Septic thrombosis of the internal jugular vein: Lemierre's syndrome revisited

OBJECTIVES/HYPOTHESIS Study of the clinical evolution of a primary ear, nose, and throat infection complicated by septic thrombophlebitis of the internal jugular vein. STUDY DESIGN Retrospective case-control study. PATIENTS AND METHODS From 1998 to 2010, 23 patients at our institution were diagnosed with a septic thrombosis of the internal jugular vein. Diagnostics included microbiologic analysis and imaging such as computed tomography, magnetic resonance imaging, and ultrasound. Therapy included broad-spectrum antibiotics, surgery of the primary infectious lesion, and postoperative anticoagulation. The patients were retrospectively analyzed. RESULTS The primary infection sites were found in the middle ear (11), oropharynx (8), sinus (3), and oral cavity (1). Fourteen patients needed intensive care unit treatment for a mean duration of 6 days. Seven patients were intubated, and two developed severe acute respiratory distress syndrome. An oropharynx primary infection site was most prone to a prolonged clinical evolution. Anticoagulation therapy was given in 90% of patients. All 23 patients survived the disseminated infection without consecutive systemic morbidity. CONCLUSION In the pre-antibiotic time, septic internal jugular vein thrombophlebitis was a highly fatal condition with a mortality rate of 90%. Modern imaging techniques allow early and often incidental diagnosis of this clinically hidden complication. Anticoagulation, intensive antibiotic therapy assisted by surgery of the primary infection site, and intensive supportive care can reach remission rates of 100%. LEVEL OF EVIDENCE 3b. Laryngoscope, 2014.

Serosurveillance of Schmallenberg virus in Switzerland using bulk tank milk samples.

Infections with Schmallenberg virus (SBV), a novel Orthobunyavirus transmitted by biting midges, can cause abortions and malformations of newborns and severe symptoms in adults of domestic and wild ruminants. Understanding the temporal and spatial distribution of the virus in a certain territory is important for the control and prevention of the disease. In this study, seroprevalence of antibodies against SBV and the spatial spread of the virus was investigated in Swiss dairy cattle applying a milk serology technique on bulk milk samples. The seroprevalence in cattle herds was significantly higher in December 2012 (99.5%) compared to July 2012 (19.7%). This high between-herd seroprevalence in cattle herds was observed shortly after the first detection of viral infections. Milk samples originating from farms with seropositive animals taken in December 2012 (n=209; mean 160%) revealed significantly higher S/P% ratios than samples collected in July 2012 (n=48; mean 103.6%). This finding suggests a high within-herd seroprevalence in infected herds which makes testing of bulk tank milk samples for the identification farms with past exposures to SBV a sensitive method. It suggests also that within-herd transmission followed by seroconversion still occurred between July and December. In July 2012, positive bulk tank milk samples were mainly restricted to the western part of Switzerland whereas in December 2012, all samples except one were positive. A spatial analysis revealed a separation of regions with and without positive farms in July 2012 and no spatial clustering within the regions with positive farms. In contrast to the spatial dispersion of bluetongue virus, a virus that is also transmitted by Culicoides midges, in 2008 in Switzerland, the spread of SBV occurred from the western to the eastern part of the country. The dispersed incursion of SBV took place in the western part of Switzerland and the virus spread rapidly to the remaining territory. This spatial pattern is consistent with the hypothesis that transmission by Culicoides midges was the main way of spreading.

Prevalence of antibodies against bluetongue virus serotype 8 in bulk-tank milk samples from dairy cattle herds located in risk areas for bluetongue virus transmission after a vaccination programme in Switzerland.

Switzerland had been affected by the bluetongue virus serotype 8 (BTV-8) epidemic in Europe in the years 2007 to 2009. After three years of mandatory vaccination and comprehensive surveillance, Switzerland showed to be free of BTV-8 in 2012. In the future Elisa testing of bulk-tank milk (BTM) samples as a very sensitive and cost-effective method should be used for the surveillance of all serotypes of BTV. To determine the prevalence of seropositive herds, BTM from 240 cattle herds was sampled in July 2012. The results showed an apparent seroprevalence of 98.7% in the investigated dairy herds. Most plausible, the high prevalence was caused by the vaccination campaigns rather than by infections with BTV-8. In the outbreak the cumulative number of BTV-8 cases in Switzerland had been 75.Thus it is very likely that the used inactivated vaccines induced long-term antibody titres. Due to the high seroprevalence, investigating for BT-antibodies cannot be used for early recognition of a new introduction of BTV at the moment. Nonetheless, testing of BTM samples is appropriate for an annual evaluation of the seroprevalence and especially as an instrument for early recognition for incursions as soon as the antibody prevalence declines.To determine this decline the BTM testing scheme should be conducted each year as described in this work.

Arterial blood pressure targets in septic shock: is it time to move to an individualized approach?

Xu and colleagues evaluated the impact of increasing mean arterial blood pressure levels through norepinephrine administration on systemic hemodynamics, tissue perfusion, and sublingual microcirculation of septic shock patients with chronic hypertension. The authors concluded that, although increasing arterial blood pressure improved sublingual microcirculation parameters, no concomitant improvement in systemic tissue perfusion indicators was found. Here, we discuss why resuscitation targets may need to be individualized, taking into account the patient's baseline condition, and present directions for future research in this field.

Angiotensin II in septic shock.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2015 and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annualupdate2015. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

The function of the murine complement *C3a and *C5a anaphylatoxin receptors in endotoxemia, bacteremia and septic shock

The complement system functions as a major effector for both the innate and adaptive immune response. Activation of the complement cascade by either the classical, alternative, or lectin pathway promotes the proteolysis of C3 and C5 thereby generating C3a and C5a. Referred to as anaphylatoxins, the C3a and C5a peptides mediate biological effects upon binding to their respective receptors; C3a binds to the C3a receptor (C3aR) while C5a binds to the C5a receptor (C5aR, CD88). Both C3a and C5a are known for their broad proinflammatory effects. Elevated levels of both peptides have been isolated from patients with a variety of inflammatory diseases such as COPD, asthma, RA, SLE, and sepsis. Recent studies suggest that C5a is a critical component in the acquired neutrophil dysfunction, coagulopathy, and progressive multi-organ dysfunction characteristic of sepsis. The primary hypothesis of this dissertation was that preventing C3a-C3aR and C5a-C5aR mediated pro-inflammatory effects would improve survival in endotoxic, bacteremic and septic shock. To test this hypothesis, the murine C3aR and C5aR genes were disrupted. Following disruption of both the C3aR and C5aR genes, no abnormalities were identified other than the absence of their respective mRNA and protein. In models of both endotoxic and bacteremic shock, C3aR deficient mice suffered increased mortality when compared to their wild type littermates. C3aR deficient mice also had elevated circulating IL-1β levels. Using a model of sepsis, C3aR deficient mice had a higher circulating concentration of IL-6 and decreased peritoneal inflammatory infiltration. While these results were unexpected, they support an emerging role for C3a in immunomodulation. In contrast, following endotoxic or bacteremic shock, C5aR deficient mice experienced increased survival, less hemoconcentration and less thrombocytopenia. It was later determined that C5a mediated histamine release significantly contributes to host morbidity and mortality in bacteremic shock. These studies provide evidence that C5a functions primarily as a proinflammatory molecule in models of endotoxic and bacteremic shock. In the same models, C3a-C3aR interactions suppress the inflammatory response and protect the host. Collectively, these results present in vivo evidence that C3a and C5a have divergent biological functions. ^

Simulation of Freight Trains Equipped with Partially Filled Tank Containers and Related Resonance Phenomenon

To study the fluid motion-vehicle dynamics interaction, a model of four, liquid filled two-axle container freight wagons was set up. The railway vehicle has been modelled as a multi-body system (MBS). To include fluid sloshing, an equivalent mechanical model has been developed and incorporated. The influence of several factors has been studied in computer simulations, such as track defects, curve negotiation, train velocity, wheel wear, liquid and solid wagonload, and container baffles. SIMPACK has been used for MBS analysis, and ANSYS for liquid sloshing modelling and equivalent mechanical systems validation. Acceleration and braking manoeuvres of the freight train set the liquid cargo into motion. This longitudinal sloshing motion of the fluid cargo inside the tanks initiated a swinging motion of some components of the coupling gear. The coupling gear consists of UIC standard traction hooks and coupling screws that are located between buffers. One of the coupling screws is placed in the traction hook of the opposite wagon thus joining the two wagons, whereas the unused coupling screw rests on a hanger. Simulation results showed that, for certain combinations of type of liquid, filling level and container dimensions, the liquid cargo could provoke an undesirable, although not hazardous, release of the unused coupling screw from its hanger. The coupling screw's release was especially obtained when a period of acceleration was followed by an abrupt braking manoeuvre at 1 m/s2. It was shown that a resonance effect between the liquid's oscillation and the coupling screw's rotary motion could be the reason for the coupling screw's undesired release. Possible solutions to avoid the phenomenon are given.Acceleration and braking manoeuvres of the freight train set the liquid cargo into motion. This longitudinal sloshing motion of the fluid cargo inside the tanks initiated a swinging motion of some components of the coupling gear. The coupling gear consists of UIC standard traction hooks and coupling screws that are located between buffers. One of the coupling screws is placed in the traction hook of the opposite wagon thus joining the two wagons, whereas the unused coupling screw rests on a hanger. This paper reports on a study of the fluid motion-train vehicle dynamics interaction. In the study, a model of four, liquid-filled two-axle container freight wagons was developed. The railway vehicle has been modeled as a multi-body system (MBS). To include fluid sloshing, an equivalent mechanical model has been developed and incorporated. The influence of several factors has been studied in computer simulations, such as track defects, curve negotiation, train velocity, wheel wear, liquid and solid wagonload, and container baffles. A simulation program was used for MBS analysis, and a finite element analysis program was used for liquid sloshing modeling and equivalent mechanical systems validation. Acceleration and braking maneuvers of the freight train set the liquid cargo into motion. This longitudinal sloshing motion of the fluid cargo inside the tanks initiated a swinging motion of some components of the coupling gear. Simulation results showed that, for certain combinations of type of liquid, filling level and container dimensions, the liquid cargo could provoke an undesirable, although not hazardous, release of an unused coupling screw from its hanger. It was shown that a resonance effect between the liquid's oscillation and the coupling screw's rotary motion could be the reason for the coupling screw's undesired release. Solutions are suggested to avoid the resonance problem, and directions for future research are given.

Domestic hot water consumption vs. solar thermal energy storage: the optimum size of the storage tank

Many efforts have been made in order to adequate the production of a solar thermal collector field to the consumption of domestic hot water of the inhabitants of a building. In that sense, much has been achieved in different domains: research agencies, government policies and manufacturers. However, most of the design rules of the solar plants are based on steady state models, whereas solar irradiance, consumption and thermal accumulation are inherently transient processes. As a result of this lack of physical accuracy, thermal storage tanks are sometimes left to be as large as the designer decides without any aforementioned precise recommendation. This can be a problem if solar thermal systems are meant to be implemented in nowadays buildings, where there is a shortage of space. In addition to that, an excessive storage volume could not result more efficient in many residential applications, but costly, extreme in space consumption and in some cases too heavy. A proprietary transient simulation program has been developed and validated with a detailed measurement campaign in an experimental facility. In situ environmental data have been obtained through a whole year of operation. They have been gathered at intervals of 10 min for a solar plant of 50 m2 with a storage tank of 3 m3, including the equipment for domestic hot water production of a typical apartment building. This program has been used to obtain the design and dimensioning criteria of DHW solar plants under daily transient conditions throughout a year and more specifically the size of the storage tank for a multi storey apartment building. Comparison of the simulation results with the current Spanish regulation applicable, “Código Técnico de la Edificación” (CTE 2006), offers fruitful details and establishes solar facilities dimensioning criteria.

Análisis de ciclo de vida de una nueva solución arquitectónica que mejora el rendimiento térmico de la envolvente del edificio: fachada natural aljibe. Life Cycle Assessment of a new architectural solution that improves the thermal performance of the building envelope: Natural Green Tank Façade

Análisis de ciclo de vida de una nueva solución arquitectónica que mejora el rendimiento térmico de la envolvente del edificio: fachada natural aljibe.

Advanced characterization of a coffee fermenting tank by multi-distributed wireless sensors: spatial interpolation and phase diagrams.

In coffee processing the fermentation stage is considered one of the critical operations by its impact on the final quality of the product. However, the level of control of the fermentation process on each farm is often not adequate; the use of sensorics for controlling coffee fermentation is not common. The objective of this work is to characterize the fermentation temperature in a fermentation tank by applying spatial interpolation and a new methodology of data analysis based on phase space diagrams of temperature data, collected by means of multi-distributed, low cost and autonomous wireless sensors. A real coffee fermentation was supervised in the Cauca region (Colombia) with a network of 24 semi-passive TurboTag RFID temperature loggers with vacuum plastic cover, submerged directly in the fermenting mass. Temporal evolution and spatial distribution of temperature is described in terms of the phase diagram areas which characterizes the cyclic behaviour of temperature and highlights the significant heterogeneity of thermal conditions at different locations in the tank where the average temperature of the fermentation was 21.2 °C, although there were temperature ranges of 4.6°C, and average spatial standard deviation of ±1.21ºC. In the upper part of the tank we found high heterogeneity of temperatures, the higher temperatures and therefore the higher fermentation rates. While at the bottom, it has been computed an area in the phase diagram practically half of the area occupied by the sensors of the upper tank, therefore this location showed higher temperature homogeneity

Stability Analysis of a Run-of-River Diversion Hydropower Plant With Surge Tank And Spillway in the Head Pond

Run-of-river hydropower plants usually lack significant storage capacity; therefore, the more adequate control strategy would consist of keeping a constant water level at the intake pond in order to harness the maximum amount of energy from the river flow or to reduce the surface flooded in the head pond. In this paper, a standard PI control system of a run-of-river diversion hydropower plant with surge tank and a spillway in the head pond that evacuates part of the river flow plant is studied. A stability analysis based on the Routh-Hurwitz criterion is carried out and a practical criterion for tuning the gains of the PI controller is proposed. Conclusions about the head pond and surge tank areas are drawn from the stability analysis. Finally, this criterion is applied to a real hydropower plant in design state; the importance of considering the spillway dimensions and turbine characteristic curves for adequate tuning of the controller gains is highlighted

Advanced Characterisation of a Coffee Fermenting Tank by Multi-distributed Wireless Sensors: Spatial Interpolation and Phase Space Graphs

The fermentation stage is considered to be one of the critical steps in coffee processing due to its impact on the final quality of the product. The objective of this work is to characterise the temperature gradients in a fermentation tank by multi-distributed, low-cost and autonomous wireless sensors (23 semi-passive TurboTag® radio-frequency identifier (RFID) temperature loggers). Spatial interpolation in polar coordinates and an innovative methodology based on phase space diagrams are used. A real coffee fermentation process was supervised in the Cauca region (Colombia) with sensors submerged directly in the fermenting mass, leading to a 4.6 °C temperature range within the fermentation process. Spatial interpolation shows a maximum instant radial temperature gradient of 0.1 °C/cm from the centre to the perimeter of the tank and a vertical temperature gradient of 0.25 °C/cm for sensors with equal polar coordinates. The combination of spatial interpolation and phase space graphs consistently enables the identification of five local behaviours during fermentation (hot and cold spots).

Comparative Life Cycle Assessment of the Conventional Façade SOS Natura and the Natural Water Tank Façade

The construction industry produces great environmental impacts to the planet. In order to tackle this problem, the European Union has put into effect Regulation No 305/2011, which compels the construction products manufacturers to carry out environmental performance studies of these products and thus make public the impact they cause on the environment. The aim of this research is to make known the environmental impacts of the SOS Natura Conventional Façade (CF) solution, obtained within the research project "SOS Natura, Vegetal Architectural Solutions" developed by the Department of Construction and Technology in Architecture of the School of Architecture of the Technical University of Madrid (Spain). In addition, we report an environmental comparative with the Natural Water Tank Façade (NWTF), studied previously by the same work group and included in the same research project.We present as well an uncertainty analysis for both façades. Following the study conducted we conclude that the NWTF profile has a slightly better environmental behaviour when compared to the CF profile for the entire life cycle in most of the impact categories analysed in this study. However it should also be noted that, in detail and at stage level, the NWTF presents a higher environmental impact than the CF.

Do pingers cause stress in fish? An experimental tank study with European sardine, Sardina pilchardus (Walbaum, 1792) (Actinopterygii, Clupeidae), exposed to a 70 kHz dolphin pinger

Date of acceptance: 06/12/2014 Acknowledgments The study was funded by the Portuguese Ministry of Science (Fundac¸a˜o para a Cieˆncia e Tecnologia– FCT) through a PhD Grant of SG (SFRH/BD/47931/2008). We would like to thank the captain of the purse-seiner (Jose´ Manuel Saveedra) and his crew for facilitating the capture and transport of live fish. Moreover, we want to thank Ana Marc¸alo for suggestions on the experimental design, Manuel Garci for technical advice on underwater video recordings and James Turner from the company Future Oceans for providing technical details on the 70 kHz dolphin pingers. We would also like to acknowledge the scientific advice of Dr. Jose´ Iglesias and the technical and logistic support for the preparation of the laboratory and the materials for tank experiments by Enrique Martı´nez Gonza´lez, Ricardo Pazo´and other staff at the aquaculture facilities of the Spanish Institute for Oceanography (IEO) and the Marine Sciences Station of Toralla (ECIMAT) in Vigo. Furthermore, we are grateful to Francisco de la Granda Grandoso for his practical assistance during the fish tank experiments and to Juan Santos Blanco for helping with statistical analysis. Finally, we would like to thank Pilar Riobo´ Agula, Amelia Fernandez Villamarin, Jose´ Franco Soler, Jose´ Luis Mun˜oz, Angela Benedetti, Marcos Antonio Lopez Patin˜o and Marta Conde Sieira for scientific advice and practical support with cortisol analysis and Rosana Rodrı´guez for preparing histological samples for us.