A comparative study of complications and long term outcomes of Surgical Tracheostomy and two techniques of Percutaneous Tracheostomy.

CONTEXT: The operative technique for surgical tracheostomy has remained unchanged, but different techniques for percutaneous tracheostomy have evolved due to interest in minimally invasive procedures for the critically ill patient. AIMS: To compare the periprocedural complications and long term outcomes of bedside surgical tracheostomy (ST) with two percutaneous tracheostomy (PCT) techniques, namely serial guide wire dilating forceps (GWDF) and PercuTwist (PT). SETTINGS AND DESIGN: This prospective observational study was carried out in ICU of a tertiary referral centre over three year period on adult intubated patients needing elective tracheostomy. MATERIALS AND METHODS: Patients with anticipated difficult neck anatomy were assigned for ST based on discretion of intensivist. Patients included for PCT were randomly assigned to the GWDT and PT technique. 90 patients underwent either bedside ST (n = 30), PCT by GWDF technique (n = 30) or PCT with PercuTwist (n = 30) and were followed up with fibreoptic bronchoscopy monthly for 06 months. STATISTICAL ANALYSIS USED: Data was analyzed by applying chi square tests for categorical variables. RESULTS: Periprocedural complications during PCT included major bleeding (>100ml) in two patients in GWDF group which required conversion to ST. Periprocedural bleeding was also the main complication in ST. Increased incidence of granulation tissue and tracheal narrowing in long term was seen in both ST and PCT groups. All of the P values analysed for the intra operative, post operative complications or long term outcomes were >0.05. CONCLUSIONS: There was no statistically significant difference in incidence of complications of ST and two techniques of PCT. Proper case selection makes PCT as safe as ST.

Growth and characterisation of a new polymorph of barium maleate: a metal organic framework.

A new polymorph of barium maleate (BM) with chemical formula C24H14O24Ba5⋅7H2O is grown by modified gel method. Transparent plate like crystals of dimensions 9×4×1 mm(3) were obtained. Single crystal X-ray Diffraction analysis was done to determine the structure and the crystal belongs to triclinic system, P-1 space group with cell dimensions a=7.2929(3) Å, b=10.5454(4) Å, c=14.2837(6) Å, α=102.0350(10)°, ß=99.1580(10)°, γ=102.9170(10)°. Hydrogen bonding stabilises the two dimensional polymeric crystal structure. Fourier Transform Infrared spectroscopic method was utilised for the analysis of various functional groups present in the complex. Elemental analysis confirmed the stoichiometry of the complex. Thermal properties of the crystal were studied by TGA/DTA. The material melts at 368°C. The optical transparency of the crystal was studied using UV-Visible absorption spectra. The optical band gap is found to be 3.35 eV.

Elimination of gaseous microemboli from cardiopulmonary bypass using hypobaric oxygenation.

BACKGROUND: Numerous gaseous microemboli (GME) are delivered into the arterial circulation during cardiopulmonary bypass (CPB). These emboli damage end organs through multiple mechanisms that are thought to contribute to neurocognitive deficits after cardiac surgery. Here, we use hypobaric oxygenation to reduce dissolved gases in blood and greatly reduce GME delivery during CPB. METHODS: Variable subatmospheric pressures were applied to 100% oxygen sweep gas in standard hollow fiber microporous membrane oxygenators to oxygenate and denitrogenate blood. GME were quantified using ultrasound while air embolism from the surgical field was simulated experimentally. We assessed end-organ tissues in swine postoperatively using light microscopy. RESULTS: Variable sweep gas pressures allowed reliable oxygenation independent of carbon dioxide removal while denitrogenating arterial blood. Hypobaric oxygenation produced dose-dependent reductions of Doppler signals produced by bolus and continuous GME loads in vitro. Swine were maintained using hypobaric oxygenation for 4 hours on CPB with no apparent adverse events. Compared with current practice standards of oxygen/air sweep gas, hypobaric oxygenation reduced GME volumes exiting the oxygenator (by 80%), exiting the arterial filter (95%), and arriving at the aortic cannula (∼100%), indicating progressive reabsorption of emboli throughout the CPB circuit in vivo. Analysis of brain tissue suggested decreased microvascular injury under hypobaric conditions. CONCLUSIONS: Hypobaric oxygenation is an effective, low-cost, common sense approach that capitalizes on the simple physical makeup of GME to achieve their near-total elimination during CPB. This technique holds great potential for limiting end-organ damage and improving outcomes in a variety of patients undergoing extracorporeal circulation.

Friend or foe: genetic and functional characterization of plant endophytic Pseudomonas aeruginosa.

Endophytic Pseudomonas aeruginosa strain BP35 was originally isolated from black pepper grown in the rain forest in Kerala, India. Strain PaBP35 was shown to provide significant protection to black pepper against infections by Phytophthora capsici and Radopholus similis. For registration and implementation in disease management programmes, several traits of PaBP35 were investigated including its endophytic behaviour, biocontrol activity, phylogeny and toxicity to mammals. The results showed that PaBP35 efficiently colonized black pepper shoots and displayed a typical spatiotemporal pattern in its endophytic movement with concomitant suppression of Phytophthora rot. Confocal laser scanning microscopy revealed high populations of PaBP35::gfp2 inside tomato plantlets, supporting its endophytic behaviour in other plant species. Polyphasic approaches to genotype PaBP35, including BOX-PCR, recN sequence analysis, multilocus sequence typing and comparative genome hybridization analysis, revealed its uniqueness among P. aeruginosa strains representing clinical habitats. However, like other P. aeruginosa strains, PaBP35 exhibited resistance to antibiotics, grew at 25-41°C and produced rhamnolipids and phenazines. PaBP35 displayed strong type II secretion effectors-mediated cytotoxicity on mammalian A549 cells. Coupled with pathogenicity in a murine airway infection model, we conclude that this plant endophytic strain is as virulent as clinical P. aeruginosa strains. Safety issues related to the selection of plant endophytic bacteria for crop protection are discussed.

Endophytic bacterial flora in root and stem tissues of black pepper (Piper nigrum L.) genotype: isolation, identification and evaluation against Phytophthora capsici.

AIM: To isolate and identify black pepper (Piper nigrum L) associated endophytic bacteria antagonistic to Phytophthora capsici causing foot rot disease. METHODS AND RESULTS: Endophytic bacteria (74) were isolated, characterized and evaluated against P. capsici. Six genera belong to Pseudomonas spp (20 strains), Serratia (1 strain), Bacillus spp. (22 strains), Arthrobacter spp. (15 strains), Micrococcus spp. (7 strains), Curtobacterium sp. (1 strain) and eight unidentified strains were isolated from internal tissues of root and stem. Three isolates, IISRBP 35, IISRBP 25 and IISRBP 17 were found effective for Phytophthora suppression in multilevel screening assays which recorded over 70% disease suppression in greenhouse trials. A species closest match (99% similarity) of IISRBP 35 was established as Pseudomonas aeruginosa (Pseudomonas EF568931), IISRBP 25 as P. putida (Pseudomonas EF568932), and IISRBP 17 as Bacillus megaterium (B. megaterium EU071712) based on 16S rDNA sequencing. CONCLUSION: Black pepper associated P. aeruginosa, P. putida and B. megaterium were identified as effective antagonistic endophytes for biological control of Phytophthora foot rot in black pepper. SIGNIFICANCE AND IMPACT OF THE STUDY: This work provides the first evidence for endophytic bacterial diversity in black pepper stem and roots, with biocontrol potential against P. capsici infection.

Enhanced production of the polysaccharide arabinogalactan using immobilized cultures of Tinospora cordifolia by elicitation and in situ adsorption.

Immobilized callus cultures of Tinospora cordifolia (Willd) Miers ex Hooks and Thoms were investigated to find out the combined effect of elicitation, cell permeabilization with chitosan and in situ product recovery by polymeric neutral resin-like Diaion HP 20. In this study, callus cultures of T. cordifolia were immobilized using sodium alginate and calcium chloride and the beads were cultured in Murashige and Skoog's basal medium along with benzyl adenine (BA), 2,4-dichlorophenoxy acetic acid (2,4-D) and 3% sucrose. The immobilized cultures, when subjected to elicitation and cell permeabilization with chitosan and in situ removal of the secondary metabolites by addition of resin, showed a 10-fold increase in production of arabinogalactan (0.490% dry weight) as compared to respective controls devoid of resin and chitosan. This indicates that in situ adsorption may have reduced the feedback inhibition caused by accumulation of secondary metabolites in the media, while the dual effect of elicitation and cell permeabilization by chitosan may have released the intracellular (secreted) berberine and the polysaccharide arabinogalactan, respectively.

Uptake and degradation of DDT by hairy root cultures of Cichorium intybus and Brassica juncea.

Hairy root cultures of Cichorium intybus and Brassica juncea were used for their ability to uptake and degrade DDT (1,1,1-trichloro-2,2-bis-(4'-chlorophenyl)ethane). After 24 h of 14C DDT treatment, only 12-13% of the total applied radioactivity was detected in the culture media, indicating the efficient uptake of DDT by the hairy roots. The majority of the applied radioactivity was associated with the roots. DDT was degraded to various other products such as DDD, DDE and DDMU, along with some unknown compounds by hairy root cultures, which were detected by thin layer chromatography (TLC) and autoradiography. The rate of in situ degradation was found to be higher during the initial stages of culture and the residual 14C DDT in the roots was found to decrease from 77% to 61% over a period of 10-days. There was no spontaneous degradation of 14C DDT in media lacking hairy root cultures or in media with autoclaved hairy roots. This suggests that endogenous root enzymes play a role in the breakdown of 14C DDT. These results suggest the potential applicability and advantage of using these plant species for phytoremediation of persistent xenobiotics such as DDT in an eco-friendly and efficient manner for environmental clean up.

The behavioral spectrum of tic disorders: a community-based study.

BACKGROUND: Tourette syndrome (TS) and related tic disorders are commonly associated with obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD). It has been argued, however, that any observed association between TS and these and other psychopathologies may be due to ascertainment bias in that individuals with multiple problems are more likely to be referred for medical evaluation. METHODS: In order to overcome the potential confounding by ascertainment bias, the authors conducted a community-based study of school children using direct interviews to determine the prevalence of tic disorders and any comorbid psychopathology. A standard psychiatric interview and standardized rating scales were utilized to diagnose childhood behavioral disorders. RESULTS: Of the 1,596 children interviewed, 339 were identified as having tics. The following psychopathologies were found more commonly (p < 0.05) in the children with tics: OCD, ADHD, separation anxiety, overanxious disorder, simple phobia, social phobia, agoraphobia, mania, major depression, and oppositional defiant behavior. CONCLUSION: The behavioral spectrum of tic disorders includes OCD, other anxiety disorders, a mood disorder, and attention-deficit and disruptive behavior disorders.

Inheritance of disease lesion mimic leaf trait in groundnut.

In groundnut, two identical mutants with disease lesion mimic leaf trait were isolated independently from two different parents through induced mutagenesis and in vitro culture technique. The leaf chlorophyll content in both the mutants was found to be drastically reduced. The segregation pattern in the F(2) and F(3) generations for normal and mutant traits fitted a 13:3 ratio, indicating that the disease lesion mimic trait in the mutants was due to suppressive gene action. Both mutants were allelic for the disease mimic trait.

Prevalence of tics in schoolchildren and association with placement in special education.

BACKGROUND: Based on the knowledge that Tourette's syndrome (TS) is associated with several clinical features that can impair school function and growing evidence that the disorder is much more common than previously thought, the authors hypothesized that TS and related tic disorders would be associated with school problems in the childhood population at large. METHODS: Direct, blinded (to educational placement) interviews of 1,596 schoolchildren in Monroe County, Rochester, NY, were conducted. RESULTS: Twenty-seven percent of 341 students classified as receiving special education (SpEd) had tics compared with 19.7% (p = 0.008) of 1,255 students in regular classroom programs (RegEd). The weighted prevalence estimates for tics were 23.4% in SpEd and 18.5% in RegEd. A higher percentage of students in SpEd (7.0%) met diagnostic criteria for TS than students in RegEd (3.8%; p = 0.01). CONCLUSIONS: Although possibly influenced by selection bias, our results indicate that tic disorders are common in children and are highly associated with school dysfunction. Tics may represent an identifiable sign of an underlying brain developmental disorder that contributes to academic difficulties.

Syntheses, structural determination, and electrochemistry of Ru(2)(Fap)(4)Cl and Ru(2)(Fap)(4)(NO)Cl.

Ru(2)(Fap)(4)Cl and Ru(2)(Fap)(4)(NO)Cl, where Fap is the 2-(2-fluoroanilino)pyridinate anion, were synthesized, and their structural, electrochemical, and spectroscopic properties were characterized. Ru(2)(Fap)(4)Cl, which was obtained by reaction between Ru(2)(O(2)CCH(3))(4)Cl and molten HFap, crystallizes in the monoclinic space group P2(1)/c, with a = 11.2365(4) A, b = 19.9298(8) A, c = 19.0368(7) A, beta = 90.905(1) degrees, and Z = 4. The presence of three unpaired electrons on the Ru(2)(5+) core and the 2.2862(3) A Ru-Ru bond length for Ru(2)(Fap)(4)Cl are consistent with the electronic configuration (sigma)(2)(pi)(4)(delta)(2)(pi*)(2)(delta*)(1). The reaction between Ru(2)(Fap)(4)Cl and NO gas yields Ru(2)(Fap)(4)(NO)Cl, which crystallizes in the orthorhombic space group Pbca, with a = 10.0468(6) A, b = 18.8091(10) A, c = 41.7615(23) A, and Z = 8. The Ru-Ru bond length of Ru(2)(Fap)(4)(NO)Cl is 2.4203(8) A, while its N-O bond length and Ru-N-O bond angle are 1.164(8) A and 155.8(6) degrees, respectively. Ru(2)(Fap)(4)(NO)Cl can be formulated as a formal Ru(2)(II,II)(NO(+)) complex with a linear Ru-N-O group, and the proposed electronic configuration for this compound is (sigma)(2)(pi)(4)(delta)(2)(pi*)(3)(delta*)(1). The binding of NO to Ru(2)(Fap)(4)Cl leads to some structural changes of the Ru(2)(Fap)(4) framework and a stabilization of the lower oxidation states of the diruthenium unit. Also, IR spectroelectrochemical studies of Ru(2)(Fap)(4)(NO)Cl show that NO remains bound to the complex upon reduction and that the first reduction involves the addition of an electron on the diruthenium core and not on the NO axial ligand.