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The role of high flow nasal oxygenation (HFNO) for pre-oxygenation before obstetric general anaesthesia remains unclear. This study aimed to determine the number of vital capacity breaths using HFNO required to pre-oxygenate 90% of parturients to an end-tidal oxygen concentration fraction (F

O

) of ≥0.90 (termed EN90).

Using up-down, sequential allocation trial design, volunteer term parturients undergoing caesarean delivery were investigated with HFNO with their mouth closed, followed by mouth open, and if F

O

≥0.90 was not achieved after a maximum of 20 vital capacity breaths, pre-oxygenation was attempted with a face mask. The primary outcome was the number of vital capacity breaths required using HFNO (mouth open and closed) to achieve EN90. Secondary outcomes included assessment of EN90 using mouth open versus mouth closed and face mask pre-oxygenation, maternal satisfaction and evaluation of fetal cardiotocography.

Twenty women at term were recruited. Successful pre-oxygenation occurred in 4 (20%), 3 (15%) and 14 (70%) women with HFNO mouth closed, HFNO mouth open, and via face mask respectively. At up to 20 vital capacity breaths, face mask pre-oxygenation was more successful at achieving EN90 compared with both HFNO with a closed (P=0.006) or open (P=0.001) mouth. Closed mouth HFNO did not outperform open mouth pre-oxygenation.

Face mask pre-oxygenation is more effective at achieving EN90 compared with to HFNO within a clinically acceptable number of vital capacity breaths. Further studies are needed to determine the role of HFNO in optimising the time before desaturation and for apnoeic oxygenation in term parturients.

Face mask pre-oxygenation is more effective at achieving EN90 compared with to HFNO within a clinically acceptable number of vital capacity breaths. Further studies are needed to determine the role of HFNO in optimising the time before desaturation and for apnoeic oxygenation in term parturients.

At diagnosis, <1% of patients with non-small cell lung cancer (NSCLC) have synchronous solitary brain metastasis (SSBM). In prior cohorts without 18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) staging, definitive treatment to intracranial and intrathoracic disease showed a 5-year overall survival (OS) of 11-21%. We investigated the long-term survival outcomes for patients with SSBM NSCLC, diagnosed in the FDG-PET/CT era and treated definitively with local therapies to both intracranial and intrathoracic sites of disease.

This retrospective study assessed patients staged with FDG-PET/CT who received definitive lung and SSBM treatment from February 1999 to December 2017. A lung-molecular graded prognostic assessment (lung-molGPA) score was assigned for each patient using age, performance status score, and, where carried out, molecular status. Overall survival and progression-free survival (PFS) were calculated using Kaplan-Meier methods. Cox proportional hazard modelsurvivors, including those with ≥N1 disease.

Definitive treatment of patients with NSCLC and SSBM staged with FDG-PET/CT can result in 5-year survivors, including those with ≥N1 disease.A large quantity of leachate is generated during municipal solid waste collection operation and in landfills due to the large amount of organic waste and high humidity. The content of medium chain fatty acids (MCFAs) in the leachate is a low cost feedstock for bio-based chemical and fuel production processes. this website The aim of this study is to investigate the MCFA production potential of three leachate ages through chain elongation process under uncontrolled pH batch test. Moreover, the effect of using different external electron donors (ethanol, methanol and a mixture of both) is studied. The experiment consists of characterizing the samples then adding external electron donors with a specific ratio to leachate samples under mesophilic temperature. For this investigation, also a statistical analysis is done, which shows the production of MCFAs is highly influenced by leachate age. The results indicate that the production of even-numbered acids increase from 600 to 1,000 mg/L by the end of the ethanol chain elongation experiment for young leachate. However, a higher MCFA production of more than 1,000 mg/L is achieved by using the mixture of methanol and ethanol as electron donor. Furthermore, all methanol chain elongation experiments lead to an odd-numbered production of MCFAs, such as pentanoic and heptanoic acids. These results confirm the potential improvement of MCFA production from leachate through choosing the optimal leachate age and electron donor. Overall, producing MCFAs from leachate is a good example of circular bio-economy because waste is used to produce biochemicals, which closes the material cycle.With the development of marine biorefinery concept, utilisation of algal waste during industrial processing as well as some "green tide" waste biomass has become an important research topic. In this work, a single-step microwave process was used to hydrolyse Laminaria japonica processing waste (LJW) and Enteromorpha prolifera (EP), producing a growth medium suitable for microbial cultivation. The medium contained a range of mono- and polysaccharides as well as macro- and micronutrients that could be used by the microbes. The cultivation behavior of three plant growth-promoting rhizobacteria (PGPR) strains (Bacillus subtilis strain Tpb55, Bacillus amyloliquefaciens strain Cas02, and Burkholderia pyrrocinia strain Lyc2) in the two media were investigated. LJW hydrolysate from 180 °C and EP hydrolysate from 150 °C performed better cultivation efficiency than those hydrolysates from other microwave conditions. Saccharide analysis showed that microbes metabolized some monosaccharide such as glucose, mannose during cultivation, leaving polysaccharide unused in the medium. Furthermore, hydrolysate-strain cultivation mixtures were applied to pepper growth. The EP hydrolysate-Cas02 broth showed better plant growth-promoting effect compared to other treatments, which might be attributed to the higher indole-3-acetic acid (IAA) production of Cas02 in the EP hydrolysate. This work shed lights on the conversion of algal waste to PGPR biomass as well as the co-application of algal hydrolysates- strains cultivation broth for a better plant growth promotion.

To evaluate the feasibility and effectiveness of computed tomography (CT)-guided percutaneous drainage (PD) in patients with iatrogenic pneumoperitoneum presenting as acute abdomen.

In this retrospective, single-center cohort study, 16 consecutive patients (9 males, 7 females; median age, 67.5 [51-85] years) undergoing PD for managing acute abdomen caused by iatrogenic pneumoperitoneum between 2013 and 2019 were analyzed. Inclusion criteria were clinical signs of acute abdomen that was unresponsive to conservative management and pneumoperitoneum due to an iatrogenic cause after PD, observed using CT imaging. Volumetry of pneumoperitoneum was performed using computer-aided image segmentation. To evaluate the clinical outcome, the paired t-test was performed to analyze the course of pain intensity on the numerical pain rating scale (NPRS, 0-10). Patient records were reviewed to determine PD-related adverse events and median drain duration.

The median pneumoperitoneum volume was 891.1 (127.7-3,677.0) mL. All PD procedures were successfully performed, with symptom relief and immediate abdominal decompression (mean segmental volume reduction, 79.8% ± 13.5). Acute abdomen symptoms were resolved, with significant improvement in pain intensity between the day of the PD procedure and the first day after the procdure (mean NPRS scores, 3.3 ± 1.9 vs 0.8 ± 1.0; P < .001). The median drain duration was 2 (1-3) days. No PD-associated adverse events were observed. After PD, 14 patients required only conservative management, whereas 2 patients with anastomotic leakage required additional surgery as they showed signs of persisting sepsis and generalized peritonitis.

PD is a safe and suitable procedure for the management of symptoms in patients with iatrogenic pneumoperitoneum presenting as acute abdomen.

PD is a safe and suitable procedure for the management of symptoms in patients with iatrogenic pneumoperitoneum presenting as acute abdomen.Bullous pemphigoid (BP) is a common autoimmune blistering skin disease that mainly affects elderly patients. Although BP risk is strongly influenced by age, genetic factors are also important determinants of this disease. Many genomic regions, especially in the HLA-II region, have been found to influence BP susceptibility through targeted sequencing studies. However, the relationship between non-HLA regions and BP susceptibility remains poorly understood and the identification of functional variants and key genes within these association regions remains a major challenge. In this review, we summarize the genetic predisposition to BP through an overview of the research history in this field.Loeffler's endocarditis (LE) is the cardiac manifestation of hypereosinophilic syndrome, a rare systemic disease characterized by the sustained production of eosinophils leading to organ damage. Few data, principally by case reports, are available regarding the diagnostic workup in patients with suspected LE. Thus, we have performed a systematic search of the literature dealing with imaging in LE and propose an integrated multimodality imaging approach in the cardiac diagnostics of LE patients. The aim is to provide an updated state-of-the-art review focused on noninvasive and invasive imaging modalities for this rare and underdiagnosed disease. Standard and advanced echocardiography are typically the first cardiac imaging examinations when LE is suspected and they are also used later in follow-up for prognostic stratification and assessing response to treatment. Cardiac magnetic resonance provides a more detailed anatomical and functional evaluation of cardiac chambers, tissue characterization for the presence and extension of myocardial edema and fibrosis, and ventricular thrombi identification. Computed tomography scan and [18F]-fluoro-deoxy-glucose positron emission tomography may be helpful in selected cases to evaluate the cardiac involvement of LE as well as the other noncardiac manifestations of hypereosinophilic syndrome. Endomyocardial biopsy may be considered in patients with high clinical suspicion of LE if noninvasive imaging findings are confusing or not conclusive. The appropriate use of invasive and noninvasive imaging modalities, combining the available techniques with the patients' clinical features, will hopefully lead to early diagnosis, more accurate staging of disease, and timely treatment of LE that may prevent the irreversible myocardial damage of LE and adverse cardiovascular events.A 4-year-old girl presented to the emergency department with right leg pain and associated limp for one day. There was no trauma or injury; she had no fever or recent illness. Her exam was notable for tenderness and swelling to the right knee, most prominent in the popliteal region. Initial laboratory testing was unremarkable except for a mildly elevated C-reactive protein. She had normal radiographs of the right lower extremity. A soft tissue ultrasound demonstrated popliteal lymphadenopathy, a rare finding in children. Reassessment of the patient revealed cat flea bites to the leg, which prompted concern for Bartonella henselae infection causing Cat-scratch Disease (CSD). The patient was treated empirically with Azithromycin and her Bartonella titers returned two days later consistent with active infection. This is a rare clinical report describing popliteal lymphadenitis and lower extremity arthropathy caused by Bartonella henselae infection secondary to cat flea bites.