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

Thermostability and regulation of Clostridium thermocellum L-lactate dehydrogenase expressed in Escherichia coli

In this study, L-lactate dehydrogenase (L-LDH) of Clostridium thermocellum previously cloned aid expressed in Escherichia coli FMJ39 was partially purified and characterised. Optimum temperature and pH of the enzyme were found as 50 degrees C and 7.5, respectively. Different concentrations of Mn2+ did not affect the enzyme activity. Addition of 20-30 mM Mg2+, or the other hand, increased the LDH activity by about 10%. Relatively high concentrations of NaCl (2 M), fructose-1,6-diphosphate (FDP, 5 mM), ATP (10 mM) and NAD (40 mM) decreased LDH activity by 36, 25, 40 and 100%, respectively. Oxamate and oxalate inhibited LDH activity by 41 and 28%, respectively, when each was added at a concentration of 0.5 mM. When compared to its non-thermotolerant counterparts, the enzyme was found to be very stable when incubated at room temperature, 4 degrees C and even at 50 degrees C

Colicinogeny in local isolates of salmonellae and plasmid transfer studies

Colicinogeny was determined in local isolates of S. typhimurium and S. enteritidis. Fourteen out of 35 S. typhimurium isolates of hospital origin were colicin producers whereas only one chicken isolate out of 82 S. enteritidis isolates of various origin (human, chicken or egg) produced colicin. A colicin producing, cephalothin (Cpt)- and piperacillin (Prl)-resistant local isolate of Salmonella havana (H32) harbored 4 plasmids of 54.0, 28.4, 2.7 and 1.9 kb. Upon curing its plasmids, the strain lost the ability to produce colicin and resistance to antibiotics and no longer expressed smooth lipopolysaccharide (LPS). The outer membrane protein (OMP) of 34.6 kDa was also lost. Using nalidixic acid (Nal)-resistant mutant of the cured strain in conjugation experiments, 10 out of 27 transconjugants were found to be resistant to Nal and Prl, 10 were resistant to Nal and Cpt and 7 showed Nal, Prl and Cpt resistance. Cpt and Prl resistance were determined by 54.0 and 28.4 kb plasmids, respectively. There was no direct correlation between plasmid contents and colicinogeny, LPS and OMP profiles

Postoperative analgesia in children: Comparison of bupivacaine with a mixture of bupivacaine and alfentanil [1]

PubMedID: 11553247[No abstract available