Prevalence, outcome and risk factors for postoperative pyothorax in 232 dogs undergoing thoracic surgery

Objective

To determine the prevalence, outcome and risk factors for postoperative pyothorax in dogs undergoing thoracic surgery.

Methods

Case records were reviewed retrospectively to identify dogs with post thoracic surgery pyothorax, defined as septic neutrophilic inflammation within the pleural space based on cytology and/or a positive bacterial culture of pleural fluid. Those identified were reviewed for potential risk factors for postoperative pyothorax based on biological plausibility and previously published data. These potential risk factors were explored by multivariable logistic regression.

Results

Of 232 dogs undergoing thoracic surgery, 15 (6·5%) dogs developed pyothorax. Bacteria cultured included methicillin-resistant Staphylococcus aureus and multi-resistant Escherichia coli. Of these dogs, six died, four were euthanased and five were treated successfully. A diagnosis of idiopathic chylothorax [Odds Ratio (OR)=12·5, 95% Confidence Interval (CI)=2·7-58·5, P=0·001], preoperative intrathoracic biopsy (OR=14·3, 95% CI=1·7-118·7, P=0·014) and preoperative thoracocentesis (OR=11·2, 95% CI=1·6-78·2, P=0·015) were identified as independent risk factors for development of postoperative pyothorax.

Clinical Significance

Idiopathic chylothorax, intrathoracic biopsy and prior thoracocentesis are independent risk factors for postoperative pyothorax, which was associated with a 67% mortality rate.

Target-controlled infusion of remifentanil for laryngeal mask airway insertion during sevoflurane induction in adults

OBJECTIVE

This randomized, double-blind study investigated the suitable target effect-site concentration of remifentanil for laryngeal mask airway (LMA) insertion during inhalation induction with sevoflurane.

METHODS

Patients aged 18 - 60 years were randomly assigned to one of three groups receiving infusions of normal saline (control group), or infusions with target effect-site remifentanil concentrations of either 1 ng/ml (R1 group) or 2 ng/ml (R2 group), 1 min after the induction of anaesthesia with sevoflurane. LMA insertion was attempted 2 min after induction. Insertion conditions were graded using a six-variable, three-point scale (excellent, intermediate or poor).

RESULTS

A total of 102 patients were included. The proportion of patients ranked as excellent for the LMA insertion was significantly higher in groups R1 and R2 compared with the control group. The incidence of apnoea was significantly more frequent in the R2 group than in the control or R1 groups.

CONCLUSIONS

Compared with 1 ng/ml remifentanil or normal saline, target-controlled infusion of 2 ng/ml remifentanil significantly improved the LMA insertion conditions during sevoflurane inhalational induction, although apnoeic episodes were more frequently observed.

Multipulse addressing of a Raman quantum memory: configurable beam splitting and efficient readout

Quantum memories are vital to the scalability of photonic quantum information processing (PQIP), since the storage of photons enables repeat-until-success strategies. On the other hand, the key element of all PQIP architectures is the beam splitter, which allows us to coherently couple optical modes. Here, we show how to combine these crucial functionalities by addressing a Raman quantum memory with multiple control pulses. The result is a coherent optical storage device with an extremely large time bandwidth product, that functions as an array of dynamically configurable beam splitters, and that can be read out with arbitrarily high efficiency. Networks of such devices would allow fully scalable PQIP, with applications in quantum computation, long distance quantum communications and quantum metrology.

Single-photon-level quantum memory at room temperature

Room-temperature, easy-to-operate quantum memories are essential building blocks for future long distance quantum information networks operating on an intercontinental scale, because devices like quantum repeaters, based on quantum memories, will have to be deployed in potentially remote, inaccessible locations. Here we demonstrate controllable, broadband and efficient storage and retrieval of weak coherent light pulses at the single-photon level in warm atomic cesium vapor using the robust far off-resonant Raman memory scheme. We show that the unconditional noise floor of this technically simple quantum memory is low enough to operate in the quantum regime, even in a room-temperature environment.

Density gradient stabilization of electron temperature gradient driven turbulence in a spherical tokamak

In this Letter we report the first clear experimental observation of density gradient stabilization of electron temperature gradient driven turbulence in a fusion plasma. It is observed that longer wavelength modes, k(⊥)ρ(s) ≲ 10, are most stabilized by density gradient, and the stabilization is accompanied by about a factor of 2 decrease in the plasma effective thermal diffusivity.

BAG3-related myofibrillar myopathy in a Chinese family

In contrast to the usual slow disease progression in myofibrillar myopathies, patients with Bag3opathy often have a rapidly progressive and more severe phenotype with a worse prognosis. We describe a Chinese patient, born to non-consanguineous parents, who first presented at age 6 with clumsy walking and difficult climbing staircase. With a history of restrictive lung disease previously diagnosed as asthma, she progressed rapidly with proximal myopathy, rigid spine and bilateral tightening of the Achilles tendons requiring surgical elongation. Hypertrophic cardiomyopathy with restrictive physiology was shown by echocardiogram. Moreover, prolonged QT interval was also noted in the patient. Family history was unremarkable yet her father was incidentally found to have prolonged QT interval. Mutation analysis with genomic DNA of the proband showed heterozygous de novo known mutation c.626C>T (p.Pro209Leu) and a germline variation c.772C>T (p.Arg258Trp) in BAG3. Her father was found to be a carrier of c.772C>T. Muscle biopsy findings were suggestive of myofibrillar myopathy on light microscopy and ultrastructural studies. To our knowledge, this is the first Chinese case of Bag3opathy so far reported.

NSTX far infrared tangential interferometer/polarimeter electronics upgrade

New electronics for the multichannel far infrared tangential interferometer/polarimeter system employed on the National Spherical Torus Experiment (NSTX) have greatly extended its capability to monitor high frequency density fluctuations. Such measurements are essential in understanding transport physics issues in NSTX as well as for the coming ITER device. The electronics, which were previously limited to ∼250 kHz, have been upgraded with a video bandwidth that extends to 4 MHz when operating as an interferometry-only configuration, and to ∼500 kHz when operating as a simultaneous interferometer/polarimeter system. Experimental details and test results of the new electronics are presented.

Use of the Far Infrared Tangential Interferometer/Polarimeter diagnostic for the study of rf driven plasma waves on NSTX

A rf detection system for waves in the 30 MHz range has been constructed for the Far Infrared Tangential Interferometer/Polarimeter on National Spherical Torus Experiment (NSTX). It is aimed at monitoring high frequency density fluctuations driven by 30 MHz high harmonic fast wave fields. The levels of density fluctuations at various radial chords and antenna phase angles can be estimated using the electric field calculated by TORIC code and linearized continuity equation for the electron density. In this paper, the experimental arrangement for the detection of rf signal and preliminary results of simulation will be discussed.

Fringe-jump corrected far infrared tangential interferometer/polarimeter for a real-time density feedback control system of NSTX plasmas

The far infrared tangential interferometer/polarimeter (FIReTIP) of the National Spherical Torus Experiment (NSTX) has been set up to provide reliable electron density signals for a real-time density feedback control system. This work consists of two main parts: suppression of the fringe jumps that have been prohibiting the plasma density from use in the direct feedback to actuators and the conceptual design of a density feedback control system including the FIReTIP, control hardware, and software that takes advantage of the NSTX plasma control system (PCS). By investigating numerous shot data after July 2009 when the new electronics were installed, fringe jumps in the FIReTIP are well characterized, and consequently the suppressing algorithms are working properly as shown in comparisons with the Thomson scattering diagnostic. This approach is also applicable to signals taken at a 5 kHz sampling rate, which is a fundamental constraint imposed by the digitizers providing inputs to the PCS. The fringe jump correction algorithm, as well as safety and feedback modules, will be included as submodules either in the gas injection system category or a new category of density in the PCS.

Triggered confinement enhancement and pedestal expansion in high-confinement-mode discharges in the national spherical torus experiment

We report observation of a new high performance regime in discharges in the National Spherical Torus Experiment, where the H mode edge "pedestal" temperature doubles and the energy confinement increases by 50%. The spontaneous transition is triggered by a large edge-localized mode, either natural or externally triggered by 3D fields. The transport barrier grows inward from the edge, with a doubling of both the pedestal pressure width and the spatial extent of steep radial electric field shear. The dynamics suggest that 3D fields could be applied to reduce edge transport in fusion devices.

Strong purified protein derivative responses are associated with poor mycobacterium inhibition in latent TB

The tuberculin skin test (TST) using purified protein derivative (PPD) of Mycobacterium tuberculosis is traditionally used to diagnose latent tuberculosis (TB) infection (LTBI). However, LTBI diagnosis by peripheral blood mononuclear cell (PBMC) interferon (IFN)-gamma responses to M. tuberculosis-specific antigens, early secreted antigenic target 6 kDa (ESAT-6) and culture filtrate protein (CFP)-10 has greater specificity. We investigated the difference in antimycobacterium cellular immunity in TB contacts who were strong TST reactors but nonresponsive to the ESAT-6/CFP-10 assay compared with those with concordant results. Healthy TB contacts were tested using the above two assays and mycobacterium survival was measured after co-culture of infected macrophages with their PBMCs. Whether PPD reactivity was tested by TST or by PBMC-specific IFN-gamma responses, strongly PPD-reactive TB contacts without ESAT-6/CFP-10 responsiveness showed significantly better mycobacterium inhibition activity than ESAT-6/CFP-10-responsive TB contacts with the same PPD reactivity. In the former group, stronger PPD reactivity was associated with improved mycobacterium killing, whereas ESAT-6/CFP-10 responders showed the opposite result. PPD-reactive ESAT-6/CFP-10-nonresponsive TB contacts in our population may have had protective immunity related to prior mycobacterium exposure. ESAT-6/CFP10-responsive TB contacts are more likely to have LTBI and, in this group, strong PPD reactivity may paradoxically be associated with poor mycobactericidal activity.

A rare cause of nephrotic syndrome: lipoprotein glomerulopathy

Lipoprotein glomerulopathy is a rare kidney disease in which lipoprotein thrombi are seen in the glomerular capillaries. Most of these patients are found in Japan and East Asian countries. The presenting symptoms include proteinuria, an abnormal plasma lipoprotein profile that resembles type III hyperlipoproteinaemia, and a marked increase in serum apolipoprotein E concentration. Previous studies have suggested that lipoprotein glomerulopathy might be related to APOE gene mutation. No effective therapeutic regimen has been established for lipoprotein glomerulopathy. We report the first case of biopsy-proven lipoprotein glomerulopathy in Hong Kong in a patient who presented with nephrotic syndrome and dyslipidaemia. DNA analysis revealed apolipoprotein E Kyoto together with a novel apolipoprotein E mutation, apolipoprotein E (Asp230Tyr) Hong Kong. There was significant improvement in the clinical parameters and resolution of symptoms after the introduction of statins. Further studies will be needed to clarify the role of apolipoprotein E Hong Kong and its interaction with apolipoprotein E Kyoto in the pathogenesis of lipoprotein glomerulopathy.

Multimode memories in atomic ensembles

The ability to store multiple optical modes in a quantum memory allows for increased efficiency of quantum communication and computation. Here we compute the multimode capacity of a variety of quantum memory protocols based on light storage in ensembles of atoms. We find that adding a controlled inhomogeneous broadening improves this capacity significantly.

PEGylation improves the hypoglycaemic efficacy of intranasally administered glucagon-like peptide-1 in type 2 diabetic db/db mice

AIMS

PEGylation - covalent modification of therapeutic peptides with polyethylene glycol (PEG) - is viewed as an effective way of prolonging the short lifetime of glucagon-like peptide-1 (GLP-1). In this study, we investigated the hypoglycaemic efficacies of PEGylated GLP-1s administered intranasally in type 2 diabetic db/db mice.

METHODS

Three types of site-specific (Lys(34)) PEGylated GLP-1 analogues (PEG molecular weight: 1, 2 or 5 kDa) were synthesized. Their metabolic stabilities were evaluated in nasal mucosa enzyme pools. Oral glucose tolerance test was conducted 30, 60 and 120 min after intranasally administering these analogues in type 2 diabetic db/db mice.

RESULTS

PEGylated GLP-1 analogues were found to have significantly longer half-lives than native GLP-1 in nasal mucosa enzymes (2.4-fold to 11.0-fold, p < 0.005). Non-PEGylated GLP-1 at 100 nmol/kg was not found to have marked efficacy irrespective of nasal administration time [total hypoglycaemic degree (HD(total)) values 2.8-17.3%]. On the contrary, PEGylated GLP-1s (100 nmol/kg) showed obvious efficacies with maximum HD(total) values of >51.8 +/- 5.8% (p < 0.005 vs. GLP-1).

CONCLUSION

This study highlights the pharmacological potential of intranasally administered PEGylated GLP-1s in terms of stabilizing postprandial hyperglycaemia in type 2 diabetic patients.

The optimal bolus dose of alfentanil for tracheal intubation during sevoflurane induction without neuromuscular blockade in day-case anaesthesia

BACKGROUND

The purpose of this study was to determine the optimal bolus dose of alfentanil required to provide successful intubating conditions following inhalation induction of anaesthesia using 5% sevoflurane and 60% nitrous oxide without neuromuscular blockade in adult day-case anaesthesia.

METHODS

Twenty-four adults, aged 18-60 years, undergoing general anaesthesia for short ambulatory surgery were enroled into the study. After vital capacity induction, with sevoflurane 5% and 60% nitrous oxide in oxygen, pre-determined dose of alfentanil was injected over 30 s. The dose of alfentanil was determined by modified Dixon's up-and-down method (2 microg/kg as a step size). Ninety seconds after the end of bolus administration of alfentanil, the trachea was intubated. Systolic blood pressure, heart rate and SpO2 were recorded at anaesthetic induction, before, 1 min and 3 min after intubation.

RESULTS

The bolus dose of alfentanil for successful tracheal intubation was 10.7+/-2.1 microg/kg in 50% of patients during inhalation induction. From probit analysis, 50% effective dose (ED(50)) and ED(95) values (95% confidence limits) of alfentanil were 10.7 microg/kg (8.0-12.9 microg/kg) and 14.9 microg/kg (12.9-31.1 microg/kg), respectively.

CONCLUSIONS

Using the modified Dixon's up-and-down method, the bolus dose of alfentanil for successful tracheal intubation was 10.7+/-2.1 microg/kg in 50% of adult patients during inhalation induction using 5% sevoflurane and 60% nitrous oxide in oxygen without neuromuscular blocking agent in day-case anaesthesia.

Sequential non-traumatic femoral shaft fractures in a patient on long-term alendronate

Fractures associated with osteoporosis are common among elderly people and postmenopausal women. Bisphosphonate is an effective anti-resorptive drug commonly used for the prevention and treatment of osteoporosis. There are, however, concerns about potential side-effects during long-term treatment with alendronate. We report a case where an 82-year-old woman who had been taking alendronate for 10 years presented with two episodes of non-traumatic femoral shaft fracture. An iliac bone biopsy showed severely suppressed bone turnover, suggestive of adynamic bone disease. We suspect the bone turnover suppression was related to the prolonged use of alendronate.

Gyrocenter shift of low-temperature plasmas and the retrograde motion of cathode spots in arc discharges

The gyrocenter shift phenomenon explained the mechanism of radial electric field formation at the high confinement mode transition in fusion devices. This Letter reports that the theory of gyrocenter shift is also applicable to low temperature high collisional plasmas such as arc discharges by the generalization of the theory resulting from a short mean free path compared with the gyroradius. The retrograde motion of cathode spots in the arc discharge is investigated through a model with the expanded formula of gyrocenter shift. It is found that a reversed electric field is formed in front of the cathode spots when they are under a magnetic field, and this reversed electric field generates a rotation of cathode spots opposite to the Amperian direction. The ion drift velocity profiles calculated from the model are in agreement with the experimental results as functions of magnetic flux density and gas pressure.

Chemesthetic responses to airborne mineral dusts: boric acid compared to alkaline materials

OBJECTIVES

(1) To assess the relation between occupationally relevant exposures to dust of boric acid and magnitude of feel in the eye, nose, and throat during activity (pedaling) equal to light industrial work. (2) To compare feel from the dust of boric acid with that of the alkaline dusts calcium oxide and sodium tetraborate pentahydrate (sodium borate). (3) To chart how magnitude of feel changes with time in exposures up to 3/4 h.

METHODS

Twelve subjects, six males and six females, participated in duplicate sessions of exposure to 2.5, 5, and 10 mg m(-3) of boric acid, 10 mg m(-3) of sodium borate, 2.5 mg m(-3) of calcium oxide presented as calcium oxide alone or diluted with hydrated calcium sulfate, and 0 mg m(-3) (blank). Exposures occurred in a plastic dome suspended over the head and closed around the neck with rubber dam. Measurements pre- and post-exposure included nasal secretion and nasal resistance. Measurements during exposure included rated magnitude of feel in the eye, nose, and throat, and respiration (Respitrace System). Six concentrations of carbon dioxide ranging from just below detectable to sharply stinging gave subjects references for their ratings.

RESULTS

In general, feel increased for periods up to half an hour, then either declined or held at a plateau. Each material had a temporal signature. The nose led with the highest feel, followed by the throat, then the eyes. This hierarchy proved weakest for boric acid; at one level of exposure, magnitude in the throat overtook that in the nose. Accompanying measures implied that change of feel with time occurred neither because of an increase in dilution of the dissolved dusts in newly secreted mucus nor an increase of consequence in nasal resistance. Most likely, sensory adaptation determined the change. Boric acid of 10 mg m(-3) fell slightly and insignificantly below 10 mg m(-3) sodium borate in feel. Boric acid, though, showed a relatively flat dose-response relationship, i.e., a change in level caused little change in feel.

CONCLUSIONS

The time-constant for feel from dusts lies on the order of tens of minutes. A flat concentration-response function for boric acid and a notable response from the throat suggests that perceived dryness, not mediated by acidity but perhaps by osmotic pressure, may account for the feel evoked at levels of exposure at or below 10 mg m(-3). More acidic dusts that could actually change nasal pH may trigger sensations differently.

A recalcitrant case of cicatricial pemphigoid

A 57-year-old woman presented with a 1-year history of blisters and erosions on her oral mucosa with bilateral conjunctivitis and symblephara formation. A diagnosis of cicatricial pemphigoid was made based on the clinical features and immunohistological findings. A multidisciplinary team managed her with different topical and systemic immunosuppressive agents but she finally succumbed due to multi-organ failure secondary to sepsis.

Errors in ABO labeling of deceased donor kidneys: case reports and approach to ensuring patient safety

Patient safety in transplantation depends on accurate testing, transcription and transmission of the ABO types of the donor and recipient. Similar to 'near-miss' transfusion labeling errors, three cases of mislabeled ABO types on deceased donor kidney containers were recognized through a pretransplant verification process. Six steps to confirming the organ and ABO identification were developed to ensure safety of the patient and prevent liability for the transplant team and facility. In each case, rapid recognition and documentation of the error source, on site confirmation of the ABO type of the accompanying blood specimen, and full disclosure to the patient and family permitted safe transplantation and avoided the need to pursue a more conservative course that would have required discarding the organs. We advocate following these measures in determining whether to persevere with transplantation of a mislabeled organ.