A short cut to definitive airway in open tracheal injury: a case report

Open tracheal injury is rare but can lead to disastrous consequences such as massive bleeding, airway obstruction or failure and aspiration of blood. We present a case of open tracheal injury of a man who tried to attempt suicide using a knife. In this case, the initial management was securing the airway by attempting orotracheal intubation. However, it was unsuccessful when the tube came out from the laceration wound. Intubation was then re-attempted through the distal cut-end of the trachea in the face of airway failure. A quick initial assessment and anticipation of a failed airway should always be the top priority in any emergency physician managing these cases. Direct intubation through the laceration wound might be the only option when all else fail and your patient is crashing

The 28-day mortality prediction in sepsis patients using static lactate concentration and early lactate clearance: an observational study.

Sepsis causes high mortality and morbidity. Static lactate concentration and early lactate clearance are cited to be a predictor for sepsis survival. This study examined the clinical utility of static lactate concentration and early lactate clearance within the first six hours of admission in Emergency Department (ED) to predict 28-day mortality rate in sepsis patients. Patients who presented with sepsis, severe sepsis or septic shock and admitted to ED of Universiti Kebangsaan Malaysia Medical Centre were recruited. Blood lactate concentrations were measured upon admission (H0), at 1st hour (H1) and 6th hour (H6), respectively. Either standard treatment of sepsis or early goal directed therapy was initiated according to sepsis severity. A follow-up report was conducted at 28 days via telephone call, e-mail or case notes. Patients were later classified into survivor and non-survivor as final outcome. Static lactate concentration appeared to be significantly higher for non-survivor as compared to the survival group at H0, H1 and H6 (p<0.05). The lactate clearance trend reflects no relationship between early lactate clearance and 28-day mortality. Static lactate concentration showed a superior predictor for sepsis over early lactate clearance. Although early lactate clearance was unable to prove its ability to predict 28-day mortality, our findings suggest it can be a useful tool to gauge the resuscitation outcome

Drivers of new venture digitalization among Malaysian SMES: a conceptual model

This study is an extension of previous studies focusing on new venture digitalization. It examines the influence of the drivers of new venture digitalization on small and medium enterprises (SMEs). Using a systematic literature review, the study developed a conceptual model to examine the drivers of new venture digitalization among Malaysian SMEs. The findings reveal the extent to which organizational factors such as size, ownership and international experience of firms can influence Malaysian SMEs' new venture digitalization. It also indicates that individual and environment factors such as age, gender, and education; government intervention, competitors and customers pressure, Covid-19 health crisis, blockchain technology and fast broadband access have the potential to drive Malaysian SMEs' new venture digitalization. The study contributes to models on new venture digitalization and provides a better understanding of general and country specific factors that drives the utilization of digitalization in new ventures

Data and videos for ultrafast synchrotron X-ray imaging studies of metal solidification under ultrasound.

The data presented in this article are related to the paper entitled 'Ultrafast synchrotron X-ray imaging studies of microstructure fragmentation in solidification under ultrasound' [Wang et al., Acta Mater. 144 (2018) 505-515]. This data article provides further supporting information and analytical methods, including the data from both experimental and numerical simulation, as well as the Matlab code for processing the X-ray images. Six videos constructed from the processed synchrotron X-ray images are also provided

Peer trainers compared with basic life support trainers in delivering effective cardiopulmonary resuscitation training to secondary school students

Teaching cardiopulmonary resuscitation (CPR) skills to the public is essential in improving cardiac arrest survival. American Heart Association suggested to incorporate it into the school curriculum. Peer trainers is a low cost and effective method in achieving this. The objective of this 3 months prospective controlled study was to compare the effectiveness of teaching compression only CPR between peers and certified basic life support (BLS) trainers to secondary school students. Improvement in knowledge and psychomotor skills of CPR compression were the primary outcome evaluated. Twelve peer trainers aged 16-years-old and twelve certified BLS trainers were recruited into the study. Compression only CPR was taught to 36 randomized secondary school students by either peer trainers (Group P) or BLS trainers (Group B). A pre-test, immediate post-test and 3 months retention test on knowledge and psychomotor skill were conducted. There was no statistically a significant difference in the mean scores of knowledge and psychomotor at pre-test, post-test and 3 months retention between Group P and Group B. There was significant increase of knowledge score between pre-test and post-test in Group P (mean difference 5.8+2.7, p<0.001) and in Group B (mean difference 4.7+2.7, p<0.001). Psychomotor score was significantly increased between pre-test and post -test in Group P (mean difference 7.11+1.49, p<0.001) and Group B (mean difference 7.22+1.5, p<0.001). Peer trainers is non-inferior to BLS trainers in teaching CPR to secondary school students as both groups showed significant improvement at post-test

Peritonitis secondary to traumatic duodenal laceration in the presence of a large pancreatic pseudocyst: a case report

<p>Abstract</p> <p>Introduction</p> <p>A pancreatic pseudocyst is a common sequela of severe acute pancreatitis. Commonly, it presents with abdominal pain and a mass in the epigastrium several weeks after the acute episode and can be managed conservatively, endoscopically or surgically. We report a patient with a pancreatic pseudocyst awaiting endoscopic therapy who developed a life-threatening complication following a rather innocuous trauma to the abdomen.</p> <p>Case presentation</p> <p>A 23-year-old Asian male student presented as an emergency with an acute abdomen a week after a minor trauma to his upper abdomen. The injury occurred when he was innocently punched in the abdomen by a friend. He experienced only moderate discomfort briefly at the time. His past medical history included coeliac disease and an admission four months previously with severe acute pancreatitis. He was hospitalized for 15 days; his pancreatitis was thought to be due to alcohol binge drinking on weekends. Ultrasound scanning showed no evidence of gallstone disease. Five days after the trauma, he became anorexic, lethargic and feverish and started vomiting bilious content. Seven days post-trauma, he presented to our emergency department with severe abdominal pain. An emergency laparotomy was performed where a transverse linear duodenal laceration was found at the junction of the first and second part of his duodenum, with generalized peritonitis. His stomach and duodenum were stretched over a large pancreatic pseudocyst posterior to his stomach. It was postulated that an incomplete duodenal injury (possibly a serosal tear) occurred following the initial minor trauma, which was followed by local tissue necrosis at the injury site resulting in a delayed presentation of generalized peritonitis.</p> <p>Conclusion</p> <p>This is the first reported case of a traumatic duodenal laceration following minor blunt trauma in the presence of a large pancreatic pseudocyst. Minor blunt abdominal trauma in a normal healthy adult would not be expected to result in a significant duodenal injury. In the presence of a large pseudocyst, however, the stretching of the duodenum over the pseudocyst had probably predisposed the duodenum to this injury. Patients awaiting therapeutic interventions for their pancreatic pseudocysts should be warned about this unusual but life-threatening risk following minor blunt abdominal trauma.</p

"...because I am something special" or "I think I will be something like a guinea pig": information and assent of legal minors in clinical trials – assessment of understanding, appreciation and reasoning

<p>Abstract</p> <p>Background</p> <p>The aim of this study is to assess and evaluate the capacities for understanding, appreciation and reasoning of legal minors with psychiatric disorders and their parents and their competence to consent or assent to participation in clinical trials. The beliefs, fears, motivation and influencing factors for decision-making of legal minors and parents were also examined.</p> <p>Methods</p> <p>Using the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), an instrument developed for adults whose capacities to consent are unclear, we provided information about clinical trials and assessed understanding, appreciation and reasoning. We adapted this tool for legal minors and examined 19 children and adolescents between the ages of 7 and 15 with attention deficit/hyperactivity disorder (ADHD) or ADHD combined with oppositional defiant disorder (DSM-IV 314.00/314.01/312.8) enrolled in clinical trials. Parents were also examined using the MacCAT-CR.</p> <p>Results</p> <p>Facts such as the procedures involved in trials or their duration were well understood by legal minors, but more abstract issues like the primary purpose of the trial were not understood by children and adolescents or by many parents. Legal minors also had difficulties understanding the nature of placebo and the probability of receiving placebo. Children's and adolescents' decisions were influenced by fears about their disorder worsening and by problems in their relationship with their parents. Parents wanted the best therapy for their children in order to minimize problems in school.</p> <p>Conclusion</p> <p>Legal minors and parents need to be informed more precisely about specific issues like placebo and the primary purpose of trials. In general, the reasoning of children and adolescents was influenced by their experience with their disorder and decision making was based on reasonable arguments. Their fears were based on everyday experiences such as school performance or family relationships.</p

SnTox3 Acts in Effector Triggered Susceptibility to Induce Disease on Wheat Carrying the Snn3 Gene

The necrotrophic fungus Stagonospora nodorum produces multiple proteinaceous host-selective toxins (HSTs) which act in effector triggered susceptibility. Here, we report the molecular cloning and functional characterization of the SnTox3-encoding gene, designated SnTox3, as well as the initial characterization of the SnTox3 protein. SnTox3 is a 693 bp intron-free gene with little obvious homology to other known genes. The predicted immature SnTox3 protein is 25.8 kDa in size. A 20 amino acid signal sequence as well as a possible pro sequence are predicted. Six cysteine residues are predicted to form disulfide bonds and are shown to be important for SnTox3 activity. Using heterologous expression in Pichia pastoris and transformation into an avirulent S. nodorum isolate, we show that SnTox3 encodes the SnTox3 protein and that SnTox3 interacts with the wheat susceptibility gene Snn3. In addition, the avirulent S. nodorum isolate transformed with SnTox3 was virulent on host lines expressing the Snn3 gene. SnTox3-disrupted mutants were deficient in the production of SnTox3 and avirulent on the Snn3 differential wheat line BG220. An analysis of genetic diversity revealed that SnTox3 is present in 60.1% of a worldwide collection of 923 isolates and occurs as eleven nucleotide haplotypes resulting in four amino acid haplotypes. The cloning of SnTox3 provides a fundamental tool for the investigation of the S. nodorum–wheat interaction, as well as vital information for the general characterization of necrotroph–plant interactions

miR-155 in the progression of lung fibrosis in systemic sclerosis

Background: MicroRNA (miRNA) control key elements of mRNA stability and likely contribute to the dysregulated lung gene expression observed in systemic sclerosis associated interstitial lung disease (SSc-ILD). We analyzed the miRNA gene expression of tissue and cells from patients with SSc-ILD. A chronic lung fibrotic murine model was used. Methods: RNA was isolated from lung tissue of 12 patients with SSc-ILD and 5 controls. High-resolution computed tomography (HRCT) was performed at baseline and 2-3 years after treatment. Lung fibroblasts and peripheral blood mononuclear cells (PBMC) were isolated from healthy controls and patients with SSc-ILD. miRNA and mRNA were analyzed by microarray, quantitative polymerase chain reaction, and/or Nanostring; pathway analysis was performed by DNA Intelligent Analysis (DIANA)-miRPath v2.0 software. Wild-type and miR-155 deficient (miR-155ko) mice were exposed to bleomycin. Results: Lung miRNA microarray data distinguished patients with SSc-ILD from healthy controls with 185 miRNA differentially expressed (q < 0.25). DIANA-miRPath revealed 57 Kyoto Encyclopedia of Genes and Genomes pathways related to the most dysregulated miRNA. miR-155 and miR-143 were strongly correlated with progression of the HRCT score. Lung fibroblasts only mildly expressed miR-155/miR-21 after several stimuli. miR-155 PBMC expression strongly correlated with lung function tests in SSc-ILD. miR-155ko mice developed milder lung fibrosis, survived longer, and weaker lung induction of several genes after bleomycin exposure compared to wild-type mice. Conclusions: miRNA are dysregulated in the lungs and PBMC of patients with SSc-ILD. Based on mRNA-miRNA interaction analysis and pathway tools, miRNA may play a role in the progression of the disease. Our findings suggest that targeting miR-155 might provide a novel therapeutic strategy for SSc-ILD

Mediastinal lymph node metastasis model by orthotopic intrapulmonary implantation of Lewis lung carcinoma cells in mice

This study is designed to establish a pulmonary tumour model to investigate the biology and therapy of lung cancer in mice. Current methods for forming a solitary intrapulmonary nodule and subsequent metastasis to mediastinal lymph nodes are not well defined. Lewis lung carcinoma (LLC) cell suspensions were orthotopically introduced into the lung parenchyma of C57/BL6 mice via a limited skin incision without thoracotomy followed by direct puncture through the intercostal space. The implantation process was performed within approximately 50 s per mouse, and the operative mortality was less than 5%. Single pulmonary nodules developed at the implanted site in 93% of animals and subsequent mediastinal lymph node metastasis was observed in all mice that formed a lung nodule after intrapulmonary implantation. The size of tumour nodule and the weight of mediastinal lymph node increased in a time-dependent manner. The mean survival time of mice implanted successfully with LLC cells was 21 ± 2 days (range 19–24 days). Histopathological analysis revealed that no metastatic tumour was detectable in the mediastinal lymph nodes on day 11, but metastatic foci at mediastinal lymph nodes were clearly observed on days 17 and 21 after implantation. Other metastases in distant organs or lymph nodes were not observed at 21 days after the implantation. Comparative studies with intrapleural and intravenous injections of LLC cells suggest that the mediastinal lymph node metastasis by intrapulmonary impantation is due to the release of tumour cells from the primary nodule, and not due to extrapulmonary leakage of cells. An intravenous administration of cis-diamine dichrolo platinum on day 1 after tumour implantation tended to suppress the primary tumour nodule and significantly inhibited lymph node metastasis. Thus, a solitary pulmonary tumour nodule model with lymph node metastasis approximates clinical lung cancer and may provide a useful basis for lung cancer research. © 1999 Cancer Research Campaig