Etiology and management of spontaneous haemothorax

Spontaneous haemothorax (SH) is a subcategory of haemothorax that involves the accumulation of blood within the pleural space in the abscence of trauma or other causes. The clinical presentation is variable and includes a rapid progression of symptoms of chest pain and dyspnea that can be life threatening when hemodynamic instability and hypovolemic shock occurs. Despite haemothorax, SH is much less common with data limited to case reports and case series. A literature review has been performed to identify and summarise all potentials causes leading to this clinical entity.

Comparing the performance of Miscanthus x giganteus and wheat straw biomass in sulfuric acid based pretreatment

The objective of this study was to assess and compare the suitability of Miscanthus x giganteus and wheat straw biomass in dilute acid catalyzed pretreatment. Miscanthus and wheat straw were treated in a dilute sulfuric acid/steam explosion pretreatment. As a result of combining dilute sulfuric acid- and steam explosion pretreatment the hemicellulose hydrolysis yields (96% in wheat straw and 90% in miscanthus) in both substrates were higher than reported in literature. The combined severity factor (=CSF) for optimal hemicellulose hydrolysis was 1.9 and 1.5 in for miscanthus and wheat straw respectively. Because of the higher CSF value more furfural, furfuryl alcohol, 5-hydroxymethylfurfural and acetic acid was formed in miscanthus than in wheat straw pretreatment.

Implementation of the cobas Liat influenza point-of-care test into an emergency department during a high-incidence season: a retrospective evaluation following real-world implementation

The cobas Liat influenza A/B and respiratory syncytial virus (RSV) assay (Liat) was used in the adult emergency department of a large London hospital from 21^st January 2018 to 14^th April 2018. Influenza was detected in 308 of 1027 (30%) samples tested; influenza A in 157 (15.3%), influenza B in 149 (14.5%) and RSV in 28 (2.7%). When compared against Fast Track Diagnostics Respiratory Pathogens 21 multiplex polymerase chain reaction and Cepheid Xpert Xpress Flu/RSV assay, Liat performance for the detection of influenza A or B was: sensitivity 85% [95% confidence interval (CI) 76–92)], specificity 98% (95% CI 97–99), negative predictive value 94% (95% CI 92–96) and positive predictive value 95% (95% CI 91–97).

Efficiency of single stage- and two stage pretreatment in biomass with different lignin content

In current study the enzymatic glucose yields of miscanthus and wheat straw were compared after single stage- and two stage pretreatment with dilute sulfuric acid at different pretreatment severities. Glucose yields after two stage pretreatment were higher than after single stage pretreatment in miscanthus. Whereas wheat straw had higher glucose yields after single stage pretreatment. The study shows that two stage pretreatment has a negative effect on glucose yield in biomass with low not-acid-degradable lignin content and a positive one in biomass with high not-acid-degradable lignin content. The not-acid-degradable lignin fraction offers a higher degree of protection of the whole lignin structure against chemical attacks by mineral acids. More severe pretreatment conditions were needed to achieve a sufficient breakup of the lignin structure. But more severe conditions enhance resin formation, leading to lower enzyme activity and reduced carbohydrate yields.

Comparison of thermochemical conversion and anaerobic digestion of perennial flower-rich herbaceous wild plant species for bioenergy production

The combustion quality of three perennial wild plant species Tanacetum vulgare L., Centaurea nigra L. and Artemisia vulgaris L. was investigated in comparison to the energy yield obtained from anaerobic digestions of these biomasses. Combustion resulted in 1.5-2.8 times higher energy yield compared to anaerobic digestion. All wild plants showed a similar higher heating value to Miscanthus × giganteus Greef et Deuter and Panicum virgatum L. (16.0-17.0 MJ kg^-1). The ash-melting behavior of all wild plants was like Sida hermaphrodita L. Rusby, since the ash did not sinter at 1200 °C. However, Artemisia vulgaris L. had highest ash content (5.2-5.7% of dry matter) with a low ash melting behavior (1000 °C) attributed to a high potassium content and calculated phase composition. Therefore, careful consideration should be given to select the wild plants to meet the requirements for their use as solid biofuels in residential and commercial applications.

Recent advances in the use of phytochemicals to manage gastrointestinal oxidative stress in poultry and pigs

Plants are integral components of pig and poultry feed, and aside from their raw nutritive value, some phytochemicals contain bioactive compounds. The aim of the present paper is to review recent advances in the use of some phytochemicals in pig and poultry feed, focusing on the examples of isoquinoline alkaloids, polyphenol rich sugarcane extracts and superoxide dismutase-rich melon pulp extracts. As gut health is critical for efficient production, the review will focus on recent results modulating oxidative stress within the gastrointestinal tract and the potential mechanisms of action.

A combined approach to correct posterior left ventricular aneurysm, aortic stenosis and coronary artery disease

Ischaemic heart disease and aortic stenosis are potentially life-threatening conditions. A post-infarct left ventricular aneurysm, when combined with the above, is particularly hazardous. We present a case where all three conditions occurred simultaneously and describe the surgical approach undertaken to attempt correction. The patient underwent aneurysmectomy together with aortic valve replacement and two-vessel coronary artery bypass grafting. The aneurysm was excised with direct linear closure of the walls using a Teflon-buttressed interrupted mattress suture technique. Post-operatively, ventricular systolic function was good (LVEF 40%) together with a well-seated aortic valve showing no paravalvular leaks. This case highlights the importance of meticulous removal of thrombus from the aneurysm and everting the edges thereby eliminating a thrombogenic surface and the risk of embolic stroke. The restorative procedure itself serves to underline the importance of ventricular shape in the effective functioning of the myocardium for sustaining an adequate stroke volume with normalized physiology.

Operative consideration in patient with cryoglobulinaemia undergoing cardiac surgery with use of cardiopulmonary bypass

Cryoglobulinaemia can be defined as the presence of single or mixed immunoglobulins in the serum, which precipitate at sub-homeostatic temperatures and redissolve at higher temperatures. This condition in the context of cardiac surgery can precipitate systemic complications secondary to cold agglutination and lead to significant perioperative problems with the cardiopulmonary bypass machine and the extracorporeal circuit. We present a case of a 74-year-old gentleman with cryoglobulinaemia who underwent mitral valve repair and coronary artery bypass graft surgery. The patient was to undergo preoperative plasmapheresis to reduce circulating levels of cryoglobulin and thereby decrease the risk of potential protein agglutination during cardiopulmonary bypass. Operative considerations included the level of systemic temperature required, the temperature of the cardioplegia solution, level of anticoagulation and the speed and timing of rewarming of the patient to normal homeostatic temperatures. The postoperative management also consisted of early plasmapheresis to further reduce the number of cryoglobulins.

Type B aortic dissection repair using a Thoraflex hybrid prosthesis in a setting of aberrant left vertebral artery

Type B aortic dissection (TBAD) is often managed conservatively with intervention reserved for complicated cases. Strategies for complicated and uncomplicated TBAD can involve optimal medical therapy, thoracic endovascular aortic replacement and open surgical repair of TBAD with replacement of the affected segment of aorta and reimplantation of aortic branches. The frozen elephant trunk technique has been reported to be a successful surgical strategy in patients with complicated TBAD, particularly in patients who possess unfavourable aortic arch anatomy for endovascular stenting or at increased risk of retrograde Type A aortic dissection. The Thoraflex is a commercially available aortic graft, manufactured by Vascutek®. We describe a successful case of addressing complicated TBAD with rare variant aortic anatomy using a Thoraflex hybrid frozen elephant trunk graft and reimplantation of the aberrant left vertebral artery to the perfusion limb of the Thoraflex graft.