Ventilatory support for infants in emergency and in the intensive care unit

Pediatric anesthesia and intensive care management has improved dramatically over the past two decades. Improved understanding of the pathophysiology underlying newborn surgical emergencies, new medications and new modes of ventilatory support have all contributed to better patient outcome. The authors have reviewed the anatomy and physiology of the infant airway, indications for and principles of endotracheal intubation, the management of newborn surgical emergencies, indications for post-operative ventilatory support, different modes of mechanical ventilation available, complications of mechanical ventilation with weaning parameters and extubation criteria. The introduction of nitric oxide and the implications of extracorpreal membrane oxygenation in the management of newborn emergency refractory to conventional ventilation are discussed.

Phthalate migration and its effects on poly(vinyl chloride)-based footwear: pathways, influence of environmental conditions, and the possibility of human exposure

The study of phthalate migration in footwear is important from an environmental viewpoint and the consumer health perspective as it remains in direct contact with the user for a long time. In this research article, the migration of phthalate, specifically di-(2-ethylhexyl) phthalate (DEHP), from the poly(vinyl chloride) (PVC) shoe sole to the attached leather insole has been studied for six months under different environmental conditions. After one month, the DEHP concentration in the PVC sole decreased by 45-58%, and that in the leather insole increased from 0.35 mg g^-1 to 38-58 mg g^-1. After six months, about 90% of the DEHP has been lost from the PVC sole, and that in the leather insole reached close to its initial value (value before the experiment). The migration rate depends on the environmental conditions and the presence of phthalate soluble solvents in the sole-adhesive-insole system of the footwear. The influence of DEHP migration on the physicochemical characteristics of the PVC sole and leather insole has been studied by Fourier transform infrared spectroscopy-attenuated total reflectance (FTIR-ATR), thermo-gravimetric analysis (TGA), and differential scanning calorimetry (DSC). The migration and emission pathways of DEHP, the influence of environmental conditions, and the possibility of human exposure to phthalate through footwear are discussed.

Teaching first-year medical students physiology: does the human patient simulator allow for more effective teaching?

BACKGROUND

Although the Human Patient Simulator (HPS) is an effective teaching tool in many medical fields, literature supporting its use in the teaching of physiology to medical students is lacking. This study investigated the effectiveness of HPS-based teaching of cardiovascular physiology to first-year medical students.

METHODS

Two hundred and ten first-year medical students were scheduled to our HPS laboratory with the purpose of demonstrating "physiology in action". Students were divided into groups of 19-25 each, and attended a lecture followed by a HPS session. Using a theatre-type simulator complete with mannequin, anaesthesia machine and monitors (METI, Sarasota FL), the scenarios of hypovolaemia, sepsis, and cardiac failure were run to demonstrate the physiological changes that occur with changes in preload, afterload, and cardiac contractility. Each student was given a true/false test before, and again after the HPS session, followed by a survey of their learning experience.

RESULTS

There was marked improvement in test scores after the HPS session (82.1% vs. 64.6%, P < 0.001). Most of the students felt that HPS was a better teaching tool (94.5%) and raised more questions (76.5%) than lectures. They wanted more topics to be taught this way (96%), as they could apply and re-enforce textbook knowledge, and visualise real-time changes. However, they felt that their experience could have been enhanced with more time and smaller groups.

DISCUSSION

HPS is an excellent teaching tool as it stimulates student curiosity and makes knowledge acquisition and understanding easier. It is highly desirable to be incorporated into the teaching of physiology.

1,3,6-Trimethyl-pyrano[4,3-b]pyrrol-4(1H)-one

All the non-H atoms of the title compound, C(10)H(11)NO(2), are almost coplanar [maximum deviation = 0.040 (3) Å]. The crystal structure is stabilized by C-H⋯O hydrogen bonds.

Do laparoscopic colectomy techniques compromise oncologic principles?

BACKGROUND

Benefits of laparoscopic techniques over traditional open techniques in colon surgery are well recognized. Although both hand-assisted laparoscopic colectomy (HALC) and laparoscopic-assisted colectomy (LAC) can beeffective in the treatment of colon cancer, the superiority of either technique has yet to be determined for oncologic procedures.

MATERIALS AND METHODS

A five-year retrospective study comparing outcomes of hand-assisted laparoscopic and laparoscopic-assisted colectomies for cancer was conducted at our community-based teaching hospital. Demographic data, tumor location and stage of the disease were analyzed. Outcomes compared between the two procedures included number of lymph nodes retrieved, presence of positive margins, operative time, length of stay, and number of early postoperative complications.

RESULTS

Fifty patients underwent HALC, while 23 underwent LAC during the study period. Demographic data were similar between the two groups. Operative time was longer for LAC, compared with HALC (178 vs. 125 min., p < 0.05), however, the average number of lymph nodes retrieved was significantly higher in LAC compared with HALC (14 vs. 10, p < 0.05). No significant differences were recorded for positive margins, postoperative complications, or the length of hospital stay.

CONCLUSIONS

While HALC was more prevalent at our institution and proved to be associated with decreased operative times, the number of lymph nodes retrieved was sub-optimal and compared less favorably with LAC. Above all, oncologic principles should be respected and achieved regardless of the operative technique used.

Impact of Severe Weather on Operations of a Radiation Oncology Department

PURPOSE/OBJECTIVE(S)

In 2022, two major storms in Western New York brought blizzard conditions and historic snowfall amounts to the region. Beyond the immediate impact to life and property, these weather events resulted in disruptions to cancer care as a result of hazardous travel conditions, and facility closures as a result of regional travel bans. We sought to understand the impact of these disruptive incidents on departmental operations to develop better contingency plans for future occurrences.

MATERIALS/METHODS

The radiation treatment machine schedules for a large academic center in Western New York, as well as a neighboring affiliated satellite clinic were queried for daily treatment adherence rates from November 1, 2022 through February 4, 2023. We classified "severe weather days" based on travel advisories issued by the National Weather Service or from local county officials. Out of a total of 68 working days during the study period, 15 days were classified as having severe weather. We compared the percentage of scheduled patients treated (adherence rates) on severe weather days compared with days without severe weather. Statistical analysis was performed using a two-tailed Z-test for proportions.

RESULTS

Under routine operating conditions, out of a total of 7045 scheduled treatment visits, we found a mean daily treatment adherence rate of 93.57%. On severe weather days, out of a total of 2093 scheduled treatments, we found a mean daily treatment adherence rate of 77.83%. Out of these 15 days, the satellite clinic closed for a total of 3 days, while the academic center closed for 1 day. Excluding the dates of facility closure, overall treatment adherence rate was 84.76% on severe weather days (Risk Ratio: 0.91). We found that the difference in treatment adherence rates between regular and severe weather days was statistically significant (p<0.001), even when excluding dates of facility closure.

CONCLUSION

This study demonstrates a significant reduction in treatment adherence rates around severe winter storms, even when excluding dates of facility closure. We suggest that preparation for such incidents be a part of facility contingency planning. Weekend openings can be considered for closures ≥ 2 days, or sustained adherence rates of 85% or less for 3 or more days.

Forecasting Particulate Matter Emissions Using Time Series Models

Environmental pollution is a serious concern nowadays with its disastrous impact on living organisms. In several types of pollution, Air pollution takes on a crucial role by directly affecting the respiratory system and causing fatal diseases in humans. Air pollution is a mixture of gaseous and particulate matter interweaved by different sources and emanating into the atmosphere. In particular, particle pollutants are critical in growing air pollution in India’s main cities. Forecasting the particulate matter could mitigate the complications caused by it. The employment of a model to predict future values based on previously observed values is known as time series forecasting. In this paper, the PM2.5 pollutant emission data recorded at the Kodungaiyur region of Chennai city were forecasted using three-time series models. The standard ARIMA model is compared with the deep learning-based LSTM model and Facebook’s developed Prophet algorithm. This comparison helps to identify an appropriate forecasting model for PM2.5 pollutant emission. The Root Mean Squared Error (RMSE) acquired from experimental findings is used to compare model performances.

4-Methylanilinium 2-carboxyacetate

In the crystal of the title salt, C7H10N+·C3H3O4 −, the cations are linked to the anions via N—H...O and trifurcated N—H...(O,O,O) hydrogen bonds. The anions are linked into [010] chains by O—H...O hydrogen bonds. Taken together, these interactions generate (100) sheets.

Heat transfer performance of Al2O3/water nanofluids in a mini channel heat sink

The high density heat removal in electronic packaging is a challenging task of modern days. Finding compact, energy efficient and cost effective methods of heat removal is being the interest of researchers. In the present work, mini channel with forced convective heat transfer in simultaneously developing regime is investigated as the heat transfer coefficient is inversely proportional to hydraulic diameter. Mini channel heat sink is made from the aluminium plate of 30 mm square with 8 mm thickness. It has 15 mini channel of 0.9 mm width, 1.3 mm height and 0.9 mm of pitch. DI water and water based 0.1% and 0.2% volume fractions of Al2O3/water nanofluids are used as coolant. The flow rates of the coolants are maintained in such a way that it is simultaneously developing. Reynolds number is varied from 400 to 1600 and heat input is varied from 40 W to 70 W. The results showed that heat transfer coefficient is more than the heat transfer coefficient of fully developed flow. Also the heat transfer is more for nanofluids compared to DI water.

Mathematical approach for segmenting chromosome clusters in metaspread images

Karyotyping is an examination that helps in detecting chromosomal abnormalities. Chromosome analysis is a very challenging task which requires various steps to obtain a karyotype. The challenges associated with chromosome analysis are overlapping and touching of chromosomes. The input considered for chromosome analysis is the metaspread G band chromosomes. The proposed work mainly focus on separation the overlapped and touching chromosomes which is considered to be the major challenge in karyotype. There are various research contribution in chromosome analysis in progress which includes both low (Machine Learning) and high level (Deep Learning) methods. This paper proposes a mathematical based approaches which is very effective in segmentation of clustered chromosomes. The accuracy of segmentation is robust compared to high level approaches.

Atrioventricular septal defect--associated anomalies and aneuploidy in prenatal life

The present study was conducted to estimate the frequency of other-cardiac, extracardiac and chromosomal anomalies in fetuses with A VSD diagnosed in a prenatal diagnosis center, analysed from the database during the 54-month period extending from November 1997 to May 2002. One hundred and three fetuses were diagnosed with A VSD. Among them other-cardiac and extra cardiac anomalies were present in 56 and 75 cases respectively. Of the 22 fetuses that had undergone karyotyping, no metaphase was seen in one case. In the remaining 21, 15 (71.4%) turned out to be normal, three (14.2%) had trisomy 18, two (9.5%) had trisomy 13 and one had trisomy 21 (4.8%). We found that AVSD almost always occurs with other-cardiac or extracardiac anomalies, though the pattern may differ between populations. It seems to be less frequently associated with chromosomal anomalies (especially trisomy 21) in South India. The genetics of AVSD underscores the importance of a thorough understanding of the target population in prenatal decision-making.

Effect of industrial effluent on the morphological parameters and chlorophyll content of green gram (Phaseolus aureus Roxb)

A pot culture experiment was conducted to study the effect of biomass power plant effluent on seed germination, seedling growth and chlorophyll content of green gram (variety LGG 460) have been estimated at different effluent concentrations and time intervals. The effluent is alkaline in nature (pH 8.5), odorless, and comprises of heavy metals such as Cr (0.071 mg l(-1)), Cu (0.014 mg l(-1)), Mn (0.036mg l(-1)), Fe (0.05 mg l(-1)), Co (0.31 mg l(-1)), Ni (0.041 mg l(-1)), Cd (0.028 mg l(-1)), Pb (0.108 mg l(-1)) and Zn (6.73 mg l(-1)). The germination percentage of seed, seedling growth and chlorophyll content showed a gradual decline with increase in effluent concentration. It has been observed that at 25% effluent concentration, there is growth in the root length (3.50 cm seedling(-1)), an increase in shoot length (23.90 cm seedling(-1)) and total chlorophyll content (4.467 mg g(-1) fresh weight) up to 20 days. After 20 day there is decline in all the parameters observed. However at higher concentrations of the effluent, toxic effects were observed from 20th day. This suggests that the effluent can be used safely for green gram cultivation, only after proper treatment and dilution.

883 Clinical Case Report: Recurrent Non-Tuberculous Psoas Abscess with Associated Discitis

Introduction

Following the discovery of modern anti-tuberculosis treatments, psoas abscesses secondary to Pott's disease of the spine rarely occur in developed countries. We present a case of a recurrent non-tuberculous psoas abscess communicating with the spine and pleural cavity, presenting as an abdominal mass.

Case

A 72-year-old man presented with a left upper quadrant mass, pain, abdominal distension and raised inflammatory markers. Cross-sectional imaging with CT and MRI revealed a large left-sided psoas abscess with a pleural effusion tracking to the retroperitoneum and associated recurrent discitis. The patient was commenced on intra-venous antibiotics and the collection was accessed via a radiologically placed drain to the retroperitoneum.

Discussion

Spinal infections may present with a lump below the inguinal ligament due to pus tracking down the psoas tendon sheath. Irritation of the psoas muscle may also present with pain on hip extension due to muscular spasm. The most common causative agent of primary psoas abscesses is Staphylococcus Aureus. Discitis is more common in men and shows a bimodal age distribution in presentation, predominantly affecting children and then those in the 6th-7th decade of life.

Learning points

Retroperitoneal disease should be considered in a patient who presents with an abdominal mass. In patients who present with a psoas abscess or an empyema communicating with the retroperitoneum, a spinal source should be considered. Crohn's disease is a common cause of secondary psoas abscesses and should also be considered. Cultures for mycobacteria should be obtained to exclude Tuberculosis as an underlying cause.