The Cauvery river basin in southern India: major challenges and possible solutions in the 21st century.

India is facing major challenges in its water resources management (WRM) sector. Water shortages are attributed to issues such as an explosion in population, rapid urbanization and industrialization, environmental degradation and inefficient water use, all aggravated by changing climate and its impacts on demand, supply and water quality. This paper focuses on the contemporary and future situation in the Cauvery river basin in Southern India, shared by different states, predominantly Karnataka and Tamil Nadu. As water issues largely fall under the authority of the states, inter-state water disputes have a long tradition in the Cauvery river basin. Future changes in precipitation during the two monsoon seasons will only increase these tensions. Both states depend on the arrival of these monsoon rains to water their crops and to replenish the groundwater. The paper identifies the major challenges and general possible solutions for sustainable WRM within the river basin. It synthesises the relevant literature, describes practices that should be addressed in the scope of integrated WRM--including water availability increase and demand management--and stresses the need for further quantitative analyses.

All-optical steering of laser-wakefield-accelerated electron beams.

We investigate the influence of a tilted laser-pulse-intensity front on laser-wakefield acceleration. Such asymmetric light pulses may be exploited to obtain control over the electron-bunch-pointing direction and in our case allowed for reproducible electron-beam steering in an all-optical way within an 8 mrad opening window with respect to the initial laser axis. We also discovered evidence of collective electron-betatron oscillations due to off-axis electron injection into the wakefield induced by a pulse-front tilt. These findings are supported by 3D particle-in-cell simulations.

Acute haemodynamic effects of a hypertonic saline/dextran solution in stable patients with severe sepsis.

OBJECTIVE: To study the haemodynamic effects of a hypertonic saline/dextran solution compared with a normal saline solution in patients with severe sepsis. DESIGN: Prospective double blind and control-randomised study. SETTING: Adult intensive care unit in a university hospital. PATIENTS: Twenty-nine patients with sepsis with a pulmonary artery occlusion pressure (PAOP) lower than 12 mmHg. INTERVENTIONS: Patients were randomised to receive 250 ml of blinded solutions of either normal saline (SS group, n=16) or hypertonic saline (NaCl 7.5%)/dextran 70 8% (HSS group, n=13) solutions. MEASUREMENTS AND RESULTS: Haemodynamic, blood gas, and sodium data were collected at the following time points: baseline, 30 min, 60 min, 120 min, and 180 min. PAOP was higher in the HSS group at 30 min (10.7+/-3.2 mmHg vs 6.8+/-3.2 mmHg) and 60 min (10.3+/-3 mmHg vs 7.4+/-2.9 mmHg); P<0.05. The cardiac index increased in the HSS group and it was greater than the SS group at 30 min (6.5+/-4.7 l min(-1) m(-2) vs 3.8+/-3.4 l min(-1) m(-2)), 60 min (4.9+/-4.5 l min(-1) m(-2) vs 3.7+/-3.3 l min(-1) m(-2)), and 120 min (5.0+/-4.3 l min(-1) m(-2) vs 4.1+/-3.4 l min(-1) m(-2)); P<0.05. The stroke volume index followed a comparable course and it was higher at 30 min [53.6(39.2-62.8) ml m(-2) vs 35.6(31.2-49.2) ml m(-2)] and 60 min [46.8(39.7-56.6) ml m(-2) vs 33.9(32.2-47.7) ml m(-2)]; P<0.05. Systemic vascular resistance decreased in the HSS group and became significantly lower at 30 min (824+/-277 dyne s(-1) cm(-5) m(-2) vs 1139+/-245 dyne s(-1) cm(-5) m(-2)), 60 min (921+/-256 dyne s(-1) cm(-5) m(-2) vs 1246+/-308 dyne s(-1) cm(-5) m(-2)), and 120 min (925+/-226 dyne s(-1) cm(-5) m(-2) vs 1269+/-494 dyne s(-1) cm(-5) m(-2)). Sodium levels increased in the HSS group (P=0.056) and were higher than in the SS group at 30 min (145+/-3 mEq l(-1)vs 137+/-7 mEq l(-1)), 60 min (143+/-4 mEq l(-1) vs 136+/-7 mEq l(-1)), 120 (142+/-5 mEq l(-1)vs 136+/-7 mEq l(-1)), and 180 min (142+/-5 mEq l(-1) vs 136+/-8 mEq l(-1)). CONCLUSION: Hypertonic saline/dextran solution may improve cardiovascular performance in severe sepsis without significant side effects. The haemodynamic effect appears related mainly to a volume effect.

Blockade of the action of nitric oxide in human septic shock increases systemic vascular resistance and has detrimental effects on pulmonary function after a short infusion of methylene blue.

To investigate the role of nitric oxide in human sepsis, ten patients with severe septic shock requiring vasoactive drug therapy and mechanical ventilation were enrolled in a prospective, open, non-randomized clinical trial to study the acute effects of methylene blue, an inhibitor of guanylate cyclase. Hemodynamic and metabolic variables were measured before and 20, 40, 60, and 120 min after the start of a 1-h intravenous infusion of 4 mg/kg of methylene blue. Methylene blue administration caused a progressive increase in mean arterial pressure (60 [55-70] to 70 [65-100] mmHg, median [25-75th percentiles]; P<0.05), systemic vascular resistance index (649 [479-1084] to 1066 [585-1356] dyne s-1 cm-5 m-2; P<0.05) and the left ventricular stroke work index (35 [27-47] to 38 [32-56] g m-1 m-2; P<0.05) from baseline to 60 min. The pulmonary vascular resistance index increased from 150 [83-207] to 186 [121-367] dyne s-1 cm-5 m-2 after 20 min (P<0.05). Mixed venous saturation decreased from 65 [56-76] to 63 [55-69]% (P<0.05) after 60 min. The PaO2/FiO2 ratio decreased from 168 [131-215] to 132 [109-156] mmHg (P<0.05) after 40 min. Arterial lactate concentration decreased from 5.1 +/- 2.9 to 4.5 +/- 2.1 mmol/l, mean +/- SD (P<0.05) after 60 min. Heart rate, cardiac filling pressures, cardiac output, oxygen delivery and consumption did not change. Methylene blue administration was safe and no adverse effect was observed. In severe human septic shock, a short infusion of methylene blue increases systemic vascular resistance and may improve myocardial function. Although there was a reduction in blood lactate concentration, this was not explained by an improvement in tissue oxygenation, since overall oxygen availability did not change. However, there was a significant increase in pulmonary vascular tone and a deterioration in gas exchange. Further studies are needed to demonstrate if nitric oxide blockade with methylene blue can be safe for patients with septic shock and, particularly, if it has an effect on pulmonary function.

Blockade of the action of nitric oxide in human septic shock increases systemic vascular resistance and has detrimental effects on pulmonary function after a short infusion of methylene blue

To investigate the role of nitric oxide in human sepsis, ten patients with severe septic shock requiring vasoactive drug therapy and mechanical ventilation were enrolled in a prospective, open, non-randomized clinical trial to study the acute effects of methylene blue, an inhibitor of guanylate cyclase. Hemodynamic and metabolic variables were measured before and 20, 40, 60, and 120 min after the start of a 1-h intravenous infusion of 4 mg/kg of methylene blue. Methylene blue administration caused a progressive increase in mean arterial pressure (60 [55-70] to 70 [65-100] mmHg, median [25-75th percentiles]; P<0.05), systemic vascular resistance index (649 [479-1084] to 1066 [585-1356] dyne s-1 cm-5 m-2; P<0.05) and the left ventricular stroke work index (35 [27-47] to 38 [32-56] g m-1 m-2; P<0.05) from baseline to 60 min. The pulmonary vascular resistance index increased from 150 [83-207] to 186 [121-367] dyne s-1 cm-5 m-2 after 20 min (P<0.05). Mixed venous saturation decreased from 65 [56-76] to 63 [55-69] per cent (P<0.05) after 60 min. The PaO2/FiO2 ratio decreased from 168 [131-215] to 132 [109-156] mmHg (P<0.05) after 40 min. Arterial lactate concentration decreased from 5.1 + or - 2.9 to 4.5 + or - 2.1 mmol/l, mean + or - SD (<0.05) after 60 min. Heart rate, cardiac filling pressures, cardiac output, oxygen delivery and consumption did not change. Methylene blue administration was safe and no adverse effect was observed. In severe human septic shock, a short infusion of methylene blue increases systemic vascular resistance and may improve myocardial function. Although there was a reduction in blood lactate concentration, this was not explained by an improvement in tissue oxygenation, since overall oxygen availability did not change. However, there was a significant increase in pulmonary vascular tone and a deterioration in gas exchange. Further studies are needed to demonstrate if nitric oxide blockade with methylene blue can be safe for patients with septic shock and, particularly, if it has an effect on pulmonary function.

Retalho medio-frontal (indiano): utilizacao em reconstrucao do canto palpebral medial / Use of frontal and medial flaps in the reconstruction of the medial corner of the eyelid

O carcinoma baso celular e uma causa frequente de deformidade do canto medial do olho. O tratamento e realizado com a resseccao primaria do tumor, seguido de reconstrucao do sistema de drenagem lacrimal e de deformidade cutanea. A reconstrucao da deformidade palpebral e realizada utilizando-se um retalho medio frontal. Apresentamos um caso em que foi utilizada essa tecnica com excelente resultado estetico e funcional, e revisao da literatura.

[Intravenous cholangiocholecystography using ioglycamide--indications and value]. / Intravenöse Cholangiocholezystographie mit Ioglykamid--Indikationen und Wertigkeit.

The introduction of modern methods of diagnostic imaging as sonography, CT and endoscopic retrograde cholangiopancreaticography has changed the value of intravenous cholegraphy. Since the introduction of the contrast medium Ioglycamide into clinical practice two years ago we evaluated the cholangiocholecystographies of 50 patients. The investigation was indicated, if no elucidation was achieved with sonography. Side effects were not registered with Ioglycamide. Indications and value of the method are discussed.

[Effect of bronchial asthma on growth and physical development]. / Der Einfluss des Asthma bronchiale auf Wachstum und körperliche Entwicklung.

Radiologic bone measurements for determination of the skeletal maturation were conducted in 243 children with bronchial asthma. The authors describe marked retardation of skeletal maturation as a general phenomenon of the atopic asthma. The grade of retardation is greater in atopics than in non-atopic asthmatics. The grade of quantitative response to allergic tests is significantly correlated with the extent of retardation of the skeletal maturation. It is discussed that in addition to asthma, eczema and allergic rhinitis the retardation of the skeletal bone maturation could be a further original manifestation of atopia.

[Radiation dosage of premature infants caused by roentgen imaging of the thorax]. / Strahlenbelastung Frühgeborener durch Röntgenaufnahmen des Thorax.

The X-ray pictures of the thorax from premature infants must be prepared by conditions of neonatal intensive care. For this X-ray pictures are available very often single-puls generators only. The radiation exposure is dependent prominently on the type of the generator. The radiation exposure was compared between single-puls generators and 6-puls generators. The dosimetry was performed with CaF2-thermoluminescent dosimeters. The results of measurement demonstrated: In the radiation fields the radiation exposure is considerable higher by the single-puls generators than by the 6-puls generators. The indication to X-ray pictures of the thorax from premature infants under conditions of bed-side with single-puls generators must be very accuratly.

Selecting for medical school.

Brief comments are addressed to definition of the best possible applicants to medical school and the means by which colleges and universities help to prepare them. In an effort to minimize the ill effects of "premed behavior" in higher education, the author makes 10 specific recommendations regarding the admissions policies and practices of medical schools. These recommendations involve such matters as the nature of an applicant's undergraduate major and other courses (the premed major should be abolished, for example), the Medical College Admission Test, the B.A. degree, grades and grading systems, early admission, and membership on admissions committees.