Infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus (PVL-SA) mostly present as recurrent skin abscesses and furunculosis. However, life-threatening infections (eg, ...necrotizing pneumonia, necrotizing fasciitis, and osteomyelitis) caused by PVL-SA have also been reported.We assessed the clinical phenotype, frequency, clinical implications (surgery, length of treatment in hospitals/intensive care units, and antibiotic treatments), and potential preventability of severe PVL-SA infections in children.Total, 75 children treated for PVL-SA infections in our in- and outpatient units from 2012 to 2017 were included in this retrospective study.Ten out of 75 children contracted severe infections (PVL-methicillin resistant S aureus n = 4) including necrotizing pneumonia (n = 4), necrotizing fasciitis (n = 2), pyomyositis (n = 2; including 1 patient who also had pneumonia), mastoiditis with cerebellitis (n = 1), preorbital cellulitis (n = 1), and recurrent deep furunculosis in an immunosuppressed patient (n = 1). Specific complications of PVL-SA infections were venous thrombosis (n = 2), sepsis (n = 5), respiratory failure (n = 5), and acute respiratory distress syndrome (n = 3). The median duration of hospital stay was 14 days (range 5-52 days). In 6 out of 10 patients a history suggestive for PVL-SA colonization in the patient or close family members before hospital admission was identified.PVL-SA causes severe to life-threatening infections requiring lengthy treatments in hospital in a substantial percentage of symptomatic PVL-SA colonized children. More than 50% of severe infections might be prevented by prompt testing for PVL-SA in individuals with a history of abscesses or furunculosis, followed by decolonization measures.
A combination of 1555 magnetic susceptibility measurements from the Antarctic Peninsula between 65°S to 72°S (for which the raw data are made available), and petrological, structural and metamorphic ...data, has been used to improve understanding of: (1) magma sources for the Antarctic Peninsula batholith; (2) genetic relationships between granitoids and metamorphic rocks, and; (3) to provide a semi-quantitative measure of the extent and grade of metamorphic zones. The redox state of Jurassic plutonic rocks indicates that these had continental magma sources in the tectonostratigraphic terranes of the Central and Eastern domains. Triassic and Cretaceous plutons, on the other hand, had subduction-related sources in the Central Domain of the western Antarctic Peninsula and continental sources in the Gondwana-margin Eastern Domain. Circum-Pacific comparisons of magnetite–ilmenite belt geometries identify the Antarctic Peninsula belt as a natural continuation of comparable South American belts. Susceptibility trends are generally retained by orthogneisses, suggesting that they formed by deformation of plutonic rocks mostly at or below upper amphibolite-facies conditions. Metasedimentary rocks are weakly magnetic across the peninsula, and are spatially associated with continentally derived or crustally contaminated plutons (ilmenite-series). Orthogneisses and metabasites from strongly magnetic plutonic environments show areas of very low magnetic susceptibilities that may be linked to fluid-enhanced, tectonometamorphism-induced reduction of magnetic susceptibility. The distribution of reduced magnetic susceptibility areas follows the surface traces of major shear and fault zones in Palmer Land. Our results are consistent with tectonic interpretations of oblique compression and uplift of an arc block on the Pacific margin of Gondwana during the Palmer Land Event.
► A new compilation of Antarctic Peninsula magnetic susceptibilities from 65°S to 72°S is presented. ► Jurassic plutons had continental magma sources in the Central and Eastern domains. ► Triassic and Cretaceous plutons were subduction-related in the west and continental in the east. ► The distribution of demagnetized areas follows major shear and fault zones in Palmer Land.
In pediatrics chronic respiratory insufficiency is increasingly treated on an outpatient basis with home mechanical ventilation. Nursing and medical teams with different structures take care of the ...often complex ill children in the outpatient setting. Structured treatment processes, especially emergency plans for the management of respiratory emergencies of home mechanical ventilated children are lacking. This article is a proposal for emergency management of respiratory infections, emergencies of non-invasively ventilated and invasively ventilated, tracheotomized children. In addition to resuscitation measures according to ERC/AHA, the focus is primarily on secretion management, as well as on the handling of ventilators and devices.
Fission track analysis has seen a major expansion in application to general geological problems reflecting its advances in understanding the temperature dependence of track annealing and track length ...distributions. However, considerable uncertainties still persist, in particular concerning the stability of fission tracks subjected to the interaction of environmental physical parameters (e.g. pressure, temperature, stress) and in extrapolation of laboratory data to geological time scales. In this work, we studied the fading behavior of spontaneous fission tracks in basic apatite hexagonal Ca
5(PO
4)
3(OH, F, Cl) when exposed simultaneously to laboratory pressures, temperatures and stress over varying time spans. The experiments showed that track fading is a complex recovery mechanism, which is extremely sensitive to the coupling of these three parameters. In particular, a strong decrease in the fission track fading rate was observed as a function of increasing pressure. And a nearly temperature-independent dramatic increase in fission track recovery was observed as a function of stress. Consequently, (1) the stability field of fission tracks in apatite increases towards temperatures higher than 110°C depending on the absolute pressure; (2) closure ages in apatite are underestimated (>100% for an ideal geothermobarometric gradient); (3) related exhumation and erosion rates are overestimated above the closure temperature and underestimated below the closure temperature; and (4) since the widely applied statistical description of thermally induced fading kinetics does not account for the influences of either pressure or stress and is based on fission track annealing data produced at ambient pressure, the accuracy in extrapolating fission track data to geological time scales and in their application to dynamical systems must be cast into doubt.
The number of children with tracheostomies with and without home mechanical ventilation has grown continuously in recent years. For some of these children, the need for tracheostomy resolves and the ...child can be weaned from the tracheal cannula. Choosing the optimal time point for decannulation after elaborated prior diagnostic work-up needs careful consideration. The decannulation process requires an interdisciplinary team; however, these specialized structures for the experienced care of these children with tracheostomy are not available in all areas. The Working Group on Chronic Respiratory Insufficiency in the German Speaking Pediatric Pneumology Society (GPP) developed these recommendations to guide through a decannulation process. Initial evaluation of decannulation feasibility starts in the outpatient clinic with a detailed history, examination, and a speaking valve trial and is followed by an inpatient workup including sleep study, airway endoscopy and possibly modifications of the tracheal cannula. Downsizing the tracheal cannula allows a stepwise controlled weaning prior to removal of the tracheal cannula. After shrinking of the tracheostomy, the final surgical closure is performed.
Conclusion
: An algorithm with diagnostic and therapeutic procedures for a safe and successful decannulation process is proposed.
What is Known:
• In children tracheostomy decannulation is a complex process that requires careful preparation and surveillance.
What is New:
• This statement of the German speaking society of pediatric pulmonology provides an expert practice guidance on the decannulation procedure and the value of one-way speaking valves.
Since an objective description is essential to determine infant's postnatal condition and efficacy of interventions, two scores were suggested in the past but weren't tested yet: The Specified-Apgar ...uses the 5 items of the conventional Apgar score; however describes the condition regardless of gestational age (GA) or resuscitative interventions. The Expanded-Apgar measures interventions needed to achieve this condition. We hypothesized that the combination of both (Combined-Apgar) describes postnatal condition of preterm infants better than either of the scores alone.
Scores were assessed in preterm infants below 32 completed weeks of gestation. Data were prospectively collected in 20 NICU in 12 countries. Prediction of poor outcome (death, severe/moderate BPD, IVH, CPL and ROP) was used as a surrogate parameter to compare the scores. To compare predictive value the AUC for the ROC was calculated.
Of 2150 eligible newborns, data on 1855 infants with a mean GA of 28(6/7) ± 2(3/7) weeks were analyzed. At 1 minute, the Combined-Apgar was significantly better in predicting poor outcome than the Specified- or Expanded-Apgar alone. Of infants with a very low score at 5 or 10 minutes 81% or 100% had a poor outcome, respectively. In these infants the relative risk (RR) for perinatal mortality was 24.93 (13.16-47.20) and 31.34 (15.91-61.71), respectively.
The Combined-Apgar allows a more appropriate description of infant's condition under conditions of modern neonatal care. It should be used as a tool for better comparison of group of infants and postnatal interventions.
clinicaltrials.gov Protocol Registration System (NCT00623038). Registered 14 February 2008.
The elastic properties of rocks are influenced by several microstructural variables, including the lattice preferred orientation and grain shape fabric of the mineral phases, variations in the ...spatial distribution of the mineral phases, the properties of the grain boundaries, and the presence of porosity/fractures. Consequently, in principle, directional variations in these variables can be inferred from seismic velocity anisotropy observations. Experimental seismic velocity measurements made on rocks of well‐characterized microstructure may be used to improve the quality of such interferences. However, since most rocks are microstructurally complex, in order to interpret the measurements fully, theoretical analyses which can accommodate all the relevant microstructural variables are required. Theoretical analyses of the requisite sophistication have only recently been developed. We have tested one of these (due to Ponte Castañeda and Willis) by using it to calculate the elastic properties of an upper mantle harzburgite and by then comparing the results with experimental velocity measurements to determine if the values of those microstructural variables which are difficult to quantify (grain boundary properties, fracture shape) are physically realistic. We find that they are and conclude that the Ponte Castañeda and Willis analysis provides a powerful method for a more detailed assessment of the causes of elastic property anistropy in rocks than has previously been possible.
Trefoil factors in human milk Vestergaard, Else Marie; Nexo, Ebba; Wendt, Anke ...
Early human development,
10/2008, Letnik:
84, Številka:
10
Journal Article
Recenzirano
Abstract We measured concentrations of the gastrointestinal protective peptides Trefoil factors in human milk. By the use of in-house ELISA we detected high amounts of TFF3, less TFF1 and virtually ...no TFF2 in human breast milk obtained from 46 mothers with infants born extremely preterm (24−27 wk gestation), preterm (28−37 wk gestation), and full term (38−42 wk gestation). Samples were collected during the first, second, third to fourth weeks and more than 4 wks postpartum. Median (range) TFF1 TFF3 concentrations in human milk were 320 (30−34000) 1500 (150−27,000) pmol/L in wk 1, 120 (30−720) 310 (50−7100) pmol/L in wk 2, 70 (20−670) 120 (20−650) pmol/L in wks 3 to 4, and 60 (30−2500) 80 (20−540) pmol/L in > 4 wks after delivery. The lowest concentrations of TFF1 and TFF3 were found later than 2 wks after birth. In conclusion, TFF was present in term and preterm human milk with rapidly declining concentrations during the first weeks post partum. The clinical significance of TFF present in human milk remains to be explored, both regarding development of the fetal gut and protection against necrotizing enterocolitis.
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