Endotracheal and Tracheostomy Tube Cytology

1979 ◽  
Vol 88 (6) ◽  
pp. 809-812 ◽  
Author(s):  
J. Kevin Fortson ◽  
Parviz Janfaza

Carcinoma of the lung is the leading cause of death from malignancy in this country. Twenty percent of patients with lung carcinoma are asymptomatic early in the course of the disease. Survival rates are much better when lung carcinoma is discovered at the asymptomatic or radiographically occult stage, therefore improved screening methods should be investigated. Many tumors in the tracheobronchial tree shed malignant cells into the bronchi and sputum cytology has been of value in the early diagnosis of carcinoma of the tracheobronchial tree. Thousands of patients are intubated daily. During endotracheal anesthesia, secretions are stimulated in the tracheobronchial tree and endotracheal or tracheostomy tubes are coated with these secretions. In a preliminary study, the cytology examination of the secretions adherent to 50 endotracheal tubes suggests that endotracheal and tracheostomy tube cytology will prove to be a reliable, noninvasive and cost-effective means of screening high risk patients for occult primary carcinomas of the lung and upper aerodigestive tract.

mBio ◽  
2020 ◽  
Vol 11 (5) ◽  
Author(s):  
J. M. Myers ◽  
A. E. Bonds ◽  
R. A. Clemons ◽  
N. A. Thapa ◽  
D. R. Simmons ◽  
...  

ABSTRACT Mycoviruses are widespread and purportedly common throughout the fungal kingdom, although most are known from hosts in the two most recently diverged phyla, Ascomycota and Basidiomycota, together called Dikarya. To augment our knowledge of mycovirus prevalence and diversity in underexplored fungi, we conducted a large-scale survey of fungi in the earlier-diverging lineages, using both culture-based and transcriptome-mining approaches to search for RNA viruses. In total, 21.6% of 333 isolates were positive for RNA mycoviruses. This is a greater proportion than expected based on previous taxonomically broad mycovirus surveys and is suggestive of a strong phylogenetic component to mycoviral infection. Our newly found viral sequences are diverse, composed of double-stranded RNA, positive-sense single-stranded RNA (ssRNA), and negative-sense ssRNA genomes and include novel lineages lacking representation in the public databases. These identified viruses could be classified into 2 orders, 5 families, and 5 genera; however, half of the viruses remain taxonomically unassigned. Further, we identified a lineage of virus-like sequences in the genomes of members of Phycomycetaceae and Mortierellales that appear to be novel genes derived from integration of a viral RNA-dependent RNA polymerase gene. The two screening methods largely agreed in their detection of viruses; thus, we suggest that the culture-based assay is a cost-effective means to quickly assess whether a laboratory culture is virally infected. This study used culture collections and publicly available transcriptomes to demonstrate that mycoviruses are abundant in laboratory cultures of early-diverging fungal lineages. The function and diversity of mycoviruses found here will help guide future studies into mycovirus origins and ecological functions. IMPORTANCE Viruses are key drivers of evolution and ecosystem function and are increasingly recognized as symbionts of fungi. Fungi in early-diverging lineages are widespread, ecologically important, and comprise the majority of the phylogenetic diversity of the kingdom. Viruses infecting early-diverging lineages of fungi have been almost entirely unstudied. In this study, we screened fungi for viruses by two alternative approaches: a classic culture-based method and by transcriptome-mining. The results of our large-scale survey demonstrate that early-diverging lineages have higher infection rates than have been previously reported in other fungal taxa and that laboratory strains worldwide are host to infections, the implications of which are unknown. The function and diversity of mycoviruses found in these basal fungal lineages will help guide future studies into mycovirus origins and their evolutionary ramifications and ecological impacts.


Diagnostics ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 506
Author(s):  
Mel Corbett ◽  
Isobel Hughes ◽  
John O’Shea ◽  
Matthew G. Davey ◽  
Jane Savage ◽  
...  

Tracheostomy is a commonly performed intervention in patients requiring ventilatory support. The insertion of inappropriately sized tracheostomy tubes carries a risk of decannulation, tissue damage, ventilatory difficulties, premature tube change or discomfort. Currently, no clear guidelines exist in determining the most appropriate size tube. Imaging of the airway preoperatively could aid clinical judgement and reduce risk. Patients included adult critical care patients who had appropriate preoperative imaging. The computed tomography scans and chest radiographs of patients were reviewed. Measurements of the airway were taken and scaled to the known internal diameter of an endotracheal tube. A four-point scoring system was developed to identify patients better suited to a non-standard sized tracheostomy tube. Data from 23 patients was analyzed using the Statistical Package for Social Sciences™ (SPSS). Four measured points on imaging corresponded to the patients’ appropriate tracheostomy tube size. Appropriate tracheostomy size correlates with tracheal diameter at endotracheal tube tip (r2 = 0.135), carina (r2 = 0.128), midpoint of larynx to carina (r2 = 0.146), bronchial diameter at the left mainstem (r2 = 0.323), and intrathoracic tracheal length (r2 = 0.23). Among our cohort, a score of 4 predicts the need for a larger tracheostomy tube. Simple imaging provides accurate measurement of patients’ airway dimensions. Our method ensures tube size is selected according to patient airway size, and potentially reduces the risks associated with inappropriate sizing.


2012 ◽  
Vol 15 (1) ◽  
pp. 4 ◽  
Author(s):  
David M. Holzhey ◽  
William Shi ◽  
A. Rastan ◽  
Michael A. Borger ◽  
Martin H�nsig ◽  
...  

<p><b>Introduction:</b> The goal of this study was to compare the short- and long-term outcomes after aortic valve (AV) surgery carried out via standard sternotomy/partial sternotomy versus transapical transcatheter AV implantation (taTAVI).</p><p><b>Patients and Methods:</b> All 336 patients who underwent taTAVI between 2006 and 2010 were compared with 4533 patients who underwent conventional AV replacement (AVR) operations between 2001 and 2010. Using propensity score matching, we identified and consecutively compared 2 very similar groups of 167 patients each. The focus was on periprocedural complications and long-term survival.</p><p><b>Results:</b> The 30-day mortality rate was 10.8% and 8.4% (<i>P</i> = .56) for the conventional AVR patients and the TAVI patients, respectively. The percentages of postoperative pacemaker implantations (15.0% versus 6.0%, <i>P</i> = .017) and cases of renal failure requiring dialysis (25.7% versus 12.6%, <i>P</i> = .004) were higher in the TAVI group. Kaplan-Meier curves diverged after half a year in favor of conventional surgery. The estimated 3-year survival rates were 53.5% � 5.7% (TAVI) and 66.7% � 0.2% (conventional AVR).</p><p><b>Conclusion:</b> Our study shows that even with all the latest successes in catheter-based AV implantation, the conventional surgical approach is still a very good treatment option with excellent long-term results, even for older, high-risk patients.</p>


2011 ◽  
Vol 39 (3) ◽  
pp. 193-209 ◽  
Author(s):  
H. Surendranath ◽  
M. Dunbar

Abstract Over the last few decades, finite element analysis has become an integral part of the overall tire design process. Engineers need to perform a number of different simulations to evaluate new designs and study the effect of proposed design changes. However, tires pose formidable simulation challenges due to the presence of highly nonlinear rubber compounds, embedded reinforcements, complex tread geometries, rolling contact, and large deformations. Accurate simulation requires careful consideration of these factors, resulting in the extensive turnaround time, often times prolonging the design cycle. Therefore, it is extremely critical to explore means to reduce the turnaround time while producing reliable results. Compute clusters have recently become a cost effective means to perform high performance computing (HPC). Distributed memory parallel solvers designed to take advantage of compute clusters have become increasingly popular. In this paper, we examine the use of HPC for various tire simulations and demonstrate how it can significantly reduce simulation turnaround time. Abaqus/Standard is used for routine tire simulations like footprint and steady state rolling. Abaqus/Explicit is used for transient rolling and hydroplaning simulations. The run times and scaling data corresponding to models of various sizes and complexity are presented.


Author(s):  
Tochukwu Moses ◽  
David Heesom ◽  
David Oloke ◽  
Martin Crouch

The UK Construction Industry through its Government Construction Strategy has recently been mandated to implement Level 2 Building Information Modelling (BIM) on public sector projects. This move, along with other initiatives is key to driving a requirement for 25% cost reduction (establishing the most cost-effective means) on. Other key deliverables within the strategy include reduction in overall project time, early contractor involvement, improved sustainability and enhanced product quality. Collaboration and integrated project delivery is central to the level 2 implementation strategy yet the key protocols or standards relative to cost within BIM processes is not well defined. As offsite construction becomes more prolific within the UK construction sector, this construction approach coupled with BIM, particularly 5D automated quantification process, and early contractor involvement provides significant opportunities for the sector to meet government targets. Early contractor involvement is supported by both the industry and the successive Governments as a credible means to avoid and manage project risks, encourage innovation and value add, making cost and project time predictable, and improving outcomes. The contractor is seen as an expert in construction and could be counter intuitive to exclude such valuable expertise from the pre-construction phase especially with the BIM intent of äóÖbuild it twiceäó», once virtually and once physically. In particular when offsite construction is used, the contractoräó»s construction expertise should be leveraged for the virtual build in BIM-designed projects to ensure a fully streamlined process. Building in a layer of automated costing through 5D BIM will bring about a more robust method of quantification and can help to deliver the 25% reduction in overall cost of a project. Using a literature review and a case study, this paper will look into the benefits of Early Contractor Involvement (ECI) and the impact of 5D BIM on the offsite construction process.


2021 ◽  
pp. 152660282110282
Author(s):  
Juan Shi ◽  
Ligang Liu ◽  
Xiang Wei ◽  
Mingjia Ma

Objectives To investigate the effectiveness of modified stent-grafts (SGs) for the management of ascending aortic pathologies. Materials and Methods From January 2015 to December 2019, 31 individuals were treated by ascending aortic endovascular repair with a back-table modified SG for acute (n=4) or chronic (n=1) type A aortic dissections, penetrating aortic ulcers (n=18), pseudoaneurysms (n=2), anastomotic fistula (n=1), and endoleaks after thoracic endovascular aortic repair (TEVAR) (n=5). The commercially available thoracic aortic SGs were modified with a fenestration or truncation technique on the back-table according to aortography during the operation. Results The 30-day mortality and aorta-related mortality rates were 12.9% and 6.5%, respectively. There were 2 strokes, 3 respiratory insufficiencies, and 6 endoleaks during hospitalization. During a mean follow-up of 28.8±16.6 months, the overall survival rates at 1 year and 3 years were both 80.6%. Free from adverse event rates at 1 year and 3 years were 88.9% and 84.7%, respectively. There were 2 deaths during follow-up: One patient died of cachexia 1 month after discharge, and the other patient died of acute myocardial infarction 3 months after discharge. One patient with a pseudoaneurysm underwent open ascending aorta replacement 3 months after discharge for a type Ia endoleak. Another patient suffered from cerebellar infarction 17 months after discharge. Conclusion The modified SG for endovascular repair of the ascending aorta is a practicable alternative and presents acceptable outcomes in high-risk patients.


Vaccines ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 390
Author(s):  
Frank Kowalzik ◽  
Daniel Schreiner ◽  
Christian Jensen ◽  
Daniel Teschner ◽  
Stephan Gehring ◽  
...  

Increases in the world’s population and population density promote the spread of emerging pathogens. Vaccines are the most cost-effective means of preventing this spread. Traditional methods used to identify and produce new vaccines are not adequate, in most instances, to ensure global protection. New technologies are urgently needed to expedite large scale vaccine development. mRNA-based vaccines promise to meet this need. mRNA-based vaccines exhibit a number of potential advantages relative to conventional vaccines, namely they (1) involve neither infectious elements nor a risk of stable integration into the host cell genome; (2) generate humoral and cell-mediated immunity; (3) are well-tolerated by healthy individuals; and (4) are less expensive and produced more rapidly by processes that are readily standardized and scaled-up, improving responsiveness to large emerging outbreaks. Multiple mRNA vaccine platforms have demonstrated efficacy in preventing infectious diseases and treating several types of cancers in humans as well as animal models. This review describes the factors that contribute to maximizing the production of effective mRNA vaccine transcripts and delivery systems, and the clinical applications are discussed in detail.


Geophysics ◽  
2014 ◽  
Vol 79 (4) ◽  
pp. T243-T255 ◽  
Author(s):  
James W. D. Hobro ◽  
Chris H. Chapman ◽  
Johan O. A. Robertsson

We present a new method for correcting the amplitudes of arrivals in an acoustic finite-difference simulation for elastic effects. In this method, we selectively compute an estimate of the error incurred when the acoustic wave equation is used to approximate the behavior of the elastic wave equation. This error estimate is used to generate an effective source field in a second acoustic simulation. The result of this second simulation is then applied as a correction to the original acoustic simulation. The overall cost is approximately twice that of an acoustic simulation but substantially less than the cost of an elastic simulation. Because both simulations are acoustic, no S-waves are generated, so dispersed converted waves are avoided. We tested the characteristics of the method on a simple synthetic model designed to simulate propagation through a strong acoustic impedance contrast representative of sedimentary geology. It corrected amplitudes to high accuracy for reflected arrivals over a wide range of incidence angles. We also evaluated results from simulations on more complex models that demonstrated that the method was applicable in realistic sedimentary models containing a wide range of seismic contrasts. However, its accuracy was reduced for wide-angle reflections from very high impedance contrasts such as a shallow top-salt interface. We examined the influence of modeling at coarse grid resolutions, in which converted S-waves in the equivalent elastic simulation are dispersed. These results provide some validation for the accuracy of the method when applied using finite-difference grids designed for acoustic modeling. The method appears to offer a cost-effective means of modeling elastic amplitudes for P-wave arrivals in a useful range of velocity models. It has several potential applications in imaging and inversion.


Author(s):  
X. C. Nguyen ◽  
Komla Miheaye ◽  
Mun-gyu Kim ◽  
Howard Newman ◽  
Dong-hoon Yoo ◽  
...  

This study describes a FLNG specifically designed to monetize Associated Gas (AG) of producing oil fields located within convenient distance of an existing LNG Plant or Port with LNG storage facility. Limited production capacity combined with short range small capacity shuttles and limited LNG storage capacity, provide a cost effective means for LNG production. This FLNG is designed to service an existing industry and does not require development of stranded gas discoveries.


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