Safety and efficacy of noninvasive ventilation in patients with blunt chest trauma: a systematic review

Abstract Introduction This systematic review looks at the use of noninvasive ventilation (NIV), inclusive of noninvasive positive pressure ventilation (NPPV) and continuous positive pressure ventilation (CPAP), in patients with chest trauma to determine its safety and clinical efficacy in patients with blunt chest trauma who are at high risk of acute lung injury (ALI) and respiratory failure. Methods We searched the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Pairs of reviewers abstracted relevant clinical data and assessed the methodological quality of randomized controlled trials (RCTs) using the Cochrane domain and observational studies using the Newcastle-Ottawa Scale. Results Nine studies were included (three RCTs, two retrospective cohort studies and four observational studies without a comparison group). There was significant heterogeneity among the included studies regarding the severity of injuries, degree of hypoxemia and timing of enrollment. One RCT of moderate quality assessed the use of NPPV early in the disease process before the development of respiratory distress. All others evaluated the use of NPPV and CPAP in patients with blunt chest trauma after the development of respiratory distress. Overall, up to 18% of patients enrolled in the NIV group needed intubation. The duration of NIV use was highly variable, but NIV use itself was not associated with significant morbidity or mortality. Four low-quality observational studies compared NIV to invasive mechanical ventilation in patients with respiratory distress and showed decreased ICU stay (5.3 to 16 days vs 9.5 to 15 days), complications (0% to 18% vs 38% to 49%) and mortality (0% to 9% vs 6% to 50%) in the NIV group. Conclusions Early use of NIV in appropriately identified patients with chest trauma and without respiratory distress may prevent intubation and decrease complications and ICU length of stay. Use of NIV to prevent intubation in patients with chest trauma who have ALI associated with respiratory distress remains controversial because of the lack of good-quality data

Precise determination of dolomite content in marine sediments

Dolomite (CaMg[CO3](2)) is a common rock-forming mineral. Nevertheless, its mechanisms of formation and the factors that cause dolomite concentration variations within the sedimentary records constitute long-standing geochemical questions. In addition, the flux of Mg2+ leaving the ocean by the formation of dolomite is a controversial question, with some studies arguing that dolomite formation is a negligible Mg2+ sink in the modern ocean, while others show that it constitutes more than 50% of the total Mg2+ removal rate. An important factor that impedes the resolution of the dolomite Mg2+ flux is the lack of analytical methods with adequate precision and detection limit to directly measure minute quantities of authigenic dolomite in marine sediments. Here, we present a new analytical method for direct, precise measurement of dolomite content in marine sediments. The method is based on sequential leaching of carbonate minerals in acid and tracks the CO2 emitted by the dissolution. Based on the measurement of gravimetric standards of calcite and dolomite, the method's detection limit and precision were determined as better than 0.2 and +/- 0.2 dry wt% of dolomite, respectively. The method out-performed dolomite quantification made by x-ray diffraction and by inductive coupled plasma mass-spectrometry, which provided precision of +/- 2 and +/- 1 dry wt%, respectively. Measurements of the dolomite content in modern sediments from the seafloor below the oligotrophic Eastern Mediterranean and the eutrophic Mississippi plume, and in clayey-silty alluvial soil from south-eastern Israel, demonstrated that the aforementioned precisions are also valid for natural samples.ISSN:1541-585

Oriented Attachment: A Path to Columnar Morphology in Chemical Bath Deposited PbSe Thin Films

We have studied columnar PbSe thin films obtained using chemical bath deposition. The columnar microstructure resulted from an oriented attachment growth mechanism, in which nuclei precipitating from solution attached along preferred crystallographic facets to form highly oriented, size-quantized columnar grains. This is shown to be an intermediate growth mechanism between the ion-by-ion and cluster growth mechanisms. A structural zone model depicting the active growth mechanisms is presented for the first time for semiconductor thin films deposited from solution. The columnar films showed well-defined twinning relations between neighboring columns, which exhibited 2D quantum confinement, as established by photoluminescence spectroscopy. In addition, anisotropic nanoscale electrical properties were investigated using current sensing AFM, which indicated vertical conductivity, while maintaining quantum confinement

Whole exome sequencing (WES) approach for diagnosing primary immunodeficiencies (PIDs) in a highly consanguineous community

Primary immunodeficiencies (PIDs) are a heterogeneous group of monogenic inborn errors of immunity. The genetic causes of these diseases can be identified using whole exome sequencing (WES). Here, DNA samples from 106 patients with a clinical suspicion of PID were subjected to WES in order to test the diagnostic yield of this test in a highly consanguineous community. A likely genetic diagnosis was achieved in 70% of patients. Several factors were considered to possibly influence the diagnostic rate of WES among our cohort including early age, presence of consanguinity, family history suggestive of PID, the number of family members who underwent WES and the clinical phenotype of the patient. The highest diagnostic rate was in patients with combined immunodeficiency or with a syndrome. Notably, WES findings altered the clinical management in 39% (41/106) of patients in our cohort. Our findings support the use of WES as an important diagnostic tool in patients with suspected PID, especially in highly consanguineous communities