Endotracheal Tube Dislodgment in a High Risk Pulmonary Hypertensive Patient due to Undiagnosed Tracheomegaly: A Case Report

Introduction Airway enlargement was first described histologically in 1872, but it was not clinically reported until 1932, when Dr. Mounier-Kuhn published his seminal radiographic studies.1 Since then, it is estimated that several hundred case reports have been published on congenital Mounier-Kuhn Syndrome (MKS), acquired tracheomegaly, and tracheobronchomegaly (TBM), yet only a few comprehensive literature reviews exist.2 Case This case report details an elective nasal procedure for a patient with a history of significant pulmonary hypertension ad COPD on 5L home O2 who had a symptomatic facial trauma. He was considered high risk secondary to his pulmonary disease, but he was considered medically optimized for surgery and had undergone a prior uncomplicated general anesthetic. An intraoperative endotracheal tube dislodgement necessitated emergency airway rescue with difficulty in re-establishing adequate ventilation resulting in the patient being brought to the ICU post-operatively. After a second endotracheal dislodgement shortly later, retrospective radiographic airway analysis revealed tracheal dimensions of 32 x 26mm, suggesting a previously undiagnosed tracheomegaly. Written consent and HIPAA authorization was obtained from the patient for the publication of this case report. Conclusion This case highlights the clinical importance for anesthesiologists to be aware of tracheobronchomegaly (TBM) despite limited provider experience with these patients and sparse reporting on the condition. It is underdiagnosed radiographically and may first present in the OR. TBM can manifest in many ways with potentially fatal complications thus it is vital for anesthesiologists to be able to recognize, troubleshoot, and potentially treat issues related to the disease

Independent evolution of neurotoxin and flagellar genetic loci in proteolytic Clostridium botulinum

<p>Abstract</p> <p>Background</p> <p>Proteolytic <it>Clostridium botulinum </it>is the causative agent of botulism, a severe neuroparalytic illness. Given the severity of botulism, surprisingly little is known of the population structure, biology, phylogeny or evolution of <it>C. botulinum</it>. The recent determination of the genome sequence of <it>C. botulinum </it>has allowed comparative genomic indexing using a DNA microarray.</p> <p>Results</p> <p>Whole genome microarray analysis revealed that 63% of the coding sequences (CDSs) present in reference strain ATCC 3502 were common to all 61 widely-representative strains of proteolytic <it>C. botulinum </it>and the closely related <it>C. sporogenes </it>tested. This indicates a relatively stable genome. There was, however, evidence for recombination and genetic exchange, in particular within the neurotoxin gene and cluster (including transfer of neurotoxin genes to <it>C. sporogenes</it>), and the flagellar glycosylation island (FGI). These two loci appear to have evolved independently from each other, and from the remainder of the genetic complement. A number of strains were atypical; for example, while 10 out of 14 strains that formed type A1 toxin gave almost identical profiles in whole genome, neurotoxin cluster and FGI analyses, the other four strains showed divergent properties. Furthermore, a new neurotoxin sub-type (A5) has been discovered in strains from heroin-associated wound botulism cases. For the first time, differences in glycosylation profiles of the flagella could be linked to differences in the gene content of the FGI.</p> <p>Conclusion</p> <p>Proteolytic <it>C. botulinum </it>has a stable genome backbone containing specific regions of genetic heterogeneity. These include the neurotoxin gene cluster and the FGI, each having evolved independently of each other and the remainder of the genetic complement. Analysis of these genetic components provides a high degree of discrimination of strains of proteolytic <it>C. botulinum</it>, and is suitable for clinical and forensic investigations of botulism outbreaks.</p

Casein Kinase II Phosphorylation of Spt6 Enforces Transcriptional Fidelity by Maintaining Spn1-Spt6 Interaction

Spt6 is a histone chaperone that associates with RNA polymerase II and deposits nucleosomes in the wake of transcription. Although Spt6 has an essential function in nucleosome deposition, it is not known whether this function is influenced by post-translational modification. Here, we report that casein kinase II (CKII) phosphorylation of Spt6 is required for nucleosome occupancy at the 5' ends of genes to prevent aberrant antisense transcription and enforce transcriptional directionality. Mechanistically, we show that CKII phosphorylation of Spt6 promotes the interaction of Spt6 with Spn1, a binding partner required for chromatin reassembly and full recruitment of Spt6 to genes. Our study defines a function for CKII phosphorylation in transcription and highlights the importance of post-translational modification in histone chaperone function

Understanding the individual to implement the ecosystem approach to fisheries management

Ecosystem-based approaches to fisheries management (EAFMs) have emerged as requisite for sustainable use of fisheries resources. At the same time, however, there is a growing recognition of the degree of variation among individuals within a population, as well as the ecological consequences of this variation. Managing resources at an ecosystem level calls on practitioners to consider evolutionary processes, and ample evidence from the realm of fisheries science indicates that anthropogenic disturbance can drive changes in predominant character traits (e.g. size at maturity). Eco-evolutionary theory suggests that human-induced trait change and the modification of selective regimens might contribute to ecosystem dynamics at a similar magnitude to species extirpation, extinction and ecological dysfunction. Given the dynamic interaction between fisheries and target species via harvest and subsequent ecosystem consequences, we argue that individual diversity in genetic, physiological and behavioural traits are important considerations under EAFMs. Here, we examine the role of individual variation in a number of contexts relevant to fisheries management, including the potential ecological effects of rapid trait change. Using select examples, we highlight the extent of phenotypic diversity of individuals, as well as the ecological constraints on such diversity. We conclude that individual phenotypic diversity is a complex phenomenon that needs to be considered in EAFMs, with the ultimate realization that maintaining or increasing individual trait diversity may afford not only species, but also entire ecosystems, with enhanced resilience to environmental perturbations. Put simply, individuals are the foundation from which population- and ecosystem-level traits emerge and are therefore of central importance for the ecosystem-based approaches to fisheries management

Fully integrated wearable sensor arrays for multiplexed in situ perspiration analysis

Wearable sensor technologies are essential to the realization of personalized medicine through continuously monitoring an individual’s state of health. Sampling human sweat, which is rich in physiological information, could enable non-invasive monitoring. Previously reported sweat-based and other non-invasive biosensors either can only monitor a single analyte at a time or lack on-site signal processing circuitry and sensor calibration mechanisms for accurate analysis of the physiological state. Given the complexity of sweat secretion, simultaneous and multiplexed screening of target biomarkers is critical and requires full system integration to ensure the accuracy of measurements. Here we present a mechanically flexible and fully integrated (that is, no external analysis is needed) sensor array for multiplexed in situ perspiration analysis, which simultaneously and selectively measures sweat metabolites (such as glucose and lactate) and electrolytes (such as sodium and potassium ions), as well as the skin temperature (to calibrate the response of the sensors). Our work bridges the technological gap between signal transduction, conditioning (amplification and filtering), processing and wireless transmission in wearable biosensors by merging plastic-based sensors that interface with the skin with silicon integrated circuits consolidated on a flexible circuit board for complex signal processing. This application could not have been realized using either of these technologies alone owing to their respective inherent limitations. The wearable system is used to measure the detailed sweat profile of human subjects engaged in prolonged indoor and outdoor physical activities, and to make a real-time assessment of the physiological state of the subjects. This platform enables a wide range of personalized diagnostic and physiological monitoring applications

Lewis revisited : tropical polities competing on the world market 1830-1938

Since the seminal work by W.A. Lewis, exports of primary products have been deemed the main or sole source of growth in tropical countries before the Great Depression. This conventional wisdom, however, relies on very limited evidence. This paper analyses the growth of exports with a constant market share analysis for 84 tropical polities. Exports grew a lot, but less than total trade, while relative prices of tropical products remained roughly constant. We thus tentatively infer that the decline in the tropical shares on world trade reflects an insufficient demand for tropical products. Asia mastered well these headwinds throughout the whole period, while African polities blossomed after World War One. The loser was (South) America, and most notably the Caribbean former slave colonies especially before 1870

Hydrographic changes in the eastern subpolar North Atlantic during the last deglaciation

Author Posting. © The Author(s), 2010. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Quaternary Science Reviews 29 (2010): 3336-3345, doi:10.1016/j.quascirev.2010.08.013.Millennial-scale climate fluctuations of the last deglaciation have been tied to abrupt changes in the Atlantic Meridional Overturning Circulation (MOC). A key to understanding mechanisms of MOC collapse and recovery is the documentation of upper ocean hydrographic changes in the vicinity of North Atlantic deep convection sites. Here we present new high-resolution ocean temperature and δ18Osw records spanning the last deglaciation from an eastern subpolar North Atlantic site that lies along the flow path of the North Atlantic Current, approaching deep convection sites in the Labrador and Greenland-Iceland-Norwegian (GIN) Seas. High-resolution temperature and δ18Osw records from subpolar Site 980 help track the movement of the subpolar/subtropical front associated with temperature and Atlantic MOC changes throughout the last deglaciation. Distinct δ18Osw minima during Heinrich-1 (H1) and the Younger Dryas (YD) correspond with peaks in ice-rafted debris and periods of reduced Atlantic MOC, indicating the presence of melt water in this region that could have contributed to MOC reductions during these intervals. Increased tropical and subtropical δ18Osw during these periods of apparent freshening in the subpolar North Atlantic suggest a buildup of salt at low latitudes that served as a negative feedback on reduced Atlantic MOC.Support for this research was provided by the U.S. National Science Foundation (JFM and DWO) and a postdoctoral scholarship funded in part by the Gary Comer Science and Education Foundation (HB)

Adipocytes disrupt the translational programme of acute lymphoblastic leukaemia to favour tumour survival and persistence

The specific niche adaptations that facilitate primary disease and Acute Lymphoblastic Leukaemia (ALL) survival after induction chemotherapy remain unclear. Here, we show that Bone Marrow (BM) adipocytes dynamically evolve during ALL pathogenesis and therapy, transitioning from cellular depletion in the primary leukaemia niche to a fully reconstituted state upon remission induction. Functionally, adipocyte niches elicit a fate switch in ALL cells towards slow-proliferation and cellular quiescence, highlighting the critical contribution of the adipocyte dynamic to disease establishment and chemotherapy resistance. Mechanistically, adipocyte niche interaction targets posttranscriptional networks and suppresses protein biosynthesis in ALL cells. Treatment with general control nonderepressible 2 inhibitor (GCN2ib) alleviates adipocyte-mediated translational repression and rescues ALL cell quiescence thereby significantly reducing the cytoprotective effect of adipocytes against chemotherapy and other extrinsic stressors. These data establish how adipocyte driven restrictions of the ALL proteome benefit ALL tumours, preventing their elimination, and suggest ways to manipulate adipocyte-mediated ALL resistance

Evidence for alternate stable states in an Ecuadorian Andean Cloud Forest

Tree diversity inventories were undertaken. The goal of this study was to understand changes in tree community dynamics that may result from common anthropogenic disturbances at the Reserva Los Cedros, a tropical montane cloud forest reserve in northern Andean Ecuador. The reserve shows extremely high alpha and beta tree diversity. We found that all primary forest sites, regardless of age of natural gaps, are quite ecologically resilient, appearing to return to a primary-forest-type community of trees following gap formation. In contrast, forests regenerating from anthropogenic disturbance appear to have multiple possible ecological states. Where anthropogenic disturbance was intense, novel tree communities appear to be assembling, with no indication of return to a primary forest state. Even in ancient primary forests, new forest types may be forming, as we found that seedling community composition did not resemble adult tree communities. We also suggest small watersheds as a useful basic spatial unit for understanding biodiversity patterns in the tropical Andes that confound more traditional Euclidean distance as a basic proxy of dissimilarity. Finally, we highlight the conservation value of Reserva Los Cedros, which has managed to reverse deforestation within its boundaries despite a general trend of extensive deforestation in the surrounding region, to protect a large, contiguous area of highly endangered Andean primary cloud forest