Facial train-of-four monitoring as an evaluation of neuromuscular blockade in a patient with ICU-acquired weakness

Neuromuscular blocking agents are used in the ICU for various reasons, such as during status asthmaticus and patient-ventilator dyssynchrony. We report a 76-year-old man with adenocarcinoma of the oesophagus treated with laparoscopic transthoracic oesophagectomy, which was complicated by a fistula between the gastric reconstruction and the right main bronchus. He developed extensive ICU-acquired weakness and was treated with differential lung ventilation followed by continuous rocuronium infusion. Evaluation of neuromuscular blockade by train-of-four (TOF) stimulation showed a discrepancy in facial and ulnar TOF monitoring. The different number of neuromuscular junctions at each muscle group could be an explanation for this. Therefore, it is suggested to use facial TOF monitoring in ICU patients instead of ulnar TOF monitoring to differentiate between an intoxication of neuromuscular blockade and ICU-acquired weakness

The Geometrical Structure of 2d Bond-Orientational Order

We study the formulation of bond-orientational order in an arbitrary two dimensional geometry. We find that bond-orientational order is properly formulated within the framework of differential geometry with torsion. The torsion reflects the intrinsic frustration for two-dimensional crystals with arbitrary geometry. Within a Debye-Huckel approximation, torsion may be identified as the density of dislocations. Changes in the geometry of the system cause a reorganization of the torsion density that preserves bond-orientational order. As a byproduct, we are able to derive several identities involving the topology, defect density and geometric invariants such as Gaussian curvature. The formalism is used to derive the general free energy for a 2D sample of arbitrary geometry, both in the crystalline and hexatic phases. Applications to conical and spherical geometries are briefly addressed.Comment: 22 pages, LaTeX, 4 eps figures Published versio

Formation of the internal structure of solids under severe action

On the example of a particular problem, the theory of vacancies, a new form of kinetic equations symmetrically incorporation the internal and free energies has been derived. The dynamical nature of irreversible phenomena at formation and motion of defects (dislocations) has been analyzed by a computer experiment. The obtained particular results are extended into a thermodynamic identity involving the law of conservation of energy at interaction with an environment (the 1st law of thermodynamics) and the law of energy transformation into internal degree of freedom (relaxation). The identity is compared with the analogous Jarzynski identity. The approach is illustrated by simulation of processes during severe plastic deformation, the Rybin kinetic equation for this case has been derived.Comment: 9 pages, 5 figure

Rituximab-EPOCH, an effective salvage therapy for relapsed, refractory or transformed B-cell lymphomas: results of a phase II study

Background: Relapsed or refractory diffuse large B-cell and mantle-cell lymphoma have a poor prognosis. The EPOCH regimen and rituximab monotherapy have demonstrated activity as salvage therapies. Because of their non-overlapping toxicity, we evaluated their combination as salvage therapy in a phase II study. Patients and methods: Patients with relapsed or refractory CD20-positive large B-cell and mantle-cell lymphoma were offered treatment with rituximab 375 mg/m2 intravenously (i.v.) on day 1, doxorubicin 15 mg/m2 as a continuous i.v. infusion on days 2-4, etoposide 65 mg/m2 as a continuous i.v. infusion on days 2-4, vincristine 0.5 mg as a continuous i.v. infusion on days 2-4, cyclophosphamide 750 mg/m2 i.v. on day 5 and prednisone 60 mg/m2 orally on days 1-14. Results: Fifty patients, with a median age of 56 years (range 23-72), entered the study. Twenty-five had primary diffuse large B-cell lymphoma, 18 transformed large B-cell lymphoma and seven mantle-cell lymphoma. The median number of prior chemotherapy regimens was 1.7 (range one to four). The median number of treatment cycles was four (range one to six). Possible treatment-related death occurred in two patients. Objective responses were obtained in 68% of patients (28% complete responses, 40% partial responses). Nineteen patients received consolidating high-dose chemotherapy with autologous stem-cell transplantation. The median follow-up was 33 months. Three patients developed a secondary myelodysplastic syndrome. The median overall survival was 17.9 months; the projected overall survival at 1, 2 and 3 years was 66, 42 and 35%, respectively. The median event-free survival was 11.8 months; the projected event-free survival at 1, 2 and 3 years was 50, 30 and 26%, respectively. Conclusion: The rituximab-EPOCH regimen is effective and well tolerated, even in extensively pretreated patients with relapsed or refractory large B-cell lymphoma and mantle-cell lymphom

Very large tunneling magnetoresistance in layered magnetic semiconductor CrI3

Magnetic layered van der Waals crystals are an emerging class of materials giving access to new physical phenomena, as illustrated by the recent observation of 2D ferromagnetism in Cr2Ge2Te6 and CrI3. Of particular interest in semiconductors is the interplay between magnetism and transport, which has remained unexplored. Here we report magneto-transport measurements on exfoliated CrI3 crystals. We find that tunneling conduction in the direction perpendicular to the crystalline planes exhibits a magnetoresistance as large as 10,000%. The evolution of the magnetoresistance with magnetic field and temperature reveals that the phenomenon originates from multiple transitions to different magnetic states, whose possible microscopic nature is discussed on the basis of all existing experimental observations. This observed dependence of the conductance of a tunnel barrier on its magnetic state is a phenomenon that demonstrates the presence of a strong coupling between transport and magnetism in magnetic van der Waals semiconductors

Regge Calculus in Teleparallel Gravity

In the context of the teleparallel equivalent of general relativity, the Weitzenbock manifold is considered as the limit of a suitable sequence of discrete lattices composed of an increasing number of smaller an smaller simplices, where the interior of each simplex (Delaunay lattice) is assumed to be flat. The link lengths between any pair of vertices serve as independent variables, so that torsion turns out to be localized in the two dimensional hypersurfaces (dislocation triangle, or hinge) of the lattice. Assuming that a vector undergoes a dislocation in relation to its initial position as it is parallel transported along the perimeter of the dual lattice (Voronoi polygon), we obtain the discrete analogue of the teleparallel action, as well as the corresponding simplicial vacuum field equations.Comment: Latex, 10 pages, 2 eps figures, to appear in Class. Quant. Gra

Snake prices and crocodile appetites: Aquatic wildlife supply and demand on Tonle Sap Lake, Cambodia

Commercial trade is a major driver of over-exploitation of wild species, but the pattern of demand and how it responds to changes in supply is poorly understood. Here we explore the markets for snakes from Tonle Sap Lake in Cambodia to evaluate future exploitation scenarios, identify entry points for conservation and, more generally, to illustrate the value of multi-scale analysis of markets to traded wildlife conservation. In Cambodia, the largest driver of snake exploitation is the domestic trade in snakes as crocodile food. We estimate that farmed crocodiles consume between 2.7 and 12.2 million snakes per year. The market price for crocodiles has been in decline since 2003, which, combined with rising prices for their food, has led to a reduced frequency of feeding and closure of small farms. The large farms that generate a disproportionate amount of the demand for snakes continue to operate in anticipation of future market opportunities, and preferences for snakes could help maintain demand if market prices for crocodiles rise to pre 2003 levels. In the absence of a sustained demand from crocodile farms, it is also possible that alternative markets will develop, such as one for human snack food. The demand for snakes, however, also depends on the availability of substitute resources, principally fish. The substitutability and low price elasticity of demand offers a relatively sustainable form of consumerism. Given the nature of these market drivers, addressing consumer preferences and limiting the protection of snakes to their breeding season are likely to be the most effective tools for conservation. This study highlights the importance of understanding the structure of markets and the behaviour of consumer demand prior to implementing regulations on wildlife hunting and trade