Safety of apnea testing for the diagnosis of brain death: a comprehensive study on neuromonitoring data and blood gas analysis.

BACKGROUND AND PURPOSE: Here, we studied the safety of apnea testing (AT) for the determination of brain death with regard to intracranial pressure (ICP), cerebral perfusion and arterial blood gas parameters. We hypothesized that ICP only increases when cerebral perfusion pressure (CPP) remains positive during AT. METHODS: A total of 34 patients who fulfilled brain death criteria were identified by chart review (2009-2017). We analysed ICP, CPP and mean arterial pressure (MAP) prior to AT, during AT and after AT, as well as arterial pH, paCO2 , paO2 and arterial O2 saturation at the start and end of AT. RESULTS: Intracranial pressure was 87.9 ± 17.7 mmHg (mean ± SD) prior to AT, 89.9 ± 17.2 mmHg during AT and 86.4 ± 15.2 mmHg after AT (P = 0.9). CPP was -6.9 ± 12.8 mmHg prior to AT, -7.1 ± 13.7 mmHg during AT and -8.6 ± 13.0 mmHg after AT (P = 0.98), respectively. MAP was 82.9 ± 14.6 mmHg prior to AT, 84.7 ± 13.9 mmHg during AT and 79.7 ± 9.6 mmHg after AT (P = 0.57), respectively. A total of 10 patients had positive CPP (8.6 ± 4.3 mmHg), but ICP did not increase during AT. Arterial pH decreased from 7.43 ± 0.06 to 7.22 ± 0.06 (P < 0.05), paCO2 increased from 38.6 ± 4.2 to 69.6 ± 8.0 mmHg (P < 0.05), paO2 decreased from 416.3 ± 113.4 to 289.2 ± 146.5 mmHg (P < 0.05), and O2 saturation was stable at 99.8 ± 0.4% and 98.2 ± 3.2% (P = 0.39). CONCLUSIONS: Apnea testing had no detrimental effect on ICP, CPP, MAP or oxygenation, regardless of the presence of an initially positive CPP. The lack of further ICP elevations is presumably explained by critical closing pressures above individual CPP levels during AT.

Reno-Duodenal Fistula as a Complication of Staghorn Stones and Renal Pelvis Tumor: A Case Presentation.

Reno alimentary fistula, a rare illness characterized by improper connection between the kidney and digestive tract, can lead to urinary tract infections, abscesses, and severe sepsis. It can also be caused by various factors such as chronic infections, malignancy, cryoablation, or abdominal surgical procedures. We present a case of a 60-year-old man with bilateral staghorn stones who was diagnosed with reno-duodenal fistula and underwent a right simple nephrectomy and fistula closure. The histopathology revealed a well-differentiated squamous cell carcinoma that originated from the renal pelvis.

Functional connectivity between motor cortex and globus pallidus in human non-REM sleep.

Recent evidence suggests that the motor system undergoes very specific modulation in its functional state during the different sleep stages. Here we test the hypothesis that changes in the functional organization of the motor system involve both cortical and subcortical levels and that these distributed changes are interrelated in defined frequency bands. To this end we evaluated functional connectivity between motor and non-motor cortical sites (fronto-central, parieto-occipital) and the globus pallidus (GP) in human non-REM sleep in seven patients undergoing deep brain stimulation (DBS) for dystonia using a variety of spectral measures (power, coherence, partial coherence and directed transfer function (DTF)). We found significant coherence between GP and fronto-central cortex as well as between GP and parieto-occipital cortex in circumscribed frequency bands that correlated with sleep specific oscillations in 'light sleep' (N2) and 'slow-wave sleep' (N3). These sleep specific oscillations were also reflected in significant coherence between the two cortical sites corroborating previous studies. Importantly, we found two different physiological activities represented within the broad band of significant coherence between 9.5 and 17 Hz. One component occurred in the frequency range of sleep spindles (12.5-17 Hz) and was maximal in the coherence between fronto-central and parieto-occipital cortex as well as between GP and both cortical sites during N2. This component was still present between fronto-central and parieto-occipital cortex in N3. Functional connectivity in this frequency band may be due to a common input to both GP and cortex. The second component consisted of a spectral peak over 9.5-12.5 Hz. Coherence was elevated in this band for all topographical constellations in both N2 and N3, but especially between GP and fronto-central cortex. The DTF suggested that the 9.5-12.5 Hz activity consisted of a preferential drive from GP to the fronto-central cortex in N2, whereas in N3 the DTF between GP and fronto-central cortex was symmetrical. Partial coherence supported distinctive patterns for the 9.5-12.5 and 12.5 and 17 Hz component, so that only coherence in the 9.5-12.5 Hz band was reduced when the effects of GP were removed from the coherence between the two cortical sites. The data suggest that activities in the GP and fronto-central cortex are functionally connected over 9.5-12.5 Hz, possibly as a specific signature of the motor system in human non-REM sleep. This finding is pertinent to the longstanding debate about the nature of alpha-delta sleep as a physiological or pathological feature of non-REM sleep.

Sequence structure of hidden 10.4-base repeat in the nucleosomes of C. elegans.

By measuring prevailing distances between YY, YR, RR, and RY dinucleotides in the large database of the nucleosome DNA fragments from C. elegans, the consensus sequence structure of the nucleosome DNA repeat of C. elegans was reconstructed: (YYYYYRRRRR)n. An actual period was estimated to be 10.4 bases. The pattern is fully consistent with the nucleosome DNA patterns of other eukaryotes, as established earlier, and, thus, the YYYYYRRRRR repeat can be considered as consensus nucleosome DNA sequence repeat across eukaryotic species. Similar distance analysis for [A, T] dinucleotides suggested the related pattern (TTTYTARAAA)n where the TT and AA dinucleotides display rather out of phase behavior, contrary to the "AA or TT" in-phase periodicity, considered in some publications. A weak 5-base periodicity in the distribution of TA dinucleotides was detected.

Epigenetic nucleosomes: Alu sequences and CG as nucleosome positioning element.

Alu sequences carry periodical pattern with CG dinucleotides (CpG) repeating every 31-32 bases. Similar distances are observed in distribution of DNA curvature in crystallized nucleosomes, at positions +/-1.5 and +/-4.5 periods of DNA from nucleosome DNA dyad. Since CG elements are also found to impart to nucleosomes higher stability when positioned at +/-1.5 sites, it suggests that CG dinucleotides may play a role in modulation of the nucleosome strength when the CG elements are methylated. Thus, Alu sequences may harbor special epigenetic nucleosomes with methylation-dependent regulatory functions. Nucleosome DNA sequence probe is suggested to detect locations of such regulatory nucleosomes in the sequences.

Sequence-directed mapping of nucleosome positions.

A nucleosome DNA sequence probe is designed that combines recently derived RR/YY counter-phase and AA/TT in-phase periodical patterns. A simple nucleosome mapping procedure is introduced for prediction of the nucleosome positions in the sequence of interest, to serve as a guide for experimental studies of the chromatin structure.

Efficiency of solar water disinfection photocatalized by titanium dioxide of varying particle size.

Titanium dioxide photocatalysed water disinfection is induced by the interaction of light with TiO(2), which generates highly reactive free hydroxyl radicals (OH(*)). These free radicals create lethal damage that leads to bacterial death. Normally, decreasing TiO(2) particle size increases the area of light interaction. This may possibly increase the concentration of OH(*) generated and hence increases disinfection efficiency. Moreover, decreasing the particle size increases the force of attraction between the particles and cells, which could create aggregates that may contribute to the local OH(*) concentration. In the present investigation cells of Escherichia coli were used as the test microorganism, TiO(2) as the photocatalyst and sunlight as the light source. Four different surface areas of TiO(2) particles corresponding to 10, 50, 80-100 and > or =300 m(2) g(-1) were tested at a concentration of 1 g l(-1). Disinfection efficiency increased with increasing the surface area producing a maximum between 80-100 m(2) g(-1) followed by a reduction at > or =300 m(2) g(-1). The reduction in the efficiency at this relatively high surface area was attributed to the increase in the local concentration of OH(*). This increase may be high enough to initiate radical-radical interaction that would compete with bacterial cells and reduce the chance of bacterial cell-radical interaction taking place. Moreover, the phenomenon of TiO(2) aggregation with bacterial cells plays an important role, and the extent of aggregation increases with decreasing particle size. Such aggregation could augment the concentration of OH(*) within the cell vicinity. This suggests that surface area is a key factor in determining the efficiency of disinfection, and that concentration is a vital factor.

Corticospinal excitability in human sleep as assessed by transcranial magnetic stimulation.

The excitability of the corticospinal system was studied in 23 healthy subjects in sleep stages NREM2, NREM4, REM, and wakefulness using transcranial magnetic stimulation. Assessment of motor thresholds, stimulus-response curves, and latencies of motor evoked potentials shows activation of the fast-conducting corticospinal fibers in all sleep stages and a neuronal recruitment pattern similar to wakefulness, however, at a lower level of excitability and with significant differences between sleep stages.

Chemical and photolytical transformation of biomedically significant compounds in the presence of deuterated solvents.

The effect of the nature of solvent on the properties of biomedically important compounds is of particular importance. The conversion of certain biomedical compounds with deuterated solvents is an area of research that has not been accorded adequate recognition in the literature. We explored this area in the interest of shedding some light on the possible effects of solvent on the nature of the solute. The transformation of specific medically important compounds such as bilirubin, thymine, uracil, dehydrocholesterol (7-DHC) and vitamin D(3) was observed in the presence of deuterated solvents such as heavy water and deuterated chloroform. The products of the relevant reactions were confirmed spectrophotometrically. An additional feature to our investigation involved the photolysis of the aforementioned compounds by solar irradiation. The pure samples were dissolved in solutions of the deuterated solvents, corresponding to concentrations of typically 10(-2) mM, and exposed to sunlight for about 15-30 min. The deuterated solvents caused chemical transformation in all chemical compounds tested, and produced intense characteristic absorbance maxima between 200 and 700 nm. Sunlight exposure was also effective in either augmenting the effects of deuterated solvent as in bilirubin and 7-DHC or reducing it as with thymine or having no effect as with uracil or completely changing it as in vitamin D(3). It has been shown that the use of deuterated solvents produces unique chemical and photochemical conversions of bilirubin, 7-DHC, thymine, uracil and vitamin D(3). This was attributed to the fact that deuterated compounds display a somewhat different chemistry to their ordinary counterparts and that possibly thermodynamic considerations could be responsible for the novel transformations.

Needs analysis of a cancer education program in south western Sydney.

Before establishing a cancer education program in South Western Sydney (SWS), a study was conducted to investigate the level of interest and presentation format preferred by patients with cancer and their relatives/friends regarding five types of cancer-related information: medical, psychological, and physical care issues as well as support services and available resources. A questionnaire using a Likert scale and open- and close-ended questions was distributed to the local cancer population and their families comprising a total sample size of 141. The results showed a uniformly high level of interest in learning about all five cancer-related topics with a preferred program format that consisted of a mixed media presentation of 1 to 6 weeks duration, consisting of 1- to 2-hour weekly sessions. A cancer education program based on the needs assessment findings was developed and implemented at Liverpool Hospital, which was positively evaluated by participants.

Calmodulin-like activity in mycobacteria.

Calmodulin-like activity has been reported for the first time in mycobacterial species, namely Mycobacterium tuberculosis BCG and M. smegmatis ATCC 14468. The activity was mainly located in the soluble fraction of the mycobacterial cells, Radioimmunoassay revealed maximum levels of calmodulin in young growing cells (early logarithmic phase of growth). Calmodulin-dependent phosphodiesterase activation assay revealed low activity (22%) of partially purified calmodulin either due to insufficient amount of calmodulin to activate phosphodiesterase or due to the presence of some factors interfering with the assay. Calmodulin antagonists, viz. trifluoperazine and phenothiazine, significantly inhibited the 32Pi incorporation into mycobacterial phospholipids. Similar inhibition was observed when EGTA (which removes calcium) was added to the medium. Significant inhibition of 32Pi incorporation in the presence of calmodulin antagonists suggested the involvement of calmodulin in mycobacterial phospholipid metabolism.

Efficacy of implementation of a 5 scale pediatric triage and acuity scale in pediatric emergency, Saudi Arabia.

OBJECTIVES: To evaluate the effectiveness of implementation of the pediatric Canadian Triage and Acuity Scale (Ped-CTAS) for children visiting the pediatric emergency department (ED). METHODS: This cross-sectional study evaluated all children presented to the ED during a 9-day period in March 2010. The Ped-CTAS triage system was used. Triage performance was analyzed on the basis of quality indicators, rate of admissions, rate of referral, observation duration, and relationship between investigations requested and CTAS level. RESULTS: During the study period, 3,337 patients were triaged. Overall, 4 patients (0.1%) were in triage level 1, 356 (12%) were level 2, 655 (22%) were level 3, 1810 (60%) were level 4, and 189 (6%) were level 5. The left without being seen rate was 6.25%. A triage duration of 5 minutes or less was carried out for 97% of cases. Within the CTAS time objectives, the waiting time to nurse and physician was 100% for cases triaged to level 1. The proportion of cases who needed observation was 100% for level 1, 85% for level 2, 53% for level 3, 33% for level 4, and 26% for level 5. The proportion of patients admitted to the hospital was 100% for level 1. The lower the level (more acute and emergent the condition) the more use of the laboratory and radiological investigations. CONCLUSION: The pediatric CTAS triage system is a good tool for categorizing pediatric patients attending the ED. Stratified by triage level, triage indicators can be used as indicators of ED performance.

Inhibitory and excitatory intracortical circuits across the human sleep-wake cycle using paired-pulse transcranial magnetic stimulation.

Studies using single-pulse transcranial magnetic stimulation (TMS) have shown that excitability of the corticospinal system is systematically reduced in natural human sleep as compared to wakefulness with significant differences between sleep stages. However, the underlying excitatory and inhibitory interactions on the corticospinal system across the sleep-wake cycle are poorly understood. Here, we specifically asked whether in the motor cortex short intracortical inhibition (SICI) and facilitation (ICF) can be elicited at all in sleep using the paired-pulse TMS protocol, and if so, how SICI and ICF vary across sleep stages. We studied 28 healthy subjects at interstimulus intervals of 3 ms (SICI) and 10 ms (ICF), respectively. Magnetic stimulation was performed over the hand area of the motor cortex using a focal coil and evoked motor potentials were recorded from the contralateral first dorsal interosseus muscle (1DI). Relevant data was obtained from 13 subjects (NREM 2: n=7; NREM 3/4: n=7; REM: n=7). Results show that both SICI and ICF were present in NREM sleep. SICI was significantly enhanced in NREM 3/4 as compared to wakefulness and all other sleep stages whereas in NREM 2 neither SICI nor ICF differed from wakefulness. In REM sleep SICI was in the same range as in wakefulness, but ICF was entirely absent. These results in humans support the hypothesis derived from animal experiments which suggests that intracortical inhibitory mechanisms are involved in the control of neocortical pyramidal cells in NREM and REM sleep, but along different intraneuronal circuits. Further, our findings suggest that cortical mechanisms may additionally contribute to the inhibition of spinal motoneurones in REM sleep.

Enhancement of solar inactivation of Escherichia coli by titanium dioxide photocatalytic oxidation.

AIMS: To improve solar water disinfection using a photocatalysing semi-conductor and to study the mechanisms involved in this process. METHODS AND RESULTS: Cells of Escherichia coli were used as the microbiological indicator to study the possibility of improving the efficiency of solar water disinfection using titanium dioxide (TiO2) as a photooxidizing semi-conductor. TiO2 was used either as a suspended powder or in an immobilized form. Both applications improved the efficiency of solar disinfection. TiO2 in suspension was more effective than the immobilized form, producing enhancement factors of 1.62 and 1.34, respectively. The concentration of TiO2 greatly affected efficiency, with a maximum effect at 1 mg ml(-1). Higher TiO2 concentrations reduced the efficiency. Dimethyl sulphoxide (DMSO) and cysteamine (Cys), hydroxyl radical (OH.) scavengers, were used to elucidate the mechanisms involved in the presence of TiO2. Both DMSO and Cys totally abolished the enhancing effect produced by the presence of TiO2. CONCLUSIONS: Sunlight has a potential water disinfecting capacity. The use of TiO2 greatly improved this efficiency. The effect of TiO2 was mainly concentration-dependent, giving maximum efficiency at 1 mg ml(-1). The presence of DMSO and Cys removed the TiO2-induced enhancement, indicating that OH. may be involved in the process of cell killing. SIGNIFICANCE AND IMPACT OF THE STUDY: The efficiency of solar disinfection is limited and time-consuming and needs to be improved. The use of a semi-conductor is promising as it reduces the time of exposure and therefore increases the efficiency of solar disinfection. This would allow for the availability of good quality water, and hence would improve the quality of life.

Can sunlight replace phototherapy units in the treatment of neonatal jaundice? An in vitro study.

BACKGROUND/AIM: Light can be efficiently used for the treatment of neonatal jaundice. Sunlight, which covers a large portion of the light spectrum including the bilirubin-absorbing range, is abundant in the Middle East. Such advantages prompted the present study to investigate the efficiency of sunlight in isomerizing bilirubin. This may introduce a practical source of light for the treatment of hyperbilirubinic infants in areas where phototherapy units are not available. METHODS: The efficiency of sunlight was quantified by a comparison with a phototherapy unit. Aqueous bilirubin solutions were exposed to periodic sunlight over the entire year and the reduction of bilirubin concentration was monitored spectrophotometrically. Bilirubin solutions were also exposed to a phototherapy unit intensity comparable to that of sunlight (17 cm away from the source). RESULTS: The data indicated that at this comparable light intensity, the phototherapy unit was as effective as sunlight. However, for the treatment of neonatal jaundice, phototherapy units are usually operated at a distance of 50 cm (where the light intensity is six times less than that of sunlight). When this distance was tested, only 16% of bilirubin was isomerized in the first 5 min of exposure. In contrast, about 65% of bilirubin was isomerized when the phototherapy unit was placed at a distance of 17 cm and when the bilirubin solutions were exposed to sunlight for the same time period. The hourly and seasonal changes in sunlight intensity affected the reduction in bilirubin concentration significantly. CONCLUSION: Data revealed that sunlight is almost 6.5 times more effective than a phototherapy unit when operating at the ward geometry after taking isomerization efficiency and area of exposure into consideration. Moreover, sunlight is still more effective during the winter season, when its intensity is lower. Thus, sunlight may be considered an alternative phototherapy source for the treatment of neonatal jaundice, particularly in areas where conventional phototherapy units are unavailable.

Prediction of growth of Bacillus megaterium spores as affected by gamma radiation dose and spore load.

AIMS: To provide data on the interaction of radiation dose (x1) and microbial contamination load (x2), as predictor variables, on the percentage of vials exhibiting growth of Bacillus megaterium spores (y). METHODS AND RESULTS: The influence of a wide range of spore loads (1-50 000 spores of B. megaterium vial-1) and gamma radiation doses (0.2-10 kGy) on the contaminated samples was determined. Each contamination load was studied by adding the specified number of spores to 100 vials containing nutrient broth and exposing them to various doses of gamma radiation. Curves representing the number of contaminated vials against the dose of radiation were sigmoidal in shape and the data showed an indirect relationship. Data were analysed by regression analysis which revealed a significant correlation (R2=0.85). The relationship among the tested variables is exponential and can be described by the following equation: y = 1 - (1 - e(0.0173x(1)))(x(2)) It was also estimated that, for each increase of 1 in the number of spores per vial, there is an increase of 1 in the number of contaminated vials. CONCLUSION: The two variables (x1 and x2) have great influence on the radiation sterilization efficiency and the proposed mathematical model is valid for the prediction of this efficiency. SIGNIFICANCE AND IMPACT OF THE STUDY: The results of the present investigation can be of useful industrial application and can help to set acceptance and rejection limits for the production of materials vulnerable to microbial contamination.

A comparative study on gamma irradiation of unconjugated bilirubin in aqueous and non-aqueous solutions.

Dilute aqueous and non-aqueous solutions of bilirubin were exposed to gamma radiation to examine the effects of ionizing radiation on the concentrations of a specimen of this nature. The ionising radiation emanated from a (137)Cs source, and was applied to 5.2 x 10(-2) mmol L(-1) solutions of the unconjugated specimen in 0.05 mol L(-1) aqueous NaOH and chloroform. Depletion of bilirubin after exposure was common to both solvents. Complete degradation was accomplished with doses in excess of 100 Gy. In the case of NaOH, it was found that the presence of molecular oxygen contributed more efficiently to the degradation process, than irradiation in air. When the experimental conditions were changed to nitrogen, the degradation process was suppressed. The sole by-product of merit originating from the NaOH work was the short-wavelength isomer of biliverdin, at 330 nm. In the case of chloroform, the exclusive product of interest was characterised as the long-wavelength isomer of biliverdin that absorbs in the broad region commencing from about 620 nm. The non-aqueous study was conducted in the presence and absence of molecular oxygen, with no significant changes in the results. Optimum production of the isomers in question occurred at a gamma dose of about 80 Gy. The general species of interest were monitored spectrophotometrically, and the results were treated mathematically to facilitate evaluation of the data. Our work represents the development of a facile gamma-ray method for the exclusive production of specific isomers of biliverdin, which are useful components in biosynthetic research.