Right place, no trace: A case report of postintubation bronchospasm.

Evidence suggests obesity correlates with airway hyperreactivity, which can result in severe bronchospasm. This report presents a 31-year-old female with a high body mass index who presented for a laparoscopic hysterectomy and bilateral salpingo-oophorectomy. She had no past medical or atopic history. After induction of anaesthesia and intubation, O2 saturation fell with no CO2 trace, breathing sounds or chest rise. Despite confirming endotracheal tube position by video laryngoscopy, the CO2 trace remained flat and mechanical ventilation was difficult with high airway pressures. Blood pressure was stable with no mucocutaneous signs of anaphylaxis. Administration of 100% O2, bronchodilators and steroids improved ventilation and oxygenation with a return of a CO2 trace. The operation was postponed. Prior to her subsequent surgery, the patient was premedicated with inhaled steroids and long-acting beta agonist with an uneventful induction and intubation. Giving a rising obese population, this case report aims to educate anaesthetists and anaesthetic practitioners as to the presentation, risk factors, mechanisms and management of uncommon, life-threatening postintubation bronchospasm.

Genome Sequencing Reveals a Large and Diverse Repertoire of Antimicrobial Peptides.

Competition among bacterial members of the same ecological niche is mediated by bacteriocins: antimicrobial peptides produced by bacterial species to kill other bacteria. Bacteriocins are also promising candidates for novel antimicrobials. Streptococcus pneumoniae (the "pneumococcus") is a leading cause of morbidity and mortality worldwide and a frequent colonizer of the human nasopharynx. Here, 14 newly discovered bacteriocin gene clusters were identified among >6,200 pneumococcal genomes. The molecular epidemiology of the bacteriocin clusters was investigated using a large global and historical pneumococcal dataset dating from 1916. These analyses revealed extraordinary bacteriocin diversity among pneumococci and the majority of bacteriocin clusters were also found in other streptococcal species. Genomic hotspots for the integration of different bacteriocin gene clusters were discovered. Experimentally, bacteriocin genes were transcriptionally active when the pneumococcus was under stress and when two strains were co-cultured in broth. These findings reveal much more diversity among bacterial defense mechanisms than previously appreciated, which fundamentally broaden our understanding of bacteriocins relative to intraspecies and interspecies nasopharyngeal competition and bacterial population structure.

Effect of elevation resolution on evapotranspiration simulations using MODFLOW.

Surface elevations represented in MODFLOW head-dependent packages are usually derived from digital elevation models (DEMs) that are available at much high resolution. Conventional grid refinement techniques to simulate the model at DEM resolution increases computational time, input file size, and in many cases are not feasible for regional applications. This research aims at utilizing the increasingly available high resolution DEMs for effective simulation of evapotranspiration (ET) in MODFLOW as an alternative to grid refinement techniques. The source code of the evapotranspiration package is modified by considering for a fixed MODFLOW grid resolution and for different DEM resolutions, the effect of variability in elevation data on ET estimates. Piezometric head at each DEM cell location is corrected by considering the gradient along row and column directions. Applicability of the research is tested for the lower Rio Grande (LRG) Basin in southern New Mexico. The DEM at 10 m resolution is aggregated to resampled DEM grid resolutions which are integer multiples of MODFLOW grid resolution. Cumulative outflows and ET rates are compared at different coarse resolution grids. Results of the analysis conclude that variability in depth-to-groundwater within the MODFLOW cell is a major contributing parameter to ET outflows in shallow groundwater regions. DEM aggregation methods for the LRG Basin have resulted in decreased volumetric outflow due to the formation of a smoothing error, which lowered the position of water table to a level below the extinction depth.