Accidental entrapment of an endo-bronchial blocker tip by a surgical stapler during selective ventilation for lung lobectomy in a dog

OBJECTIVE: To describe the use of an endobronchial blocker (EBB) and to perform selective ventilation during pulmonary lobe resection via thoracotomy in a dog and report its accidental stapling in the resection site. STUDY DESIGN: Clinical case report. ANIMAL: One female dog with a suspected abscess or neoplasia of the right caudal pulmonary lobe. METHODS: One-lung ventilation was performed using a wire-guided EBB to seal the contaminated parenchyma and facilitate surgical access. The affected lung parenchyma was resected and the resection site was closed with staples. RESULTS: Lobar resection was performed successfully, but the loop of the EBB guide wire was inadvertently entrapped in the staple line of the lobectomy. Staples were removed to release the wire loop, and the resulting air leak caused loss of ventilation control until the parenchyma was re-sealed. CONCLUSIONS: We recommend removing the wire guide associate with the EBB after successful lung separation to avoid accidents that could have life-threatening consequences if not recognized. CLINICAL RELEVANCE: One-lung ventilation is useful to isolate healthy parenchyma from diseased parenchyma during lobectomy. Anesthesiologists and surgeons need to be aware of the potential complications associated with use of EBB.

Phylogenetic relationships of German heavy draught horse breeds inferred from mitochondrial DNA D-loop variation

We analysed a 610-bp mitochondrial (mt)DNA D-loop fragment in a sample of German draught horse breeds and compared the polymorphic sites with sequences from Arabian, Hanoverian, Exmoor, Icelandic, Sorraia and Przewalski's Horses as well as with Suffolk, Shire and Belgian horses. In a total of 65 horses, 70 polymorphic sites representing 47 haplotypes were observed. The average percentage of polymorphic sites was 11.5% for the mtDNA fragment analysed. In the nine different draught horse breeds including South German, Mecklenburg, Saxon Thuringa coldblood, Rhenisch German, Schleswig Draught Horse, Black Forest Horse, Shire, Suffolk and Belgian, 61 polymorphic sites and 24 haplotypes were found. The phylogenetic analysis failed to show monophyletic groups for the draught horses. The analysis indicated that the draught horse populations investigated consist of diverse genetic groups with respect to their maternal lineage.

Angiopoietin-1 and angiopoietin-2 share the same binding domains in the Tie-2 receptor involving the first Ig-like loop and the epidermal growth factor-like repeats

Angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) have been identified as ligands with different effector functions of the vascular assembly and maturation-mediating receptor tyrosine kinase Tie-2. To understand the molecular interactions of the angiopoietins with their receptor, we have studied the binding of Ang-1 and Ang-2 to the Tie-2 receptor. Enzyme-linked immunosorbent assay-based competition assays and co-immunoprecipitation experiments analyzing the binding of Ang-1 and Ang-2 to truncation mutants of the extracellular domain of Tie-2 showed that the first Ig-like loop of Tie-2 in combination with the epidermal growth factor (EGF)-like repeats (amino acids 1-360) is required for angiopoietin binding. The first Ig-like domain or the EGF-like repeats alone are not capable of binding Ang-1 and Ang-2. Concomitantly, we made the surprising finding that Tie-2 exon-2 knockout mice do express a mutated Tie-2 protein that lacks 104 amino acids of the first Ig-like domain. This mutant Tie-2 receptor is functionally inactive as shown by the lack of ligand binding and receptor phosphorylation. Collectively, the data show that the first 104 amino acids of the Tie-2 receptor are essential but not sufficient for angiopoietin binding. Conversely, the first 360 amino acids (Ig-like domain plus EGF-like repeats) of the Tie-2 receptor are necessary and sufficient to bind both Ang-1 and Ang-2, which suggests that differential receptor binding is not likely to be responsible for the different functions of Ang-1 and Ang-2.

Two neighboring residues of loop A of the alpha1 subunit point towards the benzodiazepine binding site of GABAA receptors

Benzodiazepines are widely used drugs exerting sedative, anxiolytic, muscle relaxant, and anticonvulsant effects by acting through specific high affinity binding sites on some GABA(A) receptors. It is important to understand how these ligands are positioned in this binding site. We are especially interested here in the conformation of loop A of the alpha(1)beta(2)gamma(2) GABA(A) receptor containing a key residue for the interaction of benzodiazepines: alpha(1)H101. We describe a direct interaction of alpha(1)N102 with a diazepam- and an imidazobenzodiazepine-derivative. Our observations help to better understand the conformation of this region of the benzodiazepine pocket in GABA(A) receptor.

Port-a-Cath perforation of the right atrium closed with an amplatzer ASD occluder

Right atrial perforation can lead to tamponade and death. Closure devices are used for sealing of shunts in the heart. We describe an indwelling catheter that caused perforation of the right atrium and was treated with a percutaneous closure device.

Twelve factors influencing sustainable recycling of municipal solid waste in developing countries

Sustainable management of solid waste is a global concern, as exemplified by the United Nations Millennium Development Goals (MDG) that 191 member states support. The seventh MDG indirectly advocates for municipal solid waste management (MSWM) by aiming to ensure environmental sustainability into countries’ policies and programs and reverse negative environmental impact. Proper MSWM will likely result in relieving poverty, reducing child mortality, improving maternal health, and preventing disease, which are MDG goals one, four, five, and six, respectively (UNMDG, 2005). Solid waste production is increasing worldwide as the global society strives to obtain a decent quality of life. Several means exist in which the amount of solid waste going to a landfill can be reduced, such as incineration with energy production, composting of organic wastes, and material recovery through recycling, which are all considered sustainable methods by which to manage MSW. In the developing world, composting is already a widely-accepted method to reduce waste fated for the landfill, and incineration for energy recovery can be a costly capital investment for most communities. Therefore, this research focuses on recycling as a solution to the municipal solid waste production problem while considering the three dimensions of sustainability environment, society, and economy. First, twenty-three developing country case studies were quantitatively and qualitatively examined for aspects of municipal solid waste management. The municipal solid waste (MSW) generation and recovery rates, as well as the composition were compiled and assessed. The average MSW generation rate was 0.77 kg/person/day, with recovery rates varying from 5 – 40%. The waste streams of nineteen of these case studies consisted of 0 – 70% recyclable material and 17 – 80% organic material. All twenty-three case studies were analyzed qualitatively by identifying any barriers or incentives to recycling, which justified the creation of twelve factors influencing sustainable municipal solid waste management (MSWM) in developing countries. The presence of regulations, enforcement of laws, and use of incentive schemes constitutes the first factor, Government Policy. Cost of MSWM operations, the budget allocated to MSWM by local to national governments, as well as the stability and reliability of funds comprise the Government Finances factor influencing recycling in the third world. Many case studies indicated that understanding features of a waste stream such as the generation and recovery rates and composition is the first measure in determining proper management solutions, which forms the third factor Waste Characterization. The presence and efficiency of waste collection and segregation by scavengers, municipalities, or private contractors was commonly addressed by the case studies, which justified Waste Collection and Segregation as the fourth factor. Having knowledge of MSWM and an understanding of the linkages between human behavior, waste handling, and health/sanitation/environment comprise the Household Education factor. Individuals’ income influencing waste handling behavior (e.g., reuse, recycling, and illegal dumping), presence of waste collection/disposal fees, and willingness to pay by residents were seen as one of the biggest incentives to recycling, which justified them being combined into the Household Economics factor. The MSWM Administration factor was formed following several references to the presence and effectiveness of private and/or public management of waste through collection, recovery, and disposal influencing recycling activity. Although the MSWM Personnel Education factor was only recognized by six of the twenty-two case studies, the lack of trained laborers and skilled professionals in MSWM positions was a barrier to sustainable MSWM in every case but one. The presence and effectiveness of a comprehensive, integrative, long-term MSWM strategy was highly encouraged by every case study that addressed the tenth factor, MSWM Plan. Although seemingly a subset of private MSWM administration, the existence and profitability of market systems relying on recycled-material throughput, involvement of small businesses, middlemen, and large industries/exporters is deserving of the factor Local Recycled-Material Market. Availability and effective use of technology and/or human workforce and the safety considerations of each were recurrent barriers and incentives to recycling to warrant the Technological and Human Resources factor. The Land Availability factor takes into consideration land attributes such as terrain, ownership, and development which can often times dictate MSWM. Understanding the relationships among the twelve factors influencing recycling in developing countries, made apparent the collaborative nature required of sustainable MSWM. Factors requiring the greatest collaborative inputs include waste collection and segregation, MSWM plan, and local recycled-material market. Aligning each factor to the societal, environmental, and economic dimensions of sustainability revealed the motives behind the institutions contributing to each factor. A correlation between stakeholder involvement and sustainability existed, as supported by the fact that the only three factors driven by all three dimensions of sustainability were the same three that required the greatest collaboration with other factors. With increasing urbanization, advocating for improved health for all through the MDG, and changing consumption patterns resulting in increasing and more complex waste streams, the utilization of the collaboration web offered by this research is ever needed in the developing world. Through its use, the institutions associated with each of the twelve factors can achieve a better understanding of the collaboration necessary and beneficial for more sustainable MSWM.

Levoatrial cardinal vein in mitral atresia and closed foramen ovale: prenatal diagnosis and perinatal management

A levoatrial cardinal vein is a rare cardiovascular anomaly that may be present in malformed hearts with severe left heart obstruction and restrictive interatrial communication. We report the prenatal diagnosis at 23 weeks of a fetus with mitral atresia, double-outlet right ventricle, premature closure of the foramen ovale and a levoatrial cardinal vein draining into the innominate vein. In a prior examination performed elsewhere the levoatrial cardinal vein had been interpreted as an aortic arch perfused retrogradely, and hypoplastic left heart syndrome with aortic atresia had been diagnosed. Prenatal management, induction at 38 weeks and postnatal examinations and treatment are reported. To the best of our knowledge, this is the first reported prenatal diagnosis of this embryological vessel, presenting a potential pitfall for prenatal echocardiography.

Development of Hardware-In-the-Loop Simulation System for Hybrid Electric Vehicle Study

The development of embedded control systems for a Hybrid Electric Vehicle (HEV) is a challenging task due to the multidisciplinary nature of HEV powertrain and its complex structures. Hardware-In-the-Loop (HIL) simulation provides an open and convenient environment for the modeling, prototyping, testing and analyzing HEV control systems. This thesis focuses on the development of such a HIL system for the hybrid electric vehicle study. The hardware architecture of the HIL system, including dSPACE eDrive HIL simulator, MicroAutoBox II and MotoTron Engine Control Module (ECM), is introduced. Software used in the system includes dSPACE Real-Time Interface (RTI) blockset, Automotive Simulation Models (ASM), Matlab/Simulink/Stateflow, Real-time Workshop, ControlDesk Next Generation, ModelDesk and MotoHawk/MotoTune. A case study of the development of control systems for a single shaft parallel hybrid electric vehicle is presented to summarize the functionality of this HIL system.

Is a sustaining rod necessary for diverting loop ileostomy?

Objective: Whether or not a protective stoma reduces the rate of anastomotic leakage after distal colorectal anastomosis is still discussed controversially. It does however facilitate clinical management once leakage has occurred. Loop ileostomies seem to be associated with a lower morbidity and a better quality of life compared to loop colostomies. Generally, diverting loop ileostomies are secured at skin level by means of a supporting device in order to prevent retraction of the ileostomy into the abdomen. However, due to the supporting rod, difficulties may occur in applying a stoma bag correctly and leakage of faeces onto the skin may occur even with correct eversion of the afferent limb. Our aim was to compare morbidity and time to self-sufficient stoma-care in patients having a loop ileostomy with rod to those without rod. Methods: A total of 60 patients necessitating loop ileostomy were analyzed. Patients received surgery in of the two involved institutions according to inhouse standard procedures. 30 patients had an ileostomy with rod (VCHK Inselspital) and a further 30 without rod (KSW Winterthur). Morbidity and time to self-sufficiency regarding stoma care was analyzed during the first 90 postoperative days. Morbidity was determined according to a scoring system ranging from 0 to 4 points for any given set of possible complications (bleeding, necrosis, skin irritation, abscess, stenosis, retraction, fistula, prolapse, parastomal hernia, incomplete diversion), where 0 = no complication and 4 = severe complication. Continuous variables were expressed as median (95% Confidence Interval). For comparisons between the groups the Mann-Whitney U test was used, between categorical variables the X2 test was applied. Results: There were no significant differences in length of hospital stay or time to self-sufficient stoma-care between the groups. Although not significant, patients with a rod ileostomy had a tendency towards more stoma-related complications as well as stoma-related reoperations. The number of patients reaching total self-sufficiency regarding stoma care was higher after rodless ileostomy. Conclusion: According to our data, rodless ileostomies seemto fare just as well as those with a supporting rod, with equal morbidity rates and more patients reaching self-sufficient stoma care. Therefore routine application of a rod for diverting loop ileostomy seems unnecessary

TANK SIZING AND OPTIMIZING LOOP PLACEMENT IN A BRANCHED WATER DISTRIBUTION SYSTEM

More than eighteen percent of the world’s population lives without reliable access to clean water, forced to walk long distances to get small amounts of contaminated surface water. Carrying heavy loads of water long distances and ingesting contaminated water can lead to long-term health problems and even death. These problems affect the most vulnerable populations, women, children, and the elderly, more than anyone else. Water access is one of the most pressing issues in development today. Boajibu, a small village in Sierra Leone, where the author served in Peace Corps for two years, lacks access to clean water. Construction of a water distribution system was halted when a civil war broke out in 1992 and has not been continued since. The community currently relies on hand-dug and borehole wells that can become dirty during the dry season, which forces people to drink contaminated water or to travel a far distance to collect clean water. This report is intended to provide a design the system as it was meant to be built. The water system design was completed based on the taps present, interviews with local community leaders, local surveying, and points taken with a GPS. The design is a gravity-fed branched water system, supplied by a natural spring on a hill adjacent to Boajibu. The system’s source is a natural spring on a hill above Boajibu, but the flow rate of the spring is unknown. There has to be enough flow from the spring over a 24-hour period to meet the demands of the users on a daily basis, or what is called providing continuous flow. If the spring has less than this amount of flow, the system must provide intermittent flow, flow that is restricted to a few hours a day. A minimum flow rate of 2.1 liters per second was found to be necessary to provide continuous flow to the users of Boajibu. If this flow is not met, intermittent flow can be provided to the users. In order to aid the construction of a distribution system in the absence of someone with formal engineering training, a table was created detailing water storage tank sizing based on possible source flow rates. A builder can interpolate using the source flow rate found to get the tank size from the table. However, any flow rate below 2.1 liters per second cannot be used in the table. In this case, the builder should size the tank such that it can take in the water that will be supplied overnight, as all the water will be drained during the day because the users will demand more than the spring can supply through the night. In the developing world, there is often a problem collecting enough money to fund large infrastructure projects, such as a water distribution system. Often there is only enough money to add only one or two loops to a water distribution system. It is helpful to know where these one or two loops can be most effectively placed in the system. Various possible loops were designated for the Boajibu water distribution system and the Adaptive Greedy Heuristic Loop Addition Selection Algorithm (AGHLASA) was used to rank the effectiveness of the possible loops to construct. Loop 1 which was furthest upstream was selected because it benefitted the most people for the least cost. While loops which were further downstream were found to be less effective because they would benefit fewer people. Further studies should be conducted on the water use habits of the people of Boajibu to more accurately predict the demands that will be placed on the system. Further population surveying should also be conducted to predict population change over time so that the appropriate capacity can be built into the system to accommodate future growth. The flow at the spring should be measured using a V-notch weir and the system adjusted accordingly. Future studies can be completed adjusting the loop ranking method so that two users who may be using the water system for different lengths of time are not counted the same and vulnerable users are weighted more heavily than more robust users.