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The mucilage is an interesting compound found in cladodes of species of Opuntia (Cactaceae). The aim of this work was to extract the mucilages from Opuntia ficus-indica (OFI) and O. quimilo (OQ) cladodes and to examine their physicochemical characteristics, microstructure, and functional properties in solution. The mucilages exhibited high contents of carbohydrates, proteins, and minerals. Both mucilages presented a diverse monosaccharide composition, mainly constituted of galactose and arabinose. The FTIR spectra showed characteristic polysaccharide nature, whereas the diffractograms demonstrated an amorphous structure. The intrinsic viscosity of OFI mucilage was 3.08 dL/g, while that of OQ mucilage was 10.33 dL/g. Although the molecular weights of both mucilages are in the order of those of commercial gums, that of OQ was higher. This is consistent with the pseudoplastic behavior of OQ mucilage. However, OFI mucilage showed Newtonian behavior over the range of concentrations evaluated. This is fully consistent with that of semi-diluted solutions and in accordance with the lower molecular weight of this mucilage. The mucilages presented maximum solubility at 60 °C, although the mucilage of OFI was slightly more soluble than that of OQ. The chemical composition and functional properties of the mucilages can be affected by the extraction method and conditions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Current trends in Analytical Chemistry are highly focused on the introduction of new extraction materials with a high selectivity towards the target analytes, high extraction capacity as well as sustainable characteristics. In this context, the introduction of smart materials able to respond to an external stimulus constitutes a promising approach in the field. However, investigations regarding the development of such stimuli-responsive polymers have been basically centered on their synthesis and the control of their properties, and hardly on exploiting such properties to generate polymers that, once their extraction function is fulfilled, they can be degraded into fragments with little or negligible toxicity, or even into their constituent monomers for an efficient recycling., Results: The applicability of a degradable and recyclable dynamic covalent polymer based on the use of tetrazine as a linker was assessed as sorbent for the extraction of a group of 37 persistent organic pollutants, including 10 polycyclic aromatic hydrocarbons, 11 organochlorine pesticides, 14 polychlorinated biphenyls, and 2 antibacterial agents, from water samples. A microdispersive solid-phase extraction procedure was developed for the selective extraction of the target analytes, while their separation, determination, and quantification were achieved by gas chromatography coupled to mass spectrometry. The optimized procedure was validated for seawater and wastewater obtaining mean relative recovery values between 72 and 112 % for almost all the analytes, with satisfactory relative standard deviation values (<18 %). After extraction, the polymer could be degraded by adding the amino acid L-tyrosine, being possible a quantitative recovery of the initial functional monomer., Significance: A responsive polymer based on the chemical versatility of the tetrazine ring was used as sorbent in sample preparation providing excellent results, showing good physicochemical properties and the ability to be degraded after use. This polymer constitutes an interesting alternative to reduce chemical waste through the recycling of monomers, contributing to the development of more sustainable analytical methodologies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The study of marine toxins in shellfish is of the utmost importance to ensure people's food safety. Marine toxins in shellfish and microalgae in the water column off the south-central coast of Chile (36°‒43° S) were studied in a network of 64 stations over a 14-month period. The relative abundance of harmful species Alexandrium catenella, Alexandrium ostenfeldii, Protoceratium reticulatum, Dinophysis acuminata, Dinophysis acuta, Pseudo-nitzschia seriata group and P. delicatissima group was analyzed. The detection and quantification of lipophilic toxins and domoic acid (DA) in shellfish was determined by UHPLC-MS/MS, and for Paralytic Shellfish Toxins (PSTs) by HPLC-FD with post-column oxidation, while for a culture of A. ostenfeldii a Hylic-UHPLC-MS/MS was used. Results showed that DA, gonyautoxin (GTX)-2, GTX-3 and pectenotoxin (PTX)-2 were detected below the permitted limits, while Gymnodimine (GYM)-A and 13-desmethylespirolide C (SPX-1) were below the limit of quantitation. According to the distribution and abundance record of microalgae, DA would be associated to P. seriata and P. delicatissima-groups, PTX-2 to D. acuminata, and GTX-2, GTX-3, GYM-A, and SPX-1 to A. ostenfeldii. However, the toxin analysis of an A. ostenfeldii culture from the Biobío region only showed the presence of the paralytic toxins C2, GTX-2, GTX-3, GTX-5 and saxitoxin, therefore, the source of production of GYM and SPX is still undetermined., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Oil residues have been frequently found on the coasts all over the world as a result of different accidental releases. Their partial evaporation and solidification onto the coastal rocks can produce the formation of a new solid structure forming an agglomerate with other materials, mainly microplastics (though wood, glass, sand and rocks were also found), yielding to a new plastic formation, name herein for the first time as "plastitar". These new formations have been found in several of the islands of the Canary Islands archipelago (Spain). Their study has shown that these new formations can be permanently attached to the rock, occupying even a 56% of the sampled area with an heterogeneous distribution. It was also observed that the studied plastitar was composed mainly of tar and polyethylene (90.6% of the studied particles) and polypropylene (9.4% of the studied particles) microplastics, primarily fragments (82.5%), pellets (15.7%) and lines (1.8%). The ever more frequent presence of plastics and, in particular, microplastics in coastal environments can lead to the common occurrence of these new plastic formations (probably present in other parts of the world), which long-term effects on the coasts should be further investigated., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Low back pain (LBP) causes 2.6 million visits to U.S. emergency departments (EDs) annually. These patients are often treated with skeletal muscle relaxants (SMRs)., Objectives: The goal of this study was to determine whether efficacy of SMRs is associated with age, sex, or baseline LBP severity., Methods: This was a planned analysis of data from 4 randomized studies of patients with acute nonradicular LBP. Patients were enrolled during an ED visit and followed-up 1 week later. The primary outcome was improvement in the Roland-Morris Disability Questionnaire (RMDQ) between ED discharge and the 1-week follow-up. We compared the change in RMDQ among 8 groups: placebo, baclofen, metaxalone, tizanidine, diazepam, orphenadrine, methocarbamol, and cyclobenzaprine. All patients also received a nonsteroidal anti-inflammatory drug. We performed analysis of variance to determine statistically significant differences between medications and linear regression to determine the association of age, sex, and baseline severity with the primary outcome., Results: The mean improvement in RMDQ per group was placebo 10.5 (95% confidence interval [CI] 9.5-11.5), baclofen 10.6 (95% CI 8.6-12.7), metaxalone 10.3 (95% CI 8.1-12.4), tizanidine 11.5 (95% CI 9.5-13.4), diazepam 11.1 (95% CI 9-13.2), orphenadrine 9.5 (95% CI 7.4-11.5), methocarbamol 8.1 (95% CI 6.1-10.1), and cyclobenzaprine 10.1 (95% CI 8.3-12). The between-group differences were not statistically significantly different. Results were similar regardless of age, sex, and baseline severity. Higher baseline RMDQ was associated with greater clinical improvement (B coefficient 5.7, p < 0.01). Adverse medication effects were more common with cyclobenzaprine than with placebo (p < 0.01)., Conclusions: Among patients in the ED with acute LBP treated with a nonsteroidal anti-inflammatory drug, SMRs do not improve outcomes more than placebo. Neither age, sex, nor baseline impairment impacts these results., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

In this work, a natural deep eutectic solvent (NADES) consisting of L-menthol and acetic acid in a 1:1 molar ratio has been applied as extraction solvent for the dispersive liquid-liquid microextraction based on the solidification of the floating organic drop (DLLME-SFO) of a group of nine phthalic acid esters (dipropyl phthalate, DPP; butyl benzyl phthalate, BBP; dibutyl phthalate, DBP; dicyclohexyl phthalate, DCHP; diisopentyl phthalate, DIPP; di-n-pentyl phthalate, DNPP; di(2-ethylhexyl) phthalate, DEHP; diisononyl phthalate, DINP; and diisodecyl phthalate, DIDP) from three common infusions (camomile, pennyroyal mint, and linden teas) and three soft drinks (green tea, tonic, and lime and lemon drink), using dihexyl phthalate (DHP) and di-n-octyl phthalate (DNOP) as internal standards. After the DLLME-SFO procedure, analyses were carried out by high-performance liquid chromatography with UV detection. Method calibration showed good linearity for all the analytes and matrices, with determination coefficients (R 2 ) higher than 0.9910. Relative recovery values were between 71 and 125 %, with relative standard deviation values in the range 1-22 % for the six types of samples, while the limits of quantification of the method were in the range 4.3-51.1 µg/L for infusions and in the range 3.5-33.3 µg/L for soft drinks. Several samples purchased in different local supermarkets were analysed, finding DPP, DBP, DIPP, DEHP and DINP, although only DPP, DBP and DEHP could be quantified in some of them., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier B.V.)

Stimuli-responsive materials, frequently designated as "smart/intelligent materials", can modify their structure or properties by either a biological, physical, or chemical stimulus which, if properly controlled, could be used for specific applications. Such materials have been studied and exploited in several fields, like electronics, photonics, controlled drugs administration, imaging and medical diagnosis, among others, as well as in Analytical Chemistry where they have been used as chromatographic stationary phases, as part of sensors and for extraction purposes. This review article pretends to provide an overview of the most recent applications of these materials (mostly polymeric materials) in sample preparation for extraction purposes, as well as to provide a general vision of the current state-of-the-art of this field, their potential use and future applications., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020. Published by Elsevier B.V.)

Proliferating cyanobacterial blooms due eutrophication in reservoirs is a major global problem. The production of cyanotoxins often increases with grazing pressure and temperature while the sensitivity of zooplankton to cyanotoxins is directly related to temperature. Here we evaluate the effect of different concentrations of the crude extract of cyanobacteria from Valle de Bravo reservoir during dry (January) and rainy (September) seasons at 20 and 25 °C on the rotifer Brachionus calyciflorus based on acute and chronic toxicity tests. We filtered 20 or 150 l of lake water, depending on the intensity of the bloom, and estimated the density and diversity of the cyanobacteria. The crude extracts, after 5 cycles of freezing, thawing and sonication at 14 MHz, were filtered and the microcystin concentration quantified based on ELISA. The extracts were used to conduct the acute and chronic toxicity tests, all in quadruplicate. Acute toxicity tests were based on 24 h mortality. Chronic toxicity tests (population growth and life table experiments) were conducted at 5 and 10% of the median lethal concentration. The field samples were dominated by Microcystis sp. (January) or Woronichinia naegeliana (September). The microcystin concentration in lake water was 9.57 μg/l and 0.097 μg/l and the median lethal concentration was 5.34 μg microcystin/L and 0.35 μg microcystin/L in January and September, respectively. Survival and reproduction of B. calyciflorus were lower in the presence of the cyanobacteria crude extract, more so at 20° than at 25 °C. Our results highlight the urgency of regular monitoring based on zooplankton assays for reservoirs in tropical and temperate regions, subject to frequent and dominant cyanobacterial blooms, often as a result of climate change., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: Epilepsy surgery is the most successful method of treating medically unresponsive epilepsy, but carries a risk of morbidity. PET/MR is an emerging technique that increases detection of focal lesions whose resection may result in symptom remission., Methods: Retrospective review of 74 focal epilepsy patients over a period of 3 years who had a PET/MR was performed following IRB permission and informed consent. 27 patients underwent surgery or RNS (responsive neurostimulator) placement., Results: Hybrid PET-MR identified new anatomic or functional lesions in 10 patients not identified with standalone 3 T MR. Of the 27 patients who underwent focal surgery (19) or RNS placement (8), 24 showed improvement (Engel's I-III), 2 did not (Engel's IV), and one had an RNS explanted due to infection. MR and PET were read by 2 separate neuroradiologists and nuclear medicine physicians, respectively. Modalities were evaluated in terms of ability to detect the correct lobe and side for a focal lesion whose resection improved symptoms. Prior standalone MR exhibited 71-77% sensitivity and 0% specificity (as there were only 2 nonresponders), MR associated with PET/MR had 68-71% sensitivity and 0-50% specificity (depending on whether a lesion was seen on one of the nonresponders), and PET had 68-71% sensitivity and 25-33% specificity. Using either PET or MR to identify a focal lesion, PET/MR had sensitivity of 78-82% and specificity 0-50%., Conclusions: PET-MR provides additional sensitivity when used as two combined modalities for detecting possible epileptic foci., (Copyright © 2018 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

This randomized trial examines the dissemination and implementation of prolonged exposure (PE) therapy for posttraumatic stress symptoms in U.S. Army medical treatment facilities. The study compares two PE training models: Standard PE training, comprised of a 4-day workshop only, and Extended PE training, comprised of a 4-day workshop plus expert case consultation. Behavioral health providers (N=180) across three medium-to-large Army installations will be randomly assigned to either Standard PE training or Extended PE training. Changes in provider attitudes will be examined across groups. After completing PE training, the use of PE components with patients reporting posttraumatic stress symptoms and clinical outcomes of these participating patients (N=500) will be examined. This article describes the rationale and methods of the study. In addition, a number of methodological issues in conducting a multisite naturalistic study in the U.S. Army are discussed., (Copyright © 2017. Published by Elsevier Inc.)

Essentials DS-1040 inhibits the activated form of thrombin-activatable fibrinolysis inhibitor (TAFIa). Infusion of DS-1040 was safe and well tolerated in healthy young and elderly subjects. DS-1040 substantially decreased TAFIa activity but had no impact on bleeding time. DS-1040 may provide an option of safer thrombolytic therapy., Summary: Background Current treatments for acute ischemic stroke and venous thromboembolism, such as recombinant tissue-type plasminogen activator and thrombectomy, are limited by a narrow time window and the risk of bleeding. DS-1040 is a novel low molecular weight compound that inhibits the activated form of thrombin-activatable fibrinolysis inhibitor (TAFIa), and was developed as a fibrinolysis enhancer for the treatment of thromboembolic diseases. Objectives This first-in-human, randomized, placebo-controlled, three-part, phase 1 study was conducted to evaluate the safety, pharmacokinetics and pharmacodynamics of DS-1040 in healthy subjects. Subjects/Methods Young (18-45 years) or elderly (65-75 years) subjects (N = 103) were randomized to receive single ascending doses of DS-1040 ranging from 0.1 mg to 40 mg, or placebo, administered either as a 0.5-h intravenous infusion or as a 24-h continuous infusion. Results All doses of DS-1040 were tolerated, and no serious adverse events (AEs) or discontinuations resulting from AEs occurred during the study. Bleeding time remained within the normal range for all doses tested in all subjects. Plasma exposure of DS-1040 increased proportionally with increase in dose. Elderly subjects had higher exposures to DS-1040 and prolonged elimination times, probably because of decreased renal clearance. DS-1040 caused a substantial dose-dependent and time-dependent decrease in TAFIa activity and in 50% clot lysis time. The levels of D-dimer, indicative of endogenous fibrinolysis, increased in some individuals following DS-1040 treatment. No effects of DS-1040 on coagulation parameters or platelet aggregation were observed. Conclusions The novel fibrinolysis-enhancing agent DS-1040 has favorable pharmacokinetic/pharmacodynamic properties and a favorable safety profile, warranting further clinical development., (© 2017 International Society on Thrombosis and Haemostasis.)

In this chapter we briefly address the most common congenital brain and spinal anomalies as well as their most salient imaging, especially magnetic resonance, findings. Some of them, such as Chiari II, and open spinal defects, have become relatively rare due to their detection in utero and repair of the spinal malformation. Regardless of the type of brain anomaly, the most common clinical symptoms are mental retardation, hydrocephalus, and seizure; the latter two may need to be surgically and medically addressed. The most commonly found spinal congenital anomalies include the filum terminale lipoma which is generally asymptomatic and incidental and the caudal regression syndrome for which no primary treatment exists. Any spinal congenital anomaly may present in adulthood as a consequence of spinal cord tethering and/or development of syringomyelia., (© 2016 Elsevier B.V. All rights reserved.)

Introduction: HO/CO and l-arginine/NO pathways are critical regulators of vascular function in early human pregnancy. HO is the rate-limiting enzyme in heme catabolism leading to the formation of biliverdin, which is subsequently reduced to bilirubin by biliverdin reductase, carbon monoxide, and free iron. HO-1, the inducible isoform of the enzyme, is essential to promote placental function and fetal development (1). HO-1 is also required to maintain nitric oxide synthesis (2). Human chorionic gonadotropin (hCG) is the first blastocyst-derived hormonal signal playing a significant role in implantation and placentation (3). We hypothesized that hCG upregulates HO-1 and thus positively regulates early vascular events in human pregnancy., Objectives: In this study we used human umbilical vein endothelial cells (HUVECs) to demonstrate that hCG up-regulates mRNA and protein abundance of HO-1. The effect of hCG on l-arginine transport and the expression of hCAT1, the main cationic amino acid transporter involved in endothelial nitric oxide synthesis were evaluated., Methods: HUVEC were isolated from normal pregnancies (approval from the Institutional Review Board) by collagenase digestion and grown (37°C, 5% CO2) in medium 199 supplemented with 20% newborn and fetal calf sera. Cells were treated with hCG (0.5-100IU/mL, 0-24hours and CoCl2 (150μM, 6hours) as positive control. Total proteins were separated by SDS-PAGE electrophoresis, transferred to nitrocellulose membranes and incubated with monoclonal anti human HO-1 or anti β-actin and respective secondary antibody conjugated with horseradish peroxidase. Protein bands were detected by enhanced chemiluminiscence. Total RNA was isolated and cDNA was obtained by reverse transcription. PCR assays were performed in a reaction mix containing 0.5μM primers, dNTPs, Taq DNA polymerase, 2 mM MgCl2. Relative abundance of HO-1, hCAT-1 and 28S were determined. l-[(3)H]Arginine transport (100μM, 2 μCi ml(-1), 37°C, 1min) were determined in HUVECs exposed (30min) to hCG (0.5-100IU/mL) and CORM-2 (CO donor)., Results: The highest level of HO-1 protein were obtained at 5IU/mL of hCG and declined at higher concentrations. hCG increased HO-1 protein abundance and maximal response was observed at 6 hours (4-fold), decreasing at 24hours exposure. These effects of hCG on HO-1 protein abundance are well correlated with changes in HO-1 mRNA regarding time of exposure and concentration of hCG. L-arginine transport and hCAT-1 mRNA were also increased (2.8-fold and 4.5-fold, respectively) by hCG., Conclusion: Upregulation of HO-1 as well as the increase in l-arginine transport and hCAT-1 mRNA in HUVECs are novel effects of hCG, which occur at physiological plasma concentrations of the hormone, as those found in the first weeks of pregnancy. These changes could be relevant for the maintenance of the NO synthesis in fetal and maternal vasculature, ensuring the predominance of the vasodilator tone. These effects could be also critical for vascular remodelling of uterine circulation and placental vascular development in early stages of pregnancy, the lack of which could result in abnormal placentation as described in preeclampsia and fetal growth restriction., (Copyright © 2012. Published by Elsevier B.V.)

Background: We hypothesize that for the excision of benign cardiac masses, a minimally invasive approach through a right minithoracotomy is safe and feasible, and has lower resource utilization when compared with a standard median sternotomy., Methods: We retrospectively analyzed 39 consecutive patients who underwent benign cardiac mass excision at our institution between December 1999 and April 2010. The in-hospital outcomes of patients who had a right minithoracotomy were compared with those of patients who underwent a standard median sternotomy., Results: Of the 39 patients, 22 had cardiac masses removed through a minimally invasive approach, and 17 had a median sternotomy. The type of masses resected included 26 myxomas (66.7%), 9 papillary fibroelastomas (23.1%), and 4 thrombi (10.2%). The aortic cross-clamp and cardiopulmonary bypass times were 43 minutes (interquartile range [IQR] 30 to 64) versus 31 minutes (IQR 23 to 47; p=0.20) and 78 minutes (IQR 55 to 88) versus 57 minutes (IQR 33 to 70; p=0.02) for the minimally invasive group and the median sternotomy group, respectively. There were no significant differences in postoperative complications including mortality. The mean intensive care unit and hospital lengths of stay were 27 hours (IQR 24 to 47) versus 60 hours (IQR 48 to 79; p=0.001) and 5 days (IQR 4 to 6) versus 7 days (IQR 6 to 8; p=0.03) for the minimally invasive and the median sternotomy group, respectively., Conclusions: A minimally invasive approach through a right minithoracotomy for the resection of benign cardiac masses can be performed safely with lower resource utilization, and should be considered for these patients., (Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

The present study demonstrates that pigs experimentally infected with Taenia solium eggs develop resistance to reinfection that lasts at least five months. Thirteen 2-month-old piglets were infected with eggs of Taenia solium. After 5 months, two pigs were euthanized and five were challenged with eggs from a second tapeworm. Nine months after the first infection, six pigs were challenged with a third tapeworm. All 11 challenged pigs were euthanized 2 months after reinfection. In order to confirm the infectivity of the eggs, several piglets were inoculated with each taenia. Two of the five pigs reinfected after 5 months did not develop metacestodes, two showed few caseous non-infective forms and in the fifth pig, 14% of the metacestodes were vesicular and 86% colloidal and caseous. In the six animals challenged 9 months after the first infection, three were heavily infected with vesicular metacestodes and the other three showed only colloid and caseous forms in muscles. All parasites found in brains were vesicular. We conclude that immunity due to primary infection lasts at least 5 months. At 2 months of infection antigens of 24 and 39-42 kDa were the most frequently recognised. In those pigs with only a few caseous cysts in muscles and/or vesicular ones in brains no antibodies were detected.

Objectives: To evaluate a new imaging technique, for diagnosis of prosthetic vascular graft infection. Avidin is a protein which accumulates nonspecifically at sites of inflammation or infection. Due to its extremely low dissociation constant with biotin sites of infection can be imaged, using avidin as a pre-target, followed by injection of 111In-labelled biotin. This technique is much simpler than the common scintigraphic methods which employ labelling of blood components and its target-to-background ratio is greater than the methods employing radiolabelled proteins., Design: Prospective clinical study., Setting: A single department of vascular surgery and one of nuclear medicine of a Northern Italian hospital., Materials: Between May 1993 and May 1994, 31 grafts in 26 patients were studied; the series included 23 men and three women with a mean age of 65.5 years (range 54-76 years). The prosthetic graft (Dacron -16, ePTFE -15) were: aortoaortic 5, aortobifemoral 15, aortoiliac 1, and femoropopliteal 10. Sixteen patients were suspected of having a vascular graft infection (Group A), the other 10 patients served as controls (Group B). 20 mg of Avidin were injected iv, followed 24 h later by i.v. injection of 500 micrograms of Biotin labelled with 74 MBq of 111In., Chief Outcome Measures: Whole-body imaging was performed at 10 min and 2 h post-injection, along with SPECT imaging when indicated. Scan results were correlated with the traditional imaging modalities and the clinical outcome of the patients., Main Results: In Group A: two patients (three grafts) were excluded from the study, there were six true-positives, one false-positive and 11 true-negatives. Results in Group B: 10 true-negatives. The overall sensitivity was 100%, the specificity 95%, the accuracy 96%, the positive predictive value 86% and the negative predictive value 100%., Conclusions: These data suggest that Avidin/111In-labelled Biotin scintigraphy is a useful non invasive diagnostic method for early diagnosis of suspected prosthetic vascular graft infection.

We report herein data on single lung transplant (SLT) recipients with primary pulmonary hypertension (PPH). One patient did well following surgery but died on the 30th postoperative day due to cytomegalovirus pneumonia. The remaining two patients initially did well with unlimited exercise tolerance following transplantation, but then developed marked dyspnea on exertion and hypoxemia on postoperative days 144 and 120, respectively. Pulmonary function testing showed marked deterioration of function and transbronchial lung biopsy specimens revealed acute graft rejection in one patient and evidence of chronic graft rejection in the second patient. Quantitative ventilation-perfusion lung scanning demonstrated a marked decrease in ventilation to the transplanted lung in both cases associated with only a mild decrease in perfusion. This V/Q mismatch resulted in markedly decreased arterial oxygen saturations, widened alveolar-arterial oxygen gradients, and clinically debilitating dyspnea. We conclude that rejection may result in significant V/Q mismatch and hypoxemia in PPH patients undergoing SLT, which may limit the use of this specific type of surgery for PPH.

This study was designed to determine if clinical features apparent after seven days of mechanical ventilation predict long-term intubation beyond 14 days and subsequent need for tracheotomy in patients with ARDS. Twenty-four patients were entered into the study. Group 1 patients were successfully extubated in less than or equal to 14 days after onset of ARDS and group 2 patients remained intubated greater than 14 days. On day 7 of ARDS, group 1 had a higher PaO2/PAO2 ratio, a lower PEEP requirement, less severe chest radiographic abnormalities and a greater likelihood of an improved radiograph from the baseline study. None of group 1 and 11 group 2 patients eventually underwent tracheotomy. Clinical features apparent after seven days of mechanical ventilation in patients with ARDS suggest the likelihood of prolonged intubation beyond 14 days and eventual tracheotomy. Recognition of these features may allow more timely conversion of endotracheal intubation to tracheotomy.