SummaryThe LMA Supreme TM is a new extraglottic airway device which brings together features of the LMA ProSeal TM , Fastrach TM and Unique TM . We test the hypothesis that ease of insertion, oropharyngeal leak pressure, fibreoptic position and ease of gastric tube placement differ between the LMA ProSeal TM and the LMA Supreme TM in paralysed anesthetised patients. Ninety-three females aged 19-71 years were studied. Both devices were inserted into each patient in random order. Two attempts were allowed. Digital insertion was used for the first attempt and guided insertion for the second attempt. Oropharyngeal leak pressure and fibreoptic position were determined during cuff inflation from 0 to 40 ml in 10 ml increments. Gastric tube insertion was attempted if there was no gas leak from the drain tube. First attempt and overall insertion success were similar (LMA ProSeal TM , 92% and 100%; LMA Supreme TM 95% and 100%). Guided insertion was always successful following failed digital insertion. Oropharyngeal leak pressure was 4-8 ml higher for the LMA ProSeal TM over the inflation range (p < 0.001). Intracuff pressure was 16-35 cm higher for the LMA ProSeal TM when the cuff volume was 20-40 ml (p < 0.001). There was an increase in oropharyngeal leak pressure with increasing cuff volume from 10 to 30 ml for both devices, but no change from 0 to 10 ml and 30-40 ml. There were no differences in the fibreoptic position of the airway or drain tube. The first attempt and overall insertion success for the gastric tube was similar (LMA ProSeal TM 91% and 100%; LMA Supreme TM 92% and 100%). We conclude that ease of insertion, gastric tube placement and fibreoptic position are similar for the LMA ProSeal The LMA Supreme TM is a new extraglottic airway device which brings together features of both the LMA ProSeal TM [1] (high seal cuff, gastric access and bite block -to facilitate ventilation, airway protection and airway obstruction, respectively), the LMA Fastrach features are that the airway tube incorporates a drain tube within its lumen to shorten and straighten its path, it is oval-shaped to match the shape of the mouth and to reduce rotation in the pharynx, the inner cuff has been strengthened to prevent airway obstruction from infolding and epiglottic fins have been added to prevent airway obstruction from epiglottic downfolding. The only published data on the Supreme is a pilot study

Background. Normothermic machine perfusion (NMP) bears the potential for significant prolongation of liver preservation before transplantation. Although safety and feasibility have been recently published, no data are available describing the significant challenges of establishing NMP programs outside clinical studies. We herein present our experience and propose a multidisciplinary approach for liver NMP in the clinical routine. Methods. In February 2018, liver NMP was introduced for routine use in marginal organs, logistic challenges, and complex recipients at our institution. In a multidisciplinary effort among transplant coordinators, perfusionists, transplant surgeons, anesthesia, nurses, blood bank as well as laboratory staff, a clinical routine was established and 34 NMP cases were performed without critical incidents or organ loss. Results. Nine livers were discarded due to poor organ quality and function observed during NMP. Twenty-five livers were successfully transplanted after preservation of up to 38 h. The extended criteria donors rate was 100% and 92% in discarded and transplanted livers, respectively. Nighttime procedures and parallel transplantations were eventually omitted. Graft and patient survival was 88% at 20 mo. No cholangiopathy was observed despite the use of extended criteria donor organs in 92% of cases. Conclusions. NMP in a multidisciplinary approach enables a safe prolongation of liver preservation and overnight organ care. A first field test of NMP indicates safety and benefit of this approach.

Long-term, simultaneous, measurements of cytoplasmic free Ca(2+) concentrations and single exocytotic fusion events in surfactant-secreting type II cells were performed. All fusion (constitutive, phorbol ester-induced, and agonist-induced) was Ca(2+)-dependent. Kinetic analysis revealed that agonist (adenosine triphosphate [ATP])-induced fusion exhibited a kinetic pattern that correlated well with the Ca(2+) signal. The effects of Ca(2+) release from intracellular stores (early) and Ca(2+) entry (late) could be demonstrated for the first time by dissecting the slow (10-to-15-min) fusion response to ATP into these two components. Bath Ba(2+) or Sr(2+) could replace Ca(2+) to elicit a fusion response in thapsigargin-pretreated cells lacking ATP-induced Ca(2+) release from stores. Although the late response was partially inhibited by interrupting the phospholipase D-protein kinase C axis, a high Ca(2+) dependence of the entire secretory course was demonstrated by a significant correlation between the integrated Ca(2+) signal and the fusion response. There was also a highly significant correlation between constitutive and ATP-stimulated fusion activity in individual cells. We propose a common mechanistic model for all types of fusion in this slow secretory cell, in which constitutive and regulated forms of exocytosis are subject to the same principles of regulation.

To conclude, the LFD test of BAL specimens is performed easily and provides accurate and rapidly available results in patients after SOT. Therefore, this new point-of-care test may be a promising diagnostic approach for detecting IPA using BAL specimens from SOT patients.

IntroductionThe incidence of invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU) patients is increasing, and early diagnosis of the disease and treatment with antifungal drugs is critical for patient survival. Serum biomarker tests for IPA typically give false-negative results in non-neutropenic patients, and galactomannan (GM) detection, the preferred diagnostic test for IPA using bronchoalveolar lavage (BAL), is often not readily available. Novel approaches to IPA detection in ICU patients are needed. In this multicenter study, we evaluated the performance of an Aspergillus lateral-flow device (LFD) test for BAL IPA detection in critically ill patients.MethodsA total of 149 BAL samples from 133 ICU patients were included in this semiprospective study. Participating centers were the medical university hospitals of Graz, Vienna and Innsbruck in Austria and the University Hospital of Mannheim, Germany. Fungal infections were classified according to modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria.ResultsTwo patients (four BALs) had proven IPA, fourteen patients (sixteen BALs) had probable IPA, twenty patients (twenty-one BALs) had possible IPA and ninety-seven patients (one hundred eight BALs) did not fulfill IPA criteria. Sensitivity, specificity, negative predictive value, positive predictive value and diagnostic odds ratios for diagnosing proven and probable IPA using LFD tests of BAL were 80%, 81%, 96%, 44% and 17.6, respectively. Fungal BAL culture exhibited a sensitivity of 50% and a specificity of 85%.ConclusionLFD tests of BAL showed promising results for IPA diagnosis in ICU patients. Furthermore, the LFD test can be performed easily and provides rapid results. Therefore, it may be a reliable alternative for IPA diagnosis in ICU patients if GM results are not rapidly available.Trial registrationClinicalTrials.gov NCT02058316. Registered 20 January 2014.