Indications and clinical outcome in pediatric tracheostomy:Lessons learned

Objective: Indications for tracheostomy have changed over the last decades and clinical outcome varies depending on the indication for tracheostomy. By gaining more insight in the characteristics and outcome of the tracheostomized pediatric population, clinical care can be improved and a better individual prognosis can be given. Therefore, we studied the outcome of our pediatric tracheostomy population in relation to the primary indication over the last 16 years. Methods: We retrospectively included children younger than 18 years of age with a tracheostomy tube in the Erasmus Medical Center, Sophia children's hospital. The primary indication for tracheostomy, gender, age at tracheostomy, age at decannulation, comorbidity, mortality, closure of a persisting tracheocutaneous fistula after decannulation, surgery prior to decannulation and the use of polysomnography were recorded and analyzed. Results: Our research group consisted of 225 children. Reasons for a tracheostomy were first divided in two major diagnostic groups: 1) airway obstruction group (subgroups: laryngotracheal obstruction and craniofacial anomalies) and 2) pulmonary support group (subgroups: cardio-pulmonary diseases and neurological diseases). Children in the airway obstruction group were younger when receiving a tracheostomy (3.0 months vs. 31.0 months, p &lt; 0.05), they were tracheostomy dependent for a longer time (median 21.5 months vs. 2.0 months, p &lt; 0.05) and they required surgery more often (74.5% vs. 8.3%, p &lt; 0.05) than the children in the pulmonary support group. The decannulation rate of children with a laryngotracheal obstruction is high (74.8%), but low in all other subgroups (craniofacial anomalies; 38.5%, cardio-pulmonary diseases; 34.6% and neurological diseases; 52.9%). Significantly more children (36.7%) died in the pulmonary support group due to underlying comorbidity, mainly in the cardio-pulmonary diseases subgroup. Surgery for a persisting tracheocutaneous fistula was performed in 34 (37.8%) children, with a significant relationship between the duration of the tracheostomy and the persistence of a tracheocutaneous fistula. No cannula related death occurred during this study period. Conclusion: Main indications for a tracheostomy were airway obstruction and pulmonary support. Children in the airway obstruction group were younger when receiving a tracheostomy and they were tracheostomy dependent for a longer period. Within the airway obstruction group, the decannulation rate for children with laryngotracheal stenosis was high, but low for children with craniofacial anomalies. In the pulmonary support group, the decannulation rate was low and the mortality rate was high. Surgery for a persisting tracheocutaneous fistula was frequently needed.</p

Cortical Factor Feedback Model for Cellular Locomotion and Cytofission

Eukaryotic cells can move spontaneously without being guided by external cues. For such spontaneous movements, a variety of different modes have been observed, including the amoeboid-like locomotion with protrusion of multiple pseudopods, the keratocyte-like locomotion with a widely spread lamellipodium, cell division with two daughter cells crawling in opposite directions, and fragmentations of a cell to multiple pieces. Mutagenesis studies have revealed that cells exhibit these modes depending on which genes are deficient, suggesting that seemingly different modes are the manifestation of a common mechanism to regulate cell motion. In this paper, we propose a hypothesis that the positive feedback mechanism working through the inhomogeneous distribution of regulatory proteins underlies this variety of cell locomotion and cytofission. In this hypothesis, a set of regulatory proteins, which we call cortical factors, suppress actin polymerization. These suppressing factors are diluted at the extending front and accumulated at the retracting rear of cell, which establishes a cellular polarity and enhances the cell motility, leading to the further accumulation of cortical factors at the rear. Stochastic simulation of cell movement shows that the positive feedback mechanism of cortical factors stabilizes or destabilizes modes of movement and determines the cell migration pattern. The model predicts that the pattern is selected by changing the rate of formation of the actin-filament network or the threshold to initiate the network formation

A DFT based equilibrium study on the hydrolysis and the dehydration reactions of MgCl 2

Magnesium chloride hydrates are characterized as promising energy storage materials in the builtenvironment. During the dehydration of these materials, there are chances for the release of harmful HCl gas, which can potentially damage the material as well as the equipment. Hydrolysis reactions in magnesium chloride hydrates are subject of study for industrial applications. However, the information about the possibility of hydrolysis reaction, and its preference over dehydration in energy storage systems is still ambiguous at the operating conditions in a seasonal heat storage system. A density functional theory level study is performed to determine molecular structures, charges, and harmonic frequencies in order to identify the formation of HCl at the operating temperatures in an energy storage system. The preference of hydrolysis over dehydration is quantified by applying thermodynamic equilibrium principles by calculating Gibbs free energies of the hydrated magnesium chloride molecules. The molecular structures of the hydrates (n = 0, 1, 2, 4, and 6) of MgCl2 are investigated to understand the stability and symmetry of these molecules. The structures are found to be noncomplex with almost no meta-stable isomers, which may be related to the faster kinetics observed in the hydration of chlorides compared to sulfates. Also, the frequency spectra of these molecules are calculated, which in turn are used to calculate the changes in Gibbs free energy of dehydration and hydrolysis reactions. From these calculations, it is found that the probability for hydrolysis to occur is larger for lower hydrates. Hydrolysis occurring from the hexa-, tetra-, and dihydrate is only possible when the temperature is increased too fast to a very high value. In the case of the mono-hydrate, hydrolysis may become favorable at high water vapor pressure and at low HCl pressure

Ornamental plants: annual reports and research summaries

The Ohio State University Extension Nursery, Landscape, and Turf Team (ENLTT) -- Extension Nursery, Landscape, and Turf Team (ENLTT) directory -- An evaluation of composts for landscape soil amendments / Mary Ann Rose and Hao Wang -- Aesthetic evaluation of crabapples at Secrest Arboretum in Wooster, Ohio: 1994-1995 / James A. Chatfield, Erik A. Draper, Kenneth C. Cochran, Peter W. Bristol and Charles E. Tubesing -- Evaluation of crabapples for apple scab at Secrest Arboretum in Wooster, Ohio: 1995 / Erik A. Draper, James A. Chatfield, Kenneth C. Cochran, Peter W. Bristol and Charles E. Tubesing -- Emergence, longevity, and aesthetic evaluations of flowers in ornamental crabapples at Secrest Arboretum in Wooster, Ohio: 1995 / Erik A. Draper, James A. Chatfield and Kenneth C. Cochran -- Environmental and cultural ornamental plant problems in Ohio: 1995 / Pamela J. Bennett and Jane A. Martin -- 1995 -A Challenging Year for Ohio golf courses / Joseph W. Rimelspach, John R. Street, Karl Danneberger, William E. Pound, Barbara Bloetscher -- Plant insect pest problems in Ohio: 1995 / Joseph F. Boggs, David J. Shetlar, Gary Yu Gao, Daniel Balser, Douglas C. Caldwell, Randall H. Zondag and James A. Chatfield -- Gypsy moth in Ohio: 1995 / Allan Baumgard, David F. James and Randall H. Zondag -- Landscape ornamental disease problems in Ohio: 1995 / James A. Chatfield, Nancy Taylor, Randall H. Zondag, Mary Ann Rose, Gary Yu Gao, Daniel R. Balser and David J. Shetlar -- The Response of native and naturalized trees to construction activity / T. Davis Sydnor, Joseph F. Boggs and Mary Ann Ros

Genomic structure and alternative splicing of murine R2B receptor protein tyrosine phosphatases (PTPκ, μ, ρ and PCP-2)

BACKGROUND: Four genes designated as PTPRK (PTPκ), PTPRL/U (PCP-2), PTPRM (PTPμ) and PTPRT (PTPρ) code for a subfamily (type R2B) of receptor protein tyrosine phosphatases (RPTPs) uniquely characterized by the presence of an N-terminal MAM domain. These transmembrane molecules have been implicated in homophilic cell adhesion. In the human, the PTPRK gene is located on chromosome 6, PTPRL/U on 1, PTPRM on 18 and PTPRT on 20. In the mouse, the four genes ptprk, ptprl, ptprm and ptprt are located in syntenic regions of chromosomes 10, 4, 17 and 2, respectively. RESULTS: The genomic organization of murine R2B RPTP genes is described. The four genes varied greatly in size ranging from ~64 kb to ~1 Mb, primarily due to proportional differences in intron lengths. Although there were also minor variations in exon length, the number of exons and the phases of exon/intron junctions were highly conserved. In situ hybridization with digoxigenin-labeled cRNA probes was used to localize each of the four R2B transcripts to specific cell types within the murine central nervous system. Phylogenetic analysis of complete sequences indicated that PTPρ and PTPμ were most closely related, followed by PTPκ. The most distant family member was PCP-2. Alignment of RPTP polypeptide sequences predicted putative alternatively spliced exons. PCR experiments revealed that five of these exons were alternatively spliced, and that each of the four phosphatases incorporated them differently. The greatest variability in genomic organization and the majority of alternatively spliced exons were observed in the juxtamembrane domain, a region critical for the regulation of signal transduction. CONCLUSIONS: Comparison of the four R2B RPTP genes revealed virtually identical principles of genomic organization, despite great disparities in gene size due to variations in intron length. Although subtle differences in exon length were also observed, it is likely that functional differences among these genes arise from the specific combinations of exons generated by alternative splicing

Pattern and determinants of BCG immunisation delays in a sub-Saharan African community

<p>Abstract</p> <p>Background</p> <p>Childhood immunisation is recognised worldwide as an essential component of health systems and an indispensable indicator of quality of care for vaccine-preventable diseases. While performance of immunisation programmes is more commonly measured by coverage, ensuring that every child is immunised at the earliest/appropriate age is an important public health goal. This study therefore set out to determine the pattern and predictors of Bacille de Calmette-Guérin (BCG) immunisation delays in the first three months of life in a Sub-Saharan African community where BCG is scheduled at birth in order to facilitate necessary changes in current policy and practices for improved services.</p> <p>Methods</p> <p>A cross-sectional study in which immunisation delays among infants aged 0-3 months attending community-based BCG clinics in Lagos, Nigeria over a 2-year period from July 2005 to June 2007 were assessed by survival analysis and associated factors determined by multivariable logistic regression. Population attributable risk (PAR) was computed for the predictors of delays.</p> <p>Results</p> <p>BCG was delayed beyond three months in 31.6% of all eligible infants. Of 5171 infants enrolled, 3380 (65.4%) were immunised within two weeks and a further 1265 (24.5%) by six weeks. A significantly higher proportion of infants born in hospitals were vaccinated in the first six weeks compared to those born outside hospitals. Undernourishment was predictive of delays beyond 2 and 6 weeks while treated hyperbilirubinaemia was associated with decreased odds for any delays. Lack of antenatal care and multiple gestations were also predictive of delays beyond 6 weeks. Undernourishment was associated with the highest PAR for delays beyond 2 weeks (18.7%) and 6 weeks (20.8%).</p> <p>Conclusions</p> <p>BCG immunisation is associated with significant delays in this setting and infants at increased risk of delays can be identified and supported early possibly through improved maternal uptake of antenatal care. Combining BCG with subsequent immunisation(s) at 6 weeks for infants who missed the BCG may be considered.</p

Ornamental plants: annual reports and research reviews, 2002

Ohio State University Extension Nursery, Landscape, and Turf Team directory: 2003 / Jack Kerrigan -- Floriculture Industry Roundtable of Ohio: 2003 / Charles Behnke -- Ohio State University Extension 2002 Buckeye Yard and Garden Line evaluation survey / Amy K. Stone and James A. Chatfield -- Weather, environmental, and cultural problems of ornamental plants in Ohio: 2002 / Pamela J. Bennett -- Infectious disease problems of ornamental plants in Ohio: 2002 / James A. Chatfield, Nancy A. Taylor, Erik A. Draper, and Joseph F. Boggs -- A biological calendar for predicting pest activity: six years of plant and insect phenology in Secrest Arboretum / Daniel A. Herms -- Biological suppression of foliar diseases of ornamental plants with composted manures, biosolids, and Trichoderma hamatum 382 / Harry A. J. Hoitink, Carol A. Musselman, Terry L. Moore, Leona E. Horst, Charles R. Krause, Randy A. Zondag, and Hannah Mathers -- Growth and water use by four leguminous tree species in containers on a gravel surface or embedded in mulch / Michael Knee, Daniel K. Struve, Michael H. Bridgewater, and Joseph W. Phillips -- The effects of sprayer configuration on efficacy for the control of scab on crabapple / Charles R. Krause, Richard C. Derksen, Leona E. Horst, Randall Zondag, Ross D. Brazee, Michael G. Klein, and Michael E. Reding -- Update on honeylocust knot / Pierluigi Bonello, Maria Bellizzi, and Harry A. J. Hoitink -- Control of phytophthora and other major diseases of Ericaceous plants / Harry A. J. Hoitink, Steven T. Nameth, and James C. Locke -- Is your landscape mulch going up in smoke? / Larry G. Steward, T. Davis Sydnor, and Bert Bishop -- IR-4 ornamental trials conducted by USDA-ARS in Ohio: 2002 / Betsy A. Anderson, Michael E. Reding, Michael G. Klein, and Charles R. Krause -- Research on black vine weevil and white grubs in ornamental nurseries-in Ohio by USDA-ARS / Michael E. Reding, Michael G. Klein, Ross D. Brazee, and Charles R. Krause -- Herbaceous ornamental field trial results in Clark County, Ohio – 2002 / Pamela J. Bennett -- Results of annual trial gardens at the Cincinnati Zoo and Botanical Garden for 2002 / Dave Dyke -- Ohio State University Learning Garden annual cultivar trials / Monica M. Kmetz-Gonzalez and Claudio C. Pasian -- A collection of crabapple knowledge from Secrest Arboretum: 1993-2002 / Erik A. Draper, James A. Chatfield, and Kenneth D. Cochran -- Key results of the 2001 Ohio Green Industry Survey / Gary Y. Gao, John J. Smith, James A. Chatfield, Joseph F. Boggs, Erik A. Draper, and Hannah Mathers -- The USDA/Agricultural Research Service research weather network in Lake County, Ohio - 2002 update / R. D. Brazee, R. C. Derksen, C. R. Krause, K. A. Williams, D. Lohnes, M. G. Klein, M. Reding, R. Lyons, W. Hendricks, R. Zondag, R. D. Fox, and D. Herms -- The OSU Chadwick Arboretum Learning Gardens / Dr. Steven Still and Annette Duetz -- Choosing soil testing labs / Gary Y, Gao, Maurice E. Watson, Joseph F. Boggs, and James A. Chatfield -- Top horticultural references for a green industry professional's library / Gary Y. Gao and Pamela J. Bennett -- The maples of Secrest Arboretum / Gary W. Graham, James A. Chatfield, and Kenneth D. Cochran -- Deck the halls with boughs from Ollie! / Kenneth D. Cochran and James A. Chatfiel