Comparison of two methods of surfactant administration and the effect on dosing-associated hypoxemia

OBJECTIVE: The purpose of our study was to test the hypothesis that surfactant dosing through a proximal sideport adapter on an endotracheal tube leads to more dosing-associated hypoxemia compared with a method of dosing that uses a double-lumen endotracheal tube. STUDY DESIGN: Using adequate sample size to compare significant changes in O2 saturation (power > 0.8, alpha < 0.05) we enrolled 36 infants with respiratory distress syndrome in this randomized trial. A 10% change in O2 saturation was considered clinically significant. Nineteen infants received 38 doses of surfactant through the sideport adapter. Seventeen infants received 31 doses of surfactant through the nonventilation lumen of a double-lumen endotracheal tube. Two main outcome measures were assessed: time-averaged O2 saturation values 30 minutes after dosing and the largest absolute fall in O2 saturation for each patient. RESULTS AND CONCLUSIONS: Time-averaged O2 saturation measures were higher in the proximal sideport group (p = 0.02), but the magnitude of difference was probably not clinically significant. No significant difference was detected between groups when we compared largest absolute drop in O2 saturation. Secondary analyses found no effect of birth weight or dose number (second vs third dose) on either outcome measure.     

A case of paraquat poisoning and subsequent fatality presenting to an emergency department

Paraquat (1,1'-dimethyl-4,4'-dipyridylium) is an herbicide associated with both accidental and intentional ingestion, leading to severe and often fatal toxicity. Prognosis is largely dependent on the amount of paraquat absorbed. Rapid identification of the symptoms of paraquat toxicity (burns or ulceration at the site of ingestion or injection, acute respiratory distress, and renal failure) can facilitate early treatment intervention to limit absorption. We report a case of a 71-year-old man with a suicidal ingestion of paraquat 2 days prior to presentation. Serum paraquat levels, time elapsed since ingestion, and clinical symptoms all indicated poor prognosis. The patient developed severe respiratory distress and progressive renal failure, and died 6 days after admission to the hospital.     

Rectus abdominis muscle flap (RAMF) technique for the management of bladder exstrophies: late clinical outcome and urodynamic findings

OBJECTIVE: To investigate the efficacy of the rectus abdominis muscle flap (RAMF) technique for the closure and augmentation of small, non-compliant bladder exstrophies. PATIENTS AND METHODS: The RAMF technique was used in two girls and two boys (mean age at operation, 31.7 months, range 3-72) with bladder exstrophy. The clinical outcome and urodynamics were assessed during a follow-up of 29 months to 6 years (mean 49.2 months) and included imaging, cystoscopy, biochemical and microbiological studies. RESULTS: There were no urinary tract infections, metabolic problems or electrolyte disturbances and kidney function remained normal in all patients. Radiography confirmed intact function and anatomy of the urinary tract and cystoscopy showed complete coverage of the inner peritoneal layer of RAMF with uroepithelium. No stone formation or mucus production were detected. Currently, three patients void using clean intermittent catheterization through the native urethra and the fourth through an appendiceal Mitrofanoff valve. However, the bladder volume was insufficient at the late follow-up and three patients required bladder augmentation. CONCLUSIONS: The RAMF technique is a good alternative for closing bladder exstrophies and achieves an increase in bladder capacity; however, although there is a mild improvement in bladder capacity and compliance. RAMF should not be used as a bladder augmentation procedure. The technique is indicated in the closure of large bladder defects, bladder exstrophies with small, inelastic, non-compliant bladder remnants and failed primary closures.     

Higher order soliton pulse compression in dispersion-decreasingoptical fibers

Compression of higher order optical solitons in fibers with anomalous dispersion decreasing along their length is investigated. We demonstrate high-quality compression of pulses with initial soliton order 1相似文献   

Comparison of the effects of nonlinear gain and weak opticalfeedback on the dynamics of semiconductor lasers

The influence of nonlinear gain and optical feedback on the dynamics of single-mode semiconductor lasers are numerically investigated based on the Lang and Kobayashi model. It is well known that the nonlinear gain tends to stabilize the dynamics, while the optical feedback tends to increase the instabilities. In this paper, we study the behavior of the attractors when the feedback level k and the gain saturation coefficient ε vary and show that the effects of these parameters are surprisingly opposite. For example, we find that the route to chaos that the external cavity modes follow for increasing k is reversed for increasing ε in an almost identical manner. When the feedback increases the modes follow the usual quasi-periodic route and turn into torus. If k continues to increase, the torus become chaotic attractors as the result of several period-doubling bifurcations or a third Hopf bifurcation. Further increase of k causes the chaotic attractors to lose stability, Contrarily, if the value of the parameter ε is increased, the attractors recover their stability and reverse the route becoming simple torus again. If ε is increased further, the torus reverse the quasi-periodic route and turn into stable modes again. We also find that on the contrary to k, the parameter ε enhances the stability region of an attractor. We show that the feedback level above which a limit cycle emerges from a stable mode, the feedback level above which a torus emerges from a limit cycle, and the feedback level above which a chaotic attractor loses stability are all increasing functions of ε     

Characterization and modeling of a noncollinearly phase-matchedfemtosecond optical parametric oscillator based on KTA and operating tobeyond 4 μm

We describe the design and operation of a critically phase-matched femtosecond optical parametric oscillator based on KTA. By employing a small pump-signal noncollinear angle, tuning of the idler to beyond 4 μm is achieved using a Ti:sapphire pump laser. A Gaussian-beam model is described which can be used to identify the optimal noncollinear phase-matching geometry. Idler and signal pulses are characterized fully both temporally and spectrally and interferometric autocorrelation data at 3.5 μm showing idler pulses of only eight optical cycles duration are presented     

Microbiological safety of kinema, a fermented soya bean food

Kinema is a fermented soya bean food of Nepal and the hilly regions of North-eastern States of India. Generally, the fermentation is dominated by Bacillus spp. that often cause alkalinity and desirable stickiness in the product. The present study was undertaken in a limited number of commercial (market) kinema samples to test for the presence of foodborne pathogens and their properties. Bacillus cereus was present in numbers exceeding 10⁴ cfu/g product in five of the tested 15 market samples. Enterobacteriaceae and coliform bacteria exceeded 10⁵ cfu/g in 10 of the 15 samples. Escherichia coli exceeding 10⁵ cfu/g was found in two samples. Staphylococcus aureus was not detected in any of the tested samples. Of 31 isolated typical and atypical strains of B. cereus, 18 representative strains were tested qualitatively for the ability to produce diarrhoeal type enterotoxin (BCET) using an Oxoid BCET-RPLA test kit. Overall, BCET was formed by 12 strains in BHIG (brain heart infusion broth +1% glucose), by seven strains on sterilized cooked rice, and by five strains on sterilized cooked soya beans. Semi-quantitative tests on BCET revealed that levels exceeding 256 ng/g soya beans, produced by single pure culture inoculation with the isolated B. cereus strains, were reduced to ≤ 8 ng/g by frying kinema in oil, a common procedure when making kinema curry. It was also shown in a mixed pure culture experiment that a kinema strain B. Subtilis DK-W1, is able to suppress growth and BCET formation by a selected toxin producing strain (BC7-5) of B. cereus. It is concluded that the traditional way of making kinema and its culinary use in curries is safe. However, for novel applications of kinema, safety precautions are advisable.     

Reuse efficiency for non-uniform traffic distributions in CDMAsystems

An exact and simple method to evaluate the frequency reuse efficiency for the reverse link of cellular CDMA systems over a non-uniform traffic distribution is presented. This method is based on a traffic redistribution and decomposition process and on standard curves with which partial reuse efficiencies are obtained and conveniently added to give the final parameter