Bronchopleural fistula: An update for intensivists

Bronchopleural fistula is a potentially fatal condition that may result after a variety of clinical conditions, most commonly after pulmonary resection. Either surgical or bronchoscopic repair is required to definitively correct these lesions, though a small number may resolve spontaneously with optimal ventilatory care and other options available to an intensivist in the management of this complex condition. The successful management of a bronchopleural fistula depends on formulating a treatment strategy tailored to individual patient needs.     

Combination treatment of human umbilical cord matrix stem cell-based interferon-beta gene therapy and 5-fluorouracil significantly reduces growth of metastatic human breast cancer in SCID mouse lungs

Umbilical cord matrix stem (UCMS) cells that were engineered to express interferon-beta (IFN-beta) were transplanted weekly for three weeks into MDA 231 breast cancer xenografts bearing SCID mice in combination with 5-fluorouracil (5-FU). The UCMS cells were found within lung tumors but not in other tissues. Although both treatments significantly reduced MDA 231 tumor area in the SCID mouse lungs, the combined treatment resulted in a greater reduction in tumor area than by either treatment used alone. These results indicate that a combination treatment of UCMS-IFN-beta cells and 5-FU is a potentially effective therapeutic procedure for breast cancer.     

Proximal aortic surgery in the elderly population: Is advanced age a contraindication for surgery?

Objective

The study objective was to describe the clinical outcomes of elderly patients undergoing ascending aortic surgery.

Personal protective equipment preparedness in Asia-Pacific intensive care units during the coronavirus disease 2019 pandemic: A multinational survey

BackgroundThere has been a surge in coronavirus disease 2019 admissions to intensive care units (ICUs) in Asia-Pacific countries. Because ICU healthcare workers are exposed to aerosol-generating procedures, ensuring optimal personal protective equipment (PPE) preparedness is important.ObjectiveThe aim of the study was to evaluate PPE preparedness across ICUs in six Asia-Pacific countries during the initial phase of the coronavirus disease 2019 pandemic, which is defined by the World Health Organization as guideline adherence, training healthcare workers, procuring stocks, and responding appropriately to suspected cases.MethodsA cross-sectional Web-based survey was circulated to 633 level II/III ICUs of Australia, New Zealand (NZ), Singapore, Hong Kong (HK), India, and the Philippines.FindingsTwo hundred sixty-three intensivists responded, representing 231 individual ICUs eligible for analysis. Response rates were 68–100% in all countries except India, where it was 24%. Ninety-seven percent of ICUs either conformed to or exceeded World Health Organization recommendations for PPE practice. Fifty-nine percent ICUs used airborne precautions irrespective of aerosol generation procedures. There were variations in negative-pressure room use (highest in HK/Singapore), training (best in NZ), and PPE stock awareness (best in HK/Singapore/NZ). High-flow nasal oxygenation and noninvasive ventilation were not options in most HK (66.7% and 83.3%, respectively) and Singapore ICUs (50% and 80%, respectively), but were considered in other countries to a greater extent. Thirty-eight percent ICUs reported not having specialised airway teams. Showering and “buddy systems” were underused. Clinical waste disposal training was suboptimal (38%).ConclusionsMany ICUs in the Asia-Pacific reported suboptimal PPE preparedness in several domains, particularly related to PPE training, practice, and stock awareness, which requires remediation. Adoption of low-cost approaches such as buddy systems should be encouraged. The complete avoidance of high-flow nasal oxygenation reported by several intensivists needs reconsideration. Consideration must be given to standardise PPE guidelines to minimise practice variations. Urgent research to evaluate PPE preparedness and severe acute respiratory syndrome coronavirus 2 transmission is required.     

Salivary concentrations of pirmenol as a possible cause of unpleasant taste.

Salivary concentrations of the anti-arrhythmic, pirmenol, were compared with plasma concentrations in six patients. Group mean salivary values tended to be higher despite high plasma protein binding, suggesting the possibility of an active transport process. The observed salivary concentrations are reasonably close to those detectable in healthy volunteers as tasting unpleasant.     

Characterization of a monoclonal antibody against a 24KD antigen from rat testis important for fertility regulation

Monoclonal antibodies were raised against a 24KD antigen from rat testicular cytosol which was previously shown to produce antibody titres in rats with inhibitory effect on fertility. Of the 20 hybridoma clones selected for study, one clone HS-D5 was finally chosen for characterisation as it proved to be functionally promising. The clone was secreting IgM type of antibody. It produced strong agglutination of human sperm and prevented binding of hamster sperm to hamster oocyte. In localization studies it identified the acrosome of sperm of multiple species. Western blots with rat testicular cytosol and human sperm extracts showed a strong band at around 24KD with HS-D5. On Western blots from two dimensional gels, HS-D5 identified multiple spots at the region of 24KD. The mechanism of action of the antibody seemed to be at the level of interaction of the oocyte and spermatozoa.