Rescue Method Research Articles

Metodologia para resgate de matrizes e enraizamento de estacas de Eremanthus erythropappus

Pelo importante papel ecológico que a espécie Eremanthus erythropappus (candeia) desempenha, aliado à crescente demanda pelos produtos obtidos dessa espécie, trabalhos vêm sendo feitos com o intuito de desenvolver sua silvicultura. Dentre os estudos com a espécie, é necessário iniciar o processo de clonagem, em razão da necessidade de melhorar a qualidade dos povoamentos a serem implantados. Portanto, o passo inicial para esse objetivo foi definir uma metodologia para resgate de matrizes e enraizamento de estacas da espécie. Como forma de resgatar as matrizes, 24 árvores de um povoamento de candeia com seis anos de idade foram decepadas a 15, 30, 45 e 60 cm de altura em relação à superfície do solo, sendo que em 12 árvores, procedeu-se ao tratamento de escarificação do solo. A contagem e a coleta de brotos foram executadas aos 65 e 135 dias após a decepa, respectivamente. Das brotações obtidas, foram confeccionados três tipos de estacas: Apical 1, Apical 2 e Basal, que foram tratadas com AIB nas concentrações de 0, 200, 400, 800 ou 1600 mg kg-1 e colocadas para enraizarem em casa de vegetação climatizada. Com base nos resultados, conclui-se que a decepa, independente da altura, seguida da escarificação do solo e o enraizamento das estacas preparadas a partir das brotações coletadas de raízes é um método eficiente para resgate de matrizes e enraizamento de estacas de candeia, sendo que os maiores percentuais de enraizamento foram encontrados para as estacas apicais, não variando em função da concentração de AIB.

Use of UKCAT scores in student selection by UK medical schools, 2006-2010

BackgroundThe United Kingdom Clinical Aptitude Test (UKCAT) is a set of cognitive tests introduced in 2006, taken annually before application to medical school. The UKCAT is a test of aptitude and not acquired knowledge and as such the results give medical schools a standardised and objective tool that all schools could use to assist their decision making in selection, and so provide a fairer means of choosing future medical students.Selection of students for UK medical schools is usually in three stages: assessment of academic qualifications, assessment of further qualities from the application form submitted via UCAS (Universities and Colleges Admissions Service) leading to invitation to interview, and then selection for offer of a place. Medical schools were informed of the psychometric qualities of the UKCAT subtests and given some guidance regarding the interpretation of results. Each school then decided how to use the results within its own selection system.MethodsAnnual retrospective key informant telephone interviews were conducted with every UKCAT Consortium medical school, using a pre-circulated structured questionnaire. The key points of the interview were transcribed, 'member checked' and a content analysis was undertaken.ResultsFour equally popular ways of using the test results have emerged, described as Borderline, Factor, Threshold and Rescue methods. Many schools use more than one method, at different stages in their selection process. Schools have used the scores in ways that have sought to improve the fairness of selection and support widening participation. Initially great care was taken not to exclude any applicant on the basis of low UKCAT scores alone but it has been used more as confidence has grown.ConclusionsThere is considerable variation in how medical schools use UKCAT, so it is important that they clearly inform applicants how the test will be used so they can make best use of their limited number of applications.

Murine Model of Oligotrophic Tibial Nonunion

This study aimed to use modified distraction osteogenesis techniques to develop a reliable mouse fracture nonunion model with an oligotrophic phenotype. Twenty-six 10- to 14-week-old C57BL/6 male mice underwent a proximal diaphyseal tibial osteotomy with a 2-mm bone resection. An external fixation device was applied to the tibia using cerclage wires. A total of 2.25 mm of distraction was applied over 3 days, resulting in an average distraction gap of 4.28 mm. Plain radiographs were taken at regular intervals until euthanasia at 7 (n = 9), 10 (n = 13), or 12 (n = 4) weeks. After euthanasia, all samples were fixed in formalin, scanned with microcomputed tomography, decalcified in formic acid, prepared in paraffin, and stained with Alcian blue/Mayer's hematoxylin. In the distraction groups, five mice were prematurely euthanized as a result of wound complications stemming from loss of distal fixation. Of the remaining 21, two healed, resulting in a 90% nonunion rate. These nonunions radiographically resembled clinical nonunions with tapered, cone-like fracture ends and histologically demonstrated evidence of attempted healing as seen with cartilage capping. Additionally, the plain radiographic appearance of those nonunions from mice euthanized at 10 and 12 weeks did not change over the final 4 to 6 weeks. The use of 2-mm tibial resection osteotomy with 2-mm distraction provides a predictable model for fracture nonunion in mice with the oligotrophic phenotype closely resembling the clinical correlate. This model offers a promising means for characterization of the molecular events that occur during the development of fracture nonunion and for evaluation of noninvasive methods of nonunion rescue.

Intrahospital Transport to the Radiology Department: Risk for Adverse Events, Nursing Surveillance, Utilization of a MET, and Practice Implications

Nurses providing care in the radiology department (RD) are challenged by the broad scope of conditions and varied acuity of patients served by this unit. Nurses must facilitate the required diagnostic testing and simultaneously provide the surveillance necessary to detect physiologic changes signaling the need for rescue interventions. When instability occurs, one method of rescue involves activation of a medical emergency team (MET) to bring an experienced cadre of critical care providers to the unstable patient. Despite recognition that the RD can be a high-risk area, there is little in the literature specific to the surveillance of RD patients, risk for and prevention of adverse events, MET activation or the management of patient instability specific to the RD. The purpose of this article is to examine what is known regarding risk for adverse events during intrahospital transport, utilization of a MET as a rescue intervention, and practice implications.

Uterine arterial embolization in the management of severe post-partum hemorrhage: A successful rescue method to avoid peripartum hysterectomy

Background Although the effects of uterine arterial embolization (UAE) for the control of post-partum hemorrhage on menstruation, fertility and future pregnancy have been reported before, domestic reports on long-term outcomes are lacking. Methods From April 2001 to March 2005, 9 patients who underwent UAE for post-partum hemorrhage were evaluated retrospectively. The analyses included both immediate and long-term outcome, including menstruation, future fertility and subsequent pregnancies. Results The median follow-up was 82 months, ranging from 63 months to 108 months. All the women had regular menstruation after UAE treatment, but 5 had hypomenorrhea. Four women attempted pregnancy, and 3 had successful term deliveries. One woman was infertile. Conclusion UAE appeared to be a safe procedure. Hypomenorrhea was common after UAE treatment (55.6%), although regular menstruation returned successfully. Future pregnancy seemed possible, and without complications.

Usefulness of an algorithm for endoscopic retrieval of proximally migrated 5Fr and 7Fr pancreatic stents

Proximal migration of pancreatic stent (PMPS) is an infrequent event but its management can be technically challenging and there are no standard retrieval methods. This study aimed to determine the results of an endoscopic stent retrieval algorithm in terms of feasibility and efficacy of the endoscopic procedure. During the period from January 2008 to December 2009, 15 patients (8 women and 7 men with a mean age of 51.9 years) with PMPS were included in this study. Stent retrieval was approached initially with balloon extraction followed by rat-tooth forceps and basket. A rescue approach such as using a stent retriever was attempted when other approaches failed. All the PMPSs (six 5Fr, nine 7Fr) were retrieved successfully within one ERCP session. Balloon extraction was successful in 9 (60%) patients. In the 6 failed cases of balloon extraction, wire-guided rat-tooth forceps grasp was successful in 4, and stone extraction basket grasp was successful in 1 in whom forceps grasp failed. One stent was finally rescued with a stent retriever when balloon extraction, forceps and basket grasp all failed. In patients with successful balloon extraction, 44.4% (4/9) developed post-ERCP hyperamylasemia but none of them developed post-procedure pancreatitis. With this algorithm, 5Fr and 7Fr PMPS were successfully retrieved in all of the patients. Most PMPSs can be safely retrieved with the commonly-used approaches in this study. Those less used approaches can be used as a rescue method.

Childhood drowning and traditional rescue measures: case study from Matlab, Bangladesh

Recent mortality data indicate that approximately half a million people drown each year worldwide, with more than 97% of such deaths occurring in low-income and middle-income countries. The purpose of...

Inversed ratio ventilation as an rescue option for ventilation of very premature infants

Objective: We report on three very premature infants who were treated with inverse ratio ventilation (IRV) using a high ventilation frequency (˜60/min) as a rescue method for oxygenation. IRV has become a popular mode of ventilation in adults, but has not been used in premature infants so far. The idea of using IRV stems from a concern of possible ventilator-induced lung injury using high peak pressures to generate higher mean inspiration pressures. Using IRV creates the possibility to increase tidal volumes, overcome the critical opening pressure during inspiration and better alveolar recruitment without increasing the peak pressure. Patients: Three extremely premature infants with a birth weight ranging from 640g and 990g. All of them could not be ventilated adequately with conventional ventilation neither with high frequency oscillation. They were treated with high frequency inverse ratio ventilation. Measurements and main result: At our NICU oxygen saturation, paO2, paCO2 were measured on a regular basis and ventilation modified accordingly. When our standard ventilation schemes failed, high frequency inverse ration ventilation was used a rescue method. When this failed IRV was used as a rescue method. All infants had significant benefit of our IVR ventilation scheme. Conclusion: It seems that in our setting we were able to combine the benefits of pcIRV and of high frequency positive pressure ventilation. The IRV scheme was well tolerated without additional sedation or relaxation needed. All three infants left our NICU without radiological signs of severe BPD. Further studies are needed to describe the possible beneficial role of high frequency pcIRV in premature infants with respiratory failure

An Enhancement of Europium-/Gadolinium- Diphacinone -DL-Histidine- Cetylpyridine Bromide System for the Determination of Diphacinone in Serum

As one of the first generation anticoagulant rodenticide, diphacinone (DPN) was extensively used in China, and often occurred accidental and intentional intoxications. To meet the needs of clinical emergency rescue, a simple, rapid and sensitive method was necessary for the determination of DPN in serum. In this paper, a fluorimetric method using a ternary europium-gadolinium-DPN-DL-histidine-cetylpyridine bromide system was developed. The fluorescence intensity was measured with a 1 cm quartz cell at 335 nm excitation wavelength and 612 nm emission wavelength. The fluorescence intensity of the europium-DPN- DL- histidine complex system was further enhanced by using gadolinium ion (Gd(3+)) in a cetylpyridine bromide (CPB) colloid-type suspension. By adding Gd(3+) at pH 8.5 to 9.5 in the presence of an ammonia-ammonium chloride buffer solution, about a 100-fold enhancement of the fluorescence intensity was achieved. The enhanced fluorescence intensity showed a good linear relationship with the DPN concentration from 0.01 mg/L to 5.0 mg/L. The limit of detection was 0.001 mg/L in serum. The established method was used to determine DPN in real human serum in clinical specimens. The luminescence mechanism was discussed in detail. In the fluorescence system of the europium-gadolinium-DPN-DL-histidine-CPB, the CPB not only acted as the surfactant but also acted as the energy donor.

Proximally migrated pancreatic stent successfully removed using needle-knife and forceps: Complication after precut papillotomy assisted by pancreatic stenting

Pancreatic stent-assisted ampullary precut papillotomy is a rescue method for cases with difficult bile duct cannulation during endoscopic retrograde cholangiopancreatography (ERCP). We describe a case in which post-ERCP pancreatitis (PEP) developed due to the proximal migration of pancreatic stent, after precut papillotomy. Removal of the migrated pancreatic stent was achieved after needle-knife incision of the pancreatic duct's orifice followed by retrieval of the stent using rat-tooth forceps, which resulted in rapid resolution of the PEP. Caution is needed when pancreatic stent is placed after papillary incision. Needle-knife incision of the pancreatic duct orifice followed by forceps removal is an effective technique for rescuing pancreatic stent migration.

High-frequency oscillatory ventilation in adults: experience in Chile

The aim was to describe the epidemiological profile of adult patients who were treated with HFOV like a rescue method after conventional mechanical ventilation failure, during 2009 in our ICU, in Santiago, Chile, and to describe patient characteristics, HFOV strategies and outcomes.

The Effective Use of Plerixafor as a Real-Time Rescue Strategy for Patients with Poorly Mobilizing Autologous CD34+ Cells

AbstractAbstract 2251 Background:Plerixafor has been demonstrated to enhance peripheral blood CD34+ cell mobilization and apheresis yields in combination with G-CSF and has been shown to salvage patients who have failed prior harvests. However, the optimal use of plerixafor is unknown as the vast majority of patients can be successfully collected without the use of this agent. We hypothesized that plerixafor could effectively be employed as a “rescue” strategy in the midst of mobilization for patients with factors indicating a likely poor CD34+ cell yield. Patients and Methods:Between Feb 2009 and May 2010, 522 aphereses were performed as part of 295 autologous peripheral blood stem cell (PBSC) collections at our center. Of these, 39 (13%) utilized plerixafor as rescue strategy based on treating physicians' interpretation of clinical factors predictive of poor mobilization/collection. These included: pre-collection blood CD34+ cell concentration <10/μL (n=30, 77%, median CD34+ cell count = 5.95/μL, range 1.12– 8.64), low CD34+ cell yield from first apheresis day (n=7, 18%, median prior day's apheresis yield= 1.06 ×106 CD34+ cells/kg, range .54-1.7 ×106/kg), waning CD34+ cell yield (n=1), and clinical delay of apheresis (n=1). Baseline characteristics of these 39 patients included: median age = 62yrs (range 26–73 yrs), 23 Non-Hodgkin lymphoma, 14 multiple myeloma, 1 Hodgkin lymphoma, and 1 amyloidosis; median # of prior treatment regimens 2 (range 1–8), prior lenalidomide 14 (36%), prior fludarabine 2 (5%), prior pelvic or spinal radiation 6 (15%), prior failed mobilization 8 (21%), prior transplant 1. Twenty-six (67%) patients received chemotherapy + G-CSF for mobilization and 13 (33%) G-CSF alone prior to plerixafor. Results:Patients received a median of 1 standard dose of plerixafor (range 1–4 doses) 10–12 hours prior to apheresis. These patients had a median of 2 total days of apheresis and a median of 1 day of apheresis immediately following plerixafor. The median total CD34+ cells collected for the entire group was 5 ×106/kg (range 0.5–14.54) and 34 (87%) collected > 2 × 106 CD34/kg, 26 (67%) collected > 4 × 106 CD34/kg, and 7 (18%) collected > 8 × 106 CD34/kg. The median collections for lymphoma and myeloma patients were 4.1 × 106 and 8.3 × 106 CD34/kg, respectively. A single dose of plerixafor was associated with an increase in the mean peripheral blood precollection CD34+ cell concentration of 17.2 cells/μL (p=.005) and mean CD34+ cell yield following a single apheresis of 5.11 × 106/kg (p=.01,Table). Engraftment kinetics of 26 patients that went on to transplant included a median time to ANC>500 and plts >50K of 16 days (range 14–38 days) and 19 days (range 14–33 days), respectively. Conclusions:These data indicate that a real-time rescue strategy of adding plerixafor to G-CSF with or without prior chemotherapy in poorly mobilizing patients significantly increases the blood CD34+ cell concentration and can result in adequate PBSC collections in the majority of patients resulting in acceptable engraftment kinetics. Such an approach may provide a cost and time-effective policy by employing this agent only in those that require its use yet obviating the need for a second distinct mobilization attempt. These data suggest that a prospective validation of such a rescue method using plerixafor in autologous PBSC harvests is warranted.Table:Pre and Post plerixafor single-collection blood CD34+ cell concentrations and apheresis yields in patients treated with a real-time rescue strategy (evaluable patients with both values)nPre Plerixafor (range)Post Plerixafor (range)P valueMeanMedianRangeMeanMedianRangeBlood CD34+ concentration (cells/μL)107.306.262.46–19.7424.620.028.3–66.9.005CD34+ cell yield (× 106/kg)71.050.870.54–1.76.164.871.53–12.84.01 Disclosures:Gopal: Genzyme: Consultancy. Off Label Use: Rescue use of plerixafor. Bensinger: Genzyme: Research Funding. Holmberg: Genzyme: Research Funding.

A combined method for rescue of modified enteroviruses by mutagenic primers, long PCR and T7 RNA polymerase-driven in vivo transcription

The current methods for manipulation of enteroviral RNA genomes and production of modified virus particles include stepwise subcloning procedures and in vitro transcription and RNA transfection steps that are both time-consuming and inefficient. Several enteroviral cDNA clones with 5′-terminal T7 promoter and coxsackievirus A9 (CAV9) PCR product with the T7 promoter were transfected successfully into target cells expressing T7 RNA polymerase for the rescue of virus particles. This demonstrated the overall feasibility of the in vivo transcription method. Furthermore, a rapid method using high-fidelity DNA polymerase, Phusion™, for amplification and mutagenesis of CAV9 cDNA was generated. A long PCR method was employed together with mutagenic primers for direct introduction of a unique restriction enzyme site into the VP1-2A junction of the CAV9 cDNA clone during the PCR amplification process. Enhanced green fluorescent protein was subcloned to that site, and CAV9-eGFP cDNA was transfected to the target cells for in vivo transcription and successful rescue of CAV9-eGFP particles. The method allowed a straightforward mutagenesis and in vivo production of infectious enteroviral particles, and may be applicable routinely for rapid production of the modified picornaviruses over the use of the traditional subcloning protocols.

Evolutionary Relationships between the DiploidTurners grandifloraand the OctoploidT. fernandezii(Turneraceae)

Aiming to analyze the evolutionary relationships between the diploid species Turnera grandiflora (2n = 2x = 10) and the octoploid T. fernandezii (2n = 8x = 40), inter-specific hybrids were recovered by in vitro embryo rescue methods. The full-grown plants obtained were all pentaploids (2n = 5x = 25) confirming their hybrid nature. The chromosome associations observed in the hybrids during meiosis were indicative for an autopentaploid, suggesting that T. fernandezii carries the genome of T. grandiflora (CgCg) but at the octoploid level (CgCg CgCg CgCg CgCg). This fact confirms a close evolutionary relationship between the species and supports the hypothesis that T. grandiflora is the progenitor of T. fernandezii. A tentative hypothesis regarding the autopolyploid origin of T. fernandezii is finally formulated.

Brief review: Airway rescue with insertion of laryngeal mask airway devices with patients in the prone position

Unintentional extubation of the trachea while the anesthetized patient is in the prone position is a potentially life-threatening situation that is usually managed by turning the patient supine for emergent re-intubation. However, this approach may delay definitive airway management and lead to irreversible complications. This review evaluates the efficacy of insertion of a laryngeal mask airway device (LMAD) with the patient in the prone position as a rescue method in airway management for unintentional tracheal extubation. We searched MEDLINE and EMBASE databases in the English language for the period 1980 to October 2009 in order to identify observational studies and case reports describing insertion of the LMAD with the patient in the prone position. We found 12 such articles (n=526 patients) consisting of four retrospective studies, one prospective cohort with a control group, one non-controlled prospective study, and six case reports. On the first attempt, the LMAD was inserted successfully in 87.5-100% of the patients involved in the included reports. On the second attempt, the LMAD was inserted successfully in all patients, with or without laryngoscopy. Ventilation was maintained successfully in the lungs of 83.3-100% of the patients involved in the reported articles. Following insertion of the LMAD with patients in the prone position, the most common complications reported were sore throat, bleeding, bradycardia, and laryngospasm. Cumulative experience from published reports suggests the feasibility of placing the LMAD with the patient in the prone position in the elective setting; however, the evidence is lacking regarding the use of this method for emergency management of unintended tracheal extubation with the patient in the prone position.

Traditional postdrowning rescue methods applied in Rural Bangladesh using 10 year verbal autopsy data

Children aged 1 to 4 years in Bangladesh are at the greatest risk of drowning. From the qualitative research, rural communities reported traditional postdrowning rescue methods.ObjectiveThe overall purpose of this...

MELON BREEDING FOR RESISTANCE TO FUSARIUM WILT USING MOLECULAR MARKERS AND DIHAPLOIDIZATION

In this breeding program aimed at developing resistant varieties to Fusarium wilt in Turkish melon type, molecular markers and dihaploidization techniques were used. Cum334 was used as the donor parent in a backcross program and the haploid plants were obtained via pollination with the irradiated pollen from the BC3 population to shorten the breeding period. Four different embryo rescue methods were tested to extract haploid embryos. According to the results, the best methods were found to be inspecting seeds on the light and sowing seeds directly to nutrient media, and a total of the 122 haploid plants were obtained. The haploid plants were screened by molecular markers for fom1 and fom2 genes. A Simple Sequence Repeat (SSR) and a Randomly Amplified Polymorphic DNA (RAPD) marker were used for fom2 gene and a Cleaved Amplified Polymorphic Sequences (CAPS) and three Sequence Characterized Amplified Region (SCAR) markers were used for fom1 gene. While SSR (SSR180) did not segregate the haploid plants the RAPD marker (OPG17) segregated those haploid plants for fom2 gene. Haploid plants were screened for fom1 by a SCAR marker (SB17). Among the tested haploids, 41% of plants were found to be resistant and the rest of 59% were susceptible to the Fusarium wilt races 0 and 2. On the other hand while 34% of plants were resistant 66% were susceptible to the races 0 and 1 of the Fusarium oxysporum f.sp. melonis.

Use of high-resolution FORMOSAT-2 satellite images for post-earthquake disaster assessment: a study following the 12 May 2008 Wenchuan Earthquake

A large earthquake struck Wenchuan County, China on 12 May 2008 and is one of the most severe natural disasters of recent decades that has changed the entire landscape of Wenchuan County. This paper presents a satellite image analysis of the landslide following the Wenchuan earthquake and its consequences, and demonstrates how remote sensing techniques can be used for civilian crisis-management purpose and disaster relief. Real-time high resolution 2-dimensional and 3-dimensional information on structural deformation of land areas, directional changes of rivers, creation of new lakes, and the water levels of rivers and lakes in the earthquake affected area have been provided using the FORMOSAT-2 and Satellite pour l'Observation de la Terre (SPOT)-5 satellite images. Satellite images taken before and after the 12 May 2008 Wenchuan Earthquake have been used for landslide investigation. Possible flooding and rupture of natural dams during the post-earthquake period have been indicated through the analysis of 3-dimensional images of FORMOSAT-2. Some rescue methods have been suggested for immediate recovery of the bereaved persons and to locate the corresponding area accurately using remote sensing techniques. Some precautionary measures have also been suggested to avoid further destruction. Comparisons of panchromatic and multispectral images of FORMOSAT-2 for a particular region have been made to quantify the location accuracy. Our results show that the real-time high-spatial resolution FORMOSAT-2 satellite images could be an efficient and useful resource for decision-makers to prepare rescue and post-event recovery operation plans, especially for some isolated earthquake areas where damage distribution is often very uneven and hard to reach in time.

Magnesium Citrate Bowel Preparation for Colonoscopy

Anecdotally, many colonoscopists use magnesium citrate as part of a bowel preparation regimen or as a rescue method when a patient does not tolerate

Thawing Embryonic Stem (ES) Cells from a 96-Well Plate

The most widely used method to alter the genome of embryonic stem (ES) cells is to introduce a specifically designed DNA fragment using electroporation. The DNA will then integrate into the genome of ES cells. Colonies of cells containing the exogenous DNA are then picked, expanded, replica-plated, frozen in 96-well plates, and used as a source for genomic DNA preparation for genotyping. After ES candidate clones are identified by genomic Southern blot or polymerase chain reaction (PCR), the method of rescue of the cells from the frozen 96-well plates is very important. This protocol describes a method for thawing such cells.