Peripheral limb ischaemia from peripherally inserted central catheter (PICC) line insertion in an extreme preterm neonate : case report

Background: There is extensive literature on incorrect positioning of peripherally inserted central catheter (PICC) line tips, particularly concerning advancement into the right atrium causing cardiac tamponade. However, there is little literature concerning inadvertent arterial cannulation as a complication of PICC insertion and what steps could be taken to prevent it. Case presentation: An extreme preterm neonate had a PICC line inserted into the left arm to provide central venous access for parenteral nutrition. Following the insertion, an anteroposterior chest X-ray was used to confirm positioning and was deemed acceptable. It was reviewed by a consultant radiologist the next day. Fifteen hours after insertion, the nursing staff raised concerns that the fingertips on the neonate’s left hand appeared dusky and were getting progressively darker. Upon removal of the PICC line, an upper limb Doppler was performed, showing severe stenosis of the brachial artery with no flow distally in the radial or ulnar arteries. Conclusions: This case demonstrates that glyceryl trinitrate (GTN) patches can be used to reverse peripheral ischaemia in neonates with good effect. After reflecting on the case, we decided that monitoring distal limb colour and perfusion should be part of observations in neonates with central venous lines in situ and documentation should reflect this. Furthermore, when concerns are raised about distal perfusion in a limb with lines in situ, all lines should be removed immediately. We would like to emphasise that it is of vital importance to promote a culture of openness where all team members are empowered to raise concerns about patient safety

Comparison of clinical characteristics of acute kidney injury versus acute-on-chronic renal failure: Our experience in a developing country

SummaryBackgroundFrom developing countries, there is paucity of information regarding epidemiological characteristics of acute-on-chronic renal failure (ACRF) that differs from acute kidney injury (AKI).MethodsIn this prospective study, we analyzed and compared clinical characteristics and outcome of ACRF with AKI from January 2007 to August 2012.ResultsA total of 1117 patients with community-acquired AKI were included in study (AKI = 835; ACRF = 282). Patients with ACRF were older than patients with AKI (p < 0.001). Sepsis was the main cause of acute decline in renal functions in patients with ACRF in comparison to AKI (p < 0.001). Volume depletion/renal hypoperfusion was the most common cause of AKI and the difference was statistically significant as compared to ACRF (33.9% vs. 17.7%; p < 0.001). Need for dialysis was significantly less in patients with ACRF as compared to AKI (68% vs. 77.4%; p 0.002). Lower inhospital mortality was observed in ACRF in comparison to AKI (5% vs. 8.9%, p = 0.04), while no significant difference was noted in terms of duration of hospital stay between the two groups (p = 0.67). However, a significantly higher proportion of patients with ACRF did not recover and progressed to end-stage renal disease as compared to AKI (20% vs. 7.8%; p < 0.001).ConclusionACRF constituted an important cause (25%) of AKI. An episode of superimposed AKI is associated with significantly increased risk of progression to end-stage renal disease in patients with chronic kidney disease.背景慢性腎病合併急性腎衰竭 (ACRF) 不同於急性腎損傷 (AKI)，然而在發展中國家，ACRF 的流行病學數據仍然相當有限。方法在 2007 年 1 月至 2012 年 8 月期間，我們進行了一項前瞻性研究，分析並比較了 ACRF 與 AKI 的臨床特徵和治療後果。結果研究對象為 1117 位社區性 AKI 患者 (AKI = 835；ACRF = 282)，其中 ACRF 患者較 AKI 患者年老 (p < 0.001)。相比於 AKI，ACRF 的急性腎功能下降較常歸因於敗血症 (p < 0.001)；相比於 ACRF，AKI 則較常歸因於容積匱乏/腎灌流不足 (33.9% vs. 17.7%；p < 0.001)；ACRF 患者比 AKI 患者較少需要接受透析療法 (68% vs. 77.4%；p = 0.002)；ACRF 患者的院內死亡率低於 AKI 患者 (5% vs. 8.9%；p = 0.04)，兩組間的住院期則無明顯差別 (p = 0.67)；然而，相比於 AKI 患者，明顯較多的 ACRF 患者無法康復並惡化成末期腎病 (ESRD) (20% vs. 7.8%；p < 0.001)。結論慢性腎病合併急性腎衰竭是急性腎損傷的重要病因 (25%)；在慢性腎病患者間，AKI 的發生明顯增加惡化為 ESRD 的風險

Characterization of the Endothelial Cell Cytoskeleton following HLA Class I Ligation

Vascular endothelial cells (ECs) are a target of antibody-mediated allograft rejection. In vitro, when the HLA class I molecules on the surface of ECs are ligated by anti-HLA class I antibodies, cell proliferation and survival pathways are activated and this is thought to contribute to the development of antibody-mediated rejection. Crosslinking of HLA class I molecules by anti-HLA antibodies also triggers reorganization of the cytoskeleton, which induces the formation of F-actin stress fibers. HLA class I induced stress fiber formation is not well understood.The present study examines the protein composition of the cytoskeleton fraction of ECs treated with HLA class I antibodies and compares it to other agonists known to induce alterations of the cytoskeleton in endothelial cells. Analysis by tandem mass spectrometry revealed unique cytoskeleton proteomes for each treatment group. Using annotation tools a candidate list was created that revealed 12 proteins, which were unique to the HLA class I stimulated group. Eleven of the candidate proteins were phosphoproteins and exploration of their predicted kinases provided clues as to how these proteins may contribute to the understanding of HLA class I induced antibody-mediated rejection. Three of the candidates, eukaryotic initiation factor 4A1 (eIF4A1), Tropomyosin alpha 4-chain (TPM4) and DDX3X, were further characterized by Western blot and found to be associated with the cytoskeleton. Confocal microscopy analysis showed that class I ligation stimulated increased eIF4A1 co-localization with F-actin and paxillin.Colocalization of eIF4A1 with F-actin and paxillin following HLA class I ligation suggests that this candidate protein could be a target for understanding the mechanism(s) of class I mediated antibody-mediated rejection. This proteomic approach for analyzing the cytoskeleton of ECs can be applied to other agonists and various cells types as a method for uncovering novel regulators of cytoskeleton changes

Experimental Analysis of RSSI-based Location Estimation in Wireless Sensor Networks

Abstract—With a widespread increase in the number of mobile wireless systems and applications, the need for location aware services has risen at a very high pace in the last few years. Much research has been done for the development of new models for location aware systems, but most of it has primarily used the support of 802.11 wireless networks. Less work has been done towards an exhaustive error analysis of the underlying theories and models, especially in an indoor environment using a wireless sensor network. We present a thorough analysis of the Radio Signal Strength (RSS) model for distance estimation in wireless sensor networks through an empirical quantification of error metrics. Further on the basis of this experimental analysis, we implement a k- nearest signal space neighbor match algorithm for location estimation, and evaluate some crucial control parameters using which this technique can be adapted to different cases and scenarios, to achieve finer and more precise location estimates. I

Utility of endovascular embolisation in management of peripheral pulmonary artery aneurysms

There are no large scale studies exclusive for pulmonary artery aneurysms as a cause of massive hemoptysis, only small studies are there. No randomised control trial is there to suggest efficacy of surgical excision or endovascular treatment over each other. It's well known that definite treatment by surgical excision carries high mortality when done in emergency sitting. Endovascular approach in such a patient is a less utilised treatment modality and that too with coil embolisation is not much practiced. This article emphasises the role of CTA in diagnosing and embolisation as emergency management of these aneurysms

Energy-Exergy Analysis of Diesel Engine Fueled with Microalgae Biodiesel-Diesel Blend

Renewable energy is getting more attention in recent times due to the rapid depletion of fossil fuel reserves. Production and consumption of biofuels derived from biomass has significantly increased. In the present work, Spirulina microalgae have been chosen as feedstock for biodiesel production. Diesel and biodiesel were mixed in different volumetric ratios to prepare fuel blends (SBF0, SBF20, SBF40, SBF60, SBF80, and SBF100). Energy and exergy analysis has been performed on a four-stroke, single-cylinder diesel engine. Experimentation was done under varying loads at 1500 RPM. The effect of multiple loads and blends was investigated for brake power (BP), cooling water losses (Qw), exhaust gas losses (Qexh), and unaccounted losses (Qun). Pure diesel SBF100 has the highest and lowest exergy efficiencies, respectively equaling roughly 31.65% and 29.75%. It has been observed that BP and Qw increase with the increase in load whereas Qexh and Qun show a decreasing trend. It was also observed that with an increase in blending, Qw increases while Qexh decreases. In the exergy analysis, it was observed that the exergy destruction rate has a maximum fraction of input exergy values of 46.01% and 46.29% for Diesel and SBF20 respectively. The system engine sustainability index was in the range of 1.27 to 1.46, which is directly related to exergy efficiencies

The Experimental Investigation of a Diesel Engine Using Ternary Blends of Algae Biodiesel, Ethanol and Diesel Fuels

Algae are regarded among the most favorable feedstocks for producing sustainable biodiesel and utilizing it in diesel engines. Additionally, ethanol addition further enhanced the performance and reduce greenhouse emission. Algae biodiesel was produced, and an experimental study was performed to understand the diesel engine performance and emissions characteristics using different fuel blends by varying the ratio of diesel, biodiesel, and ethanol, such as D100, B10, B20, B5E5, and B10E10 (where number shows the percentage of the respective fuel). It was found that brake thermal efficiency was reduced by 0.49% and 1.29% for B10 and B20 blends, while the addition of ethanol enhanced the BTE by 0.37% and 1.60% respectively. However, SFC increases by 1.45%, 2.14%, 3.18%, and 3.78% respectively for B10, B20, B5E5, and B10E10 with respect to diesel fuel. Combustion characteristics were increased with increasing concentration of biodiesel and ethanol addition. Particulate matter, smoke emissions, and CO2 were slightly reduced by 3%, 4%, and 0.18%, respectively, while NOx emissions were increased by 26% for B10 blended fuel as compared to diesel fuel. Further addition of 5% (volume) ethanol in B5 fuel reduced particulate matter, smoke emissions, and CO2 emissions by 26.4%, 22%, and 23% respectively. Among the tested blends (B10, B20, B5E5, and B10E10), ethanol blended fuel was found to be more promising due to its higher combustion and performance and to have lower emissions to diesel fuel

Energy-Exergy Analysis of Diesel Engine Fueled with Microalgae Biodiesel-Diesel Blend

Renewable energy is getting more attention in recent times due to the rapid depletion of fossil fuel reserves. Production and consumption of biofuels derived from biomass has significantly increased. In the present work, Spirulina microalgae have been chosen as feedstock for biodiesel production. Diesel and biodiesel were mixed in different volumetric ratios to prepare fuel blends (SBF0, SBF20, SBF40, SBF60, SBF80, and SBF100). Energy and exergy analysis has been performed on a four-stroke, single-cylinder diesel engine. Experimentation was done under varying loads at 1500 RPM. The effect of multiple loads and blends was investigated for brake power (BP), cooling water losses (Qw), exhaust gas losses (Qexh), and unaccounted losses (Qun). Pure diesel SBF100 has the highest and lowest exergy efficiencies, respectively equaling roughly 31.65% and 29.75%. It has been observed that BP and Qw increase with the increase in load whereas Qexh and Qun show a decreasing trend. It was also observed that with an increase in blending, Qw increases while Qexh decreases. In the exergy analysis, it was observed that the exergy destruction rate has a maximum fraction of input exergy values of 46.01% and 46.29% for Diesel and SBF20 respectively. The system engine sustainability index was in the range of 1.27 to 1.46, which is directly related to exergy efficiencies