Temporal Artery versus Bladder Thermometry during Adult Medical-Surgical Intensive Care Monitoring: An Observational Study

Abstract Background We sought to evaluate agreement between a new and widely implemented method of temperature measurement in critical care, temporal artery thermometry and an established method of core temperature measurement, bladder thermometry as performed in clinical practice. Methods Temperatures were simultaneously recorded hourly (n = 736 observations) using both devices as part of routine clinical monitoring in 14 critically ill adult patients with temperatures ranging ≥1°C prior to consent. Results The mean difference between temporal artery and bladder temperatures measured was -0.44°C (95% confidence interval, -0.47°C to -0.41°C), with temporal artery readings lower than bladder temperatures. Agreement between the two devices was greatest for normothermia (36.0°C to < 38.3°C) (mean difference -0.35°C [95% confidence interval, -0.37°C to -0.33°C]). The temporal artery thermometer recorded higher temperatures during hypothermia (< 36°C) (mean difference 0.66°C [95% confidence interval, 0.53°C to 0.79°C]) and lower temperatures during hyperthermia (≥38.3°C) (mean difference -0.90°C [95% confidence interval, -0.99°C to -0.81°C]). The sensitivity for detecting fever (core temperature ≥38.3°C) using the temporal artery thermometer was 0.26 (95% confidence interval, 0.20 to 0.33), and the specificity was 0.99 (95% confidence interval, 0.98 to 0.99). The positive likelihood ratio for fever was 24.6 (95% confidence interval, 10.7 to 56.8); the negative likelihood ratio was 0.75 (95% confidence interval, 0.68 to 0.82). Conclusions Temporal artery thermometry produces somewhat surprising disagreement with an established method of core temperature measurement and should not to be used in situations where body temperature needs to be measured with accuracy

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

α2,3-Sialyltransferase ST3Gal III Modulates Pancreatic Cancer Cell Motility and Adhesion In Vitro and Enhances Its Metastatic Potential In Vivo

Background: Cell surface sialylation is emerging as an important feature of cancer cell metastasis. Sialyltransferase expression has been reported to be altered in tumours and may account for the formation of sialylated tumour antigens. We have focused on the influence of alpha-2,3-sialyltransferase ST3Gal III in key steps of the pancreatic tumorigenic process. Methodology/Principal Findings: ST3Gal III overexpressing pancreatic adenocarcinoma cell lines Capan-1 and MDAPanc-28 were generated. They showed an increase of the tumour associated antigen sialyl-Lewis x. The transfectants ’ E-selectin binding capacity was proportional to cell surface sialyl-Lewis x levels. Cellular migration positively correlated with ST3Gal III and sialyl-Lewis x levels. Moreover, intrasplenic injection of the ST3Gal III transfected cells into athymic nude mice showed a decrease in survival and higher metastasis formation when compared to the mock cells. Conclusion: In summary, the overexpression of ST3Gal III in these pancreatic adenocarcinoma cell lines underlines the rol

Extracorporeal Membrane Oxygenation for Acute Pediatric Respiratory Failure

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.The use of extracorporeal membrane oxygenation (ECMO) to support children with acute respiratory failure has steadily increased over the past several decades, with major advancements having been made in the care of these children. There are, however, many controversies regarding indications for initiating ECMO in this setting and the appropriate management strategies thereafter. Broad indications for ECMO include hypoxia, hypercarbia, and severe air leak syndrome, with hypoxia being the most common. There are many disease-specific considerations when evaluating children for ECMO, but there are currently very few, if any, absolute contraindications. Venovenous rather than veno-arterial ECMO cannulation is the preferred configuration for ECMO support of acute respiratory failure due to its superior side-effect profile. The approach to lung management on ECMO is variable and should be individualized to the patient, with the main goal of reducing the risk of VILI. ECMO is a relatively rare intervention, and there are likely a minimum number of cases per year at a given center to maintain competency. Patients who have prolonged ECMO runs (i.e., greater than 21 days) are less likely to survive, though no absolute duration of ECMO that would mandate withdrawal of ECMO support can be currently recommended

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

Scientia Horticulturae

Not AvailableCoconut is grown along the coasts and islands that are vulnerable to climate change-induced sea level rise. Though coconut is considered moderately salt tolerant, our understanding on the growth and physiological response to sea water, either inundation or subsurface water contamination, is very limited. This understanding will enable to effectively manage coconut in coastal systems under future climatic scenarios. In this study, ten month old hydroponically grown coconut seedlings were subjected to 0, 10, 25, 50, 75 and 100 % of sea water substitution (SWS), equivalent to 2.17, 8.32, 16.32, 30.03, 42.14 and 53.69 dS m?1 EC, respectively. Substituting Hoagland solution in hydroponic system by sea water of increasing concentration (>50 % SWS) significantly changed physiological processes; Fv/Fm decreased and rs increased as early as 7 and 18 days after treatment imposition (DAT), respectively which led to significant decline in leaf area and root length expansion as early as 24 DAT. At 25 % SWS, root system (root length and root biomass) was stable but the aerial part biomass was declined by 47 %. On the other hand plant height, leaf area, collar girth and biomass accumulation of seedlings under 10 % SWS (8.32 EC) was on par with the control plants suggesting coconut seedlings could tolerate 10 % SWS. Though, PN declined by 19 % and 43 % at 10 % and 25 % SWS, respectively and a similar decline in gs without a concomitant change in leaf water potential suggested that root-generated signals regulated the stomatal movement in coconut under salinity. Still the biomass accumulation at 10 % SWS was not affected by decline in PN. Under increasing sea water treatments, most of the Na+ absorbed was compartmentalized in root and shoot, while leaf had more accumulation of K+, that ensured high K+/Na+ ratio in the leaves which is an important salinity tolerant mechanism observed in coconut. The leaf Cl? content also had strong negative correlation with [PN] (r=-0.873) and biomass (r=-0.833), therefore in addition to K+ and Na+ homeostasis, the level of tolerance to the increased Cl? content in the leaves may also play an important role in salinity tolerance of coconut. This understanding will help in making appropriate strategies for managing coconut grown at coastal systems in the face of sea level rise under climate change

International Journal of Biometeorology

Not AvailableIn this study, the response of 6-month-old cocoa (Theobroma cacao L.) seedlings to elevated CO2 concentration [ECO2], elevated temperature [ET], and their interaction with water deficit stress was studied in an open top chamber (OTC). Each OTC was maintained at chamber control (400 ppm CO2), [ECO2] 550 ppm, [ECO2] 700 ppm, ET 3 ?C above chamber control, and ET 3 ?C + [ECO2] 550 ppm. Inside each OTC, a set of plants received moisture at 100% FC, while the other set was at 50% FC, which was the water deficit stress treatment. Increasing the CO2 concentration in cocoa increased photosynthesis (Pn) by 27%, which resulted in high biomass accumulation, thus improving the whole plant water use efficiency (WUE). The impact of high temperature (Tmax), around 39 ?C in ET treatment against 36 ?C in chamber control, is quite severe on Pn, leaf ?, and biomass accumulation. Similarly, water deficit at 50% FC resulted in the leaf ? reducing to ??14.06 bars at which Pn, leaf area, and biomass were significantly reduced. [ECO2] could ameliorate the negative effect of high temperature and water deficit stress to certain extent. However, the relative response of cocoa seedlings to [ECO2] in improving Pn, leaf ?, biomass, and WUE was greater under 50% FC compared to plants at 100% FC suggested additional advantage of [ECO2] to cocoa under water limited conditions