Toschlog, Eric A. MD, FACSa; Bauer, Charles R. MD, FACSb; Hall, Edward L. MD, FACSc; Dart, Richard C. MD, PhDd,e; Khatri, Vaishali MPHd; Lavonas, Eric J. MDd,e,* Author Information

Study objective: Early antidotal therapy may be lifesaving in hazardous materials victims. Intravenous line placement is difficult while wearing personal protective equipment (PPE). We assessed the ability of protected, experienced first responders and limited-experience first receivers to place intraosseous (IO) lines for antidote administration.Methods: Six first responders donned 4 (A, B, C, and D) and 12 first receivers donned 2 (C and D) United States Environmental Protection Agency PPE levels in random order and then placed IO lines in 1 of 4 anatomical sites in 12 anesthetized Spanish goats. Observers timed interventions until bolus injection of isotonic sodium chloride solution.Results: First responders placed IO lines successfully in 100% of cases. The median (interquartile range) times to completion (in seconds) were as follows: level A, 43.5 (23.0); B, 45.0 (29.0); C, 40.0 (15.0); D, 30.0 (17.0). First receivers placed IO lines successfully in 91% of cases. The median (interquartile range) times to completion (in seconds) were as follows: level C, 42.0 (19.5); D, 37.0 (11.0). There were no significant differences in time to completion among PPE levels (overall or pairwise) or between operator groups. Two (4%) of 48 line placements resulted in recognized extravasation due to penetration of the opposite cortex. Infusions were completed successfully.Conclusion: Hazardous materials first responders and receivers can effectively place IO lines in a goat while wearing PPE. Intraosseous lines may facilitate earlier administration of antidotes in hazardous materials victims. (C) 2011 Elsevier Inc. All rights reserved.

Study Objective: Hydroxocobalamin may be lifesaving in cyanide (CN) poisoning, but personal protective equipment (PPE) wear, rescue, and decontamination may delay intravenous administration. Intraosseous (IO) lines may be rapidly placed even when wearing PPE. We assessed the hemodynamics of hydroxocobalamin (OHCo) and normal saline (NS) by the IO route.Methods: Twelve anesthetized Spanish goats underwent arterial line catheterization. Operators in PPE placed IO lines. After placement confirmation by fluoroscopy, animals randomly received hydroxocobalamin 75 mg/kg (3 mL/kg) (n = 6) or normal saline (NS) 3 mL/kg (n = 6) 10 over approximately 7.5 minutes. Blood pressures and heart rates were monitored for 240 minutes after infusion initiation.Results: In the OHCo group, mean systolic and diastolic pressures peaked at 120 minutes, with mean increases of 14% and 17%, respectively, relative to infusion start, returning to near preinfusion values at 240 Minutes. Heart rate changes were virtually nil. In the NS group, mean systolic pressures peaked at 60 minutes, with a mean increase of 36%, whereas diastolic pressures peaked at about 110 minutes, increasing 42%, returning to near preinfusion values at 240 minutes. Heart rate changes were minimal.Conclusion: Hemodynamic effects of OHCo given by the IO route in non-CN-poisoned goats are mild and well tolerated. Increases in mean blood pressure at peak after baseline were greater in the NS group, but the mean values over time were not significantly different from those observed in the OHCo group. Hemodynamic effects would likely differ somewhat in a CN-poisoned goat. Intraosseous OHCo administration warrants additional investigation. (C) 2009 Elsevier Inc. All rights reserved.

The porcine lymphotropic herpesviruses (PLHV) are discussed as possible risk factors in xenotransplantation because of the high prevalence of PLHV-1, PLHV-2 and PLHV-3 in pig populations world-wide and the fact that PLHV-1 has been found to be associated with porcine post-transplant lymphoproliferative disease. To provide structural and functional knowledge on the PLHV immediate-early (IE) transactivator genes, the central regions of the PLHV genomes were characterized by genome walking, sequence and splicing analysis. Three spliced genes were identified (ORF50, ORFA6/BZLF1(h), ORF57) encoding putative IE transactivators, homologous to (i) ORF50 and BRLF1/Rta, (ii) K8/K-bZIP and BZLF1/Zta and (iii) ORF57 and BMLF1 of HHV-8 and EBV, respectively. Expressed as myc-tag or HA-tag fusion proteins, they were located to the cellular nucleus. In reporter gene assays, several PLHV-promoters were mainly activated by PLHV-1 ORF50, to a lower level by PLHV-1 ORFA6/BZLF1(h) and not by PLHV-1 ORF57. However, the ORF57-encoded protein acted synergistically on ORF50-mediated activation.

To demonstrate the feasibility of CT and B-mode Ultrasound (US) targeted HIFU, a prototype coaxial focused ultrasound transducer was registered and integrated to a CT scanner. CT and diagnostic ultrasound were used for HIFU targeting and monitoring, with the goals of both thermal ablation and non-thermal enhanced drug delivery. A 1 megahertz coaxial ultrasound transducer was custom fabricated and attached to a passive position-sensing arm and an active six degree-of-freedom. robotic arm via a CT stereotactic frame. The outer therapeutic transducer with a 10 cm fixed focal zone was coaxially mounted to an inner diagnostic US transducer (2-4 megahertz, Philips Medical Systems). This coaxial US transducer was connected to a modified commercial focused ultrasound generator (Focus Surgery, Indianapolis, IN) with a maximum total acoustic power of 100 watts. This pre-clinical paradigm was tested for ability to heat tissue in phantoms with monitoring and navigation from CT and live US. The feasibility of navigation via image fusion of CT with other modalities such as PET and MRI was demonstrated. Heated water phantoms were tested for correlation between CT numbers and temperature (for ablation monitoring). The prototype transducer and integrated CT/US imaging system enabled simultaneous multimodality imaging and therapy. Pre-clinical phantom models validated the treatment paradigm and demonstrated integrated multimodality guidance and treatment monitoring. Temperature changes during phantom cooling corresponded to CT number changes. Contrast enhanced or non-enhanced CT numbers may potentially be used to monitor thermal ablation with HIFU. Integrated CT, diagnostic US, and therapeutic focused ultrasound bridges a gap between diagnosis and therapy. Preliminary results show that the multimodality system may represent a relatively inexpensive, accessible, and simple method of both targeting and monitoring HIFU effects. Small animal pre-clinical models may be translated to large animals and humans for HIFU-induced ablation and drug delivery. Integrated CT-guided focused ultrasound holds promise for tissue ablation, enhancing local drug delivery, and CT thermometry for monitoring ablation in near real-time.

OBJECTIVE:To compare two dosing regimens for caffeine citrate in the periextubation period for neonates born at less than 30 weeks gestation in terms of successful extubation and adverse effects.DESIGN:A multicentre, randomised, double blind, clinical trial.SETTING:Four tertiary neonatal units within Australia.PATIENTS:Infants born less than 30 weeks gestation ventilated for more than 48 hours.INTERVENTIONS:Two dosing regimens of caffeine citrate (20 v 5 mg/kg/day) for periextubation management. Treatment started 24 hours before a planned extubation or within six hours of an unplanned extubation.MAIN OUTCOME MEASURE:Failure to extubate within 48 hours of caffeine loading or reintubation and ventilation or doxapram within seven days of caffeine loading.RESULTS:A total of 234 neonates were enrolled. A significant reduction in failure to extubate was shown for the 20 mg/kg/day dosing group (15.0% v 29.8%; relative risk 0.51; 95% confidence interval (CI) 0.31 to 0.85; number needed to treat 7 (95% CI 4 to 24)). A significant difference in duration of mechanical ventilation was shown for infants of less than 28 weeks gestation receiving the high dose of caffeine (mean (SD) days 14.4 (11.1) v 22.1 (17.1); p = 0.01). No difference in adverse effects was detected in terms of mortality, major neonatal morbidity, death, or severe disability or general quotient at 12 months.CONCLUSIONS:This trial shows short term benefits for a 20 mg/kg/day dosing regimen of caffeine citrate for neonates born at less than 30 weeks gestation in the periextubation period, without evidence of harm in the first year of life.

Zusammenfassung In Deutschland, Österreich und der Schweiz sind Resistenzen gegen Benzimidazole (BZ) bei kleinen Strongyliden des Pferdes und Trichostrongyliden (vor allem Haemonchus) des Schafes sehr weit verbreitet. Gelegentlich wurden bei Trichostrongyliden kleiner Wiederkäuer auch Mehrfachresistenzen gegen BZ, Levamisol oder makrozyklische Laktone (ML) festgestellt. Aus Großbritannien liegen Einzelberichte über ML-resistente Cooperia beim Rind vor. Triclabendazol- resistente Fasciola hepatica wurden in britischen und holländischen Schaf- und Rinderherden nachgewiesen. In der vorliegenden Arbeit werden Grundlagen der Resistenzentwicklung erläutert und für jede Wirtstierart praktikable Maßnahmen vorgestellt, durch die eine weitere Resistenzentwicklung verzögert werden kann.

The Journal of Trauma: Injury, Infection, and Critical Care: August 1997 - Volume 43 - Issue 2 - p 385

This article describes a new inventory for preschool social development. Scale construction was undertaken as an ancillary project in a multi-site study of early intervention for high-risk infants. Scale development began with extensive review; piloting was conducted to ensure appropriateness for mothers of varying educational levels. Descriptive and psychometric data on the 30-item inventory are presented for the sample of 545 3-year-olds. The three subscales are Express, Comply, and Disrupt. Intercorrelations among the scales are reported, as well as correlations with other competence variables. Differences are noted for gender and site, but not birthweight. Potential value of the inventory is discussed.

Flower, et. al. have reported that newborn animals made hypercarbic had both an increased incidence and severity of RLF. This study concerns data on 74 surviving infants with birth weights ≤ 1000 grams, half of whom (37 infants) had RLF diagnosed either while in hospital or shortly after discharge. Twenty eight independent variables were analyzed to determine their role in the occurrence of RLF. By discriminant analysis, 9 of these variables correlated with the development of RLF (r=.70) and accounted for 49% of the variance. The total function (nos. 1-9) yielded a Chi-square of p < .0007. This function would correctly predict infants with RLF 84% of the time. The component which best predicted the outcome was the highest PaCO2 measured in the infant (#1). The second most important variable was the total number of high PaCO2's (> 50 TORR) which occurred simultaneously with an elevated PaO2 (> 100 TORR). Other variables included the total number of PaO2's > 100 TORR (#3), the Apgar Score at 1 minute (#4), the Ponderal Index (#5), total days on CPAP (#6), the highest recorded PaO2 (#7), total respirator days (#8) and the Ponderal Index Percentile (#9). These data suggest that PaCO2 may be a very significant variable in the development of RLF. Retinal vasoconstriction, if viewed as protective, may be abolished by hypercarbia; thereby allowing free flow of potentially toxic hyperoxic blood into the retinal tissues. We suggest that continuous PaCO2 monitoring may be as important as PaCO2 monitoring in the prevention of RLF.

One hundred and ten neonates requiring intensive care and felt to be at risk for developmental deficits were followed for periods up to 2 years. Denver Developmental Screening Test (DDST) and Bayley Scales were administered alternately at 6 month intervals. The DDST was scored as normal or abnormal and the Bayley was considered abnormal if the Mental Developmental Index (MDI) was less than 80. Data was analyzed in terms of conditional probabilities; that is, the percent of later diagnoses of normality or abnormality predicted from earlier testing.Results: Assuming the 24 month test has the most predictive validity, then these results suggest that testing prior to 18 months may not reliably predict later performance. This may be explained by the fact that early developmental assessment consists of primarily sensory and motor tasks; whereas later tests begin to stress verbal and conceptual abilities. Parents of infants considered to be high risk due to perinatal events should be encouraged to participate in long term evaluations and overly optimistic prediction pased on early motor progress alone should be avoided.

This report describes 20 premature infants who have undergone surgical ligation of a patent ductus arteriosus (PDA), diagnosed solely by physical examination in all but 2 instances. There were no operative deaths. Eleven of these 20 infants had severe associated hyaline membrane disease (HMD) necessitating mechanical ventilatory support from the first or second day of life. Only 3 of these 11 infants (27%) ultimately survived to leave the hospital. In contrast, 8 of 9 premature meonates (89%) with severe congestive heart failure but without HMD were discharged alive. Surgical ligation of the PDA in a premature infant is an appropriate and successful mode of treatment when congestive heart failure is refractory to medical management. Proof is lacking, however, to establish the efficacy of PDA ligation in the premature infant with HMD.