Isolated fallopian tube torsion: A systematic review of case reports

OBJECTIVE

To combine all literature describing cases of isolated fallopian tube torsion in adult non pregnant patients in a systematic manner, to optimize knowledge and practice both for diagnosis and management.

STUDY DESIGN

EMBASE and PubMed databases were searched for the terms 'tubal' OR 'fallopian tube' AND 'isolated' AND 'torsion' from the inception of these databases to July 5, 2023. All case reports or case series of adult patients (18 years or older) with isolated fallopian tube torsion were included. Exclusion criteria included: all other study types; cases involving children and adolescents (less than 18 years old); pregnant patients of all trimesters; tubo-ovarian torsion; studies not published in English; duplicates and those not available in text. Following the database search, two authors independently screened the studies and search results were subsequently reported in accordance with PRISMA guidelines. Data was extracted independently by two authors and analysed using Excel. All cases were assessed for bias using a modified version of the tool proposed by Murad et al. RESULTS: 92 unique articles enrolling 131 individual cases were included in this systematic review. Isolated fallopian tube torsion most commonly occurs during reproductive ages between 18 and 45 years. It is uncommon in postmenopausal women. The most common presenting symptoms include unilateral lower abdominal or pelvic pain along the affected side with nausea and vomiting. Risk factors can be intrinsic or extrinsic and can include conditions such as hydrosalpinx, sterilization, pelvic inflammatory disease or cysts. Ultrasound is the optimal imaging modality however Computed Tomography and Magnetic Resonance Imaging can also be used. Imaging in general has low sensitivity, however isolated fallopian tube torsion can be identified with appropriate expertise. The gold standard for isolated fallopian tube torsion management is laparoscopy and detorsion however currently, the most common intervention performed is salpingectomy.

CONCLUSIONS

Isolated fallopian tube torsion is a rare but important gynaecological emergency with significant fertility implications. This study summarizes the most common presentations, investigation findings and surgical interventions in patients with isolated fallopian tube torsion. This study also emphasizes the importance of clinicians maintaining a high degree of suspicion and low threshold for early laparoscopic intervention to retain fertility.

An externally validated guide to anatomical interpretation using a direct-vision ('IRIS') feeding tube

BACKGROUND & AIMS

Most of the 11.5 million feeding tubes placed annually in Europe and the USA are placed 'blind'. This carries a 1.6% risk that these tubes will enter the lung and 0.5% cause pneumothorax or pneumonia regardless of whether misplacement is identified prior to feeding. Tube placement by direct vision may reduce the risk of respiratory or oesophageal misplacement. This study externally validated whether an 'operator guide' would enable novice operators to differentiate the respiratory and alimentary tracts.

METHODS

One IRIS tube was placed in each of 40 patients. Novice operators interpreted anatomical position using the built-in tube camera. Interpretation was checked from recorded images by consultant gastroenterologists and end-of-procedure checks using pH or X-ray checked by Radiologists and a consultant intensivist.

RESULTS

The 40 patients were a median of 68y (IQR: 56-75), 70% male, mostly medical (65%), conscious (67.5%) and 70% had no artificial airway. Three tubes were removed due to failed placement. In the remaining 37 placements, novice operators identified the airway in 17 (45.9%) and airway + respiratory tract in 19 (51.4%), but redirected all these tubes into the oesophagus. By using direct vision to reduce the proportion of tubes near the airway or in respiratory tract from 0.514 to 0, operator discrimination between the respiratory and alimentary tracts was highly significant (0.514 vs 0: p < 0.0001, power >99.9% when significance = 0.05). In addition, organ boundaries (respiratory tract vs oesophagus, oesophagus vs stomach, stomach vs intestine) were identified in 100%.

CONCLUSIONS

Novice operators, trained using the guide, identified all respiratory misplacements and accurately interpreted IRIS tube position. Guide-based training could enable widespread use of direct vision as a means to prevent tube-related complications.

Failures analysis of tube coating in Circulating Fluidized Bed (CFB) boiler

Circulating Fluidized Bed (CFB) boiler often experience leaks in the wall tube due to corrosion and abrasion of the bed material after use that varies between 3 and 8 months. To avoid erosion corrosion, a coating was done in the form of Chrome Clad Tube Armor (CTA). In this research, a Failure Analysis (FA) was performed on the characterization of the boiler tube using several types of samples, which are Wall Tube Without Coating (WT) and CTA (in new condition and after eight months of use). Macro visual, Field emission scanning electron microscopes (FE-SEM), Fourier-transform infrared spectroscopy (FTIR), corrosion, and Thermogravimetric analysis (TGA) tests showed that the CTA type has better corrosion and thermal resistance. The hardness values of the CTA and WT coating substrates after eight months of use were 197.75 and 195.2 HV. The failure mechanism on the tube was caused by high temperatures (long-term overheating) and friction between the tube and the fluid or metal. Wall tubes in furnaces fail due to erosion and corrosion due to fluid and solid particle mixtures and environmental contact.

Collapsing behavior of spark-induced cavitation bubble in rigid tube

The phenomenon of cavitation within tubes is a common scenario in the fields of medicine and industry. This paper focuses on the effects of rigid circular tube length, diameter and the distance of bubble - tube port on the behavior of bubble in tube. The low-voltage discharge technique was utilized to induce a cavitation bubble in deionized water. The effects of rigid tube lengths, diameters, and bubble-tube port distances on the morphology of bubbles are observed using high-speed camera. It has been found that as the length of the rigid tube increases, so does the period, and this effect is more pronounced in tubes with smaller diameters. Conversely, the cavitation bubble period decreased and then stabilized as the tube diameter increased, the ratio of tube radius and the bubble radius exceeds 4.8, the period of bubble in tube is similar to that of bubble in free field. Further analysis of the influence of tube characteristics on microjets reveals that a pair of oppositely microjets were formed along the tube axis by the bubble near the midpoint of the tube axis. Moreover, when the non-dimensional tube length η < 3.5, the increase tube diameter results in a decrease microjet velocity. It has also been observed that as the bubble gradually approaches the interior of the tube, the velocity of microjets directed inward decreases. Additionally, the smaller the diameter of the tube, the greater the bubble-tube port distance required for the microjets to reach the same level of velocity as bubble near the center of the tube axis. These findings hold theoretical implications for improvement of targeted drug delivery efficiency in medicine and enhance the operational efficiency of inertial micropumps in industries.

Baerveldt-350 with 3-0 Prolene Ripcord to Minimize Hypotony-Associated Complications after Spontaneous Ligature Dissolution

PURPOSE

To describe the technique and demonstrate the utility and outcomes of using a thick 3-0 Prolene ripcord in the lumen of a Baerveldt-350 aqueous shunt until after the ligature suture dissolves.

DESIGN

Single-center, noncontrolled, retrospective case series.

PARTICIPANTS

A total of 50 eyes from 50 patients with glaucoma undergoing placement of Baerveldt-350 aqueous shunts with 3-0 Prolene ripcords.

METHODS

A retrospective chart review was performed for all eyes of adult patients that had undergone a Baerveldt-350 aqueous shunt placement by a single surgeon at a single academic center between October 1, 2019 and June 30, 2022.

MAIN OUTCOME MEASURES

Data collected included demographic and clinical characteristics of the patients, preoperative and postoperative clinical data including intraocular pressure (IOP) and glaucoma medications, postoperative timepoints of ligature suture dissolution, and timepoints of 3-0 Prolene ripcord removal or whether they were permanently left in place.

RESULTS

In total, 50 eyes from 50 patients were included; mean age was 69.5 years, 54.0% of patients were female, 92% of patients were Black, and 66% of eyes had primary open-angle glaucoma. Twenty-six of 50 (52%) eyes had ripcord removal at the soonest postoperative visit after spontaneous ligature dissolution, 19/50 (38%) eyes had delayed ripcord removal, and 5/50 (10%) eyes had no ripcord removal. There were no cases of hypotony-associated complications (shallow anterior chamber, hypotony maculopathy, choroidal effusion, suprachoroidal hemorrhage) in this subgroup of eyes that underwent no ripcord removal.

CONCLUSIONS

Our results demonstrate that routine use of a 3-0 Prolene ripcord to partially occlude the lumen of a Baerveldt-350 is a useful strategy to minimize sudden hypotony-associated complications when the ligature suture dissolves. This strategy allows for a more controlled postoperative course and a safe 2-step decrease in IOP (1: when the ligature dissolves, and 2: when the ripcord is removed).

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Self-sacrifice-template epitaxial growth of hierarchical MnO2@NiCo2O4 heterojunction electrode for high-performance asymmetric supercapacitor

Constructing three-dimensional (3D) hierarchical bimetallic pseudocapacitive materials with abundant opening channel and heterojunction structures is rather promising but still challenging for high-performance supercapacitors. Herein, a self-sacrifice-template epitaxial growth strategy was proposed for the first time to construct 3D hierarchical bimetallic pseudocapacitive material. By using this strategy, NiCo2O4 nanowires (NiCo2O4NW) arrayed randomly to form a porous shell via in-situ epitaxial growth fully enclosing a MnO2 tube core, forming multiple transport channels and nano-heterojunctions between MnO2 and NiCo2O4NW, which facilitates electron transfer, i.e. exhibiting high electronic conductivity than any single component. As a result of the self-sacrifice-template epitaxial growth method, special hollow tectorum-like 3D hierarchical structure with considerable inter-nanowire space and hollow interior space enables easy access of electrolyte to NiCo2O4NW surface and MnO2 core, thereby resulting in highly exposed redox active sites of MnO2 core and NiCo2O4NW shell for energy storage. Comprehensive evaluations confirmed MnO2@NiCo2O4NW was a supercapacitor electrode candidate, delivering a superior energy density of 106.37 Wh kg-1. Such performance can be ascribed to the synergistic coupling effect of 3D hierarchical tube and nano-heterojunction structures. The proposed self-sacrifice-template epitaxial growth strategy provides important guidance for designing high-performance energy storage materials.

Safety of blind versus guided feeding tube placement: Misplacement and pneumothorax risk

Most intensive care unit patients require a feeding tube, but misplacement risk is high due to the presence of artificial airways and because unconsciousness reduces clinical warnings. Predominantly, tubes are placed 'blindly', where position is not known throughout placement. The result is that 1.6% enter the lung, 0.5% cause pneumothorax and potentially 5% are left in the oesophagus. Guided placement, by identifying tube position in real time, may prevent these problems, but undetected misplacements still occur. We review the safety of guided methods of confirming tube position, including rates of pneumothorax, in the context of current unguided methods. During blind tube placement, tube position can only be tracked intermittently. Excepting X-ray and ultra-sound, most methods of checking position are simple. Conversely, guided tube placement can track tube position from the nose to small intestine (IRIS®), or oesophagus to jejunum (Cortrak™, ENvue®). However, this requires expertise. Overall, guided placement is associated with lower rates of pneumothorax. Unfortunately, for Cortrak, low-use centres have higher rates of undetected misplacement compared with blind placement whereas Cortrak use in high-use centres had lower risk compared with blind placement and low use centres. Because guided placement requires high-level expertise manufacturer training packages have been developed but currently appear insufficient. Specifically, Cortrak's package is less accurate in determining tube position compared to the 'gastrointestinal flexure' system. Validation of an evidence-based guide for IRIS placement is underway. Recommendations are made regarding the training of new operators, including minimum numbers of placements required to achieve expertise.

Effectiveness of Trabeculectomy and Tube Shunt with versus without Concurrent Phacoemulsification: Intelligent Research in Sight Registry Longitudinal Analysis

OBJECTIVE

To determine the effectiveness of trabeculectomy and glaucoma drainage device (GDD) surgery performed with concurrent phacoemulsification compared with stand-alone procedures.

DESIGN

Multicenter retrospective cohort study.

PARTICIPANTS

Patients in the Intelligent Research in Sight Registry who underwent trabeculectomy or GDD from 2013 through 2019.

METHODS

The Kaplan-Meier survival analysis was used to determine reoperation rates. Reoperation was defined as any subsequent glaucoma surgery occurring 1 month to 3 years after the initial procedure. Multivariable Cox proportional hazard models were used to determine reoperation risk factors.

MAIN OUTCOME MEASURES

Reoperation rate, intraocular pressure (IOP), visual acuity, reoperation procedure type, postoperative complications, and predictors of surgical failure.

RESULTS

A total of 117 697 eyes undergoing glaucoma surgery alone and 35 657 eyes undergoing surgery with phacoemulsification were included. The cumulative reoperation rates at postoperative years 1 and 3 were 4.9% and 11.5%, respectively, for trabeculectomy alone and 3.0% and 7.3%, respectively, for trabeculectomy combined with phacoemulsification (P < 0.001). The reoperation rates at postoperative 1 and 3 years were 3.8% and 7.8%, respectively, for GDD alone and 2.1% and 5.4%, respectively, for GDD with phacoemulsification (P < 0.001). Stand-alone procedures achieved greater IOP reduction by percentage change from baseline (trabeculectomy alone, 35.3% vs. trabeculectomy with phacoemulsification, 23.1%, P < 0.001; and GDD alone, 36.0% vs. GDD with phacoemulsification, 29.3%; P < 0.001). Visual acuity improved by 0.12 logarithm of the minimum angle of resolution (logMAR) (95% confidence interval [CI], 0.11-0.12) and 0.10 logMAR (95% CI, 0.08-0.11) after trabeculectomy and GDD with phacoemulsification and declined by 0.15 logMAR (95% CI, 0.14-0.15) and 0.12 logMAR (95% CI, 0.11-0.12) after stand-alone trabeculectomy and GDD. The overall documented complication rate was 2.9% for GDD and 1.4% for trabeculectomy. Age, sex, race, ethnicity, baseline IOP, and glaucoma diagnosis and severity were associated with surgical failure risk. The most common reoperation procedure was GDD.

CONCLUSIONS

Reoperation rates within the first 3 years after trabeculectomy and GDD with and without phacoemulsification were low. Trabeculectomy and GDD with phacoemulsification had lower reoperation rates than those with stand-alone procedures. However, stand-alone procedures resulted in greater IOP reduction compared with combined procedures. Postoperative complications were uncommon overall. Patient age, sex, race, ethnicity, baseline IOP, and glaucoma diagnosis and severity were associated with surgical success.

Effect of Preserving the Percutaneous Gallbladder Drainage Tube Before Laparoscopic Cholecystectomy on Surgical Outcome: Post Hoc Analysis of the CSGO-HBP-017

BACKGROUND

When percutaneous transhepatic gallbladder drainage (PTGBD) is followed by laparoscopic cholecystectomy (LC), there is no consensus regarding whether the drainage tube should be preserved or removed before LC. We hypothesized that the surgical results of LC might differ between cases with PTGBD tube preservation versus removal. Here, we investigated how drainage tube preservation or removal affected the surgical outcome of LC.

METHODS

Using data from our previous multicenter study, we compared LC outcomes after PTGBD between patients with PTGBD tube preservation versus removal. This study included 208 patients who underwent LC over 12 days after PTGBD. In 83 cases, the PTGBD tube was preserved until LC, and in 125 cases, the tube was removed before LC. The results were verified by propensity score matching with 50 patients in each group.

RESULTS

Cases with tube preservation versus removal exhibited significantly longer surgery duration (174 ± 105 min vs 145 ± 61 min, P = .0118) and postoperative hospital stay (14 ± 16 days vs 7 ± 7 days, P < .0001), a significantly higher postoperative complication rate (13.2% vs 3.2%, P = .0061), and a marginally higher incidence of open conversion (12.0% vs 4.8%, P = .0547). Propensity score matching verified the inferior surgical outcomes in cases with tube preservation.

CONCLUSIONS

These results imply that when LC is performed > 12 days after PTGBD, the surgical outcome may be inferior when the drainage tube is preserved rather than removed before LC.

Non-invasive Ventilation: Effect of Vented and Non-vented Exhalation Systems on Inspiratory CO2 and O2 Concentrations, Ventilation, and Breathing Pattern

INTRODUCTION

To increase CO₂ elimination and to reduce work of breathing in hypercapnic patients, non-invasive ventilation (NIV) can be applied via mask either with non-vented CO₂ exhalation systems or with vented systems with leak port. The effect of the exhalation system on CO₂ rebreathing in the mask and total gas exchange remains widely unknown. Aim of this study was to compare the exhalation systems in terms of inspiratory O₂ and CO₂ concentrations, breathing patterns and gas exchange.

METHODS

We prospectively examined 10 healthy subjects and 10 hypercapnic patients with both exhalation systems. O₂ and CO₂ were measured in the nose, in the mask, and in the ventilation circuit, and respiratory rate, tidal volume, and transcutaneous capnometry (PtcCO₂) were recorded during the experiments.

RESULTS

Using the non-vented system, CO₂ concentrations in the mask were significantly higher in both subject groups, and PtcCO₂ values in the patient group increased up to 3.6 mmHg compared to the vented system (p = 0.011). O₂ concentrations increased with higher O₂ flow rates, but were significantly lower in the vented settings in both groups. No effect in breathing pattern could be demonstrated during the measurement time.

CONCLUSION

Using NIV, the chosen exhalation system influences CO₂ and O₂ concentrations under the mask, CO₂ rebreathing from the mask and could influence the effectiveness of the ventilation support with regards to hypercapnia treatment. To compensate for relevant hypoxia, the O₂ supplementation must be set up to a sufficient level under a vented system.

Effects of Postoperative Intravitreal Injections on Outcomes of Traditional Glaucoma Surgery in Patients with Preoperative Intravitreal Injections

PURPOSE

To compare outcomes of glaucoma drainage device (GDD) implantation and trabeculectomies with and without postoperative intravitreal injections (IVIs) in glaucoma patients with a history of preoperative IVIs.

DESIGN

Retrospective cohort study.

PARTICIPANTS

A total of 133 eyes of 133 glaucoma patients who underwent GDD implantation or trabeculectomy with at least 1 IVI preoperatively between January 2005 and October 2020 at Massachusetts Eye and Ear.

METHODS

Chart review of glaucoma patients with traditional glaucoma surgery and at least 1 IVI before surgery. All statistical analyses were conducted with R statistical programming software.

MAIN OUTCOME MEASURES

Intraocular pressure (IOP), medication burden, best-corrected visual acuity (BCVA), Kaplan-Meier success rates, adjusted hazard ratios (HRs), and complications.

RESULTS

Baseline demographics were similar between the groups with and without postoperative IVIs. The group with postoperative IVIs had a higher proportion of diabetic retinopathy and retinal vascular occlusions than the group without postoperative IVIs, which had more eyes with age-related macular degeneration. Intraocular pressure, medication burden, and visual acuity were similar between groups at all time points except for IOP at 6 weeks, which was lower in the group with postoperative IVIs. The group with postoperative IVIs had significantly more preoperative IVIs than the group without postoperative IVIs (6.6 vs. 3.3, P = 0.017). For success defined as IOP reduction ≥ 20% with 5 < IOP ≤ 21 mmHg, Kaplan-Meier analyses demonstrated similar success rates between groups with and without IVIs. When stratified by the number of IVIs, success rates for the group with 7 or more IVIs were significantly higher than the success rates for the group with 0-6 IVIs (P = 0.005). Each additional postoperative IVI resulted in a 7.2% decrease in the hazard of failure to achieve our stated success criteria. With regard to late complications, the group with postoperative IVIs had a higher incidence of vitreous hemorrhage (18.5% vs. 3.2%, P = 0.039) than the group without postoperative IVIs.

CONCLUSIONS

A higher number of postoperative IVIs, specifically 7 or more IVIs, may be associated with improved success rates of traditional glaucoma surgery in glaucoma patients who received IVIs before surgery.

Approach to nephrostomy tubes in the emergency department

BACKGROUND

Nephrostomy tubes are commonly placed for urinary obstruction, urinary diversion, or future endourologic procedures. While the technical success of nephrostomy tube placement is high, nephrostomy tube complications may occur.

OBJECTIVE OF REVIEW

Limited literature exists regarding the complication of nephrostomy tubes and their approach in the emergency department. This review summarizes the existing literature and provides a framework for emergency providers regarding the evaluation and management of nephrostomy tube complications.

DISCUSSION

Nephrostomy tube failure, caused by kinking, dislodgment, or migration can manifest with obstructive signs and symptoms. In well appearing patients, asymptomatic bacteriuria is common and should not be treated. However, in the presence of infectious symptoms, patients should be treated similarly to complicated cystitis or pyelonephritis. While gross hematuria is common following catheter placement, prolonged hematuria, or the return of hematuria after previous resolution should trigger investigation for hematoma formation or a delayed presentation of an intraoperative vascular injury. Finally, clinicians should obtain laboratory testing, advanced imaging, and specialty consultation if serious complications are suspected.

CONCLUSION

This narrative review highlights general nephrostomy tube care, minor complications, and troubleshooting in the emergency department. The majority of these minor complications can be managed at the bedside without specialty consultation. However, in patients with more serious complications including dislodgement, obstruction, infection, bleeding, and pleural injury, laboratory assessment and advanced imaging to include ultrasound and computed tomography with specialty consultation are essential in the patient's evaluation and management, particularly in cases of immune compromise and worsening renal function.

Simulation and performance study of circular ultrasonic array for tubes' internal inspection

A circular array (CA) transducer is developed and validated to implement internal inspection of the small diameter tubes, one of whose potential application targets is the heat exchanger tubes in Modular High Temperature Gas-cooled Reactor. A geometric model of the transducer and the delay law are proposed according to the inspection setup. Using k-Wave, an open source acoustic simulation toolbox, the beam profiles of various aperture sizes are analyzed to select a suitable aperture. The beams with different focal depths are compared to verify the delay law and to choose a preferable focus. Reflector responses are simulated to predict the transducer's detection sensitivity. To validate the simulation results, a prototype transducer composed of 64 elements is fabricated. Its electrical and acoustical performances are acquired with a pulser-receiver. A 4-element aperture with the focal depth of 1.0 mm is selected to perform internal inspection experiment according to the simulation results. The eight longitudinal grooves with widths of 0.2, 0.3, 0.4, and 0.5 mm on inner and outer tube walls are applied as typical reflectors to test circumferential detection sensitivity. The other five grooves with depths from 0.1 mm to 0.5 mm are chosen to verify radial detection sensitivity. The experiment results demonstrate the detection sensitivity of the CA transducer reaches at least 0.2 mm in circumferential direction and 0.1 mm in radial direction. The CA is proven capable of inspecting small diameter tubes.

Visualization of the renal vein filled with contrast agent may indicate the renal vein injury during percutaneous nephrolithotomy: two case reports

Background

Intravenous misplacement of a nephrostomy tube is a rare complication of percutaneous nephrolithotomy (PCNL) or percutaneous nephrostomy. The mechanism of misplacement of a nephrostomy tube into the vascular system is seldom investigated. One type of the possible mechanism is that the puncture needle penetrates a major intrarenal tributary of the renal vein and enters the collecting system. However, the guidewire is located outside the collecting system near the large branches of renal vein or perforates into the renal vein. The dilation is performed and causes a large torn injury. Subsequently, the nephrostomy tube is placed inside the vessel when radiological monitoring is not used. However, there is no imaging evidence and the scene of procedure is not demonstrated. This paper reports two cases of visualization of the renal vein filled with contrast agent during PCNL. The findings may be good evidence to support the step of renal vein injury in patients with intravenous nephrostomy tube misplacement.

Case presentation

We presented two cases with visualization of the renal vein filled with contrast agent during PCNL. In the process of injecting the contrast agent through the puncture needle, we could see the renal vein. Moreover, it was identified that the puncture needle tip was not on the optimal position. The position of puncture needle tip lay outside the collecting system, which was close to the calyceal infundibulum and branches of renal vein.

Conclusions

Visualization of the renal vein filled with contrast agent may be good evidence to verify the renal vein injury in patients with intravenous nephrostomy tube misplacement during PCNL or percutaneous nephrostomy. The suboptimal location of the puncture needle tip and visualization of the renal vein filled with contrast agent indicate the renal vein injury. One type of mechanism of intravenous nephrostomy tube misplacement is as following. Firstly, the guidewire stays outside the collecting system. Subsequently, dilatation directed by the guidewire results in the injury of the vein. Then, the nephrostomy tube migrates into the venous system due to prompt tube inserting and the direction of the sheath and/or the guidewire to the injured vein.

Evolution of Toll, Spatzle and MyD88 in insects: the problem of the Diptera bias

BACKGROUND

Arthropoda, the most numerous and diverse metazoan phylum, has species in many habitats where they encounter various microorganisms and, as a result, mechanisms for pathogen recognition and elimination have evolved. The Toll pathway, involved in the innate immune system, was first described as part of the developmental pathway for dorsal-ventral differentiation in Drosophila. Its later discovery in vertebrates suggested that this system was extremely conserved. However, there is variation in presence/absence, copy number and sequence divergence in various genes along the pathway. As most studies have only focused on Diptera, for a comprehensive and accurate homology-based approach it is important to understand gene function in a number of different species and, in a group as diverse as insects, the use of species belonging to different taxonomic groups is essential.

RESULTS

We evaluated the diversity of Toll pathway gene families in 39 Arthropod genomes, encompassing 13 different Insect Orders. Through computational methods, we shed some light into the evolution and functional annotation of protein families involved in the Toll pathway innate immune response. Our data indicates that: 1) intracellular proteins of the Toll pathway show mostly species-specific expansions; 2) the different Toll subfamilies seem to have distinct evolutionary backgrounds; 3) patterns of gene expansion observed in the Toll phylogenetic tree indicate that homology based methods of functional inference might not be accurate for some subfamilies; 4) Spatzle subfamilies are highly divergent and also pose a problem for homology based inference; 5) Spatzle subfamilies should not be analyzed together in the same phylogenetic framework; 6) network analyses seem to be a good first step in inferring functional groups in these cases. We specifically show that understanding Drosophila's Toll functions might not indicate the same function in other species.

CONCLUSIONS

Our results show the importance of using species representing the different orders to better understand insect gene content, origin and evolution. More specifically, in intracellular Toll pathway gene families the presence of orthologues has important implications for homology based functional inference. Also, the different evolutionary backgrounds of Toll gene subfamilies should be taken into consideration when functional studies are performed, especially for TOLL9, TOLL, TOLL2_7, and the new TOLL10 clade. The presence of Diptera specific clades or the ones lacking Diptera species show the importance of overcoming the Diptera bias when performing functional characterization of Toll pathways.

Tube placement using 'IRIS': A pilot assessment of its utility and safety

INTRODUCTION

Most critically ill patients have a feeding tube placed blindly, but 0.5% result in a major lung complication because misplacement is only detected at the end of procedure. Real-time guided tube placement may pre-empt such complications. This clinical effectiveness study examined the ability to visualise anatomy using Kangaroo™ feeding tubes with IRIS technology ('IRIS' tube).

METHODS

In a single centre, gastric or intestinal integrated real-time imaging system (IRIS) tubes were prospectively placed in critically ill patients noting the anatomical visualisation.

RESULTS

Of 15 placements, 13 were successful gastric placements and used for feeding but one gastric and one intestinal placement failed because of signal loss and inability to find the pylorus, respectively; both tubes were removed. Air insufflation and fluid aspiration were possible with all tubes. Respiratory misplacement was clearly differentiated, prior to reaching the main carina, from gastrointestinal (GI) anatomical markers, permitting removal before causing trauma. Furthermore, non-traumatic placement was visualised in high-risk cases including during advancement through a nostril with a base of skull fracture and into a stomach with a recently haemorrhaging gastric polyp. Individually assessed, direct vision may offer greater safety. X-ray or pH of aspirated fluid confirmed the position of GI tube placements. One adverse event occurred during placement, reversible bradycardia, in a patient previously having bradycardia. Vision was intermittently obscured by bile, mucus or impaction with mucosa.

CONCLUSION

'IRIS' tubes offer real-time guidance regarding anatomical position. Larger studies are needed to establish the best techniques of deploying this equipment and over-coming the difficulties observed.

Comparative evaluation of blood collection tubes for clinical chemistry analysis

BACKGROUND

Routine chemistry testing is typically performed using serum or plasma to assess a patient's clinical status. At our institution, serum is the specimen type used. To reduce processing times, evaluation of plasma-based and rapid serum gel separator tubes was performed.

METHODS

We compared the results of routine chemistry analytes collected in serum gel separator tubes (SST), plasma gel separator tubes (PST), rapid serum gel separator tubes (RST), and plasma tubes without gel separators (DGT). Result concordance was assessed at baseline (immediate testing after processing) and up to one week of refrigerated storage. Other parameters assessed were the susceptibility to hemolysis and lipemia interference, and changes in results after re-centrifugation. Percent changes were compared against the SST and evaluated according to established bias thresholds.

RESULTS

Total protein and potassium results at baseline in plasma-based tubes had percent changes from the SST that exceeded acceptability thresholds. Stability was significantly shortened for glucose, potassium, aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) when collected in the PST as compared to the SST. The RST was the least susceptible to hemolysis and lipemia interferents. Re-centrifugation affected the serum-based analysis of potassium.

CONCLUSIONS

Plasma may reduce processing time at the expense of shortened sample stability and may require specimen source-specific reference intervals for potassium and total protein. The RST provides an alternate option to reduce processing time, while maintaining storage stability.

Beyond the tube: Can we reduce chest tube complications in trauma patients?

BACKGROUND

We sought to identify opportunities for interventions to mitigate complications of tube thoracostomy (TT).

METHODS

Retrospective review of all trauma patients undergoing TT from 6/30/2016-6/30/2019. Multivariable logistic regression identified independent predictors of complications.

RESULTS

Out of 451 patients, 171 (37.9%) had at least one TT malpositioning or complication. Placement in the emergency department, placement by emergency medicine physicians, and body mass index >30 kg/m² were independent predictors of complication. Malpositioning increased the likelihood of early complication (6.5%-53.5%), and early complication increased the likelihood of late complication (4.3%-13.6%). Patients with a late complication had, on average, a 7.56 day longer hospital stay than patients without a late complication.

CONCLUSION

TT complications were associated with placement in the emergency department, placement by emergency medicine physicians, and BMI>30 kg/m². We identified associations between malpositioning, early complications, and late complications, and demonstrated that TT complications impact patient outcomes.

Brain response to odors presented inside the nose, directly in front of the nose or with ambient air

OBJECTIVE

Functional magnetic resonance imaging (fMRI) allows the measurement of changes in blood flow in association with changes in brain activity. This technique has been used frequently to study brain activation in response to odorous stimuli. The aim of this study was to evaluate the effects of odor delivery conditions on brain responses obtained with fMRI.

STUDY DESIGN

Prospective cohort study SETTING: Academic institution.

METHODS

Twenty healthy volunteers (mean age = 29.5 years; 9 women, 11 men) participated. Three odor delivery methods were used: "tube" (odor presented intranasally with separate tubing for each nostril), "mask" (odor presented in a face mask covering the subject's nose) and "vacuum" (odor presented into the ambient air). Presentation of the pleasant "peach" odor was performed using a computer-controlled olfactometer. Subjects were asked to evaluate the intensity of the odors after each fMRI run.

RESULTS

"Tube" showed higher self-rated odor intensity compared to "mask" and "vacuum" (F = 18.4, p < 0.001). Odor intensity had a positive correlation (r = 0.6, p < 0.05) with percent signal change extracted from the secondary olfactory cortex region in the mask condition. In the tube condition, several selected regions of interest (Amygdala, Insula, Thalamus) showed lower activations compared to the other two conditions (p_uncorrected < 0.001, mask > tube, vacuum > tube).

CONCLUSION

Activations of region of interests (ROIs) in response to the odorous stimuli showed differences under the three conditions (mask, tube, vacuum). In this passive fMRI paradigm, this may partly reflect the differences in odor intensity, but also in attention and contextual variables related to odor perception.

Assessment of odor perception related to stimulation modes in a mock MRI scanner

BACKGROUND

Numerous studies investigated the central-nervous processing of olfactory information in humans, often based on functional MRI studies. However, when describing the olfactory perception, the course of olfactory sensations over time has received little attention although this constitutes a fundamental portion of the experimental paradigm. Hence, the aim of this study was to evaluate overall perception and the perception of odors over the time course of repeated odorous stimulation under different conditions of stimulus presentation.

NEW METHOD

Twenty-eight subjects with a normal sense of smell were asked to lie in a mock MRI scanner during the experiment. Three conditions of odor presentations were Tubing, (odors presented intranasally with separate tubing for each nostril), mask (odors presented to a mask covering the subject's nose) and vacuum (odors presented into the bore of the sham scanner). A pleasant odor (peach) and an unpleasant (fish) odor were presented using a computer-controlled olfactometer. Participants were asked to evaluate intensity and pleasantness of the odors. They also rated the comfortability of each presentation mode. For the vacuum and mask conditions, subjects were tracked with the time course of the odor intensity.

RESULTS

For all sessions, intensity was influenced by conditions (F = 29.6, p < 0.001, ηp² = 0.8, mask > tube > vacuum) and odors (F = 11.8, p = 0.003, ηp² = 0.4, fish > peach). Pleasantness was influenced by odors (F = 26.2, p = 0.001, ηp² = 0.593, peach > fish), comfortability was significantly influenced by conditions (F = 9.3, p = 0.002, ηp² = 0.5, vacuum > mask > tube). For peach odor, pleasantness was positively correlated with intensity (r = 0.3, p = 0.03) and negatively with fish odor intensity (r = -0.4, p < 0.001). Overall, the onset latency of intensity ratings (mean = 3.5 s, SD = 2.6) was significantly longer than the offset latency (mean = 1.6 s, SD = 0.8) (t = 3.5, p = 0.001). For the amplitude, conditions had a significant effect (F = 4.5, p = 0.04, ηp² = 0.2, mask > vacuum).

CONCLUSIONS

Perceived odor intensity was affected by the odor presentation being strongest in the mask condition, whereas this was not different for odor pleasantness. The vacuum condition was rated as most comfortable. Within the present design, the latency of onset and offset does not seem to be influenced by conditions, odors and blocks. Models of fMRI analyses should be adjusted to account for this shift in odor intensity perception.

Subannular ventilation tubes in the pediatric population: Clinical outcomes of over 1000 insertions

OBJECTIVES

Long-term transtympanic tube insertions for chronic middle ear disease are associated with high rates of complications. The objective of this study was to examine the clinical outcomes achieved with an alternate technique, the subannular tube insertion, by determining mean tube lifespan, cumulative incidence of post-operative events and complications, audiometric changes and risk factors associated with earlier tube extrusion in the pediatric population.

METHODS

A retrospective chart review of all patients operated for subannular tube insertion between January 2007 and 2013 was conducted in a single pediatric tertiary care center. Exploratory Cox regression analysis was performed to identify potential risk factors.

RESULTS

A total of 1014 tubes from 459 patients were included in the study. Mean subannular tube lifespan was 41.3 months with median time of 35.0 months. Cumulative incidence of post-operative events in decreasing frequency were otorrhea (21.7%), tube blockage (16.0%), tympanic membrane retraction (12.5%), otitis media with effusion (10.0%), acute otitis media (6.4%), perforation (4.6%) and cholesteatoma formation (1.1%). For patients with available pre- and post-operative audiograms, mean air-bone gap improved from 19.5 dB to 7.0 dB after subannular tube insertion (p < 0.01). Increasing age and previous subannular tube insertion carried hazard ratios of 1.029 (p < 0.01) and 1.749 (p < 0.01) for tube extrusion respectively, while craniofacial anomalies and concomitant tympanoplasty at the time of tube insertion had hazard ratios of 0.795 (p < 0.01) and 0.680 (p = 0.03).

CONCLUSIONS

Subannular tube insertion appears to be a safe and effective alternate technique for middle ear ventilation in cases of intractable disease.

[Efficacy tubular paraspinal approach and conventional semi-laminar approach in treating lumbar stenosis]

Objective: To analysis of the efficacy of tubular paraspinal approach and conventional semi-laminar approach in treating lumbar stenosis. Methods: Retrospective research of clinical data of 56 lumbar stenosis cases who were operated in neurosurgery department of first center of PLA general hospital from May 2015 to June 2018. Collecting the information of sex, age, operating time, intraoperative blood loss, postoperative duration in bed, as well as length of hospital stay of those patients. The 2 groups of cases, tubular paraspinal approach group (n=35)and semi-laminal approachgroup (n=21), compared by Japanese orthopedic association (JOA) score and visual analogue scale to assess the functional situation of the patients before operation, 1 week after operation, 1 month after operation, 6 months after operation, and the last follow up. Results: The operating time(83.1±7.3 vs 86.1±9.6 min), intraoperative blood loss(18.2±3.9 vs 40.5±13.3 ml), postoperative duration in bed(37.4±7.8 vs 63.7±15.8 h), as well as length of hospital stay (3.8±1.1 vs 6.5±2.0 d)were all obviously better in tubular paraspinal approach group than in traditional semi-laminar approach group(P<0.05). The postoperative 1 week, 1month, and 6 months JOA score (21.8±3.4, 23.6±2.4, 24.2±2.4 vs 19.9±3.7, 21.6±2.8, 22.4±2.1)and VAS (2.2±1.0, 2.0±1.1, 0.4±0.1 vs 3.1±1.2, 2.6±1.3, 0.5±0.1) were better in tubular paraspinal approach group than semi-laminar approach group (P<0.05). While at the last follow up, the JOA score and VAS were similar in the 2 groups (P>0.05) . Conclusions: In non-fusion techniques for treating lumbar stenosis, tubular paraspinal approach demonstrated less blood loss, shorter stay in bed as well as in hospital, and better symptom relief in early postoperative period than traditional semi-laminal approach. While at long term follow up, both approaches achieved satisfactory outcome.

Undetected Cortrak tube misplacements in the United Kingdom 2010-17: An audit of trace interpretation

OBJECTIVES

Determine why Cortrak-guided, undetected tube misplacement may occur in relation to the system of trace interpretation used.

METHODOLOGY

From 2010 to 2017 we obtained seven of the eight Cortrak traces from the United Kingdom where misplacement was undetected and the patient received feed. Seven suffered serious harm. Each misplacement was interpreted by three systems: screen position, manufacturer guidance and gastrointestinal (GI) flexures.

SETTING

National and local records.

MAIN OUTCOME MEASURES

Ability to identify misplacement.

RESULTS

Traces that were later identified as misplacements, could not be differentiated from GI position when they wholly or partially: a) overlapped with the GI screen area plotted from historical records (57-71%) or b) met both manufacturer guidance criteria or were confused with receiver misplacement or unusual anatomy and reached the lower left quadrant (14-71%). Conversely, all lung misplacements were identified as unsafe using the GI flexure system. All three systems failed to detect the intra-peritoneal trace. Traces were inconsistently stored by healthcare centres.

CONCLUSION

Trace file storage should be mandated by and accessible to relevant health authorisation bodies to improve safety research. Screen position alone and manufacturer guidance fail to consistently differentiate the shape of safe from unsafe traces. GI flexure interpretation appears safer but requires testing in larger studies.

ZKF-based optimal robust fault estimation of descriptor LPV systems with measurement error-affected scheduling variables

This paper proposes a robust state and fault estimation (SFE) method for discrete-time descriptor linear-parameter-varying (LPV) systems with inexact scheduling variables. As an important robust method dealing with system uncertainties, the set-membership estimation method is combined with the technique of generalized fault detectability indices and matrix to compute a state and fault tube to contain the real system states and fault signals at each time instant under the assumption that the system uncertainties (i.e., modeling errors, process disturbances, measurement noises and errors of scheduling variables) are bounded to guarantee the robustness of SFE. Theoretically, any trajectory in the tube can be used as a point-wise estimation of the real system states and fault signals. Meanwhile, the optimal parametric matrices both for set-membership estimation and unknown input observer (UIO) are designed by using the zonotopic Kalman filter (ZKF) procedure to guarantee the optimality of SFE under a set-theoretic framework. Furthermore, a collection of stability conditions for the proposed optimal SFE method are established based on the linear matrix inequalities (LMIs). At the end, a practical electric circuit and a vehicle example are used to illustrate the effectiveness of the proposed SFE method.

Simple Vestibuloplasty Using a Tube in Combination with Cortical Bone Screws Around Dental Implant

Introduction

We developed a novel, reliable and easy method that retains stability of the repositioned flap and vestibular expansion.

Method

The conventionally elevated mucosal flap is secured to the desired depth of the vestibule by the pressure created by the polyvinyl chloride 6Fr suction catheter which is fixed to the alveolar bone with cortical bone screws passing through the inner lumen of the tube. The keratinized free flap is placed on the periosteum conventionally, and horizontal mattress suturing is performed for immobilization, with the suture running through the inner lumen of the tube transversally.

Conclusion

This simple method gives us great benefit on the vestibuloplasty.

Gastric tube volvulus following an Ivor-Lewis esophagectomy

Gastric tube conduit is the method of choice for restoring continuity of the digestive track after a partial or total esophagectomy. Redundant gastric conduit (i.e. an elongated, floppy conduit) is a rare cause of dysphagia in patients with long survival. Gastric tube volvulus is exceedingly rare with only three cases described in the literature. We present the diagnostic and therapeutic course of a 57-year-old man who presented to our department with gastric tube volvulus 32 months after an Ivor-Lewis esophagectomy. Diagnosis was made with computed tomography and volvulus was reduced endoscopically. To the best of our knowledge, this is only the fourth case of gastric tube volvulus described in the English literature. This rare situation might be a consequence of a redundant gastric tube. Endoscopic volvulus decompression was successful in our case.

Morphology of hindwing veins in the shield bug Graphosoma italicum (Heteroptera: Pentatomidae)

Light, fluorescence, and electron microscopy were applied to cross sections and -breakage and whole-mount preparations of the anterior hindwing vein of the shield bug Graphosoma italicum. These analyses were complemented by investigations of the basal part of the forewing Corium and Clavus. The integration of structural, histological, and fluorescence data revealed a complex arrangement of both rigid and elastic structures in the wall of wing veins and provided insights into the constitution of transition zones between rigid and elastic regions. Beneath the exocuticular layers, which are continuous with the dorsal and ventral cuticle of the wing membrane, the lumen of the veins is encompassed by a mesocuticular layer, an internal circular exocuticular layer, and an internal longitudinal endocuticular layer. Separate parallel lumina within the anterior longitudinal vein of the hindwing, arranged side-by-side rostro-caudally, suggest that several veins have fused in the phylogenetic context of vein reduction in the pentatomid hindwing. Gradual structural transition zones and resilin enrichment between sclerotized layers of the vein wall and along the edges of the claval furrow are interpreted as mechanical adaptations to enhance the reliability and durability of the mechanically stressed wing veins.

Water Drinking Test: Intraocular Pressure Changes after Tube Surgery and Trabeculectomy

PURPOSE

To study the effects of filtration surgeries (tube and trabeculectomy) on changes in intraocular pressure after a water-drinking test.

METHODS

In this prospective, non-randomized, comparative clinical study, 30 patients who had tube surgery and 30 age- and sex-matched trabeculectomy patients underwent a water-drinking test. Only one eye of each patient was included. The baseline intraocular pressure was ≤21 mmHg in all enrolled eyes with or without adjunctive topical medications. After the water-drinking test, the intraocular pressure was measured and recorded at 15, 30, 45, and 60 minutes and the results were compared between the two groups.

RESULTS

In both groups, intraocular pressure significantly increased from baseline at all measured time-points (P < 0.001). In the trabeculectomy group, the average intraocular pressure increased from 14.8 ± 2.9 to 18.8 ± 4.7 mmHg at 30 minutes, but decreased at 60 min (18.0 ± 5.2 mmHg). In the Tube group, intraocular pressure increased incrementally until the last measurement (14.2 ± 3.9, 18.8 ± 5.6, and 19.7 ± 6.0 mmHg at baseline, 30, and 60 minutes, respectively). The end-pressure difference (intraocular pressure at 60 minutes vs. baseline) was significantly greater in the tube group (5.6 ± 3.6 mmHg; 41% change) than in the trabeculectomy group (3.2 ± 4.7; 23% change; P = 0.03).

CONCLUSION

Intraocular pressure significantly increased after the water-drinking test in both the groups. Intraocular pressure started to decline 30 minutes after the water-drinking test in the trabeculectomy group, while it continued to increase up to 60 minutes in the Tube group. This finding may have implications regarding the efficacy or safety of the procedures in advanced glaucoma patients.

Intestinal epithelial organoids fuse to form self-organizing tubes in floating collagen gels

Multiple recent examples highlight how stem cells can self-organize in vitro to establish organoids that closely resemble their in vivo counterparts. Single Lgr5⁺ mouse intestinal stem cells can be cultured under defined conditions forming ever-expanding epithelial organoids that retain cell polarization, cell type diversity and anatomical organization of the in vivo epithelium. Although exhibiting a remarkable level of self-organization, the so called 'mini-guts' have a closed cystic structure of microscopic size. Here, we describe a simple protocol to generate macroscopic intestinal tubes from small cystic organoids. Embedding proliferating organoids within a contracting floating collagen gel allows them to align and fuse to generate macroscopic hollow structures ('tubes') that are lined with a simple epithelium containing all major cell types (including functional stem cells) of the small intestine. Cells lining the central contiguous lumen closely resemble the epithelial cells on luminal villi in vivo, whereas buds that protrude from the main tube into the surrounding matrix closely resemble crypts. Thus, the remarkable self-organizing properties of Lgr5⁺ stem cells extend beyond the level of the microscopic cystic organoid to the next, macroscopic, level of tube formation.

Host MicroRNA-217 Promotes White Spot Syndrome Virus Infection by Targeting Tube in the Chinese Mitten Crab (Eriocheir sinensis)

MicroRNAs (miRNAs), a group of small molecule non-encoding RNAs, are key post-transcriptional regulators of gene expression that are implicated in many biological processes. In the current study, miR-217 from Eriocheir sinensis was selected for studying its roles during host-virus interaction. Overexpression or silencing of miR-217 led to considerable effects on white spot syndrome virus (WSSV) replication, implying that miR-217 played a positive role in WSSV infection. In insect High Five cells, miR-217 significantly inhibited Tube gene expression by binding to the 3'-untranslated region of the Tube. Overexpression of miR-217 in crab led to downregulation of tube expression. Knockdown of Tube in vivo led to significant enhancement of WSSV infection and inhibited the expression of five antimicrobial peptide (AMP) genes (Anti-lipopolysaccharide factor ALF1, ALF2, ALF3; Crustin Crus1, Crus2) in WSSV-challenged crabs. Overexpression of miR-217 also led to downregulation of these AMP genes in WSSV-challenged crabs. Our results showed that host miRNA played positive roles in virus infection by regulation of host tube gene, which is the key component of Toll signaling pathway.

Crocetin treatment inhibits proliferation of colon cancer cells through down-regulation of genes involved in the inflammation

Background

The current study was designed to investigate the effect of crocetin on the proliferation inhibition of colon cancer cells and the underlying mechanism.

Methods

MTT assay showed inhibition of proliferation of colon cancer cells in a dose based manner by crocetin treatment. At 30 µM concentration of crocetin proliferation rate of colon cancer cells was reduced to 14% after 24 h. Flow cytometry and fluorescence microscopy revealed induction of apoptosis in colon cancer cells on treatment with crocetin. The tube formation was suppressed significantly in the cultures of HUVEC treated with 30 µM concentration of crocetin compared to the control cultures.

Results

The results from transwell assay revealed a significant reduction in the population of DU-145 cells passing through filters of transwell on treatment with crocetin compared to the control cells. Treatment of the DU-145 cells with crocetin caused a significant reduction in the expression levels of NF-κB, VEGF and MMP-9. The results from RT-PCR analysis revealed a significant reduction in the expression of genes involved in inflammation including, HMGB1, IL-6 and IL-8 on treatment of DU-145 cells with crocetin. However, the expression of NAG-1 gene was increased by crocetin treatment in DU-145 cells significantly compared to the control cells.

Conclusion

Crocetin inhibits growth of colon cancer cells and prevents tube formation through induction of apoptosis. Therefore, crocetin can be used efficiently for the treatment of colon cancer.

Design, fabrication, and implantation of tube-shaped devices for the treatment of salivary duct diseases

Introduction: Starch-based materials were designed using a special extrusion die in order to obtain a tube-shaped device for application to salivary duct treatment in the field of endoscopy, i.e., sialendoscopy . Methods: Extrusion process was used to produce starch tubes. Mechanical properties of the dry tube before implantation were determined using an axial compression test. A finite element study was carried out to simulate the behavior of the hydrated tube under external axial pressure. Hydrolysis of these devices in a simulated salivary solution was studied, as well as its glycerol kinetics release. An animal short-term implantation model for salivary ducts was proposed as a feasibility study for starch tube-shaped devices. Results: A continuous production of regular and size-controlled tubes was obtained. The very small diameter obtained, less than 2 mm, corresponds to the requirement of being insertable in a human salivary duct using sialendoscopy guidewire. Finite element analysis showed that the starch tube can still support an external pressure higher than 0.2 MPa without irreversible damage. After 4 days of implantation, the host response is encouraging and the inflammatory response for this type of procedure remains normal. Conclusion: These devices were adapted to sialendoscopic guidewires and able to be implanted in the salivary ducts of pigs. If a longer lasting tube is required, the crystallinity of the starch material should be improved.

The impact of tobacco exposure on development of otorrhea after myringotomy tube placement

INTRODUCTION

Otorrhea is a common sequela after myringotomy with tube placement (MTP). The purpose of this study was to identify any significant relationship between passive tobacco exposure and the development of post-tympanostomy tube otorrhea.

METHODS

Retrospective chart review was performed on 774 cases of patients who underwent MTP by a single surgeon at a tertiary pediatric hospital from 2012 to 2014. Patients with multiple medical comorbidities, craniofacial anomalies, syndromes and those over 12 years of age were excluded. Multivariate logistic regression analysis was performed to determine if there was a relationship between risk factors (including tobacco exposure, age, pre-operative diagnosis, operative findings and duration of follow-up) and the development of post-tympanostomy tube otorrhea.

RESULTS

One hundred and ninety-one patients (average age of 1.92 years) were included. Overall, 16.8% of patients (32/191) had exposure to tobacco smoke. Of patients with passive smoke exposure, 65.6% (21/32) developed otorrhea, as compared to 45.3% (72/159) of those without tobacco exposure. Passive exposure to tobacco smoke by (OR = 2.307; p = 0.009; 95% CI, 1.734-6.028) and younger age (p = 0.012; 95% CI, 0.602-0.938) were associated with increased risk for otorrhea.

DISCUSSION

This study suggests that in a cohort of patients undergoing MTP, passive exposure to tobacco smoke significantly increases the risk of developing post-operative otorrhea. This information is valuable to include in parental preoperative counseling regarding tympanostomy tube placement.

Blood collection tubes as medical devices: The potential to affect assays and proposed verification and validation processes for the clinical laboratory

Blood collection tubes (BCTs) are an often under-recognized variable in the preanalytical phase of clinical laboratory testing. Unfortunately, even the best-designed and manufactured BCTs may not work well in all clinical settings. Clinical laboratories, in collaboration with healthcare providers, should carefully evaluate BCTs prior to putting them into clinical use to determine their limitations and ensure that patients are not placed at risk because of inaccuracies due to poor tube performance. Selection of the best BCTs can be achieved through comparing advertising materials, reviewing the literature, observing the device at a scientific meeting, receiving a demonstration, evaluating the device under simulated conditions, or testing the device with patient samples. Although many publications have discussed method validations, few detail how to perform experiments for tube verification and validation. This article highlights the most common and impactful variables related to BCTs and discusses the validation studies that a typical clinical laboratory should perform when selecting BCTs. We also present a brief review of how in vitro diagnostic devices, particularly BCTs, are regulated in the United States, the European Union, and Canada. The verification and validation of BCTs will help to avoid the economic and human costs associated with incorrect test results, including poor patient care, unnecessary testing, and delays in test results. We urge laboratorians, tube manufacturers, diagnostic companies, and other researchers to take all the necessary steps to protect against the adverse effects of BCT components and their additives on clinical assays.

Inappropriate fixation of an endotracheal tube causing cuff malfunction resulting in difficult extubation

We discuss a case of difficult extubation, due to inadequate deflation of the tracheal tube cuff, despite collapse of the pilot balloon, on its aspiration. This was caused by inadvertent kinking of the pilot balloon tubing due to inappropriate tape fixation of the endotracheal tube.

Isolated fallopian tube torsion: two case reports of a rare entity

Isolated fallopian tube torsion is a rare entity that is difficult to diagnose, as its clinical presentation is often highly nonspecific. Early diagnosis is important to avoid damage or loss of the fallopian tube or even the ovary, as this diagnosis occurs predominantly in women of child-bearing age. Imaging may be helpful in suggesting this difficult diagnosis, with confirmation of this entity made in the operating room. Treatment can range from detorsing the tube to salpingectomy or even salpingo-oopherectomy. Here, we present two cases of isolated fallopian tube torsion, followed by a discussion of its imaging findings.

In vitro evaluation of the method effectiveness to limit inflation pressure cuffs of endotracheal tubes

BACKGROUND AND OBJECTIVE

Cuffs of tracheal tubes protect the lower airway from aspiration of gastric contents and facilitate ventilation, but may cause many complications, especially when the cuff pressure exceeds 30cm H2O. This occurs in over 30% of conventional insufflations, so it is recommended to limit this pressure. In this study we evaluated the in vitro effectiveness of a method of limiting the cuff pressure to a range between 20 and 30cm H2O.

METHOD

Using an adapter to connect the tested tube to the anesthesia machine, the relief valve was regulated to 30cm H2O, inflating the cuff by operating the rapid flow of oxygen button. There were 33 trials for each tube of three manufacturers, of five sizes (6.5-8.5), using three times inflation (10, 15 and 20s), totaling 1485 tests. After inflation, the pressure obtained was measured with a manometer. Pressure >30cm H2O or <20cm H2O were considered failures.

RESULTS

There were eight failures (0.5%, 95% CI: 0.1-0.9%), with all by pressures <20cm H2O and after 10s inflation (1.6%, 95% CI: 0 5-2.7%). One failure occurred with a 6.5 tube (0.3%, 95% CI: -0.3 to 0.9%), six with 7.0 tubes (2%, 95% CI: 0.4-3.6%), and one with a 7.5 tube (0.3%, 95% CI: -0.3 to 0.9%).

CONCLUSION

This method was effective for inflating tracheal tube cuffs of different sizes and manufacturers, limiting its pressure to a range between 20 and 30cm H2O, with a success rate of 99.5% (95% CI: 99.1-99.9%).

p114RhoGEF governs cell motility and lumen formation during tubulogenesis through a ROCK-myosin-II pathway

Tubulogenesis is fundamental to the development of many epithelial organs. Although lumen formation in cysts has received considerable attention, less is known about lumenogenesis in tubes. Here, we utilized tubulogenesis induced by hepatocyte growth factor (HGF) in MDCK cells, which form tubes enclosing a single lumen. We report the mechanism that controls tubular lumenogenesis and limits each tube to a single lumen. Knockdown of p114RhoGEF (also known as ARHGEF18), a guanine nucleotide exchange factor for RhoA, did not perturb the early stages of tubulogenesis induced by HGF. However, this knockdown impaired later stages of tubulogenesis, resulting in multiple lumens in a tube. Inhibition of Rho kinase (ROCK) or myosin IIA, which are downstream of RhoA, led to formation of multiple lumens. We studied lumen formation by live-cell imaging, which revealed that inhibition of this pathway blocked cell movement, suggesting that cell movement is necessary for consolidating multiple lumens into a single lumen. Lumen formation in tubules is mechanistically quite different from lumenogenesis in cysts. Thus, we demonstrate a new pathway that regulates directed cell migration and formation of a single lumen during epithelial tube morphogenesis.

[In vitro evaluation of the method effectiveness to limit inflation pressure cuffs of endotracheal tubes]

BACKGROUND AND OBJECTIVE

Cuffs of tracheal tubes protect the lower airway from aspiration of gastric contents and facilitate ventilation, but may cause many complications, especially when the cuff pressure exceeds 30cm H2O. This occurs in over 30% of conventional insufflations, so it is recommended to limit this pressure. In this study we evaluated the in vitro effectiveness of a method of limiting the cuff pressure to a range between 20 and 30cm H2O.

METHOD

Using an adapter to connect the tested tube to the anesthesia machine, the relief valve was regulated to 30cm H2O, inflating the cuff by operating the rapid flow of oxygen button. There were 33 trials for each tube of three manufacturers, of five sizes (6.5 to 8.5), using three times inflation (10, 15 and 20seconds), totaling 1485 tests. After inflation, the pressure obtained was measured with a manometer. Pressure >30cm H2O or <20cm H2O were considered failures.

RESULTS

There were eight failures (0.5%, 95% CI: 0.1-0.9%), with all by pressures <20cm H2O and after 10seconds inflation (1.6%, 95% CI: 0 5-2.7%). One failure occurred with a 6.5 tube (0.3%, 95% CI: -0.3-0.9%), six with 7.0 tubes (2%, 95% CI: 0.4 to 3.6%), and one with a 7.5 tube (0.3%, 95% CI: -0.3-0.9%).

CONCLUSION

This method was effective for inflating tracheal tube cuffs of different sizes and manufacturers, limiting its pressure to a range between 20 and 30cm H2O, with a success rate of 99.5% (95% CI: 99.1-99.9%).

Progress in the direct structural characterization of fibrous amphiphilic supramolecular assemblies in solution by transmission electron microscopic techniques

The self-assembly of amphiphilic molecules into fibrous structures has been the subject of numerous studies over past decades due to various current and promising technical applications. Although very different in their head group chemistry many natural as well as synthetic amphiphilic compounds derived from carbohydrates, carbocyanine dyes, or amino acids tend to form fibrous structures by molecular self-assembly in water predominantly twisted ribbons or tubes. Often a transition between these assembly structures is observed, which is a phenomenon already theoretically approached by Wolfgang Helfrich and still focus point in current research. With the development of suitable sample preparation and electron optical imaging techniques, cryogenic transmission electron microscopy (cryo-TEM) in combination with three-dimensional (3D) reconstruction techniques has become a particular popular direct characterization technique for supramolecular assemblies in general. Here we review the recent progress in deriving precise structural information from cryo-TEM data of particularly fibrous structures preferably in three dimensions.

Identification and characterization of Tube in the Chinese mitten crab Eriocheir sinensis

As a key component of the Toll signaling pathway, Tube plays central roles in many biological activities, such as survival, development and innate immunity. Tube has been found in shrimps, but has not yet been reported in the crustacean, Eriocheir sinensis. In this study, we cloned the full-length cDNA of the adaptor Tube for the first time from E. sinensis and designated the gene as EsTube. The full-length cDNA of EsTube was 2247-bp with a 1539-bp open reading frame (ORF) encoding a 512-amino acid protein. The protein contained a 116-residue death domain (DD) at its N-terminus and a 272-residue serine/threonine-protein kinase domain (S_TKc) at its C-terminus. Phylogenetic analysis clustered EsTube initially in one group with other invertebrate Tube and Tube-like proteins, and then with the vertebrate IRAK-4 proteins, finally with other invertebrate Pelle proteins. Quantitative real-time polymerase chain reaction (qRT-PCR) analysis results showed that EsTube was highly expressed in the ovary and testis, and moderately expressed in the thoracic ganglia and stomach. EsTube was expressed at all selected stages and was highly expressed in the spermatid stage (October, testis) and the stage III-2 (November, ovary). EsTube was differentially induced after injection of lipopolysaccharides (LPS), peptidoglycan (PG) or zymosan (β-1,3-glucan). Our study indicated that EsTube might possess multiple functions in immunity and development in E. sinensis.

Inappropriate fixation of an endotracheal tube causing cuff malfunction resulting in difficult extubation

We discuss a case of difficult extubation, due to inadequate deflation of the tracheal tube cuff, despite collapse of the pilot balloon, on its aspiration. This was caused by inadvertent kinking of the pilot balloon tubing due to inappropriate tape fixation of the endotracheal tube.