Indications and clinical outcome in pediatric tracheostomy:Lessons learned

Objective: Indications for tracheostomy have changed over the last decades and clinical outcome varies depending on the indication for tracheostomy. By gaining more insight in the characteristics and outcome of the tracheostomized pediatric population, clinical care can be improved and a better individual prognosis can be given. Therefore, we studied the outcome of our pediatric tracheostomy population in relation to the primary indication over the last 16 years. Methods: We retrospectively included children younger than 18 years of age with a tracheostomy tube in the Erasmus Medical Center, Sophia children's hospital. The primary indication for tracheostomy, gender, age at tracheostomy, age at decannulation, comorbidity, mortality, closure of a persisting tracheocutaneous fistula after decannulation, surgery prior to decannulation and the use of polysomnography were recorded and analyzed. Results: Our research group consisted of 225 children. Reasons for a tracheostomy were first divided in two major diagnostic groups: 1) airway obstruction group (subgroups: laryngotracheal obstruction and craniofacial anomalies) and 2) pulmonary support group (subgroups: cardio-pulmonary diseases and neurological diseases). Children in the airway obstruction group were younger when receiving a tracheostomy (3.0 months vs. 31.0 months, p &lt; 0.05), they were tracheostomy dependent for a longer time (median 21.5 months vs. 2.0 months, p &lt; 0.05) and they required surgery more often (74.5% vs. 8.3%, p &lt; 0.05) than the children in the pulmonary support group. The decannulation rate of children with a laryngotracheal obstruction is high (74.8%), but low in all other subgroups (craniofacial anomalies; 38.5%, cardio-pulmonary diseases; 34.6% and neurological diseases; 52.9%). Significantly more children (36.7%) died in the pulmonary support group due to underlying comorbidity, mainly in the cardio-pulmonary diseases subgroup. Surgery for a persisting tracheocutaneous fistula was performed in 34 (37.8%) children, with a significant relationship between the duration of the tracheostomy and the persistence of a tracheocutaneous fistula. No cannula related death occurred during this study period. Conclusion: Main indications for a tracheostomy were airway obstruction and pulmonary support. Children in the airway obstruction group were younger when receiving a tracheostomy and they were tracheostomy dependent for a longer period. Within the airway obstruction group, the decannulation rate for children with laryngotracheal stenosis was high, but low for children with craniofacial anomalies. In the pulmonary support group, the decannulation rate was low and the mortality rate was high. Surgery for a persisting tracheocutaneous fistula was frequently needed.</p

Pathways for outpatient management of venous thromboembolism in a UK centre.

It has become widely recognised that outpatient treatment may be suitable for many patients with venous thromboembolism. In addition, non-vitamin K antagonist oral anticoagulants that have been approved over the last few years have the potential to be an integral component of the outpatient care pathway, owing to their oral route of administration, lack of requirement for routine anticoagulation monitoring and simple dosing regimens. A robust pathway for outpatient care is also vital; one such pathway has been developed at Sheffield Teaching Hospitals in the UK. This paper describes the pathway and the arguments in its favour as an example of best practice and value offered to patients with venous thromboembolism. The pathway has two branches (one for deep vein thrombosis and one for pulmonary embolism), each with the same five-step process for outpatient treatment. Both begin from the point that the patient presents (in the Emergency Department, Thrombosis Clinic or general practitioner's office), followed by diagnosis, risk stratification, treatment choice and, finally, follow-up. The advantages of these pathways are that they offer clear, evidence-based guidance for the identification, diagnosis and treatment of patients who can safely be treated in the outpatient setting, and provide a detailed, stepwise process that can be easily adapted to suit the needs of other institutions. The approach is likely to result in both healthcare and economic benefits, including increased patient satisfaction and shorter hospital stays

Ornamental plants: annual reports and research reviews

Ohio State University Extension Nursery, Landscape, and Turf Team Directory: 1998 / Jack Kerrigan -- Floriculture Industry Roundtable of Ohio: 1998 / Charles Behnke -- Ohio State University Extension Buckeye Yard and Garden Line / James A. Chatfield, Pamela J. Bennett, Joseph F. Boggs, Gary Y. Gao, Jane C. Martin, David J. Shetlar and Randall H. Zondag -- Environmental and cultural problems of ornamental plants in Ohio: 1997 / Pamela J. Bennett and Jane C. Martin -- Insect and mite activity noted in Ohio nurseries and landscapes: 1997 / Joseph F. Boggs, David J. Shetlar, Jane C. Martin, Pamela J. Bennett, James A. Chatfield, Gary Y. Gao and Chris Carlson -- Summary of ornamental diseases in Ohio: 1997 / James A. Chatfield, Nancy J. Taylor, Stephen N. Nameth, Chris Carlson, Joseph F. Boggs, Jane C. Martin, Dan Balser and David Madison -- Weed problems in Ohio landscapes and nurseries: 1997 / Gary Y. Gao, Joseph F. Boggs, Pamela J. Bennett, Jane C. Martin, Mary Ann Rose, Joseph W. Rimelspach, Randall H. Zondag and William E. Pound -- Wildlife problems in Ohio landscapes: 1997 / Gary Y. Gao, Joseph F. Boggs, Jane C. Martin, Charles T. Behnke and James A. Chatfield -- Summary of turf cultural and disease problems in 1997 / Gary Y. Gao, Joseph F. Boggs, Pamela J. Bennett, Jane C. Martin, Joseph W. Rimelspach and James A. Chatfield -- Master Gardeners serve Ohio / Marianne Riofrio -- The greening of Poland's nurseries / Kenneth D. Cochran and Wojtek Grabczewski -- The marketing potential of Ginkgo biloba in the United States / Kenneth D. Cochran -- Composts in the Landscape: Effects on Soil pH and plant growth / Mary Ann Rose and Hao Wang -- How to optimize disease control using composts / Harry A. J. Hoitink, Wei-Zheng Zhang, David Y. Han, Alexandra G. Stone, Matthew S. Krause and Warren A. Dick -- The flowering sequence of ornamental plants as a tool for predicting the phenology of insect pests / Daniel A. Herms -- Reducing maintenance costs may mean selecting plants with the fewest flaws / T. Davis Sydnor-- Comprehensive aesthetic evaluations of crabapples at Secrest Arboretum in Wooster: 1993-1997 / Erik A. Draper, James A. Chatfield, Kenneth D. Cochran, Peter W. Bristol and David E. Allen -- Precision control of microirrigation for container-grown mini-roses / Robert C. Hansen, Ted H. Short, C. C. Pasian and R. Peter Fynn -- Red thread (Laetisaria fuciformis) control study on perennial ryegrass / Joseph W. Rimelspach, Kerry Kline, Karl Danneberger and Michael Boehm-- Red thread (Laetisaria fuciformis) control study on Kentucky bluegrass / Joseph W. Rimelspach, Kerry Kline, Karl Danneberger and Michael Boehm -- Red thread - from novelty to nuisance / Joseph W. Rimelspach -- Chrysanthemum cultivars differ in response to photoperiod when grown under far-red absorbing filters / M. J. McMahon -- Improving fuchsia cutting performance by grafting / D. M. Napier and M. J. McMahon -- Paint/paclobutrazol mix on the inside surface of rooting wedge cells to control poinsettia cutting height / Claudio C. Pasian -- Response of poinsettias to paclobutrazol in paint applications / Claudio C. Pasian and Daniel K. Struve -- Dynamic transpiration of highly stressed container-grown Acer rubrum / Ted H. Short, Ahmet Irvem and Robert C. Hansen -- Effects of temperature on the development of Asiatic Lilies / J. Steininger and C. C. Pasian-- New publications for 1997-199

2000 Ohio-Grape Wine Short Course

Air, water, sun, and fire--the cooper's footprint on the barrel / Henry Work -- Keeping the bugs unhappy; successful barrel sanitation and maintenance / Henry Work -- Recommended methods for cleaning and maintaining oak cooperage / Phil Burton and Henry Work, with Jim Yerkes -- Chip me, stave me, oak me! The romance, dollars and sense of barrel alternatives / Tim DiPlacido -- Oak experiments / Roland Riesen -- Barrel experiment / Nick Ferrante -- Exploring the versatility and potential of vidal / Roland Riesen -- Ferrante: 1999 vineyard planting / Nick Ferrante -- Breeding rootstocks for current and impending viticultural problems / Andrew Walker -- Grape expectations looking toward traditional and non-traditional sponsors to enhance your event / Doniella Winchell -- Assessing grape maturity by taste and by numbers / Thomas Henick-Kling -- Influence of fruit condition on wine quality / James F. Gallander -- Influence of post bottling storage temperature and SO2 on wine quality / T. E. Steiner -- What we do at harvest to help wine quality / Tony Debevc -- Delivering wine quality / Nick Ferrante -- Criteria for selecting rootstocks / Andrew Walker -- A comparison of Pinot noir production in New York and Burgundy / Pascal Durand and Leslie Weston -- A unique approach to harvest labor / Fran Massaro -- New fungicide registrations for grapes in the year 2000 / Michael Ellis -- Studies to determine time of susceptibility of grape berry and rachis tissues to infection by Phomopsis viticola / O. Erincik, L. V. Madden, D. C. Ferree and M. A. Ellis -- Rootstock performance in Ohio / Arnie Esterer -- Growing your own: vinifera grafting experiments (1999) / Ron Barrett -- Developing an effective fungicide spray program for wine grapes in Ohio / Michael Ellis -- Light and fruit set / David C. Ferree, David M. Scurlock and John C. Schmid -- Soil amendments and mulches in tree health management / Harry Hoitink, Matthew Krause and Randy Zondag -- Report of 5th International Symposium on Cool Climate Viticulture and Enology / Roland Riesen -- Control strategies for soil insects in the vineyard / Roger Williams and Dan Fickl

Leukocyte Tyrosine Kinase Functions in Pigment Cell Development

A fundamental problem in developmental biology concerns how multipotent precursors choose specific fates. Neural crest cells (NCCs) are multipotent, yet the mechanisms driving specific fate choices remain incompletely understood. Sox10 is required for specification of neural cells and melanocytes from NCCs. Like sox10 mutants, zebrafish shady mutants lack iridophores; we have proposed that sox10 and shady are required for iridophore specification from NCCs. We show using diverse approaches that shady encodes zebrafish leukocyte tyrosine kinase (Ltk). Cell transplantation studies show that Ltk acts cell-autonomously within the iridophore lineage. Consistent with this, ltk is expressed in a subset of NCCs, before becoming restricted to the iridophore lineage. Marker analysis reveals a primary defect in iridophore specification in ltk mutants. We saw no evidence for a fate-shift of neural crest cells into other pigment cell fates and some NCCs were subsequently lost by apoptosis. These features are also characteristic of the neural crest cell phenotype in sox10 mutants, leading us to examine iridophores in sox10 mutants. As expected, sox10 mutants largely lacked iridophore markers at late stages. In addition, sox10 mutants unexpectedly showed more ltk-expressing cells than wild-type siblings. These cells remained in a premigratory position and expressed sox10 but not the earliest neural crest markers and may represent multipotent, but partially-restricted, progenitors. In summary, we have discovered a novel signalling pathway in NCC development and demonstrate fate specification of iridophores as the first identified role for Ltk