Mean Peak Temperature Research Articles

AB-452654-3 AVOIDING THERMAL INJURY OF THE ESOPHAGUS BY USING LUMINAL ESOPHAGEAL TEMPERATURE MONITORING DURING HIGH-POWER, SHORT-DURATION RADIOFREQUENCY ABLATION: RESULTS OF A “ZERO TOLERANCE” PROTOCOL

The prevention of esophageal thermal injury (ETI) during atrial fibrillation (AF) ablation is still a challenge and the optimal luminal esophageal temperature (LET) strategy remains to be proved. Recent studies showed a lower incidence (3.5- 6%) of endoscopic ETI during high-power, short-duration (HPSD) AF ablation in which radiofrequency (RF) delivery was tolerated at LET cutoff point of 39-41°C. We investigated whether the LET monitoring with “zero tolerance” towards any rise of temperature is a safe and effective strategy in terms of endoscopic ETI and acute pulmonary vein isolation (PVI) in HPSD ablation. Observational study of consecutive patients with symptomatic AF undergoing HPSD RF ablation. The previously estimated sample size was 87, considering an estimated prevalence of 6%, margin of error of 5%, and 95% of significance level. HPSD RF ablation was defined as maximum temperature at 43°C, power delivery at 50 or 40 W for 5 and 10 seconds, respectively (the lowest power was at the left atrium posterior wall [LAPW]), 20 ml/min., and contact force of 5-30 grams. The applications were monitored by the impedance curve and real-time LET using a 9F insulated single thermocouple temperature probe. The “zero-tolerance” protocol was defined as stopping the point-by-point RF delivery at any LET rise in the LAPW in which the tip of the temperature probe was always positioned, via fluoroscopy vision, at the closest ablation site. The RF application was resumed only after the LET fell back to the baseline. All patients were scheduled to undergo esophageal endoscopy 1-3 days after procedure. We included 87 consecutive patients (59±13 years, 62 [71%] males) with paroxysmal (58[66.6%] and persistence AF (29[33.3%]). PVI was achieved in all patients with 16±7 min. of fluoroscopy time and 168±38 min. of procedure time. The LET rose in 86 (98.8%) patients, with a mean peak temperature of 37.3±1.2°C. There were no major complications. All patients underwent esophageal endoscopy and no ETI was found. They were discharged on the day after the procedure and no complications, including esophagus perforation or atrio-esophageal fistula, were clinically detected in at least 3 months of follow-up. The LET monitoring with “zero tolerance” towards any rise of temperature in HPSD RF ablation of AF prevented the occurrence of endoscopic esophageal thermal lesion without compromising the acute PVI.

Carbonyl Emissions and Heating Temperatures across 75 Nominally Identical Electronic Nicotine Delivery System Products: Do Manufacturing Variations Drive Pulmonary Toxicant Exposure?

Studies of factors that impact electronic nicotine delivery systems (ENDSs) carbonyl compound (CC) emissions have been hampered by wide within-condition variability. In this study, we examined whether this variability may be related to heating coil temperature variations stemming from manufacturing differences. We determined the mean peak temperature rise (ΔTmax) and CC emissions from 75 Subox ENDSs powered at 30 W. We found that ΔTmax and CC emissions varied widely, with greater ΔTmax resulting in exponentially higher CC emissions. Also, 12% of atomizers accounted for 85% of total formaldehyde emissions. These findings suggest that major reductions in toxicant exposure might be achieved through regulations focusing on limiting coil temperature.

Smouldering combustion in cellulose and hemicellulose mixtures: Examining the roles of density, fuel composition, oxygen concentration, and moisture content

Smouldering combustion plays a key role in wildfires in forests, grasslands, and peatlands due to its common occurrence in porous fuels like peat and duff. As a consequence, understanding smouldering behaviour in these fuels is crucial. Such fuels are generally composed of cellulose, hemicellulose, and lignin. Here we present an updated computational model for simulating smouldering combustion in cellulose and hemicellulose mixtures. We used this model to examine changes in smouldering propagation speed and peak temperatures with varying fuel composition and density. For a given fuel composition, increases in density decrease the propagation speed and increase mean peak temperature; for a given density, increases in hemicellulose content increase both propagation speed and peak temperature. We also examined the role of natural fuel expansion with the addition of water. Without expansion, addition of moisture content reduces the propagation speed primarily due to increasing (wet) fuel density. However, with fuel expansion similar to that observed in peat, the propagation speed increases due to the overall drop in fuel density. Finally, we studied the influence of fuel composition on critical moisture content of ignition and extinction: mixtures dominated by hemicellulose have 10% higher critical moisture content due to the increase in peak temperature.

Simulation of Friction Stir Spot Welding of Copper and Aluminium During Plunging Phase

Simulation is limited and remains briefly addressed in the literature of friction stir spot welding (FSSW) process in joining dissimilar copper and aluminium. Thus, this study simulated the FSSW process of copper and aluminium to investigate the peak temperature during the plunging phase produced by all possible combinations of levels for tool rotational speed, plunge rate, and plunge depth according to the full factorial design. The modeling was established by Coupled Eulerian-Lagrangian (CEL) model and ‘dynamic, temperature-displacement, explicit’ analysis. The highest peak temperature of 994.4 oC was produced by 2400 rpm rotational speed, 100 mm/min plunge rate, and 1.6 mm plunge depth. The combination was suggested to be the optimum welding parameters in joining copper to aluminium as sufficient heat input was essential to soften the area around the welding tool and adequately plasticize the material. Three sets of confirmation tests presented consistent responses with a mean peak temperature of 994.4 °C, which validated that the response produced by the suggested optimum welding parameters was reliable. The statistical result reported that the variability in the factors could explain 84.12% of the variability in the response. However, only the rotational speed and plunge depth were statistically significant. The residual plots showed that the regression line model was valid.

Thermal Profile of Pulse Precision Capsulotomy: In vivo and In vitro Infrared Thermography Study.

PurposeThis study aimed to elucidate the thermal safety of precision pulse capsulotomy (PPC) via in vivo and in vitro evaluation of the thermal profile using infrared thermography.MethodsThis prospective observational study enrolled 15 eyes from 15 participants who underwent cataract surgery using the Zepto PPC. All patients underwent temperature measurements of the incision site and the entire cornea using an infrared thermographer during the capsulotomy procedure. To accurately analyze the temperature change of the Zepto PPC, infrared thermography was performed with the Zepto handpiece while exposed to air and then in porcine eyes. Moreover, in each case, the difference in temperature change according to the use of an ophthalmic viscosurgical device (OVD) was also checked to determine the temperature buffering effect.ResultsIn the clinical evaluations, the mean temperature elevation around the corneal incision and time duration from baseline to peak temperature during the Zepto capsulotomy were 4.0°C ± 1.9°C and 4.43 ± 1.26 seconds, respectively, with a mean peak temperature of 32.6°C ± 2.0°C. The mean peak temperature and rise time of the naïve Zepto nitinol ring, as measured from the bottom side, were 109.0°C ± 22.9°C and 43.40 ± 11.06 seconds in the experimental procedures, respectively. In the porcine eyes, the mean elevation of temperature and rise time of the Zepto nitinol ring were 6.2°C ± 1.6°C and 11.67 ± 2.08 seconds with the use of OVDs, and 10.5°C ± 3.3°C and 14.00 ± 3.61 seconds without OVDs, respectively.ConclusionsZepto PPC has the potential to generate extremely high thermal energy, according to an in vitro study. However, the temperature rise of the Zepto capsulotomy can be minimized by using OVDs.

Age clinical and laboratory features of primary Epstein-Barr viral infection in children

Aim: to delineate the clinical presentation and laboratory profile of primary Epstein-Barr viral infection (EBVI) in children.Materials and methods. A retrospective study was conducted on the demographic, clinical and laboratory data of 104 children with infectious mononucleosis due to Epstein–Barr virus (EBV) infection in children. The analysis included serologically confirmed cases – the presence of IgM to the capsid EBV antigen (VCA IgM) with the absence of antibodies to the nuclear EBV antigen (EBNA IgG).Results. The mean age of children was 4.0 (2.6; 9.0) years. The maximum hospital morbidity for infectious mononucleosis was observed in children from 2 to 5 years – 35.6 % whereas in patients from 12 years to 17 years – 19.2 %. The mean peak temperature was higher in young children. The rate of the cervical lymphadenopathy was significantly higher in adolescents compared with infants (P < 0.001). Tonsillitis syndrome was more commonly seen in children aged from 2 to 11 years (P < 0.05). Rash was detected in 22.1 % (n = 23) of children. The presence of petechiae was more common in older children. Hepatosplenomegaly syndrome was reported in 50 % of older children and only in 8.7 % of infants. Cytolytic syndrome was reported in 54.2 % of patients from 6 to 11 years and in 100 % of the adolescents from 12 to 17 years, although in infants it was only in 34.8 % (P < 0.001). Atypical mononuclear cells were detected in 8.7% of early age children and in 24.3–37.5 % of older children.Conclusions. Age differences were noted in clinical findings for cervical lymphadenopathy and splenomegaly, which were less common in children of the first 2 years. A significant difference in the incidence of hepatitis was found: with increasing age of the patient, the mean level of ALT increased significantly and gradually.

Body Temperature Responses During Phases of Work in Human Remains Detection Dogs Undergoing a Simulated Deployment.

Simple SummaryWorking dogs are frequently transported via crates in vehicles to various deployment scenarios. Body temperature increase associated with exercise is common but has not been assessed throughout the entire work cycle for dogs during a deployment scenario. We measured continuous temperature changes for dogs throughout an entire day of search operations including each stage of the work cycle, namely waiting-to-work, active work, and post-work recovery. We found that dogs did not increase in temperature while waiting-to-work but temperature did increase during the period of active work. Additionally, when dogs were returned to vehicles for crate and rest during the post-work recovery period, body temperatures continued to increase. We suggest that post-work recovery in the vehicle should be further investigated to better manage dogs through continuing search operations.Body temperature responses were recorded during phases of work (waiting-to-work in close proximity to search site, active work in a search site, and post-work recovery crated in vehicle) in human remains detection dogs during search training. State or federally certified human remains detection dogs (n = 8) completed eight iterations of searching across multiple novel search environments to detect numerous scent sources including partial and complete, buried, hidden, or fully visible human remains. Internal temperature (Tgi) of the body was measured continuously using an ingestible thermistor in the gastrointestinal tract. Mean total phase times were: waiting-to-work: 9.17 min (±2.27); active work: 8:58 min (±2:49); and post-work recovery: 24:04 min (±10.59). Tgi was impacted by phase of work (p < 0.001) with a small increase during active work, with mean peak temperature 39.4 °C (±0.34 °C) during that period. Tgi continued to increase for a mean of 6:37 (±6:04) min into the post-work recovery phase in the handler’s vehicle with a mean peak Tgi of 39.66 °C (±0.41 °C). No significant increase in temperature was measured during the waiting-to-work phase, suggesting behaviors typical of anticipation of work did not appear to contribute to overall body temperature increase during the waiting-to-work recovery cycle. Continued increase of gastrointestinal body temperature several minutes after cessation of exercise indicates that risk of heat injury does not immediately stop when the dog stops exercising, although none of the dogs in this study reached clinically concerning body temperatures or displayed any behavioral signs suggestive of pending heat injury. More work is needed to better understand the impact of vehicle crating on post-work recovery temperatures in dogs.

Hyperoxia enhances self-paced exercise performance to a greater extent in cool than hot conditions.

What is the central question of this study? Hyperoxia enhances endurance performance by increasing O2 availability to locomotor muscles. We investigated whether hyperoxia can also improve prolonged self-paced exercise in conditions of elevated thermal and cardiovascular strain. What is the main finding and its importance? Hyperoxia improved self-paced exercise performance in hot and cool conditions. However, the extent of the improvement (increased work rate relative to normoxia) was greater in cool conditions. This suggests that the development of thermal and cardiovascular strain during prolonged self-paced exercise under heat stress might attenuate the hyperoxia-mediated increase in O2 delivery to locomotor muscles. The aim of this study was to determine whether breathing hyperoxic gas when self-paced exercise performance is impaired under heat stress enhances power output. Nine well-trained male cyclists performed four 40min cycling time trials: two at 18°C (COOL) and two at 35°C (HOT). For the first 30min, participants breathed ambient air, and for the remaining 10min normoxic (fraction of inspired O2 0.21; NOR) or hyperoxic (fraction of inspired O2 0.45; HYPER) air. During the first 30min of the time trials, power output was lower in the HOT (∼250W) compared with COOL (∼273W) conditions (P<0.05). In the final 10min, power output was higher in HOT-HYPER (264±25W) than in HOT-NOR (244±31W; P=0.008) and in COOL-HYPER (315±28W) than in COOL-NOR (284±25W; P<0.001). The increase in absolute power output in COOL-HYPER was greater than in HOT-HYPER (∼12W; P=0.057), as was normalized power output (∼30%; P<0.001). The peripheral capillary percentage oxygen saturation increased in HOT-HYPER and COOL-HYPER (P<0.05), with COOL-HYPER being higher than HOT-HYPER (P<0.01). Heart rate was higher during the HOT compared with COOL trials (P<0.01), as were mean skin temperature (P<0.001) and peak rectal temperature (HOT, ∼39.5°C and COOL, ∼38.9°C; P<0.01). Thermal discomfort was also higher in the HOT compared with COOL (P<0.01), whereas ratings of perceived exertion were similar (P>0.05). Hyperoxia enhanced performance during the final 25% of a 40min time trial in both HOT and COOL conditions compared with normoxia. However, the attenuated increase in absolute and normalized power output noted in the HOT condition suggests that heat stress might mitigate the influence of hyperoxia.

A Pilot Prospective Single-Arm Clinical Study on Decitabine Plus CAG or IA Followed with HLA-Mismatched Nonmyeloablative Transplantation (micro transplantation) on De Novo Elderly Acute Myeloid Leukemia and Int-2/High Risk Myelodysplastic Syndrome Patients

Objective: To observe the efficacy and safety of Decitabine plus CAG or IA followed with HLA-mismatched nonmyeloablative transplantation (micro transplantation) on de novo elderly Acute Myeloid Leukemia and Int-2/high risk Myelodysplastic Syndrome patientsMethods: Till submission of this article, 10 patients were enrolled in this prospective clinical study. Patients were admitted from January 2017 to June 2018 to our centre. 6 of whom were elderly AML (≥60 years) and 4 were Int-2/high risk MDS according to IPSS-R scoring system. Induction chemotherapy were decitabine (15 mg/m2) for 5 days followed with CAG (cytarabine 10 mg/m2 q12h; aclarubicin 10 mg/day and G-CSF at 300 μg/day x 6 days for AML and 4 days for MDS), then followed with a transfusion of HLA-mismatched (≤7/10 matched HLA loci) related donor peripheral stem cells (micro transplantation) 24 hours after chemotherapy. Consolidation therapy was another 3 courses of chemotherapies which were decitabine (15 mg/m2) for 5 days with IA (3+7) for AML or CAG (6 days) for MDS, followed by micro transplantation 24 hours after each course. Till now, the total observable treatment courses were 21.Results: The average age of the patients was 63.5 years (range from 55 to 71 years). The average number of transfusion mononuclear cells (MNC) at per course was 3.26 (1.87-5.25) x 108/kg, the average CD34+ cells was 1.12 (0.34-3.16) x 106/kg, and the average of CD3+ T cells was 3.93 (1.87-7.17) x 107/kg. Among them, 5 cases (50%) obtained CR (CR+CRi), 3 cases obtained PR (30%). The ORR was 83.3% for elderly AML patients, 75% for MDS patients and 80% for all patients. The median recovery time of neutrophil (from the end of chemo to neutrophil ≥0.5 x 109) was 9 days and was 8.5 days for platelets (from the end of chemo to platelets ≥20 x 109). 1 patient developed severe aGVHD and died, 1 patient died of heart failure, no other serious adverse events were observed in rest patients. 7 of 10 cases developed peripheral T cell increase after stem cell transfusion, including the total CD3+ T cells, CD4+ and CD8+ T cells, with an average peak at day7. The increased T cells were verified as host origin by short tandem repeat (STR) detection performed on 1 patient. 8 of 10 cases occurred cytokine related fever (CRF) after stem cell transfusion. The fever was usually happened within 24 hours after stem cell transfusion, with an average duration of 5 days and a mean peak temperature at 39.7 ℃. With CRF there was an increase of cytokines with different patterns in different patients but majorly on IL-6, IL-2, IFN-r and TNF-a. Also there was an increase of C-Reactive Protein (CRP) which reached an average peak level as 116.9 mg/L. Patients with CRF had a CR+CRi rate at 62.5%.Conclusion: Our preliminary results of this study indicate that Decitabine plus CAG or IA followed with micro transplantation have an ORR at 80% in de novo elderly Acute Myeloid Leukemia and Int-2/high risk Myelodysplastic Syndrome patients with controllable recover time of neutrophils and platelets. Although the incidence of acute graft versus host disease (aGVHD) in micro transplantation was as low as 1-2% according to reports, it is still possible. How to predict and avoid severe aGVHD is still under investigate. The presence of cytokine related fever may associate with the increase of hosts' T cells, which may relate to the improvement of therapeutic response. Larger cohorts and more investigates need to be done to clarify above findings. DisclosuresNo relevant conflicts of interest to declare.

Computational study of the effects of density, fuel content, and moisture content on smoldering propagation of cellulose and hemicellulose mixtures

Smoldering combustion plays an important role in forest and wildland fires. Fires from smoldering combustion can last for long periods of time, emit more pollutants, and be difficult to extinguish. This makes the study of smoldering in woody fuels and forest duff important. Cellulose, hemicellulose, and lignin are the major constituents in these type of fuels, in different proportions for different fuels. In this article, we developed a 1-D model using the open-source software Gpyro to study the smoldering combustion of cellulose and hemicellulose mixtures. We first validated our simulations against experimentally obtained values of propagation speed for mixtures with fuel compositions including 100%, 75%, 50%, and 25% cellulose, with the remaining proportion of hemicellulose. Then, we studied the effects of varying fuel composition, density, and moisture content on smoldering combustion. We found that propagation speed of smoldering increases with decreasing density and increasing hemicellulose content, which we attribute to the role of oxygen diffusion. Propagation speed increases with moisture content for pure cellulose up to a certain limiting value, after which the propagation speed drops by up to 70%. The mean peak temperature of smoldering increases with hemicellulose content and density, and decreases with increasing moisture content.

Heat generation during removal of an abutment screw fragment from dental implants

Statement of problemLittle information is available on the effect of drilling speed on surrounding bone during the removal of an abutment screw fragment. PurposeThe purpose of this in vitro study was to compare, in vitro, the peak temperature increase during the removal of fractured abutment screws from implants placed in a porcine mandible, using drilling speeds of 600 or 2000 rpm. Material and methodsTwenty 4.3×13-mm dental implants were placed in 10 dissected porcine mandibles: 2 implants per mandible, 1 on each side. Localized defects were created in 20 surface-treated abutment screws, which were then tightened into each implant until a reproducible fracture occurred in each screw. The fractured screws were removed with a handpiece removal kit and irrigated with room-temperature water at either 600 or 2000 rpm. The temperature rise at the implant surface was measured at 3 levels with 3 type-K thermocouples. Repeated measure ANOVA was performed with the Tukey-Kramer post hoc test for mean pair-wise comparisons (α=.05 for all tests). ResultsMean peak temperatures were significantly higher at 2000 rpm than at 600 rpm in the mid-body (P<.001) and crestal (P=.003) regions but not in the apical (P=.225) implant locations. No significant differences in mean peak temperatures were found among the 3 locations using 600 rpm (P=.179). In the 2000-rpm group, mean peak temperature in the mid-body area was consistently higher than that in the apical (P<.001) area, and more instances of temperature rise above 56°C and 60°C were observed. In 1 implant from this group, the estimated peak temperature exceeded the bone damage threshold value (50°C for 30 seconds). ConclusionsA drilling speed of 2000 rpm during the removal of abutment screw fragments caused overheating of the outer surface of the implant which may damage the surrounding bone; a speed of 600 rpm appears to be safe.

Subacromial temperature profile during bipolar radiofrequency use in shoulder arthroscopy. Comparison of Coblation® vs. VAPR®

BackgroundThe use of bipolar electrodes for arthroscopic procedures carries a theoretical ex vivo risk of inducing burn injuries. Few studies have measured the in vivo temperatures produced by bipolar electrodes during arthroscopy, and their results are conflicting. The objective of this study was to evaluate the temperature profile within the subacromial space during shoulder arthroscopy with two different electrode systems. HypothesisThe primary hypothesis was that the two electrode systems produced similar temperature variations and peak temperatures. The secondary hypothesis was that neither electrode system produced irrigation-fluid temperatures above the tissue-damage threshold. Material and methodsA comparative, prospective, single-centre, single-surgeon, single-blind study was conducted to compare the Coblation® system (Smith&Nephew, Andover, MA, USA) and the VAPR® system (DePuy Synthes Mitek Sports Medicine, Raynham, MA, USA) in 13 patients undergoing shoulder arthroscopy. A temperature probe inserted into the subacromial space was used to record temperatures at 10-second intervals for 60seconds during continuous radiofrequency application. ResultsMean baseline temperature was 21.4±0.7°C with VAPR® and 23.0±2.2°C with Coblation®. No significant between-group differences were found during the first 40seconds. The mean peak temperature reached after 60seconds was 25.0±1.9°C with VAPR® and 27.9±2.8°C with Coblation® (P<0.05). DiscussionFew studies have compared the in vivo temperatures produced during arthroscopy by different electrode systems. In vivo studies have established that temperature increases can cause tissue damage, particularly to chondrocytes, and that the irrigation flow rate plays a key role in lowering the in vivo temperatures. Our study showed a significant difference between the two electrode systems after 50seconds of use, with lower temperatures with the VAPR®. Nevertheless, neither system increased the irrigation-fluid temperatures above the tissue-damage threshold. Both systems can be used safely, provided the manufacturer instructions are followed and the irrigation system is effective. Level of evidenceII (prospective randomized trial).

Global Energetics of Solar Flares. V. Energy Closure in Flares and Coronal Mass Ejections

Abstract In this study we synthesize the results of four previous studies on the global energetics of solar flares and associated coronal mass ejections (CMEs), which include magnetic, thermal, nonthermal, and CME energies in 399 solar M- and X-class flare events observed during the first 3.5 yr of the Solar Dynamics Observatory (SDO) mission. Our findings are as follows. (1) The sum of the mean nonthermal energy of flare-accelerated particles ( ), the energy of direct heating ( ), and the energy in CMEs ( ), which are the primary energy dissipation processes in a flare, is found to have a ratio of , compared with the dissipated magnetic free energy , which confirms energy closure within the measurement uncertainties and corroborates the magnetic origin of flares and CMEs. (2) The energy partition of the dissipated magnetic free energy is: 0.51 ± 0.17 in nonthermal energy of electrons, 0.17 ± 0.17 in nonthermal ions, 0.07 ± 0.14 in CMEs, and 0.07 ± 0.17 in direct heating. (3) The thermal energy is almost always less than the nonthermal energy, which is consistent with the thick-target model. (4) The bolometric luminosity in white-light flares is comparable to the thermal energy in soft X-rays (SXR). (5) Solar energetic particle events carry a fraction of the CME energy, which is consistent with CME-driven shock acceleration. (6) The warm-target model predicts a lower limit of the low-energy cutoff at , based on the mean peak temperature of the differential emission measure of T e = 8.6 MK during flares. This work represents the first statistical study that establishes energy closure in solar flare/CME events.

A Novel Cast Removal Training Simulation to Improve Patient Safety

Cast application and removal are essential to orthopedics and performed by providers of variable training. Simulation training and practice of proper cast application and removal may reduce injury, optimize outcomes, and reduce health care costs. The purpose of this educational initiative was to develop, validate, and implement a novel simulation trainer and curriculum to improve safety during cast removal. In all, 30 thermocouples (Omega, Stamford, CT) were applied to a radius fracture model (Sawbones, Vashon, WA). After reduction and cast application, a saw (Stryker, Kalamazoo, MI) was used to cut the cast with temperature recording. Both "good" and "poor" techniques-as established by consensus best practices-were used. Maximal temperatures were compared to known thresholds for thermal injury; humans experience pain at temperatures exceeding 47°C and contact temperatures exceeding 60°C may lead to epidermal necrosis. Construct validity was evaluated by assessing novice (postgraduate year 1), intermediate (postgraduate year 3), and expert (pediatric orthopedic attending) performance. With the "good" technique, mean peak temperatures were 43°C + 4.3°C. The highest recorded was 51.9°C. With the "poor" technique, mean peak temperature was 75.2°C + 17.3°C. The maximum temperature recorded with the "poor" technique was 112.4°C. Construct validity testing showed that novices had the highest increases in temperatures (12.9°C). There was a decline in heat generation as experience increased with the intermediate group (9.7°C), and the lowest heat generation was seen in the expert group (5.0°C). A novel task simulator and curriculum have been developed to assess competency and enhance performance in the application and removal of casts. There was a 32.2°C temperature decrease when the proper cast saw technique was used. Furthermore, the "poor" technique consistently achieved temperatures that would cause epidermal necrosis in patients. Clinical experience was a predictor of decreased heat generation during cast removal. This task trainer allows instruction and safety monitoring of the casting technique.

Viral infections associated with Kawasaki disease

Background/PurposeKawasaki disease (KD) is a disease of unknown cause. To investigate the infectious etiology of Kawasaki disease, we initiated a prospective case-control study to investigate possible links between common viral infections and Kawasaki disease.MethodsWe enrolled 226 children with KD and 226 age- and sex-matched healthy children from February 2004 to March 2010. Throat and nasopharyngeal swabs were taken for both viral isolation and polymerase chain reaction (PCR) for various viruses.ResultsThe mean age of the 226 KD cases was 2.07 years, and the male to female ratio was 1.43 (133 boys to 93 girls). Their mean fever duration was 7.5 days with a mean peak temperature of 39.7°C. In addition to the typical symptoms of fever, neck lymphadenopathy, lip fissure and/or strawberry tongue, skin rash, nonpurulent bulbar conjunctivitis, palm/sole erythema, and induration followed by periungual desquamation, these KD cases also exhibited cough (69%), rhinorrhea (58%), and diarrhea (45%). Cases of KD had a significantly higher positive rate of viral isolation in comparison with the control group (7.5% vs. 2.2%, p = 0.02). Compared with the control group, cases of KD were more likely to have overall positive rates of viral PCR (50.4% vs. 16.4%, p < 0.001) and for various viruses including enterovirus (16.8% vs. 4.4%, p < 0.001), adenovirus (8.0% vs. 1.8%, p = 0.007), human rhinovirus (26.5% vs. 9.7%, p < 0.001), and coronavirus (7.1% vs. 0.9%, p = 0.003).ConclusionWe found that some common respiratory viruses, such as adenoviruses, enteroviruses, rhinoviruses, and coronaviruses, were associated with KD cases.

Effect of lung flooding and high-intensity focused ultrasound on lung tumours: an experimental study in an ex vivo human cancer model and simulated in vivo tumours in pigs

BackgroundHigh-intensity focused ultrasound is a valuable tool for minimally invasive tumour ablation. However, due to the air content in ventilated lungs, lung tumours have never been treated with high-intensity focused ultrasound. Lung flooding enables efficient lung sonography and tumour imaging in ex vivo human and in vivo porcine lung cancer models. The current study evaluates the effectiveness of lung flooding and sonography-guided high-intensity focused ultrasound for lung tumour ablation in ex vivo human and in vivo animal models.MethodsLung flooding was performed in four human lung lobes which were resected from non-small cell lung cancers. B-mode imaging and temperature measurements were simultaneously obtained during high-intensity focused ultrasonography of centrally located lung cancers. The tumour was removed immediately following insonation and processed for nicotinamide adenine dinucleotide phosphate-diaphorase and H&E staining. In addition, the left lungs of three pigs were flooded. Purified BSA in glutaraldehyde was injected centrally into the left lower lung lobe to simulate a lung tumour. The ultrasound was focused transthoracically through the flooded lung into the simulated tumour with the guidance of sonography. The temperature of the tumour was simultaneously measured. The vital signs of the animal were monitored during the procedure.ResultsA well-demarcated lesion of coagulation necrosis was produced in four of four human lung tumours. There did not appear to be any damage to the surrounding lung parenchyma. After high-intensity focused ultrasound insonation, the mean temperature increase was 7.5-fold higher in the ex vivo human tumour than in the flooded lung tissue (52.1 K ± 8.77 K versus 7.1 K ± 2.5 K). The transthoracic high-intensity focused ultrasound of simulated tumours in the in vivo model resulted in a mean peak temperature increase up to 53.7°C (±4.5). All of the animals survived the procedure without haemodynamic complications.ConclusionsHigh-intensity focused ultrasound with lung flooding produced a thermal effect in an ex vivo human lung carcinoma and in vivo simulated lung tumours in a porcine model. High-intensity focused ultrasound is a potential new strategy for treating lung cancer.

Intrapulpal thermal changes during direct provisionalization using various autopolymerizing resins: Ex-vivo study

BackgroundResin materials used in the fabrication of direct provisional restoration exhibit an exothermic reaction and the extent of damage may also depend on the remaining dentine thickness. An ex-vivo study was envisaged to compare the time related temperature changes in the pulp chamber during the fabrication of fixed partial denture provisional restorations using direct technique. The effect of differently prepared teeth (with varying remaining dentine thickness) on the above mentioned temperature changes were also evaluated. MethodsThermal changes were calculated in pulp chamber of three differently prepared tooth having different amount of remaining dentinal thickness (45 samples) and control with no tooth media (15 samples), using three different types of autopolymerizing provisional restorative materials using Cr/Al thermocouple connected to digital thermometer. ResultsThe data for the mean peak temperature rise was subjected to one way ANOVA analysis for relative comparison among subgroups within each main group and across the main groups. The results showed a statistically significant difference across both the subgroups and the main groups (p < 0.001). Then Turkey HSD test was applied to determine the significance of statistical difference between the means, within the groups. The differences in temperature rise were statistically significant for the three resins (p < 0.001). ConclusionPolymethylmethacrylate (DPI) showed the highest temperature rise value followed by polyethyl methacrylate (Tempron) and Bis-acrylate composite (CoolTemp). The maximum temperature rise was found on molar full veneer preparation followed by molar three quarter preparation and premolar three quarter preparation. Data and results from current study may assist clinicians to select an autopolymerizing provisional restorative resin when employing direct technique of fabricating provisional restorations for a specific tooth preparation which would cause minimal thermal trauma to pulpal tissue.

901 CLINICAL COURSES OF ADULTS WITH ACUTE PYELONEPHRITIS CORRELATED WITH GRADE USING COMPUTED TOMOGRAPHY

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder1 Apr 2012901 CLINICAL COURSES OF ADULTS WITH ACUTE PYELONEPHRITIS CORRELATED WITH GRADE USING COMPUTED TOMOGRAPHY Hyeong Gon Kim, Kyung Kyu Jun, Gwoan Youb Choo, Hyoung Keun Park, Sung Hyun Paick, and Yong Soo Lho Hyeong Gon KimHyeong Gon Kim Seoul, Korea, Republic of More articles by this author , Kyung Kyu JunKyung Kyu Jun Seoul, Korea, Republic of More articles by this author , Gwoan Youb ChooGwoan Youb Choo Seoul, Korea, Republic of More articles by this author , Hyoung Keun ParkHyoung Keun Park Seoul, Korea, Republic of More articles by this author , Sung Hyun PaickSung Hyun Paick Seoul, Korea, Republic of More articles by this author , and Yong Soo LhoYong Soo Lho Seoul, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.997AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study is to develop acute pyelonephritis (APN) grading system using computed tomography (CT) and find relationship with clinical courses of APN. METHODS We performed the prospective study between 2007 and 2011. All APN patients were underwent CT study and were divided into 4 grade groups according to the renal parenchyma involvement of infection on CT finding; grade 1: no lesion in CT, grade 2: <25% of parenchyma involvement, grade 3: 25% - 50% involvement and grade 4 group: >50% involvement. The severity index of APN was evaluated with the peak body temperature, the level of CRP and the level of leukocytosis. The recovery index was evaluated with the hospital days, duration of fever and duration of intravenous antibiotics treatment. The severity index and recovery index were compared among the patients groups. RESULTS A total of 234 patients were included in this study. Among these patients, urinary stone was found in 21 patients and renal abscess was found in 10 patients. Excluding these patients, analysis was performed in 204 patients. Mean peak temperature was 38.9°C. The level of c-reactive protein (CRP) elevation was 11.4 mg/dl and the level of white blood cell elevation was 12097.8 /ul. Mean hospital day was 6.5 days and the duration of fever was 1.6 days. As the increase of CT grading, the severity index including the peak body temperature, the level of CRP and the level of leukocytosis was significantly increased. In addition, the recovery index was increased according to the CT grading group. Hospital day was increased from 5.7 days in the group 1 to 7.6 days in the group 4 (p < 0.001) and fever duration was increased from 0.9 days in the group 1 to 1.9 days in the group 4 ( p = 0.005). CONCLUSIONS CT grading according to renal involvement was well correlated with the severity and recovery in APN patients. This CT grading might provides a useful tool to predict the clinical course of APN. Table 1. Comparisons according to APN grades Overall Group 1 Group 2 Group 3 Group 4 P value Severity index Peak body temperature (°) 38.9 38.2 38.6 39.1 38.9 0.001 Peak CRP (mg/dl) 11.4 3.6 6.8 12.4 21.9 0.000 Peak leukocytosis (/ul) 12098.1 9935.4 10210.6 12411.0 16005.4 0.000 Recovery index Hospital stay (days) 6.5 5.7 6.1 6.5 7.6 0.000 Fever duration (days) 1.5 0.9 1.4 1.7 1.9 0.005 Antibiotics duration (days) 6.2 5.5 5.9 6.1 7.4 0.000 © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e367 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hyeong Gon Kim Seoul, Korea, Republic of More articles by this author Kyung Kyu Jun Seoul, Korea, Republic of More articles by this author Gwoan Youb Choo Seoul, Korea, Republic of More articles by this author Hyoung Keun Park Seoul, Korea, Republic of More articles by this author Sung Hyun Paick Seoul, Korea, Republic of More articles by this author Yong Soo Lho Seoul, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

In vivo temperature measurement in the subacromial bursa during arthroscopic subacromial decompression

The purpose of the study was to evaluate whether use of a bi-polar radiofrequency (RF) ablation wand would cause excess heating, which may lead to collateral damage to the surrounding tissues during arthroscopic subacromial decompression. Cadaveric studies have shown that high temperatures can potentially be reached when using RF ablation wands in arthroscopic shoulder surgery. Only 1 other published study assesses these temperature rises in the clinical setting. Fifteen patients were recruited to participate in the study. A standard arthroscopic subacromial decompression was performed using continuous flow irrigation, with intermittent use of the RF ablation wand for soft tissue debridement. The temperature of the irrigation fluid within the subacromial bursa and the outflow fluid from the suction port of the wand were measured during the procedure using fiber-optic thermometers. The mean peak temperature recorded in the subacromial bursa was 32.0°C (29.3-43.1°C), with a mean rise from baseline of 9.8°C. The mean peak temperature recorded from the outflow fluid from the wand was 71.6°C (65.6-77.6°C), with a mean rise from baseline of 49.4°C. High temperatures were noted in the outflow fluid from the wand; however, this was not evident in the subacromial bursa itself. Use of room temperature inflow fluid, maintenance of flow through the bursa, and avoidance of prolonged uninterrupted use of the wand all appear to ensure that safe temperatures are maintained in the subacromial bursa not only in the laboratory but also in a clinical setting.

Influence of the volumes of bis-acryl and poly(methyl methacrylate) resins on their exothermic behavior during polymerization

This study aimed to evaluate the influence of the volumes of a bis-acryl resin (Luxatemp) and a poly(methyl methacrylate) resin (Jet) on their exothermic behaviors during polymerization based on vinyl group conversion. The number of vinyl groups reacted and exotherm were determined based on weight percent of methacrylate groups using FTIR spectroscopy. Temperature changes during polymerization at 23°C were recorded for 20 minutes using a multiple cavity mold overlying a thermocouple. The number of vinyl groups reacted and exotherm of Luxatemp were consistently lower than those of Jet at each resin volume. Mean peak temperature rises of Luxatemp and Jet were in the range of 2.0-6.6°C and 4.2-11.6°C respectively, with Luxatemp and Jet taking 2 and 10 minutes respectively to reach their peak temperatures. As their resin volumes increased, their peak temperatures and total peak areas were also observed to increase significantly (p<0.01).