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Sample records for ett massabruks sodapanna

  1. Escherichia coli type III secretion system 2 (ETT2) is widely distributed in avian pathogenic Escherichia coli isolates from Eastern China.

    PubMed

    Wang, S; Liu, X; Xu, X; Zhao, Y; Yang, D; Han, X; Tian, M; Ding, C; Peng, D; Yu, S

    2016-10-01

    Pathogens utilize type III secretion systems to deliver effector proteins, which facilitate bacterial infections. The Escherichia coli type III secretion system 2 (ETT2) which plays a crucial role in bacterial virulence, is present in the majority of E. coli strains, although ETT2 has undergone widespread mutational attrition. We investigated the distribution and characteristics of ETT2 in avian pathogenic E. coli (APEC) isolates and identified five different ETT2 isoforms, including intact ETT2, in 57·6% (141/245) of the isolates. The ETT2 locus was present in the predominant APEC serotypes O78, O2 and O1. All of the ETT2 loci in the serotype O78 isolates were degenerate, whereas an intact ETT2 locus was mostly present in O1 and O2 serotype strains, which belong to phylogenetic groups B2 and D, respectively. Interestingly, a putative second type III secretion-associated locus (eip locus) was present only in the isolates with an intact ETT2. Moreover, ETT2 was more widely distributed in APEC isolates and exhibited more isoforms compared to ETT2 in human extraintestinal pathogenic E. coli, suggesting that APEC might be a potential risk to human health. However, there was no distinct correlation between ETT2 and other virulence factors in APEC.

  2. 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.

  3. 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. PMID:25991552

  4. 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. PMID:27189623

  5. 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.

  6. Case study involving suctioning of an electromyographic endotracheal tube.

    PubMed

    Evanina, Eileen Youshock; Hanisak, Jill L

    2005-04-01

    The electromyographic endotracheal tube (EMG-ETT) is a relatively new tool used to measure integrity of the vocal cord structures during surgery. We describe a case in which an EMG-ETT was inserted for the operative period but not replaced with an ETT during the immediate postoperative period. Intensive care unit nurses had difficulty suctioning the EMG-ETT. The patient was not provided the pulmonary toilet necessary until the EMG-ETT was removed and replaced with a regular ETT. The purpose of this article is to make anesthesia providers aware that when mechanical ventilation is required during the postoperative period, the EMG-ETT should be removed and replaced with a regular ETT to facilitate pulmonary toilet. PMID:15835830

  7. Epithelioid Trophoblastic Tumor in a Postmenopausal Woman: A Case Report

    PubMed Central

    Park, Jung-Woo

    2016-01-01

    Epithelioid trophoblastic tumor (ETT) is a rare gestational trophoblastic neoplasm composed of intermediate trophoblasts. Most cases of ETT are reported in women of reproductive age following a prior gestation within 2 weeks to 30 years. ETT is extremely rare in postmenopausal women. It is commonly misdiagnosed as a poorly differentiated carcinoma or another type of gestational trophoblastic tumor. We report a case of ETT in a 56-year-old woman that developed 23 years after the patient's last pregnancy. PMID:27152314

  8. 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.

  9. Evidence-based guideline for suctioning the intubated neonate and infant.

    PubMed

    Gardner, Denice L; Shirland, Lee

    2009-01-01

    The endotracheal tube (ETT) is the most common artificial airway used in NICUs. Suctioning of the ETT is imperative to maintain patency and prevent complications. An extensive review of the literature revealed a lack of standardized criteria or guidelines for suctioning the ETT of neonates and infants in the NICU. The purpose of this article is to report the implementation of an evidence-based guideline that can be utilized in NICU care.

  10. Negative tracheal pressure during neonatal endotracheal suction.

    PubMed

    Kiraly, Nicholas J; Tingay, David G; Mills, John F; Morley, Colin J; Copnell, Beverley

    2008-07-01

    Endotracheal tube (ETT) suction is the most frequently performed invasive procedure in ventilated newborn infants and is associated with adverse effects related to negative tracheal pressure. We aimed to measure suction catheter gas flow and intratracheal pressure during ETT suction of a test lung and develop a mathematical model to predict tracheal pressure from catheter and ETT dimensions and applied pressure. Tracheal pressure and catheter flow were recorded during suction of ETT sizes 2.5-4.0 mm connected to a test lung with catheters 5-8 French Gauge and applied pressures of 80-200 mm Hg. The fraction of applied pressure transmitted to the trachea was calculated for each combination, and data fitted to three nonlinear models for analysis. Tracheal pressure was directly proportional to applied pressure (r = 0.82-0.99), and catheter flow fitted a turbulent flow model (R = 0.85-0.96). With each ETT, increasing catheter size resulted in greater catheter flow (p < 0.0001) and thus lower intratracheal pressure (p < 0.0001). The fraction of applied pressure transmitted to the trachea was accurately modeled using ETT and catheter dimensions (R = 0.98-0.99). Negative tracheal pressure during in vitro ETT suction is directly proportional to applied pressure. This relationship is determined by ETT and catheter dimensions.

  11. Children's Implicit Learning of Graphotactic and Morphological Regularities

    ERIC Educational Resources Information Center

    Pacton, Sbastien; Fayol, Michel; Perruchet, Pierre

    2005-01-01

    In French, the transcription of the same sound can be guided by both probabilistic graphotactic constraints (e.g., t is more often transcribed ette after -v than after -f) and morphological constraints (e.g., t is always transcribed ette when used as a diminutive suffix). Three experiments showed that pseudo-word spellings of 8-to 11-year-old…

  12. [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.

  13. Removal of endotracheal tube obstruction with a secretion clearance device.

    PubMed

    Mietto, Cristina; Foley, Kevin; Salerno, Lindsay; Oleksak, Jenna; Pinciroli, Riccardo; Goverman, Jeremy; Berra, Lorenzo

    2014-09-01

    Accumulation of secretions may suddenly occlude an endotracheal tube (ETT), requiring immediate medical attention. The endOclear catheter (Endoclear LLC, Petoskey, Michigan) is a novel device designed to clear mucus and debris from an ETT and restore luminal patency. We present 3 subsequent cases of life-threatening partial ETT occlusions recorded over a period of 6 months at Massachusetts General Hospital. After conventional methods (standard tracheal suctioning and bronchoscopy) failed, the endOclear was used, with successful restoration of the airways in all 3 cases. The respiratory conditions rapidly improved, and all 3 patients tolerated the ETT-cleaning maneuver. These results show that such a device is safe and easy to use during an emergency airway situation for efficient and rapid removal of secretions from obstructed ETTs by respiratory therapists.

  14. Additional work of breathing imposed by endotracheal tubes, breathing circuits, and intensive care ventilators.

    PubMed

    Bersten, A D; Rutten, A J; Vedig, A E; Skowronski, G A

    1989-07-01

    A disadvantage of spontaneous breathing through an endotracheal tube (ETT) and connector attached to a breathing circuit and/or ventilator (breathing device) is an increase in the work of breathing. The work of breathing associated with ETT of 6 to 9-mm diameter and eight breathing devices was determined, using a lung simulator to mimic spontaneous inspiration at flow rates of 20 to 100 L/min and a tidal volume of 500 ml, at both zero end-expiratory pressure (ZEEP) and 10 cm H2O continuous positive airway pressure (CPAP). Work associated with the breathing devices alone (WCIR) ranged from -0.002 kg.m/L (Servo 900-C ventilator, 7-mm ETT, 20 L/min, ZEEP) to 0.1 kg.m/L (continuous flow circuit, 7-mm ETT, 100 L/min, CPAP), the latter representing 196% of the work of normal breathing. When the devices were attached to ETT, total apparatus work (WAPP) ranged from 0.009 kg.m/L (Mapleson-D circuit, 9-mm ETT, 20 L/min, ZEEP) to 0.25 kg.m/L (Drager EV-A, 6-mm ETT, 100 L/min, ZEEP), the latter representing 490% of the work of normal breathing. This additional work imposed by the ETT varied considerably among devices. Spontaneous breathing through modern ventilators, circuits and ETT imposes a burden of increased work, most of which is associated with the presence of the ETT and connector. Whether this burden represents an impediment to the weaning patient, or has training value for the ultimate resumption of unassisted spontaneous ventilation, remains to be determined.

  15. 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. PMID:22296848

  16. Eletriptan metabolism by human hepatic CYP450 enzymes and transport by human P-glycoprotein.

    PubMed

    Evans, David C; O'Connor, Desmond; Lake, Brian G; Evers, Raymond; Allen, Christopher; Hargreaves, Richard

    2003-07-01

    "Reaction phenotyping" studies were performed with eletriptan (ETT) to determine its propensity to interact with coadministered medications. Its ability to serve as a substrate for human P-glycoprotein (P-gp) was also investigated since a central mechanism of action has been proposed for this "triptan" class of drug. In studies with a characterized bank of human liver microsome preparations, a good correlation (r2 = 0.932) was obtained between formation of N-desmethyl eletriptan (DETT) and CYP3A4-catalyzed testosterone 6 beta-hydroxylation. DETT was selected to be monitored in our studies since it represents a significant ETT metabolite in humans, circulating at concentrations 10 to 20% of those observed for parent drug. ETT was metabolized to DETT by recombinant CYP2D6 (rCYP2D6) and rCYP3A4, and to a lesser extent by rCYP2C9 and rCYP2C19. The metabolism of ETT to DETT in human liver microsomes was markedly inhibited by troleandomycin, erythromycin, miconazole, and an inhibitory antibody to CYP3A4, but not by inhibitors of other major P450 enzymes. ETT had little inhibitory effect on any of the P450 enzymes investigated. ETT was determined to be a good substrate for human P-gp in vitro. In bidirectional transport studies across LLC-MDR1 and LLC-Mdr1a cell monolayers, ETT had a BA/AB transport ratio in the range 9 to 11. This finding had significance in vivo since brain exposure to ETT was reduced 40-fold in Mdr1a+/+ relative to Mdr1a-/- mice. ETT metabolism to DETT is therefore catalyzed primarily by CYP3A4, and plasma concentrations are expected to be increased when coadministered with inhibitors of CYP3A4 and P-gp activity. PMID:12814962

  17. Inadvertent migration of guidewire into Murphy's eye of endotracheal tube during percutaneous dilatational tracheostomy

    PubMed Central

    Panigrahi, Binita; Samaddar, Devi Prasad; Kumar, Tushar

    2016-01-01

    Percutaneous dilatational tracheostomy is a commonly performed bedside procedure in the Intensive Care Unit. Although serious and fatal complications have been reported, the procedure is by and large safe to perform in experienced hands. We report here an innocuous problem encountered twice. After the guidewire insertion and dilatation, subsequent railroading became difficult owing to migration of guidewire into the Murphy's eye of the endotracheal tube (ETT). Awareness about this possibility can avert inadvertent delays and complications during the procedure. A tug or gentle pulling of ETT after insertion of the guidewire rules out an impaction in the eye or other part of the ETT. PMID:27076734

  18. 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.

  19. Hybrid SPECT/CT evaluation of dual ectopia of thyroid in the absence of orthotopic thyroid gland.

    PubMed

    Harisankar, Chidambaram Natrajan Balasubramanian; Preethi, Govindababu Rajalakshmi; George, Mv

    2012-06-01

    Ectopic thyroid tissue (ETT) refers to all cases in which the thyroid gland is present at a location other than its usual site. The prevalence of ETT is approximately 1 per 100,000 to 300,000 persons and is reported to occur in 1 of 4000 to 8000 patients with thyroid disease. Multiple ectopia of the thyroid is extremely rare, with fewer than 35 cases published in literature to date. We report a 4-year-old girl with euthyroid and dual ectopia of thyroid without orthotopic thyroid gland. The role of hybrid SPECT/CT in the localization of the sites of ETT is also highlighted. PMID:22614198

  20. Strength investigation of artificial substitutes for human teeth in in vitro studies.

    PubMed

    Rosentritt, Martin; Reill, Margarete; Naumann, Michael; Nowak, Arnold; Handel, Gerhard

    2009-01-01

    This study investigated whether metals or resins can replace human teeth in in vitro fracture tests of endodontically treated teeth (ETT), as ETT show high heterogeneity and small availability. Eight incisor-shaped roots per group were adhesively restored with fiber-reinforced composite posts, composite core build-ups and Co-Cr-Mo crowns. Specimens were thermally cycled and mechanically loaded (TCML) and fracture strength was determined. The results varied between 0 N and 348 N. Extracted ETT may show comparable strength and survival during TCML to teeth in situ and therefore are the first choice for in vitro testing. Substitutes show comparable fracture patterns but different fracture values. PMID:19260430

  1. Calculation of a volume effect accompanying an electronic topological transition in pure cerium

    NASA Astrophysics Data System (ADS)

    Ponomaryova, S. O.; Koval', Yu. M.; Ponomaryov, O. P.

    2012-10-01

    An analytic expression for estimating the volume effect accompanying an electronic topological transition (ETT) in pure cerium is derived on the basis of the microscopic Falikov-Ramirez-Kimball model.

  2. 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

  3. Estimated times to exhaustion at the PWC V O2, PWC HRT, and VT.

    PubMed

    Mielke, Michelle; Housh, Terry J; Malek, Moh H; Beck, Travis W; Hendrix, C Russell; Schmidt, Richard J; Johnson, Glen O

    2008-11-01

    The purpose of this study was to validate the Physical Working Capacity at the Heart Rate Threshold (PWC HRT) and Physical Working Capacity at the Oxygen Consumption Threshold (PWC V O2) tests by 1) using individual power vs. duration relationships to estimate the times to exhaustion (ETTE) at the PWC HRT and PWC V O2, and 2) comparing the power outputs and ETTE values of the PWC HRT and PWC V O2 with those of the ventilatory threshold (VT). Ten adults (mean age +/- SD = 23 +/- 1 years) performed an incremental test to exhaustion on a cycle ergometer for the determination of V O2 peak and VT. The subjects also performed four randomly ordered workbouts to exhaustion at different power outputs (ranging from 98 to 246 W) to determine the PWC V O2, PWC HRT, and power vs. duration relationship. Power curve analyses (y = ax b) were used to define the hyperbolic power vs. duration relationship for each subject and to determine the ETTE at the PWC V O2, PWC HRT, and VT. Two separate one-way repeated-measures analyses of variance indicated that there were significant differences among the fatigue thresholds (PWC V O2 > PWC HRT) and ETTE values (PWC HRT > PWC V O2): PWC V O2 (mean +/- SD = 147 +/- 43 W; ETTE = 21 +/- 3 minutes), PWCHRT (136 +/- 37 W; ETTE = 29 +/- 6 minutes), and VT (143 +/- 44 W; ETTE = 27 +/- 11 minutes). These findings were consistent with previous studies that indicated that the PWC HRT occurred at a lower power output than the PWC V O2. Furthermore, the PWC HRT was maintained for a mean of 29 minutes, whereas the PWC V O2 and VT were maintained for 21 and 27 minutes, respectively. These findings indicate that the ETTE values for the PWC V O2 and PWC HRT were substantially less than those suggested in previous studies. PMID:18978609

  4. 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. PMID:27563242

  5. Comparison of prophylactic effects of polyurethane cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes on ventilator-associated pneumonia.

    PubMed

    Mahmoodpoor, Ata; Peyrovi-far, Ali; Hamishehkar, Hadi; Bakhtyiari, Zhaleh; Mirinezhad, Mir Mousa; Hamidi, Masoud; Golzari, Samad Eslam Jamal

    2013-08-07

    Because microaspiration of contaminated supraglottic secretions past the endotracheal tube cuff is considered to be central in the pathogenesis of pneumonia, improved design of tracheal tubes with new cuff material and shape have reduced the size and number of folds, which together with the addition of suction ports above the cuff to drain pooled subglottic secretions leads to reduced aspiration of oropharyngeal secretions. So we conducted a study to compare the prophylactic effects of polyurethane-cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes (ETT) on ventilator-associated pneumonia. This randomized clinical trial was carried out in a 12 bed surgical intensive care unit. 96 patients expected to require mechanical ventilation more than 96 hours were randomly allocated to one of three following groups: Polyvinyl chloride cuff (PCV) ETT, Polyurethane (PU) cylindrical Sealguard ETT and PU Taperguard ETT. Cuff pressure monitored every three hours 3 days in all patients. Mean cuff pressure didn't have significant difference between three groups during 72 hours. Pneumonia was seen in 11 patients (34%) in group PVC, 8 (25%) in Sealguard and 7 (21%) in Taperguard group. Changes in mean cuff pressure between Sealguard and PVC tubes and also between Taperguard and PVC tubes did not show any significant difference. There was no significant difference in overinflation between three groups. The use of ETT with PU material results in reducing ventilator-associated pneumonia compared to ETT with PVC cuff. In PU tubes Taperguard has less incidence of ventilator-associated pneumonia compared to Sealguard tubes.

  6. Analgesic and anti-inflammatory activities of the ethanol extract of Taxillus tsaii Chiu in mice.

    PubMed

    Liu, Chia-Yu; Chiu, Yung-Jia; Kuo, Chao-Lin; Chien, Tzu-Mei; Wu, Lung-Yuan; Peng, Wen-Huang

    2015-06-01

    Preclinical Research This study was conducted to investigate the analgesic activities and mechanism of anti-inflammatory activities of a 50% ethanol extract of Taxillus tsaii (ETT) in vivo using the acetic acid induced writhing test and formalin induced paw licking in mice. The anti-inflammatory effect of ETT was evaluated using a mouse model of λ-carrageenan (Carr)-induced paw edema. ETT reduced the writhing in the acetic acid assay test at a dose 1.0 g/kg po and reduced the licking time in the late phase of the formalin test at doses of 0.5 and 1.0 g/kg po). Carr-induced paw edema was reduced when ETT (0.5 and 1.0 g/kg po) was administered 3-5 h after Carr injection. ETT (1.0 g/kg po) reduced the level of malondialdehyde in the edemic paw by increasing the activity of antioxidant enzymes, e.g., superoxide dismutase and glutathione reductase, in the liver and reducing TNF-α, IL-1β, and IL-6 activity in the edemic paw. This study demonstrates the analgesic and anti-inflammatory effects of ETT, thus verifying its application in traditional Chinese medicine.

  7. The effect of tadalafil on the time to exercise-induced myocardial ischaemia in subjects with coronary artery disease

    PubMed Central

    Patterson, Dean; Kloner, Robert; Effron, Mark; Emmick, Jeffrey; Bedding, Alun; Warner, Margaret; Mitchell, Malcolm; Braat, Simon; MacDonald, Thomas

    2005-01-01

    Objective To investigate the effect of tadalafil on the time to exercise-induced myocardial ischaemia in subjects with coronary artery disease (CAD). Background CAD and erectile dysfunction (ED) share similar risk factors. It is important to know the cardiovascular effects of tadalafil in patients with CAD during physical exertion that is comparable with sexual activity. Methods A randomized, placebo-controlled, double-blind, two-period, crossover study comparing the effects of tadalafil 10 mg and placebo on the time to exercise treadmill test (ETT)-induced myocardial ischaemia in subjects with stable CAD (n = 23; age range: 53–75 years, all exhibited ST-segment depression >1.5 mm at screening ETT at >5METS). Haemodynamic responses to sublingual nitroglycerin (NTG) were assessed before and after ETT. Results Compared with placebo, tadalafil did not significantly affect the time to ETT-induced ischaemia (13 min/31 s vs. 13 min/36 s, respectively). Before exercise, NTG evoked decreases in sitting systolic blood pressure (SBP) that were significantly greater when subjects received tadalafil compared with placebo, and after exercise, more subjects experienced a decrease in SBP <85 mmHg in response to NTG after taking tadalafil vs. placebo. When subjects received tadalafil compared with placebo, SBP was lower at rest (−7 mmHg; −12,-2), during ETT (−10 mmHg; −16, −3), and after ETT (−13 mmHg; −19, −7). Conclusion Tadalafil did not significantly alter the time to ETT-induced ischaemia compared with placebo in subjects with CAD. Tadalafil reduced resting and exercise SBP. Due to the potential for hypotension, the concomitant use of nitrates and tadalafil is contraindicated. PMID:16236035

  8. 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

  9. Geographic access to cancer care: a disparity and a solution.

    PubMed

    Ahamad, Anesa

    2011-09-01

    BACKGROUND The rising cancer incidence in developing countries outpaces easy access to care. Time and effort spent on travel for care is a burden to patients and detracts from patient centredness, efficiency, and equitability. In Trinidad and Tobago, significant distress was observed among patients who made long journeys to the single public cancer clinic. The journey time among non-radiotherapy patients was measured. METHODS Over 19 weekdays in June 2007, the study assessed estimated travel time per visit (ETT), reason for visit for care, and number of visits per patient during their treatment course up to the time of study, and compared the findings with ETT to nearest centres for the US population. RESULTS 1447 episodes of care utilised 5296 h of patient travel time. Median ETT was 3.75 h (IQR 2-5 h, range 0.5-9 h). 74.1% of patients spent 2.25-9 h ETT. 44% of patients spent >4 h ETT. Median number of visits per patient was 34 (IQR 23-43; range 13-62). Median total ETT per patient was 127.5 h. Median ETT to the centre (1.75 h) was eight times greater than in the USA (13 min). More than 70% of patients attended for reasons other than chemotherapy. CONCLUSIONS Cancer patients endured a burden of long travel times in 2007. The prevailing policy of the Ministry of Health to build a single centralised modern centre would not have alleviated this burden. Based on these findings, three outlying cancer clinics were created which now provide non-radiotherapy oncology management of patients nearer their homes.

  10. The effects of closed endotracheal suction on ventilation during conventional and high-frequency oscillatory ventilation.

    PubMed

    Kiraly, Nicholas J; Tingay, David G; Mills, John F; Morley, Colin J; Dargaville, Peter A; Copnell, Beverley

    2009-10-01

    In newborn infants, closed endotracheal tube (ETT) suction may reduce associated adverse effects, but it is not clear whether ventilation is maintained during the procedure. We aimed to determine the effect of ETT size, catheter size, and suction pressure on ventilation parameters measured distal to the ETT. Suction was performed on a test lung, ventilated with conventional (CMV) and high-frequency oscillatory ventilation (HFOV) using ETT sizes 2.5-4.0 mm, catheter sizes 5-8 French gauge (Fr), and suction pressures 80-200 mm Hg. Tracheal and circuit peak inspiratory pressure, positive end-expiratory pressure, and tracheal tidal volume (VT) were recorded for each suction episode. During both CMV and HFOV, tracheal pressures and VT were considerably reduced by suctioning; this reduction was dependent on the combination of ETT, catheter, and suction pressure. Loss of VT, inflation pressure (CMV), and pressure amplitude (HFOV) occurred primarily with insertion of the catheter, and loss of end-expiratory pressure (CMV) and mean tracheal pressure (HFOV) occurred with the application of suction. Circuit pressures were reduced to lesser degree. We conclude that airway pressures and VT are not maintained during closed endotracheal suction with either CMV or HFOV, and choice of equipment and settings will affect the degree of interruption to ventilation.

  11. Escherichia coli Type III Secretion System 2 ATPase EivC Is Involved in the Motility and Virulence of Avian Pathogenic Escherichia coli.

    PubMed

    Wang, Shaohui; Liu, Xin; Xu, Xuan; Yang, Denghui; Wang, Dong; Han, Xiangan; Shi, Yonghong; Tian, Mingxing; Ding, Chan; Peng, Daxin; Yu, Shengqing

    2016-01-01

    Type III secretion systems (T3SSs) are crucial for bacterial infections because they deliver effector proteins into host cells. The Escherichia coli type III secretion system 2 (ETT2) is present in the majority of E. coli strains, and although it is degenerate, ETT2 regulates bacterial virulence. An ATPase is essential for T3SS secretion, but the function of the ETT2 ATPase has not been demonstrated. Here, we show that EivC is homologous to the β subunit of F0F1 ATPases and it possesses ATPase activity. To investigate the effects of ETT2 ATPase EivC on the phenotype and virulence of avian pathogenic Escherichia coli (APEC), eivC mutant and complemented strains were constructed and characterized. Inactivation of eivC led to impaired flagella production and augmented fimbriae on the bacterial surface, and, consequently, reduced bacterial motility. In addition, the eivC mutant strain exhibited attenuated virulence in ducks, diminished serum resistance, reduced survival in macrophage cells and in ducks, upregulated fimbrial gene expression, and downregulated flagellar and virulence gene expression. The expression of the inflammatory cytokines interleukin (IL)-1β and IL-8 were increased in HD-11 macrophages infected with the eivC mutant strain, compared with the wild-type strain. These virulence-related phenotypes were restored by genetic complementation. These findings demonstrate that ETT2 ATPase EivC is involved in the motility and pathogenicity of APEC. PMID:27630634

  12. Escherichia coli Type III Secretion System 2 ATPase EivC Is Involved in the Motility and Virulence of Avian Pathogenic Escherichia coli

    PubMed Central

    Wang, Shaohui; Liu, Xin; Xu, Xuan; Yang, Denghui; Wang, Dong; Han, Xiangan; Shi, Yonghong; Tian, Mingxing; Ding, Chan; Peng, Daxin; Yu, Shengqing

    2016-01-01

    Type III secretion systems (T3SSs) are crucial for bacterial infections because they deliver effector proteins into host cells. The Escherichia coli type III secretion system 2 (ETT2) is present in the majority of E. coli strains, and although it is degenerate, ETT2 regulates bacterial virulence. An ATPase is essential for T3SS secretion, but the function of the ETT2 ATPase has not been demonstrated. Here, we show that EivC is homologous to the β subunit of F0F1 ATPases and it possesses ATPase activity. To investigate the effects of ETT2 ATPase EivC on the phenotype and virulence of avian pathogenic Escherichia coli (APEC), eivC mutant and complemented strains were constructed and characterized. Inactivation of eivC led to impaired flagella production and augmented fimbriae on the bacterial surface, and, consequently, reduced bacterial motility. In addition, the eivC mutant strain exhibited attenuated virulence in ducks, diminished serum resistance, reduced survival in macrophage cells and in ducks, upregulated fimbrial gene expression, and downregulated flagellar and virulence gene expression. The expression of the inflammatory cytokines interleukin (IL)-1β and IL-8 were increased in HD-11 macrophages infected with the eivC mutant strain, compared with the wild-type strain. These virulence-related phenotypes were restored by genetic complementation. These findings demonstrate that ETT2 ATPase EivC is involved in the motility and pathogenicity of APEC.

  13. Escherichia coli Type III Secretion System 2 ATPase EivC Is Involved in the Motility and Virulence of Avian Pathogenic Escherichia coli

    PubMed Central

    Wang, Shaohui; Liu, Xin; Xu, Xuan; Yang, Denghui; Wang, Dong; Han, Xiangan; Shi, Yonghong; Tian, Mingxing; Ding, Chan; Peng, Daxin; Yu, Shengqing

    2016-01-01

    Type III secretion systems (T3SSs) are crucial for bacterial infections because they deliver effector proteins into host cells. The Escherichia coli type III secretion system 2 (ETT2) is present in the majority of E. coli strains, and although it is degenerate, ETT2 regulates bacterial virulence. An ATPase is essential for T3SS secretion, but the function of the ETT2 ATPase has not been demonstrated. Here, we show that EivC is homologous to the β subunit of F0F1 ATPases and it possesses ATPase activity. To investigate the effects of ETT2 ATPase EivC on the phenotype and virulence of avian pathogenic Escherichia coli (APEC), eivC mutant and complemented strains were constructed and characterized. Inactivation of eivC led to impaired flagella production and augmented fimbriae on the bacterial surface, and, consequently, reduced bacterial motility. In addition, the eivC mutant strain exhibited attenuated virulence in ducks, diminished serum resistance, reduced survival in macrophage cells and in ducks, upregulated fimbrial gene expression, and downregulated flagellar and virulence gene expression. The expression of the inflammatory cytokines interleukin (IL)-1β and IL-8 were increased in HD-11 macrophages infected with the eivC mutant strain, compared with the wild-type strain. These virulence-related phenotypes were restored by genetic complementation. These findings demonstrate that ETT2 ATPase EivC is involved in the motility and pathogenicity of APEC. PMID:27630634

  14. 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.

  15. 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

  16. 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.

  17. Lung ultrasound associated to capnography to verify correct endotracheal tube positioning in prehospital.

    PubMed

    Brun, Pierre-Marie; Bessereau, Jacques; Cazes, Nicolas; Querellou, Emgan; Chenaitia, Hichem

    2012-11-01

    Endotracheal intubation is the “gold standard” of the control of airway patency but is associated with nonnegligible morbidity rates. A rapid detection of esophageal intubation is essential. Capnography is considered the reference technique for correct endotracheal tube (ETT) positioning confirmation. However, capnography can provide false-positive and false-negative results in some situations. Recently, the ultrasound assessment has been studied for confirming ETT placement. Despite of few trials, the ultrasound procedure may enhance physician confidence and decision making in airway management. We report the case of a 52-year-old female patient presenting cardiorespiratory failure. During cardiopulmonary resuscitation, there was a sudden absence of end-tidal CO2 capnographic detection. Correct tube positioning could not be ascertained by auscultation because the environment had become extremely noisy. However, TM-mode (Time Motion--mode) lung ultrasound revealed bilateral pleural sliding during insufflation with the self-filling balloon, thus confirming correct ETT positioning.

  18. Interface-Located Photothermoelectric Effect of Organic Thermoelectric Materials in Enabling NIR Detection.

    PubMed

    Huang, Dazhen; Zou, Ye; Jiao, Fei; Zhang, Fengjiao; Zang, Yaping; Di, Chong-an; Xu, Wei; Zhu, Daoben

    2015-05-01

    Organic photothermoelectric (PTE) materials are promising candidates for various photodetection applications. Herein, we report on poly[Cux(Cu-ett)]:PVDF, which is an excellent polymeric thermoelectric composite, possesses unprecedented PTE properties. The NIR light irradiation on the poly[Cu(x)(Cu-ett)]:PVDF film could induce obvious enhancement in Seebeck coefficient from 52 ± 1.5 to 79 ± 5.0 μV/K. By taking advantage of prominent photothermoelectric effect of poly[Cu(x)(Cu-ett)]:PVDF, an unprecedented voltage of 12 mV was obtained. This excellent performance enables its promising applications in electricity generation from solar energy and NIR detection to a wide range of light intensities ranging from 1.7 mW/cm(2) to 17 W/cm(2). PMID:25875974

  19. Clinical Evaluation of Heart Failure: Agreement among Tests.

    PubMed

    Pandey, Amit K; Penny, William F; Bhargava, Valmik; Lai, N Chin; Xu, Ronghui; Hammond, H Kirk

    2016-01-01

    Methods commonly used clinically to assess cardiac function in patients with heart failure include ejection fraction (EF), exercise treadmill testing (ETT), and symptom evaluation. Although these approaches are useful in evaluating patients with heart failure, there are at times substantial mismatches between individual assessments. For example, ETT results are often discordant with EF, and patients with minimal symptoms sometimes have surprisingly low EFs. To better define the relationship of these methods of assessment, we studied 56 patients with heart failure with reduced EF (HFrEF) who underwent measurement of ETT duration, EF by echocardiography, quantitative symptom evaluation, and LV peak dP/dt (rate of left ventricular pressure development and decline, measured invasively). Correlations were determined among these four tests in order to assess the relationship of EF, ETT, and symptoms against LV peak dP/dt. In addition, we sought to determine whether EF, ETT, and symptoms correlated with each other. Overall, correlations were poor. Only 15 of 63 total correlations (24%) were significant (p < 0.05). EF correlated most closely with LV peak -dP/dt. Linear regression analysis indicated that EF, ETT, and symptoms taken together predicted LV peak dP/dt better than any one measure alone. We conclude that clinical tests used to assess LV function in patients with HFrEF may not be as accurate or correlate as well as expected. All three clinical measures considered together may be the best representation of cardiac function in HFrEF patients currently available. PMID:27537778

  20. Efficacy of Hi-Lo Evac Endotracheal Tube in Prevention of Ventilator-Associated Pneumonia in Mechanically Ventilated Poisoned Patients.

    PubMed

    Ghoochani Khorasani, Ahmad; Shadnia, Shahin; Mashayekhian, Mohammad; Rahimi, Mitra; Aghabiklooei, Abbas

    2016-01-01

    Background. Ventilator-associated pneumonia (VAP) is the most common health care-associated infection. To prevent this complication, aspiration of subglottic secretions using Hi-Lo Evac endotracheal tube (Evac ETT) is a recommended intervention. However, there are some reports on Evac ETT dysfunction. We aimed to compare the incidence of VAP (per ventilated patients) in severely ill poisoned patients who were intubated using Evac ETT versus conventional endotracheal tubes (C-ETT) in our toxicology ICU. Materials and Methods. In this clinical randomized trial, 91 eligible patients with an expected duration of mechanical ventilation of more than 48 hours were recruited and randomly assigned into two groups: (1) subglottic secretion drainage (SSD) group who were intubated by Evac ETT (n = 43) and (2) control group who were intubated by C-ETT (n = 48). Results. Of the 91 eligible patients, 56 (61.5%) were male. VAP was detected in 24 of 43 (55.8%) patients in the case group and 23 of 48 (47.9%) patients in the control group (P = 0.45). The most frequently isolated microorganisms were S. aureus (54.10%) and Acinetobacter spp. (19.68%). The incidence of VAP and ICU length of stay were not significantly different between the two groups, but duration of intubation was statistically different and was longer in the SSD group. Mortality rate was less in SSD group but without a significant difference (P = 0.68). Conclusion. The SSD procedure was performed intermittently with one-hour intervals using 10 mL syringe. Subglottic secretion drainage does not significantly reduce the incidence of VAP in patients receiving MV. This strategy appears to be ineffective in preventing VAP among ICU patients. PMID:27651976

  1. Efficacy of Hi-Lo Evac Endotracheal Tube in Prevention of Ventilator-Associated Pneumonia in Mechanically Ventilated Poisoned Patients

    PubMed Central

    Mashayekhian, Mohammad; Rahimi, Mitra; Aghabiklooei, Abbas

    2016-01-01

    Background. Ventilator-associated pneumonia (VAP) is the most common health care-associated infection. To prevent this complication, aspiration of subglottic secretions using Hi-Lo Evac endotracheal tube (Evac ETT) is a recommended intervention. However, there are some reports on Evac ETT dysfunction. We aimed to compare the incidence of VAP (per ventilated patients) in severely ill poisoned patients who were intubated using Evac ETT versus conventional endotracheal tubes (C-ETT) in our toxicology ICU. Materials and Methods. In this clinical randomized trial, 91 eligible patients with an expected duration of mechanical ventilation of more than 48 hours were recruited and randomly assigned into two groups: (1) subglottic secretion drainage (SSD) group who were intubated by Evac ETT (n = 43) and (2) control group who were intubated by C-ETT (n = 48). Results. Of the 91 eligible patients, 56 (61.5%) were male. VAP was detected in 24 of 43 (55.8%) patients in the case group and 23 of 48 (47.9%) patients in the control group (P = 0.45). The most frequently isolated microorganisms were S. aureus (54.10%) and Acinetobacter spp. (19.68%). The incidence of VAP and ICU length of stay were not significantly different between the two groups, but duration of intubation was statistically different and was longer in the SSD group. Mortality rate was less in SSD group but without a significant difference (P = 0.68). Conclusion. The SSD procedure was performed intermittently with one-hour intervals using 10 mL syringe. Subglottic secretion drainage does not significantly reduce the incidence of VAP in patients receiving MV. This strategy appears to be ineffective in preventing VAP among ICU patients.

  2. Clinical Evaluation of Heart Failure: Agreement among Tests

    PubMed Central

    Pandey, Amit K.; Penny, William F.; Bhargava, Valmik; Lai, N. Chin; Xu, Ronghui; Hammond, H. Kirk

    2016-01-01

    Methods commonly used clinically to assess cardiac function in patients with heart failure include ejection fraction (EF), exercise treadmill testing (ETT), and symptom evaluation. Although these approaches are useful in evaluating patients with heart failure, there are at times substantial mismatches between individual assessments. For example, ETT results are often discordant with EF, and patients with minimal symptoms sometimes have surprisingly low EFs. To better define the relationship of these methods of assessment, we studied 56 patients with heart failure with reduced EF (HFrEF) who underwent measurement of ETT duration, EF by echocardiography, quantitative symptom evaluation, and LV peak dP/dt (rate of left ventricular pressure development and decline, measured invasively). Correlations were determined among these four tests in order to assess the relationship of EF, ETT, and symptoms against LV peak dP/dt. In addition, we sought to determine whether EF, ETT, and symptoms correlated with each other. Overall, correlations were poor. Only 15 of 63 total correlations (24%) were significant (p < 0.05). EF correlated most closely with LV peak -dP/dt. Linear regression analysis indicated that EF, ETT, and symptoms taken together predicted LV peak dP/dt better than any one measure alone. We conclude that clinical tests used to assess LV function in patients with HFrEF may not be as accurate or correlate as well as expected. All three clinical measures considered together may be the best representation of cardiac function in HFrEF patients currently available. PMID:27537778

  3. Efficacy of Hi-Lo Evac Endotracheal Tube in Prevention of Ventilator-Associated Pneumonia in Mechanically Ventilated Poisoned Patients

    PubMed Central

    Mashayekhian, Mohammad; Rahimi, Mitra; Aghabiklooei, Abbas

    2016-01-01

    Background. Ventilator-associated pneumonia (VAP) is the most common health care-associated infection. To prevent this complication, aspiration of subglottic secretions using Hi-Lo Evac endotracheal tube (Evac ETT) is a recommended intervention. However, there are some reports on Evac ETT dysfunction. We aimed to compare the incidence of VAP (per ventilated patients) in severely ill poisoned patients who were intubated using Evac ETT versus conventional endotracheal tubes (C-ETT) in our toxicology ICU. Materials and Methods. In this clinical randomized trial, 91 eligible patients with an expected duration of mechanical ventilation of more than 48 hours were recruited and randomly assigned into two groups: (1) subglottic secretion drainage (SSD) group who were intubated by Evac ETT (n = 43) and (2) control group who were intubated by C-ETT (n = 48). Results. Of the 91 eligible patients, 56 (61.5%) were male. VAP was detected in 24 of 43 (55.8%) patients in the case group and 23 of 48 (47.9%) patients in the control group (P = 0.45). The most frequently isolated microorganisms were S. aureus (54.10%) and Acinetobacter spp. (19.68%). The incidence of VAP and ICU length of stay were not significantly different between the two groups, but duration of intubation was statistically different and was longer in the SSD group. Mortality rate was less in SSD group but without a significant difference (P = 0.68). Conclusion. The SSD procedure was performed intermittently with one-hour intervals using 10 mL syringe. Subglottic secretion drainage does not significantly reduce the incidence of VAP in patients receiving MV. This strategy appears to be ineffective in preventing VAP among ICU patients. PMID:27651976

  4. 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.

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

    PubMed

    DA, Harvie; Jn, Darvall; M, Dodd; A, De La Cruz; M, Tacey; Rl, D'Costa; D, Ward

    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. PMID:27608343

  6. Obstruction of a non-resterilized reinforced endotracheal tube during craniotomy under general anesthesia

    PubMed Central

    Itani, Omar; Mallat, Claude; Jazzar, Mohammad; Hammoud, Rola; Shaaban, Jamil

    2015-01-01

    Many cases of reinforced endotracheal tube (ETT) obstruction were reported in the literature. In most of these cases, the obstruction was related to the use of a resterilized tube with or without the use of nitrous oxide (N2O). Resterilization and autoclaving of the tube may result in dissection or formation of a bleb between the two layers of the tube that may expand after the use of N2O. We describe a case of acute non-resterilized reinforced ETT obstruction, by bleb formation, during occipital craniotomy under general anesthesia. PMID:26417140

  7. Obstruction of a non-resterilized reinforced endotracheal tube during craniotomy under general anesthesia.

    PubMed

    Itani, Omar; Mallat, Claude; Jazzar, Mohammad; Hammoud, Rola; Shaaban, Jamil

    2015-01-01

    Many cases of reinforced endotracheal tube (ETT) obstruction were reported in the literature. In most of these cases, the obstruction was related to the use of a resterilized tube with or without the use of nitrous oxide (N2O). Resterilization and autoclaving of the tube may result in dissection or formation of a bleb between the two layers of the tube that may expand after the use of N2O. We describe a case of acute non-resterilized reinforced ETT obstruction, by bleb formation, during occipital craniotomy under general anesthesia. PMID:26417140

  8. 2011 North Plains research field 12-200 limited irrigation corn production study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    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...

  9. 78 FR 30243 - Airworthiness Directives; Eclipse Aerospace, Inc. Airplanes

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-22

    ... revision or the ACS software update. Costs of Compliance We estimate that this proposed AD affects 81... software update. Authority for this Rulemaking Title 49 of the United States Code specifies the FAA's...) Update Aircraft Computer Software (ACS) (1) For airplanes equipped with Avio or Avio with ETT...

  10. Extrauterine epithelioid trophoblastic tumors presenting as primary lung carcinomas: morphologic and immunohistochemical features to resolve a diagnostic dilemma.

    PubMed

    Lewin, Sharyn N; Aghajanian, Carol; Moreira, Andre L; Soslow, Robert A

    2009-12-01

    Our objective was to describe the clinicopathologic features of epithelioid trophoblastic tumors (ETTs) in a series of patients who presented with elevated beta-human chorionic gonadotrophin (hCG) levels and extrauterine lesions resembling primary lung carcinomas. Clinical and pathologic materials were reviewed and Shih and Kurman's diagnostic criteria were applied. Three parous women (38, 49, and 34 y of age) with elevated beta-hCG levels had nondiagnostic gynecologic evaluations, including negative dilation and curettage specimens. Imaging revealed isolated pulmonary lesions, 2 to 8.5 cm in size, resembling primary lung carcinomas. Two patients received multiagent chemotherapy consisting of etoposide, methotrexate, dactinomycin, alternating with cisplatin and etoposide, and all underwent pulmonary resection. Histologically, the cytologic features, epithelioid growth pattern, and hyaline-like material simulated the appearance of nonsmall cell lung carcinoma, but overall, the histologic features along with the immunophenotype supported classification as ETT. Follow-up hysterectomy specimens were histologically normal. All 3 patients are alive and well. The rarity of ETT and its resemblance to squamous and pleomorphic carcinomas of lung have led to diagnostic difficulties. When reproductive-age women present with elevated beta-hCG levels, a pulmonary lesion, and no apparent intrauterine disease, primary pulmonary ETT should be considered. Correlating clinical indices with specific morphologic and immunohistochemical features can ensure diagnostic accuracy and appropriate treatment for favorable outcomes.

  11. 75 FR 45075 - Airworthiness Directives; Eclipse Aerospace, Inc. Model EA500 Airplanes

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-02

    ... Register on July 9, 2010 (75 FR 39472), and applies to certain Eclipse Aerospace, Inc. (Eclipse) Model..., 000113 through 000115, 000120, and 000123 through 000124, that incorporate Avionics Upgrade to AVIO NG Configuration for ETT Configured Aircraft per any revision level of Eclipse SB 500-99-002.'' This...

  12. Linking Basic Skills to Entry-Level Electronics Test Technician Tasks. Instructional Resources. Assessments.

    ERIC Educational Resources Information Center

    Gaillard, Don; Mostaghel, Debbie

    This project first identified the specific mathematics, reading, writing, listening, and speaking skills required of an entry-level electronics testing technician (ETT), using a modified DACUM (Developing a Curriculum) occupational analysis process. This approach involves a panel of expert workers from the electronics industry who analyze and…

  13. The Cement Prosthesis-Like Spacer: An Intermediate Halt on the Road to Healing

    PubMed Central

    Ahmad, Sufian S.; Huber, Kim; Evangelopoulos, Dimitrios S.; Kleer, Barbara; Kohlhof, Hendrik; Schär, Michael; Eggli, Stefan; Kohl, Sandro

    2013-01-01

    Background. Periprosthetic infections remain a devastating problem in the field of joint arthroplasty. In the following study, the results of a two-stage treatment protocol for chronic periprosthetic infections using an intraoperatively molded cement prosthesis-like spacer (CPLS) are presented. Methods. Seventy-five patients with chronically infected knee prosthesis received a two-stage revision procedure with the newly developed CPLS between June 2006 and June 2011. Based on the microorganism involved, patients were grouped into either easy to treat (ETT) or difficult to treat (DTT) and treated accordingly. Range of motion (ROM) and the knee society score (KSS) were utilized for functional assessment. Results. Mean duration of the CPLS implant in the DTT group was 3.6 months (range 3–5 months) and in the ETT group 1.3 months (range 0.7–2.5 months). Reinfection rates of the final prosthesis were 9.6% in the ETT and 8.3% in the DTT group with no significant difference between both groups regarding ROM or KSS (P = 0.87, 0.64, resp.). Conclusion. The results show that ETT patients do not necessitate the same treatment protocol as DTT patients to achieve the same goal, emphasizing the need to differentiate between therapeutic regimes. We also highlight the feasibility of CLPS in two-stage protocols. PMID:24198728

  14. Changes in uncuffed endotracheal tube leak during laparoscopic inguinal herniorrhaphy in children.

    PubMed

    Noguchi, Akiko; Kuga, Kumiko; Tashiro, Naoki; Shimakawa, Yusuke; Shono, Takeshi; Hirakawa, Naomi; Sakaguchi, Yoshiro

    2016-08-01

    The present study was conducted to investigate changes in uncuffed endotracheal tube (ETT) leak during laparoscopic surgery. The study included 31 patients aged between 1 and 6 years scheduled for elective laparoscopic inguinal herniorrhaphy. Inspiratory and expiratory tidal volumes (TVi and TVe) were measured during mechanical ventilation, and ETT leak was calculated using the formula-ETT leak = (TVi - TVe)/TVi × 100 (%), assessed at the following time-points-5 min after the start of mechanical ventilation (T1, baseline), just before the start of surgery (T2), 5 min after the induction of pneumoperitoneum with 15° Trendelenburg tilt (T3), and at the end of surgery (T4). Additionally, leak pressure was assessed after successful tracheal intubation (T0, baseline) at T2, T3 and T4. Uncuffed ETT leak significantly decreased at T3 compared with T1 (baseline). Leak pressure significantly increased at T3 and T4 compared with T0 (baseline). Further studies are needed in order to determine whether the results are universal and associated with clinically significant outcomes. PMID:27193326

  15. 77 FR 68117 - Electric Transmission Texas, LLC; Notice of Petition for Declaratory Order

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-15

    ... Energy Regulatory Commission Electric Transmission Texas, LLC; Notice of Petition for Declaratory Order... Commission's (Commission) Rules of Practice and Procedure 18 CFR 385.207(a)(2), Electric Transmission Texas... Act (FPA) jurisdiction over (1) the transmission lines that ETT, an electric utility in the...

  16. 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.

  17. Dobutamine stress echo is superior to exercise stress testing in achieving target heart rate among patients on beta blockers.

    PubMed

    Sabbath, Adam; Pack, Michael; Markiewicz, Richard; John, Jooby; Gaballa, Mohamed; Goldman, Steven; Thai, Hoang

    2005-01-01

    Published guidelines recommend continuing beta-adrenergic receptor blockade in patients undergoing stress testing. We evaluated the role of pharmacological versus exercise stress testing in achieving target heart rate (THR) among patients on beta-adrenergic blockade. We compared data from 140 patients who underwent dobutamine stress echo (DSE) and 143 patients who underwent exercise treadmill testing (ETT). In both groups, beta-adrenergic blocker was continued at the time of stress testing. Overall, patients undergoing DSE achieved THR more frequently than ETT. With beta-adrenergic blockade, DSE patients met THR more frequently than ETT patients (p < 0.001). Without beta-adrenergic blockade, there was no difference between either modality in achieving THR. In both DSE and ETT patients, absence of beta-adrenergic blockade increased the odds of achieving THR [odds ratio (OR): 2.46, p = 0.042 and OR: 7.44, p < 0.001, respectively]. Atropine use with DSE increased the odds of achieving THR (OR: 3.76, p = 0.006). In conclusion, pharmacological stress testing appears to be superior to exercise stress testing in achieving THR among patients on beta-adrenergic blockade.

  18. 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

  19. Protective effect of an aphrodisiac herb Tribulus terrestris Linn on cadmium-induced testicular damage

    PubMed Central

    Rajendar, B.; Bharavi, K.; Rao, G. S.; Kishore, P.V.S; Kumar, P. Ravi; Kumar, C.S.V Satish; Patel, T. Pankaj

    2011-01-01

    Aim: The aim of the present study was to investigate whether Tribulus terrestris Linn (TT) could protect the cadmium (Cd)-induced testicular tissue peroxidation in rats and to explore the underlying mechanism of the same. Materials and Methods: In vitro and in vivo studies were conducted to know the protective effect of ethanolic extract of TT (eTT) in Cd toxicity. In in vitro studies, total antioxidant and ferrous metal ion chelating activity of TT was studied. In vivo studies were conducted in rats. A total of 40 Wistar strain adult male rats were divided into four groups. Group 1 served as control, while group 2 to 4 received CdCl2 (3 mg/kg b. wt. s/c once a week). In addition to Cd, group 3 and 4 rats also received eTT (5 mg/kg b.wt. daily as oral gavage) and α-tocopherol (75 mg/kg daily by oral gavage), respectively. At the end of 6th week, all the rats were sacrificed and the separated testes were weighted and processed for estimation of tissue peroxidation markers, antioxidant markers, functional markers, and Cd concentration. The testes were also subjected to histopathological screening. Results: In in vitro studies, the percentage of metal ion chelating activity of 50 μg/ml of eTT and α-tocopherol were 2.76 and 9.39, respectively, and the antioxidant capacity of eTT was equivalent to 0.063 μg of α-tocopherol/μg of eTT. In in vivo studies, administration of Cd significantly reduced the absolute and relative testicular weight, antioxidant markers such as superoxide dismutase and glutathione, and functional markers such as LDH and ALP, along with significant increase in peroxidation markers such as malondialdehyde and protein carbonyls in testicular tissue. Testes of Cd only-treated group showed histological insults like necrotic changes in seminiferous tubules and interstitium, shrunken tubules with desquamated basal lamina, vacuolization and destruction of sertoli cells, and degenerating Leydig cells. This group also had higher Cd levels in testicular

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

    PubMed

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

    2013-07-01

    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.

  1. On the '-1' scaling of air temperature spectra in atmospheric surface layer flows

    NASA Astrophysics Data System (ADS)

    Li, D.; Katul, G. G.; Gentine, P.

    2015-12-01

    The spectral properties of scalar turbulence at high wavenumbers have been extensively studied in turbulent flows, and existing theories explaining the k-5/3 scaling within the inertial subrange appear satisfactory at high Reynolds numbers. Equivalent theories for the low wavenumber range have been comparatively lacking because boundary conditions prohibit attainment of such universal behavior. A number of atmospheric surface layer (ASL) experiments reported a k-1 scaling in air temperature spectra ETT(k) at low wavenumbers but other experiments did not. Here, the occurrence of a k-1 scaling in ETT(k) in an idealized ASL flow across a wide range of atmospheric stability regimes is investigated theoretically and experimentally. Experiments reveal a k-1 scaling persisted across different atmospheric stability parameter values (ζ) ranging from mildly unstable to mildly stable conditions (-0.1< ζ < 0.2). As instability increases, the k-1 scaling vanishes. Based on a combined spectral and co-spectral budget models and upon using a Heisenberg eddy viscosity as a closure to the spectral flux transfer term, conditions promoting a k-1 scaling are identified. Existence of a k-1 scaling is shown to be primarily linked to an imbalance between the production and dissipation rates of half the temperature variance. The role of the imbalance between the production and dissipation rates of half the temperature variance in controlling the existence of a '-1' scaling suggests that the '-1' scaling in ETT(k) does not necessarily concur with the '-1' scaling in the spectra of longitudinal velocity Euu(k). This finding explains why some ASL experiments reported k-1 in Euu(k) but not ETT(k). It also differs from prior arguments derived from directional-dimensional analysis that lead to simultaneous k-1 scaling in Euu(k) and ETT(k) at low wavenumbers in a neutral ASL.

  2. Endotracheal tube cuff pressure before, during, and after fixed-wing air medical retrieval.

    PubMed

    Brendt, Peter; Schnekenburger, Marc; Paxton, Karen; Brown, Anthony; Mendis, Kumara

    2013-01-01

    Abstract Background. Increased endotracheal tube (ETT) cuff pressure is associated with compromised tracheal mucosal perfusion and injuries. No published data are available for Australia on pressures in the fixed-wing air medical retrieval setting. Objective. After introduction of a cuff pressure manometer (Mallinckrodt, Hennef, Germany) at the Royal Flying Doctor Service (RFDS) Base in Dubbo, New South Wales (NSW), Australia, we assessed the prevalence of increased cuff pressures before, during, and after air medical retrieval. Methods. This was a retrospective audit in 35 ventilated patients during fixed-wing retrievals by the RFDS in NSW, Australia. Explicit chart review of ventilated patients was performed for cuff pressures and changes during medical retrievals with pressurized aircrafts. Pearson correlation was calculated to determine the relation of ascent and ETT cuff pressure change from ground to flight level. Results. The mean (± standard deviation) of the first ETT cuff pressure measurement on the ground was 44 ± 20 cmH2O. Prior to retrieval in 11 patients, the ETT cuff pressure was >30 cmH2O and in 11 patients >50 cmH2O. After ascent to cruising altitude, the cuff pressure was >30 cmH2O in 22 patients and >50 cmH2O in eight patients. The cuff pressure was reduced 1) in 72% of cases prior to take off and 2) in 85% of cases during flight, and 3) after landing, the cuff pressure increased in 85% of cases. The correlation between ascent in cabin altitude and ETT cuff pressure was r = 0.3901, p = 0.0205. Conclusions. The high prevalence of excessive cuff pressures during air medical retrieval can be avoided by the use of cuff pressure manometers. Key words: cuff pressure; air medical retrieval; prehospital. PMID:23252881

  3. Relocation of earthquakes recorded by SIL network (Iceland) using empirical travel-time tables

    NASA Astrophysics Data System (ADS)

    Abril Lopez, C.; Gudmundsson, O.

    2015-12-01

    Three dimensional empirical travel time tables (ETT) are estimated for each station of the South Iceland Lowlands network (SIL) by interpolating travel-time observations mapped to the hypocenter of each event. ETT are used to relocate SIL database earthquakes using P- and S- arrival times. Results are compared with the initial locations from the SIL database and locations from local sub-networks in Iceland. The SIL database locations are estimated using 5 different 1-D velocity models for different regions. The arrival times were re-referenced to one single model (the SIL model). Minor discrepancies in archived travel-time reduction were identified and removed together with outliers. Travel times are decomposed into 1) the prediction of a 1-D reference velocity model; 2) deterministic variation of residuals from that 1-D model constructed by smoothing over a regional scale; and 3) a smaller-scale, stochastic component. The stochastic component is separated into a spatially incoherent part (noise) and a spatially coherent part assumed to correspond to remaining structural signal. The stochastic structural component is interpolated and summed to the other two travel time components in order to construct the ETTs. Relocation is computed with a non-linear grid-search algorithm. The resulting ETTs are useful for improving earthquake location where 1-D velocity models are frequently used and a fast secondary relocation process is required. Moreover, ETTs are "cleaned" travel times that can be used as input into 3D tomography, where the error estimation (incoherent component of residuals) serves as a useful guideline for data weighting.

  4. Endotracheal tube cuff pressure before, during, and after fixed-wing air medical retrieval.

    PubMed

    Brendt, Peter; Schnekenburger, Marc; Paxton, Karen; Brown, Anthony; Mendis, Kumara

    2013-01-01

    Abstract Background. Increased endotracheal tube (ETT) cuff pressure is associated with compromised tracheal mucosal perfusion and injuries. No published data are available for Australia on pressures in the fixed-wing air medical retrieval setting. Objective. After introduction of a cuff pressure manometer (Mallinckrodt, Hennef, Germany) at the Royal Flying Doctor Service (RFDS) Base in Dubbo, New South Wales (NSW), Australia, we assessed the prevalence of increased cuff pressures before, during, and after air medical retrieval. Methods. This was a retrospective audit in 35 ventilated patients during fixed-wing retrievals by the RFDS in NSW, Australia. Explicit chart review of ventilated patients was performed for cuff pressures and changes during medical retrievals with pressurized aircrafts. Pearson correlation was calculated to determine the relation of ascent and ETT cuff pressure change from ground to flight level. Results. The mean (± standard deviation) of the first ETT cuff pressure measurement on the ground was 44 ± 20 cmH2O. Prior to retrieval in 11 patients, the ETT cuff pressure was >30 cmH2O and in 11 patients >50 cmH2O. After ascent to cruising altitude, the cuff pressure was >30 cmH2O in 22 patients and >50 cmH2O in eight patients. The cuff pressure was reduced 1) in 72% of cases prior to take off and 2) in 85% of cases during flight, and 3) after landing, the cuff pressure increased in 85% of cases. The correlation between ascent in cabin altitude and ETT cuff pressure was r = 0.3901, p = 0.0205. Conclusions. The high prevalence of excessive cuff pressures during air medical retrieval can be avoided by the use of cuff pressure manometers. Key words: cuff pressure; air medical retrieval; prehospital.

  5. A prospective randomized control study comparing classic laryngeal mask airway with Guedel's airway for tracheal tube exchange and smooth extubation

    PubMed Central

    Jain, Shruti; Nazir, Nazia; Khan, Rashid M.; Ahmed, Syed M.

    2016-01-01

    Introduction: Extubation in deep plane of anesthesia followed by Guedel's oropharyngeal airway (OPA™) insertion is a routine method to avoid hemodynamic changes associated with tracheal extubation. Exchange of endotracheal tube (ETT) with Classic laryngeal mask airway (LMA™) prior to emergence from anesthesia also serves similar purpose. We had compared the hemodynamic changes involved during this ETT/LMA™ and ETT/OPA™ exchange technique. Material and Methods: This was a randomized prospective study on ASA I and 2 patients undergoing elective surgery under general anesthesia. These patients were randomly divided into two groups i.e. OPA group and LMA group of 50 patients each. Hemodynamic parameters i.e. systolic blood pressure (SBP) and heart rate (HR) were recorded during exchange of ETT with OPA™ or LMA™. Coughing / bucking during removal of OPA™ and LMA™, and presence of post operative sore throat for both the groups were also graded and recorded. Data within the groups have been analyzed using paired “t” test while those between the groups were analyzed using unpaired “t” test. Chi square test was used to analyze grades of coughing and post operative sore throat. Results: In both groups, hemodynamic parameters rose significantly as OPA™/LMA™ was placed (P < 0.05) and then started declining. Hemodynamic parameters continued to fall in LMA group after extubation. However in OPA group, hemodynamic parameters continued to rise even after extubation and declined only when OPA™ was removed. There was no statistical significant difference between the LMA and OPA group in respect to coughing and post operative sore throat. Conclusion: LMA™ is superior to OPA™ for exchange of ETT as it provides greater hemodynamic stability. PMID:27746550

  6. Better Hemodynamic Profile of Laryngeal Mask Airway Insertion Compared to Laryngoscopy and Tracheal Intubation

    PubMed Central

    Jarineshin, Hashem; Kashani, Saeed; Vatankhah, Majid; Abdulahzade Baghaee, Alireza; Sattari, Sahar; Fekrat, Fereydoon

    2015-01-01

    Background: Laryngoscopy and tracheal intubation can cause serious cardiovascular responses in patients such as hypertension, tachycardia, and arrhythmias. Alternative airway maintenance techniques may attenuate these hemodynamic stress responses. Objectives: This study aimed to compare the immediate hemodynamic effects of the insertion of laryngeal mask airway supreme (LMA-S) and classic (LMA-C) with laryngoscopy and Endotracheal Intubation (ETT). Patients and Methods: This study was a prospective, double-blind, and randomized clinical trial conducted on 150 patients aged 18 to 50 years with ASA I (American Society of Anesthesiologists), in the general operating room of Shahid Mohammadi hospital, Hormozgan university of medical sciences, Bandar Abbas, Iran. In the ETT group, endotracheal intubation was performed using the Macintosh laryngoscope; while for the LMA-C and LMA-S groups, LMA Classic and LMA Supreme were inserted, respectively. The induction and maintenance of anesthesia were similar in all patients. The hemodynamic parameters such as heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured before (baseline) and after induction of anesthesia at 4 different time points. The statistical analysis was done and P value less than 0.05 was considered significant. Results: Participants in all groups were similar in terms of gender, age, weight, height, and Mallampati class. The mean ± SD of SBPs (105.62 ± 12.12, 112.90 ± 12.2, and 112.48 ± 15.14 mm Hg, respectively for ETT, LMA-C, and LMA-S) and DBPs (64.64 ± 10.23, 73.78 ± 9.70, and 71.20 ± 12.27 mm Hg, respectively for ETT, LMA-C, and LMA-S) were significantly lower in the ETT group compared to LMA groups 5 minutes after device insertion (P < 0.01 for SBPs and P < 0.001 for DBPs); however these values were lower than the baseline values in all groups. There were no differences in the mean SBP and DBPs between the three groups at the other time points. The mean

  7. Endotracheal tube fires during carbon dioxide laser surgery on the larynx--a case report.

    PubMed

    Kuo, C H; Tan, P H; Chen, J J; Peng, C H; Lee, C C; Chung, H C; Tseng, C K

    2001-03-01

    Endotracheal tube (ETT) fire is a catastrophic disaster that may occur during laser surgery of the upper airway. Several means are available for protection of polyvinyl chloride (PVC) tube from fire, but they are not perfect in prevention of fires caused by laser beam. The PVC tube is hazardous for carbon dioxide (CO2) laser surgery if it is not well wrapped with metallized foil tape. We report a case that a PVC ETT wrapped with aluminum foil ignited during CO2 laser surgery of the larynx. In this report, we emphasize the shaft of the PVC tube must be completely wrapped with aluminum foil to prevent exposure of any surface if it is used in CO2 laser surgery of the upper aero digestive tract. PMID:11407297

  8. 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

  9. Children's implicit learning of graphotactic and morphological regularities.

    PubMed

    Pacton, Sébastien; Fayol, Michel; Perruchet, Pierre

    2005-01-01

    In French, the transcription of the same sound can be guided by both probabilistic graphotactic constraints (e.g., /epsilon t/ is more often transcribed ette after -v than after -f) and morphological constraints (e.g., /epsilon t/ is always transcribed ette when used as a diminutive suffix). Three experiments showed that pseudo-word spellings of 8-to 11-year-old children and adults were influenced by both types of constraints. The influence of graphotactic regularities persisted when reliance on morphological rules was possible, without any falling off as a function of age. This suggests that rules are not abstracted, even after massive amounts of exposure to a rule-based material. These results can be accounted for by a statistical model of implicit learning. PMID:15784085

  10. 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.

  11. [Successful Use of the i-gel and Dexmedetomidine for Tracheal Resection and Construction Surgery in a Patient with Severe Tracheal Stenosis].

    PubMed

    Kashii, Tomoko; Nabatame, Maki; Okura, Nahomi; Fujinaga, Ayumi; Namoto, Kazuko; Mori, Masafumi; Tsujimura, Shigehisa

    2016-04-01

    A 51-year-old man, 170 cm, 86 kg, was diagnosed with a tracheal tumor existing just below the glottis occupying more than 80% of his tracheal lumen, and was scheduled for tracheal resection and construction. The patient had a strider due to the severe tracheal stenosis. We could insert i-gel easily under dexmedetomidine sedation. After successful i-gel insertion, tracheotomy and endotracheal intubation were performed. Until ETT insertion, the patient maintained spontaneous respiration without any hypoxic event. Followed by ETT insertion, tracheal resection and construction were performed under general anesthesia. After the operation, the patient was extubated and transferred to the intensive care unit (ICU), where he was given DEX infusion to keep the tracheal anastomosis immobilized. There was no serious complication during the perioparative period. PMID:27188107

  12. 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

  13. Respiratory and hemodynamic outcomes following exchange extubation with laryngeal mask airway as compared to traditional awake extubation

    PubMed Central

    Suppiah, Ramanathan Kannan; Rajan, Sunil; Paul, Jerry; Kumar, Lakshmi

    2016-01-01

    Background: Traditional awake extubation leads to respiratory complications and hemodynamic response which are detrimental in neurosurgery, ENT surgery and patients with comorbidities. Aims: The primary objective was to compare the respiratory complications and hemodynamic stress response between traditional awake extubation of a endotracheal tube (ETT) and that following exchange extubation of ETT by using a laryngeal mask airway (LMA). Settings and Design: This prospective randomized study was conducted in a Tertiary Care Centre in 60 American Society of Anesthesiologists I and II patients coming for general surgery. Materials and Methods: Patients were randomized by permuted blocks into traditional awake extubation group and exchange extubation group. At the end of surgery in traditional group, awake extubation of ETT was done. In exchange group, 0.3 mg/kg propofol was administered, and the ETT was exchanged for a LMA. Awake extubation of LMA was then performed. Respiratory complications such as bucking, coughing, desaturation and the need for airway maneuvers and hemodynamic response were noted in both groups. Analysis Tools: Chi-square test, independent sample t- and paired t-tests were used as applicable. Results: Incidence of respiratory complication was 93.3% in traditional extubation while it was only 36.7% in exchange extubation group (P < 0.001). Hemodynamic response measured immediately at extubation in terms of heart rate, systolic blood pressure (BP), diastolic BP, mean arterial pressure, and rate pressure product were all significantly lesser in exchange group when compared to traditional extubation. Conclusion: Exchange extubation with LMA decreases respiratory complications and hemodynamic stress response when compared to traditional awake extubation. PMID:27212749

  14. The changes of endotracheal tube cuff pressure by the position changes from supine to prone and the flexion and extension of head

    PubMed Central

    Kim, Deokkyu; Jeon, Byeongdo; Son, Ji-Seon; Lee, Jun-Rae; Ko, Seonghoon

    2015-01-01

    Background The proper cuff pressure is important to prevent complications related to the endotracheal tube (ETT). We evaluated the change in ETT cuff pressure by changing the position from supine to prone without head movement. Methods Fifty-five patients were enrolled and scheduled for lumbar spine surgery. Neutral angle, which was the angle on the mandibular angle between the neck midline and mandibular inferior border, was measured. The initial neutral pressure of the ETT cuff was measured, and the cuff pressure was subsequently adjusted to 26 cmH2O. Flexed or extended angles and cuff pressure were measured in both supine and prone positions, when the patient's head was flexed or extended. Initial neutral pressure in prone was compared with adjusted neutral pressure (26 cmH2O) in supine. Flexed and extended pressure were compared with adjusted neutral pressure in supine or prone, respectively. Results There were no differences between supine and prone position for neutral, flexed, and extended angles. The initial neutral pressure increased after changing position from supine to prone (26.0 vs. 31.5 ± 5.9 cmH2O, P < 0.001). Flexed and extended pressure in supine were increased to 38.7 ± 6.7 (P < 0.001) and 26.7 ± 4.7 cmH2O (not statistically significant) than the adjusted neutral pressure. Flexed and extended pressure in prone were increased to 40.5 ± 8.8 (P < 0.001) and 29.9 ± 8.7 cmH2O (P = 0.002) than the adjusted neutral pressure. Conclusions The position change from supine to prone without head movement can cause a change in ETT cuff pressure. PMID:25664152

  15. A randomized control study comparing the pharyngolaryngeal morbidity of laryngeal mask airway versus endotracheal tube

    PubMed Central

    Venugopal, A.; Jacob, Ron Mathew; Koshy, Rachel Cherian

    2016-01-01

    Introduction: Endotracheal tube (ETT) has been associated with various pharyngolaryngeal morbidities (PLMs) following general anesthesia (GA). Laryngeal mask airway (LMA), currently the most commonly used supraglottic airway device, has several advantageous over the ETT but has been associated with varying results of PLM. The aim of our study was to compare the PLM between them and to know whether LMA is a better alternative. Materials and Methods: One hundred and seventy American Society of Anesthesiologists Grades 1 and 2 women scheduled for elective mastectomy were included in the study, 85 each in either group, E Group (intubated with ETT) and L Group (using LMA) on a random basis. All patients received GA with controlled ventilation using a muscle relaxant. PLMs such as hoarseness, pain on phonation, sore throat, and difficulty in swallowing were documented by an interview done postoperatively. Peroperative parameters such as intubation attempts, trauma during airway device insertion, and intraoperative incidents were also analyzed. A sample size of 85 patients in each group was calculated in order to achieve a study power of 0.8 and alpha level was taken as 0.05. Data were analyzed using SPSS version 16 using Chi-square test, Mann–Whitney U-test and Fisher's exact test were used as nonparametric tests. A two-tailed P< 0.05 was considered significant. Results: Patients in E Group had statistically significant increased incidence of a sore throat and voice complaints whereas L Group showed a statistically significant increase of swallowing problems. There was also a significant correlation between traumatic insertion and sore throat, pain on swallowing in the L Group, which could be due to direct trauma. Conclusions: ETT was associated with an increased incidence of voice problems and sore throat whereas LMA had an increased incidence of dysphagia and odynophagia. Use of LMA changes the pharyngolaryngeal profile to a more acceptable one. PMID:27212745

  16. 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.

  17. 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.

  18. Incidental diagnosis of an H-type tracheo-oesophageal fistula.

    PubMed

    Donnelly, Peter; McVea, Steven; Flannigan, Christopher; Bali, Sanjeev

    2016-06-29

    A 6-day-old term neonate who was intubated on day 1 of life for apnoeic episodes, was transferred to the regional paediatric intensive care unit (PICU) for specialist opinion following 3 failed extubations in the neonatal unit. Escherichia coli congenital pneumonia was diagnosed and the child discharged to the local hospital. Chest radiographs and inflammatory markers were in keeping with infection. However, ongoing difficulties with secretions necessitated readmission to the PICU, following a significant cyanotic episode associated with coughing. On arrival at the PICU, a large leak around the endotracheal tube (ETT) was noted. On direct laryngoscopy, the ETT was found correctly positioned, through the cords, but air was noted to be coming back from the oesophagus. Advancing the ETT towards the carina terminated the leak and raised the suspicion of a tracheo-oesophageal fistula. An H-type tracheo-oesophageal fistula was confirmed on bronchoscopy. An uneventful fistula repair was performed and the baby discharged from the PICU on day 23 of life.

  19. Fluid flow and particle transport in mechanically ventilated airways. Part II: particle transport.

    PubMed

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

    2016-07-01

    The flow mechanisms that play a role on aerosol deposition were identified and presented in a companion paper (Timothy et al. in Med Biol Eng Comput. doi: 10.1007/s11517-015-1407-3 , 2015). In the current paper, the effects of invasive conventional mechanical ventilation waveforms and endotracheal tube (ETT) on the aerosol transport were investigated. 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 jet caused by the ETT. The orientation of the ETT toward right bronchus resulted in a substantial deposition inside right lung compared to left lung. The deposition inside right lung was ~12-fold higher than left lung for all considered cases, except for the case of using pressure-controlled sinusoidal waveform where a reduction of this ratio by ~50 % was found. The total deposition during pressure constant, volume ramp, and ascending ramp waveforms was similar and ~1.44 times higher than deposition fraction when using pressure sinusoidal waveform. Varying respiratory waveform demonstrated a significant role on the deposition enhancement factors and give evidence of drug aerosol concentrations in key deposition sites, which may be significant for drugs with negative side effects in high concentrations. These observations are thought to be important for ventilation treatment strategy. PMID:26541600

  20. Epithelioid trophoblastic tumor of the uterus in a postmenopausal woman: a case report and review of the literature.

    PubMed

    Coulson, L E; Kong, C S; Zaloudek, C

    2000-11-01

    We report an epithelioid trophoblastic tumor (ETT), a recently delineated type of gestational trophoblastic tumor (GTT), discovered in the uterus of a 66-year-old woman. She had been treated for a hydatidiform mole 17 years previously without chemotherapy. The resected uterus contained a solid/cystic tumor located entirely within the myometrium. Microscopically, there was an epithelial-like growth pattern. The tumor was circumscribed, with a pushing border, and the tumor cells grew in cords, nests, and sheets within which were aggregates of hyaline material and necrotic debris. Most tumor cells were mononuclear and had an epithelioid appearance with distinct cell borders, eosinophilic cytoplasm, and nuclei with occasional indistinct nucleoli. Scattered multinucleated cells consistent with syncytiotrophoblastic cells were also present. Immunohistochemical staining revealed strong diffuse reactivity for cytokeratins (CK7, AE1/AE3, CAM 5.2, CK18) and epidermal growth factor receptor, and focal reactivity, mainly in syncytiotrophoblastic cells, for beta-human chorionic gonadotropin, human placental lactogen, and inhibin-alpha. The histologic and immunohistochemical features were characteristic of ETT, and helped to distinguish the tumor from other trophoblastic tumors and squamous cell carcinoma. An unusual observation was a high mitotic count, reflected in a Ki-67 proliferative index of 68.6%. Our findings indicate that ETT, like other types of GTT, can occur in postmenopausal women, even years after a gestational event.

  1. Intracuff alkalized lidocaine reduces sedative/analgesic requirements for mechanically ventilated patients

    PubMed Central

    Basuni, Ahmed Sobhy

    2014-01-01

    Background: The objective of this study is to investigate the effect of intracuff alkalized lidocaine on sedative/analgesic requirements for mechanically ventilated patients and its consequence on patient-ventilator interaction. Materials and Methods: A total of 64 patients who expected to require ventilatory support for a period of more than 48 h were randomly assigned to groups S and L. In group S, the endotracheal tube (ETT) cuffs were inflated with normal saline. In group L, the ETT cuffs were inflated with lidocaine 2% and sodium bicarbonate 8.4%. The investigator and the surgical intensive care unit staff were blinded to the nature of cuff-filled solutions. Sedation was maintained with propofol and fentanyl infusions. The total requirements for propofol and fentanyl, frequency and severity of cough and number of ineffective triggering during the first 24 h of mechanical ventilation were recorded. Results: There was a significant reduction (about 30%) in the requirements for propofol and fentanyl in patients who received intracuff alkalinized lidocaine; P < 0.001. The frequency and severity of cough were significantly lower in group L compared with group S and the frequency of ineffective triggering was significantly lower in group L; P < 0.001 for both comparisons. Conclusion: Intracuff alkalized lidocaine increases ETT tolerance and hence, decreases sedatives/analgesics requirements for mechanically ventilated patients. This results in improved patient-ventilator synchronization. PMID:25422600

  2. 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

  3. 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

  4. 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.

  5. A model for an early role of auxin in Arabidopsis gynoecium morphogenesis

    PubMed Central

    Hawkins, Charles; Liu, Zhongchi

    2014-01-01

    The female reproductive organ of angiosperms, the gynoecium, often consists of the fusion of multiple ovule-bearing carpels. It serves the important function of producing and protecting ovules as well as mediating pollination. The gynoecium has likely contributed to the tremendous success of angiosperms over their 160 million year history. In addition, being a highly complex plant organ, the gynoecium is well suited to serving as a model system for use in the investigation of plant morphogenesis and development. The longstanding model of gynoecium morphogenesis in Arabidopsis holds that apically localized auxin biosynthesis in the gynoecium results in an apical to basal gradient of auxin that serves to specify along its length the development of style, ovary, and gynophore in a concentration-dependent manner. This model is based primarily on the observed effects of the auxin transport blocker N-1-naphthylphthalamic acid (NPA) as well as analyses of mutants of Auxin Response Factor (ARF) 3/ETTIN (ETT). Both NPA treatment and ett mutation disrupt gynoecium morphological patterns along the apical–basal axis. More than a decade after the model’s initial proposal, however, the auxin gradient on which the model critically depends remains elusive. Furthermore, multiple observations are inconsistent with such an auxin-gradient model. Chiefly, the timing of gynoecium emergence and patterning occurs at a very early stage when the organ has little-to-no apical–basal dimension. Based on these observations and current models of early leaf patterning, we propose an alternate model for gynoecial patterning. Under this model, the action of auxin is necessary for the early establishment of adaxial–abaxial patterning of the carpel primordium. In this case, the observed gynoecial phenotypes caused by NPA and ett are due to the disruption of this early adaxial–abaxial patterning of the carpel primordia. Here we present the case for this model based on recent literature and

  6. 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.

  7. 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

  8. 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.

  9. Retrograde and submental intubation.

    PubMed

    Ramsey, Cyrus A; Dhaliwal, Sukhdeep S

    2010-03-01

    Direct laryngoscopy remains the technique of choice for placing an endotracheal tube (ETT). However, alternative techniques are needed for the difficult airway or unsuccessful intubation. Retrograde intubation may be used in adult or pediatric patients, whether awake, sedated, or obtunded. Contraindications include nonpalpable neck landmarks, pretracheal mass, severe flexion deformities of the neck, tracheal stenosis, coagulopathies, and infections. Submental intubation allows simultaneous access to the dental occlusion and nasal pyramid without the morbidity associated with tracheostomy. Contraindications include patients who require long periods of assisted ventilation and a severe traumatic wound on the floor of mouth. Complications include localized infection and sepsis, poor wound healing or scarring, and postoperative salivary fistula.

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

    PubMed Central

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

    2014-01-01

    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. PMID:25191201

  11. Fibre reinforcement in a structurally compromised endodontically treated molar: a case report

    PubMed Central

    de Ataide, Ida de Noronha; Fernandes, Marina; Lambor, Rajan

    2016-01-01

    The reconstruction of structurally compromised posterior teeth is a rather challenging procedure. The tendency of endodontically treated teeth (ETT) to fracture is considerably higher than vital teeth. Although posts and core build-ups followed by conventional crowns have been generally employed for the purpose of reconstruction, this procedure entails sacrificing a considerable amount of residual sound enamel and dentin. This has drawn the attention of researchers to fibre reinforcement. Fibre-reinforced composite (FRC), designed to replace dentin, enables the biomimetic restoration of teeth. Besides improving the strength of the restoration, the incorporation of glass fibres into composite resins leads to favorable fracture patterns because the fibre layer acts as a stress breaker and stops crack propagation. The following case report presents a technique for reinforcing a badly broken-down ETT with biomimetic materials and FRC. The proper utilization of FRC in structurally compromised teeth can be considered to be an economical and practical measure that may obviate the use of extensive prosthetic treatment. PMID:27200283

  12. 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.

  13. Airway accidents in critical care unit: A 3-year retrospective study in a Public Teaching Hospital of Eastern India

    PubMed Central

    Dasgupta, Sugata; Singh, Shipti Shradha; Chaudhuri, Arunima; Bhattacharya, Dipasri; Choudhury, Sourav Das

    2016-01-01

    Background: Although tracheal tubes are essential devices to control and protect airway in a critical care unit (CCU), they are not free from complications. Aims: To document the incidence and nature of airway accidents in the CCU of a government teaching hospital in Eastern India. Methods: Retrospective analysis of all airway accidents in a 5-bedded (medical and surgical) CCU. The number, types, timing, and severity of airway accidents were analyzed. Results: The total accident rate was 19 in 233 intubated and/or tracheostomized patients over 1657 tube days (TDs) during 3 years. Fourteen occurred in 232 endotracheally intubated patients over 1075 endotracheal tube (ETT) days, and five occurred in 44 tracheostomized patients over 580 tracheostomy TDs. Fifteen accidents were due to blocked tubes. Rest four were unplanned extubations (UEs), all being accidental extubations. All blockages occurred during night shifts and all UEs during day shifts. Five accidents were mild, the rest moderate. No major accident led to cardiorespiratory arrest or death. All blockages occurred after 7th day of intubation. The outcome of accidents were more favorable in tracheostomy group compared to ETT group (P = 0.001). Conclusions: The prevalence of airway accidents was 8.2 accidents per 100 patients. Blockages were the most common accidents followed by UEs. Ten out of the 15 blockages and all 4 UEs were in endotracheally intubated patients. Tracheostomized patients had 5 blockages and no UEs. PMID:27076709

  14. 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. PMID:26563199

  15. 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.

  16. The role of SEUSS in auxin response and floral organ patterning.

    PubMed

    Pfluger, Jennifer; Zambryski, Patricia

    2004-10-01

    Genetic and physiological analyses implicate auxin flux in patterning, initiation and growth of floral organs. Within the Arabidopsis flower, the ETTIN/ARF3 transcription factor responds to auxin to effect perianth organ number and reproductive organ differentiation. This work describes a modifier of ettin that causes filamentous, mispositioned outer whorl organs and reduced numbers of malformed stamens in the double mutant. The modifier was discovered to be a new allele of the seuss (seu) mutant. SEU encodes a novel protein that is predicted to transcriptionally co-repress the AGAMOUS floral organ identity gene. The effects of seu on ett are shown to be independent of the SEU-AG pathway. Furthermore, morphological, physiological and genetic evidence implicate SEU in auxin-regulated growth and development. seu has a pleiotropic phenotype that includes reductions in several classic auxin responses such as apical dominance, lateral root initiation, sensitivity to exogenous auxin and activation of the DR5 auxin response reporter. seu displays a synergistic interaction with the auxin response mutant pinoid, producing flowers with few outer whorl organs. Collectively, these data suggest that SEU is a novel factor affecting auxin response. A model is proposed in which SEU functions jointly with ETT in auxin response to promote floral organ patterning and growth.

  17. 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

  18. 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

  19. 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

  20. 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. PMID:26734314

  1. Archaeology and direct imaging of exoplanets

    NASA Astrophysics Data System (ADS)

    Campbell, John B.

    The search for extraterrestrial technology effectively began 45 years ago with Frank Drake's Project Ozma and a radioastronomy start to the search for extraterrestrial intelligence (SETI). Eventually searches began for possible interstellar probes in stable orbits in the Solar System, as well as for infrared excesses from possible Dyson spheres round Sun-like stars. Whilst the Cold War was still underway, some scientists looked for evidence of nuclear waste dumps and nuclear wars elsewhere in the Milky Way. None of this work was carried out by archaeologists, even though by their very nature archaeologists are experts in the detection of ancient technologies. The technologies being searched for would have been partly ancient in age though advanced in techniques and science. The development of ESA's Darwin and NASA's TPF for detection and imaging of Earth-like exoplanets in our galactic neighbourhood represents an opportunity for the testing of techniques for detecting signatures of technological activities. Ideally, both Darwin and TPF might be able to provide spectroscopic data on the chemistry and biochemistry of the atmospheres of Earth-like exoplanets, and thus to detect some of the signs of life. If this can be accomplished successfully, then in theory evidence for pollution and nuclear accidents and wars should be detectable. Some infrared signatures of ETT on or round exoplanets might be detectable. Direct visual imaging of ETT structures will probably not be feasible till we have extremely powerful interstellar telescopes or actually send orbital craft.

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

    PubMed

    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; Machida, Yasunori

    2016-01-01

    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

  3. Postprocedural chest radiograph: Impact on the management in critical care unit.

    PubMed

    Gupta, Prashant K; Gupta, Kumkum; Jain, Manish; Garg, Tanuj

    2014-01-01

    Postprocedural chest radiograph is done to illustrate the position of endotracheal tubes (ETTs), nasogastric and drainage tubes, indwelling catheters, and intravascular lines or any other lifesaving devices to confirm their position. These devices are intended to save life, but may be life-threatening if in the wrong place. The incidence of malposition and complications ranges from 3% to 14%, respectively. The portable chest radiograph is of tremendous value, inexpensive and can be obtained quickly at the patient's bedside in any location of the hospital. A systemic literature search was performed in PubMed and the Cochranre library by setting up the search using either single text word or combinations. Those studies were also included where the chest radiograph was compared with other imaging modalities. Its clinical efficacy, cost-effectiveness and practicality allow anesthesiologist to evaluate the post-procedural position and complications of ETT, indwelling catheters, and multi lumen intravascular lines. Knowledge of the radiological features of commonly used devices is of utmost importance. PMID:25886216

  4. Core-Level Crossing and the High-Pressure Equation of State of Heavy Elements

    NASA Astrophysics Data System (ADS)

    Wills, John

    2015-06-01

    The structural properties of the 5d transition metal osmium have recently been probed at static pressures up to ~ 770 GPa. In this study, anomalies in the hcp c/a ratio were found at pressures of in the vicinity of 150 GPa and 440 GPa. The anomaly at 150 GPa approximately coincides in pressure with an electron topological transition (ETT) observed in Density Functional Theory (DFT) band structure. However, no ETT is observed at higher pressures. Instead, we find that the anomaly in the c / a ratio of osmium is correlated with the crossing of the 5p3 / 2 and 4f7 / 2 ``core'' levels, which at this pressure are found to have bandwidths ~ .2-.3 Ry, in our DFT calculations. In this talk, I discuss the calculated structural properties and calculated equation of state of osmium and other heavy 5d elements at pressures less than 1 TPa and the effect of core-level crossing on the equation of state and structural properties of these elements.

  5. 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

  6. A case of sick building syndrome in a Japanese office worker.

    PubMed

    Nakazawa, Hiroko; Ikeda, Hiroki; Yamashita, Toshio; Hara, Ichiro; Kumai, Yuko; Endo, Ginji; Endo, Yoko

    2005-04-01

    The adverse health effects caused by indoor air pollution are termed "sick building syndrome". We report such a patient whose symptoms appeared in the workplace. A 36-year-old female office worker developed nausea and headache during working hours in a refurbished office. After eight months of seeking help at other clinics or hospitals without improvement, she was referred to our hospital. At that time she reacted to the smells of various chemicals outside of the office building. Biochemical findings were all within normal ranges. Specific IgE antibody to cedar pollen was positive and the ratio of TH1/TH2 was 4.5. In the Eye Tracking Test (ETT), vertical eye movement was saccadic. Her anxiety level was very high according to the State-Trait Anxiety Inventory (STAI) questionnaire. Subjective symptoms, ETT findings and anxiety levels on STAI gradually improved during two years of follow-up. One year after the onset of her illness, the formaldehyde concentrations in the building air ranged from 0.017-0.053 ppm. Even though relatively low, chemical exposure from building materials such as formaldehyde induced a range of symptoms. Also, lack of recognition by superiors and doctors that sick building syndrome might have been the source of her illness coupled with her high state of anxiety may have exacerbated her symptoms and led to the onset of multiple chemical sensitivity. Thus psychosocial factors may contribute to sick building syndrome in the workplace.

  7. 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

  8. Effect of age on 16.1-km time-trial performance.

    PubMed

    Balmer, James; Bird, Steve; Davison, Richard; Lucia, Alejandro

    2008-01-15

    In this study, we assessed the performance of trained senior (n = 6) and veteran (n = 6) cyclists (mean age 28 years, s = 3 and 57 years, s = 4 respectively). Each competitor completed two cycling tests, a ramped peak aerobic test and an indoor 16.1-km time-trial. The tests were performed using a Kingcycle ergometer with the cyclists riding their own bicycle fitted with an SRM powermeter. Power output, heart rate, and gas exchange variables were recorded continuously and blood lactate concentration [HLa] was assessed 3 min after the peak ramped test and at 2.5-min intervals during the time-trial. Peak values for power output (RMP(max)), heart rate (HR(peak)), oxygen uptake (VO2(peak)), and ventilation (V(Epeak)) attained during the ramped test were higher in the senior group (P < 0.05), whereas [HLa](peak), RER(peak), V(E): VO2(peak), and economy(peak) were similar between groups (P > 0.05). Time-trial values (mean for duration of race) for power output (W(TT)), heart rate (HR(TT)), VO2 (VO(2TT)), and V(E) (V(ETT)) were higher in the seniors (P < 0.05), but [HLa](TT), RER(TT), V(ETT): VO2(TT), and economy(TT) were similar between the groups (P > 0.05). Time-trial exercise intensity, expressed as %RMP(max), %HR(peak), % VO2(peak), and % V(Epeak), was similar (P > 0.05) for seniors and veterans (W(TT): 81%, s = 2 vs. 78%, s = 8; HR(TT): 96%, s = 4 vs. 94%, s = 4; VO2(TT): 92%, s = 4 vs. 95%, s = 10; V(ETT): 89%, s = 8 vs. 85%, s = 8, respectively). Overall, seniors attained higher absolute values for power output, heart rate, VO2, and V(E) but not blood lactate concentration, respiratory exchange ratio (RER), V(E): VO2, and economy. Veterans did not accommodate age-related declines in time trial performance by maintaining higher relative exercise intensity.

  9. 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

  10. Role of upper airway ultrasound in airway management.

    PubMed

    Osman, Adi; Sum, Kok Meng

    2016-01-01

    Upper airway ultrasound is a valuable, non-invasive, simple, and portable point of care ultrasound (POCUS) for evaluation of airway management even in anatomy distorted by pathology or trauma. Ultrasound enables us to identify important sonoanatomy of the upper airway such as thyroid cartilage, epiglottis, cricoid cartilage, cricothyroid membrane, tracheal cartilages, and esophagus. Understanding this applied sonoanatomy facilitates clinician to use ultrasound in assessment of airway anatomy for difficult intubation, ETT and LMA placement and depth, assessment of airway size, ultrasound-guided invasive procedures such as percutaneous needle cricothyroidotomy and tracheostomy, prediction of postextubation stridor and left double-lumen bronchial tube size, and detecting upper airway pathologies. Widespread POCUS awareness, better technological advancements, portability, and availability of ultrasound in most critical areas facilitate upper airway ultrasound to become the potential first-line non-invasive airway assessment tool in the future. PMID:27529028

  11. 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

  12. The frequency and importance of bronchial hyperreactivity in patients with allergic and non-allergic rhinitis.

    PubMed

    Dziedziczko, A; Gniazdowski, R

    1977-01-01

    A trial was undertaken to evaluate the occurrence of bronchial hyperreactivity, typical of bronchial asthma, in 50 patients with hay fever (rhinitis allergica) and 45 patients with rhinitis vasomotorica nonallergica, as opposed to a group of healthy subjects and patients with bronchial asthma. All the patients were subjected to spirographic examinations at rest (VC, FEV1, ETT, SI), after exercise (PWC170), and after histamine inhalation. The authors believe that it is expedient to study bronchial hyperreactivity in patients with hay fever and rhinitis vasomotorica nonallergica in that it affords possibilities for the prevision of the conceivable unfavourable evolution of the disease towards the atopic or non-atopic bronchial asthma, as well as for the taking of adequate preventive and therapeutic measures. PMID:920144

  13. The Making of a Best-Selling Book on Reproduction: Lennart Nilsson's A Child Is Born.

    PubMed

    Jülich, Solveig

    2015-01-01

    This article examines the 1965 first edition of Swedish photographer Lennart Nilsson's Ett barn blir till (A Child Is Born) by placing the book back in the historical context in which it was produced, marketed, and reviewed. In particular it shows how medicine and the media in Sweden were intertwined in the process of incorporating Nilsson's photographs of aborted embryos and fetuses into a best-selling book on the origin and development of human life. Nilsson's work is related to other books in the same genre as well as the popular picture magazines of the time, in order to highlight how it aspired to offer something new. It is argued that a number of commercial and other interests were involved and that an immense effort went into not only making and promoting the book but also trying to control the meaning of the images.

  14. 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

  15. Role of upper airway ultrasound in airway management.

    PubMed

    Osman, Adi; Sum, Kok Meng

    2016-01-01

    Upper airway ultrasound is a valuable, non-invasive, simple, and portable point of care ultrasound (POCUS) for evaluation of airway management even in anatomy distorted by pathology or trauma. Ultrasound enables us to identify important sonoanatomy of the upper airway such as thyroid cartilage, epiglottis, cricoid cartilage, cricothyroid membrane, tracheal cartilages, and esophagus. Understanding this applied sonoanatomy facilitates clinician to use ultrasound in assessment of airway anatomy for difficult intubation, ETT and LMA placement and depth, assessment of airway size, ultrasound-guided invasive procedures such as percutaneous needle cricothyroidotomy and tracheostomy, prediction of postextubation stridor and left double-lumen bronchial tube size, and detecting upper airway pathologies. Widespread POCUS awareness, better technological advancements, portability, and availability of ultrasound in most critical areas facilitate upper airway ultrasound to become the potential first-line non-invasive airway assessment tool in the future.

  16. 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.

  17. Variability of the breathing pattern before and after extubation.

    PubMed

    Krieger, B P; Chediak, A; Gazeroglu, H B; Bizousky, F P; Feinerman, D

    1988-04-01

    A stable breathing pattern during unassisted ventilation through an endotracheal tube (ETT) prior to extubation is an important factor in determining whether a patient can be successfully extubated. Proper interpretation of changes in the breathing pattern requires knowledge of the normal variability of the breathing pattern in critically ill, intubated patients. To establish these guidelines, 50 spontaneously breathing patients who were being weaned from mechanical ventilation were monitored with respiratory inductive plethysmography for one hour immediately prior to and following successful extubation. Immediately after extubation, respiratory rate (f), tidal volume (VT), minute ventilation, and mean inspiratory flow increased slightly. By 30 minutes postextubation, these parameters were similar to preextubation values. There was no significant change in variability of f or VT. Although the breathing pattern of these relatively stable, intensive care patients differed from values of normal ambulatory subjects, values were similar in the preextubation and postextubation periods.

  18. Inelastic neutron scattering from single crystal Zn under high pressure

    NASA Astrophysics Data System (ADS)

    Morgan, J. G.; von Dreele, R. B.; Wochner, P.; Shapiro, S. M.

    1996-07-01

    Inelastic neutron-scattering experiments have been performed for single crystals of Zn under pressures up to 8.8 GPa at 300 K. The phonon modes q/qmax=ξ=0.075 and ξ=0.10 were measured in the transverse acoustic branch Σ3, where q=0 corresponds with the elastic constant C44. The phonon energy showed a substantial hardening with increasing pressure. The experimental data below 6.8 GPa for ξ=0.075 yield a constant Grüneisen mode γi=-lnωi/lnV of 2.25 in good agreement with a previous calculation [H. Ledbetter, Phys. Status Solidi B 181, 81 (1994)]. Above 6.8 GPa, there is a very rapid increase of γi which is indicative of the presence of a giant Kohn anomaly. This rapid divergence at high pressure indicates that a phonon softening may occur at pressures higher than 8.8 GPa caused by the collapse of the giant Kohn anomaly via an electronic topological transition (ETT). In an earlier Mössbauer Zn study at 4 K [W. Potzel et al., Phys. Rev. Lett. 74, 1139 (1994)], a drastic drop of the Lamb-Mössbauer factor was observed at 6.6 GPa, which was interpreted as being due to phonon softening, indicating this ETT had occurred. This paper also compares the compressibility data for single crystal Zn and Zn powder using neutron scattering. The results were found to be similar to an earlier x-ray Zn powder experiment [O. Schulte et al., High Pressure Res. 6, 169 (1991)].

  19. Determinants of developing diabetes mellitus and vascular complications in patients with impaired fasting glucose

    PubMed Central

    Sharifi, Faranak; Jaberi, Yahya; Mirzamohammadi, Fatemeh; Mirzamohammadi, Hamid; Mousavinasab, Nouraddin

    2013-01-01

    Aims: To detect the risk factors of diabetes mellitus (DM) and cardiovascular complications in subjects with impaired fasting glucose (IFG). Materials and Methods: One hundred and twenty three subjects with proved IFG in Zanjan Healthy Heart Study (2002-2003) were recalled and participated in this study (2009-2010). Demographic and laboratoryinformation of the participants were collected.Ischemic heart disease (IHD) was assessed by the exercise tolerance test (ETT). All the subjects with abnormal ETT or documented past history of IHD confirmed by angiographic evaluation. Ophthalmic complications including cataract, glaucoma, and diabetic retinopathy were estimated by an ophthalmologist. Results: Incidence of DM was 19.5%. All the diabetic and pre-diabetic patients had at least one of the other components of metabolic syndrome. Obesity (P: 0.04, OR: 1.8, 95%CI: 1.2-9) and low physical activity (P < 0.001, OR: 9.6, 95%CI: 3.4-32) were the only independent prognostic risk factors for progression to DM in patients with IFG. Total incidence of IHD was 14.6% and had a strong correlation with sex (P: 0.01, OR: 1.8, 95%CI: 1.2-1.5), age (P < 0.001, OR: 23, 95%CI: 2.1-67) and cigarette smoking (P < 0.001, OR: 36.5, 95%CI: 3.9-337). Non-proliferative diabetic retinopathy was shown in 2 (1.6%) subjects who were all women. Conclusion: Obesity and low physical activity are the main factors of developing DM and its macrovascular complications in subjects with IFG. PMID:24083174

  20. The complex of ASYMMETRIC LEAVES (AS) proteins plays a central role in antagonistic interactions of genes for leaf polarity specification in Arabidopsis.

    PubMed

    Machida, Chiyoko; Nakagawa, Ayami; Kojima, Shoko; Takahashi, Hiro; Machida, Yasunori

    2015-01-01

    Leaf primordia are born around meristem-containing stem cells at shoot apices, grow along three axes (proximal-distal, adaxial-abaxial, medial-lateral), and develop into flat symmetric leaves with adaxial-abaxial polarity. Axis development and polarity specification of Arabidopsis leaves require a network of genes for transcription factor-like proteins and small RNAs. Here, we summarize present understandings of adaxial-specific genes, ASYMMETRIC LEAVES1 (AS1) and AS2. Their complex (AS1-AS2) functions in the regulation of the proximal-distal leaf length by directly repressing class 1 KNOX homeobox genes (BP, KNAT2) that are expressed in the meristem periphery below leaf primordia. Adaxial-abaxial polarity specification involves antagonistic interaction of adaxial and abaxial genes including AS1 and AS2 for the development of two respective domains. AS1-AS2 directly represses the abaxial gene ETTIN/AUXIN RESPONSE FACTOR3 (ETT/ARF3) and indirectly represses ETT/ARF3 and ARF4 through tasiR-ARF. Modifier mutations have been identified that abolish adaxialization and enhance the defect in the proximal-distal patterning in as1 and as2. AS1-AS2 and its modifiers synergistically repress both ARFs and class 1 KNOXs. Repression of ARFs is critical for establishing adaxial-abaxial polarity. On the other hand, abaxial factors KANADI1 (KAN1) and KAN2 directly repress AS2 expression. These data delineate a molecular framework for antagonistic gene interactions among adaxial factors, AS1, AS2, and their modifiers, and the abaxial factors ARFs as key regulators in the establishment of adaxial-abaxial polarity. Possible AS1-AS2 epigenetic repression and activities downstream of ARFs are discussed.

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

    PubMed

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

    2016-03-01

    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.

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

    PubMed

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

    2016-03-01

    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

  3. 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

  4. 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

  5. Evidence of Long-Lived Founder Virus in Mother-to-Child HIV Transmission

    PubMed Central

    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. PMID:25793402

  6. Thermal protein denaturation and protein aggregation in cells made thermotolerant by various chemicals: role of heat shock proteins.

    PubMed

    Kampinga, H H; Brunsting, J F; Stege, G J; Burgman, P W; Konings, A W

    1995-08-01

    Thermotolerance (TT) induced by sodium arsenite (A-TT: 100 microM, 1 h, 37 degrees C) was compared to heat-induced thermotolerance (H-TT: 15 min, 44 degrees C) using HeLa S3 cells. All four pretreatments led to comparable levels of thermotolerance and also induced resistance to arsenite-, ethanol-, and diamide-induced toxicity (clonogenic ability). Stress-induced expression of the major heat shock proteins (hsp27, hsc70(p73), hsp70(p72), and hsp90) was generally highest in H-TT cells and lowest in A-TT cells. Interestingly, the four types of TT cells showed distinct differences in certain aspects of resistance against thermal protein damage. Thermal protein denaturation and aggregation determined in isolated cellular membrane fractions was found to be attenuated when they were isolated from H-TT and A-TT cells but not when isolated from E-TT and D-TT cells. The heat resistance in the proteins of the membrane fraction corresponded with elevated levels of hsp70(p72) associated with the isolated membrane fractions. In the nuclear fraction, only marginal (not significant) attenuation of the formation of protein aggregates (as determined by TX-100 (in)solubility) was observed. However, the postheat recovery from heat-induced protein aggregation in the nucleus was faster in H-TT, E-TT, and D-TT cells, but not in A-TT cells. Despite the fact that elevated levels of hsp27, hsp70(p73), and hsp70(p72) were found in the TX-100 insoluble nuclear fraction derived from all TT cells, no correlation was found with the degree of resistance in terms of the accelerated recovery from nuclear protein aggregation. The only correlation between accelerated recovery from nuclear protein aggregates was that with total cellular levels of hsp27. The data indicate that heat-induced loss of clonogenic ability may be a multitarget rather than a single target event. A threshold of damage may exist in cells after exposure to heat; multiple sets of proteins in (different compartments of) the cell

  7. Insufficient evidence on whether to restore root-filled teeth with single crowns or routine fillings.

    PubMed

    McReynolds, David; Duane, Brett

    2016-06-01

    Data sourcesMedline, Cochrane Oral Health Groups Trials Register, Cochrane Central Register of Controlled Trials, Embase, CINAHL, LILACS.Study selectionThree authors independently assessed the abstracts of studies resulting from the above searches which compared indirect restorations of single endodontically treated teeth (ETT) to direct restoration of single ETT.Data extraction and synthesisTitles and abstracts of all reports identified through the electronic searches were assessed independently by two authors with any disagreements on eligibility resolved by a third reviewing author based on agreed upon inclusion and exclusion criteria. Study quality was assessed using the Cochrane risk of bias tool. Catastrophic failure of the restored tooth or restoration leading directly to extraction was the primary outcome measure. Secondary outcome measures included patient quality of life, incidence of recurring caries, periodontal health status and cost of the use of different interventions. Data analysis was carried out using the, 'treatment as allocated', patient population, expressing estimates of intervention effect for dichotomous data as risk ratios, with 95% confidence intervals (CI).ResultsOne trial which was judged to be at high risk of performance, detection and attrition bias was included. There was no clear difference between the crown and composite group and the composite only group for non-catastrophic failures of the restoration (1/54 versus 3/53; RR 0.33; 95% CI 0.04 to 3.05) or failures of the post (2/54 versus 1/53; RR 1.96; 95% CI 0.18 to 21.01) at three years. The quality of the evidence for these outcomes was judged to be very low. There was no evidence available for any secondary outcomes.ConclusionsInsufficient evidence exists to assess the effects of crowns compared to conventional fillings for the restoration of root-filled teeth. Until more evidence becomes available, clinicians should continue to base decisions about how to restore root

  8. 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

  9. Systemic and regional hemorheological consequences of warm and cold hind limb ischemia-reperfusion in a canine model.

    PubMed

    Nemeth, N; Szokoly, M; Acs, G; Brath, E; Lesznyak, T; Furka, I; Miko, I

    2004-01-01

    We have studied systemic and regional changes in hemorheological parameters after complete acute limb ischemia and reperfusion (I/R) in 24 mongrel dogs. Unilateral cooled and non-cooled vascular ischemia (3 h)-reperfusion (4 h), and sham-operations were performed. Blood samples were collected from the excluded region, during reperfusion and for 5 days. Whole blood and plasma viscosity (WBV, PV), relative cell transit time (RCTT) of erythrocytes, fibrinogen level and hematological parameters were determined. In I/R groups WBV of excluded blood was significantly higher compared to the base (p < 0.05), and RCTT increased during the reperfusion. On 2nd-3rd days RCTT increased significantly in both I/R groups. In each group PV and fibrinogen showed continuous increase during the postoperative period, prominently in cooled I/R group, and furthermore WBV corrected for hematocrit (40%) was the highest in cooled I/R group. These suggest that surgical acute limb I/R may cause hemorheological changes, which are more serious after cooling. (Grants: OTKA-T032571, 6003/1/2001/ETT.)

  10. The selective recovery and recycling of heavy metals from soils and sludges

    SciTech Connect

    Elston, G.W.; Burson, J.A.

    1994-12-31

    In 1984, RCRA was amended by the Hazardous and Solid Waste Amendments. A key provision of HSWA is Land Disposal Restrictions (LDR`s aka Land Bans). Over the past six years, nearly all groups of hazardous wastes have become prohibited from land disposal unless they are first treated to meet USEPA specified treatment standards. The final group of wastes to be restricted by the LDR`s is frequently referred to the ``third third`` and includes soils contaminated with regulated metals when these soils fail the USEPA`s Toxicity Characteristic Leaching Procedure. Originally, the ``third third`` was to be banned from land disposal on May 8, 1990. In anticipation of this date, the principals of Earth Treatment Technologies, Inc. initiated the development of an extraction technology for the remediation of metals contaminated soils in 1988. Earth Treatment Technologies, Inc. (ETT) has developed and commercialized an acidic extraction technology for remediation of metals contaminated soils which meets these objectives. This paper describes the process technology and physical configuration of the treatment equipment and provides case studies and process performance results.

  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. 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

  13. 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

  14. 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

  15. The Different Effects of BMI and WC on Organ Damage in Patients from a Cardiac Rehabilitation Program after Acute Coronary Syndrome.

    PubMed

    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

  16. The Different Effects of BMI and WC on Organ Damage in Patients from a Cardiac Rehabilitation Program after Acute Coronary Syndrome.

    PubMed

    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.

  17. 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.

  18. 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

  19. 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.

  20. 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.

  1. 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.

  2. 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).

  3. The Isolation and Characterization of Glycosylated Phosphoproteins from Herring Fish Bones*

    PubMed Central

    Zhou, Hai-Yan; Salih, Erdjan; Glimcher, Melvin J.

    2010-01-01

    Past studies of bone extracellular matrix phosphoproteins such as osteopontin and bone sialoprotein have yielded important biological information regarding their role in calcification and the regulation of cellular activity. Most of these studies have been limited to proteins extracted from mammalian and avian vertebrates and nonvertebrates. The present work describes the isolation and purification of two major highly glycosylated and phosphorylated extracellular matrix proteins of 70 and 22 kDa from herring fish bones. The 70-kDa phosphoprotein has some characteristics of osteopontin with respect to amino acid composition and susceptibility to thrombin cleavage. Unlike osteopontin, however, it was found to contain high levels of sialic acid similar to bone sialoprotein. The 22-kDa protein has very different properties such as very high content of phosphoserine (∼270 Ser(P) residues/1000 amino acid residues), Ala, and Asx residues. The N-terminal amino acid sequence analysis of both the 70-kDa (NPIMA(M)ETTS(M)DSKVNPLL) and the 22-kDa (NQDMAMEASSDPEAA) fish phosphoproteins indicate that these unique amino acid sequences are unlike any published in protein databases. An enzyme-linked immunosorbent assay revealed that the 70-kDa phosphoprotein was present principally in bone and in calcified scales, whereas the 22-kDa phosphoprotein was detected only in bone. Immunohistological analysis revealed diffusely positive immunostaining for both the 70- and 22-kDa phosphoproteins throughout the matrix of the bone. Overall, this work adds additional support to the concept that the mechanism of biological calcification has common evolutionary and fundamental bases throughout vertebrate species. PMID:20833721

  4. 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.

    2016-09-01

    We present ground-based and Swift photometric and spectroscopic observations of the tidal disruption event (TDE) ASASSN-15oi, discovered at the center of 2MASX J20390918-3045201 (d ≃ 216 Mpc) by the All-Sky Automated Survey for SuperNovae (ASAS-SN). The source peaked at a bolometric luminosity of L ≃ 1.3 × 1044 ergs s-1 and radiated a total energy of E ≃ 6.6 × 1050 ergs 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 ergs s-1 to L ≃ 2.3 × 1043 ergs 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 days for t0 ≃ 57241.6 (MJD), while a power-law decline of L∝(t - t0)-α with t0 ≃ 57212.3 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 color evolution of ASASSN-15oi are consistent with a TDE, but the rapid spectral evolution is unique among optically-selected TDEs.

  5. 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.

  6. 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.

  7. Embryo toxicity of pesticides and heavy metals to the ramshorn snail, Marisa cornuarietis (Prosobranchia).

    PubMed

    Sawasdee, Banthita; Köhler, Heinz-R

    2009-06-01

    An invertebrate embryo toxicity test with the ampullariid snail, Marisacornuarietis, to assess the toxicity of pesticides and heavy metals recently was established. Snail embryos were treated with atrazine (100, 1000, 10000, and 30000 microg/L), imidacloprid (10000, 25000, and 50000 microg/L), Ni(2+) (0.1, 1, 10, and 100 microg/L) or Zn(2+) (100, 200, 500, 1000, 2000, and 5000 microg/L). The effect of these substances was examined by monitoring the following endpoints: mortality, formation of tentacles and eyes, heart rate, hatching, and weight after hatching. Effects in term of a significant delay on the formation of both tentacles and eyes were found after treatment with 100 microg/L Ni(2+) or 200 microg/L Zn(2+). The heart rate was shown to significantly decrease at 25000 microg/L imidacloprid or 1000 microg/L Zn(2+). At 100 microg/L atrazine, 10 microg/L Ni(2+), or 1000 microg/L Zn(2+) a significant delay in hatching became visible. No significant mortality was observed for the tested concentrations of atrazine, imidacloprid, or Ni(2+), while 5000 microg/L Zn(2+) resulted in 100% mortality after 10d. The weight of freshly hatched individuals remained unaffected in all treatments. On the basis of the lowest observed effect concentrations (LOECs) recorded, we could show the M.cornuarietis embryo toxicity test (MariETT) to react up to three orders of magnitude more sensitive (for metals) and at least one order of magnitude more sensitive (for the tested organics) than the established Danio rerio embryo test.

  8. TAS3 Genes for small ta-siARF RNAs in plants belonging to subtribe Senecioninae: occurrence of prematurely terminated RNA precursors.

    PubMed

    Ozerova, L V; Krasnikova, M S; Troitsky, A V; Solovyev, A G; Morozov, S Y

    2013-01-01

    The various classes of plant 21 - to 24-nt siRNAs derive from long dsRNA precursors that are processed by the ribonuclease Dicer-like (DCL). The species of ta-siRNA were originally discovered in Arabidopsis thaliana. Four gene families have been identified in Arabidopsis that each produces a number of ta-siRNAs: TAS1, TAS2, TAS3 and TAS4. The TAS3 genes encode tasiR-ARF species which target the mRNA of three Auxin Response Factor (ARF) genes (ARF2, ARF3/ETT and ARF4) for subsequent degradation. The function of TAS3 precursor RNA is controlled by two miR390 target sites flanking tandem of ta-siARF sequences. In this paper, we have studied the presence ofta-siARF RNA genes in the representatives of subtribe Senecioninae. Senecioneae is the largest tribe of Asteraceae, comprised of ca. 150 genera and 3,000 species which include many common succulents of greenhouses. Approximately one-third of species are placed in genus Senecio, making it one of the largest genera of flowering plants. However, there was no information on the structure of TAS genes in these plants. We revealed that the TAS3 species (TAS3-Sen1) in Senecio representatives was actively transcribed, and its homologues are distributed among many Asteracea plants and found to be similar to Arabidopsis AtTAS3a gene. We revealed several prematurely terminated transcripts of TAS3-Sen1. Finding the alternative shortened transcripts of TAS3-Sen1 lacking the 3'-terminal site cleaved by miR390 and retaining the 5'-terminal miR390 non-cleaved site suggested their using as decoys for the modulation of miR390 activity to regulate synthesis of ta-siARF RNAs in different Senecioninae species.

  9. The novel panel assay to define tumor-associated antigen-binding antibodies in patients with metastatic melanomas may have diagnostic value.

    PubMed

    Kotlan, Beatrix; Liszkay, Gabriella; Blank, Miri; Csuka, Orsolya; Balatoni, Timea; Toth, Laszlo; Eles, Klara; Horvath, Szabolcs; Naszados, Gyorgy; Olasz, Judit; Banky, Balazs; Toth, Jozsef; Godeny, Maria; Marincola, Francesco M; Kasler, Miklos; Shoenfeld, Yehuda

    2015-02-01

    We aim to harness the natural humoral immune response by various technologies to get novel biomarkers. A complex antibody analysis in sera and in the tumor microenvironment leads to reveal tumor-specific antibodies. More strategies were introduced to select the most effective one to identify potential tumor antigen-binding capacity of the host. Epstein-Barr virus transformation and cloning with limiting dilution assay, magnetic cell sorting and antibody phage display with further methodological improvements were used in epithelial and neuroectodermal cancers. Column-purified sera of patient with melanoma were tested by immunofluorescence assay, while sera of further melanoma patients were processed for membrane-binding enzyme-linked immunosorbent assay. Some supernatants of selected B cell clones and purified antibodies showed considerable cancer cell binding capacity by immunofluorescence FACS analysis and confocal laser microscopy. Our native tumor cell membrane preparations helped to test soluble scFv and patients' sera for tumor binder antibodies. A complex tumor immunological study was introduced for patients with melanoma (ethical permission: ETT TUKEB 16462-02/2010); peripheral blood (n = 57) and surgically removed primary or metastatic tumors (n = 44) were gathered and processed at cellular immunological level. The technological developments proved to be important steps forward to the next antibody profile analyses at DNA sequence level. Cancer cell binding of patient-derived antibodies and natural immunoglobulin preparations of pooled plasma product intravenous immunoglobulins support the importance of natural human antibodies. Important cancer diagnostics and novel anticancer strategies are going to be built on these tools.

  10. 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

  11. 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.

  12. 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

  13. 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