Diamonds have substantial hardness and durability, but attempting to deform diamonds usually results in brittle fracture. We demonstrate ultralarge, fully reversible elastic deformation of nanoscale (~300 nanometers) single-crystalline and polycrystalline diamond needles. For single-crystalline diamond, the maximum tensile strains (up to 9%) approached the theoretical elastic limit, and the corresponding maximum tensile stress reached ~89 to 98 gigapascals. After combining systematic computational simulations and characterization of pre- and postdeformation structural features, we ascribe the concurrent high strength and large elastic strain to the paucity of defects in the small-volume diamond nanoneedles and to the relatively smooth surfaces compared with those of microscale and larger specimens. The discovery offers the potential for new applications through optimized design of diamond nanostructure, geometry, elastic strains, and physical properties.

Inhalation of a foreign body into the respiratory passage can be a serious and sometimes fatal childhood accident. In this paper we analyse the management of 223 children with laryngo-tracheo-bronchial foreign bodies. Children below three years of age were found to be the most vulnerable. The majority of the patients were boys. Over a quarter of the patients did not present with a history of inhalation. Only 52 per cent reported within 24 hours of inhalation. Endoscopic removal was possible in all but nine cases. One hundred and forty eight (66.4 per cent) of the recovered foreign bodies were organic in origin, the majority of them being peanuts. In one hundred and five (47.1 per cent) the objects found their way into the right bronchial tree. There were two deaths. The modalities of diagnosis and management are discussed.

Congenital lobar emphysema is a rare entity presenting in the first month of life. It appears with varying degrees of respiratory distress, clinical and radiological evidence of over-aeration of the upper and middle lobes, mediastinal shift and hypoxia. Its early recognition and surgical intervention can be life-saving. Even today, despite advanced diagnostic techniques, pitfalls in diagnosis and management are not uncommon and the condition may be mistaken for pneumothorax or pneumonia. This report elucidates the anesthetic management of three such cases with a review of literature.

Nephrotoxicity from non-steroidal anti-in ammatory drugs (NSAID) is well recognized. We report a case of severe hypokalaemia and weakness due to renal tubular acidosis in a young woman who was taking 40-60 tablets per day of Nurofen Plus 1 (ibuprofen 200 mg and codeine phosphate 12 ¢ 8 mg). Proprietary brands of ibuprofen are freely available to the public and those containing codeine may be potentially subject to abuse. This case highlights the need to be aware of this potential and of the life-threatening electrolyte and acid-base disturbances that might be encountered with the widespread availability of these types of NSAID. Case reportA 28-year-old woman presented to the emergency department with a 2-day history of severe generalized weakness. She was unable to stand up or hold her neck straight. She said that she had one episode of vomiting on the day before admission and that, 2 weeks earlier, she had bronchitis for which her general practitioner prescribed amoxycillin. She was taking pantoprazole for a duodenal ulcer, diagnosed 7 months earlier. She was also taking over-the-counter analgesics for relapsing knee pains. She had a history of depression and alcohol dependence for which she had previously received psychiatric counselling.On examination, she was afebrile (36¢78C), her pulse rate was 90 per min, regular, and blood pressure 110/60 mmHg. She had severe generalized muscle weakness but no neurological de¢cit. Body mass index was 20¢4 kg/m 2 . The ECG showed prolonged QT intervals and inverted T waves.Blood tests on admission, showed serum potassium 1Í4 mmol/L (3Í6-5Í3), sodium 141 mmol/L (138-146), urea 6Í4 mmol/ L (2Í5-7Í5), creatinine 64 mmol/L (50-130), calcium 2Í54 mmol/ L (2Í2-2Í6) and phosphate 0Í43 mmol/ L (0Í8-1Í4). Further investigations revealed serum bicarbonate 14Í7 mmol/ L (21-28), chloride 112 mmol/ L (96-104) and an anion gap of 15Í7 mmol/L (12-16). Urinary potassium was inappropriately high at 26Í6 mmol/ L and the renal tubular maximum reabsorption of phosphate (TmP/GFR) was low at 0 Í31mmol/ L GFR (0 Í8-1Í4).In view of the hypokalaemia, hyperchloraemia, low serum bicarbonate and normal anion gap, the diagnosis of renal tubular acidosis was made. She was treated with intravenous potassium therapy over the following 4 days (a total of 340 mmol) and her serum potassium rose gradually to 3Í7 mmol/ L and bicarbonate to 23Í9 mmol/ L by day 4; 2 days later, and without any further treatment, her serum potassium was 4Í9 mmol/ L and bicarbonate 26Í5 mmol/ L. The TmP/GFR was normal (1Í4 mmol/ L GFR) and the fractional excretion of bicarbonate was 1%. An ammonium chloride acidi¢cation test was undertaken but was inconclusive because she vomited shortly after ingesting the ammonium chloride.A review of her notes revealed that, 8 months earlier, she was admitted to hospital with an episode of abdominal pain and diarrhoea. Her serum potassium at the time was 2Í4 mmol/ L and had normalized with intravenous and oral potassium. Her hypokalaemia was thought to be due to the diarrhoea and she...

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Electron-and ion-induced bending (EIB/IIB) phenomena have been studied in self-supported polycrystalline metallic and metal-amorphous bilayered nanocantilevers. The experiments reveal many interesting facts regarding electron/ion-matter interaction, which builds a proper foundation for the understanding of the phenomenon. The mechanism for bending of metallic cantilevers has been proposed to be primarily due to void-induced stress generation during ion beam irradiation. On the other hand, thermal effects have been found to play the dominant role in the case of bending of bilayer (amorphous-metal) nanocantilevers. The instantaneous, reversible, highly controllable and permanent nature of the process has been exploited to fabricate several complicated nanostructures in three dimensions. IIB of the fabricated cantilevers is shown to have a high precession mass sensing aptitude, capable of detecting a change in mass of the order of femtograms.

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Biatrial involvement or multiplicity of myxomas does not mandate recurrence. Surgical excision has excellent overall survival and freedom from reoperation rates, but annual follow-up including echocardiographic surveillance is recommended as familial cases tend to recur.