Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study

BACKGROUND: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. METHODS: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. RESULTS: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1–6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. CONCLUSIONS: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event

Immunogenicity and protective efficacy of the recombinant Pasteurella lipoprotein E and outer membrane protein H from Pasteurella multocida A:3 in mice

Pasteurella multocida serotype A:3 is a Gram-negative bacterial pathogen, one of the causative agents of shipping fever of cattle. In this study, outer membrane protein H (ompH) and Pasteurella lipoprotein E (plpE) genes were cloned and plpEC-ompH fusion was constructed and expressed in Escherichia coli. Recombinant PlpE, OmpH and PlpEC-OmpH fusion proteins were purified and formulated with oil-based and oil-based CpG ODN adjuvants. Antibody responses in mice vaccinated with recombinant PlpE and PlpEC-OmpH proteins formulated with both adjuvants were significantly (p&lt;0.05) increased. However, a significant (p&lt;0.05) increment in serum IFN-γ level was only observed upon immunization with oil-based CpG formulations. Protectivity of the vaccines were evaluated via intraperitoneal challenge of mice with 10 LD50 of P. multocida A:3. The recombinant proteins PlpE and PlpEC-OmpH fusion conferred 100% protection when formulated with oil-based CpG ODN while the protectivity was found to be 80% and 60%, respectively when only oil-based adjuvant was used in respective formulations. These findings indicated that the recombinant PlpE or PlpEC-OmpH fusion proteins formulated with oil-based CpG ODN adjuvant are possible acellular vaccine candidates against shipping fever. © 2012 Elsevier Ltd

Pertussis Vaccines: State-of-the-Art and Future Trends

Bordetella pertussis is the causative agent of whooping cough ( pertussis) which is a worldwide vaccine preventable acute respiratory illness that predominantly involves infants. The reactogenicity of whole-cell (Pw) vaccines and the difficulty of their consistent production have led to the development of acellular pertussis (Pa) vaccines. However, despite high vaccination coverage using either Pw or Pa and introduction of adolescent and adult vaccines with reduced antigen content, there are still reports about the circulation of the microorganism in populations, morbidity in infants and increasing incidence of pertussis among adolescent and adults who transmit the infection to yet unimmunized infants. Waning vaccine-induced immunity and antigenic divergence in circulating strains seem to be the major problems accounting for resurgence of pertussis. Considering the need for new vaccination strategies, improvement of current Pa vaccines by including new virulence factors would probably be the most rationale strategy. Recent advances in B. pertussis proteomics, subproteomics and immunoproteomics greatly aided in identifying novel antigens of the pathogen. Future studies involving quantitative transcriptomic and proteomic profiling of host-B. pertussis interactions, studying gene expression in vivo and reverse vaccinology will also be very promising approaches and tools to develop pertussis vaccines inducing long term immunity

Effects of ultrasound-guided thoracic paravertebral block on postoperative pain in children undergoing percutaneous nephrolithotomy

Objective: To compare the effects of ultrasound-guided thoracic paravertebral block (PVB) and intravenous paracetamol on postoperative pain control in paediatric patients undergoing percutaneous nephrolithotomy (PNL). Methods: Forty patients aged 1-5 years, with an American Society of Anesthesiologists physical status I-II, scheduled for PNL were enrolled into this prospective randomised controlled trial. After arrival in the operating room, all patients were administered standardised general anaesthesia. Patients in Group PVB received ultrasound-guided PVB using bupivacaine 0.5% at a total volume of 0.5 mL kg-1 at the vertebral levels T11, T12 and L1. Patients in Group P were administered paracetamol intravenously (15 mg kg-1) before the beginning of surgery. Patients in both groups were given tramadol (1 mg kg-1) for supplemental analgesia. Patient demographics, haemodynamic parameters, peripheral oxygen saturation and sevoflurane concentration were recorded. The Face, Legs, Activity, Cry and Consolability pain scores; satisfaction of parents; the number of patients requiring supplemental analgesia; and complications were evaluated during the postoperative period. Results: Pain scores were significantly lower in Group PVB compared with Group P (p=0.001). There were no analgesic requirements in Group PVB; however, all patients needed a supplemental analgesic in Group P. Parental satisfaction was higher in Group PVB than in Group P. Conclusion: This study demonstrated that ultrasound-guided PVB provides more effective postoperative analgesia with no side effects compared to intravenous paracetamol in children undergoing PNL. © 2019 by Turkish Anaesthesiology and Intensive Care Society

Expression of chitinase A (chiA) gene from a local isolate of Serratia marcescens in Coleoptera-specific Bacillus thuringiensis

Aims: The present study focused on cloning and expression of chiA gene from a highly chitinolytic local isolate of Serratia marcescens in an anti-Coleopteran Bacillus thuringiensis and comparison of the characteristics of the native and recombinant ChiAs

Bacillus subtilis overproduces industrially important extracellular enzymes upon the targeted deletion of bacilysin biosynthetic operon

Bacilysin being produced by Bacillus subtilis is the smallest peptide antibiotic ever known. It is composed of an N-terminal l-alanine and a modified amino acid at its C-terminal, namely anticapsin. bacABCDEF operon and a monocistronic gene bacG are functional for bacilysin production in the organism, bacABCDFG being needed for the flux from prephenate to anticapsin and then to mature bacilysin while bacE gene within the operon is involved in resistance of the producer by pumping bacilysin out of the cell. Our earlier studies demonstrated that quorum sensing global regulation operates in bacilysin biosynthesis through the action of ComQ/ComX, PhrC (CSF), ComP/ComA and molecular regulation also requires an intact surfactin biosynthetic operon, srfA. We recently performed a dynamic secretome analysis of B. subtilis PY79 and its bac operon-deleted derivative OGU1 by taking 2DE MALDI TOF/MS and LC–MS MS as complementary approaches and identified ca. 200 proteins (extracellular, membrane and wall-associated proteins) differentially expressed between two strains. Since B. subtilis is one of the most important cell-factories with a significant capacity to produce a wide range of extracellular enzymes, of biotechnological interest was a significant increment in levels of the industrially-important extracellular enzymes upon the deletion of bac operon. These enzymes included chitosanase, arabinanase, levanase, lipase, phytase, endonuclease, bacillopeptidase F and minor extracellular protease. In this report, the results of quantitative transcript analysis of the respective csn, abn2, sac, estA, phy, yhcR, bpr and vpr genes as well as enzymatic activities of their products are presented

Response surface optimization of antidipteran delta-endotoxin production by Bacillus thuringiensis subsp israelensis HD 500

Response surface optimization of Bacillus thuringiensis subsp. israelensis HD 500 fermentation for the production of its toxin proteins Cry4Ba and Cry11Aa was performed. Since the interaction of the medium components as well as cultivation conditions were expected to influence the production of the toxin proteins, an experimental chart was prepared by accepting the previously reported optimal values for the most important parameters as zero points: [Mn], 10(-6) M; [K2HPO4], 50 mM; C:N ratio, 20:1 and incubation temperature; 30 degrees C. When the combinations of these variables at different levels were studied at 30 batch cultures and analysed for the optimum toxin protein concentrations: temperature, 28.3 degrees C; [Mn], 3.3 x 10(-7) M; C:N ratio, 22.2 and [K2HPO4], 66.1 mM yielded the highest concentrations of both Cry4Ba and Cry11Aa toxin proteins

The effect of sevoflurane and dexmedetomidine on pulmonary mechanics in ICU patients [Yoğun bakım hastalarında sevofluran ve deksmedetomidinin pulmoner mekanikler üzerine etkisi]

Objective: In intensive care unit (ICU) patients, intravenous (iv) and volatile agents are used for sedation. The aim of the present study was to investigate the effects of dexmedetomidine and sevoflurane on pulmonary mechanics in ICU patients with pulmonary disorders. Methods: After approval of the ethical committee and informed consent between the ages of 18-65 years were obtained, 30 patients with an American Society of Anesthesiologist status I-III, who were mechanically ventilated, who had pulmonary disorders and who needed sedation were included in the study. Exclusion criteria were severe hepatic, pulmonary and renal failures; pregnancy; convulsion and/or seizure history; haemodynamic instability and no indication for sedation. Patients were divided into two groups by randomised numbers generated by a computer. For sedation, 0.5%-1% sevoflurane (4-10 mL h-1) was used by an Anaesthetic Conserving Device in Group S (n=15), and iv dexmedetomidine infusion (1 µg-1 kg-1 10 min-1 loading and 0.2-0.7 µg-1 kg-1 h-1 maintenance) was performed in Group D (n=15). Arterial blood gas analysis, airway resistance, positive end-expiratory pressure (PEEP), frequency, tidal volume (TV), peak airway pressure (Ppeak), static pulmonary compliance and end-tidal CO2 values were recorded at baseline, 1, 3, 6, 9, 12 and 24 h. Results: Demographic data, airway resistance, PEEP, frequency, TV, Ppeak and static pulmonary compliance values were similar between the groups. PaCO2 and end-tidal CO2 values were higher in Group S than in Group D. Sedation and patient comfort scores were similar between the two groups. Conclusion: Both sevoflurane and dexmedetomidine are suitable sedative agents in ICU patients with pulmonary diseases. © 2019 by Turkish Anaesthesiology and Intensive Care Society