Eradication of endotracheal tube biofilm by nebulised gentamicin.

Objective: To compare the efficacy of gentamicin, nebulised via the endotracheal tube (ET), with that of parenteral cefotaxime or parenteral cefuroxime in preventing the formation of ET biofilm.

Setting: General intensive care units in two university teaching hospitals.

Design: The microbiology of ET biofilm from 36 ICU patients eligible to receive antibiotic prophylaxis was examined. Peak and trough tracheal concentrations of gentamicin, cefotaxime or cefuroxime were measured in each patient group, on the 2nd day of intubation.

Patients: Twelve patients received gentamicin (80 mg) nebulised in 4 ml normal saline every 8 h, 12 cefotaxime (1 g, 12 hourly) and 12 cefuroxime (750 mg, 8 hourly). Prophylaxis was continued for the duration of intubation.

Measurements and results: Samples of tracheal secretions were taken on the 2nd day of ventilation for determination of antibiotic concentrations. Following extubation, ETs were examined for the presence of biofilm. Pathogens considered to be common aetiological agents for VAP included Staphylococcus aureus, enterococci, Enterobacteriaceae and pseudomonads. While microbial biofilm was found on all ETs from the cephalosporin group, microbial biofilm of these micro-organisms was found on 7 of the 12 ET tubes from patients receiving cefotaxime [S. aureus (4), pseudomonads (1), Enterobacteriaceae (1), enterococcus (1)] and 8 of the 12 ET tubes from patients receiving cefuroxime [Enterobacteriaceae (6), P. aeruginosa (1) and enterococcus (1)]. While microbial biofilm was observed on five ETs from patients receiving nebulised gentamicin, none of these were from pathogens for ventilator-associated pneumonia (VAP). Tracheal concentrations of both cephalosporins were lower than those needed to inhibit the growth of pathogens recovered from ET tube biofilm. The median (and range) concentrations for cefotaxime were 0.90 (<0.23–1.31) mg/l and 0.28 (<0.23–0.58) mg/l for 2 h post-dose and trough samples, respectively. Two hours post-dose concentrations of cefuroxime (median and range) were 0.40 (0.34–0.83) mg/l, with trough concentrations of 0.35 (<0.22–0.47) mg/l. Tracheal concentrations (median and range) of gentamicin measured 1 h post-nebulisation were 790 (352–>1250) mg/l and then, before the next dose, were 436 (250–1000) mg/l.

Conclusion: Nebulised gentamicin attained high concentrations in the ET lumen and was more effective in preventing the formation of biofilm than either parenterally administered cephalosporin and therefore may be effective in preventing this complication of mechanical ventilation.

A phase Ib trial of Docetaxel, Carboplatin and Erlotinib in ovarian, fallopian tube and primary peritoneal cancers.

The safety and maximum tolerated dose (MTD) of erlotinib with docetaxel/carboplatin were assessed in patients with ovarian cancer. Chemonaive patients received intravenous docetaxel (75 mg m(-2)) and carboplatin (area under the curve 5) on day 1 of a 3-week cycle, and oral erlotinib at 50 (cohort 1), 100 (cohort 2a) or 75 mg day(-1) (cohort 2b) for up to six cycles. Dose-limiting toxicities were determined in cycle 1. Forty-five patients (median age 59 years) received treatment. Dose-limiting toxicities occurred in 1/5/5 patients (cohorts 1/2a/2b). The MTD of erlotinib in this regimen was determined to be 75 mg day(-1) (cohort 2b; the erlotinib dose was escalated to 100 mg day(-1) in 11 out of 19 patients from cycle 2 onwards). Neutropaenia was the predominant grade 3/4 haematological toxicity (85/100/95% respectively). Common non-haematological toxicities were diarrhoea, fatigue, nausea and rash. There were five complete and seven partial responses in 23 evaluable patients (52% response rate). Docetaxel/carboplatin had no measurable effect on erlotinib pharmacokinetics. In subsequent single-agent maintenance, erlotinib was given at 100-150 mg day(-1), with manageable toxicity, until tumour progression. Further investigation of erlotinib in epithelial ovarian carcinoma may be warranted, particularly as maintenance therapy

Is the flow tube reactor with NO2 titration a reliable absolute source for atomic hydrogen?

The H+NO2 titration scheme for the determination of atomic hydrogen densities within a microwave excited flow tube reactor has been investigated by laser-induced fluorescence spectroscopy in the vacuum UV. Absolute hydrogen densities are determined on the basis of calibration by Rayleigh scattering from argon. The measurement is performed at a gas mixture containing 0.5% of D2 added to the main gas H2. The ground state density of the hydrogen atoms generated in the flow tube reactor was inferred from the fluorescence radiation of the spectrally shifted optically thin D-Lyman-a transition.

HTS Machines as Enabling Technology for All-Electric Airborne Vehicles

Environmental protection has now become paramount as evidence mounts to support the thesis of human activity-driven global warming. A global reduction of the emissions of pollutants into the atmosphere is therefore needed and new technologies have to be considered. A large part of the emissions come from transportation vehicles, including cars, trucks and airplanes, due to the nature of their combustion-based propulsion systems. Our team has been working for several years on the development of high power density superconducting motors for aircraft propulsion and fuel cell based power systems for aircraft. This paper investigates the feasibility of all-electric aircraft based on currently available technology. Electric propulsion would require the development of high power density electric propulsion motors, generators, power management and distribution systems. The requirements in terms of weight and volume of these components cannot be achieved with conventional technologies; however, the use of superconductors associated with hydrogen-based power plants makes possible the design of a reasonably light power system and would therefore enable the development of all-electric aero-vehicles. A system sizing has been performed both for actuators and for primary propulsion. Many advantages would come from electrical propulsion such as better controllability of the propulsion, higher efficiency, higher availability and less maintenance needs. Superconducting machines may very well be the enabling technology for all-electric aircraft development.

HTS Motors in Aircraft Propulsion: Design Considerations

Current high temperature superconducting (HTS) wires exhibit high current densities enabling their use in electrical rotating machinery. The possibility of designing high power density superconducting motors operating at reasonable temperatures allows for new applications in mobile systems in which size and weight represent key design parameters. Thus, all-electric aircrafts represent a promising application for HTS motors. The design of such a complex system as an aircraft consists of a multi-variable optimization that requires computer models and advanced design procedures. This paper presents a specific sizing model of superconducting propulsion motors to be used in aircraft design. The model also takes into account the cooling system. The requirements for this application are presented in terms of power and dynamics as well as a load profile corresponding to a typical mission. We discuss the design implications of using a superconducting motor on an aircraft as well as the integration of the electrical propulsion in the aircraft, and the scaling laws derived from physics-based modeling of HTS motors.