Anaesthetic concerns of difficult airway in case of large oral hemangioma posted for robotic cystectomy

A difficult airway poses a challenge to attending anaesthesiologist. Fibreoptic intubation (FOI) to secure airway can be a valuable option in such a scenario. Steep Trendelenberg’s position with pneumoperitoneum in robotic surgery causes respiratory changes with airway oedema and congestion. We are describing here a case report of 56-year male patient with a large congenital oral cavity hemangioma with primary urothelial neoplasm of bladder posted for robotic radical cystectomy with ileal conduit with urethrectomy. We emphasize the importance of difficult airway management by using fibre optic technique in such cases complicated by steep Trendelenburg’s position required during robotic surgeries

Fatal pulmonary embolism after middle ear surgery: a case report

Pulmonary thromboembolism is a complication of underlying venous thrombosis. Factors contributing to thrombus formation include venous stasis, hypercoagulable state, immobilisation, surgery and pregnancy. Authors present the challenges authors faced in diagnosing pulmonary embolism in a post-operative patient. 35-year-old female with complaint of decreased hearing for 2 years along with tinnitus and giddiness was admitted for stapedectomy. She also gave history of dyspnoea and pedal oedema one month back for which she was hospitalized and underwent investigations which were normal. Patient was discharged as her clinical symptoms improved. On postoperative day 5, she developed sudden dyspnoea after getting up and walking a few steps. Dyspnoea along with falling saturation and bradycardia progressed to cardiopulmonary arrest. Intensive care was started. Bilateral lower limb venous doppler showed deep venous thrombosis. Clinical diagnosis of pulmonary embolism was made, and patient was lysed with Tenecteplase 30 mg. Echocardiography showed signs of resolution of embolism after lysis, but gradually patient deteriorated and developed cardiogenic shock. Intra-aortic balloon pump was inserted via right femoral artery and inotropic support was continued. However, patient’s condition worsened, and she developed cardiopulmonary arrest the next day and could not be revived. Prevention of pulmonary embolism is a major clinical problem for which prophylactic measures like early ambulation in post-operative periods, elastic stockings, graduated compressive stockings for bed ridden patients and preventive anticoagulation therapy in high risk patients should be considered

Spatial representation of temporal information through spike timing dependent plasticity

We suggest a mechanism based on spike time dependent plasticity (STDP) of synapses to store, retrieve and predict temporal sequences. The mechanism is demonstrated in a model system of simplified integrate-and-fire type neurons densely connected by STDP synapses. All synapses are modified according to the so-called normal STDP rule observed in various real biological synapses. After conditioning through repeated input of a limited number of of temporal sequences the system is able to complete the temporal sequence upon receiving the input of a fraction of them. This is an example of effective unsupervised learning in an biologically realistic system. We investigate the dependence of learning success on entrainment time, system size and presence of noise. Possible applications include learning of motor sequences, recognition and prediction of temporal sensory information in the visual as well as the auditory system and late processing in the olfactory system of insects.Comment: 13 pages, 14 figures, completely revised and augmented versio

Solar pond powered liquid desiccant evaporative cooling

Liquid desiccant cooling systems (LDCS) are energy efficient means of providing cooling, especially when powered by low-grade thermal sources. In this paper, the underlying principles of operation of desiccant cooling systems are examined, and the main components (dehumidifier, evaporative cooler and regenerator) of the LDCS are reviewed. The evaporative cooler can take the form of direct, indirect or semi-indirect. Relative to the direct type, the indirect type is generally less effective. Nonetheless, a certain variant of the indirect type - namely dew-point evaporative cooler - is found to be the most effective amongst all. The dehumidifier and the regenerator can be of the same type of equipment: packed tower and falling film are popular choices, especially when fitted with an internal heat exchanger. The energy requirement of the regenerator can be supplied from solar thermal collectors, of which a solar pond is an interesting option especially when a large scale or storage capability is desired

Functional Redundancy in Perchlorate and Nitrate Electron Transport Chains and Rewiring Respiratory Pathways to Alter Terminal Electron Acceptor Preference

Most dissimilatory perchlorate reducing bacteria (DPRB) are also capable of respiratory nitrate reduction, and preferentially utilize nitrate over perchlorate as a terminal electron acceptor. The similar domain architectures and phylogenetic relatedness of the nitrate and perchlorate respiratory complexes suggests a common evolutionary history and a potential for functionally redundant electron carriers. In this study, we identify key genetic redundancies in the electron transfer pathways from the quinone pool(s) to the terminal nitrate and perchlorate reductases in Azospira suillum PS (hereafter referred to as PS). We show that the putative quinol dehydrogenases, (PcrQ and NapC) and the soluble cytochrome electron carriers (PcrO and NapO) are functionally redundant under anaerobic growth conditions. We demonstrate that, when grown diauxically with both nitrate and perchlorate, the endogenous expression of NapC and NapO during the nitrate reduction phase was sufficient to completely erase any growth defect in the perchlorate reduction phase caused by deletion of pcrQ and/or pcrO. We leveraged our understanding of these genetic redundancies to make PS mutants with altered electron acceptor preferences. Deletion of the periplasmic nitrate reductase catalytic subunit, napA, led to preferential utilization of perchlorate even in the presence of equimolar nitrate, and deletion of the electron carrier proteins napQ and napO, resulted in concurrent reduction of nitrate and perchlorate. Our results demonstrate that nitrate and perchlorate respiratory pathways in PS share key functionally redundant electron transfer proteins and that mutagenesis of these proteins can be utilized as a strategy to alter the preferential usage of nitrate over perchlorate

Education competencies for integrative oncology - Results of a systematic review and an international and interprofessional consensus procedure

Integrative oncology is a burgeoning field and typically provided by a multiprofessional team. To ensure cancer patients receive effective, appropriate, and safe care, health professionals providing integrative cancer care should have a certain set of competencies. The aim of this project was to define core competencies for different health professions involved in integrative oncology. The project consisted of two phases. A systematic literature review on published competencies was performed, and the results informed an international and interprofessional consensus procedure. The second phase consisted of three rounds of consensus procedure and included 28 experts representing 7 different professions (medical doctors, psychologists, nurses, naturopathic doctors, traditional Chinese medicine practitioners, yoga practitioners, patient navigators) as well as patient advocates, public health experts, and members of the Society for Integrative Oncology. A total of 40 integrative medicine competencies were identified in the literature review. These were further complemented by 18 core oncology competencies. The final round of the consensus procedure yielded 37 core competencies in the following categories: knowledge (n = 11), skills (n = 17), and abilities (n = 9). There was an agreement that these competencies are relevant for all participating professions. The integrative oncology core competencies combine both fundamental oncology knowledge and integrative medicine competencies that are necessary to provide effective and safe integrative oncology care for cancer patients. They can be used as a starting point for developing profession-specific learning objectives and to establish integrative oncology education and training programs to meet the needs of cancer patients and health professionals

Mechanism of H2S Oxidation by the Dissimilatory Perchlorate-Reducing Microorganism Azospira suillum PS.

The genetic and biochemical basis of perchlorate-dependent H2S oxidation (PSOX) was investigated in the dissimilatory perchlorate-reducing microorganism (DPRM) Azospira suillum PS (PS). Previously, it was shown that all known DPRMs innately oxidize H2S, producing elemental sulfur (So). Although the process involving PSOX is thermodynamically favorable (ΔG°' = -206 kJ ⋅ mol-1 H2S), the underlying biochemical and genetic mechanisms are currently unknown. Interestingly, H2S is preferentially utilized over physiological electron donors such as lactate or acetate although no growth benefit is obtained from the metabolism. Here, we determined that PSOX is due to a combination of enzymatic and abiotic interactions involving reactive intermediates of perchlorate respiration. Using various approaches, including barcode analysis by sequencing (Bar-seq), transcriptome sequencing (RNA-seq), and proteomics, along with targeted mutagenesis and biochemical characterization, we identified all facets of PSOX in PS. In support of our proposed model, deletion of identified upregulated PS genes traditionally known to be involved in sulfur redox cycling (e.g., Sox, sulfide:quinone reductase [SQR]) showed no defect in PSOX activity. Proteomic analysis revealed differential abundances of a variety of stress response metal efflux pumps and divalent heavy-metal transporter proteins, suggesting a general toxicity response. Furthermore, in vitro biochemical studies demonstrated direct PSOX mediated by purified perchlorate reductase (PcrAB) in the absence of other electron transfer proteins. The results of these studies support a model in which H2S oxidation is mediated by electron transport chain short-circuiting in the periplasmic space where the PcrAB directly oxidizes H2S to So The biogenically formed reactive intermediates (ClO2- and O2) subsequently react with additional H2S, producing polysulfide and So as end products.IMPORTANCE Inorganic sulfur compounds are widespread in nature, and microorganisms are central to their transformation, thereby playing a key role in the global sulfur cycle. Sulfur oxidation is mediated by a broad phylogenetic diversity of microorganisms, including anoxygenic phototrophs and either aerobic or anaerobic chemotrophs coupled to oxygen or nitrate respiration, respectively. Recently, perchlorate-respiring microorganisms were demonstrated to be innately capable of sulfur oxidation regardless of their phylogenetic affiliation. As recognition of the prevalence of these organisms intensifies, their role in global geochemical cycles is being queried. This is further highlighted by the recently recognized environmental pervasiveness of perchlorate not only across Earth but also throughout our solar system. The inferred importance of this metabolism not only is that it is a novel and previously unrecognized component of the global sulfur redox cycle but also is because of the recently demonstrated applicability of perchlorate respiration in the control of biogenic sulfide production in engineered environments such as oil reservoirs and wastewater treatment facilities, where excess H2S represents a significant environmental, process, and health risk, with associated costs approximating $90 billion annually