Percutaneous Large-Bore Pulmonary Thrombectomy with the FlowTriever Device: Initial Experience in Intermediate-High and High-Risk Patients.

OBJECTIVES: This retrospective cohort study investigates outcomes of patients with intermediate-high and high-risk pulmonary embolism (PE) who were treated with transfemoral mechanical thrombectomy (MT) using the large-bore Inari FlowTriever aspiration catheter system. MATERIAL AND METHODS: Twenty-seven patients (mean age 56.1 ± 15.3 years) treated with MT for PE between 04/2021 and 11/2021 were reviewed. Risk stratification was performed according to European Society of Cardiology (ESC) guidelines. Clinical and hemodynamic characteristics before and after the procedure were compared with the paired Student's t test, and duration of hospital stay was analyzed with the Kaplan-Meier estimator. Procedure-related adverse advents were assessed. RESULTS: Of 27 patients treated, 18 were classified as high risk. Mean right-to-left ventricular ratio on baseline CT was 1.7 ± 0.6. After MT, a statistically significant reduction in mean pulmonary artery pressures from 35.9 ± 9.6 to 26.1 ± 9.0 mmHg (p = 0.002) and heart rates from 109.4 ± 22.5 to 82.8 ± 13.8 beats per minute (p < 0.001) was achieved. Two patients died of prolonged cardiogenic shock. Three patients died of post-interventional complications of which a paradoxical embolism can be considered related to MT. One patient needed short cardiopulmonary resuscitation during the procedure due to clot displacement. Patients with PE as primary driver of clinical instability had a median intensive care unit (ICU) stay of 2 days (0.5-3.5 days). Patients who developed PE as a complication of an underlying medical condition spent 11 days (9.5-12.5 days) in the ICU. CONCLUSION: In this small study population of predominantly high-risk PE patients, large-bore MT without adjunctive thrombolysis was feasible with an acceptable procedure-related complication rate.

Impact of Intrapartum Antibiotic Prophylaxis on Offspring Microbiota.

Infants are born into a world filled with microbes and must adapt without undue immune response while exploiting the microbiota's ability to produce otherwise unavailable nutrients. The process by which humans and microbes establish this relationship has only recently begun to be studied with the aid of genomic methods. Nearly half of all pregnant women receive antibiotics during gestation to prevent maternal and neonatal infection. Though this has been largely successful in reducing early-onset sepsis, we have yet to understand the long-term consequences of antibiotic administration during gestation to developing infants. Studies involving antibiotic use in infants suggest that dysbiosis during this period is associated with increased obesity, allergy, autoimmunity, and chronic diseases in adulthood, however, research around the limited doses of intravenous antibiotics used for intrapartum prophylaxis is limited. In this mini review, we focused on the state of the science regarding the effects of intrapartum antibiotic prophylaxis on the newborn microbial colonization process. Although, the literature indicates that there is wide variety in the specific bacteria that colonize infants from birth, limited parenteral antibiotic administration prior to delivery consistently affects the microbiota of infants by decreasing bacteria in the phylum Bacteroidetes and increasing bacteria in the phylum Proteobacteria, thus altering the normal pattern of colonization that infants experience. Delivery by cesarean section and formula feeding magnify and prolong this effect. Our mini review shows that the impact of intravenous antibiotic administration during gestation has on early colonization, growth, or immune programming in the developing offspring has not been well studied in human or animal models.

Safety guideline: skin antisepsis for central neuraxial blockade.

Concise guidelines are presented that recommend the method of choice for skin antisepsis before central neuraxial blockade. The Working Party specifically considered the concentration of antiseptic agent to use and its method of application. The advice presented is based on previously published guidelines, laboratory and clinical studies, case reports, and on the known properties of antiseptic agents.

GeSn/Ge multiquantum well photodetectors on Si substrates.

Vertical incidence GeSn/Ge multiquantum well (MQW) pin photodetectors on Si substrates were fabricated with a Sn concentration of 7%. The epitaxial structure was grown with a special low temperature molecular beam epitaxy process. The Ge barrier in the GeSn/Ge MQW was kept constant at 10 nm. The well width was varied between 6 and 12 nm. The GeSn/Ge MQW structures were grown pseudomorphically with the in-plane lattice constant of the Ge virtual substrate. The absorption edge shifts to longer wavelengths with thicker QWs in agreement with expectations from smaller quantization energies for the thicker QWs.

Systematic review: Helicobacter pylori and the risk of upper gastrointestinal bleeding risk in patients taking aspirin.

BACKGROUND: Aspirin is widely used to modify the risk of recurrent vascular events. It is, however, associated with increased upper gastrointestinal bleeding risk. The influence of Helicobacter pylori on this risk is uncertain. AIM: To determine the influence of H. pylori on upper gastrointestinal bleeding risk in patients taking aspirin. METHODS: MEDLINE and EMBASE databases were searched. All studies providing data regarding H. pylori infection in adults taking aspirin and presenting with upper gastrointestinal bleeding were included. RESULTS: A total of 13 studies that included 1 case-control, 10 cohort studies and 2 randomized-controlled trials (RCTs) were analysed. The case-control study (n = 245) determined H. pylori to be a significant independent risk factor for upper gastrointestinal bleeding. The cohort studies were heterogeneous, varying in inclusion criteria, doses and duration of aspirin used, mode of H. pylori testing and causative GI pathology considered. Comprising 5465 patients, H. pylori infection was tested for in 163 (0.03%) aspirin users with upper gastrointestinal bleeding. The RCTs yielded no significant results. CONCLUSIONS: The current data are not sufficient to allow meta-analyses. The widely held belief that H. pylori is a risk factor for upper gastrointestinal bleeding in regular aspirin users is not supported by the very limited evidence available.

Holocene thinning of the Greenland ice sheet.

On entering an era of global warming, the stability of the Greenland ice sheet (GIS) is an important concern, especially in the light of new evidence of rapidly changing flow and melt conditions at the GIS margins. Studying the response of the GIS to past climatic change may help to advance our understanding of GIS dynamics. The previous interpretation of evidence from stable isotopes (delta(18)O) in water from GIS ice cores was that Holocene climate variability on the GIS differed spatially and that a consistent Holocene climate optimum-the unusually warm period from about 9,000 to 6,000 years ago found in many northern-latitude palaeoclimate records-did not exist. Here we extract both the Greenland Holocene temperature history and the evolution of GIS surface elevation at four GIS locations. We achieve this by comparing delta(18)O from GIS ice cores with delta(18)O from ice cores from small marginal icecaps. Contrary to the earlier interpretation of delta(18)O evidence from ice cores, our new temperature history reveals a pronounced Holocene climatic optimum in Greenland coinciding with maximum thinning near the GIS margins. Our delta(18)O-based results are corroborated by the air content of ice cores, a proxy for surface elevation. State-of-the-art ice sheet models are generally found to be underestimating the extent and changes in GIS elevation and area; our findings may help to improve the ability of models to reproduce the GIS response to Holocene climate.

Dietzia strain X: a newly described Actinomycete isolated from confluent and reticulated papillomatosis.

Confluent and reticulated papillomatosis (CRP) is a rare skin disorder. To date its aetiology remains uncertain. The possibility of an infectious aetiology has been supported by case reports of therapeutic response to antibiotic therapy. We have isolated and identified a previously unknown Dietzia strain, an Actinomycete, from skin scrapings of a 17-year-old boy with CRP. We propose that this organism may be the aetiological agent of CRP. Further investigations are necessary to determine the potential role of this Actinomycete in the pathogenesis of CRP.

Bacterial adhesion to titanium-oxy-nitride (TiNOX) coatings with different resistivities: a novel approach for the development of biomaterials.

In this study the quantitative adhesion of a strain of Staphylococcus epidermidis, Streptococcus mutans and Pseudomonas aeruginosa to and the ease of removal from different TiNOX coatings was investigated by means of a parallel plate flow chamber and in situ image analysis. Quality of adhesion was determined by counting bacteria which remained attached to the surface after exposure to an air-liquid interface. S. epidermidis and S. mutans showed a bipolar adhesion pattern with highest numbers of adhesion at low and high resistivity with lowest adhesions at a resistivity of 10(4) microohms cm. P. aeruginosa was the least adherent organism. These results indicate that the affinity of these three strains under the current experimental conditions is minimal for TiNOX coatings with a specific resistivity. TiNOX coatings with pre-adsorbed fibrinogen showed different numbers of S. epidermidis adhered to the different coatings. However, the affinity of this strain for fibrinogen-coated TiNOX remains low when the resistivity is around 10(4) microohms cm. This indicates that the specific influence of the resistivities of the TiNOX coatings is transferred through the adsorbed fibrinogen film to the interface with adhering bacteria.

Treatment of Staphylococcus aureus endocarditis using moxifloxacin.

The conventional treatment of staphylococcal endocarditis requires in-patient administration, is inconvenient, and is potentially toxic. Increasing experience with well-absorbed, well-tolerated and highly active agents such as the new quinolones has prompted interest in their use as therapeutic alternatives for the treatment of such infections. We describe a case of staphylococcal endocarditis which failed to respond to conventional therapy, but where the addition of moxifloxacin, an 8-methoxyquinolone, was curative.

Verdoheme reactivity. Remarkable paramagnetically shifted (1)H NMR spectra of intermediates from the addition of hydroxide or methoxide with Fe(II) and Fe(III) verdohemes.

Studies of the reaction of 5-oxaporphyrin iron complexes (verdohemes) with methoxide ion or hydroxide ion have been undertaken to understand the initial step of ring opening of verdohemes. High-spin [ClFe(III)(OEOP)] undergoes a complex series of reactions upon treatment with hydroxide ion in chloroform, and similar species are also detected in dichloromethane, acetonitrile, and dimethyl sulfoxide. Three distinct paramagnetic intermediates have been identified by (1)H NMR spectroscopy. These reactive species are formed by addition of hydroxide to the macrocycle and to the iron as an axial ligand. Treatment of low-spin [(py)(2)Fe(II)(OEOP)]Cl (OEOP is the monoanion of octaethyl-5-oxaporphyrin) with excess methoxide ion in pyridine solution produces [(py)(n)()Fe(II)(OEBOMe)] (n = 1 or 2) ((OEBOMe), dianion of octaethylmethoxybiliverdin), whose (1)H NMR spectrum undergoes marked alteration upon addition of further amounts of methoxide ion. An identical (1)H NMR spectrum, which is characterized by methylene resonances with both upfield and downfield paramagnetic shifts, is formed upon treatment of [Fe(II)(OEBOMe)](2) with methoxide in pyridine solution and results from the formation of [(MeO)Fe(II)(OEBOMe)](-).

Determination of trace amounts of heavy metals in arctic ice core samples using inductively coupled plasma mass spectrometry.

Trace amounts of heavy metals in the ice cores from Canadian Arctic were analyzed using inductively coupled plasma mass spectrometry (ICP-MS). A custom made plastic device and ceramic knives were used to remove the contamination on the ice core surface. Ice cores could be broken into small sections (2-3 cm thick) after decontamination with the plastic device and ceramic knives. High-resolution depth profiles of various elements, i.e. As, Cd, Co, Cu, Ni, Pb, Zn and U, were thus attained. Concentrations in 518 ice core samples range from 0.1 (U) to 673.3 (Zn) pg g(-1).

Outbreak of gram-negative septicaemia caused by contaminated continuous infusions prepared in a non-clinical area.

An outbreak of Gram-negative septicaemia due to cross infection on an acute cardiology ward is reported. This outbreak was facilitated by two factors: first, an area originally designed for non-clinical purposes was converted into a clean utility area without consulting the infection control team, and second, changes in staff had taken place at the same time. This outbreak emphasizes the importance of continuous staff training in infection control, the involvement of the infection control team in all building alterations and the need to improve recommendations by the Department of Health in the design of clean utility areas.

Contribution of endotracheal tubes to the pathogenesis of ventilator-associated pneumonia.

The contribution of ventilatory equipment to the pathogenesis of ventilator-associated pneumonia (VAP) is well-established but the design of endotracheal tubes has been improved only to reduce tracheal traumatization. However many factors, including the surface properties of the endotracheal tube, humidity of the ventilatory gases, ventilatory mode and nursing management result in the formation of an infective, highly viscous and adhesive layer inside of the endotracheal tube. Endotracheal tubes may contribute to the pathogenesis of VAP when infective particles of this adhesive layer are dislodged into the lower airways by shear forces imparted by the respiratory gasflow. The current state of research is reviewed and potential solutions to this problem are discussed.

Do blood cultures need continuous monitoring so that clinical action can be taken outside normal working hours?

Many automated blood culture reading systems monitor bacterial growth 24 hours a day but it is unclear if reacting to prompts indicating bacterial growth outside normal laboratory hours is of clinical benefit. An analysis of 50 blood cultures from 43 patients which had organisms seen on Gram films and had triggered positive out-of-hours showed that examination of the Gram film altered management of seven patients and the results of culture or sensitivity testing altered that of a further four. However, after review, it was felt the clinical outcome would not have been influenced by earlier intervention in any of these patients. We therefore consider that an out-of-hours service for dealing with positive blood cultures is not justified in our hospital. This conclusion may not apply universally, especially in hospitals where potential pathogens show less predictable antimicrobial sensitivity patterns.

Ice core evidence for extensive melting of the greenland ice sheet in the last interglacial.

Evidence from ice at the bottom of ice cores from the Canadian Arctic Islands and Camp Century and Dye-3 in Greenland suggests that the Greenland ice sheet melted extensively or completely during the last interglacial period more than 100 ka (thousand years ago), in contrast to earlier interpretations. The presence of dirt particles in the basal ice has previously been thought to indicate that the base of the ice sheets had melted and that the evidence for the time of original growth of these ice masses had been destroyed. However, the particles most likely blew onto the ice when the dimensions of the ice caps and ice sheets were much smaller. Ice texture, gas content, and other evidence also suggest that the basal ice at each drill site is superimposed ice, a type of ice typical of the early growth stages of an ice cap or ice sheet. If the present-day ice masses began their growth during the last interglacial, the ice sheet from the earlier (Illinoian) glacial period must have competely or largely melted during the early part of the same interglacial period. If such melting did occur, the 6-meter higher-than-present sea level during the Sangamon cannot be attributed to disintegration of the West Antarctic ice sheet, as has been suggested.

Balloon dilatation of esophageal strictures.

Esophageal dilatation is a safe and effective method for treating most esophageal strictures. Balloon dilatation is primarily used in those strictures in which conventional techniques were initially unsuccessful. We have successfully treated 13 patients with severe esophageal strictures of both benign and malignant etiologies. The patients subjectively felt better and weight gain was uniform. The patients were able to maintain adequate patency of the esophagus with bougie and self-dilatation. The length of follow-up ranged from 2 to 30 months. The various techniques used for balloon dilatation of esophageal strictures are presented. No serious complications were encountered. Dilatation by balloon catheter appears to be a safe method to dilate severe strictures and provides maximum patient benefit with minimal trauma and morbidity.