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Two thirds of the surface of our planet are covered by water and are still poorly instrumented, which has prevented the earth science community from addressing numerous key scientific questions. The potential to leverage the existing fiber optic seafloor telecom cables that criss-cross the oceans, by using them as dense arrays of seismo-acoustic sensors, remains to be evaluated. Here, we report Distributed Acoustic Sensing measurements on a 41.5 km-long telecom cable that is deployed offshore Toulon, France. Our observations demonstrate the capability to monitor with unprecedented details the ocean-solid earth interactions from the coast to the abyssal plain, in addition to regional seismicity (e.g., a magnitude 1.9 micro-earthquake located 100 km away) with signal characteristics comparable to those of a coastal seismic station.

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OBJECTIVES: Falcor 350 (A. Menarini Diagnostics) is a wet-reagent biochemistry analyser that is available for in-house use. The aim of this study was to compare the results produced by this analyser with those obtained by a wet-reagent analyser (KoneLab 30i; Thermo Clinical Labsystems) that served as the reference instrument. METHODS: Blood samples from 120 clinical cases (60 dogs and 60 cats) were analysed for 18 analytes (urea, creatinine, total proteins, albumin, creatine kinase, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, amylase, lipase, glucose, triacylglycerol, cholesterol, total calcium, phosphate, sodium and potassium) using both the reference and Falcor instruments. RESULTS: Good to excellent correlations (r(s) value) (canine/feline) were identified for urea (0.87/0.86), creatinine (0.96/0.99), total proteins (0.91/0.95), albumin (0.96/0.93), creatine kinase (0.98/0.99), aspartate aminotransferase (0.95/0.98), alanine aminotransferase (0.99/0.99), alkaline phosphatase (0.99/0.98), total bilirubin in dogs (0.88), amylase (0.99/0.87), lipase in dogs (0.88), glucose (0.97/0.98), triacylglycerol (0.93/0.97), cholesterol (0.99/0.99), total calcium (0.88/0.89), phosphate (0.94/0.97) and potassium (0.96/0.97). The correlations for sodium (0.41/0.61), total bilirubin in cats (0.78) and lipase in cats (0.25) were considered unacceptable. CLINICAL SIGNIFICANCE: For 13 of the 18 analytes (creatinine, total proteins, albumin, creatine kinase, aspartate aminotransferase, alanine aminotransferase, amylase, glucose, cholesterol, triacylglycerol, phosphate, potassium and urea) in both canine and feline samples, the two instruments produce values that are closely related to each other (excellent correlation) and are sufficiently similar to allow them to be used interchangeably without the need for additional correction factor computations (good agreement). Because of differences in the methodologies, the Falcor results for alkaline phosphatase, total calcium, sodium, lipase and total bilirubin cannot be used interchangeably with those generated by the KoneLab and should be interpreted using reference intervals established from the Falcor analyser.

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To achieve normocarbia during conventional mechanical ventilation, ventilator settings are determined initially on the basis of body weight. The best ventilator settings for CO2 elimination during high-frequency jet ventilation (HFJV) have not been so clearly defined. A recent study has suggested that eucarbia will be obtained with HFJV when tidal volume (VT) per kg of body weight is kept within a narrow, well-defined range. In the same study, a "bench test" demonstrated that VT was directly proportional to the jet ventilator driving pressure (DP). The goal of our study was to confirm this recommended VT/kg to obtain eucarbia and to determine whether the relation observed between VT and DP in the laboratory was true clinically. We studied 14 patients admitted to the ICU for postoperative support. We determined a good correlation between DP and VT/kg (r = .811, p less than .001) for the group as a whole and a good inverse correlation between DP or VT/kg and PaCO2 for most individual patients; however, there was a poor inverse correlation between DP or VT/kg and PaCO2 for the group as a whole, due to wide patient-to-patient variation in the efficiency of jet ventilation. We conclude that there is no universal formula for setting jet ventilator DP or VT/kg to affect normocarbia in humans.

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In order to compare the differences of high-frequency jet ventilation (HFJV) synchronized with the cardiac cycle (sync) to that nonsynchronized with the cardiac cycle (async), ten stable postoperative ICU patients, without heart failure, in sinus rhythm were ventilated randomly in either mode. The async mode was HFJV at 100 cycle/min, while the sync mode was HFJV triggered by the R-wave of the ECG tracing. The heart rate ranged between 64 and 127 beat/min. Synchronization was studied at one of two periods, sync 0 and sync 60. Sync 0 consisted of inspiration triggered by the R-wave, with jet ventilation occurring early in systole; sync 60 represented a 60% delay of the time between the succeeding R-waves, with jet ventilation occurring in mid-diastole. There was no significant difference in the cardiorespiratory data when async was compared to either sync 0 or sync 60. Therefore, in these patients without heart failure, the selection of async vs. either sync mode appeared to have neither adverse nor beneficial hemodynamic effects.

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Nine ventilator-dependent patients were successfully weaned from mechanical ventilatory support by high-frequency jet ventilation. All patients had been on ventilatory support for at least 2 wk, and had not responded to attempts at weaning by intermittent mandatory ventilation.

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Oxygenation and ventilation were assessed in 15 postoperative patients before, immediately after, and 3 min after 15 sec of tracheobronchial suctioning in the presence or in the absence of high-frequency jet ventilation (HFJV). When HFJV was continued during suctioning, the mean PaO2 decrease was only 15 +/- 9 torr, compared to a 90 +/- 16 torr decrease when HFJV was discontinued. This difference demonstrates that continuation of HFJV during tracheobronchial suctioning prevents a decrease in PaO2.

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Airway pressures and cardiorespiratory variables were compared for conventional ventilation (CV) and high-frequency jet ventilation (HFJV), at a similar fraction of inspired O2 (FIO2), positive end-expiratory pressure (PEEP) and PaCO2 in 11 ICU patients. For CV and HFJV, respectively, peak (PAP) and mean airway pressures (Paw) were 15.4 and 9.1 mm Hg and 4.4 and 5 mm Hg. Cardiac index (CI) was 2.54 and 2.60 L/min X m2, total systemic vascular resistance index (SVRI) 2846 and 2923 dyne X sec/cm5 X m2, PaO2 207 and 149 torr, and Qsp/Qt 7% and 11%. HFJV decreased significantly PAP and was less likely to produce pulmonary barotrauma. Cardiac indices were not different, indicating that this variable may be affected by Paw. HFJV neither increased nor decreased CI at similar PEEP and PaCO2 as compared to CV. The decrease in PaO2 and increase in Qsp/Qt may be due to small inspired gas volumes potentiating microatelectasis. On the basis of this study, we recommend initiating HFJV at FIO2 of 0.9 and PEEP of 5 cm H2O, and monitoring both PAP and Paw.

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One hundred patients were ventilated with high-frequency jet ventilation (HFJV) during the initial 24-h postoperative period in the surgical and neurosurgical ICUs. Eighty-three were successfully weaned, 2 could not be ventilated adequately with HFJV, and 15 with criteria of acute respiratory failure received HFJV for up to 21 days. A HFJV delivery system consisted of jetting and entrainment systems, both with their own humidification designs. An initial mode of HFJV using 35 psi, jet rate 100 cycle/min and inspiratory time 30% provided a mean PaCO2 of 34 torr in 38 patients studied. A comparison of HFJV without and with a positive end-expiratory pressure (PEEP) of 10 cm H2O indicated a decrease in mean Qsp/Qt from 17% to 13% with decrease in cardiac index (CI) from 3.39 to 2.81 L/min X m2; this effect is similar to PEEP applied to a conventional ventilator. Weaning proved to be simple and comfortable for the patient. In the light of our experience, we believe that HFJV is both feasible and practical for the postoperative patient and should be introduced into routine clinical use.

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The effects of total-body hyperthermia on phosphorus homeostasis are controversial. To evaluate the problem, 10 clearance studies were performed in seven patients undergoing total-body hyperthermia as an adjunct to the treatment of solid malignant tumors. Total-body hyperthermia was associated with significant reduction in plasma phosphorus concentration from a baseline value of 3.51 +/- 0.18 to 0.6 +/- 0.1 mg/dl (p less than 0.001), returning to baseline following cessation of total-body hyperthermia. The clearance of phosphorus increased from 15.2 +/- 2.5 to 26.1 +/- 3.1 ml per minute (p less than 0.01), and the fractional excretion of phosphorus increased from 11.37 +/- 2.2 to 47.68 +/- 9.7 percent (p less than 0.01). The reduction in plasma phosphorus during total-body hyperthermia was also associated with a significant reduction in the renal threshold phosphorus concentration from 3.17 +/- 0.16 to 0.38 +/- 0.08 (p less than 0.001). The changes in phosphorus homeostasis during total-body hyperthermia were independent of changes in circulating parathyroid hormone level, urinary cyclic AMP excretion, and arterial carbon dioxide tension.

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The effect of positive end-expiratory pressure (PEEP) on plasma renin activity (PRA), renal function, and cardiovascular (CV) hemodynamics during high frequency jet ventilation (HFJV) was observed in 7 patients. The addition of PEEP during HFJV increased PRA while decreasing stroke index (SI) and cardiac index (CI). These changes were associated with decreased urinary flow, creatinine clearance, and fractional excretion of sodium. In contrast, HFJV at zero end-expiratory pressure (ZEEP) maintained normal PRA, renal function, and CV hemodynamics. The authors conclude that the alteration of renal function during HFJV is a function of airway pressure rather than the effects of the ventilatory frequency. The deterioration of renal function may have been due to changes in PRA or CV dynamics.

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Cerebral air embolism occurred in a patient undergoing trigeminal rhizotomy in the sitting position. During the acute episode, a murmur was detected by the Doppler probe and foam was aspirated from the central venous catheter. The patient did not regain consciousness postoperatively, and computerized tomography demonstrated diffuse cerebral infarction. Subsequently, the patient died, and neuropathological examination revealed multifocal discrete infarcts in the gray and white matter with normal intervening brain. No intracardiac septal defects were present. This is the first fully documented case of cerebral air embolism of venous origin in the absence of intracardiac septal defects, and reemphasizes the hazards of operative procedures in the sitting position.

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The adult respiratory distress syndrome (ARDS) is a sequel to pulmonary injury that may be direct, closed chest trauma or indirect, through air or vascular passages, aspiration, or fat embolization. An understanding of this syndrome is essential for the oral surgeon who not only manages severe maxillofacial injuries but is also a member of a trauma team that manages multisystem injuries. Emphasis on pathophysiologic pathways resulting in ARDS is presented with a discussion on oxygenation and ventilation abnormalities. Application of these guidelines will assist the oral surgeon in understanding the management of patients with this acute progressive syndrome.

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