Study protocol for DICE trial: Video-assisted thoracoscopic surgery decortication versus interventional radiology guided chest tube insertion for the management of empyema
Background: Empyema is a common thoracic surgery presentation, defined as pus in the pleural space. Despite the commonality of empyema, consensus on initial management remains ambiguous. Two standard of care treatment options include inserting a chest tube (thoracostomy) and the administration of intrapleural fibrinolytics, or an initial surgical approach, surgical decortication. Due to the complexity of this pleural space infection, often repeat interventions are required after initial management in order to achieve source control and resolution of clinical symptoms. This study aims to identify the most effective initial management option for empyema.
Study design: We present a study protocol for a randomized control trial (RCT) comparing adult individuals with empyema to one of two standard of care initial management options. Participants will be randomized into either interventional radiology guided chest tube insertion with intrapleural fibrinolytics (Dornase 5 mg and Alteplase 10 mg intrapleural twice daily for three days) or video-assisted thoracoscopic surgery (VATS) decortication.
Methods: All adults with empyema meeting inclusion criteria will be invited to participate. They will be randomized into one of two intervention groups; interventional radiology guided chest tube insertion with fibrinolytics or initial VATS decortication. Each intervention will take place within 48 hours of randomization. The primary outcome will be the rate of re-intervention within 30 days. Re-intervention is defined as repeat chest tube insertion, VATS decortication, or decortication via thoracotomy. Secondary outcomes include a change in the size of empyema, length of stay, morbidity, as well as 30-day and 90-day mortality, as well as quality of life measurements.
Anticipated impact: This study is aimed at identifying the most effective initial management option for individuals with empyema
Villin Controls the Formation and Enlargement of Punctate Actin Foci in Pollen Tubes
Self-incompatibility (SI) in Papaver rhoeas triggers dramatic actin alterations in pollen. However, how actin alterations in SI pollen tubes are mechanistically achieved remains largely unexplored. Here we have used treatment with the calcium ionophore A23187 to mimic the SI-induced elevation in cytosolic Ca2+ and trigger the formation of the distinctive F-actin foci. Live-cell imaging reveals that this remodeling involves F-actin fragmentation and depolymerization, accompanied by the rapid formation of punctate actin foci and subsequent increase in their size.
We establish that actin foci are generated and enlarged from crosslinking of fragmented actin filament structures. Moreover, we show that villins associate with actin structures and are involved in this actin reorganization process. Notably, we demonstrate that Arabidopsis villin5 promotes actin depolymerization and formation of actin foci by fragmenting actin filaments, and controlling the enlargement of actin foci via bundling actin filaments. Our study thus uncovers important, novel insights about the molecular players and mechanisms involved in forming the distinctive actin foci in pollen tubes.
Piggy? Tube Rotator, including rotisserie for 42 x 0.5mL~0.8mL tubes, 2/pk, 50 x 1.5mL~2.0mL tubes, 2/pk, rotisserie for 14 x 5mL~7mL tubes, 2/pk, rotisserie for 14 x 10mL~15mL tubes, 2/pk, rotisserie for 6 x 50mL tubs, 1/pk
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0.1ML PCR STRIP TUBES AND CAPS (0.07ML WORKING VOLUME)4 TUBES/4 CAPS PER STRIP, 250 STRIP TUBES AND STRIP CAPS PER UNIT
A method for percutaneous radiologic gastrostomy tube placement without sedation as a bridge to lung transplantation
Gastrostomy tube placement is an appropriate option for long-term nutritional support for patients who cannot tolerate oral intake. Common indications for a gastrostomy tube include head and neck tumors and neurological disorders. Several methods for gastrostomy tube insertion exist (eg, surgical, endoscopic, and radiologic) that require sedation or general anesthesia, which can pose risks of cardiopulmonary compromise and postsurgical pulmonary complications. Unlike other methods, our practice uses a percutaneous balloon-assisted gastrostomy tube insertion method for which we can perform without sedation.
We report a case of a percutaneous radiologic gastrostomy procedure for a patient with end stage lung disease as a bridge to lung transplantation, who is not a candidate for sedation and is high-risk for general anesthesia. Through enteral feeds administered through the successfully placed gastrostomy tube, the patient showed steady improvement in weight gain over the course of several months before approval for listing by the lung transplant selection committee. Our case highlights how gastrostomy tube placement can be safely performed in patients who are not sedation candidates using the minimally invasive balloon-assisted gastrostomy tube insertion method and local anesthetic.
Passive Release Technique Produces the Most Accurate Endotracheal Tube Cuff Pressure Than Manual Palpation and Minimum Occlusive Volume Technique in the Absence of Manometer
Objective: This study aimed to compare the accuracy of the endotracheal tube (ETT) cuff pressure of the manual palpation (MP), passive release (PR), and minimum occlusive volume (MOV) techniques.
Methods: This study is a true experiment with simple randomisation. The subjects of this study were 105 patients divided into 3 groups: MP group (n=35), PR group (n=35), and MOV group (n=35). After intubation, ETT cuff inflation was performed using 3 different techniques. The ETT cuff pressure was recorded using a manometer. The data were analysed using the chi-square test, Kruskal-Wallis test, and Mann-Whitney test in the SPSS 20 software.
Results: The mean ETT cuff pressure was 60.2±28.8 cmH2O in the MP group, 30.4±5.5 cmH2O in the PR group, and 25.8±9.6 cmH2O in the MOV group (p=0.000). The PR group had the highest pressure accuracy (77%) (p=0.000).
Conclusion: The PR technique had the highest accuracy and can be used as an alternative ETT cuff inflation technique in the absence of a manometer.
Non-contact detection of thiodiglycol vapors and associated degradation products using atmospheric flow tube mass spectrometry
Thiodiglycol (TDG) is a synthetic precursor and an environmental degradation product of sulfur mustard (HD). Consequently, its presence can be indicative of illicit preparation or historical presence of chemical weapons, but its lower toxicity lends itself to use as an HD simulant for testing and method development. Detection of TDG vapor often proves elusive with existing techniques exhibiting undesirably high detection limits in the gas phase (>ppm). Moreover, traditional approaches to detecting TDG vapor rely upon non-specific approaches that do not provide the certainty afforded by mass spectrometry.
Using atmospheric flow tube mass spectrometry (AFT-MS), which has previously demonstrated the capacity to detect parts-per-quadrillion levels of vapor, we evaluate the capacity of this approach for non-contact residue analysis based upon TDG vapor sampling and nitrate clustering chemistry. Furthermore, we discuss challenges with ambient vapor detection using the AFT-MS system and associated observations related to TDG degradation into 2,2′-sulfonyldiglycol from exposure to ambient conditions with vapor detection being possible even after 7-weeks of sample aging.
