Percutaneous tracheostomy-beware of the thyroidea-ima artery

Percutaneous tracheostomy is a minimally invasive operation performed in patients, in order to provide an air passage through the windpipe. A rare cause of severe bleeding during such operation is the injury of the thyroidea-ima artery. This case report presents a patient with hemorrhage after thyroidea-ima injury during percutaneous dilatational tracheostomy. Surgeons should always be aware of such anatomic variation, in order to prevent urgent sternotomy

'Same, but different' : a mixed methods realist evaluation of a cluster-randomized controlled participatory organizational intervention

Participatory organizational interventions are a recommended approach to improve the psychosocial work environment. As interventions of this type are shaped by employees and managers, their implementation can vary considerably, making evaluation challenging. This study contributes to our understanding of interventions by focusing on how the intervention mechanisms and the organizational context interact. In a mixed-methods design, we use multi-group structural equation modelling of pre-and post-intervention survey data (N = 204) to test multiple mediational mechanisms in three different contexts. We then analyse interviews (N = 67) and field observations of workshops to identify the role of contextual factors. The findings suggest that participatory organizational interventions do not produce one-size-fits-all results; on the contrary, intervention results are better understood as products of multiple intervention mechanisms interacting with the specific organizational contexts

Increasing extracellular H2O2 produces a bi-phasic response in intracellular H2O2, with peroxiredoxin hyperoxidation only triggered once the cellular H2O2-buffering capacity is overwhelmed

Reactive oxygen species, such as H2O2, can damage cells but also promote fundamental processes, including growth, differentiation and migration. The mechanisms allowing cells to differentially respond to toxic or signaling H2O2 levels are poorly defined. Here we reveal that increasing external H2O2 produces a bi-phasic response in intracellular H2O2. Peroxiredoxins (Prx) are abundant peroxidases which protect against genome instability, ageing and cancer. We have developed a dynamic model simulating in vivo changes in Prx oxidation. Remarkably, we show that the thioredoxin peroxidase activity of Prx does not provide any significant protection against external rises in H2O2. Instead, our model and experimental data are consistent with low levels of extracellular H2O2 being efficiently buffered by other thioredoxin-dependent activities, including H2O2-reactive cysteines in the thiol-proteome. We show that when extracellular H2O2 levels overwhelm this buffering capacity, the consequent rise in intracellular H2O2 triggers hyperoxidation of Prx to thioredoxin-resistant, peroxidase-inactive form/s. Accordingly, Prx hyperoxidation signals that H2O2 defenses are breached, diverting thioredoxin to repair damage

Hordeolum externum

Male 63 years old. Anterior view of globe.https://commons.pacificu.edu/od/1485/thumbnail.jp

Fast-track rehabilitation following video-assisted pulmonary sublobar wedge resection: A prospective randomized study

Background: Postoperative morbidity and inhospital length of stay are considered major determinants of total health care expenditure associated with thoracic operations. The aim of this study was to prospectively evaluate the role of video-assisted thoracic surgery (VATS) compared to mini-muscle-sparing thoracotomy in facilitating early recovery and hospital discharge after pulmonary sublobar wedge resections. Patients and Methods: A total number of 120 patients undergoing elective pulmonary sublobar wedge resection were randomly assigned to VATS (n = 60) or mini-muscle-sparing thoracotomy (n = 60). The primary endpoint was time to hospital discharge. Postoperative complications, cardiopulmonary morbidity and 30-day mortality served as secondary endpoints. Results: Patients' baseline demographic and clinical data did not differ among study arms as well as the number of pulmonary segments resected and the morphology of the nodular lesions. Total hospital stay was significantly shorter in patients assigned to the thoracoscopic technique as opposed to those who were operated using the mini-muscle-sparing thoracotomy approach (4 ± 0.6 versus 4.4 ± 0.6 days respectively, P = 0.006). Multivariate analysis revealed that VATS approach was inversely associated with longer inhospital stay whereas the number of resected segments was positively associated with an increased duration of hospitalization. Patients in the VATS group were less likely to develop atelectasis (≥1 lobe) compared to those who underwent thoracotomy (0% versus 6.7% respectively, P = 0.042). Kaplan-Meier analysis revealed similar 30-day mortality rates in both study arms (Log-rank P = 0.560). Conclusion: VATS was associated with shorter duration of hospitalization positively affecting the patients' quality of life and satisfaction. Significant suppression of the total cost of recovery after thoracoscopic pulmonary resections is expected

Design and Construction of a Micro Aerial Vehicle for the 2014 SAE Aero Design East Competition

This project involved the analysis, design, and fabrication of an aircraft meeting the requirements of the 2014 SAE Aero Design Competition, Micro-Class. Best competition scoring favored an aircraft of maximum payload that could be loaded into a 24”x18”x8” box. The team used various tools including wind tunnel and mathematical modeling to determine the Micro’s aerodynamics and power characteristics. Final design used a combination of conventional and high performance materials, balsa, carbon fiber, and UltraCote wing covering. Configuration was conventional with 4 wing panels totaling 90” span using an 1100 W motor. Outer wing panels were given +8 degrees of dihedral to permit two-axis control. The Micro is expected to carry 5-10 pounds of payload at speeds of 25-35 ft. /sec