Time needed to intubate and suction a manikin prior to instituting positive pressure ventilation: a simulation trial

Tracheal suctioning in non-vigorous newborn delivered through meconium-stained amniotic fluid (MSAF) is supposed to delay initiation of positive pressure ventilation (PPV), but the magnitude of such delay is unknown. To compare the time of PPV initiation when performing immediate laryngoscopy with intubation and suctioning vs. performing immediate PPV without intubation in a manikin model. Randomized controlled crossover (AB/BA) trial comparing PPV initiation with or without endotracheal suctioning in a manikin model of non-vigorous neonates born through MSAF. Participants were 20 neonatologists and 20 pediatric residents trained in advanced airway management. Timing of PPV initiation was longer with vs. without endotracheal suctioning in both pediatric residents (mean difference 13\ua0s, 95% confidence interval 8 to 18\ua0s; p\ua0< 0.0001) and neonatologists (mean difference 12\ua0s, 95% confidence interval 8 to 16\ua0s; p < 0.0001). The difference in timing of PPV initiation was similar between pediatric residents and neonatologists (mean difference 12 1\ua0s, 95% confidence interval 12 7 to 6\ua0s; p\ua0= 0.85). Conclusions: Performing immediate laryngoscopy with intubation and suctioning was associated with longer\u2014but not clinically relevant\u2014time of initiation of PPV compared with immediate PPV without intubation in a manikin model. While suggesting negligible delay in starting PPV, further studies in a clinical setting are warranted. Registration: clinicaltrial.gov NCT04076189.What is Known:\u2022 Management of the non-vigorous newborn delivered through meconium-stained amniotic fluid remains still controversial.\u2022 Tracheal suctioning in non-vigorous newborn delivered through meconium-stained amniotic fluid is supposed to delay initiation of positive pressure ventilation, but the magnitude of such delay is unknown.What is New:\u2022 Performing immediate ventilation without intubation was associated with shorter\u2014but not clinically relevant\u2014time of initiation of ventilation compared to immediate laryngoscopy with intubation and suctioning in a manikin model.\u2022 Further studies in a clinical setting are warranted

Left Spigelian Hernia in Super-Obese Patient: A Case-Report.

Abstract: We report a case in which a giant Spigelian hernia presented with severe, persistent abdominal pain in a 62- year-old super-obese woman with a history of total abdominal hysterectomy-bilateral salpingo-oopherectomy at the age of 40 years for benign neoplasia, who later underwent open hernia repair (maximal diameter of the hernia sac: 21 cm) because of the development of compartment syndrome. Afterward, although a large incarcerated hernia disease was found, the sac removal was technically difficult and an open procedure was carried out, with double-mesh placement. No complications were recorded during the post-operative course. We report a difficult issue related to the diagnosis and management of this pathology, underlining the complete surgical repair to avoid hernia recurrence

Walls talk: Microbial biogeography of homes spanning urbanization.

Westernization has propelled changes in urbanization and architecture, altering our exposure to the outdoor environment from that experienced during most of human evolution. These changes might affect the developmental exposure of infants to bacteria, immune development, and human microbiome diversity. Contemporary urban humans spend most of their time indoors, and little is known about the microbes associated with different designs of the built environment and their interaction with the human immune system. This study addresses the associations between architectural design and the microbial biogeography of households across a gradient of urbanization in South America. Urbanization was associated with households' increased isolation from outdoor environments, with additional indoor space isolation by walls. Microbes from house walls and floors segregate by location, and urban indoor walls contain human bacterial markers of space use. Urbanized spaces uniquely increase the content of human-associated microbes-which could increase transmission of potential pathogens-and decrease exposure to the environmental microbes with which humans have coevolved

A comparison of the effectiveness of three LED phototherapy machines, single- and double-sided, for treating neonatal jaundice in a low resource setting

© 2018 Arnolda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Neonatal jaundice is one of the most common reasons for hospital admission in low resource settings. Treatment is frequently inadequate as conventional phototherapy requires frequent bulb changes. LED phototherapy has comparable efficacy to conventional phototherapy, and the bulbs last over 40,000 hours. This observational study compares the effectiveness of three LED machines, two single-sided and one double-sided in routine use in Vietnam. Methods We included all infants weighting 1500g and with jaundice diagnosed visually or by Total Serum Bilirubin (TSB) measurement at The Da Nang Hospital for Women and Children (Da Nang, Vietnam). The primary endpoint was the average hourly change in TSB over the first six hours of treatment. The secondary endpoints were duration of treatment; average hourly change in TSB over treatment, and length of stay in the neonatal unit. Multivariable analysis and bootstrap methods was performed to compare outcomes, adjusting for potential confounders. Results All outcomes were comparable in the two single-sided machines. The double-sided machine showed 54% increase in the hourly speed of TSB reduction (1.3 μmol/L/hr, 95% CI 0.3-2.3), with a 45% increase in the speed of TSB reduction over the duration of treatment (0.9 μmol/ L/hr, 95% CI 0.6-1.3). In addition, the double-sided machine was associated with 21% reduction in the duration of treatment (14 hours, 95% CI 5-22) and 16% reduction of length of stay (14 hours, 95% CI 3-25). Conclusion The results confirm and quantify the benefits of increasing surface-area exposure during phototherapy. Adjusted for multiple potential confounders, use of double-sided phototherapy can substantially increase the speed of TSB reduction, and substantially decrease the duration of treatment and length of stay in the NCU

Shielding efficiency and E(J) characteristics measured on large melt cast Bi-2212 hollow cylinders in axial magnetic fields

We show that tubes of melt cast Bi-2212 used as current leads for LTS magnets can also act as efficient magnetic shields. The magnetic screening properties under an axial DC magnetic field are characterized at several temperatures below the liquid nitrogen temperature (77 K). Two main shielding properties are studied and compared with those of Bi-2223, a material that has been considered in the past for bulk magnetic shields. The first property is related to the maximum magnetic flux density that can be screened, Blim; it is defined as the applied magnetic flux density below which the field attenuation measured at the centre of the shield exceeds 1000. For a cylinder of Bi-2212 with a wall thickness of 5 mm and a large ratio of length over radius, Blim is evaluated to 1 T at T = 10 K. This value largely exceeds the Blim value measured at the same temperature on similar tubes of Bi-2223. The second shielding property that is characterized is the dependence of Blim with respect to variations of the sweep rate of the applied field, dBapp/dt. This dependence is interpreted in terms of the power law E = Ec(J/Jc)^n and allows us to determine the exponent n of this E(J) characteristics for Bi-2212. The characterization of the magnetic field relaxation involves very small values of the electric field. This gives us the opportunity to experimentally determine the E(J) law in an unexplored region of small electric fields. Combining these results with transport and AC shielding measurements, we construct a piecewise E(J) law that spans over 8 orders of magnitude of the electric field.Comment: 16 pages, 7 figure

Landscapes of Northern Lombardy: from the glacial scenery of Upper Valtellina to the prealpine lacustrine environment of Lake Como

In the region between Valtellina and Lake Como in the Central Italian Alps, one can visit, in a relatively small area, some of the best examples of mountain geomorphological landscapes of Italy. Eight specific sites-showing peculiar glacial, periglacial, structural, gravity-induced and erosional landforms-have been selected to illustrate how different landscapes may originate from geomorphological modelling of different lithotypes in different morphogenetic systems. These eight sites are exemplary cases in which significant evidence of past and current climatic and structural conditions characterising this region is exhibited

Cytomegalovirus Prophylaxis versus Pre-emptive Strategy: Different CD4(+) and CD8(+) T Cell Reconstitution after Allogeneic Hematopoietic Stem Cell Transplantation

Reconstitution of T cells after transplantation is a determinant of the long-term success of the procedure, and the correlation with T cell recovery and cytomegalovirus reactivation and disease is well known. We evaluated 110 patients who underwent transplantation: 55 received pre-emptive antiviral treatment, and in the other 55 patients, prophylaxis with letermovir was employed. A progressive statistically significant difference in T cell reconstitution between the 2 groups was observed, starting from day +60 with faster recovery in the pre-emptive group. Moreover, a higher incidence of cytomegalovirus reactivation was observed in prophylactic group after discontinuation of letermovir, and subsequent antiviral treatment has been necessary. Our findings confirm, as previously reported, that cytomegalovirus reactivation is a potent stimulator of T cell function

Logística inversa de residuos agroquímicos en Argentina: resolución heurística y exacta

Argentina es uno de los principales exportadores de productos agrícolas del mundo, localizándose gran parte de esta producción en la región pampeana. Debido a su enorme escala, esta actividad, además de generar importantes ingresos a nuestro país, también origina una gran cantidad de residuos especiales, entre ellos, los envases de los agroquímicos. Son conocidos los problemas ambientales y económicos que genera el incorrecto manejo de estos residuos por poseer sustancias que representan un riesgo para la salud y el medio ambiente. Teniendo en cuenta esta problemática, la Universidad Nacional del Sur (UNS) y la Universidad Provincial del Sudoeste (UPSO), proponen diseñar un sistema de reciclado de dichos envases en la región que comprende los veintiún municipios del sudoeste bonaerense (SOB). En el marco de este proyecto, el presente trabajo consistió en la optimización de la red logística de recolección de los residuos agroquímicos y la evaluación de la localización de la planta de tratamiento de los mismos. El modelado de la red se abordó como un problema CVRP (Capacitated Vehicle Routing Problem). Se consideraron distintas frecuencias de recolección y se resolvió mediante técnicas exactas y heurísticas.Sociedad Argentina de Informática e Investigación Operativ

Mismatch-repair protein expression in high-grade gliomas: A large retrospective multicenter study

Background: DNA mismatch repair (MMR) is a system for repairing errors in DNA replication. Cancer cells with MMR deficiency can have immunohistochemical loss of MMR protein expression leading to a hypermutable phenotype that may correlate with anti-PD1 efficacy. Scant data exist about immunohistochemical loss of MMR protein expression in high-grade gliomas (HGG). Materials and Methods: We performed a large multicenter retrospective study to investigate the frequency and the prognostic role of immunohistochemical loss of MMR protein expression in HGG patients; we nevertheless evaluated the association between this status and clinical or molecular characteristics. Immunohistochemical loss of MMR protein expression was recorded as partial or complete loss of at least 1 MMR protein. Results: We analyzed the expression of MMR proteins in tumor tissue of 355 consecutive patients. Partial and complete immunohistochemical loss of MMR proteins was found in 43/355 samples (12.1%) and among these, 15 cases (4.2%) showed a complete loss of at the least one MMR protein. Alteration of MSH2 expression was found in 55.8%, MSH6 in 46.5%, PMS2 in 34.9%, and MLH1 in 30.2%. Alteration of MMR protein expression was statistically more frequent in anaplastic gliomas, in recurrent disease, in patients treated with temozolomide, and in IDH-mut gliomas. Immunohistochemical loss of MMR proteins was not associated with survival, adjusting for clinically relevant confounders. Conclusions: MMR protein expression status did not affect survival in HGG patients. We identified clinical and molecular characteristics correlating with immunohistochemical loss of MMR proteins expression. A large study should be performed to analyze its predictive role of immune checkpoint inhibitor efficacy in these subgroups of patients

Association between thyroid function and regorafenib efficacy in patients with relapsed wild-type IDH glioblastoma: a large multicenter study

Purpose: Regorafenib demonstrated encouraging results in recurrent glioblastoma patients. Some studies showed that changes in circulating thyroid hormones (fT3, fT4, fT3/fT4 ratio) can be considered as prognostic factors in patients with various types of tumors. We designed this study to investigate the relationship between baseline thyroid variables and outcome in IDH-wild type GBM patients who were treated with regorafenib. Methods: This multicenter retrospective study included recurrent IDH-wild-type glioblastoma patients treated with regorafenib. Only patients with baseline thyroid function values (TSH, fT3, fT4, fT3/fT4 ratio) available were evaluated. RANO criteria were used to analyze neuroradiological response. Survival curves were estimated using the Kaplan–Meier method. The relationships between baseline thyroid variables (TSH, fT3, fT4, fT3/fT4) and survival (PFS, OS) were investigated with Cox regression models. Results: From November 2015 to April 2022, 134 recurrent IDH-wildtype GBM patients were treated with regorafenib and 128 of these had information on baseline thyroid function value. Median follow-up was 8 months (IQR 4.7–14.0). Objective Response Rate was 9% and Disease Control Rate was 40.9%. Median PFS was 2.7 months (95%CI 2.2–3.6) and median OS was 10.0 months (95%CI 7.0–13.0). Lower baseline TSH value in the blood was correlated with a higher rate of disease progression to regorafenib (p = 0.04). Multivariable analyses suggested a non-linear relationship between PFS (p = 0.01) and OS (p = 0.03) with baseline fT3/fT4 ratio. Conclusion: In recurrent wild-type IDH glioblastoma patients, baseline fT3/fT4 ratio showed a non-linear relationship with survival, with different impacts across the spectrum of fT3/fT4 ratio. Moreover, baseline TSH may be a predictor of regorafenib activity