMID:27095990

  10. Fiberoptic intubation through laryngeal mask airway for management of difficult airway in a child with Klippel-Feil syndrome.

    PubMed

    Bhat, Ravi; Mane, Rajesh S; Patil, Manjunath C; Suresh, S N

    2014-07-01

    The ideal airway management modality in pediatric patients with syndromes like Klippel-Feil syndrome is a great challenge and is technically difficult for an anesthesiologist. Half of the patients present with the classic triad of short neck, low hairline, and fusion of cervical vertebra. Numerous associated anomalies like scoliosis or kyphosis, cleft palate, respiratory problems, deafness, genitourinary abnormalities, Sprengel's deformity (wherein the scapulae ride high on the back), synkinesia, cervical ribs, and congenital heart diseases may further add to the difficulty. Fiberoptic bronchoscopy alone can be technically difficult and patient cooperation also becomes very important, which is difficult in pediatric patients. Fiberoptic bronchoscopy with the aid of supraglottic airway devices is a viable alternative in the management of difficult airway in children. We report a case of Klippel-Feil syndrome in an 18-month-old girl posted for cleft palate surgery. Imaging of spine revealed complete fusion of the cervical vertebrae with hypoplastic C3 and C6 vertebrae and thoracic kyphosis. We successfully managed airway in this patient by fiberoptic intubation through classic laryngeal mask airway (LMA). After intubation, we used second smaller endotracheal tube (ETT) to stabilize and elongate the first ETT while removing the LMA.

  11. Fluid flow and particle transport in mechanically ventilated airways. Part I. Fluid flow structures.

    PubMed

    Van Rhein, Timothy; Alzahrany, Mohammed; Banerjee, Arindam; Salzman, Gary

    2016-07-01

    A large eddy simulation-based computational study of fluid flow and particle transport in upper tracheobronchial airways is carried out to investigate the effect of ventilation parameters on pulmonary fluid flow. Respiratory waveforms commonly used by commercial mechanical ventilators are used to study the effect of ventilation parameters and ventilation circuit on pulmonary fluid dynamics. A companion paper (Alzahrany et al. in Med Biol Eng Comput, 2014) reports our findings on the effect of the ventilation parameters and circuit on particle transport and aerosolized drug delivery. The endotracheal tube (ETT) was found to be an important geometric feature and resulted in a fluid jet that caused an increase in turbulence and created a recirculation zone with high wall shear stress in the main bronchi. Stronger turbulence was found in lower airways than would be found under normal breathing conditions due to the presence of the jet caused by the ETT. The pressure-controlled sinusoidal waveform induced the lowest wall shear stress on the airways wall.

  12. Classifying movement behaviour in relation to environmental conditions using hidden Markov models.

    PubMed

    Patterson, Toby A; Basson, Marinelle; Bravington, Mark V; Gunn, John S

    2009-11-01

    1. Linking the movement and behaviour of animals to their environment is a central problem in ecology. Through the use of electronic tagging and tracking (ETT), collection of in situ data from free-roaming animals is now commonplace, yet statistical approaches enabling direct relation of movement observations to environmental conditions are still in development. 2. In this study, we examine the hidden Markov model (HMM) for behavioural analysis of tracking data. HMMs allow for prediction of latent behavioural states while directly accounting for the serial dependence prevalent in ETT data. Updating the probability of behavioural switches with tag or remote-sensing data provides a statistical method that links environmental data to behaviour in a direct and integrated manner. 3. It is important to assess the reliability of state categorization over the range of time-series lengths typically collected from field instruments and when movement behaviours are similar between movement states. Simulation with varying lengths of times series data and contrast between average movements within each state was used to test the HMMs ability to estimate movement parameters. 4. To demonstrate the methods in a realistic setting, the HMMs were used to categorize resident and migratory phases and the relationship between movement behaviour and ocean temperature using electronic tagging data from southern bluefin tuna (Thunnus maccoyii). Diagnostic tools to evaluate the suitability of different models and inferential methods for investigating differences in behaviour between individuals are also demonstrated.

  13. A genetic link between epigenetic repressor AS1-AS2 and a putative small subunit processome in leaf polarity establishment of Arabidopsis

    PubMed Central

    Matsumura, Yoko; Ohbayashi, Iwai; Takahashi, Hiro; Kojima, Shoko; Ishibashi, Nanako; Keta, Sumie; Nakagawa, Ayami; Hayashi, Rika; Saéz-Vásquez, Julio; Echeverria, Manuel; Sugiyama, Munetaka; Nakamura, Kenzo; Machida, Chiyoko

    2016-01-01

    ABSTRACT Although the DEAD-box RNA helicase family is ubiquitous in eukaryotes, its developmental role remains unelucidated. Here, we report that cooperative action between the Arabidopsis nucleolar protein RH10, an ortholog of human DEAD-box RNA helicase DDX47, and the epigenetic repressor complex of ASYMMETRIC-LEAVES1 (AS1) and AS2 (AS1-AS2) is critical to repress abaxial (ventral) genes ETT/ARF3 and ARF4, which leads to adaxial (dorsal) development in leaf primordia at shoot apices. Double mutations of rh10-1 and as2 (or as1) synergistically up-regulated the abaxial genes, which generated abaxialized filamentous leaves with loss of the adaxial domain. DDX47 is part of the small subunit processome (SSUP) that mediates rRNA biogenesis. In rh10-1 we found various defects in SSUP-related events, such as: accumulation of 35S/33S rRNA precursors; reduction in the 18S/25S ratio; and nucleolar hypertrophy. Double mutants of as2 with mutations of genes that encode other candidate SSUP-related components such as nucleolin and putative rRNA methyltransferase exhibited similar synergistic defects caused by up-regulation of ETT/ARF3 and ARF4. These results suggest a tight link between putative SSUP and AS1-AS2 in repression of the abaxial-determining genes for cell fate decisions for adaxial development. PMID:27334696

  14. Who gets admitted to the Chest Pain Unit (CPU) and how do we manage them? Improving the use of the CPU in Waikato DHB, New Zealand

    PubMed Central

    Jade, Judith; Huggan, Paul; Stephenson, Douglas

    2015-01-01

    Chest pain is a commonly encountered presentation in the emergency department (ED). The chest pain unit at Waikato DHB is designed for patients with likely stable angina, who are at low risk of acute coronary syndrome (ACS), with a normal ECG and Troponin T, who have a history which is highly suggestive of coronary artery disease (CAD). Two issues were identified with patient care on the unit (1) the number of inappropriate admissions and (2) the number of inappropriate exercise tolerance tests. A baseline study showed that 73% of admissions did not fulfil the criteria and the majority of patients (72%) had an exercise tolerance test (ETT) irrespective of clinical picture. We delivered educational presentations to key stakeholders and the implementation of a new fast track chest pain pathway for discharging patients directly from the ED. There was an improvement in the number of patients inappropriately admitted, which fell to 61%. However, the number of inappropriate ETTs did not decrease, and were still performed on 76.9% of patients. PMID:26734314

  15. Exaggerated blood pressure response during the exercise treadmill test as a risk factor for hypertension

    PubMed Central

    Lima, S.G.; Albuquerque, M.F.P.M.; Oliveira, J.R.M.; Ayres, C.F.J.; Cunha, J.E.G.; Oliveira, D.F.; Lemos, R.R.; Souza, M.B.R.; Silva, O. Barbosa e

    2013-01-01

    Exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) has been considered to be a risk factor for hypertension. The relationship of polymorphisms of the renin-angiotensin system gene with hypertension has not been established. Our objective was to evaluate whether EBPR during exercise is a clinical marker for hypertension. The study concerned a historical cohort of normotensive individuals. The exposed individuals were those who presented EBPR. At the end of the observation period (41.7 months = 3.5 years), the development of hypertension was analyzed within the two groups. Genetic polymorphisms and blood pressure behavior were assessed as independent variables, together with the classical risk factors for hypertension. The I/D gene polymorphism of the angiotensin-converting enzyme and M235T of angiotensinogen were ruled out as risk factors for hypertension. EBPR during ETT is not an independent influence on the chances of developing hypertension. No differences were observed between the hypertensive and normotensive individuals regarding gender (P = 0.655), skin color (P = 0.636), family history of hypertension (P = 0.225), diabetes mellitus (P = 0.285), or hypertriglyceridemia (P = 0.734). The risk of developing hypertension increased with increasing body mass index (BMI) and advancing age. The risk factors, which independently influenced the development of hypertension, were age and BMI. EBPR did not constitute an independent risk factor for hypertension and is probably a preclinical phase in the spectrum of normotension and hypertension. PMID:23598646

  16. Validation of maternal cardiac output assessed by transthoracic echocardiography against pulmonary artery catheterization in severely ill pregnant women: prospective comparative study and systematic review.

    PubMed

    Cornette, J; Laker, S; Jeffery, B; Lombaard, H; Alberts, A; Rizopoulos, D; Roos-Hesselink, J W; Pattinson, R C

    2017-01-01

    ámicos serios, debido a los cuales existe la necesidad de sistemas validados de monitorización hemodinámica para mujeres embarazadas. Aunque la cateterización de la arteria pulmonar (CAP) mediante termodilución es el patrón de referencia clínico para la medición del gasto cardíaco (GC), este método se usa con poca frecuencia debido a su naturaleza invasiva. La ecocardiografía transtorácica (ETT) permite la determinación no invasiva del GC. El objetivo de este estudio fue validar la ETT frente al CAP para determinar el GC en mujeres embarazadas gravemente enfermas. MÉTODOS: Este estudio consistió en un metaanálisis que combinó datos de un estudio prospectivo y una revisión sistemática. El estudio prospectivo se llevó a cabo en Pretoria (Sudáfrica) en 2003. Se incluyeron mujeres con complicaciones graves en el embarazo que requerían una monitorización invasiva mediante CAP según las directrices de ese momento. Se realizó una ETT en un plazo de 15 minutos de haber realizado el CAP y el investigador no tuvo acceso a las mediciones del CAP. Las mediciones comparativas se extrajeron de estudios similares obtenidos a partir de una revisión sistemática de la literatura y se añadieron a una base de datos. Se compararon las mediciones simultáneas del GC mediante ETT y CAP. La concordancia entre métodos se evaluó a través del método estadístico de Bland-Altman y de coeficientes de correlación intraclase (CCI). Se incluyeron treinta y cuatro mediciones comparativas en el metaanálisis. Los valores medios del GC obtenidos mediante CAP y ETT fueron de 7,39 l/min y 7.18 l/min, respectivamente. El sesgo fue de 0,21 l/min, siendo los límites inferior y superior de la concordancia de -1,18 l/min y 1.60 l/min; el error porcentual fue del 19,1%, y el CCI entre ambos métodos fue de 0,94. Las mediciones del GC en mujeres embarazadas mediante ETT muestran una excelente concordancia con las obtenidas mediante CAP. Dada su naturaleza no invasiva y su

  17. What does it take to start an oropharyngeal fire? Oxygen requirements to start fires in the operating room.

    PubMed

    Roy, Soham; Smith, Lee P

    2011-02-01

    Airway fires are a well-described and potentially devastating complication of oropharyngeal surgery. However, the actual factors required to ignite the fire have never been well-delineated in the medical literature. In this study, we used a mechanical model to assess the oxygen parameters necessary to cause an oropharyngeal fire. An electrosurgical unit (Bovie) was grounded to a whole raw chicken and a 6.0 endotracheal tube (ETT) was inserted into the cranial end of the degutted central cavity. Oxygen (O(2)) was then titrated through the ETT tube at varying concentrations, with flow rates varying from 10 to 15L/min. Electrocautery (at a setting of 15W) was performed on tissue in the central cavity of the chicken near the ETT. All trials were repeated twice to ensure accuracy. Positive test results were quantified by the time required to obtain ignition of any part of the mechanical setup and time required to produce a sustained flame. A test was considered negative if no ignition could be obtained after four minutes of direct electrocautery. At an O(2) concentration of 100% and a flow rate of 15L/min, ignition with a sustained flame was obtained between 15 and 30s after initiation of electrocautery. At 100% O(2) at 10L/min, ignition was obtained at 70s with immediate sustained flame. At an O(2) concentration of 60%, ignition occurred at 25s and sustained fire after 60s. At an O(2) concentration of 50% ignition with a sustained flame occurred between 128 and 184s. At an O(2) concentration of 45%, neither ignition nor sustained flames could be obtained in any trial. Operating room fires remain a genuine danger when performing oropharyngeal surgery where electrocautery is performed in an oxygen-enriched environment. In our study, higher O(2) flow rates with higher FiO(2) correlated with quicker ignition in the chicken cavity. A fire was easily obtained when using 100% O(2); as the O(2) concentration decreases, longer exposure to electrocautery is required for ignition

  18. Correction of Tibial Torsion in Children With Cerebral Palsy by Isolated Distal Tibia Rotation Osteotomy: A Short-term, In Vivo Anatomic Study.

    PubMed

    Andrisevic, Emily; Westberry, David E; Pugh, Linda I; Bagley, Anita M; Tanner, Stephanie; Davids, Jon R

    2016-01-01

    Excessive internal or external tibial torsion is frequently present in children with cerebral palsy. Several surgical techniques have been described to correct excessive tibial torsion, including isolated distal tibial rotation osteotomy (TRO). The anatomic changes surrounding this technique are poorly understood. The goal of the study was to examine the anatomic relationship between the tibia and fibula following isolated distal TRO in children with cerebral palsy. Twenty patients with 29 limbs were prospectively entered for study. CT scans of the proximal and distal tibiofibular (TF) articulations were obtained preoperatively, at 6 weeks, and 1 year postoperatively. Measurements of tibia and fibula torsion were performed at each interval. Qualitative assessments of proximal and distal TF joint congruency were also performed. The subjects with internal tibia torsion (ITT, 19 limbs) showed significant torsional changes for the tibia between preoperative, postoperative, and 1 year time points (mean torsion 13.21, 31.05, 34.84 degrees, respectively). Measurement of fibular torsion in the ITT treatment group also showed significant differences between time points (mean -36.77, -26.77, -18.54 degrees, respectively). Proximal and distal TF joints remained congruent at all time points in the study.Subjects with external tibia torsion (ETT, 10 limbs) showed significant differences between preoperative and postoperative tibial torsion, but not between postoperative and 1 year (mean torsion 54, 19.3, 23.3 degrees, respectively). Measurement of fibular torsion in the ETT treatment group did not change significantly between preoperative and postoperative, but did change significantly between postoperative and 1 year (mean torsion -9.8,-16.9, -30.7 degrees, respectively). Nine of 10 proximal TF joints were found to be subluxated at 6 weeks postoperatively. At 1 year, all 9 of these joints had reduced. Correction of ITT by isolated distal tibial external rotation osteotomy

  19. Clinical use of the volume-time curve for endotracheal tube cuff management.

    PubMed

    Bolzan, Douglas Willian; Gomes, Walter Jose; Peixoto, Thatiana Cristina Alves; Faresin, Sônia Maria; Carvalho, Antônio Carlos de Camargo; De Paola, Angelo Amato Vincenzo; Guizilini, Solange

    2014-11-01

    Previous investigation showed that the volume-time curve technique could be an alternative for endotracheal tube (ETT) cuff management. However, the clinical impact of the volume-time curve application has not been documented. The purpose of this study was to compare the occurrence and intensity of a sore throat, cough, thoracic pain, and pulmonary function between these 2 techniques for ETT cuff management: volume-time curve technique versus minimal occlusive volume (MOV) technique after coronary artery bypass grafting. A total of 450 subjects were randomized into 2 groups for cuff management after intubation: MOV group (n = 222) and volume-time curve group (n = 228). We measured cuff pressure before extubation. We performed spirometry 24 h before and after surgery. We graded sore throat and cough according to a 4-point scale at 1, 24, 72, and 120 h after extubation and assessed thoracic pain at 24 h after extubation and quantified the level of pain by a 10-point scale. The volume-time curve group presented significantly lower cuff pressure (30.9 ± 2.8 vs 37.7 ± 3.4 cm H2O), less incidence and intensity of sore throat (1 h, 23.7 vs 51.4%; and 24 h, 18.9 vs 40.5%, P < .001), cough (1 h, 19.3 vs 48.6%; and 24 h, 18.4 vs 42.3%, P < .001), thoracic pain (5.2 ± 1.8 vs 7.1 ± 1.7), better preservation of FVC (49.5 ± 9.9 vs 41.8 ± 12.9%, P = .005), and FEV1 (46.6 ± 1.8 vs 38.6 ± 1.4%, P = .005) compared with the MOV group. The subjects who received the volume-time curve technique for ETT cuff management presented a significantly lower incidence and severity of sore throat and cough, less thoracic pain, and minimally impaired pulmonary function than those subjects who received the MOV technique during the first 24 h after coronary artery bypass grafting. Copyright © 2014 by Daedalus Enterprises.

  20. Acceptance and commitment therapy improves exercise tolerance in sedentary women.

    PubMed

    Ivanova, Elena; Jensen, Dennis; Cassoff, Jamie; Gu, Fei; Knäuper, Bärbel

    2015-06-01

    To test the efficacy of an acute intervention derived from acceptance and commitment therapy (ACT) for increasing high-intensity constant work rate (CWR) cycle exercise tolerance in a group of low-active women age 18-45 yr. The secondary goals were to examine whether ACT would reduce perceived effort and improve in-task affect during exercise and increase postexercise enjoyment. In a randomized controlled trial, 39 women were randomized to either the experimental (using ACT-based cognitive techniques and listening to music during the CWR exercise tests) or a control group (listening to music during the CWR exercise tests). Before (CWR-1) and after the intervention (CWR-2), participants completed a CWR cycle exercise test at 80% of maximal incremental work rate (Wmax) until volitional exhaustion. On average, ACT (n = 18) and control (n = 21) groups were matched for age, body mass index, weekly leisure activity scores, and Wmax (all P > 0.05). Exercise tolerance time (ETT) increased by 15% from CWR-1 to CWR-2 for the ACT group (392.05 ± 146.4 vs 459.39 ± 209.3 s; mean ± SD) and decreased by 8% (384.71 ± 120.1 vs 353.86 ± 127.9 s) for the control group (P = 0.008). RPE were lower (e.g., by 1.5 Borg 6-20 scale units at 55% of ETT, P ≤ 0.01) during CWR-2 in the ACT versus that in the control group. By contrast, ACT had no effect on in-task affect. Exercise enjoyment was higher after CWR-2 in the ACT group versus that in the control group (P < 0.001). An acute ACT intervention increased high-intensity ETT and postexercise enjoyment and reduced perceived effort in low-active women. Further investigations of ACT as an effective intervention for enhancing the established health benefits of high-intensity exercise need to be provided.

  1. [Anesthetic management of patients with mental retardation during autologous transplantation of peripheral blood mononuclear cells outside the operating room].

    PubMed

    Li, Meng-meng; Zhang, Qing-hong; Liu, Ying-hui; Yue, Li; Liu, Zhi-hui; Hao, Jian-hua

    2011-06-01

    To observe the anesthetic effect and safety of differential airway management in patients with mental retardation (MR) during autologous peripheral blood mononuclear cell transplantation (APBMCT) outside the operating room. In this prospective study, 30 uncooperative patients with MR receiving total intravenous anesthesia (TIVA) with propofol for APBMCT were randomized into 3 groups with monitored anesthesia care (MAC group), inserted classic laryngeal mask airway under general anesthesia (LMA group), or endotracheal tube placement (ETT group). The blood pressure (BP), heart rate (HR), SpO(2) and pH, PaCO(2), and HCO(3)(-) were monitored at 5 min and 1 h after anesthesia, before completion of the operation and at 1 h after the operation. The total operative time, dosage of propofol, awake time and body movement during the procedure were recorded. Compared with LMA and ETT groups, the MAC groups showed a significantly increased total dosage of propofol (66.07±5.41, 35.83±5.80, and 34.61±3.68 g·kg(-1)·min(-1), respectively, P<0.05 ), body movements (9.90±3.07, 2.5 1±1.50, and 0.82±0.93, P<0.05) and awake time (16.82±7.60, 4.31±1.32, and 3.73±1.33 min, P<0.05). The pH, PaCO(2), or HCO(3)(-) showed no marked changes at 5 min after anesthesia and at 1 h after the operation in the 3 groups (P>0.05). At 1 h after anesthesia, the pH in MAC group decreased markedly compared with that in LMA and ETT groups (P<0.05), and maintained a low level till the completion of the operation; the PaCO(2) was significantly elevated in MAC group and remained so till the end of the surgery (P<0.05). Endotracheal tube placement is safer than laryngeal mask airway placement and monitored anesthesia care in patients with MR during APBMCT, and allows rapid onset of sedation with minimal cardiovascular responses, body movement and recovery, therefore is more suitable in the setting outside the operating room.

  2. Use of carbonated water in reduction of adjacent gastric activity in 456 consecutive technetium-99m myocardial perfusion imaging studies.

    PubMed

    Thomas, Dustin M; Lee, Joshua S; Charmforoush, Anthony; Rubal, Bernard J; Rosenblatt, Stephen A; Butler, Joshua T; Clemenshaw, Michael; Cheezum, Michael K; Slim, Ahmad M

    2015-12-01

    Small, observational trials have suggested a reduction in adjacent gastric activity with ingestion of soda water in myocardial perfusion imaging (MPI). We report our findings prior to and after implementation of soda water in 467 consecutive MPI studies. Consecutive MPI studies performed at a high-volume facility referred for vasodilator (VD) or exercise treadmill testing (ETT) were retrospectively reviewed before and after implementation of the soda water protocol. Patients undergoing the soda water protocol received 100 ml of soda water administered 30 min prior to image acquisition and after stress. Studies were performed using a same day rest/stress protocol. Incidence of adjacent gastric activity, diaphragmatic attenuation, stress and rest perfusion defects, and major adverse cardiovascular events (MACE) outcomes defined as death, myocardial infarction, stroke, reevaluation for chest pain, and late revascularization (>90 days from MPI) were abstracted using International Classification of Diseases, Ninth Revision (ICD-9) search. Two hundred and eighteen studies were performed prior to implementation of the soda water protocol and 249 studies were performed with the use of soda water. Baseline demographic data were equal between the groups with the exception of more patients undergoing VD stress receiving soda water (p < 0.001). Soda water was not associated with a decreased incidence of adjacent gastric activity with stress (54.7% versus 61.9% with no soda water, p = 0.129) or rest (68.6% versus 69.5% with no soda water, p = 0.919) imaging. Less adjacent gastric activity was observed with patients undergoing ETT who received soda water (42.5% versus 56.9% with no soda water, p = 0.031), but no difference was observed between the groups with VD stress (69.0% versus 68.1% with no soda water, p = 1.000). The use of soda water prior to technetium-99m MPI was associated with lower rates of adjacent gastric activity only in patients undergoing ETT stress but not

  3. Optimization of Endotracheal Tube Cuff Pressure by Monitoring CO2 Levels in the Subglottic Space in Mechanically Ventilated Patients: A Randomized Controlled Trial.

    PubMed

    Efrati, Shai; Bolotin, Gil; Levi, Leon; Zaaroor, Menashe; Guralnik, Ludmila; Weksler, Natan; Levinger, Uriel; Soroksky, Arie; Denman, William T; Gurman, Gabriel M

    2017-10-01

    Many of the complications of mechanical ventilation are related to inappropriate endotracheal tube (ETT) cuff pressure. The aim of the current study was to evaluate the effectiveness of automatic cuff pressure closed-loop control in patients under prolonged intubation, where presence of carbon dioxide (CO2) in the subglottic space is used as an indicator for leaks. The primary outcome of the study is leakage around the cuff quantified using the area under the curve (AUC) of CO2 leakage over time. This was a multicenter, prospective, randomized controlled, noninferiority trial including intensive care unit patients. All patients were intubated with the AnapnoGuard ETT, which has an extra lumen used to monitor CO2 levels in the subglottic space.The study group was connected to the AnapnoGuard system operating with cuff control adjusted automatically based on subglottic CO2 (automatic group). The control group was connected to the AnapnoGuard system, while cuff pressure was managed manually using a manometer 3 times/d (manual group). The system recorded around cuff CO2 leakage in both groups. Seventy-two patients were recruited and 64 included in the final analysis. The mean hourly around cuff CO2 leak (mm Hg AUC/h) was 0.22 ± 0.32 in the manual group and 0.09 ± 0.04 in the automatic group (P = .01) where the lower bound of the 1-sided 95% confidence interval was 0.05, demonstrating noninferiority (>-0.033). Additionally, the 2-sided 95% confidence interval was 0.010 to 0.196, showing superiority (>0.0) as well. Significant CO2 leakage (CO2 >2 mm Hg) was 0.027 ± 0.057 (mm Hg AUC/h) in the automatic group versus 0.296 ± 0.784 (mm Hg AUC/h) in the manual group (P = .025). In addition, cuff pressures were in the predefined safety range 97.6% of the time in the automatic group compared to 48.2% in the automatic group (P < .001). This study shows that the automatic cuff pressure group is not only noninferior but also superior compared to the manual cuff pressure group

  4. Evaluation of the Effect of Tracheal Tube Orientation on Success of Intubation through Intubating Laryngeal Mask Airway

    PubMed Central

    Chhatrapati, Swati; Auti, Subhhash Sadashiv; Aswar, Swapnil Ganesh

    2016-01-01

    Introduction Polyvinyl Chloride Endotracheal Tube (PVC ETT) can be used as an alternative to Fastrach Silicone Wire-Reinforced Tube (FTST) for intubation through Intubating Laryngeal Mask Airway (ILMA) as the latter is expensive and has low volume high pressure cuff. Aim To evaluate the effects of orientation of PVC ETT (normal curve and reverse curve) on the success of intubation through ILMA, haemodynamic response and postoperative sore throat. Materials and Methods Sixty healthy adult patients of ASA physical status I & II scheduled for elective surgery under general anaesthesia requiring endotracheal intubation were randomly divided into two groups. In Normal (N) group (n=30), the tracheal tube was inserted with its natural curve following the 90° curvature of ILMA. In Reverse (R) group (n=30), the tracheal tube was inserted with its natural curve directed opposite to the curvature of ILMA. The time taken to intubate, number of attempts, and maneuvers required for successful endotracheal intubation along with haemodynamics and oxygen saturation were noted. Postoperative sore throat was evaluated using a Verbal Analogue Scale (VAS) (0-10). Qualitative data was analysed by Chi-Square test and Fisher’s exact test. Quantitative data was analysed by unpaired t-test and Mann-Whitney test. Results Placement of ILMA was successful in all patients. Total Intubation Time (mean±SD) in Group N was 12.53±1.78 seconds and in Group R was 11.97±1.33 seconds (p>0.05). Tracheal intubation through ILMA was successful in all patients. First attempt success rate in R Group (26 patients, 86.7%) was higher than N Group (22 patients, 73.3%) (p>0.05). Four patients (13.3%) in R Group and 8 patients (26.7%) in N Group required 2nd step of Chandy’s maneuver during second attempt for successful intubation. Incidence of sore throat 6 hours postoperatively was statistically significant (median value 2.00 in N Group vs. 0.00 in R Group) between two groups. Conclusion PVC ETT with

  5. The laryngeal mask airway for pediatric adenotonsillectomy: predictors of failure and complications.

    PubMed

    Lalwani, Kirk; Richins, Scott; Aliason, Inger; Milczuk, Henry; Fu, Rongwei

    2013-01-01

    We hypothesize that the laryngeal mask airway (LMA) is a safe technique for airway management in pediatric adenotonsillectomy (T&A). After institutional review board (I.R.B.) approval, we conducted a retrospective review of 1199 medical records of children who underwent T&A from 2002 to 2006 at Doernbecher Children's Hospital, a teaching institution in Portland, OR. There were no significant demographic differences between the LMA (n=451), endotracheal tube (ETT) (n=715), and failed LMA groups (n=33). Outcome variables were LMA failure (LMA replaced with endotracheal tube), and any complication. We collected demographic and medical data to determine the incidence and predictors of LMA failure, and to characterize the failed LMA group. The incidence of LMA failure was 6.8%. Patients who underwent adenoidectomy had significantly lower odds of LMA failure compared to patients who had a tonsillectomy or adenotonsillectomy (OR 0.28, 95% CI 0.15-0.52, P<0.0001). One of the surgeons (OR 0.46, 95% CI 0.45-0.48, P<0.0001) was also associated with decreased odds of LMA failure. Controlled ventilation (OR 7.17, 95% CI 4.99-10.32, P<0.0001), and younger patients (OR 1.05 for each year decrease in age, 95% CI 1.03-1.07, P ≤ 0.0001) were associated with increased odds of LMA failure. The complication rate was 14.2% in the LMA group and 7.7% in the ETT group. Increased odds of developing any complication were seen in male patients (OR 1.4, 95% CI 1.01-1.7, P=0.04), and in patients with co-morbidities other than obstructive sleep apnea syndrome or upper respiratory tract infection (OR 4.2, 95% CI 1.03-17.2, P=0.04). The odds of developing a complication were lower in the ETT group compared to the LMA group (0.63, 0.46, 0.8, P=0.005). LMA use for pediatric T&A is associated with a higher incidence of complications, mainly as a result of airway obstruction following insertion of the LMA or McIvor gag placement. Complications were more likely if tonsillectomy was performed when

  6. Effects of Glutamine and Omega-3 Fatty Acids on Erythrocyte Deformability and Oxidative Damage in Rat Model of Enterocolitis

    PubMed Central

    Cehreli, Ruksan; Akpinar, Hale; Artmann, Aysegul Temiz; Sagol, Ozgul

    2015-01-01

    Background The aim of the study was to investigate preventive effects of glutamine (Gln), omega-3 fatty acids (FA) on erythrocyte deformability (EDEF) in rat model of indomethacin-induced enterocolitis. Methods Nineteen Wistar albino male rats were divided into three groups: control group, colitis induced by indomethacin and were fed with a standard laboratory diet (group 1), and colitis induced by indomethacin and were also fed with Gln, omega-3 FA (group 2). An investigation was performed in a rat model of experimental colitis induced by subcutaneous injections of 2 mL intdomethacine solution applied at 24 and 48 hours intervals to male Wistar rats for 14 days. Gln and omega-3 FA were added to the daily standard diets of the animals during 14 days of injections. During the study, changes in body weight were evaluated. The intestines were examined, and colitis was macroscopic and histologically scored. The circulating tumor necrosis factor alpha (TNF-α) and interleukine-1β (IL-1β), erythrocyte transit time (ETT) and thiobarbituric acid reactive substances (TBARS) levels were determined in addition to calculation of EDEF indices in all groups. Results No significant differences in body weight changes could be determined between the standard diet and special diet groups at the end of the experiment. After macroscopic and microscopic scoring, in all of the groups that colitis was found induced, the lowest microscopic score was observed in the group 2. But Gln and omega-3 FA supplemented diet did not change the mean macroscopic and histological scores in all rats. The proliferating cell nuclear antigen (PCNA) levels were significantly higher in group 1 and group 2 compared to the control group. Effects of the diet on circulating TNF-α and IL-1β levels were found correlated with inflammation but statistically significant differences were not found in the group 1 and group 2 (P < 0.05). The ETT and TBARS levels in standard and special diet groups were significantly

  7. DMSP Special Sensor Microwave/Imager Calibration/Validation

    DTIC Science & Technology

    1991-05-20

    DMAX. When D > 1, the ice concentration will be more than 90% -And old ice is arcsent in the fleid of view. 1 1A. I LTL)I 9-f(seoson) 1, TA37 -1(u"os4)I...N I>NID 1yF-cs NI ___ T___ 37:tr7J=3)j -I- Mc OGE r1LTER RIOR AThm(spt4fRE.- - -- 1 tIS/T37>NI2 N "-OX2 O>CMIN2 ~-y Ofi>N14)c A * N T937-I V37. TA37 §T...n N rTA37-$(T837) TO ~ TUS,-rC- TA37 ) - I C7ET-T7U Fi&r 1OA. -cniu 40 lOA-9 The data points for which D < DmAx and D > Dm are given a second test. This

  8. Humidification on Ventilated Patients: Heated Humidifications or Heat and Moisture Exchangers?

    PubMed

    Cerpa, F; Cáceres, D; Romero-Dapueto, C; Giugliano-Jaramillo, C; Pérez, R; Budini, H; Hidalgo, V; Gutiérrez, T; Molina, J; Keymer, J

    2015-01-01

    The normal physiology of conditioning of inspired gases is altered when the patient requires an artificial airway access and an invasive mechanical ventilation (IMV). The endotracheal tube (ETT) removes the natural mechanisms of filtration, humidification and warming of inspired air. Despite the noninvasive ventilation (NIMV) in the upper airways, humidification of inspired gas may not be optimal mainly due to the high flow that is being created by the leakage compensation, among other aspects. Any moisture and heating deficit is compensated by the large airways of the tracheobronchial tree, these are poorly suited for this task, which alters mucociliary function, quality of secretions, and homeostasis gas exchange system. To avoid the occurrence of these events, external devices that provide humidification, heating and filtration have been developed, with different degrees of evidence that support their use.

  9. Humidification on Ventilated Patients: Heated Humidifications or Heat and Moisture Exchangers?

    PubMed Central

    Cerpa, F; Cáceres, D; Romero-Dapueto, C; Giugliano-Jaramillo, C; Pérez, R; Budini, H; Hidalgo, V; Gutiérrez, T; Molina, J; Keymer, J

    2015-01-01

    The normal physiology of conditioning of inspired gases is altered when the patient requires an artificial airway access and an invasive mechanical ventilation (IMV). The endotracheal tube (ETT) removes the natural mechanisms of filtration, humidification and warming of inspired air. Despite the noninvasive ventilation (NIMV) in the upper airways, humidification of inspired gas may not be optimal mainly due to the high flow that is being created by the leakage compensation, among other aspects. Any moisture and heating deficit is compensated by the large airways of the tracheobronchial tree, these are poorly suited for this task, which alters mucociliary function, quality of secretions, and homeostasis gas exchange system. To avoid the occurrence of these events, external devices that provide humidification, heating and filtration have been developed, with different degrees of evidence that support their use. PMID:26312102

  10. An Interactive Computer Session to Initiate Physical Activity in Sedentary Cardiac Patients: Randomized Controlled Trial

    PubMed Central

    Smith-Ray, Renae L; Dzewaltowski, David A; Glasgow, Russell E; Lee, Rebecca E; Thomas, Deborah SK; Xu, Stanley; Estabrooks, Paul A

    2015-01-01

    Background Physical activity (PA) improves many facets of health. Despite this, the majority of American adults are insufficiently active. Adults who visit a physician complaining of chest pain and related cardiovascular symptoms are often referred for further testing. However, when this testing does not reveal an underlying disease or pathology, patients typically receive no additional standard care services. A PA intervention delivered within the clinic setting may be an effective strategy for improving the health of this population at a time when they may be motivated to take preventive action. Objective Our aim was to determine the effectiveness of a tailored, computer-based, interactive personal action planning session to initiate PA among a group of sedentary cardiac patients following exercise treadmill testing (ETT). Methods This study was part of a larger 2x2 randomized controlled trial to determine the impact of environmental and social-cognitive intervention approaches on the initiation and maintenance of weekly PA for patients post ETT. Participants who were referred to an ETT center but had a negative-test (ie, stress tests results indicated no apparent cardiac issues) were randomized to one of four treatment arms: (1) increased environmental accessibility to PA resources via the provision of a free voucher to a fitness facility in close proximity to their home or workplace (ENV), (2) a tailored social cognitive intervention (SC) using a “5 As”-based (ask, advise, assess, assist, and arrange) personal action planning tool, (3) combined intervention of both ENV and SC approaches (COMBO), or (4) a matched contact nutrition control (CON). Each intervention was delivered using a computer-based interactive session. A general linear model for repeated measures was conducted with change in PA behavior from baseline to 1-month post interactive computer session as the primary outcome. Results Sedentary participants (n=452; 34.7% participation rate) without

  11. Catalogue of UBVRI photometry of T Tauri stars and analysis of the causes of their variability

    NASA Technical Reports Server (NTRS)

    Herbst, William; Herbst, Debra K.; Grossman, Elan J.; Weinstein, Daryl

    1994-01-01

    A computer-based catalogue of UBVRI photoelectric photometry of T Tauri stars and their earlier type analogs has been compiled. It presently includes over 10 000 entries on 80 stars and will be updated on a regular basis; it is available on Internet. The catalogue is used to analyze the sometimes bizarre light variations of pre-main-sequence stars on time scales of days to months in an attempt to illuminate the nature and causes of the phenomenon. It is useful in discussing their light variations to divide the stars into three groups according to their spectra. These are: weak T Tauri stars (WTTS; spectral class later than K0 and W(sub H-alpha less than 10 A), classical T Tauri stars (CTTS; spectral class later than K0 and W(sub H-alpha) greater than 10 A), and early type T Tauri stars (ETTS; spectral class of K0 or earlier). Three distinct types of variability are displayed by stars in the catalogue. Type I variations are periodic in VRI and undoubtedly caused by rotational modulation of a star with an asymmetric distribution of cool spots on its surface. Irregular flare activity is sometimes seen on such stars in U and B. Type I variations are easiest to see on WTTS but are clearly present on CTTS and ETTS as well. Type II variations are caused by hot 'spots' or zones and, it is argued, result from changes in the excess or 'veiling' continuum commonly attributed to an accretion boundary layer or impact zone of a magnetically channeled accretion flow. This type of variation is seen predominantly or solely in CTTS. A subcategory, designated Type IIp, consists of stars which display periodic variations caused by hot spots. Whereas cool spots may last for hundreds or thousands of rotations, hot spots appear to come and go on a much shorter time scale. This suggests that both unsteady accretion and rotation of the star contribute to Type II variations. It is shown that a third type of variation exists among ETTS, including stars as early as A type. UX Ori is a typical

  12. Absent upper blind Pouch in a case of tracheo-esophageal fistula

    PubMed Central

    Harjai, Man Mohan; Badal, Sachendra; Khanna, Sangeeta; Singh, Ajit Kumar

    2015-01-01

    A common upper airway and digestive tract is a rare congenital anomaly that is usually fatal and its exact incidence is not known. It is a diagnostic challenge as it requires high index of suspicion. It should be considered in a neonate with respiratory distress in a non-vigorous baby requiring endotracheal intubation, which is difficult even in expert hand. We present a newborn with suspected tracheo-esophageal fistula that was diagnosed intraoperatively to have absent upper blind pouch of the esophagus and on autopsy found to have laryngeal atresia with absent vocal cords and a common aerodigestive tract continuing distally with trachea. The neonate was ventilated with endotracheal tube (ETT) placement which in retrospect we came to know that it was in the esophagus. The neonate also had associated multiple congenital anomalies of VACTERL association. The importance of teamwork between neonatologist, pediatric surgeon, anesthesiologist, and radiologist is highlighted for diagnosis and management of such rare cases. PMID:25552830

  13. An Interactive Computer Session to Initiate Physical Activity in Sedentary Cardiac Patients: Randomized Controlled Trial.

    PubMed

    Almeida, Fabio A; Smith-Ray, Renae L; Dzewaltowski, David A; Glasgow, Russell E; Lee, Rebecca E; Thomas, Deborah S K; Xu, Stanley; Estabrooks, Paul A

    2015-08-24

    Physical activity (PA) improves many facets of health. Despite this, the majority of American adults are insufficiently active. Adults who visit a physician complaining of chest pain and related cardiovascular symptoms are often referred for further testing. However, when this testing does not reveal an underlying disease or pathology, patients typically receive no additional standard care services. A PA intervention delivered within the clinic setting may be an effective strategy for improving the health of this population at a time when they may be motivated to take preventive action. Our aim was to determine the effectiveness of a tailored, computer-based, interactive personal action planning session to initiate PA among a group of sedentary cardiac patients following exercise treadmill testing (ETT). This study was part of a larger 2x2 randomized controlled trial to determine the impact of environmental and social-cognitive intervention approaches on the initiation and maintenance of weekly PA for patients post ETT. Participants who were referred to an ETT center but had a negative-test (ie, stress tests results indicated no apparent cardiac issues) were randomized to one of four treatment arms: (1) increased environmental accessibility to PA resources via the provision of a free voucher to a fitness facility in close proximity to their home or workplace (ENV), (2) a tailored social cognitive intervention (SC) using a "5 As"-based (ask, advise, assess, assist, and arrange) personal action planning tool, (3) combined intervention of both ENV and SC approaches (COMBO), or (4) a matched contact nutrition control (CON). Each intervention was delivered using a computer-based interactive session. A general linear model for repeated measures was conducted with change in PA behavior from baseline to 1-month post interactive computer session as the primary outcome. Sedentary participants (n=452; 34.7% participation rate) without a gym membership (mean age 58.57 years

  14. A Digital Simulation Model of Message Handling in the Tactical Operations System. V. User’s Guide to the Integrated MANMOD/CASE/SAMTOS Computer Simulation

    DTIC Science & Technology

    1979-10-01

    LFJ.a - - 2* I TIr𔃻(50,b)TTE2(9fl,6)eTTE3(rn,6)PT T C4 (5Op6)’ PFrRF(6)9 TD)L(I1,6)e ____- ~ -- C0%.AsA0.-PAEWi flAEA, TT, -K,’ YY p* ’ MrS(2p2...TAPIVT Il&fl* CAMSnf11(mGJ) = mSCT 141* xnO CONTINUE -- -4110 CONTINUF 143* IF( IPO(2) . NIF . Cr4AR(t)) GO TO 435 11&4* C WPTTF OUT AO-Al’ HOUR OUIEI’r 88

  15. Technology Insertion (TI)/Industrial Process Improvement (IPI) Task Order Number 1. Data Base Documentation Book for SA-ALC/MATPSS (Assembly and Test GTE’s)

    DTIC Science & Technology

    1989-08-14

    8217 -- - AD-A237 070 JMENTATION PAGE _ N tt t *. 0 ’t o0t o f im lt0 e o mn’t0 tfverage Itott I ( flh t Ett 9 ain q ’ tc "I"? O" 3t W turce* i i...technology Insertion (TI)/Industrial Process Improvement (IPI).D(taas%V’ocumentatioh ,ook Folume-; f or SA-ALC/MATPSS (Assembl’V & Test GTE’s X . this...ffo6A Fir W~ r-uFL sTAgTFR &FEs) 13e r14 JET FUE STRT~ER (jFS) c! ?6O7A ,F15 (&/FI-RAL 6-iARt9,-; X k/6rR )27I2A F/ ACcfKS~tQR VR,]F (,FARBcX (At&-) Od

  16. Slotted Waveguide Antenna Stiffened Structures (SWASS) Development for Commercial Off-the-Shelf (COTS) Radar (Briefing Charts)

    DTIC Science & Technology

    2016-10-01

    R Fi n 3- G ND 4- V6 5-V5 6-V4 7-V3 8-V2 H M C 42 4L P3 E 6- B it D ig it al A tte nu ato r ...0. 5 dB LS B D C -1 3 GH z E rr or : 0. 3 + 3% of S ett ing 22 dB m I np ut fo r 1 Pd B In se rt io n Lo ss : 4 .0 dB 12 -G ND R Fo ut 10...S hi fte r 9- 12 G H z R M S P ha se E rro r : 4. 5

  17. Numerical Methods for Singularly Perturbed Differential Equations with Applications

    DTIC Science & Technology

    1993-03-31

    e e on . :nOrmaton Send comments r t e@aradg tt •rden estimate :ir an, nher t p ( of At,$ -tr :C "Id~tn t-to" He&aQa .Jtters Ser vces. Directorate ror...no,) at ton Do~ers I.ors snap gr-c),rs 󈧝 .ette’i.D -e a _2 2 4 r to 4 S e )f management -no 8..aqet. Paer .s0r RC~edu ci P ’,ect 0C,04-0’S .󈨜...refinement and coarsening (h-refinement, order variation ( p -refinement), and occasionally, mesh motion (r-refinement), we addressed problems in

  18. Current Chemotherapeutic Management of Patients with Gestational Trophoblastic Neoplasia

    PubMed Central

    May, Taymaa; Goldstein, Donald P.; Berkowitz, Ross S.

    2011-01-01

    Gestational trophoblastic neoplasia (GTN) describes a heterogeneous group of interrelated lesions that arise from abnormal proliferation of placental trophoblasts. GTN lesions are histologically distinct, malignant lesions that include invasive hydatidiform mole, choriocarcinoma, placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). GTN tumors are generally highly responsive to chemotherapy. Early stage GTN disease is often cured with single-agent chemotherapy. In contrast, advanced stage disease requires multiagent combination chemotherapeutic regimens to achieve a cure. Various adjuvant surgical procedures can be helpful to treat women with GTN. Patients require careful followup after completing treatment and recurrent disease should be aggressively managed. Women with a history of GTN are at increased risk of subsequent GTN, hence future pregnancies require careful monitoring to ensure normal gestational development. This article will review the workup, management and followup of women with all stages of GTN as well as with recurrent disease. PMID:22312558

  19. Bias/Variance Analysis for Relational Domains

    DTIC Science & Technology

    2007-08-15

    EDtr ,Dte,t[L(t, y)] = EDtr ,Dte,t[(t − y)2] = Et[(t − E[t])2] + EDtr ,Dte...y − E[t])2] = NT (x) + EDtr ,Dte[(y − EDtr ,Dte[y] + EDtr ,Dte[y]− E[t])2] = NT (x) + EDtr ,Dte[(y − EDtr ,Dte[y])2 + ( EDtr ,Dte[y]− E[t])2 + 2(y − EDtr ,Dte...y]) · ( EDtr ,Dte[y]− E[t])] = NT (x) + EDtr ,Dte[(y − EDtr ,Dte[y])2] + ( EDtr ,Dte[y]− E[t])2 = NT (x) + VT (x) + BT (x) In this decomposition the

  20. Summary of the Northeast Artificial Intelligence Consortium (NAIC)

    DTIC Science & Technology

    1991-09-01

    rwwmg ranjac , s ,ct vm V w- ta so’l-e- gattwrig anl r %w-,"g Tor d"n reec " ,T rr wid rmwmV tlcdeax, of rformrou Serd cTrrts r wdeg u- s b’u-d e,te cr m...y Orw aspec c: ’ded=of iormr ru.dig & ux for redc"- & ,ase to WastVcn Hoec e*tts S wuvc DcIaraoe for forz Operg us a iRepl . 12s 5 .-e-i-c D Nis HkwW... S l* 1204. Arkxpcr VA 202432, n to &is Office of Mwvgrr rt and BLcxg Ppwwork Reducr1 Prj ;t (0704-010 ). WsagwigtoR OC 205C3 . AGENCY USE ONLY

  1. Catalogue of UBVRI photometry of T Tauri stars and analysis of the causes of their variability

    NASA Technical Reports Server (NTRS)

    Herbst, William; Herbst, Debra K.; Grossman, Elan J.; Weinstein, Daryl

    1994-01-01

    A computer-based catalogue of UBVRI photoelectric photometry of T Tauri stars and their earlier type analogs has been compiled. It presently includes over 10 000 entries on 80 stars and will be updated on a regular basis; it is available on Internet. The catalogue is used to analyze the sometimes bizarre light variations of pre-main-sequence stars on time scales of days to months in an attempt to illuminate the nature and causes of the phenomenon. It is useful in discussing their light variations to divide the stars into three groups according to their spectra. These are: weak T Tauri stars (WTTS; spectral class later than K0 and W(sub H-alpha less than 10 A), classical T Tauri stars (CTTS; spectral class later than K0 and W(sub H-alpha) greater than 10 A), and early type T Tauri stars (ETTS; spectral class of K0 or earlier). Three distinct types of variability are displayed by stars in the catalogue. Type I variations are periodic in VRI and undoubtedly caused by rotational modulation of a star with an asymmetric distribution of cool spots on its surface. Irregular flare activity is sometimes seen on such stars in U and B. Type I variations are easiest to see on WTTS but are clearly present on CTTS and ETTS as well. Type II variations are caused by hot 'spots' or zones and, it is argued, result from changes in the excess or 'veiling' continuum commonly attributed to an accretion boundary layer or impact zone of a magnetically channeled accretion flow. This type of variation is seen predominantly or solely in CTTS. A subcategory, designated Type IIp, consists of stars which display periodic variations caused by hot spots. Whereas cool spots may last for hundreds or thousands of rotations, hot spots appear to come and go on a much shorter time scale. This suggests that both unsteady accretion and rotation of the star contribute to Type II variations. It is shown that a third type of variation exists among ETTS, including stars as early as A type. UX Ori is a typical

  2. Genomic Avenue to Avian Colisepticemia

    PubMed Central

    Huja, Sagi; Oren, Yaara; Trost, Eva; Brzuszkiewicz, Elzbieta; Biran, Dvora; Blom, Jochen; Goesmann, Alexander; Gottschalk, Gerhard; Hacker, Jörg

    2015-01-01

    ABSTRACT Here we present an extensive genomic and genetic analysis of Escherichia coli strains of serotype O78 that represent the major cause of avian colisepticemia, an invasive infection caused by avian pathogenic Escherichia coli (APEC) strains. It is associated with high mortality and morbidity, resulting in significant economic consequences for the poultry industry. To understand the genetic basis of the virulence of avian septicemic E. coli, we sequenced the entire genome of a clinical isolate of serotype O78—O78:H19 ST88 isolate 789 (O78-9)—and compared it with three publicly available APEC O78 sequences and one complete genome of APEC serotype O1 strain. Although there was a large variability in genome content between the APEC strains, several genes were conserved, which are potentially critical for colisepticemia. Some of these genes are present in multiple copies per genome or code for gene products with overlapping function, signifying their importance. A systematic deletion of each of these virulence-related genes identified three systems that are conserved in all septicemic strains examined and are critical for serum survival, a prerequisite for septicemia. These are the plasmid-encoded protein, the defective ETT2 (E. coli type 3 secretion system 2) type 3 secretion system ETT2sepsis, and iron uptake systems. Strain O78-9 is the only APEC O78 strain that also carried the regulon coding for yersiniabactin, the iron binding system of the Yersinia high-pathogenicity island. Interestingly, this system is the only one that cannot be complemented by other iron uptake systems under iron limitation and in serum. PMID:25587010

  3. Iloprost drug delivery during infant conventional and high-frequency oscillatory ventilation

    PubMed Central

    DiBlasi, Robert M.; Crotwell, Dave N.; Shen, Shuijie; Zheng, Jiang; Fink, James B.; Yung, Delphine

    2016-01-01

    Abstract Iloprost is a selective pulmonary vasodilator approved for inhalation by the Food and Drug Administration. Iloprost has been increasingly used in the management of critically ill neonates with hypoxic lung disease. This in vitro study was designed to test the hypothesis that aerosol drug delivery could be effectively administered to infants with both conventional ventilation and high-frequency oscillatory ventilation (HFOV). A neonatal test lung model configured with newborn lung mechanics was ventilated with a conventional ventilator and an HFOV with standard settings. A vibrating-mesh nebulizer was placed (1) proximal to the patient airway in the inspiratory limb between the humidifier probe and patient wye (conventional) as well as between the vent circuit and the endotracheal tube (ETT) for HFOV and (2) between the ventilator and humidifier (distal). Iloprost was nebulized in three separate runs using three new nebulizers in each of the circuit locations. A collecting filter was placed at the distal end of the ETT for each trial. Iloprost was quantified using high-performance liquid chromatography. The percentage of nominal dose delivered was greater with the nebulizer placed proximal to the airway for conventional ventilation (10.74% ± 2%) and HFOV (29% ± 2%) than with it placed in the distal position (2.96% ± 0.2% vs. 0.96% ± 0.8%, respectively; P < 0.05). Drug delivery in proximal position was nearly threefold greater during HFOV than during conventional ventilation. In conclusion, iloprost drug delivery was best achieved when the nebulizer was placed proximal to the patient airway during neonatal mechanical ventilation. Drug delivery appears to be more efficient during HFOV than during conventional ventilation. PMID:27162615

  4. Why, when, and how general practitioners restore endodontically treated teeth: a representative survey in Germany.

    PubMed

    Naumann, Michael; Neuhaus, Klaus W; Kölpin, Manja; Seemann, Rainer

    2016-03-01

    The purpose of this study was to assess current opinions, applied techniques, and materials for the restoration of endodontically treated teeth (ETT) in a nationwide survey in Germany. Completed questionnaires from 1,648 dentists were returned (response rate 63%). In general, posts were reported to be used more frequently (51%) for indirect restorations than for direct restorations (21%). Dentists restored anterior teeth (65%) more frequently with direct restorations than posterior teeth (48%). Compared to an earlier survey, fewer dentists stated that posttreatment stabilizes the remaining tooth structure. The ferrule effect as a key success factor was held by the vast majority of dentists (88%). A trend towards adhesive techniques both for post placement and core build-up was observed. Composite resins (49%) were reported to be used twice as much as zinc phosphate cement (24%) for the luting of posts; composite resins were the core build-up material of choice (75%). Amalgam was rarely used (0.2%). Irrespective of the final restoration, fiber posts were the most popular post material (46% for telescopic crowns vs. 69% for single crowns). Adhesive composite core build-ups with and without fiber posts were the predominant treatment approach to restore ETT in Germany. There was widespread agreement with the ferrule effect as a key restorative success factor for indirect restorations. Today, it is general accepted that ferrule preparation is key. Glass-fiber posts appear to be most popular. Still different systems are used depending on type of final restoration, while the reasons to do so remain unclear.

  5. Electronic Topological Transition in Ag2Te at High-pressure

    PubMed Central

    Zhang, Yuhang; Li, Yan; Ma, Yanmei; Li, Yuwei; Li, Guanghui; Shao, Xuecheng; Wang, Hui; Cui, Tian; Wang, Xin; Zhu, Pinwen

    2015-01-01

    Recently, Ag2Te was experimentally confirmed to be a 3D topological insulator (TI) at ambient pressure. However, the high-pressure behaviors and properties of Ag2Te were rarely reported. Here, a pressure-induced electronic topological transition (ETT) is firstly found in Ag2Te at 1.8 GPa. Before ETT, the positive pressure coefficient of bulk band-gap, which is firstly found in TIs family, is found by both first-principle calculations and in situ high-pressure resistivity measurements. The electrical resistivity obtained at room temperature shows a maximum at 1.8 GPa, which is nearly 3.3 times to that at ambient pressure. This result indicates that the best bulk insulating character and topological nature in Ag2Te can be obtained at this pressure. Furthermore, the high-pressure structural behavior of Ag2Te has been investigated by in situ high-pressure synchrotron powder X-ray diffraction technique up to 33.0 GPa. The accurate pressure-induced phase transition sequence is firstly determined as P21/c → Cmca → Pnma. It is worth noting that the reported isostructural P21/c phase is not existed, and the reported structure of Cmca phase is corrected by CALYPSO methodology. The second high-pressure structure, a long puzzle to previous reports, is determined as Pnma phase. A pressure-induced metallization in Ag2Te is confirmed by the results of temperature-dependent resistivity measurements. PMID:26419707

  6. Endotracheal Suctioning in Preterm Infants Using Four-Handed versus Routine Care

    PubMed Central

    Cone, Sharon; Pickler, Rita H.; Grap, Mary Jo; McGrath, Jacqueline; Wiley, Paul M.

    2013-01-01

    Objective To evaluate the effect of four-handed care on preterm infants’ physiologic and behavioral responses to and recovery from endotracheal suctioning versus routine endotracheal (ETT) suctioning. Design Randomized crossover design with infants as their own controls. Setting Single-family-room newborn intensive care unit in an academic health center. Participants Ten intubated infants on conventional ventilation with inline suctioning who were fewer than 37 weeks gestation at birth, and less than one week of age. Methods Each infant was observed twice on a single day. One observation involved routine ETT suctioning and one involved four-handed care. Physiologic and behavioral response data were collected. Results No differences were noted when comparing baseline heart rate (HR) or oxygen saturation (SpO2) data to those obtained during and after suctioning while in the routine care condition. In the four-handed care condition, mean SpO2 increased from preobservation 95.49 to during observation saturation 97.75 (p = .001). Salivary cortisol levels did not differ between groups at baseline or postsuctioning. No significant difference in behavior state was observed between the two conditions. More stress and defense behaviors occurred postsuctioning when infants received routine care as opposed to four-handed care (p = .001) and more self-regulatory behaviors were exhibited by infants during (p = .019) and after suctioning (p = .016) when receiving four-handed care. No statistical difference was found in the number of monitor call-backs postsuctioning. Conclusions Four-handed care during suctioning was associated with a decrease in stress and defense behaviors and an increase in self-regulatory behaviors. PMID:23316894

  7. The effect of mouth prop on endotracheal tube intracuff pressure in children during dental rehabilitation under general anaesthesia.

    PubMed

    Canpolat, Dilek Günay; Cantekin, Kenan; Bayram, Adnan; Yıldırım, Mustafa Denizhan

    2017-01-20

    Although the endotracheal tube (ETT) cuff may be associated with tracheal morbidity, cuffed tubes may reduce the aspiration risk in oral procedures. Dentists must use a mouth prop to facilitate oral visualization and to protect the oral soft tissues during dental rehabilitation under general anaesthesia (DRGA). The aim of this study was to evaluate the effect of mouth prop on endotracheal tube intracuff pressure in children during DRGA. Two-hundred and three ASA I-II patients, <18 years of age (mean: 5.3 ± 2.4 years) were included in the prospective observational study whose comprehensive dental treatment was performed under general anaesthesia. Following the induction of general anaesthesia, placement of a cuffed endotracheal tube which was an appropriate size for children was fixed. The intracuff pressure was measured intermittently after the intubation (baseline) (T0), immediately after the mouth prop (T1), 30 min after the mouth prop (T2), after taking out the mouth prop (T3) and just before extubation (T4). The mean intracuff pressure was 28.3 ± 2.01 cm H2O at T0. The mean intracuff pressure significantly increased at T1 (30.8 ± 2.7) and T2 (29.6 ± 3.7) compared to T0 (P < 0.001). No significant differences were observed between the duration of the procedure and intracuff pressure or postoperative complications (P > 0.05). Cough, sore throat and nausea were observed in 4, 1 and 5 patients, respectively. Because a mouth prop may increase the intracuff pressure of ETT, strict measurement and readjustment of cuff pressures should be employed when used in children during DRGA.

  8. Effect of intensive physician oversight on a prehospital rapid-sequence intubation program.

    PubMed

    Cushman, Jeremy T; Zachary Hettinger, Aaron; Farney, Aaron; Shah, Manish N

    2010-01-01

    To examine the effects of adding close concurrent and retrospective physician oversight, consistent with National Association of EMS Physicians (NAEMSP) recommendations, to an existing regional prehospital rapid-sequence intubation (RSI) program. This study involved a retrospective cohort of patients receiving RSI between January 1, 2004, and July 31, 2008. On January 1, 2007, an updated program including additional concurrent and retrospective physician oversight, increased RSI-specific continuing medical education, and cadaver laboratory training was implemented. Study patients were divided into a preintervention group (group 1) and a postintervention group (group 2) based on date of medical care. Data regarding baseline characteristics, airway management, medication usage, and performance factors were compared between the groups. A retrospective review by two emergency medical services (EMS) physicians assessed whether the RSI was "clearly indicated" based on a predetermined set of criteria. There were 109 RSIs performed in group 1 and 54 in group 2. Absolute increases in the use of both basic life support (BLS) (5%, p = 0.2) and advanced life support (ALS) (41%, p = 0.001) airway techniques were observed. Increases in postintubation administration of midazolam (30%, p = 0.001) and morphine (24%, p = 0.001) and a decrease for vecuronium (-28%, p = 0.001) were observed. There was no statistically significant difference in the intubation success rates (92% vs. 94%) and the frequencies of recognized esophageal endotracheal tube (ETT) placement (5% vs. 6%). The number of unrecognized esophageal ETT placements remained zero. Physician chart review demonstrated an absolute increase in "clearly indicated" RSIs (17%, p = 0.01). Close concurrent and retrospective physician oversight consistent with recommendations from the NAEMSP is associated with improved cognitive skills in paramedics, including appropriate patient selection for RSI. Further research is warranted to

  9. Effect of Intensive Physician Oversight on a Prehospital Rapid Sequence Induction Program

    PubMed Central

    Cushman, Jeremy T.; Hettinger, A. Zachary; Farney, Aaron; Shah, Manish N.

    2010-01-01

    Objective To examine the effects of adding close concurrent and retrospective physician oversight, consistent with NAEMSP recommendations, to an existing regional prehospital rapid sequence induction (RSI) program. Methods This study involved a retrospective cohort of patients receiving RSI between January 1st, 2004 and July 31st, 2008. On January 1st, 2007 an updated program including additional concurrent and retrospective physician oversight, increased RSI specific continuing medical education, and cadaver lab training was implemented. Study patients were divided into pre- (1) and post- (2) intervention groups based on date of medical care. Data regarding baseline characteristics, airway management, medication usage, and performance factors were compared between groups. A retrospective review by two EMS physicians assessed if the RSI was “clearly indicated” based on a predetermined set of criteria Results There were 109 RSIs performed in Group 1, and 54 in Group 2. Absolute increases in the use of both BLS (5%, p=0.02) and ALS (41%, p=0.001) airway techniques were observed. Increases in post-intubation administration of midazolam (30%, p=0.001) and morphine (24%, p=0.001), and decrease for vecuronium (−28%, p=0.001) were observed. The intubation success rate (92 vs. 94%) and frequency of recognized esophageal ETT placement (5 vs. 6%) were not statistically different. The number of unrecognized esophageal ETT placements remained zero. Physician chart review demonstrated an absolute increase in “clearly indicated” RSIs (17%, p=0.013). Conclusions Close concurrent and retrospective physician oversight consistent with recommendations from the National Association of EMS Physicians is associated with improved cognitive skills in paramedics, including appropriate patient selection for RSI. Further research is warranted to validate this model and optimize where resources are best used to enhance patient safety and improve clinical management for this

  10. Predicting Which Patients will Likely Benefit from Subglottic Secretion Drainage Endotracheal Tubes: A Retrospective Study.

    PubMed

    Mareiniss, Darren P; Xu, Tim; Pham, Julius Cuong; Hsieh, Yu-Hsiang; Zhao, Jiawei; Nguyen, Christopher; Nguyen, Michael; Winters, Bradford

    2016-03-01

    Subglottic secretion drainage endotracheal tubes (SSD ETTs) have been shown to decrease ventilator-associated pneumonia and are recommended for patients intubated > 48 h or 72 h. However, it is difficult to determine which patients will be intubated > 48 h or 72 h at the time of intubation. We attempted to determine which patient characteristics were associated with intubations ≥ 48 h or 72 h in order to guide proper placement of SSD ETTs. The medical records of 2,159 ventilated patients at a single institution were retrospectively reviewed for intubation duration, age, sex, race, body mass index, weight, intubation reason, whether the intubation was emergent, operative status, intensive care unit (ICU) diagnosis, intubation location, ICU location, comorbidities (e.g., congestive heart failure, chronic obstructive pulmonary disorder, coronary artery disease, dementia, and liver disease), acute kidney injury (AKI), and chronic renal injury. A multivariate regression analysis was then performed with all reliable data. The following were associated with intubation ≥ 48 h: neuroscience critical care unit (NCCU) admission (risk ratio [RR] = 1.85; 95% confidence interval [CI] 1.34-2.56), emergent intubation (RR = 1.97; 95% 1.28-3.03), comorbid dementia (RR = 2.31; 95% 1.28-4.18), nonoperative intubation (RR = 1.77; 95% 1.28-4.18), and AKI (RR = 3.32; 95% 2.56-4.3). The following were independently associated with intubation ≥ 72 h: NCCU admission (RR = 2.2; 95 CI 1.57-3.08), nonoperative intubation (RR = 3.38; 95% CI 2.63-4.35), comorbid dementia (RR = 3.03; 95% CI 1.67-5.48), and AKI (RR = 3.11; 95% CI 2.38-4.07). Nonoperative intubation, emergent intubation, history of dementia, admission to NCCU and AKI all appear to be independently associated with increased RRs for either ≥ 48 h or 72 h of ventilation. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Post-anaesthetic emergence delirium in adults: incidence, predictors and consequences.

    PubMed

    Munk, L; Andersen, G; Møller, A M

    2016-09-01

    Emergence delirium (ED) after general anaesthesia (GA) is a well-known phenomenon, yet the risk factors are still unclear. The aims of this study were to determine the incidence and independent predictors of ED and secondly to determine to which degree ED has any relevant, clinical consequences to medical staff as well as to patients. This prospective, observational cohort study assessed adult patients emerging from GA in the operating room, using the Richmond Agitation-Sedation Scale (RASS). Signs of ED, defined as RASS≥1 along with possible clinical consequences were noted. Patients with ED were re-evaluated in the post-anaesthesia care unit (PACU) and concomitant patient and anaesthesia related factors were noted. Among the 1970 patients enrolled, 73 (3.7%) showed signs of ED when emerging from anaesthesia. When reassessed in PACU, the number had declined to 25 patients (1.3%). Male sex, endotracheal tube (ETT) and volatile anaesthetics were found to be significantly related to developing ED after anaesthesia. In 20 cases, additional staff had to be called for and in one case, an i.v. access was accidentally removed. Neither patients nor staff were hurt. Male sex, volatile anaesthetics and ETT were factors significantly related to ED. Whether gender, choice of respiratory devices and anaesthetics are true predictors or derived factors of surgery procedures, duration of surgery and the patients' physical condition need further investigation. The most notable clinical consequence of ED was the need of additional staff in order to restrain the agitated patient. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  12. A prospective multicenter evaluation of prehospital airway management performance in a large metropolitan region.

    PubMed

    2009-01-01

    To determine 1) the success rate of prehospital endotracheal intubation; 2) the unrecognized tube malposition rate; and 3) predictors of tube malposition upon arrival to the emergency department (ED) in the setting of a large metropolitan area that includes 18 hospitals and 34 transporting emergency medical services (EMS) agencies. Prospective data were collected on patients for whom prehospital intubation was attempted between September 1, 2004, and January 31, 2005. Endotracheal tube (ETT) position upon arrival to the ED was verified by emergency medicine attending physicians. Missing cases were identified by matching prospective data with lists of attempted intubations submitted by EMS agencies, and data were obtained for these cases by retrospective chart review. Successful intubation was defined as an "endotracheal tube balloon below the cords" on arrival to the ED. Patients were the unit of analysis; proportions with 95% confidence intervals were calculated. Nine hundred twenty-six patients had an attempted intubation. Methods of airway management were determined for 97.5% (825/846) of those transported to a hospital and 33.8% (27/80) of those who died in the field. For transported patients, 74.8% were successfully intubated, 20% had a failed intubation, 5.2% had a malpositioned tube on arrival to the ED, and 0.6% had another method of airway management used. Malpositioned tubes were significantly more common in pediatric patients (13.0%, compared with 4.0% for nonpediatric patients). Overall intubation success was low, and consistent with previously published series. The frequency of malpositioned ETT was unacceptably high, and also consistent with prior studies. Our data support the need for ongoing monitoring of EMS providers' practices of endotracheal intubation.

  13. New functional and aesthetic composite materials used as an alternative to traditional post materials for the restoration of endodontically treated teeth.

    PubMed

    Almaroof, A; Alhashimi, R; Mannocci, F; Deb, S

    2015-11-01

    To tailor composites of polyethylene-hydroxyapatite to function as a new intracanal post for the restoration of endodontically treated teeth (ETT). Silanated hydroxyapatite (HA) and zirconium dioxide (ZrO2) filled low-density polyethylene (LDPE) composites were fabricated by a melt extrusion process and characterised using infrared spectroscopy (FTIR), differential scanning calorimetry (DSC) and dynamic mechanical analysis (DMA). The flexural strength and modulus were determined in dry state and post ageing in simulated body fluid and fractured surfaces analysed by SEM. The water uptake and radiographic appearance of the experimental composites were also measured and compared with a commercially known endodontic fibre post. Data were submitted to one-way analysis of variance (ANOVA) and post hoc Tukey multiple comparison tests at a level of significance P<0.05. The LDPE/HA composites were structurally flexible and the HA content had a significant effect on the flexural strength and modulus. A univariate analysis of variance showed no significant differences in modulus and strength (P<0.05) post accelerated ageing in simulated body fluid with very low water uptake. The melting point of the LDPE/HA composites ranged between 135 and 136°C, which would facilitate removal in case of retreatment using conventional dental heating devices. The inclusion of HA reduced the damping thereby enhancing dimensional stability, whilst the addition of zirconia yielded a semi-translucent material that was sufficiently radiopaque, comparable to commercial posts, thus yielding aesthetic materials. Innovative materials for restoration of ETT were developed; offering considerable benefits over the currently available material in terms of biomechanical and thermal properties. This study provided a new option for the development of a new intracanal post made up of functional and aesthetic composites. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Epidemiologic surveillance of nosocomial infections in a Pediatric Intensive Care Unit of a developing country

    PubMed Central

    2010-01-01

    Background Nosocomial Infections (NI) are a frequent and relevant problem. The purpose of this study was to determine the epidemiology of the three most common NI in a Pediatric Intensive Care Unit from a developing country. Methods We performed a prospective study in a single Pediatric Intensive Care Unit during 12 months. Children were assessed for 3 NI: bloodstream infections (BSI), ventilator-associated pneumonia (VAP) and urinary tract infections (UTI), according to Center for Disease Control criteria. Use of devices (endotracheal tube [ETT], central venous catheter [CVC] and urinary catheter [UC]) was recorded. Results Four hundred fourteen patients were admitted; 81 patients (19.5%) developed 85 NIs. Density of incidence of BSI, VAP and UTI was 18.1, 7.9 and 5.1/1000 days of use of CVC, ETT and UC respectively. BSI was more common in children with CVCs than in those without CVCs (20% vs. 4.7%, p < 0.05). Candida spp. was the commonest microorganism in BSI (41%), followed by Coagulase-negative Staphylococcus (17%). Pseudomonas (52%) was the most common germ for VAP and Candida (71%) for UTI. The presence of NI was associated with increased mortality (38.2% vs. 20.4% in children without NI; p < 0.001) and the median length of ICU stay (23 vs. 6 days in children without NI; p < 0.001). Children with NI had longer average hospital stay previous to diagnosis of this condition (12.3 vs. 6 days; p < 0.001). Conclusions One of every 5 children acquires an NI in the PICU. Its presence was associated with increased mortality and length of stay. At the same time a longer stay was associated with an increased risk of developing NI. PMID:20831797

  15. The effect of vardenafil, a potent and highly selective phosphodiesterase-5 inhibitor for the treatment of erectile dysfunction, on the cardiovascular response to exercise in patients with coronary artery disease.

    PubMed

    Thadani, Udho; Smith, William; Nash, Stephen; Bittar, Neville; Glasser, Stephen; Narayan, Puneet; Stein, Richard A; Larkin, Sharon; Mazzu, Arthur; Tota, Robert; Pomerantz, Kenneth; Sundaresan, Pavur

    2002-12-04

    The effect of vardenafil, a potent and highly selective phosphodiesterase-5 (PDE5) inhibitor, on symptom-limited exercise time, time to first awareness of angina, and time to ischemic threshold (ST-segment depression > or =1 mm from baseline) during exercise tolerance testing (ETT) was examined in patients with stable coronary artery disease (CAD). Erectile dysfunction (ED) is common among men with CAD. PDE5 inhibition is increasingly the preferred treatment option for ED. However, the effect of PDE5 inhibition on exercise-induced ischemia in CAD patients has received limited prospective evaluation. In this double-blind, crossover, single-dose multicenter study, 41 men with reproducible stable exertional angina due to ischemic CAD received vardenafil 10 mg or placebo, followed by ETT (5 to 10 metabolic equivalents [METS], Bruce protocol) 1 h postdose. Sublingual nitrate use was prohibited for > or =24 h pre- and postexercise study days. End points included symptom-limited treadmill exercise time, time to first awareness of angina, time to ischemic threshold, and safety. Relative to placebo, vardenafil 10 mg did not alter exercise treadmill time (427 +/- 105 s vs. 433 +/- 109 s, p = 0.39), or time to first awareness of angina (292 +/- 110 s vs. 291 +/- 123 s, p = 0.59), but significantly prolonged time to ischemic threshold (334 +/- 108 s vs. 381 +/- 108, p = 0.0004). At peak exercise, vardenafil 10 mg did not alter blood pressure, heart rate, or rate-pressure product relative to placebo. The most common adverse events (facial flushing and headache) were of mild or moderate intensity, and short-lived. Vardenafil 10 mg did not impair the ability of patients with stable CAD to exercise at levels equivalent or greater than that attained during sexual intercourse (average of 2.5 to 3.3 METS).

  16. The relationship between head and neck position and endotracheal tube intracuff pressure in the pediatric population.

    PubMed

    Kako, Hiromi; Krishna, Senthil G; Ramesh, Archana S; Merz, Meredith N; Elmaraghy, Charles; Grischkan, Jonathan; Jatana, Kris R; Ruda, James; Tobias, Joseph D

    2014-03-01

    Over the past few years, there has been a change in clinical practice with a transition to the use of cuffed instead of uncuffed endotracheal tubes (ETTs) in pediatric patients. These changes have led to concerns regarding unsafe intracuff pressures in pediatric patients, which may result in postoperative morbidity. To avoid these issues, it is generally suggested that the intracuff pressure be maintained at ≤30 cmH2 O. The current study prospectively assesses the changes in intracuff pressure related to alterations in head and neck position in pediatric patients. Patients less than 18 years of age, undergoing surgery, requiring endotracheal intubation with a cuffed ETT were eligible for inclusion. No alteration in the technique of anesthetic induction or maintenance was required for the study. Following endotracheal intubation and inflation of the cuff with the head and neck in a neutral position, the intracuff pressure was measured. The intracuff pressure was then subsequently measured with the head turned to the right, head turned to the left, head and neck flexed, and head and neck extended. A total of 200 patients were included in the study resulting in a total of 1000 intracuff pressure readings. When compared to the neutral position, the intracuff pressure increased in 545 instances (68.1%) with changes in position of the head and neck. An increase in intracuff pressure was noted more frequently and to the greatest degree with head and neck flexion. The pressure decreased in 153 instances (19.1%), most frequently with neck extension. Significant changes in the intracuff pressure occur with changes in head and neck position. In several cases, this resulted in a significant increase in the intracuff pressure. For prolonged cases with the head and neck turned from the neutral position, the intracuff pressure should be measured following patient positioning to ensure that the intracuff pressure is within the clinically recommended range. © 2013 John Wiley

  17. A New Lifshitz Transition and the Equation of State of Osmium

    SciTech Connect

    Occelli, F; Aracne, C M; Teter, D M; Hanfland, M; Canny, B; Couzinet, B; Chervin, J; Badro, J; Farber, D L

    2003-11-05

    We have measured the equation of state (EoS) of osmium to 75 GPa under hydrostatic conditions at room temperature using angle dispersive x-ray diffraction. A least-squares fit of the data using a third order Birch-Murnaghan EoS yields K{sub 0} = 411 {+-} 6 GPa and K'{sub 0} = 4.0 {+-} 0.2, showing osmium is in fact more compressible than diamond. Most importantly, we have documented an anomaly in the compressibility at 20.3 GPa associated with a large discontinuity in the first pressure derivative of the c/a ratio. This discontinuity likely arises from the collapse of the small hole-ellipsoid in the Fermi surface near the L point. There has been much interest in the possibility of a Lifshitz [1] or electronic topological transition (ETT) in zinc at high-pressure near 10 GPa. Interestingly, while the experimental data remain somewhat ambiguous [2-5], most simulations suggest the ETT exists in this pressure range [6-8]. Recently, Steinle-Neumann et al. [8] have shown that the transition arises from changes in the band structure near the high-symmetry point K where three bands cross the Fermi surface upon compression. Thus one might expect that other hcp metals should exhibit similar phenomena. The hcp 4d and 5d transition elements Re, Os and Ru are known to be among the densest and stiffest metals [9,10] suggesting that these might in fact be poor candidates in which to look for such effects. In osmium however, experimental and theoretical results [11,12] have shown the existence of small local maxima in the band structure just above the Fermi energy near the high-symmetry point L on the zone boundary [11]. These structures might potentially fall below the Fermi energy upon compression and give rise to an ETT. Osmium is of further interest as recent EoS measurements by Cynn et al. [13] have suggested that Os (K{sub 0} = 462 GPa and K'{sub 0} = 2.4) has the lowest known compressibility, lower even than diamond (K{sub 0} = 446 GPa and K'{sub 0} = 3) [14]. This

  18. The 'best fit' endotracheal tube in children --comparison of four formulae.

    PubMed

    Turkistani, A; Abdullah, K M; Delvi, B; Al-Mazroua, K A

    2009-10-01

    Uncuffed endotracheal tubes are still being recommended by most pediatric of anesthetists at our Institutes. Different algorithms and formulae have been proposed to choose the best-fitting size of the tracheal tube. The most widely accepted is related to the age of the child [inner diameter [ID] in mm = (age in yr/4) + 4; the second is a body, length-related formula (ID in mm = 2 + height in cm/30); the third, a multivariate formula (ID in mm = 2.44 + age in yr x 0.1 + height in cm x 0.02 + weight in kg x 0.016]5; the fourth, the width of the 5th fingernail is used for ID prediction of the ETT (ID in mm = maximum width of the 5th fingernail). The primary endpoint of this prospective study was to compare the size of the 'best fit' tracheal tube with the size predicted using each of the above mentioned formulae. With Institutional Ethics Committee approval and parental consent, 27 boys, 23 girls, ASA I-III, 2-10 years, scheduled for different surgical procedures requiring general anesthesia and endotracheal intubation, were enrolled in the study. The size of 'best fit' endotracheal tubes in those children were compared. The internal diameter considered the 'best fit' by the attending pediatric anesthesiologist was compared to age-based, length-based, multivariate-based and 5th fingernail width-based formulae. For all tests, P < 0.05 was considered to be statistically significant. The mean (SD) IDs for the 'best fit', age-based, length-based, multivariate and 5th fingernail techniques were 5.31 (0.691), 5.54 (0.622), 5.82 (0.572), 5.71 (0.67) and 5.43 (0.821) mm, respectively. The age-based and 5th fingernail width-based predictions of ETT size are more accurate than length-based and multivariate-based formulae in terms of mean value and case matching.

  19. A feasibility study on bedside upper airway ultrasonography compared to waveform capnography for verifying endotracheal tube location after intubation

    PubMed Central

    2013-01-01

    Background In emergency settings, verification of endotracheal tube (ETT) location is important for critically ill patients. Ignorance of oesophageal intubation can be disastrous. Many methods are used for verification of the endotracheal tube location; none are ideal. Quantitative waveform capnography is considered the standard of care for this purpose but is not always available and is expensive. Therefore, this feasibility study is conducted to compare a cheaper alternative, bedside upper airway ultrasonography to waveform capnography, for verification of endotracheal tube location after intubation. Methods This was a prospective, single-centre, observational study, conducted at the HRPB, Ipoh. It included patients who were intubated in the emergency department from 28 March 2012 to 17 August 2012. A waiver of consent had been obtained from the Medical Research Ethics Committee. Bedside upper airway ultrasonography was performed after intubation and compared to waveform capnography. Specificity, sensitivity, positive and negative predictive value and likelihood ratio are calculated. Results A sample of 107 patients were analysed, and 6 (5.6%) had oesophageal intubations. The overall accuracy of bedside upper airway ultrasonography was 98.1% (95% confidence interval (CI) 93.0% to 100.0%). The kappa value (Κ) was 0.85, indicating a very good agreement between the bedside upper airway ultrasonography and waveform capnography. Thus, bedside upper airway ultrasonography is in concordance with waveform capnography. The sensitivity, specificity, positive predictive value and negative predictive value of bedside upper airway ultrasonography were 98.0% (95% CI 93.0% to 99.8%), 100% (95% CI 54.1% to 100.0%), 100% (95% CI 96.3% to 100.0%) and 75.0% (95% CI 34.9% to 96.8%). The likelihood ratio of a positive test is infinite and the likelihood ratio of a negative test is 0.0198 (95% CI 0.005 to 0.0781). The mean confirmation time by ultrasound is 16.4 s. No adverse effects

  20. Methods For Collecting , Culturing And Performing Toxicity Tests With Daphnia ambigua

    SciTech Connect

    Specht, Winona L.

    2005-07-01

    Toxicity tests conducted on water collected from impacted locations in SRS streams often failed chronic toxicity tests and sometimes failed acute toxicity tests (Specht 1995). These findings prompted SRS to determine the cause of the failures. Some SRS NPDES outfalls were also failing chronic toxicity tests, even though no toxicant could be identified and when TIEs were performed, none of the TIE treatments removed the toxicity. Ultimately, it was determined that the failures were due to the low hardness of SRS surface waters, rather than to the presence of a toxicant. The species of cladoceran that the EPA recommends for toxicity testing, Ceriodaphnia dubia, is stressed by the very low hardness of SRS waters. SRS developed an alternate species toxicity test that is similar to the EPA test, but uses an indigenous cladoceran, Daphnia ambigua (Specht and Harmon, 1997; Harmon et al., 2003). In 2001, SCDHEC approved the use of D. ambigua for toxicity testing at SRS, contingent upon approval by EPA Region 4. In 2002, EPA Region 4 approved the use of this species for compliance toxicity testing at SRS. Ultimately, the use of this species demonstrated that SRS effluents were not toxic, and most toxicity testing requirements were removed from the NPDES permit that was issued in December 2003, with the exception of one round of chronic definitive testing on outfalls A-01, A-11, and G-10 just before the next NPDES permit application is submitted to SCDHEC. Although the alternate species test was developed at SRS (1996-1998), the culture was transferred to a contract toxicity testing lab (ETT Environmental) located in Greer, SC in 1998. ETT Environmental became certified by SCDHEC to perform toxicity tests using D. ambigua in 2002, and at this time is the only laboratory certified by SCDHEC to perform tests with this species. Because of the expense associated with maintaining the D. ambigua culture for several years when no toxicity testing is required, SRS decided to suspend

  1. [Left ventricular hypertrophy of athletes: adaptative physiologic response of the heart].

    PubMed

    Ghorayeb, Nabil; Batlouni, Michel; Pinto, Ibraim M F; Dioguardi, Giuseppe S

    2005-09-01

    To verify whether left ventricular hypertrophy (LVH) of elite competition athletes (marathoners) represents a purely physiological, adaptative process, or it may involve pathological aspects in its anatomical and functional characteristics. From November 1999 to December 2000, consecutive samples from 30 under 50-year-old marathoners in full sportive activity, with previously documented LVH and absence of cardiopathy were selected. They were submitted to clinical exams, electrocardiogram, color Doppler echocardiogram and exercise treadmill test (ETT). Fifteen were assorted to be also submitted to ergoespirometric test and heart magnetic resonance imaging (MRI). In ETT, all of them showed good physical pulmonary capacity, with no evidences of ischemic response to exercise, symptoms or arrhythmias. In Doppler echocardiogram, values of diameter and diastolic thickness of LV posterior wall, interventricular septum, LV mass and left atrium diameter, were significantly higher when compared to non-athlete control group, with similar ages and anthropometric measurements. The mean of LV mass of athletes indexed to body surface (126 g/m2) was significantly greater than the one in control group (70 g/m2) (p < 0.001). Magnetic resonance imaging (MRI) showed there was not impairment of contractile strength or LV performance, and values of end diastolic volume, end systolic volume and EF within limits of normality. On the other hand, average ventricular parietal mass, 162.93 +/- 17.90 g, and LV parietal thickness, 13.67 +/- 2.13 mm, at the end of diastole in athlete group, differed significantly from control group: 110 +/- 14.2 g (p = 0.0001) and 8 +/- 0.9 mm, respectively (p = 0.0001). The same happened to the thickness at the end of systole, which was 18.87 +/- 3.40 mm (control group: 10 +/- 1.80 mm, p = 0.0001). Results allowed for concluding that LVH in marathoners in full sportive activity period, assessed by non-invasive methods, represents an adaptative response to

  2. Evidence of long-lived founder virus in mother-to-child HIV transmission.

    PubMed

    Danaviah, Sivapragashini; de Oliveira, Tulio; Bland, Ruth; Viljoen, Johannes; Pillay, Sureshnee; Tuaillon, Edouard; Van de Perre, Philippe; Newell, Marie-Louise

    2015-01-01

    Exposure of the infant's gut to cell-associated and cell-free HIV-1 trafficking in breast milk (BM) remains a primary cause of mother-to-child transmission (MTCT). The mammary gland represents a unique environment for HIV-1 replication and host-virus interplay. We aimed to explore the origin of the virus transmitted during breastfeeding, and the link with quasi-species found in acellular and cellular fractions of breast-milk (BM) and in maternal plasma. The C2-V5 region of the env gene was amplified, cloned and sequenced from the RNA and DNA of BM, the RNA from the mother's plasma (PLA) and the DNA from infant's dried blood spot (DBS) in 11 post-natal mother-infant pairs. Sequences were assembled in Geneious, aligned in ClustalX, manually edited in SeAL and phylogenetic reconstruction was undertaken in PhyML and MrBayes. We estimated the timing of transmission (ETT) and reconstructed the time for the most recent common ancestor (TMRCA) of the infant in BEAST. Transmission of single quasi-species was observed in 9 of 11 cases. Phylogenetic analysis illustrated a BM transmission event by cell-free virus in 4 cases, and by cell-associated virus in 2 cases but could not be identified in the remaining 5 cases. Molecular clock estimates, of the infant ETT and TMRCA, corresponded well with the timing of transmission estimated by sequential infant DNA PCR in 10 of 11 children. The TMRCA of BM variants were estimated to emerge during gestation in 8 cases. We hypothesize that in the remaining cases, the breast was seeded with a long-lived lineage latently infecting resting T-cells. Our analysis illustrated the role of DNA and RNA virus in MTCT. We postulate that DNA archived viruses stem from latently infected quiescent T-cells within breast tissue and MTCT can be expected to continue, albeit at low levels, should interventions not effectively target these cells.

  3. Optimal Delivery of Aerosols to Infants During Mechanical Ventilation

    PubMed Central

    Azimi, Mandana; Hindle, Michael

    2014-01-01

    Abstract Purpose: The objective of this study was to determine optimal aerosol delivery conditions for a full-term (3.6 kg) infant receiving invasive mechanical ventilation by evaluating the effects of aerosol particle size, a new wye connector, and timing of aerosol delivery. Methods: In vitro experiments used a vibrating mesh nebulizer and evaluated drug deposition fraction and emitted dose through ventilation circuits containing either a commercial (CM) or new streamlined (SL) wye connector and 3-mm endotracheal tube (ETT) for aerosols with mass median aerodynamic diameters of 880 nm, 1.78 μm, and 4.9 μm. The aerosol was released into the circuit either over the full inhalation cycle (T1 delivery) or over the first half of inhalation (T2 delivery). Validated computational fluid dynamics (CFD) simulations and whole-lung model predictions were used to assess lung deposition and exhaled dose during cyclic ventilation. Results: In vitro experiments at a steady-state tracheal flow rate of 5 L/min resulted in 80–90% transmission of the 880-nm and 1.78-μm aerosols from the ETT. Based on CFD simulations with cyclic ventilation, the SL wye design reduced depositional losses in the wye by a factor of approximately 2–4 and improved lung delivery efficiencies by a factor of approximately 2 compared with the CM device. Delivery of the aerosol over the first half of the inspiratory cycle (T2) reduced exhaled dose from the ventilation circuit by a factor of 4 compared with T1 delivery. Optimal lung deposition was achieved with the SL wye connector and T2 delivery, resulting in 45% and 60% lung deposition for optimal polydisperse (∼1.78 μm) and monodisperse (∼2.5 μm) particle sizes, respectively. Conclusions: Optimization of selected factors and use of a new SL wye connector can substantially increase the lung delivery efficiency of medical aerosols to infants from current values of <1–10% to a range of 45–60%. PMID:24299500

  4. Optimal delivery of aerosols to infants during mechanical ventilation.

    PubMed

    Longest, P Worth; Azimi, Mandana; Hindle, Michael

    2014-10-01

    The objective of this study was to determine optimal aerosol delivery conditions for a full-term (3.6 kg) infant receiving invasive mechanical ventilation by evaluating the effects of aerosol particle size, a new wye connector, and timing of aerosol delivery. In vitro experiments used a vibrating mesh nebulizer and evaluated drug deposition fraction and emitted dose through ventilation circuits containing either a commercial (CM) or new streamlined (SL) wye connector and 3-mm endotracheal tube (ETT) for aerosols with mass median aerodynamic diameters of 880 nm, 1.78 μm, and 4.9 μm. The aerosol was released into the circuit either over the full inhalation cycle (T1 delivery) or over the first half of inhalation (T2 delivery). Validated computational fluid dynamics (CFD) simulations and whole-lung model predictions were used to assess lung deposition and exhaled dose during cyclic ventilation. In vitro experiments at a steady-state tracheal flow rate of 5 L/min resulted in 80-90% transmission of the 880-nm and 1.78-μm aerosols from the ETT. Based on CFD simulations with cyclic ventilation, the SL wye design reduced depositional losses in the wye by a factor of approximately 2-4 and improved lung delivery efficiencies by a factor of approximately 2 compared with the CM device. Delivery of the aerosol over the first half of the inspiratory cycle (T2) reduced exhaled dose from the ventilation circuit by a factor of 4 compared with T1 delivery. Optimal lung deposition was achieved with the SL wye connector and T2 delivery, resulting in 45% and 60% lung deposition for optimal polydisperse (∼1.78 μm) and monodisperse (∼2.5 μm) particle sizes, respectively. Optimization of selected factors and use of a new SL wye connector can substantially increase the lung delivery efficiency of medical aerosols to infants from current values of <1-10% to a range of 45-60%.

  5. Cost-effectiveness of cardiovascular magnetic resonance in the diagnosis of coronary heart disease: an economic evaluation using data from the CE-MARC study.

    PubMed

    Walker, Simon; Girardin, François; McKenna, Claire; Ball, Stephen G; Nixon, Jane; Plein, Sven; Greenwood, John P; Sculpher, Mark

    2013-06-01

    To evaluate the cost-effectiveness of diagnostic strategies for coronary heart disease (CHD) derived from the CE-MARC study. Cost-effectiveness analysis using a decision analytic model to compare eight strategies for the diagnosis of CHD. Secondary care out-patients (Cardiology Department). Patients referred to cardiologists for the further evaluation of symptoms thought to be angina pectoris. Eight different strategies were considered, including different combinations of exercise treadmill testing (ETT), single-photon emission CT (SPECT), cardiovascular magnetic resonance (CMR) and coronary angiography (CA). Costs expressed as UK sterling in 2010-2011 prices and health outcomes in quality-adjusted life-years (QALYs). The time horizon was 50 years. Based on the characteristics of patients in the CE-MARC study, only two strategies appear potentially cost-effective for diagnosis of CHD, both including CMR. The choice is between two strategies: one in which CMR follows a positive or inconclusive ETT, followed by CA if CMR is positive or inconclusive (Strategy 3 in the model); and the other where CMR is followed by CA if CMR is positive or inconclusive (Strategy 5 in the model). The more cost-effective of these two rests on the threshold cost per QALY gained below which health systems define an intervention as cost-effective. Strategy 3 appears cost-effective at the lower end of the threshold range used in the UK (£20 000 per QALY gained), while Strategy 5 appears cost-effective at the higher end of the threshold range (£30 000 per QALY). The results are robust to various sources of uncertainty although prior likelihood of CHD requiring revascularisation and the rate at which false negative patients are eventually appropriately identified do impact upon the results. The CE-MARC study showed that CMR had superior diagnostic accuracy to SPECT and concluded that CMR should be more widely used in the investigation of patients with CHD. The economic evaluation results

  6. Load capability of excessively flared teeth restored with fiber-reinforced composite posts and all-ceramic crowns.

    PubMed

    Naumann, Michael; Preuss, Anja; Frankenberger, Roland

    2006-01-01

    This investigation evaluated the stabilizing effect of glass fiber reinforced posts (FRP) luted with self-adhesive universal cement on the fracture resistance of excessively flared endodontically treated teeth (ETT). Values were compared to teeth with no ferrule, 2 mm ferrule and resin cement for luting with 2 mm ferrule. Thirty-two caries-free maxillary central incisors were randomly assigned to 4 groups (n=8) and endodontically treated. Two groups were flattened 2 mm above and 2 groups at the cemen-to-enamel junction (CEJ). The teeth received FRPs as follows: 1) post was cemented with self-adhesive cement (RelyX Unicem, 3M ESPE) (U), no ferrule (F) was prepared, root canal entrance was excessively flared with a remaining wall thickness of 0.5 - 0.75 mm (UNF/flared); 2) post was cemented with U, no F was prepared; 3) post was luted with U, F was prepared; 4) post was cemented with a resin cement (Panavia F, Kuraray, Japan), F was prepared. All specimens were built-up using a resin composite (Clearfil Core, Kuraray). All-ceramic crowns were adhesively luted (U). Specimens were exposed to thermo-mechanical loading and statically loaded until failure. The mean fracture load values [N](SD) were: UNF/flared=68 (126); UNF=315 (136); UF=488 (72); PF=860 (190). All groups exhibited statistically significant differences regarding maximum fracture load (p<0.05).

  7. Transition state analogs of 5'-methylthioadenosine nucleosidase disrupt quorum sensing.

    SciTech Connect

    Gutierrez, J.; Crowder, T; Rinaldo-Matthis, A; Ho, M; Almo, S; Schramm, V

    2009-01-01

    5'-Methylthioadenosine/S-adenosylhomocysteine nucleosidase (MTAN) is a bacterial enzyme involved in S-adenosylmethionine-related quorum sensing pathways that induce bacterial pathogenesis factors. Transition state analogs MT-DADMe-Immucillin-A, EtT-DADMe-Immucillin-A and BuT-DADMe-Immucillin-A are slow-onset, tight-binding inhibitors of Vibrio cholerae MTAN (VcMTAN), with equilibrium dissociation constants of 73, 70 and 208 pM, respectively. Structural analysis of VcMTAN with BuT-DADMe-Immucillin-A revealed interactions contributing to the high affinity. We found that in V. cholerae cells, these compounds are potent MTAN inhibitors with IC50 values of 27, 31 and 6 nM for MT-, EtT- and BuT-DADMe-Immucillin-A, respectively; the compounds disrupt autoinducer production in a dose-dependent manner without affecting growth. MT- and BuT-DADMe-Immucillin-A also inhibited autoinducer-2 production in enterohemorrhagic Escherichia coli O157:H7 with IC{sub 50} values of 600 and 125 nM, respectively. BuT-DADMe-Immucillin-A inhibition of autoinducer-2 production in both strains persisted for several generations and caused reduction in biofilm formation. These results support MTAN's role in quorum sensing and its potential as a target for bacterial anti-infective drug design.

  8. The Type Three Secretion System 2-Encoded Regulator EtrB Modulates Enterohemorrhagic Escherichia coli Virulence Gene Expression

    PubMed Central

    Luzader, Deborah H.; Willsey, Graham G.; Wargo, Matthew J.

    2016-01-01

    Enterohemorrhagic Escherichia coli O157:H7 (EHEC) is a foodborne pathogen that causes bloody diarrhea and hemolytic uremic syndrome throughout the world. A defining feature of EHEC pathogenesis is the formation of attaching and effacing (AE) lesions on colonic epithelial cells. Most of the genes that code for AE lesion formation, including a type three secretion system (T3SS) and effectors, are carried within a chromosomal pathogenicity island called the locus of enterocyte effacement (LEE). In this study, we report that a putative regulator, which is encoded in the cryptic E. coli type three secretion system 2 (ETT2) locus and herein renamed EtrB, plays an important role in EHEC pathogenesis. The etrB gene is expressed as a monocistronic transcript, and EtrB autoregulates expression. We provide evidence that EtrB directly interacts with the ler regulatory region to activate LEE expression and promote AE lesion formation. Additionally, we mapped the EtrB regulatory circuit in EHEC to determine a global role for EtrB. EtrB is regulated by the transcription factor QseA, suggesting that these proteins comprise a regulatory circuit important for EHEC colonization of the gastrointestinal tract. PMID:27324484

  9. The Different Effects of BMI and WC on Organ Damage in Patients from a Cardiac Rehabilitation Program after Acute Coronary Syndrome

    PubMed Central

    Xu, Lin; Zhao, Hui; Qiu, Jian; Zhu, Wei; Lei, Hongqiang; Cai, Zekun; Lin, Wan-Hua; Huang, Wenhua; Zhang, Heye; Zhang, Yuan-Ting

    2015-01-01

    One of the purposes of cardiac rehabilitation (CR) after acute coronary syndrome (ACS) is to monitor and control weight of the patient. Our study is to compare the different obesity indexes, body mass index (BMI), and waist circumference (WC), through one well-designed CR program (CRP) with ACS in Guangzhou city of Guangdong Province, China, in order to identify different effects of BMI and WC on organ damage. In our work, sixty-one patients between October 2013 and January 2014 fulfilled our study. We collected the vital signs by medical records, the clinical variables of body-metabolic status by fasting blood test, and the organ damage variables by submaximal exercise treadmill test (ETT) and ultrasonic cardiogram (UCG) both on our inpatient and four-to-five weeks of outpatient part of CRP after ACS. We mainly used two-tailed Pearson's test and liner regression to evaluate the relationship of BMI/WC and organ damage. Our results confirmed that WC could be more accurate than BMI to evaluate the cardiac function through the changes of left ventricular structure on the CRP after ACS cases. It makes sense of early diagnosis, valid evaluation, and proper adjustment to ACS in CRP of the obesity individuals in the future. PMID:26247035

  10. Evidence for the antiferromagnetic ground state of Zr2TiAl: a first-principles study.

    PubMed

    Reddy, P V Sreenivasa; Kanchana, V; Vaitheeswaran, G; Ruban, Andrei V; Christensen, N E

    2017-07-05

    A detailed study on the ternary Zr-based intermetallic compound Zr2TiAl has been carried out using first-principles electronic structure calculations. From the total energy calculations, we find an antiferromagnetic L11-like (AFM) phase with alternating (1 1 1) spin-up and spin-down layers to be a stable phase among some others with magnetic moment on Ti being 1.22 [Formula: see text]. The calculated magnetic exchange interaction parameters of the Heisenberg Hamiltonian and subsequent Heisenberg Monte Carlo simulations confirm that this phase is the magnetic ground structure with Néel temperature between 30 and 100 K. The phonon dispersion relations further confirm the stability of the magnetic phase while the non-magnetic phase is found to have imaginary phonon modes and the same is also found from the calculated elastic constants. The magnetic moment of Ti is found to decrease under pressure eventually driving the system to the non-magnetic phase at around 46 GPa, where the phonon modes are found to be positive indicating stability of the non-magnetic phase. A continuous change in the band structure under compression leads to the corresponding change of the Fermi surface topology and electronic topological transitions (ETT) in both majority and minority spin cases, which are also evident from the calculated elastic constants and density of state calculations for the material under compression.

  11. Effect of Pressure Controlled Waveforms on Flow Transport and Gas mixing in a Patient Specific Lung Model during Invasive High Frequency Oscillatory Ventilation

    NASA Astrophysics Data System (ADS)

    Alzahrany, Mohammed; Banerjee, Arindam

    2012-11-01

    A computational fluid dynamic study is carried out to investigate gas transport in patient specific human lung models (based on CT scans) during high frequency oscillatory ventilation (HFOV). Different pressure-controlled waveforms and various ventilator frequencies are studied to understand the effect of flow transport and gas mixing during these processes. Three different pressure waveforms are created by solving the equation of motion subjected to constant lung wall compliance and flow resistance. Sinusoidal, exponential and constant waveforms shapes are considered with three different frequencies 6, 10 and 15 Hz and constant tidal volume 50 ml. The velocities are calculated from the obtained flow rate and imposed as inlet flow conditions to represent the mechanical ventilation waveforms. An endotracheal tube ETT is joined to the model to account for the effect of the invasive management device with the peak Reynolds number (Re) for all the cases ranging from 6960 to 24694. All simulations are performed using high order LES turbulent model. The gas transport near the flow reversal will be discussed at different cycle phases for all the cases and a comparison of the secondary flow structures between different cases will be presented.

  12. Troponin-I positivity in patients referred to Rapid Access Chest Pain Clinic.

    PubMed

    Hayat, Umar; Motwani, J; Burrell, C J

    2010-01-01

    Rapid Access Chest Pain Clinics (RACPCs) are set up to access patients with new onset chest pain (within the preceding three weeks), of possible cardiac origin. These patients are seen in the clinic within two weeks of referral and the attending physician takes a history, performs a routine clinical examination, and if clinically justified, a treadmill exercise test is performed according to Bruce Protocol. Within the group of patients referred to the RACPC with new onset but otherwise stable angina, there is a potential overlap with patients who in fact may have an evolving acute coronary syndrome, i.e., unstable angina. The aim of this study was to assess the prevalence of Troponin-I positivity as an indicator of acute coronary syndrome. This cross-sectional descriptive study included 60 consecutive patients referred to the RACPC with history of recent onset chest pain (within the last three weeks) of possible cardiac origin and positive ETT or confirmed abnormal ischemic ECG at baseline. Troponin-L was measured in these patients. Out of the total 60 patients, 8.33% of the patients referred to RACPC with new onset angina had positive cTnI. Point of care test (POCT) for cTnI can help to identify the high risk patient referred to RACPC.

  13. Pathophysiological Basis of Acute Respiratory Failure on Non-Invasive Mechanical Ventilation.

    PubMed

    Romero-Dapueto, C; Budini, H; Cerpa, F; Caceres, D; Hidalgo, V; Gutiérrez, T; Keymer, J; Pérez, R; Molina, J; Giugliano-Jaramillo, C

    2015-01-01

    Noninvasive mechanical ventilation (NIMV) was created for patients who needed noninvasive ventilator support, this procedure decreases the complications associated with the use of endotracheal intubation (ETT). The application of NIMV has acquired major relevance in the last few years in the management of acute respiratory failure (ARF), in patients with hypoxemic and hypercapnic failure. The main advantage of NIMV as compared to invasive mechanical ventilation (IMV) is that it can be used earlier outside intensive care units (ICUs). The evidence strongly supports its use in patients with COPD exacerbation, support in weaning process in chronic obstructive pulmonary disease (COPD) patients, patients with acute cardiogenic pulmonary edema (ACPE), and Immunosuppressed patients. On the other hand, there is poor evidence that supports the use of NIMV in other pathologies such as pneumonia, acute respiratory distress syndrome (ARDS), and during procedures as bronchoscopy, where its use is still controversial because the results of these studies are inconclusive against the decrease in the rate of intubation or mortality.

  14. Evidence for the antiferromagnetic ground state of Zr2TiAl: a first-principles study

    NASA Astrophysics Data System (ADS)

    Sreenivasa Reddy, P. V.; Kanchana, V.; Vaitheeswaran, G.; Ruban, Andrei V.; Christensen, N. E.

    2017-07-01

    A detailed study on the ternary Zr-based intermetallic compound Zr2TiAl has been carried out using first-principles electronic structure calculations. From the total energy calculations, we find an antiferromagnetic L11-like (AFM) phase with alternating (1 1 1) spin-up and spin-down layers to be a stable phase among some others with magnetic moment on Ti being 1.22 {μ\\text{B}} . The calculated magnetic exchange interaction parameters of the Heisenberg Hamiltonian and subsequent Heisenberg Monte Carlo simulations confirm that this phase is the magnetic ground structure with Néel temperature between 30 and 100 K. The phonon dispersion relations further confirm the stability of the magnetic phase while the non-magnetic phase is found to have imaginary phonon modes and the same is also found from the calculated elastic constants. The magnetic moment of Ti is found to decrease under pressure eventually driving the system to the non-magnetic phase at around 46 GPa, where the phonon modes are found to be positive indicating stability of the non-magnetic phase. A continuous change in the band structure under compression leads to the corresponding change of the Fermi surface topology and electronic topological transitions (ETT) in both majority and minority spin cases, which are also evident from the calculated elastic constants and density of state calculations for the material under compression.

  15. Pathophysiological Basis of Acute Respiratory Failure on Non-Invasive Mechanical Ventilation

    PubMed Central

    Romero-Dapueto, C; Budini, H; Cerpa, F; Caceres, D; Hidalgo, V; Gutiérrez, T; Keymer, J; Pérez, R; Molina, J; Giugliano-Jaramillo, C

    2015-01-01

    Noninvasive mechanical ventilation (NIMV) was created for patients who needed noninvasive ventilator support, this procedure decreases the complications associated with the use of endotracheal intubation (ETT). The application of NIMV has acquired major relevance in the last few years in the management of acute respiratory failure (ARF), in patients with hypoxemic and hypercapnic failure. The main advantage of NIMV as compared to invasive mechanical ventilation (IMV) is that it can be used earlier outside intensive care units (ICUs). The evidence strongly supports its use in patients with COPD exacerbation, support in weaning process in chronic obstructive pulmonary disease (COPD) patients, patients with acute cardiogenic pulmonary edema (ACPE), and Immunosuppressed patients. On the other hand, there is poor evidence that supports the use of NIMV in other pathologies such as pneumonia, acute respiratory distress syndrome (ARDS), and during procedures as bronchoscopy, where its use is still controversial because the results of these studies are inconclusive against the decrease in the rate of intubation or mortality. PMID:26312101

  16. Gestational Trophoblastic Disorders: An Update in 2015

    PubMed Central

    Stevens, F. T.; Katzorke, N.; Tempfer, C.; Kreimer, U.; Bizjak, G. I.; Fleisch, M. C.; Fehm, T. N.

    2015-01-01

    Gestational trophoblastic diseases (GTD) are a group of pregnancy-related disorders representing rare human tumours. They encompass premalignant disorders including complete (CHM), partial hydatidiform mole (PHM), exaggerated placental site (EPS), and placental-site nodule (PSN) as well as malignant disorders (also known as “gestational trophoblastic neoplasia [GTN]”) including invasive mole, choriocarcinoma (CC), placenta-site trophoblastic tumour (PSTT), and epitheloid trophoblastic tumours (ETT) (Fig. 1). Originally, GTD develop from abnormal proliferation of trophoblastic tissue and form botryoid arranged vesicles. Premalignant moles are usually treated by suction curettage while persistent and recurrent moles and malignant forms require systemic therapy with methotrexate or combination chemotherapy consisting of etoposide, actimomycin D, methotrexate, vincristine, and cyclophosphamide (EMA-CO). β-human chorion gonadotropin (β-hCG) plays a crucial role in diagnosis and monitoring therapeutic effects. Since the definitive diagnosis cannot be obtained by histology in most cases, persistent or recurrent disease is diagnosed by elevated or persistent serum levels of β-hCG. While curing rates are described to be as high as 98 %, GTD may initially present, recur, or end up as a metastasising systemic disease. This underlines the importance of a regular and consistent follow-up after treatment. PMID:26556906

  17. Gestational Trophoblastic Disorders: An Update in 2015.

    PubMed

    Stevens, F T; Katzorke, N; Tempfer, C; Kreimer, U; Bizjak, G I; Fleisch, M C; Fehm, T N

    2015-10-01

    Gestational trophoblastic diseases (GTD) are a group of pregnancy-related disorders representing rare human tumours. They encompass premalignant disorders including complete (CHM), partial hydatidiform mole (PHM), exaggerated placental site (EPS), and placental-site nodule (PSN) as well as malignant disorders (also known as "gestational trophoblastic neoplasia [GTN]") including invasive mole, choriocarcinoma (CC), placenta-site trophoblastic tumour (PSTT), and epitheloid trophoblastic tumours (ETT) (Fig. 1). Originally, GTD develop from abnormal proliferation of trophoblastic tissue and form botryoid arranged vesicles. Premalignant moles are usually treated by suction curettage while persistent and recurrent moles and malignant forms require systemic therapy with methotrexate or combination chemotherapy consisting of etoposide, actimomycin D, methotrexate, vincristine, and cyclophosphamide (EMA-CO). β-human chorion gonadotropin (β-hCG) plays a crucial role in diagnosis and monitoring therapeutic effects. Since the definitive diagnosis cannot be obtained by histology in most cases, persistent or recurrent disease is diagnosed by elevated or persistent serum levels of β-hCG. While curing rates are described to be as high as 98 %, GTD may initially present, recur, or end up as a metastasising systemic disease. This underlines the importance of a regular and consistent follow-up after treatment.

  18. Epithelioid trophoblastic tumor after induced abortion with previous broad choriocarcinoma: a case report and review of literature

    PubMed Central

    Zhang, Xiaofei; Shi, Haiyan; Chen, Xiaoduan

    2014-01-01

    Epithelioid trophoblastic tumor (ETT) is a rare trophoblastic tumor originating from chorionic-type intermediate trophoblasts (ITs). It is usually associated with a prior gestational event. We present a 44-year-old woman who had unusual pregnancy related history. The patient received her second spontaneous abortion at the age of 25 years and had suffered from choriocarcinoma in left board ligament at the age of 29 years. She admitted no more treatment after 3 courses of multiagent chemotherapy when serum β-hCG returned to normal. Then she had Full-term delivery, induced abortion at the ages of 32, 33 years. The patient had high serum levels of beta-human chorionic gonadotropin (6587 IU/L). Microscopically, the tumor was composed of mainly mononuclear tumor cells, grew in cords, nests, and sheets within which were aggregates of hyaline material. Most were with distinct cell borders, eosinophilic cytoplasm. Immunohistochemical staining revealed strong diffuse reactivity for cytokeratins (AE1/AE3, CK18), P63, focal reactivity for beta-human chorionic gonadotropin, human placental lactogen, and inhibin-alpha. The Ki-67 index was 77%. The histological and immunohistochemical features were characteristic of epithelioid trophoblastic tumor. This is the first reported case of these two gestational trophoblastic tumor happened on one person with the intervening normal pregnancy. PMID:25550880

  19. Preoperative Anxiety in Patients With Myasthenia Gravis and Risk for Myasthenic Crisis After Extended Transsternal Thymectomy: A CONSORT Study.

    PubMed

    Zou, Jianyong; Su, Chunhua; Lun, Xueping; Liu, Weibing; Yang, Weiling; Zhong, Beilong; Zhu, Haoshuai; Lei, Yiyan; Luo, Honghe; Chen, Zhenguang

    2016-03-01

    A thymectomy can ameliorate the symptoms of myasthenia gravis (MG) and prevent the progression of ocular MG (OMG) to generalized MG (GMG). However, postoperative myasthenic crisis (POMC) is a serious post-thymectomy complication. Preoperative anxiety (POA) is common but typically neglected in MG patients. The association of POA with POMC has not yet been examined.From June 2007 to December 2013, 541 cases of MG were admitted to the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China). All cases underwent extended transsternal thymectomy (ETT). The clinical and pathological characteristics of these patients, including POA and POMC, were analyzed.A total of 179 patients experienced POA and 67 patients experienced POMC. Patients with POA were more likely to have POMC, a thymoma, and an ectopic thymus. Univariate analysis showed that POMC correlated with POA, presence of an ectopic thymus, dose of pyridostigmine bromide (PYR), presence of a thymoma, MGFA stage, preoperative myasthenic crisis, and postoperative pneumonia. Multivariate logistic regression analysis showed that the independent risk factors for POMC were POA, preoperative myasthenic crisis, higher dose of PYR, and postoperative pneumonia.Our results suggest that clinicians should consider the risk factors for POMC-especially preoperative anxiety-before performing a thymectomy in patients with MG.

  20. Preoperative Anxiety in Patients With Myasthenia Gravis and Risk for Myasthenic Crisis After Extended Transsternal Thymectomy

    PubMed Central

    Zou, Jianyong; Su, Chunhua; Lun, Xueping; Liu, Weibing; Yang, Weiling; Zhong, Beilong; Zhu, Haoshuai; Lei, Yiyan; Luo, Honghe; Chen, Zhenguang

    2016-01-01

    Abstract A thymectomy can ameliorate the symptoms of myasthenia gravis (MG) and prevent the progression of ocular MG (OMG) to generalized MG (GMG). However, postoperative myasthenic crisis (POMC) is a serious post-thymectomy complication. Preoperative anxiety (POA) is common but typically neglected in MG patients. The association of POA with POMC has not yet been examined. From June 2007 to December 2013, 541 cases of MG were admitted to the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China). All cases underwent extended transsternal thymectomy (ETT). The clinical and pathological characteristics of these patients, including POA and POMC, were analyzed. A total of 179 patients experienced POA and 67 patients experienced POMC. Patients with POA were more likely to have POMC, a thymoma, and an ectopic thymus. Univariate analysis showed that POMC correlated with POA, presence of an ectopic thymus, dose of pyridostigmine bromide (PYR), presence of a thymoma, MGFA stage, preoperative myasthenic crisis, and postoperative pneumonia. Multivariate logistic regression analysis showed that the independent risk factors for POMC were POA, preoperative myasthenic crisis, higher dose of PYR, and postoperative pneumonia. Our results suggest that clinicians should consider the risk factors for POMC—especially preoperative anxiety—before performing a thymectomy in patients with MG. PMID:26962777

  1. Use of laryngeal mask airway for non-endotracheal intubated anesthesia for patients with pectus excavatum undergoing thoracoscopic Nuss procedure

    PubMed Central

    Du, Xiaojun; Mao, Songsong; Cui, Jianxiu; Ma, Jue; Zhang, Guangyan; Zheng, Yong; Zhou, Haiyu; Xie, Liang; Zhang, Dongkun; Shi, Ruiqing

    2016-01-01

    Background The aim of the present study was to determine the safety and feasibility of the use of laryngeal mask airway (LMA) for non-endotracheal intubated anesthesia for patients with pectus excavatum (PE) undergoing thoracoscopic Nuss procedure. Methods Between July 2015 and December 2015, 30 selected patients with PE were planned to undergo a thoracoscopic Nuss procedure using LMA for non-endotracheal intubated anesthesia in the Guangdong General Hospital. The clinical data were analyzed to evaluate the safety and feasibility of this technique. Results Of the 30 selected patients, two were female, the mean age was 16.04±5.09 years and the average Haller index was 3.37±0.88. A total of 27 cases (90%) succeeded at the first attempt, one patient required conversion to an endotracheal tube (ETT) because of continuous air leak. The peripheral O2 saturation (SpO2), end-tidal carbon dioxide (EtCO2) values, heart rate (HR), and mean arterial blood pressure (MAP) remained stable throughout the procedure in all cases. All of the 30 patients were successfully corrected without requiring conversion to an open surgery. Two patients experienced postoperative nausea and one reported a sore throat. Neither gastro-esophageal reflux nor in-hospital mortality occurred. Conclusions The use of LMA for non-endotracheal intubated anesthesia for selected patients with PE undergoing thoracoscopic Nuss procedure is clinically safe and technically feasible. PMID:27621860

  2. Mars Global Surveyor Ka-Band Frequency Data Analysis

    NASA Astrophysics Data System (ADS)

    Morabito, D.; Butman, S.; Shambayati, S.

    2000-01-01

    for the feed and electronics equipment. A dichroic plate is used to reflect the X-band energy and pass the Ka-band energy to another mirror. The RF energy for each band is then focused onto a feed horn and low-noise amplifier package. After amplification and RF/IF downconversion, the IF signals are sent to the Experimental Tone Tracker (ETT), a digital phase-lock-loop receiver, which simultaneously tracks both X-band and Ka-band carrier signals. Once a signal is detected, the ETT outputs estimates of the SNR in a I -Hz bandwidth (Pc/No), baseband phase and frequency of the signals every I -sec. Between December 1996 and December 1998, the Ka-band and X-band signals from MGS were tracked on a regular basis using the ETT. The Ka-band downlink frequencies described here were referenced to the spacecraft's on-board USO which was also the X-band frequency reference (fka= 3.8 fx). The ETT estimates of baseband phase at I -second sampled time tags were converted to sky frequency estimates. Frequency residuals were then generated for each band by removing a model frequency from each observable frequency at each time tag. The model included Doppler and other effects derived from spacecraft trajectory files obtained from the MGS Navigation Team. A simple troposphere correction was applied to the data. In addition to residuals, the USO frequencies emitted by the spacecraft were estimated. For several passes, the USO frequencies were determined from X-band data and from Ka-band data (referred to X-band by dividing by 3.8) and were found to be in good agreement. In addition, X-band USO frequency estimates from MGS Radio Science data acquired from operational DSN stations were available for comparison and were found to agree within the I Hz level. The remaining sub-Hertz differences were attributed to the different models and software algorithms used by MGS Radio Science and KaBLE-11. A summary of the results of a linear fit of the USO frequency versus time (day of year) is

  3. Mars Global Surveyor Ka-Band Frequency Data Analysis

    NASA Technical Reports Server (NTRS)

    Morabito, D.; Butman, S.; Shambayati, S.

    2000-01-01

    environment for the feed and electronics equipment. A dichroic plate is used to reflect the X-band energy and pass the Ka-band energy to another mirror. The RF energy for each band is then focused onto a feed horn and low-noise amplifier package. After amplification and RF/IF downconversion, the IF signals are sent to the Experimental Tone Tracker (ETT), a digital phase-lock-loop receiver, which simultaneously tracks both X-band and Ka-band carrier signals. Once a signal is detected, the ETT outputs estimates of the SNR in a I -Hz bandwidth (Pc/No), baseband phase and frequency of the signals every I -sec. Between December 1996 and December 1998, the Ka-band and X-band signals from MGS were tracked on a regular basis using the ETT. The Ka-band downlink frequencies described here were referenced to the spacecraft's on-board USO which was also the X-band frequency reference (f(sub ka)= 3.8 f(sub x)). The ETT estimates of baseband phase at I -second sampled time tags were converted to sky frequency estimates. Frequency residuals were then generated for each band by removing a model frequency from each observable frequency at each time tag. The model included Doppler and other effects derived from spacecraft trajectory files obtained from the MGS Navigation Team. A simple troposphere correction was applied to the data. In addition to residuals, the USO frequencies emitted by the spacecraft were estimated. For several passes, the USO frequencies were determined from X-band data and from Ka-band data (referred to X-band by dividing by 3.8) and were found to be in good agreement. In addition, X-band USO frequency estimates from MGS Radio Science data acquired from operational DSN stations were available for comparison and were found to agree within the I Hz level. The remaining sub-Hertz differences were attributed to the different models and software algorithms used by MGS Radio Science and KaBLE-11. A summary of the results of a linear fit of the USO frequency versus time (day of

  4. Polarity in the early floral meristem of Arabidopsis.

    PubMed

    Thoma, Rahere; Chandler, John William

    2015-01-01

    The diversity of angiosperm flowers depends on organ meristy and position. However, the signaling pathways that establish polarity and positional information remain largely unelucidated. Use of the founder-cell marker DORNRÖSCHEN-LIKE (DRNL) in Arabidopsis has recently highlighted the importance of the abaxial-adaxial axis for early floral development. We have extended the use of DRNL::GFP to further characterize floral organogenesis in genotypes that are altered in floral organ meristy or position, including ettin (ett-3) and blade-on-petiole (bop)1-11 bop2-4 double mutants. The creation of supernumery sepals by the splitting of sepal founder-cell populations along an ab-/adaxial axis strengthens the importance of the ab-/adaxial developmental axis in early floral meristem development. Furthermore, we confirm the dependency of the wildtype sequence of sepal initiation on bract suppression and demonstrate that supernumery stamens derive from the imprecise resolution of a ring of DRNL expression. Expression of DRNL in apetala1 (ap1-1) and ap2-8 mutants reflect the altered whorl structure and show that these homeotic genes function upstream of DRNL. Analyzing the dynamism of early floral meristem ontogeny at a fine temporal and spatial resolution in Arabidopsis can reveal mechanisms of organogenesis and is applicable to other species with differing floral body plans in a comparative evolutionary context.

  5. AICA syndrome with facial palsy following vertigo and acute sensorineural hearing loss.

    PubMed

    Ikegami-Takada, Tomoko; Izumikawa, Masahiko; Doi, Tadashi; Takada, Yohei; Tomoda, Koichi

    2012-04-01

    We report a case of infarction of the anterior inferior cerebellar artery (AICA) with peripheral facial palsy following vertigo and acute sensorineural hearing loss. A 39-year-old female presented with vertigo and sudden hearing loss, tinnitus, and aural fullness of the right ear. An audiogram revealed a severe hearing loss at all tested frequencies in the right ear. Spontaneous nystagmus toward the left side was also observed. Otoneurological examinations showed sensorineural hearing loss of the right ear and horizontal and rotatory gaze nystagmus toward the left side, and a caloric reflex test demonstrated canal paresis. Initially, we diagnosed the patient for sudden deafness with vertigo. However, right peripheral facial palsy appeared 2 days later. An eye tracking test (ETT) and optokinetic pattern test (OKP) showed centralis abnormality. The patient's brain was examined by magnetic resonance imaging (MRI) and magnetic resonance angioglaphy (MRA) and showed an infarction localized in the pons and cerebellum. MRI and MRA revealed infarction of the right cerebellar hemisphere indicating occlusion of the AICA. Consequently, the patient was diagnosed with AICA syndrome but demonstrated regression following steroid and edaravone treatment. We suggest that performing MRI and MRA in the early stage of AICA syndrome is important for distinguishing cerebellar infarction resulting from vestibular disease.

  6. Assessment of v-gel supraglottic airway device placement in cats performed by inexperienced veterinary students.

    PubMed

    Barletta, M; Kleine, S A; Quandt, J E

    2015-11-21

    Endotracheal intubation has been associated with several complications in cats. The v-gel supraglottic airway device (SGAD) has been developed to adapt to the unique oropharynx of the cat and to overcome these complications. Thirty-three cats were randomly assigned to receive an endotracheal tube (ETT group) or a v-gel SGAD (v-gel group) after induction of general anaesthesia. Third year veterinary students without previous clinical experience placed these devices under direct supervision of an anaesthesiologist. Amount of propofol, number of attempts, time required to secure the airway, leakage around the device, signs of upper airway discomfort and food consumption were compared between the two groups. The v-gel group required less propofol (P=0.03), less time (P<0.01) and fewer attempts (P<0.01) to secure the cats' airway. The incidence of leakage was lower for the v-gel group immediately after placement of the device (P<0.01) and 60 minutes after induction of general anaesthesia (P=0.04). Cats that received the v-gel SGAD presented a lower incidence of upper airway discomfort immediately after the device was removed (P=0.03) and recorded a higher food consumption score (P=0.03). The v-gel SGAD is a feasible way to secure the airway of healthy cats when performed by inexperienced personnel.

  7. [Transthoracic echocardiography in a heart institute in Abidjan (Ivory Coast): Indications and evaluation of the request appropriateness].

    PubMed

    Anzouan-Kacou, J B; Siransy, E; Nchoh-Mottoh, M P; Ekou, A; Bamba-Kamagaté, D; Kadio, E M

    2014-02-01

    The aim of this study was to clarify the clinical situations motivating indications of transthoracic echocardiography (TTE) in a cardiology institute in Côte d'Ivoire and to assess the appropriateness of indications. This is a prospective and observational study conducted over a period of 6 months. The 1733 enrolled were classified according to the indications and their relevance defined by the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Echocardiography and the American Heart Association (ACCF/ASE/AHA). In five cases (0.3%), indications were not listed in the document ACCF/ASE/AHA. The most common indication was the initial evaluation of hypertension (HTA) and suspicion of hypertensive heart disease (47.3%). All indications, the assessment in the context of hypertension represented 853 examinations (49.2%). Heart failure accounted for 5.3% of indications, but consisted of 302 applications (17.4%) when was associated hypertension with signs suggestive of heart failure. Requests were considered as appropriate in 95.3%, inappropriate in 3.2% and uncertain in 1.6%. In the group of inappropriate indications patients were significantly younger, and were examinations more often normal and less often absolutely abnormal. The profile of cardiovascular morbidity in our institution is dominated by the spectrum of hypertension and heart failure. Each indication must be balanced for the profitability of the ETT. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  8. Pressure-induced phase transition in Bi2Se3 at 3 GPa: electronic topological transition or not?

    PubMed

    Bera, Achintya; Pal, Koushik; Muthu, D V S; Waghmare, U V; Sood, A K

    2016-03-16

    In recent years, a low pressure transition around P3 GPa exhibited by the A2B3-type 3D topological insulators is attributed to an electronic topological transition (ETT) for which there is no direct evidence either from theory or experiments. We address this phase transition and other transitions at higher pressure in bismuth selenide (Bi2Se3) using Raman spectroscopy at pressure up to 26.2 GPa. We see clear Raman signatures of an isostructural phase transition at P2.4 GPa followed by structural transitions at ∼ 10 GPa and 16 GPa. First-principles calculations reveal anomalously sharp changes in the structural parameters like the internal angle of the rhombohedral unit cell with a minimum in the c/a ratio near P3 GPa. While our calculations reveal the associated anomalies in vibrational frequencies and electronic bandgap, the calculated Z2 invariant and Dirac conical surface electronic structure remain unchanged, showing that there is no change in the electronic topology at the lowest pressure transition.

  9. OCTN1 is a high-affinity carrier of nucleoside analogs.

    PubMed

    Drenberg, Christina; Gibson, Alice A; Pounds, Stanley; Shi, Lei; Rhinehart, Dena; Li, Lie; Hu, Shuiying; Du, Guoqing; Nies, Anne T; Schwab, Matthias; Pabla, Navjotsingh; Blum, William; Gruber, Tanja A; Baker, Sharyn D; Sparreboom, Alex

    2017-02-16

    Resistance to xenobiotic nucleosides used to treat acute myeloid leukemia (AML) and other cancers remains a major obstacle to clinical management. One process suggested to participate in resistance is reduced uptake into tumor cells via nucleoside transporters, although precise mechanisms are not understood. Through transcriptomic profiling, we determined that low expression of the ergothioneine transporter OCTN1 (SLC22A4; ETT) strongly predicts poor event-free survival and overall survival in multiple cohorts of AML patients receiving treatment with the cytidine nucleoside analog cytarabine. Cell biological studies confirmed OCTN1-mediated transport of cytarabine and various structurally-related cytidine analogs, such as 2'deoxycytidine and gemcitabine, occurs through a saturable process that is highly sensitive to inhibition by the classic nucleoside transporter inhibitors dipyridamole and nitrobenzylmercaptopurine ribonucleoside (NBMPR). Our findings have immediate clinical implications given the potential of the identified transport system to help refine strategies that could improve patient survival across multiple cancer types where nucleoside analogs are used in cancer treatment.

  10. SMQIE: The shower max QIE chip

    SciTech Connect

    James R. Hoff

    1999-06-02

    A QIE-like full-custom chip has been designed by members of the Fermilab PPD/ETT/ES Group as well as members of the CDF/Shower Max Group. This chip contains two channels each with an eight range QIE front end capable of handling charges from roughly 12 fC to roughly 100 pC. Each channel also contains a five-bit flash A-to-D converter, a 38 stage deep FIFO for level 1 trigger delay and storage for holding selected time slices. It communicates with the outside world via LVDS-like differential signals. This chip utilizes a 1.2mm double-metal, double-polysilicon process with a vertical NPN transistor option. It has been prototyped using ORBIT Semiconductor�s Foresight program. As of this writing, it has been submitted to Super Tex (new owner of the ORBIT fabrication facility) for fabrication. However, it has not yet returned from fabrication.

  11. Fluid management and postoperative respiratory disturbances in patients with transthoracic esophagectomy for carcinoma.

    PubMed

    Kita, Takashi; Mammoto, Tadanori; Kishi, Yoshihiko

    2002-06-01

    To investigate whether intraoperative fluid management contributes to postoperative respiratory disturbances in esophagectomy for carcinoma. Retrospective study. Operating room and postanesthetic care unit of the cancer center. From 1997 to 2000, 112 ASA physical status I, II, and III patients with primary carcinoma of the esophagus undergoing transthoracic esophagectomy. As of 1998, we altered fluid management during esophagectomy to save intraoperative fluid administration. Then, we investigated postoperative respiratory disturbances after esophagectomy in the period from 1998 to 2000 (late period) compared with the period from 1997 to 1998 (early period). We also investigated the relationship between perioperative risk factors and postoperative respiratory disturbances. The need for frequent (>10) bronchoscopic suctioning of sputum during postoperative period, the need for tracheostomy, and failure in the removal of endotracheal tube (ETT) (extubation) on the first postoperative day (1 POD) were investigated for respiratory disturbances after surgery. Intraoperative volume balance decreased more so in the late period compared with early period (p < 0.0,001). The need for tracheostomy, bronchoscopic suctioning, and extubation failure on 1 POD were more frequent in the early period than in the late period (p = 0.0083, p = 0.0319, and p = 0.0024, respectively). The hospital recovery period after surgery was shortened during the late period (p = 0.032). Intraoperative volume balance affected the need for tracheostomy and frequent bronchoscopy postoperatively. Careful intraoperative fluid administration may decrease postoperative respiratory disturbances.

  12. Quantum cascade laser with low threshold and high characteristic temperature T0> 300K at ˜ 14 μm

    NASA Astrophysics Data System (ADS)

    Huang, Xue; Charles, William; Gmachl, Claire; Mirthe Team

    2011-03-01

    High-performance quantum cascade (QC) lasers with wavelength in 4 ~ 12 μ m range are widely used in trace gas sensing. However, lack of high performance for longer wavelength in the 12 ~ 16 μ m range, where exist the strongest absorption lines of BTEX (benzene, toluene, ethylbenzene, and xylenes) and Uranium Hexafluoride, prohibits QC laser applications in sensing these important gases. The QC laser emitting at ~ 14 μ m we investigate here is based on a diagonal-transition design. The depletion of the lower laser state is achieved by a one-phonon-continuum scheme instead of the widely used ``continuum'' lower mini-bands in existing long-wavelength lasers. This scheme reduces LO scattering from the upper laser state, the leakage from the injector and thermal back-filling to the lower laser state, thus attaining population inversion efficiently. The laser shows low threshold (Jth = 2.4 kA/cm2 for a 1.97-mm-long laser at room temperature), and a high characteristic temperature T0 = 309K fitted from Jth (T) = J 0 eT/T0 , which is comparable with the record highest characteristic temperature. The peak power is 1.4W at 80K and 0.25W at 300K. Work supported in part by MIRTHE (NSF-ERC).

  13. Gestational trophoblastic diseases - clinical guidelines for diagnosis, treatment, follow-up, and counselling.

    PubMed

    Niemann, Isa; Vejerslev, Lars O; Frøding, Ligita; Blaakær, Jan; Maroun, Lisa Leth; Hansen, Estrid Stæhr; Grove, Anni; Lund, Helle; Havsteen, Hanne; Sunde, Lone

    2015-11-01

    , either orally every third week or IV every week (B). In MTX-resistant PTD, IV act D is added (or replaces the MTX) (B). Third line chemotherapy is BEP or EP, alternatively EMA-CO (B). Choriocarcinoma is primarily treated with chemotherapy. Hysterectomy and/or resection of metastases are possible treatments (A). Placental site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT) are primarily treated with hysterectomy. In the case of disseminated disease, chemotherapy is considered (A). The risk of reoccurrence after trophoblastic disease treated with chemotherapy is approximately 3%. Most reoccurrences are seen within 12 months, and for this reason monitoring of hCG is recommended for one year, the first third months once or twice a month, thereafter every second to third month. Patients with PSTT and ETT are monitored with measurement of hCG throughout their lifetimes (C). In genetically verified twin pregnancy with hydatidiform mole and a living foetus, the pregnancy can continue if serum hCG is monitored and ultrasound scans regularly performed, and possible obstetric complications dealt with (C). In the case of recurrent hydatidiform mole and/or familial hydatidiform mole, patients should be referred to genetic workup and counselling (C). Women with a hereditary disposition to hydatidiform mole because of a mutation in NLRP7 should be informed of the possibility of becoming pregnant via egg donation (C).

  14. Do PICU patients meet technical criteria for performing indirect calorimetry?

    PubMed

    Beggs, Megan R; Garcia Guerra, Gonzalo; Larsen, Bodil M K

    2016-10-01

    Indirect calorimetry (IC) is considered gold standard for assessing energy needs of critically ill children as predictive equations and clinical status indicators are often unreliable. Accurate assessment of energy requirements in this vulnerable population is essential given the high risk of over or underfeeding and the consequences thereof. The proportion of patients and patient days in pediatric intensive care (PICU) for which energy expenditure (EE) can be measured using IC is currently unknown. In the current study, we aimed to quantify the daily proportion of consecutive PICU patients who met technical criteria to perform indirect calorimetry and describe the technical contraindications when criteria were not met. Prospective, observational, single-centre study conducted in a cardiac and general PICU. All consecutive patients admitted for at least 96 h were included in the study. Variables collected for each patient included age at admission, admission diagnosis, and if technical criteria for indirect calorimetry were met. Technical criteria variables were collected within the same 2 h each morning and include: provision of supplemental oxygen, ventilator settings, endotracheal tube (ETT) leak, diagnosis of chest tube air leak, provision of external gas support (i.e. nitric oxide), and provision of extracorporeal membrane oxygenation (ECMO). 288 patients were included for a total of 3590 patient days between June 2014 and February 2015. The main reasons for admission were: surgery (cardiac and non-cardiac), respiratory distress, trauma, oncology and medicine/other. The median (interquartile range) patient age was 0.7 (0.3-4.6) years. The median length of PICU stay was 7 (5-14) days. Only 34% (95% CI, 32.4-35.5%) of patient days met technical criteria for IC. For patients less than 6 months of age, technical criteria were met on significantly fewer patient days (29%, p < 0.01). Moreover, 27% of patients did not meet technical criteria for IC on any day

  15. Superconductivity on the verge of electronic topological transition in Fe based superconductors

    NASA Astrophysics Data System (ADS)

    Ghosh, Haranath; Sen, Smritijit

    2017-04-01

    A comprehensive first principles study on the electronic topological transition in a number of 122 family of Fe based superconductors is presented. Doping as well as temperature driven Lifshitz transitions are predicted from ab-initio simulations in a variety of Fe based superconductors that are consistent with experimental findings. In all the studied compounds the Lifshitz transitions are consistently found to take place at a doping concentration just around where superconductivity is known to acquire the highest Tc and magnetism disappears. This indicates the intriguing heed to the inter-relationship between superconductivity and Lifshitz transition in Fe-based 122 materials. Systematically, the Lifshitz transition occurs (above certain threshold doping) in some of the electronic Fermi surfaces for hole doped 122 compounds, whereas in hole Fermi surfaces for electron as well as iso-electronic doped 122 compounds. Temperature driven Lifshitz transition is found to occur in the iso-electronic Ru-doped BaFe2As2 compounds. A systematic study of Fermi surface area e.g., variations of (i) areas of each individual Fermi surfaces, (ii) sum total areas of all the electron Fermi Surfaces, (iii) sum total areas of all the hole Fermi Surfaces, (iv) sum total areas of all the five Fermi Surfaces, (v) difference of all hole and all electron Fermi surface areas as a function of doping is a rare wealth of information that can be verified by the de Haas-van Alphen and allied effects (i.e. , Shubnikov-de Haas effect) are presented. Fermi surface area are found to carry sensitivity of topological modifications more acutely than the band structures and can be used as a better experimental tool to identify ETT/LT.

  16. [Postoperative visual loss due to conversion disorder after spine surgery: a case report].

    PubMed

    Bezerra, Dailson Mamede; Bezerra, Eglantine Mamede; Silva Junior, Antonio Jorge; Amorim, Marco Aurélio Soares; Miranda, Denismar Borges de

    2016-01-21

    Patients undergoing spinal surgeries may develop postoperative visual loss. We present a case of total bilateral visual loss in a patient who, despite having clinical and surgical risk factors for organic lesion, evolved with visual disturbance due to conversion disorder. A male patient, 39 years old, 71kg, 1.72 m, ASA I, admitted to undergo fusion and discectomy at L4-L5 and L5-S1. Venoclysis, cardioscopy, oximetry, NIBP; induction with remifentanil, propofol and rocuronium; intubation with ETT (8.0mm) followed by capnography and urinary catheterization for diuresis. Maintenance with full target-controlled intravenous anesthesia. During fixation and laminectomy, the patient developed severe bleeding and hypovolemic shock. After 30minutes, hemostasis and hemodynamic stability was achieved with infusion of norepinephrine, volume expansion, and blood products. In the ICU, the patient developed mental confusion, weakness in the limbs, and bilateral visual loss. It was not possible to identify clinical, laboratory or image findings of organic lesion. He evolved with episodes of anxiety, emotional lability, and language impairment; the hypothesis of conversion syndrome with visual component was raised after psychiatric evaluation. The patient had complete resolution of symptoms after visual education and introduction of low doses of antipsychotic, antidepressant, and benzodiazepine. Other symptoms also regressed, and the patient was discharged 12 days after surgery. After 60 days, the patient had no more symptoms. Conversion disorders may have different signs and symptoms of non-organic origin, including visual component. It is noteworthy that the occurrence of this type of visual dysfunction in the postoperative period of spinal surgery is a rare event and should be remembered as a differential diagnosis. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  17. Material properties of novel polymeric films

    NASA Astrophysics Data System (ADS)

    Kim, Gene

    the two polymer systems. Also, unique in-house characterization methods such as the vibrational holographic interferometry to measure residual stress in these polymer coatings upon processing, and the environmental tensile tester (ETT) to measure ink diffusion and swelling stresses were used to further characterize these two polymers.

  18. Surgical fires in laser laryngeal surgery: are we safe enough?

    PubMed

    Roy, Soham; Smith, Lee P

    2015-01-01

    Laser surgery of the larynx and airway remains high risk for the formation of operating room fire. Traditional methods of fire prevention have included use of "laser safe" tubes, inflation of a protective cuff with saline, and wet pledgets to protect the endotracheal tube from laser strikes. We tested a mechanical model of laser laryngeal surgery to evaluate the fire risk. Mechanical model. Laboratory. An intubation mannequin was positioned for suspension microlaryngoscopy. A Laser-Shield II cuffed endotracheal tube was placed through the larynx and the cuff inflated using saline. Wet pledgets covered the inflated cuff. A CO2 laser created an inadvertent cuff strike at varying oxygen concentrations. Risk reduction measures were implemented to discern any notable change in the outcome after fire. At 100% FiO2 an immediate fire with sustained flame was created and at 40% FiO2 a near immediate sustained flame was created. At 29% FiO2, a small nonsustained flame was noted. At room air, no fire was created. There was no discernible difference in the severity of laryngeal damage after the fire occurred whether the tube was immediately pulled from the mannequin or if saline was poured down the airway as a first response. While "laser safe" tubes provide a layer of protection against fires, they are not fire proof. Inadvertent cuff perforation may result in fire formation in low-level oxygen enriched environments. Placement of wet pledgets do not provide absolute protection. Endotracheal tube (ETT) cuffs should be placed distally well away from an inadvertent laser strike while maintaining the minimum supplemental oxygen necessary. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

  19. [¹⁸F]fluorodeoxyglucose positron emission tomography/computed tomography and trophoblastic disease: the gynecologist perspective.

    PubMed

    Mangili, Giorgia; Bergamini, Alice; Giorgione, Veronica; Picchio, Maria; Petrone, Micaela; Mapelli, Paola; Rabaiotti, Emanuela; Incerti, Elena; Candiani, Massimo

    2016-06-01

    Gestational trophoblastic disease (GTD) is a group of different pregnancy-related diseases that includes hydatidiform mole (HM), invasive mole, gestational choriocarcinoma (CC), placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). The potential role of 18F-2-fluoro-2-deoxy-D-glucose ([18F]FDG) positron emission tomography (PET) in diagnostic setting and follow up phase of GTD is still largely debated. The aim of this review is to examine the role of [18F]FDG PET/computed tomography (CT) in diagnosis, treatment and follow up of different disease subtypes. A systematic computerized search of the literature, from 1996 until December 2015 was performed in PubMed and MEDLINE to identify relevant papers to be included for this purpose. All pertinent articles and their reference lists were systematically reviewed in order to identify other studies for potential inclusion. Regarding HM a potential prognostic relevance of maximum standardized uptake value (SUV max) of molar tissue within the uterus before evacuation has been suggested. Considering CC staging, most [18F]FDG PET evaluations confirmed the results of conventional imaging. However [18F]FDG PET played a key role in discriminating ambiguous lesions on routine imaging work-up. [18F]FDG PET was particularly useful in evaluating disease recurrence and chemo-resistance, thanks to the possibility of an early identification of the active tumor site. Since the main treatment of PSTT is surgery, the contribution of [18F]FDG PET in differential diagnosis and in providing a more precise mapping of resectable metastasis or the complete response to treatment is advisable. Since the role of [18F]FDG PET and PET/CT in diagnostic setting and follow up of GTN is still controversial, further studies are required to clarify this issue.

  20. A Decision support system (DSS) for municipal nurses encountering health deterioration among older people.

    PubMed

    Kihlgren, Annica; Svensson, Fredrik; Lövbrand, Conny; Gifford, Mervyn; Adolfsson, Annsofie

    2016-01-01

    This study is part of a larger project called ViSam and includes testing of a decision support system developed and adapted for older people on the basis of M (R) ETTS (Rapid Emergency Triage and Treatment System). The system is designed to allow municipal nurses to determine the optimal level of care for older people whose health has deteriorated. This new system will allow more structured assessment, the patient should receive optimal care and improved data transmission to the next caregiver. This study has an explanatory approach, commencing with quantitative data collection phase followed by qualitative data arising from focus group discussions over the RNs professional experience using the Decision Support system. Focus group discussions were performed to complement the quantitative data to get a more holistic view of the decision support system. Using elements of the decision support system (vital parameters for saturation, pain and affected general health) together with the nurses' decision showed that 94 % of the older persons referred to hospital were ultimately hospitalized. Nurses felt that they worked more systematically, communicated more effectively with others and felt more professional when using the decision support system. The results of this study showed that, with the help of a decision support system, the correct patients are sent to the Emergency Department from municipal home care. Unnecessary referrals of older patients that might lead to poorer health, decreased well-being and confusion can thus be avoided. Using the decision support system means that healthcare co-workers (nurses, ambulance/emergency department/district doctor/SOS alarm) begin to communicate more optimally. There is increased understanding leading to the risk of misinterpretation being reduced and the relationship between healthcare co-workers is improved. However, the decision support system requires more extensive testing in order to enhance the evidence base relating

  1. Comparison of sevoflurane concentration for insertion of proseal laryngeal mask airway and tracheal intubation in children (correlation with BIS).

    PubMed

    Mudakanagoudar, Mahantesh S; Santhosh, M C B

    2016-01-01

    Sevoflurane is an inhalational agent of choice in paediatric anaesthesia. For management of airways in children a suitable alternative to ETT is a paediatric proseal laryngeal mask airway (benchmark second generation SAD). Various studies have shown that less sevoflurane concentration is required for LMA insertion in comparison to TI. BIS is a useful monitor of depth of anaesthesia. To compare concentration of sevoflurane (end tidal and MAC value) required for proseal laryngeal mask airway insertion and tracheal intubation in correlation with BIS index. The prospective randomised single blind study was done in children between 2 and 9 years of ASA I and II and they were randomly allocated to Group P (proseal laryngeal mask airway insertion) and Group TI (tracheal intubation). No sedative premedication was given. Induction was done with 8% sevoflurane and then predetermined concentration was maintained for 10 min. Airway was secured either by proseal laryngeal mask airway or endotracheal tube without using muscle relaxant. End tidal sevoflurane concentration, MAC, BIS, and other vital parameters were monitored every minute till insertion of an airway device. Insertion conditions were observed. Statistical analysis was done by ANOVA and Students t test. Difference between ETLMI (2.49 ± 0.44) and ETTI (2.81 ± 0.65) as well as MACLMI (1.67 ± 0.13) and MACTI (1.77 ± 0.43) was statistically very significant, while BISLMI (49.05 ± 10.76) and BISTI (41.25 ± 3.25) was significant. Insertion conditions were comparable in both the groups. We can conclude that in children airway can be secured safely with proseal laryngeal mask airway using less sevoflurane concentration in comparison to tracheal intubation and this was supported by BIS index. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  2. [Comparison of sevoflurane concentration for insertion of proseal laryngeal mask airway and tracheal intubation in children (correlation with BIS)].

    PubMed

    Mudakanagoudar, Mahantesh S; Santhosh, M C B

    2016-01-01

    Sevoflurane is an inhalational agent of choice in paediatric anaesthesia. For management of airways in children a suitable alternative to ETT is a paediatric proseal laryngeal mask airway (benchmark second generation SAD). Various studies have shown that less sevoflurane concentration is required for LMA insertion in comparison to TI. BIS is a useful monitor of depth of anaesthesia. To compare concentration of sevoflurane (end tidal and MAC value) required for proseal laryngeal mask airway insertion and tracheal intubation in correlation with BIS index. The prospective randomised single blind study was done in children between 2 and 9 years of ASA I and II and they were randomly allocated to Group P (proseal laryngeal mask airway insertion) and Group TI (tracheal intubation). No sedative premedication was given. Induction was done with 8% sevoflurane and then predetermined concentration was maintained for 10min. Airway was secured either by proseal laryngeal mask airway or endotracheal tube without using muscle relaxant. End tidal sevoflurane concentration, MAC, BIS, and other vital parameters were monitored every minute till insertion of an airway device. Insertion conditions were observed. Statistical analysis was done by Anova and Student's t test. Difference between ETLMI (2.49±0.44) and ETTI (2.81±0.65) as well as MACLMI (1.67±0.13) and MACTI (1.77±0.43) was statistically very significant, while BISLMI (49.05±10.76) and BISTI (41.25±3.25) was significant. Insertion conditions were comparable in both the groups. We can conclude that in children airway can be secured safely with proseal laryngeal mask airway using less sevoflurane concentration in comparison to tracheal intubation and this was supported by BIS index. Copyright © 2014. Publicado por Elsevier Editora Ltda.

  3. Effect of Intracuff Lidocaine on Postoperative Sore Throat and the Emergence Phenomenon: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Lam, Fai; Lin, Yu-Cih; Tsai, Hsiao-Chien; Chen, Ta-Liang

    2015-01-01

    Background Postoperative sore throat and other airway morbidities are common and troublesome after endotracheal tube intubation general anesthesia (ETGA). We propose lidocaine as endotracheal tube (ETT) cuff inflation media to reduce the postintubation-related emergence phenomenon. Methods We searched PubMed, EMBASE, and Cochrane databases systematically for randomized controlled trials (RCTs) that have investigated the outcome of intracuff lidocaine versus air or saline in patients receiving ETGA. Using a random-effects model, we conducted a meta-analysis to assess the relative risks (RRs) and mean difference (MD) of the incidence and intensity of relevant adverse outcomes. Results We reviewed nineteen trials, which comprised 1566 patients. The incidence of early- and late-phase postoperative sore throat (POST), coughing, agitation, hoarseness, and dysphonia decreased significantly in lidocaine groups, with RRs of 0.46 (95% confidence interval [CI]: 0.31 to 0.68), 0.41 (95% CI: 0.25 to 0.66), 0.43 (95% CI: 0.31 to 0.62), 0.37 (95% CI: 0.25 to 0.55), 0.43 (95% CI: 0.29 to 0.63), and 0.19 (95% CI: 0.08 to 0.5), respectively, when compared with the control groups. The severity of POST also reduced significantly (mean difference [MD] -16.43 mm, 95% CI: -21.48 to -11.38) at 1 h and (MD -10.22 mm, 95% CI: -13.5 to -6.94) at 24 h. Both alkalinized and non-alkalinized lidocaine in the subgroup analyses showed significant benefits in emergence phenomena prevention compared with the control. Conclusion Our results indicate that both alkalinized and non-alkalinized intracuff lidocaine may prevent and alleviate POST and postintubation-related emergence phenomena. PMID:26288276

  4. Comparison of open and closed suction on safety, efficacy and nursing time in a paediatric intensive care unit.

    PubMed

    Evans, Janine; Syddall, Sophie; Butt, Warwick; Kinney, Sharon

    2014-05-01

    Endotracheal suctioning (ETS) is one of the most common procedures performed in the paediatric intensive care. The two methods of endotracheal suctioning used are known as open and closed suction, but neither method has been shown to be the superior suction method in the Paediatric Intensive Care Unit (PICU). The primary purpose was to compare open and closed suction methods from a physiological, safety and staff resource perspective. All paediatric intensive care patients with an endotracheal tube were included. Between June and September 2011 alternative months were nominated as open or closed suction months. Data were prospectively collected including suction events, staff involved, time taken, use of saline, and change from pre-suction baseline in heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO2). Blocked or dislodged ETTs were recorded as adverse events. Closed suction was performed more often per day (7.2 vs 6.0, p<0.01), used significantly less nursing time (23 vs 38 min, p<0.01) and had equivalent rates of adverse events compared to open suction (5 vs 3, p<0.23). Saline lavage usage was significantly higher in the open suction group (18% vs 40%). Open suction demonstrated a greater reduction in SpO2 and nearly three times the incidence of increases in HR and MAP compared to closed suction. Reductions in MAP or HR were comparable across the two methods. In conclusion, CS could be performed with less staffing time and number of nurses, less physiological disturbances to our patients and no significant increases in adverse events. Copyright © 2014. Published by Elsevier Ltd.

  5. Comparison of suction above cuff and standard endotracheal tubes in neurological patients for the incidence of ventilator-associated pneumonia and in-hospital outcome: A randomized controlled pilot study

    PubMed Central

    Jena, Sritam; Kamath, Sriganesh; Masapu, Dheeraj; Veenakumari, H. B.; Ramesh, Venkatapura J.; Bhadrinarayan, Varadarajan; Ravikumar, R.

    2016-01-01

    Background: Ventilator-associated pneumonia (VAP) is a common complication with endotracheal intubation. The occurrence of VAP results in significant mortality and morbidity. Earlier studies have shown reduction in the incidence of VAP with subglottic secretion drainage. The incidence of VAP in neurologically injured patients is higher and can impact the neurological outcome. This study aimed to compare the incidence of VAP with standard endotracheal tube (SETT) and suction above cuff endotracheal tube (SACETT) in neurologically ill patients and its impact on clinical outcome. Methods: Fifty-four patients with neurological illnesses aged ≥18 years and requiring intubation and/or ventilation and anticipated to remain on ETT for ≥48 h were randomized to receive either SETT or SACETT. All the VAP preventive measures were similar between two groups except for the difference in type of tube. Results: The data of 50 patients were analyzed. The incidence of clinical VAP was 20% in SETT group and 12% in SACETT group; (P = 0.70). The incidence of microbiological VAP was higher in the SETT group (52%) as compared to SACETT group (44%) but not statistically significant; (P = 0.78). There was no difference between the two groups for measured outcomes such as duration of intubation, mechanical ventilation, and Intensive Care Unit stay. Conclusions: In this pilot study in neurological population, a there was no significant difference in incidence of clinical and microbiological VAP was seen between SETT and SACETT, when other strategies for VAP prevention were similar. Other outcomes were similar with use of either tube for intubation. PMID:27275073

  6. Analysis of complications of prone position in acute respiratory distress syndrome: quality standard, incidence and related factors.

    PubMed

    Jové Ponseti, E; Villarrasa Millán, A; Ortiz Chinchilla, D

    The monitoring system based on standards of quality allows clinicians to evaluate and improve the patient's care. According to the quality indicators recommended by Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias, and due to the importance of prone position (PP) as a treatment in patients with acute respiratory distress syndrome, it is fundamental to keep accurate record of serious adverse events occurring during the prone position procedure and its posterior analysis. To establish fulfilment of the Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias standards of quality according to the register of serious complications. To identify the incidence of serious complications registered as well as to identify possible factors related to these complications. Retrospective, cross-sectionsl descriptive study, polyvalent ICU (16 beds). Study population Patients with acute respiratory distress syndrome treated with PP (January 2012-December 2013). Study variables PP recording, accidental extubation, removal of catheters, decubitus ulcers (DU), ETT obstruction, urgency of the procedure, hours in PP, nutritional intake, type of feeding tube, food regurgitation/retention and use of prokinetics/muscle relaxant. The study sample comprised 38 cases, with an adequate record of complications in 92.1% of the cases. DU were the only serious complication recorded, with a 25.7% incidence. Possible factors related to DU: more hours in PP in patients developing DU (p= .067). Less incidence of DU in well-nourished patients (p= .577). 82.9% of patients were not appropriately nourished. The percentage of records duly completed is very high. The presence of DU (grade 1-2 mostly) is to be noted. There is no stastistical significance, although a trend is obversed, between DU and hours in PP. Copyright © 2017 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

  7. An Evolutionary Framework for Carpel Developmental Control Genes.

    PubMed

    Pfannebecker, Kai C; Lange, Matthias; Rupp, Oliver; Becker, Annette

    2017-02-01

    Carpels are the female reproductive organs of flowering plants (angiosperms), enclose the ovules, and develop into fruits. The presence of carpels unites angiosperms, and they are suggested to be the most important autapomorphy of the angiosperms, e.g., they prevent inbreeding and allow efficient seed dispersal. Many transcriptional regulators and coregulators essential for carpel development are encoded by diverse gene families and well characterized in Arabidopsis thaliana. Among these regulators are AGAMOUS (AG), ETTIN (ETT), LEUNIG (LUG), SEUSS (SEU), SHORT INTERNODE/STYLISH (SHI/STY), and SEPALLATA1, 2, 3, 4 (SEP1, 2, 3, 4). However, the timing of the origin and their subsequent molecular evolution of these carpel developmental regulators are largely unknown. Here, we have sampled homologs of these carpel developmental regulators from the sequenced genomes of a wide taxonomic sampling of the land plants, such as Physcomitrella patens, Selaginella moellendorfii, Picea abies, and several angiosperms. Careful phylogenetic analyses were carried out that provide a phylogenetic background for the different gene families and provide minimal estimates for the ages of these developmental regulators. Our analyses and published work show that LUG-, SEU-, and SHI/STY-like genes were already present in the Most Recent Common Ancestor (MRCA) of all land plants, AG- and SEP-like genes were present in the MRCA of seed plants and their origin may coincide with the ξ Whole Genome Duplication. Our work shows that the carpel development regulatory network was, in part, recruited from preexisting network components that were present in the MRCA of angiosperms and modified to regulate gynoecium development. © The Author 2016. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. [Validity of schintigraphy in the study of neurogenic dysphagia].

    PubMed

    Galli, J; Valenza, V; D'Alatri, L; Gajate Samanes, A M; Reale, F; La Mura, F

    2000-08-01

    The purpose of the present study was to verify the validity and potential application of oropharyngealesophageal scintigraphy in the analysis of neurogenic dysphagia. Scintigraphy was used on 36 patients divided into 2 groups: Group 1 (control) comprised 17 healthy volunteers; Group 2 included 19 patients suffering from various neurological and neuromuscular pathologies (myasthenia gravis, Parkinson's disease, polymyositis, stroke, paralysis of the last cranial nerves). In group 1 scintigraphy provided normal results both for mode of swallowing and transit, and for the values of the various parameters studied. On the other hand, scintigraphy showed that in group 2 all oral, pharyngeal and esophageal phases of swallowing were altered vs the controls with a statistically significant increase in the average values for the oral transit time (OTT) (1.45 sec., p = 0.0005), pharyngeal transit time (OTT) (3.23 sec., p = 0.044), esophageal transit time (ETT) e19.87 sec., p = 0.005) as well as in the corresponding bolus retention indexes ORU (12.95%, p = 0.0003), FIR (15.05%, p = 0.0003) and ERI (28.63%, p = 0.002). Moreover, the quality and means of swallowing also proved altered while tracheobronchial aspiration was only seen in 6 of the 19 patients (maximum value: 90%, average value; 7.66%) with a marked prevalence in the stroke subgroup (4/8). In light of these results and considering the low dose of radiation (0.00043 Gy), the lack of invasiveness and excellent tolerability, scintigraphy has confirmed its clinical validity in the functional, objective and quali-quantitative study of deglutition, even in patients suffering from neurogenic dysphagia.

  9. Polymicrobial Ventilator-Associated Pneumonia: Fighting In Vitro Candida albicans-Pseudomonas aeruginosa Biofilms with Antifungal-Antibacterial Combination Therapy.

    PubMed

    Rodrigues, Maria E; Lopes, Susana P; Pereira, Cláudia R; Azevedo, Nuno F; Lourenço, Anália; Henriques, Mariana; Pereira, Maria O

    2017-01-01

    The polymicrobial nature of ventilator-associated pneumonia (VAP) is now evident, with mixed bacterial-fungal biofilms colonizing the VAP endotracheal tube (ETT) surface. The microbial interplay within this infection may contribute for enhanced pathogenesis and exert impact towards antimicrobial therapy. Consequently, the high mortality/morbidity rates associated to VAP and the worldwide increase in antibiotic resistance has promoted the search for novel therapeutic strategies to fight VAP polymicrobial infections. Under this scope, this work aimed to assess the activity of mono- vs combinational antimicrobial therapy using one antibiotic (Polymyxin B; PolyB) and one antifungal (Amphotericin B; AmB) agent against polymicrobial biofilms of Pseudomonas aeruginosa and Candida albicans. The action of isolated antimicrobials was firstly evaluated in single- and polymicrobial cultures, with AmB being more effective against C. albicans and PolyB against P. aeruginosa. Mixed planktonic cultures required equal or higher antimicrobial concentrations. In biofilms, only PolyB at relatively high concentrations could reduce P. aeruginosa in both monospecies and polymicrobial populations, with C. albicans displaying only punctual disturbances. PolyB and AmB exhibited a synergistic effect against P. aeruginosa and C. albicans mixed planktonic cultures, but only high doses (256 mg L-1) of PolyB were able to eradicate polymicrobial biofilms, with P. aeruginosa showing loss of cultivability (but not viability) at 2 h post-treatment, whilst C. albicans only started to be inhibited after 14 h. In conclusion, combination therapy involving an antibiotic and an antifungal agent holds an attractive therapeutic option to treat severe bacterial-fungal polymicrobial infections. Nevertheless, optimization of antimicrobial doses and further clinical pharmacokinetics/pharmacodynamics and toxicodynamics studies underpinning the optimal use of these drugs are urgently required to improve therapy

  10. Polymicrobial Ventilator-Associated Pneumonia: Fighting In Vitro Candida albicans-Pseudomonas aeruginosa Biofilms with Antifungal-Antibacterial Combination Therapy

    PubMed Central

    Pereira, Cláudia R.; Azevedo, Nuno F.; Lourenço, Anália; Henriques, Mariana; Pereira, Maria O.

    2017-01-01

    The polymicrobial nature of ventilator-associated pneumonia (VAP) is now evident, with mixed bacterial-fungal biofilms colonizing the VAP endotracheal tube (ETT) surface. The microbial interplay within this infection may contribute for enhanced pathogenesis and exert impact towards antimicrobial therapy. Consequently, the high mortality/morbidity rates associated to VAP and the worldwide increase in antibiotic resistance has promoted the search for novel therapeutic strategies to fight VAP polymicrobial infections. Under this scope, this work aimed to assess the activity of mono- vs combinational antimicrobial therapy using one antibiotic (Polymyxin B; PolyB) and one antifungal (Amphotericin B; AmB) agent against polymicrobial biofilms of Pseudomonas aeruginosa and Candida albicans. The action of isolated antimicrobials was firstly evaluated in single- and polymicrobial cultures, with AmB being more effective against C. albicans and PolyB against P. aeruginosa. Mixed planktonic cultures required equal or higher antimicrobial concentrations. In biofilms, only PolyB at relatively high concentrations could reduce P. aeruginosa in both monospecies and polymicrobial populations, with C. albicans displaying only punctual disturbances. PolyB and AmB exhibited a synergistic effect against P. aeruginosa and C. albicans mixed planktonic cultures, but only high doses (256 mg L-1) of PolyB were able to eradicate polymicrobial biofilms, with P. aeruginosa showing loss of cultivability (but not viability) at 2 h post-treatment, whilst C. albicans only started to be inhibited after 14 h. In conclusion, combination therapy involving an antibiotic and an antifungal agent holds an attractive therapeutic option to treat severe bacterial-fungal polymicrobial infections. Nevertheless, optimization of antimicrobial doses and further clinical pharmacokinetics/pharmacodynamics and toxicodynamics studies underpinning the optimal use of these drugs are urgently required to improve therapy

  11. Likelihood of Myocardial Infarction during Stroke Rehabilitation Preceded by Cardiovascular Screening and an Exercise Tolerance Test: The LEAPS Experience

    PubMed Central

    Nadeau, Stephen E.; Rose, Dorian K.; Dobkin, Bruce; Wu, Samuel S.; Dai, Yunfeng E.; Schofield, Richard; Duncan, Pamela W

    2014-01-01

    Background Coronary artery disease is highly prevalent in patients with stroke but, because revascularization does not improve major clinical outcomes in patients with stable coronary artery disease relative to intensive medical therapy, routine evaluation for this disease is not warranted in stroke patients. However, it might be warranted in patients destined to undergo vigorous physical therapy. The Locomotor Experience Applied Post-Stroke (LEAPS) study, a randomized controlled trial of 408 participants that tested the relative efficacy of two rehabilitation techniques on functional walking level, provided the opportunity to address this question. Aim Test the efficacy of screening for cardiovascular disease and an exercise tolerance test in assuring safety among patients undergoing vigorous rehabilitation for gait impairment. Methods All participants were screened for serious cardiovascular and pulmonary conditions. At 6-weeks post-stroke, they also completed a cardiovascular screening inventory and underwent an exercise tolerance test involving bicycle ergometry. Participants received 36 90-minute sessions of a prescribed physical therapy (3/week), initiated at either 2 months or 6 months post-stroke. Results 29 participants were excluded on the basis of the cardiac screening questionnaire and 15 failed the exercise tolerance test for cardiovascular reasons. No participant experienced a cardiac event during a treatment session. Two participants experienced myocardial infarctions but continued in the trial. In 3 additional participants, myocardial infarctions caused or contributed to death. Conclusions The combination of a negative cardiac screen and the absence of ETT failure appeared to have a high negative predictive value for cardiac events during treatment, despite the likelihood of a high prevalence of coronary artery disease in our population. PMID:25156340

  12. High Incidence of Virulence Factors Among Clinical Enterococcus faecalis Isolates in Southwestern Iran

    PubMed Central

    Heidari, Hamid; Hasanpour, Somayeh; Ebrahim-Saraie, Hadi Sedigh

    2017-01-01

    Background Over the past two decades, enterococci have emerged as an important agent responsible for hospital acquired infection. Several virulence factors contribute to the adherence, colonization, evasion of the host immune response, and pathogenicity and severity of the infection. Enterococcus faecalis is the most common and virulent species causing infections in hospitalized patients. The aim of the present study was to examine the prevalence of genes encoding virulence factors and antimicrobial resistance patterns of E. faecalis strains isolated from hospitalized patients in Shiraz, south west of Iran. Materials and Methods A total of 51 E. faecalis isolates from the urine, blood, pleural fluid, peritoneal fluid, eye discharge, endotracheal tube (ETT) and transjugular intrahepatic portosystemic shunt (TIPS) specimens of patients were identified by phenotypic and genotypic methods. Antimicrobial sensitivity tests and detection of virulence factors were performed using standard methods. Results The efa and asa1 were the most frequently detected gene (100%) among the isolates, followed by esp (94.1%), ace (90.2%), gelE (80.4%), cylA (64.7%), and hyl (51%). More than half of the isolates (52.9%) were high level gentamicin resistant (HLGR). Vancomycin resistance was observed among 23 (45.1%) isolates. The lowest antimicrobial activity was related to erythromycin (3.9%), tetracycline (5.9%) and ciprofloxacin (9.8%). No isolate was found resistant to fosfomycin and linezolid. Conclusion Our data indicated a high incidence of virulence factors among E. faecalis strains isolated from clinical samples. Colonization of drug resistant virulent isolates in hospital environment may lead to life threatening infection in hospitalized patients. Therefore, infection control procedures should be performed. PMID:28332345

  13. Hydrologic Evaluation of a Humid Climate Poplar Phytoremediation Barrier

    NASA Astrophysics Data System (ADS)

    Swensen, K.; Rabideau, A. J.

    2016-12-01

    The emplacement of hybrid poplar trees to function as phytoremediation barriers is an appealing and sustainable groundwater management strategy because of low maintenance costs and the potential to extract large amounts of groundwater without pumping. While the effectiveness of poplar barriers has been assessed by groundwater quality monitoring, less attention has been given to physical hydrologic evaluations needed to improve barrier designs. In this research, a five year hydrologic evaluation was conducted at a poplar phytoremediation site in western NY, with the goal of quantifying ETg (evapotranspiration from groundwater) as a measure of the barrier's effectiveness in a humid climate. To consider transpiration from both vadose zone and groundwater, the hydrologic evaluation included four components: physical ET measurements, theoretical ET calculations, analysis of diurnal groundwater table fluctuations, and vadose zone modeling. The direct measurements of ETT (total) were obtained using sap flow meters installed on multiple trees within the barrier. These data were interpreted using a regression model that included theoretical ET calculations and site-specific measurements of weather parameters and poplar trunk area. Application of this model was challenged by the spatial variation in rooting depth as determined by tree excavations. To further quantify the removal of groundwater by the phytobarrier (ETg), the White Method was applied to interpret diurnal groundwater fluctuations from monitoring wells located within the barrier, in conjunction with a variably saturated-saturated flow model configured to confirm water extraction from ETg. Taken together, the results of this five year hydrologic evaluation highlight the complexity in quantifying humid climate groundwater extraction, as a large number of variables were found to influence these rates. Improved understanding of these controls will contribute to improved barrier designs that maximize ETg.

  14. Six months of multiwavelength follow-up of the tidal disruption candidate ASASSN-14li and implied TDE rates from ASAS-SN

    NASA Astrophysics Data System (ADS)

    Holoien, T. W.-S.; Kochanek, C. S.; Prieto, J. L.; Stanek, K. Z.; Dong, Subo; Shappee, B. J.; Grupe, D.; Brown, J. S.; Basu, U.; Beacom, J. F.; Bersier, D.; Brimacombe, J.; Danilet, A. B.; Falco, E.; Guo, Z.; Jose, J.; Herczeg, G. J.; Long, F.; Pojmanski, G.; Simonian, G. V.; Szczygieł, D. M.; Thompson, T. A.; Thorstensen, J. R.; Wagner, R. M.; Woźniak, P. R.

    2016-01-01

    We present ground-based and Swift photometric and spectroscopic observations of the candidate tidal disruption event (TDE) ASASSN-14li, found at the centre of PGC 043234 (d ≃ 90 Mpc) by the All-Sky Automated Survey for SuperNovae (ASAS-SN). The source had a peak bolometric luminosity of L ≃ 1044 erg s-1 and a total integrated energy of E ≃ 7 × 1050 erg radiated over the ˜6 months of observations presented. The UV/optical emission of the source is well fitted by a blackbody with roughly constant temperature of T ˜ 35 000 K, while the luminosity declines by roughly a factor of 16 over this time. The optical/UV luminosity decline is broadly consistent with an exponential decline, L∝ e^{-t/t_0}, with t0 ≃ 60 d. ASASSN-14li also exhibits soft X-ray emission comparable in luminosity to the optical and UV emission but declining at a slower rate, and the X-ray emission now dominates. Spectra of the source show broad Balmer and helium lines in emission as well as strong blue continuum emission at all epochs. We use the discoveries of ASASSN-14li and ASASSN-14ae to estimate the TDE rate implied by ASAS-SN, finding an average rate of r ≃ 4.1 × 10-5 yr-1 per galaxy with a 90 per cent confidence interval of (2.2-17.0) × 10-5 yr-1 per galaxy. ASAS-SN found roughly 1 TDE for every 70 Type Ia supernovae in 2014, a rate that is much higher than that of other surveys.

  15. ASASSN-15oi: a rapidly evolving, luminous tidal disruption event at 216 Mpc

    NASA Astrophysics Data System (ADS)

    Holoien, T. W.-S.; Kochanek, C. S.; Prieto, J. L.; Grupe, D.; Chen, Ping; Godoy-Rivera, D.; Stanek, K. Z.; Shappee, B. J.; Dong, Subo; Brown, J. S.; Basu, U.; Beacom, J. F.; Bersier, D.; Brimacombe, J.; Carlson, E. K.; Falco, E.; Johnston, E.; Madore, B. F.; Pojmanski, G.; Seibert, M.

    2016-12-01

    We present ground-based and Swift photometric and spectroscopic observations of the tidal disruption event (TDE) ASASSN-15oi, discovered at the centre of 2MASX J20390918-3045201 (d ≃ 216 Mpc) by the All-Sky Automated Survey for SuperNovae. The source peaked at a bolometric luminosity of L ≃ 1.3 × 1044 erg s-1 and radiated a total energy of E ≃ 6.6 × 1050 erg over the first ˜3.5 months of observations. The early optical/UV emission of the source can be fit by a blackbody with temperature increasing from T ˜ 2 × 104 K to T ˜ 4 × 104 K while the luminosity declines from L ≃ 1.3 × 1044 erg s-1 to L ≃ 2.3 × 1043 erg s-1, requiring the photosphere to be shrinking rapidly. The optical/UV luminosity decline during this period is most consistent with an exponential decline, L∝ e^{-(t-t_0)/τ}, with τ ≃ 46.5 d for t0 ≃ 57241.6 (MJD), while a power-law decline of L ∝ (t - t0)-α with t0 ≃ 57 212.3 and α = 1.62 provides a moderately worse fit. ASASSN-15oi also exhibits roughly constant soft X-ray emission that is significantly weaker than the optical/UV emission. Spectra of the source show broad helium emission lines and strong blue continuum emission in early epochs, although these features fade rapidly and are not present ˜3 months after discovery. The early spectroscopic features and colour evolution of ASASSN-15oi are consistent with a TDE, but the rapid spectral evolution is unique among optically selected TDEs.

  16. Partitioning Evapotranspiration in Semiarid Grassland and Shrubland Ecosystems Using Diurnal Surface Temperature Variation

    NASA Technical Reports Server (NTRS)

    Moran, M. Susan; Scott, Russell L.; Keefer, Timothy O.; Paige, Ginger B.; Emmerich, William E.; Cosh, Michael H.; O'Neill, Peggy E.

    2007-01-01

    The encroachment of woody plants in grasslands across the Western U.S. will affect soil water availability by altering the contributions of evaporation (E) and transpiration (T) to total evapotranspiration (ET). To study this phenomenon, a network of flux stations is in place to measure ET in grass- and shrub-dominated ecosystems throughout the Western U.S. A method is described and tested here to partition the daily measurements of ET into E and T based on diurnal surface temperature variations of the soil and standard energy balance theory. The difference between the mid-afternoon and pre-dawn soil surface temperature, termed Apparent Thermal Inertia (I(sub A)), was used to identify days when E was negligible, and thus, ET=T. For other days, a three-step procedure based on energy balance equations was used to estimate Qe contributions of daily E and T to total daily ET. The method was tested at Walnut Gulch Experimental Watershed in southeast Arizona based on Bowen ratio estimates of ET and continuous measurements of surface temperature with an infrared thermometer (IRT) from 2004- 2005, and a second dataset of Bowen ratio, IRT and stem-flow gage measurements in 2003. Results showed that reasonable estimates of daily T were obtained for a multi-year period with ease of operation and minimal cost. With known season-long daily T, E and ET, it is possible to determine the soil water availability associated with grass- and shrub-dominated sites and better understand the hydrologic impact of regional woody plant encroachment.

  17. The impact of airway management on quality of cardiopulmonary resuscitation: an observational study in patients during cardiac arrest.

    PubMed

    Yeung, Joyce; Chilwan, Mehboob; Field, Richard; Davies, Robin; Gao, Fang; Perkins, Gavin D

    2014-07-01

    Minimising interruptions in chest compressions is associated with improved survival from cardiac arrest. Current in-hospital guidelines recommend continuous chest compressions after the airway is secured on the premise that this will reduce no flow time. The aim of this study was to determine the effect of advanced airway use on the no flow ratio and other measures of CPR quality. Consecutive adult patients who sustained an in-hospital cardiac arrest were enrolled in this prospective observational study. The quality of CPR was measured using the Q-CPR device (Phillips, UK) before and after an advanced airway device (endotracheal tube [ET] or laryngeal mask airway [LMA]) was inserted. Patients receiving only bag-mask ventilation were used as the control cohort. The primary outcome was no flow ratio (NFR). Secondary outcomes were chest compression rate, depth, compressions too shallow, compressions with leaning, ventilation rate, inflation time, change in impedance and time required to successfully insert airway device. One hundred patients were enrolled in the study (2008-2011). Endotracheal tube and LMA placement took similar durations (median 15.8 s (IQR 6.8-19.4) vs. LMA median 8.0s (IQR 5.5-15.9), p=0.1). The use of an advanced airway was associated with improved no flow ratios (endotracheal tube placement (n=50) improved NFR from baseline median 0.24 IQR 0.17-0.40) to 0.15 to (IQR 0.09-0.28), p=0.012; LMA (n=25) from median 0.28 (IQR 0.23-0.40) to 0.13 (IQR 0.11- 0.19), p=0.0001). There was no change in NFR in patients managed solely with bag valve mask (BVM) (n=25) (median 0.29 (IQR 0.18-0.59) vs. median 0.26 (IQR 0.12-0.37), p=0.888). There was no significant difference in time taken to successfully insert the airway device between the two groups. The use of an advanced airway (ETT or LMA) during in-hospital cardiac arrest was associated with improved no flow ratio. Further studies are required to determine the effect of airway devices on overall patient

  18. Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study.

    PubMed

    Liu, Jianhui; Zhang, Xiaoqing; Gong, Wei; Li, Shitong; Wang, Fen; Fu, Shukun; Zhang, Mazhong; Hang, Yannan

    2010-11-01

    control group than in the study group. ETTc pressure estimated by palpation with personal experience is often much higher than measured or what may be optimal. Proper control of ETTc pressure by a manometer helped reduce ETT-related postprocedural respiratory complications such as cough, sore throat, hoarseness, and blood-streaked expectoration even in procedures of short duration (1-3 hours).

  19. iPTF16fnl: A Faint and Fast Tidal Disruption Event in an E+A Galaxy

    NASA Astrophysics Data System (ADS)

    Blagorodnova, N.; Gezari, S.; Hung, T.; Kulkarni, S. R.; Cenko, S. B.; Pasham, D. R.; Yan, L.; Arcavi, I.; Ben-Ami, S.; Bue, B. D.; Cantwell, T.; Cao, Y.; Castro-Tirado, A. J.; Fender, R.; Fremling, C.; Gal-Yam, A.; Ho, A. Y. Q.; Horesh, A.; Hosseinzadeh, G.; Kasliwal, M. M.; Kong, A. K. H.; Laher, R. R.; Leloudas, G.; Lunnan, R.; Masci, F. J.; Mooley, K.; Neill, J. D.; Nugent, P.; Powell, M.; Valeev, A. F.; Vreeswijk, P. M.; Walters, R.; Wozniak, P.

    2017-07-01

    We present ground-based and Swift observations of iPTF16fnl, a likely tidal disruption event (TDE) discovered by the intermediate Palomar Transient Factory (iPTF) survey at 66.6 Mpc. The light curve of the object peaked at an absolute mag {M}g=-17.2. The maximum bolometric luminosity (from optical and UV) was {L}p≃ (1.0+/- 0.15)× {10}43 erg s-1, an order of magnitude fainter than any other optical TDE discovered so far. The luminosity in the first 60 days is consistent with an exponential decay, with L\\propto {e}-(t-{t0)/τ }, where t 0 = 57631.0 (MJD) and τ ≃ 15 days. The X-ray shows a marginal detection at {L}X={2.4}-1.11.9× {10}39 erg s-1 (Swift X-ray Telescope). No radio counterpart was detected down to 3σ, providing upper limits for monochromatic radio luminosities of {ν L}ν < 2.3× {10}36 erg s-1 and {ν L}ν < 1.7× {10}37 erg s-1 (Very Large Array, 6.1 and 22 GHz). The blackbody temperature, obtained from combined Swift UV and optical photometry, shows a constant value of 19,000 K. The transient spectrum at peak is characterized by broad He ii and Hα emission lines, with FWHMs of about 14,000 km s-1 and 10,000 km s-1, respectively. He i lines are also detected at λλ 5875 and 6678. The spectrum of the host is dominated by strong Balmer absorption lines, which are consistent with a post-starburst (E+A) galaxy with an age of ˜650 Myr and solar metallicity. The characteristics of iPTF16fnl make it an outlier on both luminosity and decay timescales, as compared to other optically selected TDEs. The discovery of such a faint optical event suggests a higher rate of tidal disruptions, as low-luminosity events may have gone unnoticed in previous searches.

  20. Atteinte cardiaque au cours de la dystrophie myotonique de Steinert: expérience marocaine, à propos de 18 cas

    PubMed Central

    Saghi, Ghita; Bouhouch, Rachida; Salaheddine, Loubna; Birouk, Nezha; Nadifi, Salama; Fellat, Ibtissam; Cherti, Mohamed

    2015-01-01

    La maladie de Steinert ou dystrophie myotonique de type 1 (DM1) est une maladie génétique à transmission autosomique dominante caractérisée par une myotonie et une atteinte de plusieurs organes dont le cœur. L'atteinte cardiaque est la plus grave des atteintes systémiques puisqu'elle conditionne le pronostic vital. Ce travail a pour but de déterminer les anomalies cardiaques rencontrées au cours de la DM1 et de mettre en exergue l'intérêt d'un examen cardiaque rigoureux et régulier, indépendamment de la sévérité de l'atteinte neuromusculaire, ainsi que l'apport des examens cardiaques complémentaires et notamment l'exploration électrophysiologique. 18 patients atteints de DM1 ont bénéficiés d'une exploration cardiaque systématique. Il s'agit de 9 hommes et de 9 femmes, d’âge moyen de 41,8 +/- 16,2 ans. 66 p.100 des patients sont symptomatiques sur le plan cardiovasculaire. Les anomalies électrocardiographiques sont dominées par un trouble de la conduction intra-ventriculaire dans 16 p.100 des cas et un BAV de 1er degré dans 16 p.100 des cas. L'Holter ECG objective une hyperexcitabilité à l’étage atrial et/ou ventriculaire dans 50p.100 des cas. L'ETT est normale chez 95 p.100 des patients. L'exploration électrophysiologique, réalisée chez 4 patients symptomatiques, a objectivé un bloc tronculaire dans un cas ayant conduit à l'implantation d'un PM double chambre. Un seul patient est décédé suite à une détresse respiratoire. Enfin, on n'a pas noté de corrélation entre l'atteinte cardiaque et neuromusculaire. Une exploration cardiaque est indispensable chez tout patient atteint de DM1, en dépit de l'absence de symptômes, et un bilan annuel minimal s'impose pour guetter un éventuel trouble rythmique et/ou conductif, fatal en l'absence de traitement adéquat. PMID:26097635

  1. Calcifications valvulaires chez l'hémodialysé au Maroc

    PubMed Central

    Noto-Kadou-Kaza, Béfa; Abouamrane, Lalla Meryam; Mtiou, Naoufal; El Khaya, Selma; Zamd, Mohamed; Medkouri, Ghislaine; Bengahanem, Mohamed Gharbi; Ramdani, Benyounes

    2016-01-01

    Introduction Les calcifications valvulaires constituent une des complications cardiovasculaires majeures de l'hémodialysé de par sa prévalence et son caractère prédictif de morbidité et de mortalité. De nombreux facteurs de risque sont à l'origine de ces calcifications. Le but de notre étude est d’évaluer à la fois la prévalence des calcifications valvulaires chez nos patients hémodialysés ainsi que leurs facteurs de risque. Méthodes Il s'agissait d'une étude transversale monocentrique, descriptive et analytique, ayant inclus 111 patients adultes hémodialysés depuis plus de 6 mois au centre d'hémodialyse du CHU Ibn Rochd de Casablanca et qui ont eu à bénéficier d'une ETT durant l'année 2013. Résultats L’âge moyen de nos patients était de 44 ± 14 ans. L'ancienneté moyenne en hémodialyse était de 146 ± 80 mois. La pression artérielle moyenne était de 123 ± 23 mmHg pour la systolique et de 72 ± 13 mmHg pour la diastolique, la PTHi moyenne de 529±460 pg/ml, la calcémie moyenne de 86±10 mg/l et la phosphatémie moyenne de 40±15 mg/l. La CRP moyenne était de 11±19,8 mg/L. Sur le plan thérapeutique, 96% des patients étaient sous carbonate de calcium, 11% sous 25 OH vitamine D, 55,5% sous 1 hydroxy-vitamine D3. La prévalence des calcifications valvulaires était de 15% avec une localisation valvulaire aortique dans 41,2% et valvulaire mitrale dans 41,2%. En analyse univariée, seule la durée d'hémodialyse semble être associée à la survenue des calcifications avec p = 0,09 proche du seuil de significativité. Conclusion La prévalence des calcifications valvulaires chez nos patients hémodialysés reste élevée même si elle parait relativement moindre comparée aux données de la littérature. Aucun facteur de risque connu n'est apparu significativement associé à ces calcifications. PMID:27642453