Measurement of relative lung perfusion with electrical impedance and positron emission tomography: an experimental comparative study in pigs.

BACKGROUND: Electrical impedance tomography (EIT) with indicator dilution may be clinically useful to measure relative lung perfusion, but there is limited information on the performance of this technique. METHODS: Thirteen pigs (50-66 kg) were anaesthetised and mechanically ventilated. Sequential changes in ventilation were made: (i) right-lung ventilation with left-lung collapse, (ii) two-lung ventilation with optimised PEEP, (iii) two-lung ventilation with zero PEEP after saline lung lavage, (iv) two-lung ventilation with maximum PEEP (20/25 cm H2O to achieve peak airway pressure 45 cm H2O), and (v) two-lung ventilation under unilateral pulmonary artery occlusion. Relative lung perfusion was assessed with EIT and central venous injection of saline 3%, 5%, and 10% (10 ml) during breath holds. Relative perfusion was determined by positron emission tomography (PET) using 68Gallium-labelled microspheres. EIT and PET were compared in eight regions of equal ventro-dorsal height (right, left, ventral, mid-ventral, mid-dorsal, and dorsal), and directional changes in regional perfusion were determined. RESULTS: Differences between methods were relatively small (95% of values differed by less than 8.7%, 8.9%, and 9.5% for saline 10%, 5%, and 3%, respectively). Compared with PET, EIT underestimated relative perfusion in dependent, and overestimated it in non-dependent, regions. EIT and PET detected the same direction of change in relative lung perfusion in 68.9-95.9% of measurements. CONCLUSIONS: The agreement between EIT and PET for measuring and tracking changes of relative lung perfusion was satisfactory for clinical purposes. Indicator-based EIT may prove useful for measuring pulmonary perfusion at bedside.

Variable versus conventional lung protective mechanical ventilation during open abdominal surgery (PROVAR): a randomised controlled trial.

BACKGROUND: Experimental studies showed that controlled variable ventilation (CVV) yielded better pulmonary function compared to non-variable ventilation (CNV) in injured lungs. We hypothesized that CVV improves intraoperative and postoperative respiratory function in patients undergoing open abdominal surgery. METHODS: Fifty patients planned for open abdominal surgery lasting >3 h were randomly assigned to receive either CVV or CNV. Mean tidal volumes and PEEP were set at 8 ml kg-1 (predicted body weight) and 5 cm H2O, respectively. In CVV, tidal volumes varied randomly, following a normal distribution, on a breath-by-breath basis. The primary endpoint was the forced vital capacity (FVC) on postoperative Day 1. Secondary endpoints were oxygenation, non-aerated lung volume, distribution of ventilation, and pulmonary and extrapulmonary complications until postoperative Day 5. RESULTS: FVC did not differ significantly between CVV and CNV on postoperative Day 1, 61.5 (standard deviation 22.1) % vs 61.9 (23.6) %, respectively; mean [95% confidence interval (CI)] difference, -0.4 (-13.2-14.0), P=0.95. Intraoperatively, CVV did not result in improved respiratory function, haemodynamics, or redistribution of ventilation compared to CNV. Postoperatively, FVC, forced expiratory volume at the first second (FEV1), and FEV1/FVC deteriorated, while atelectasis volume and plasma levels of interleukin-6 and interleukin-8 increased, but values did not differ between groups. The incidence of postoperative pulmonary and extrapulmonary complications was comparable in CVV and CNV. CONCLUSIONS: In patients undergoing open abdominal surgery, CVV did not improve intraoperative and postoperative respiratory function compared with CNV. CLINICAL TRIAL REGISTRATION: NCT 01683578.

Comparison of different degrees of variability in tidal volume to prevent deterioration of respiratory system elastance in experimental acute lung inflammation.

BACKGROUND: Variable ventilation improves respiratory function, but it is not known whether the amount of variability in tidal volume (VT) can be reduced in recruited lungs without a deterioration of respiratory system elastance. METHODS: Acute lung inflammation was induced by intratracheal instillation of lipopolysaccharide in 35 Wistar rats. Twenty-eight animals were anaesthetized and ventilated in volume-controlled mode. Lungs were recruited by random variation of VT (mean 6 ml kg(-1), coefficient of variation 30%, normal distribution) for 30 min. Animals were randomly assigned to different amounts of VT variability (n=7 for 90 min per group): 30, 15, 7.5, or 0%. Lung function, diffuse alveolar damage, and gene expression of biological markers associated with cell mechanical stress, inflammation, and fibrogenesis were assessed. Seven animals were not ventilated and served as controls for post-mortem analyses. RESULTS: A VT variability of 30%, but not 15, 7.5, or 0%, prevented deterioration of respiratory system elastance [Mean (SD) -7.5 (8.7%), P<0.05; 21.1 (9.6%), P<0.05; 43.3 (25.9), P<0.05; and 41.2 (16.4), P<0.05, respectively]. Diffuse alveolar damage was lower with a VT variability of 30% than with 0% and without ventilation, because of reduced oedema and haemorrhage. A VT variability of 30, 15, or 7.5% reduced the gene expression of amphiregulin, cytokine-induced neutrophil chemoattractant-1, and tumour necrosis factor α compared with a VT variability of 0%. CONCLUSIONS: In this model of acute lung inflammation, a VT variability of 30%, compared with 15 and 7.5%, was necessary to avoid deterioration of respiratory system elastance and was not associated with lung histological damage.

[Does intraoperative lung-protective ventilation reduce postoperative pulmonary complications?]. / Reduziert eine intraoperative lungenprotektive Beatmung postoperative pulmonale Komplikationen?

BACKGROUND: Recent studies show that intraoperative protective ventilation is able to reduce postoperative pulmonary complications (PPC). OBJECTIVES: This article provides an overview of the definition and ways to predict PPC. We present different factors that lead to ventilator-induced lung injury and explain the concepts of stress and strain as well as driving pressure. Different strategies of mechanical ventilation to avoid PPC are discussed in light of clinical evidence. MATERIALS AND METHODS: The Medline database was used to selectively search for randomized controlled trials dealing with intraoperative mechanical ventilation and outcomes. RESULTS: Low tidal volumes (VT) and high levels of positive end-expiratory pressure (PEEP), combined with recruitment maneuvers, are able to prevent PPC. Non-obese patients undergoing open abdominal surgery show better lung function with the use of higher PEEP levels and recruitment maneuvers, however such strategy can lead to hemodynamic impairment, while not reducing the incidence of PPC, hospital length of stay and mortality. An increase in the level of PEEP that results in an increase in driving pressure is associated with a greater risk of PPC. CONCLUSIONS: The use of intraoperative VT ranging from 6 to 8 ml/kg based on ideal body weight is strongly recommended. Currently, a recommendation regarding the level of PEEP during surgery is not possible. However, a PEEP increase that leads to a rise in driving pressure should be avoided.

Parametric amplification of the mechanical vibrations of a suspended nanowire by magnetic coupling to a Bose-Einstein condensate.

We show how the vibrational modes of a nanowire may be coherently manipulated with a Bose-Einstein condensate of ultracold atoms. We consider the magnetomechanical coupling between paramagnetic atoms and a suspended nanowire carrying a dc current. Atomic spin flips produce a backaction onto the wire vibrations, which can lead to mechanical mode amplification. In contrast to systems considered before, the condensate has a finite energy bandwidth in the range of the chemical potential and we explore the consequences of this on the parametric drive. Applying the resolvent method, we determine the threshold coupling and we also find a significant frequency shift of the vibration due to magnetomechanical dressing.

Prevalence of Anaplasma phagocytophilum infection in European wild boar (Sus scrofa) populations from Transylvania, Romania.

Between 2007-2008 and 2010-2012, 870 organ samples were collected from wild boars in 16 Transylvanian counties. Anaplasma phagocytophilum DNA was identified using a nested PCR protocol that amplifies a fragment of the 16S rRNA gene. Prevalence was compared between sampling periods and counties using Fisher's exact test. In total, 39 (4·48%) samples tested positive, with significantly higher values recorded in the second period, caused by an increased infection rate in boars from Sibiu county. Positive cases tended to concentrate in the central part of the country. During the second sampling period, A. phagocytophilum was detected in two additional counties, suggesting a spatial spreading of the pathogen. The results confirm that Transylvanian wild boars are naturally infected with A. phagocytophilum, thus raising awareness concerning a potential zoonotic cycle. This is the first study to evaluate spatial and temporal variations of A. phagocytophilum distribution in wild boar populations from Transylvania.

Quantum galvanometer by interfacing a vibrating nanowire and cold atoms.

We evaluate the coupling of a Bose-Einstein condensate (BEC) of ultracold, paramagnetic atoms to the magnetic field of the current in a mechanically vibrating carbon nanotube within the frame of a full quantum theory. We find that the interaction is strong enough to sense quantum features of the nanowire current noise spectrum by means of hyperfine-state-selective atom counting. Such a nondestructive measurement of the electric current via its magnetic field corresponds to the classical galvanometer scheme, extended to the quantum regime of charge transport. The calculated high sensitivity of the interaction in the nanowire-BEC hybrid systems opens up the possibility of quantum control, which may be further extended to include other relevant degrees of freedom.

Asymptotic dynamics of coined quantum walks on percolation graphs.

Quantum walks obey unitary dynamics: they form closed quantum systems. The system becomes open if the walk suffers from imperfections represented as missing links on the underlying basic graph structure, described by dynamical percolation. Openness of the system's dynamics creates decoherence, leading to strong mixing. We present a method to analytically solve the asymptotic dynamics of coined, percolated quantum walks for a general graph structure. For the case of a circle and a linear graph we derive the explicit form of the asymptotic states. We find that a rich variety of asymptotic evolutions occur: not only the fully mixed state, but other stationary states; stable periodic and quasiperiodic oscillations can emerge, depending on the coin operator, the initial state, and the topology of the underlying graph.

Evidence for a cos(4φ) modulation of the superconducting energy gap of optimally doped FeTe(0.6)Se(0.4) single crystals using laser angle-resolved photoemission spectroscopy.

We study the superconducting-gap anisotropy of the Γ-centered hole Fermi surface in optimally doped FeTe(0.6)Se(0.4) (T(c)=14.5 K), using laser-excited angle-resolved photoemission spectroscopy. We observe sharp superconducting (SC) coherence peaks at T=2.5 K. In contrast to earlier angle-resolved photoemission spectroscopy studies but consistent with thermodynamic results, the momentum dependence shows a cos(4φ) modulation of the SC-gap anisotropy. The observed SC-gap anisotropy strongly indicates that the pairing interaction is not a conventional phonon-mediated isotropic one. Instead, the results suggest the importance of second-nearest-neighbor electronic interactions between the iron sites in the framework of s(±)-wave superconductivity.

pH-specific hydrothermal assembly of binary and ternary Pb(II)-(O,N-carboxylic acid) metal organic framework compounds: correlation of aqueous solution speciation with variable dimensionality solid-state lattice architecture and spectroscopic signatures.

Hydrothermal pH-specific reactivity in the binary/ternary systems of Pb(II) with the carboxylic acids N-hydroxyethyl-iminodiacetic acid (Heida), 1,3-diamino-2-hydroxypropane-N,N,N',N'-tetraacetic acid (Dpot), and 1,10-phenanthroline (Phen) afforded the new well-defined crystalline compounds [Pb(Heida)](n)·nH(2)O(1), [Pb(Phen)(Heida)]·4H(2)O(2), and [Pb(3)(NO(3))(Dpot)](n)(3). All compounds were characterized by elemental analysis, FT-IR, solution or/and solid-state NMR, and single-crystal X-ray diffraction. The structures in 1-2 reveal the presence of a Pb(II) center coordinated to one Heida ligand, with 1 exhibiting a two-dimensional (2D) lattice extending to a three-dimensional (3D) one through H-bonding interactions. The concurrent aqueous speciation study of the binary Pb(II)-Heida system projects species complementing the synthetic efforts, thereby lending credence to a global structural speciation strategy in investigating binary/ternary Pb(II)-Heida/Phen systems. The involvement of Phen in 2 projects the significance of nature and reactivity potential of N-aromatic chelators, disrupting the binary lattice in 1 and influencing the nature of the ultimately arising ternary 3D lattice. 3 is a ternary coordination polymer, where Pb(II)-Dpot coordination leads to a 2D metal-organic-framework material with unique architecture. The collective physicochemical properties of 1-3 formulate the salient features of variable dimensionality metal-organic-framework lattices in binary/ternary Pb(II)-(hydroxy-carboxylate) structures, based on which new Pb(II) materials with distinct architecture and spectroscopic signature can be rationally designed and pursued synthetically.

[Anesthesia in endourological and robot-assisted interventions]. / Anästhesie bei endourologischen und roboterassistierten Eingriffen.

The improved drug therapy leads to increasingly older patients with complex comorbidities in the discipline of operative urology. Today, improved technical equipment provides new operational capabilities in the field of urology. The prone and lithotomy position during surgery leads to physiological changes that affect anesthesia management. The surgical risk of procedures such as transurethral surgery of the prostate or bladder is being altered by laser surgery and other new technologies. Although the incidence of transurethral resection (TUR) syndrome has been reduced in recent years, the intrusion of irrigation fluid still has to be considered during anesthesia. Robot-assisted surgery has successfully completed the experimental stage and is widely used so that new targets have to be challenged. Ureterorenoscopy is performed with flexible, small caliber ureteroscopes which even allow treatment of renal calculi under analgosedation within short time periods. Percutaneous nephrostomy and litholapaxy are still frequently performed in the prone position. With respect to the risks arising from patient positioning, supine or lateral positioning should be considered in individual cases. A good communication between the surgeon and anesthetist allows deviation from daily routine procedures if special indications require a modified approach. In conclusion, a profound knowledge of the (patho-)physiology of general anesthesia and endourological diseases enables anesthetists to provide a prospective type anesthesia, which should prevent the occurrence of life-threatening incidents.

Morphology, ultrastructure and contractile properties of muscles responsible for superior tentacle movements of the snail.

Bending, twitching and quivering are different types of tentacle movements observed during olfactory orientation of the snail. Three recently discovered special muscles, spanning along the length of superior tentacles from the tip to the base, seem to be responsible for the execution of these movements. In this study we have investigated the ultrastructure, contractile properties and protein composition of these muscles. Our ultrastructural studies show that smooth muscle fibers are loosely embedded in a collagen matrix and they are coupled with long sarcolemma protrusions. The muscle fibers apparently lack organized SR and transverse tubular system. Instead subsarcolemmal vesicles and mitochondria have been shown to be possible Ca2+ pools for contraction. It was shown that external Ca2+ is required for contraction elicited by high (40 mM) K+ or 10-4 M ACh. Caffeine (5 mM) induced contraction in Ca2+-free solution suggesting the presence of a substantial intracellular Ca2+ pool. High-resolution electrophoretic analysis of columellar and tentacular muscles did not reveal differences in major contractile proteins, such as actin, myosin and paramyosin. Differences were observed however in several bands representing presumably regulatory enzymes. It is concluded that, the ultrastructural, biochemical and contractile properties of the string muscles support their special physiological function.

The neuroanatomical and ultrastructural organization of statocyst hair cells in the pond snail, Lymnaea stagnalis.

The ultrastructure, neuroanatomy and central projection patterns, including the intercellular connections of the statocyst hair cells of the pond snail, Lymnaea stagnalis, were studied, applying different intra- and extracellular cellular staining techniques combined with correlative light- and electron microscopy. Based on the ultrastructure different hair cells could be distinguished according to their vesicle and granule content, meanwhile the general organization of the sensory neurons was rather uniform, showing clearly separated perinuclear and "vesicular" cytoplasmic regions. Following intra- and extracellular labeling with fluorescence dyes or HRP a typical, local arborization of the hair cells was demonstrated in the cerebral ganglion neuropil, indicating a limited input-output system connected to the process of gravireception. Correlative light- and electron microscopy of HRP-labeled hair cells revealed both axo-somatic and axo-axonic output contacts of hair cell varicosities, and input on sensory axons located far from the terminal arborizations. Our findings suggest (i) a versatile ultrastructural background of hair cells corresponding possibly to processing different gravireceptive information, and (ii) the synaptic (or non-synaptic) influence of gravireception at different anatomical (terminal, axonal and cell body) levels when processed centrally. The results may also serve as a functional morphological background for previously obtained physiological and behavioral observations.

Measurement-induced chaos with entangled states.

The dynamics of an ensemble of identically prepared two-qubit systems is investigated which is subjected to the iteratively applied measurements and conditional selection of a typical entanglement purification protocol. The resulting dynamics exhibits strong sensitivity to initial conditions. For one class of initial states two types of islands characterize the asymptotic limit. They correspond to a separable and a fully entangled two-qubit state, respectively, and their boundaries form fractal-like structures. In the presence of incoherent noise an additional stable asymptotic cycle appears.

Function and synthesis of small nucleolar RNAs.

Eukaryotic cells contain an extraordinarily complex population of small nucleolar RNAs (snoRNAs). During its brief lifetime, each human pre-rRNA molecule will transiently associate with approximately 150 different snoRNA species. In the past year our understanding of snoRNAs has been clarified by the recognition that the snoRNA population can be divided into a small number of groups which are structurally and functionally distinct. The two largest groups of snoRNAs direct the site-specific modification of the pre-rRNA at positions of 2'-O-methylation and pseudouridine formatio. Other groups of snoRNAs function in pre-rRNA cleavage and in the formation of the correct structure of the pre-rRNA.

Orbital-dependent modifications of electronic structure across the magnetostructural transition in BaFe2As2.

Laser angle-resolved photoemission spectroscopy (ARPES) is employed to investigate the temperature (T) dependence of the electronic structure in BaFe2As2 across the magnetostructural transition at T{N} approximately 140 K. A drastic transformation in Fermi surface (FS) shape across T{N} is observed, as expected by first-principles band calculations. Polarization-dependent ARPES and band calculations consistently indicate that the observed FSs at k{z} approximately pi in the low-T antiferromagnetic state are dominated by the Fe3d{zx} orbital, leading to the twofold electronic structure. These results indicate that magnetostructural transition in BaFe2As2 accompanies orbital-dependent modifications in the electronic structure.

The next generation of patient education: multilingual Dental Explorer 3D.

The A3 Imperative (Anything, Anywhere, Anytime) that has left its mark on our information and knowledge society also characterizes the healthcare sector: we see "informed patients" who always consult the Web prior to their visit to the physician or dentist. The problem is that the knowledge concerning their suspected disease is often superficial. It is the task of the treatment provider to make factual information available and to discuss diagnostic aspects and therapeutic concepts with the patient, competently and based on the merits of the individual case. Dentistry is particularly affected by the online information trend, because the available restorative options cover a broad therapeutic spectrum with many conceivable alternatives that present a highly complex picture. Against this background, a dedicated three-dimensional multimedia software program was developed that visualizes all relevant individual dental treatment options in 3D as appropriate to the patient's oral status, actively supporting chairside communication. A 2D and 3D database containing more than 20,000 image and video files was created that visualizes--in several languages--the status of the individual patient and the planned restorative treatment. With this far-ranging concept, the process of patient-shared or participatory decision-making has been raised to new qualitative levels.

Fermi surface sheet-dependent superconductivity in 2H-NbSe2.

High-resolution angle-resolved photoemission spectroscopy was used to study the superconducting energy gap and changes in the spectral function across the superconducting transition in the quasi-two-dimensional superconductor 2H-NbSe2. The momentum dependence of the superconducting gap was determined on different Fermi surface sheets. The results indicate Fermi surface sheet-dependent superconductivity in this low-transition temperature multiband system and provide a description consistent with thermodynamic measurements and the anomalous de Haas-van Alphen oscillations observed in the superconducting phase. The present data suggest the importance of Fermi surface sheet-dependent superconductivity in explaining exotic superconductivity in other multiband systems with complex Fermi surface topology, such as the borides and f-electron superconductors.

Protective ventilation with high versus low positive end-expiratory pressure during one-lung ventilation for thoracic surgery (PROTHOR): study protocol for a randomized controlled trial.

BACKGROUND: Postoperative pulmonary complications (PPC) may result in longer duration of in-hospital stay and even mortality. Both thoracic surgery and intraoperative mechanical ventilation settings add considerably to the risk of PPC. It is unclear if one-lung ventilation (OLV) for thoracic surgery with a strategy of intraoperative high positive end-expiratory pressure (PEEP) and recruitment maneuvers (RM) reduces PPC, compared to low PEEP without RM. METHODS: PROTHOR is an international, multicenter, randomized, controlled, assessor-blinded, two-arm trial initiated by investigators of the PROtective VEntilation NETwork. In total, 2378 patients will be randomly assigned to one of two different intraoperative mechanical ventilation strategies. Investigators screen patients aged 18 years or older, scheduled for open thoracic or video-assisted thoracoscopic surgery under general anesthesia requiring OLV, with a maximal body mass index of 35 kg/m2, and a planned duration of surgery of more than 60 min. Further, the expected duration of OLV shall be longer than two-lung ventilation, and lung separation is planned with a double lumen tube. Patients will be randomly assigned to PEEP of 10 cmH2O with lung RM, or PEEP of 5 cmH2O without RM. During two-lung ventilation tidal volume is set at 7 mL/kg predicted body weight and, during OLV, it will be decreased to 5 mL/kg. The occurrence of PPC will be recorded as a collapsed composite of single adverse pulmonary events and represents the primary endpoint. DISCUSSION: PROTHOR is the first randomized controlled trial in patients undergoing thoracic surgery with OLV that is adequately powered to compare the effects of intraoperative high PEEP with RM versus low PEEP without RM on PPC. The results of the PROTHOR trial will support anesthesiologists in their decision to set intraoperative PEEP during protective ventilation for OLV in thoracic surgery. TRIAL REGISTRATION: The trial was registered in clinicaltrials.gov ( NCT02963025 ) on 15 November 2016.

Correction to: Protective ventilation with high versus low positive end-expiratory pressure during one-lung ventilation for thoracic surgery (PROTHOR): study protocol for a randomized controlled trial.

After publication of the original article [1], the authors have notified us that two of the collaborator first and last names have been inverted in the "PROTHOR Investigators" table.