Rapid infusion system for neurosurgical treatment of massive intraoperative hemorrhage

Using an illustrative case of severe closed head injury that resulted in a posterior fossa epidural hematoma (EDH) and supratentorial epidural/subdural hematomas (SDH), the massive blood losses associated with operative repair of the torn sigmoid sinus and the significant fluid losses associated with refractory diabetes insipidus were treated by the intraoperative use of the Rapid Infusion System (RIS, Haemonetics). The RIS can rapidly infuse warm blood, crystalloid, or colloid at rates up to 1.5 L/min, thereby limiting the commonly associated hypotension, hypothermia, and coagulopathies. During the suboccipital craniectomy for evacuation of the EDH and repair of the sigmoid sinus, the patient required 18 units of blood replacement secondary to a large tear in the sigmoid sinus. During a separate craniotomy for evacuation of the SDH, the patient also developed diabetes insipidus, which increased the operative fluid replacement to 39 L. Despite these massive blood and fluid losses, the RIS limited the hypotension to less than 2 min and prevented hypothermia and the frequently associated coagulopathies. When used in a neurosurgical setting associated with massive blood and/or fluid losses, the RIS accomplishes three important objectives: (1) rapid infusion of intravenous fluids for maintaining perfusion pressure, (2) rapid warming of fluids despite high intravenous infusion rates of cold crystalloids, thereby preventing intraoperative hypothermia, and (3) continuous monitoring of infusion rates and totals.     

Ultrasonically activated shears in thyroid surgery

BACKGROUND: Ultrasonically activated shears (UAS) have been documented to be both safe and fast devices in laparoscopic surgery. We studied whether the use of UAS would have some advantage in thyroid surgery. METHODS: Thyroidectomies, performed by one senior endocrine surgeon between December 1996 and February 1997, were retrospectively matched, with patients operated on by the same surgeon using the conventional method. RESULTS: Six pairs of total thyroidectomies and one pair of lobectomies could be matched. Mean operating time was 100 minutes for the patients operated on with the UAS and 154 minutes for the patients operated on with the conventional method. The mean operating time with the UAS was thus on average 64.6% of the operation time with the conventional method, with a 95% confidence interval from 50.1% to 83.5% (t = 4.00, 6 df, P = 0.007). CONCLUSIONS: In this material the use of UAS reduced significantly operating time in thyroidectomies.     

Large Particle Penetration During PM10 Sampling

The objective of the present study was to characterize the performance of a federal reference method (FRM) PM₁₀ size-selective inlet using analysis methods designed to minimize uncertainty in measured sampling efficiencies for large particles such as those most often emitted from agricultural operations. The performance of an FRM PM₁₀ inlet was characterized in a wind tunnel at a wind speed of 8 km/h. Data were also collected for 20 and 25 μm particles at wind speeds of 2 and 24 km/h. Results of the present sampler evaluation compared well with those of previous studies for a similar inlet near the cutpoint, and the sampler passed the criteria required for certification as a FRM sampler when tested at 8 km/h. Sampling effectiveness values for particles with nominal diameters of 20 and 25 μm exceeded 3% for 8 and 24 km/h wind speeds in the present study and were statistically higher than both the “ideal” PM₁₀ sampler (as defined in 40 CFR 53) and the ISO (1995) standard definition of thoracic particles (p < 0.05) for 25 μm particles leading to the potential for significant sampling bias relative to the “ideal” PM₁₀ sampler when measuring large aerosols.

Copyright 2014 American Association for Aerosol Research     

Effects of flour from different barley varieties on barley sour dough bread

Twenty flours from 16 different barley varieties cultivated in 1990 and 1992, and a Swedish reference flour, were fermented by Lactobacillus plantarum A1 to sour doughs. Barley breads (40% barley/60% wheat flour) from each flour type were baked with and without an admixture of barley sour dough in order to investigate how the sour dough admixture would affect the baking properties. A trained panel carried out sensory evaluation by conventional profiling on breads made from three of the barley varieties and the Swedish reference flour, made with and without sour dough admixture.

The barley varieties influenced both the sour dough properties and the properties of the barley bread. The pH of bread with sour dough ranged from 4.6 to 4.8 as compared to 5.4 to 5.6 in bread without sour dough. The acidity of the breads with sour dough ranged from 4.1 to 5.0 ml NaOH/ 10 g bread crumb as compared to 2.4 to 3.6 in breads without sour dough. In 14 of the twenty bread types an addition of sour dough lowered the bread volume. Breads with a sour dough admixture scored higher for total taste and acidulous taste than breads without sour dough. The β-glucan content of the flours had no significant influence on the sour dough or the sensory characteristics of the bread, except for the breadcrumb colour.     

Liquid Consumption of Wetted Wall Bioaerosol Sampling Cyclones: Characterization and Control

Advances in microfluidic, lab on chip, and other near-real-time biological identification technologies have driven the desire to concentrate bioaerosols into hydrosol sample volumes on the order of tens of microliters (μL). However, typical wet biological aerosol collector outputs are an order or two of magnitude above this goal. The ultimate success of bioaerosol collectors and biological identifiers requires an effective coupling at the macro-to-micro interface. Liquid collection performance was studied experimentally for a family of dynamically scaled wetted wall bioaerosol sampling cyclones (WWC's). Steady-state liquid collection rates and system response times were measured for a range of environmental conditions (temperatures from 10°C to 50°C and relative humidities from 10% to 90%), liquid input rates, and WWC airflow configurations. A critical liquid input rate parameter was discovered that collapsed all experimental data to self-similar empirical performance correlations. A system algorithm was then developed from empirical correlations to provide control over the liquid output rate and resulting concentration factor for a cyclone with an airflow rate of 100 L/min. Desired liquid output rates of 25 to 50 μL/min were maintained while sampling outdoor air over diurnal ranges of environmental conditions. These flow rates are associated with concentration factors on the order of 1,000,000 to 2,000,000 and liquid outputs that are a steady stream of 10 to 30 drops/min of 7 to 10 μL droplets. These developments should allow wetted wall cyclones to be effectively coupled to advanced biological identification systems.     

Differences in late fetal death rates in association with determinants of small for gestational age fetuses: population based cohort study

OBJECTIVE: To examine differences in late fetal death rates in association with determinants of small for gestational age fetuses. DESIGN: Population based cohort study. SUBJECTS: 1 026 249 pregnancies without congenital malformations. SETTING: Sweden 1983-92. MAIN OUTCOME MEASURE: Late fetal death rate. RESULTS: Depending on underlying determinants late fetal death rates were greatly increased in extremely small for gestational age fetuses (range 16 to 45 per 1000) compared with non-small for gestational age fetuses (1.4 to 4.6). In extremely small for gestational age fetuses late fetal death rates were increased from 31 per 1000 in mothers aged less than 35 years to 45 per 1000 in older mothers, and from 22 per 1000 in women <155 cm in height to 33 per 1000 in women >=175 cm tall. Late fetal death rates were also higher in extremely small for gestational age fetuses in singleton compared with twin pregnancies and in non-hypertensive pregnancies compared with pregnancies complicated by severe pre-eclampsia or other hypertensive disorders. Slightly higher late fetal death rates were observed in nulliparous compared with parous women and in non-smokers compared with smokers. CONCLUSIONS: Although the risk of late fetal death is greatly increased in fetuses that are extremely small for gestational age the risk is strongly modified by underlying determinants-for example, there is a lower risk of late fetal death in a small for gestational age fetus if the mother is of short stature, has a twin pregnancy, or has hypertension.     

Helios: A 15 TW carbon dioxide laser-fusion facility

Helios is an eight-beam carbon dioxide laser and target facility for the study of laser-fusion processes. The design of file laser is based on the principle of the electron-beam controlled high-pressure electrical discharge. The eight beams deliver a total of 9 kJ to targets in subnanosecond pulses and the peak intensity at focus exceeds 10¹⁶W/cm²/beam. The laser can be fired at 5 min intervals but the system shot rate is restricted to 2/h because of target insertion, alignment, and preparation of diagnostic systems.