bluuebunny/crossref_metadata_2025 huggingface dataset:
Real-time ultrasound-guided thoracentesis in the intensive care unit: prevalence of mechanical complications
Authors: Rodriguez Lima David Rene , Yepes Andrés Felipe , Birchenall Jiménez Claudia Inés , Mercado Díaz Mario Andrés , Pinilla Rojas Darío Isaías
Published: April 2020

Background

The use of thoracic ultrasound during thoracentesis reduces complications. The aim of this study was to determine the prevalence of complications for real-time ultrasound-guided thoracentesis performed by intensivists. As a secondary objective, the change in oxygenation before and after the procedure was evaluated.

Patients and methods

An observational prospective study was conducted. A total of 81 cases of real-time ultrasound-guided thoracentesis performed by intensivists in the intensive care unit (ICU) of Méderi Major University Hospital, Bogotá, Colombia, between August 2018 and August 2019 were analyzed. Thoracentesis performed by interventional radiologists and using techniques different from the focus of this study were excluded from the analysis.

Results

There was one pneumothorax, for a prevalence rate of mechanical complications in this population of 1.2%. The mean partial oxygen pressure to inspired oxygen fraction ratio (PaO2/FiO2) prior to the procedure was 198.1 (95% CI 184.75–211.45), with a PaO2/FiO2 after the procedure of 224.6 (95% CI 213.08–226.12) (p < 0.05).

Conclusions

Real-time ultrasound-guided thoracentesis performed by intensivists is a safe procedure and leads to a significant improvement in oxygenation rates. Future studies are required to determine the impact of these results on other outcomes, such as mortality, ICU stay, and days of mechanical ventilation.
The influence of contextual factors on healthcare quality improvement initiatives: a realist review
Authors: Coles Emma , Anderson Julie , Maxwell Margaret , Harris Fiona M. , Gray Nicola M. , Milner Gill , MacGillivray Stephen
Published: April 2020

Background

Recognising the influence of context and the context-sensitive nature of quality improvement (QI) interventions is crucial to implementing effective improvements and successfully replicating them in new settings, yet context is still poorly understood. To address this challenge, it is necessary to capture generalisable knowledge, first to understand which aspects of context are most important to QI and why, and secondly, to explore how these factors can be managed to support healthcare improvement, in terms of implementing successful improvement initiatives, achieving sustainability and scaling interventions. The research question was how and why does context influence quality improvement initiatives in healthcare?

Methods

A realist review explored the contextual conditions that influence healthcare improvement. Realist methodology integrates theoretical understanding and stakeholder input with empirical research findings. The review aimed to identify and understand the role of context during the improvement cycle, i.e. planning, implementation, sustainability and transferability; and distil new knowledge to inform the design and development of context-sensitive QI initiatives. We developed a preliminary theory of the influence of context to arrive at a conceptual and theoretical framework.

Results

Thirty-five studies were included in the review, demonstrating the interaction of key contextual factors across healthcare system levels during the improvement cycle. An evidence-based explanatory theoretical model is proposed to illustrate the interaction between contextual factors, system levels (macro, meso, micro) and the stages of the improvement journey. Findings indicate that the consideration of these contextual factors would enhance the design and delivery of improvement initiatives, across a range of improvement settings.

Conclusions

This is the first realist review of context in QI and contributes to a deeper understanding of how context influences quality improvement initiatives. The distillation of key contextual factors offers the potential to inform the design and development of context-sensitive interventions to enhance improvement initiatives and address the challenge of spread and sustainability. Future research should explore the application of our conceptual model to enhance improvement-planning processes.

Systematic review registration

PROSPERO CRD42017062135
Noninvasive oxygenation strategies in adult patients with acute respiratory failure: a protocol for a systematic review and network meta-analysis
Authors: Ferreyro Bruno L. , Angriman Federico , Munshi Laveena , Del Sorbo Lorenzo , Ferguson Niall D. , Rochwerg Bram , Ryu Michelle J. , Saskin Refik , Wunsch Hannah , da Costa Bruno R. , Scales Damon C.
Published: April 2020

Background

Acute hypoxemic respiratory failure is one of the leading causes of intensive care unit admission and is associated with high mortality. Noninvasive oxygenation strategies such as high-flow nasal cannula, standard oxygen therapy, and noninvasive ventilation (delivered by either face mask or helmet interface) are widely available interventions applied in these patients. It remains unclear which of these interventions are more effective in decreasing rates of invasive mechanical ventilation and mortality. The primary objective of this network meta-analysis is to summarize the evidence and compare the effect of noninvasive oxygenation strategies on mortality and need for invasive mechanical ventilation in patients with acute hypoxemic respiratory failure.

Methods

We will search key databases for randomized controlled trials assessing the effect of noninvasive oxygenation strategies in adult patients with acute hypoxemic respiratory failure. We will exclude studies in which the primary focus is either acute exacerbations of chronic obstructive pulmonary disease or cardiogenic pulmonary edema. The primary outcome will be all-cause mortality (longest available up to 90 days). The secondary outcomes will be receipt of invasive mechanical ventilation (longest available up to 30 days). We will assess the risk of bias for each of the outcomes using the Cochrane Risk of Bias Tool. Bayesian network meta-analyses will be conducted to obtain pooled estimates of head-to-head comparisons. We will report pairwise and network meta-analysis treatment effect estimates as risk ratios and 95% credible intervals. Subgroup analyses will be conducted examining key populations including immunocompromised hosts. Sensitivity analyses will be conducted by excluding those studies with high risk of bias and different etiologies of acute respiratory failure. We will assess certainty in effect estimates using GRADE methodology.

Discussion

This study will help to guide clinical decision-making when caring for adult patients with acute hypoxemic respiratory failure and improve our understanding of the limitations of the available literature assessing noninvasive oxygenation strategies in acute hypoxemic respiratory failure.

Systematic review registration

PROSPEROCRD42019121755
Numerical Simulation of Consolidation Behavior of Large Hydrating Fill Mass
Authors: Cui Liang , Fall Mamadou
Published: April 2020

Underground mined-out voids need to be backfilled for the stability of the surrounding rock and also to increase ore extraction from adjacent pillars. One of the relatively newer means is cemented paste backfilling, which has been extensively adopted in underground mining operations around the world. During and after the placement of cemented paste backfill (CPB) into stopes, complex multiphysics (thermal, hydraulic, mechanical and chemical) processes take place in the large mass of CPB and could affect its consolidation behavior. An analysis of the consolidation process in CPB mass is essential for the assessment of CPB behavior and cost-effective designs in practice. In this paper, multiphysics simulation of the consolidation behavior of CPB mass is performed under different conditions, including the mixture recipe, and backfilling, drainage, surrounding rock and curing conditions. It is found that the in situ consolidation behavior of CPB structures is a function of the multiphysics processes that occur in the cementing backfill mass. Moreover, the rock mass conditions, including the geometry and rock wall roughness, influence the consolidation process of CPB structures. Cement content, curing time and backfilling rate play a crucial role in the consolidation process of CPB. The obtained results can facilitate a better understanding of the consolidation behaviour of CPB for backfill designers and engineers, and thus contribute to enhance the engineering of CPB structures.
Metacognitive beliefs mediate the relationship between anxiety sensitivity and traits of obsessive-compulsive symptoms
Authors: Gutierrez Roberto , Hirani Tulsi , Curtis Leo , Ludlow Amanda K.
Published: April 2020

Background

Metacognition has been shown as a key contributor to Obsessive Compulsive Disorder as well as other anxiety-related disorders, yet its role in the development and maintenance of these disorders remains unclear. This study aims to investigate whether anxiety sensitivity traits are related to obsessive-compulsive symptoms in the general population and whether the relationship between anxiety sensitivity and obsessive-compulsive symptoms is mediated by metacognition.

Methods

Non-clinical volunteers (N = 156, mean age: 23.97, 121 females) completed measures related to state/trait anxiety, anxiety sensitivity, obsessive compulsive symptoms and metacognition.

Results

A direct relationship between anxiety sensitivity and obsessive-compulsive symptoms was established. Further analysis revealed that metacognition was the strongest mediator of this relationship, even when accounting for state and trait anxiety.

Conclusions

Results suggest that the relationships between traits of anxiety sensitivity and obsessive-compulsive symptoms are partially attributable to the role of metacognition.
THM modeling of gravity anomalies related to deep hydrothermal circulation at Soultz-sous-Forêts (France)
Authors: Vallier Bérénice , Magnenet Vincent , Schmittbuhl Jean , Fond Christophe
Published: April 2020

Gravity measurements in the Upper Rhine Graben evidence spatial variations at the regional scale and close to the geothermal sites. They are classically interpreted as linked to the geology. We aim to bring new insights on another potential origin of these gravity changes. Our approach is to quantify gravity anomalies related to the deep hydrothermal circulation. A thermo-hydro-mechanical model is developed at the reservoir scale for the Soultz-sous-Forêts site (Soultz), France. A finite element method is used in 2D and 3D. The size of the representative elementary volume is assumed to be 100 m with no regional fault in the reservoir. Surface gravity profiles and maps associated to the large-scale hydrothermal circulation are computed from the variations of the effective density through the model. Synthetic spatial gravity variations in 2D and 3D models are shown to have an amplitude of 0.02 mGal. They are shown to be mostly linked to the convective system. Their wavelength is about 7.5 km, consistent with the width of the hydrothermal convection cells. The anomaly maximum is located at the top of the maximum surface heat flux. However, gravity anomaly observations show much higher amplitude and heterogeneity. Spatial gravity variations linked to the hydrothermal circulation are shown to be smaller than the observed gravity spatial variations, but still measurable with very sensitive instruments (absolute gravimeters).
Sorting big data by revealed preference with application to college ranking
Authors: Hu Xingwei
Published: April 2020

When ranking big data observations such as colleges in the United States, diverse consumers reveal heterogeneous preferences. The objective of this paper is to sort out a linear ordering for these observations and to recommend strategies to improve their relative positions in the ranking. A properly sorted solution could help consumers make the right choices, and governments make wise policy decisions. Previous researchers have applied exogenous weighting or multivariate regression approaches to sort big data objects, ignoring their variety and variability. By recognizing the diversity and heterogeneity among both the observations and the consumers, we instead apply endogenous weighting to these contradictory revealed preferences. The outcome is a consistent steady-state solution to the counterbalance equilibrium within these contradictions. The solution takes into consideration the spillover effects of multiple-step interactions among the observations. When information from data is efficiently revealed in preferences, the revealed preferences greatly reduce the volume of the required data in the sorting process. The employed approach can be applied in many other areas, such as sports team ranking, academic journal ranking, voting, and real effective exchange rates.
Leptospirosis as an important differential of pulmonary haemorrhage on the intensive care unit: a case managed with VV-ECMO
Authors: Barnacle James , Gurney Stefan , Ledot Stephane , Singh Suveer
Published: April 2020

Background

Leptospirosis is a potentially fatal zoonosis. It can cause a wide range of symptoms, including diffuse alveolar haemorrhage which occurs in a minority of cases but carries a mortality of over 70%. These patients may present with severe acute respiratory failure. The differential diagnosis for diffuse alveolar haemorrhage is broad whereas prompt diagnosis and treatment can be lifesaving.

Case presentation

A 20-year-old previously fit and well trout farm worker presented with a 3-day history of malaise, fevers, diarrhoea, vomiting and jaundice. He developed haemoptysis, severe headaches, neck stiffness and photophobia on the day of emergency admission. He was anaemic and thrombocytopenic. Anuric acute kidney injury (urea 32, creat 507) required immediate haemofiltration. In view of progressive respiratory failure with four-quadrant lung infiltrates on imaging, he was given broad spectrum antibiotics and pulsed methylprednisolone empirically, in case of a vasculitic pulmonary-renal presentation. He was intubated within 48 h of admission. Despite attempted protective ventilatory management, he remained hypoxaemic and developed pneumomediastinum. He was retrieved to a specialist cardiorespiratory intensive care unit on femoro-femoral mobile VV-ECMO. Three days from admission, results showed positive Leptospira IgM and real-time PCR. Serial bronchoscopies showed old and fresh clots, but not the classical progressive late red tinge of the returned lavage fluid. After eight days, VV-ECMO was weaned, he was extubated three days later, and made a full recovery. At 9 months follow-up, he was clinically better, with resolution of the CT scan findings and near normal lung function, albeit with low normal gas transfer.

Conclusions

Leptospirosis is a rare but important differential to be considered in diffuse alveolar haemorrhage presenting to the ICU, especially in young males. A thorough history for occupational or recreational risk factors may offer the diagnostic clue. Most patients recover fully with antibiotics. However, resulting acute severe respiratory failure can ensue. In this situation, early consideration for respiratory ECMO support offers time for clearance of endobronchial clot, parenchymal recovery, and prevention of ventilator-induced lung injury. Steroids have no clear evidence but may be used to avoid delay in treating suspected vasculitic or autoimmune causes of diffuse alveolar haemorrhage.
Impact of host- and early treatment-related factors on mortality in ICU patients with candidemia: a bicentric retrospective observational study
Authors: Ohki Shingo , Shime Nobuaki , Kosaka Tadashi , Fujita Naohisa
Published: April 2020

Background

Candidemia is one of the most life-threatening infections among critically ill patients in the intensive care unit. However, the number of studies on the impact of host- and early treatment-related factors on mortality in this cohort is limited. The aim of this study was to investigate the relationship between clinically relevant factors, including early treatment (appropriate antifungal therapy and/or central venous catheter removal) and mortality in intensive care unit patients with candidemia.

Methods

We performed a retrospective observational study in two Japanese University hospitals between January 2007 and December 2016. Adult intensive care unit patients with candidemia who met the following inclusion criteria: (1) ≥ 18 years old; (2) admitted in intensive care unit at the time of onset; and (3) central venous catheter in situ at the time of onset were included. We performed univariate and multivariate logistic regression analysis to identify factors associated with 30-day crude mortality.

Results

A total of 68 patients met the inclusion criteria, 47 (69%) of whom were males. The median age was 68.0 (interquartile range, 61.0–76.0) years. The most common causative Candida species was Candida albicans (40 [59%] patients). With respect to the source of infection, central venous catheter-related candidemia was the most frequent (30 [44%] patients). Thirty-day crude mortality was 54% (37 patients). In multivariate logistic regression analysis, Acute Physiology and Chronic Health Evaluation II score (1-point increments) was the only factor that was independently associated with higher 30-day crude mortality. Other variables, including appropriate antifungal therapy and/or central venous catheter removal ≤ 24 h and ≤ 48 h following onset, did not significantly influence mortality.

Conclusions

Candidemia in intensive care unit patients is still associated with high 30-day crude mortality rates. The only predictor of death was Acute Physiology and Chronic Health Evaluation II score ≤ 24 h following candidemia onset. Early empiric antifungal therapy and/or early CVC removal conferred no significant clinical benefit on survival in this patient population.
Eye-tracking and artificial intelligence to enhance motivation and learning
Authors: Sharma Kshitij , Giannakos Michail , Dillenbourg Pierre
Published: April 2020

The interaction with the various learners in a Massive Open Online Course (MOOC) is often complex. Contemporary MOOC learning analytics relate with click-streams, keystrokes and other user-input variables. Such variables however, do not always capture users’ learning and behavior (e.g., passive video watching). In this paper, we present a study with 40 students who watched a MOOC lecture while their eye-movements were being recorded. We then proposed a method to define stimuli-based gaze variables that can be used for any kind of stimulus. The proposed stimuli-based gaze variables indicate students’ content-coverage (in space and time) and reading processes (area of interest based variables) and attention (i.e., with-me-ness), at the perceptual (following teacher’s deictic acts) and conceptual levels (following teacher discourse). In our experiment, we identified a significant mediation effect of the content coverage, reading patterns and the two levels of with-me-ness on the relation between students’ motivation and their learning performance. Such variables enable common measurements for the different kind of stimuli present in distinct MOOCs. Our long-term goal is to create student profiles based on their performance and learning strategy using stimuli-based gaze variables and to provide students gaze-aware feedback to improve overall learning process. One key ingredient in the process of achieving a high level of adaptation in providing gaze-aware feedback to the students is to use Artificial Intelligence (AI) algorithms for prediction of student performance from their behaviour. In this contribution, we also present a method combining state-of-the-art AI technique with the eye-tracking data to predict student performance. The results show that the student performance can be predicted with an error of less than 5%.
Serious sports-related injury in England and Wales from 2012-2017: a study protocol
Authors: Davies Madeleine A. M. , Lawrence Tom , Edwards Antoinette , Lecky Fiona , McKay Carly D. , Stokes Keith A. , Williams Sean
Published: April 2020

Background

Physical activity is an important component of healthy lifestyles, with a central role in morbidity prevention. However, sporting and physical activity also involve an inherent injury risk. Some sports and activities have a higher injury risk, and may involve more severe injuries. Furthermore, injuries of a severe nature have substantial individual and societal consequences, including the burden of assessment, treatment, and potential on-going care costs. There are limited data on severe sports injury risk in England and Wales, and no national data describing risk across sports. The aims of this study are to identify the cases and incidence of: i) paediatric and ii) adult severe sports injury from 2012 to 2017; and to describe injury incidence in individual sports.

Methods

This study is an analysis of prospectively collected sport-related injuries, treated from January 2012 to December 2017. Incidents involving a severe injury (in-patient trauma care) in England and Wales, will be identified from the Trauma Audit Research Network registry. Data for patients who were: transfers or direct hospital admissions, with inpatient stays of ≥3 days, admissions to High Dependency areas, or in-hospital mortality after admission; and whose injury mechanism was sport, or incident description included one of 62 sporting activities, will be extracted. Data will be categorised by sport, and sports participation data will be derived from Sport England participation surveys. Descriptive statistics will be estimated for all demographic, incident, treatment and sport fields, and crude serious annual injury incidence proportions estimated. Poisson confidence intervals will be estimated for each sport and used to describe injury risk (incidence) across sporting activities.

Discussion

This study will be the first to describe the number of, and trends in severe sport-related injuries in England and Wales. These data are useful to monitor the number and burden of severe sports injury, and inform injury prevention efforts. The monitoring and mitigation of sports injury risk is essential for individuals, health services and policy, and to encourage physically active lifestyles and safer participation for adults and children.
Femoral revision knee Arthroplasty with Metaphyseal sleeves: the use of a stem is not mandatory of a structural point of view
Authors: Fonseca F. , Sousa A. , Completo A.
Published: April 2020

Purpose

Although metaphyseal sleeves are usually used with stems, little is known about the exact contribution/need of the stem for the initial sleeve-bone interface stability, particularly in the femur, if the intramedullary canal is deformed or bowed. The aim of the present study is (1) to determine the contribution of the diaphyseal-stem on sleeve-femur interface stability and (2) to determine experimentally the strain shielding effect on the metaphyseal femur with and without diaphyseal-stem. It is hypothesised that diaphyseal-stem addition increases the sleeve-femur interface stability and the strain-shielding effect on the metaphyseal femur relatively to the stemless condition.

Material and methods

The study was developed through a combined experimental and finite-element analysis approach. Five synthetic femurs were used to measure cortex strain (triaxial-rosette-gages) behaviour and implant cortex micromotions (Digital Image Correlation) for three techniques: only femoral-component, stemless-sleeve and stemmed-sleeve. Paired t-tests were performed to evaluate the statistical significance of the difference of cortex strains and micromotions. Finite-element models were developed to assess the cancellous bone strain behaviour and sleeve-bone interface micromotions; these models were validated against the measurements.

Results

Cortex strains are significantly reduced (p < 0.05) on the stemmed-sleeve with a 150 μstrain mean reduction at the medial and lateral distal sides which compares with a 60 μstrain mean reduction (p > 0.05) on the stemless condition. Both techniques presented a mean cancellous bone strain reduction of 700 μstrain (50%) at the distal region and a mean increase of 2500 μstrain (4x) at the sleeve proximal region relative to the model only with the femoral component. Both techniques presented sleeve-bone micromotions amplitude below 50-150 μm, suitable for bone ingrowth.

Conclusions

The use of a supplemental diaphyseal-stem potentiates the risk of cortex bone resorption as compared to the stemless-sleeve condition; however, the stem is not essential for the enhancement of the initial sleeve-bone stability and has minor effect on the cancellous bone strain behaviour. Based on a purely structural point view, it appears that the use of a diaphyseal-femoral-stem with the metaphyseal sleeve is not mandatory in the revision TKA, which is particularly relevant in cases where the use of stems is impracticable.
SARS-CoV-2 in the ocular surface of COVID-19 patients
Authors: Xie Hua-Tao , Jiang Shi-Yun , Xu Kang-Kang , Liu Xin , Xu Bing , Wang Lin , Zhang Ming-Chang
Published: April 2020

The 2019 novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread globally, while the routes of transmission of this virus are still controversial. We enrolled 33 patients, without any ocular manifestation, with their ocular surface swabs collected for virus detection. RNA was detected strong positive in samples of both eyes from two patients. Therefore, SARS-CoV-2 may exist in the normal ocular surface of COVID-19 patients, suggesting that this virus might be spread through conjunctival contact.
Trade-offs between ecosystem service provision and the predisposition to disturbances: a NFI-based scenario analysis
Authors: Temperli Christian , Blattert Clemens , Stadelmann Golo , Brändli Urs-Beat , Thürig Esther
Published: April 2020

Background

Scenario analyses that evaluate management effects on the long-term provision and sustainability of forest ecosystem services and biodiversity (ESB) also need to account for disturbances. The objectives of this study were to reveal potential trade-offs and synergies between ESB provision and disturbance predisposition at the scale of a whole country.

Methods

The empirical scenario model MASSIMO was used to simulate forest development and management from years 2016 to 2106 on 5086 sample plots of the Swiss National Forest Inventory (NFI). We included a business-as-usual (BAU) scenario and four scenarios of increased timber harvesting. Model output was evaluated with indicators for 1) ESB provision including a) timber production, b) old-growth forest characteristics as biodiversity proxies and c) protection against rockfall and avalanches and 2) for a) storm and b) bark beetle predisposition.

Results

The predisposition indicators corresponded well (AUC: 0.71–0.86) to storm and insect (mostly bark beetle) damage observations in logistic regression models. Increased timber production was generally accompanied with decreased predisposition (storm: >−11%, beetle: >−37%, depending on region and scenario), except for a scenario that promoted conifers where beetle predisposition increased (e.g. + 61% in the Southern Alps). Decreased disturbance predisposition and decreases in old-growth forest indicators in scenarios of increased timber production revealed a trade-off situation. In contrast, growing stock increased under BAU management along with a reduction in conifer proportions, resulting in a reduction of beetle predisposition that in turn was accompanied by increasing old-growth forest indicators. Disturbance predisposition was elevated in NFI plots with high avalanche and rockfall protection value.

Conclusions

By evaluating ESB and disturbance predisposition based on single-tree data at a national scale we bridged a gap between detailed, stand-scale assessments and broader inventory-based approaches at the national scale. We discuss the limitations of the indicator framework and advocate for future amendments that include climate-sensitive forest development and disturbance modelling to strengthen decision making in national forest policy making.
Effect of scots pine forest management on soil properties and carabid beetle occurrence under post-fire environmental conditions - a case study from Central Europe
Authors: Błońska Ewa , Bednarz Bartłomiej , Kacprzyk Magdalena , Piaszczyk Wojciech , Lasota Jarosław
Published: April 2020

Background

Fires have a fundamental impact on phytocoenoses and, depending on the size of the fire, can have a positive or negative effect. The role of fires in the formation of the species composition of plants, restoration of stands and changes in soil properties is well studied. However, the long-term relationship between forest management methods, soil properties and epigeic entomofauna assemblages in post-fire areas is still not clear. The effects of Scots pine stand management methods on biochemical soil properties and ground beetle assemblages in the largest post-fire area in Central Europe after the second World were investigated. The study was conducted in the Rudy Raciborskie Forest district in southern Poland. The soil properties and epigeic beetle community structure were analysed. The research covered areas with natural and artificial pine regeneration, which were subjected to various care treatments.

Results

The tendency for higher accumulations of organic matter in the soil of stands that underwent natural regeneration was proven. The stimulating role of soil organic carbon on the activity of dehydrogenases in the soil of naturally renewed areas with silvicultural treatment (NRAT) was noted. Regardless of the manner of stand regeneration, the activity of β-glucosidase was higher in the areas in which breeding treatments were practised. Furthermore, managed forest stands presented a higher abundance of carabid beetles than stands without treatment practices. Thirteen epigeic beetle species from the families Geotrupidae, Carabidae, Curculionidae, Cerambycidae and Silphidae were captured, with beetles from the first two families being the most numerous. Rare epigeal carabid species in the fauna of Poland and Europe, such as Carabus glabratus (Paykull) and Carabus auronitens Fabr., found appropriate habitat conditions for survival in the post-fire areas. Compared with the other areas, in the NRAT area, there were better stand and soil properties and more features conducive to epigeic entomofaunal occurrences. The highest post-fire content of polycyclic aromatic hydrocarbons was recorded in the soils of the sites that underwent artificial regeneration. The results suggest that preparing the soil before the introduction of new vegetation affects the amount of aromatic hydrocarbons (PAHs).

Conclusions

The better performance of the NRAT stand draws attention to the positive aspects of the use of natural regeneration, both from ecological and economic perspectives. The effects of forest management on the amount of soil organic matter after fires have been proven. The natural regeneration of stands was conducive to the accumulation of organic matter. The enzymatic activity of soils is influenced by the renewal method and forest management strategy. The NRAT area was characterized by the highest number of carabid species.
Ex vivo limb perfusion for traumatic amputation in military medicine
Authors: Kaltenborn Alexander , Krezdorn Nicco , Hoffmann Sebastian , Gutcke André , Haastert-Talini Kirsten , Vogt Peter M. , Haverich Axel , Wiegmann Bettina
Published: April 2020

Background

Limb loss has a drastic impact on a patient’s life. Severe trauma to the extremities is common in current military conflicts. Among other aspects, “life before limb” damage control surgery hinders immediate replantation within the short post-traumatic timeframe, which is limited in part by the ischemic time for successful replantation. Ex vivo limb perfusion is currently being researched in animal models and shows promising results for its application in human limb replantation and allotransplantation.

Presentation of the hypothesis

The current lack of replantation possibilities in military operations with high rates of amputation can be addressed with the development of a portable ex vivo limb perfusion device, as there are several opportunities present with the introduction of this technique on the horizon. We hypothesize that ex vivo limb perfusion will enable overcoming the critical ischemic time, provide surgical opportunities such as preparation of the stump and limb, allow for spare-part surgery, enable rigorous antibiotic treatment of the limb, reduce ischemia-reperfusion injuries, enable a tissue function assessment before replantation, and enable the development of large limb transplant programs.

Testing the hypothesis

Data from in vivo studies in porcine models are limited by the relatively short perfusion time of 24 h. In the military setting, notably longer perfusion times need to be realized. Therefore, future animal studies must focus especially on long-term perfusion, since this represents the military setting, considering the time for stabilization of the patient until evacuation to a tertiary treatment center.

Implications of the hypothesis

The development and clinical introduction of ex vivo limb perfusion in the military setting could lead to a drastic reduction in the number of limb amputations among service members. Ex vivo limb perfusion enables replantation surgery in Role 4 facilities and changes the clinical setting from a highly urgent, life-threatening situation to a highly methodical, well-prepared starting point for optimal treatment of the wounded service member. With its introduction, the principle of “life before limb” will change to “life before limb before elective replantation/allotransplantation after ex vivo limb perfusion”.
Two cases of breast angiosarcoma after breast conserving surgery
Authors: Shiraki Eriko , Kang Yookija , Shibayama Takahiro , Tsuyuki Shigeru
Published: April 2020

Background

Breast angiosarcoma (AS) is a rare malignant breast tumor arising from endothelial cells lining the blood vessels. The prognosis of AS is reportedly poor. However, the effectiveness of chemotherapy and radiation is still controversial. Surgery is the only curable treatment, and removal of AS with adequate surgical margin is important.

Case presentation

We report two cases of primary and radiation-induced breast angiosarcoma (AS) after performing breast conserving surgery (BCS) for breast cancer. In case 1, a 72-year-old woman underwent right BCS with adjuvant radiation therapy (RT) for breast cancer 5 years prior. She was diagnosed with AS of the right breast and underwent mastectomy with a wide skin resection of the breast. As the tumor cells were positive for c-myc, this tumor was diagnosed as a radiation-induced AS. In case 2, an 80-year-old woman underwent BCS without adjuvant RT. She was diagnosed with AS 3 years after BCS and underwent mastectomy with a wide skin resection of the breast. The tumor was diagnosed to be a primary AS because there were no episodes of RT or lymphedema. Both cases developed local recurrence within 1 year of surgery.

Conclusion

Our cases suggest that surgical margin is associated with the risk of local recurrence, and the difficulty of deciding a safe surgical margin should be set during preoperative diagnosis.
Intraperitoneal onlay mesh repair (IPOM) plus technique using a hybrid procedure of open laparotomy and laparoscopic approach (hybrid IPOM plus) for incarceration of umbilical hernia in a severely obese patient: a case report
Authors: Yanari Shingo , Suto Takayuki , Fujiwara Hisataka , Ariyoshi Yu , Umemura Akira , Sasaki Akira
Published: April 2020

Background

A standard procedure for the treatment of incarcerated umbilical hernia among severely obese patients has yet to be established. We used the hybrid intraperitoneal onlay mesh repair (IPOM) plus method, which combines open and laparoscopic surgery to treat incarcerated umbilical hernia in a severely obese patient.

Case presentation

A 46-year-old man presented in our department with a chief complaint of a painful mass in the umbilical region. Incarcerated umbilical hernia was diagnosed on the basis of abdominal computed tomography, and the decision was made to perform emergency surgery. The patient was severely obese (body mass index, 53.8 kg/m2), and the incarcerated portion of the hernia was therefore first addressed by open surgery. As bowel resection was unnecessary, the risk of infection was considered low, and after direct closure of the hernia orifice, IPOM was performed laparoscopically using the hybrid IPOM plus method.

Conclusion

Among severely obese patients, first trocar insertion is difficult and the wound site tends to come under strain, meaning that simple closure of the hernia orifice results in a high recurrence rate. The hybrid IPOM plus method used in this case combines open surgery and laparoscopy and appears useful for treating uninfected incarcerated umbilical hernia in severely obese patients safely and with an anticipated low rate of postoperative recurrence.
Laparoscopic approach to early gastric cancer in a patient with a prior history of open right hepatectomy: a case report
Authors: Ikegame Ko , Hikage Makoto , Kamiya Satoshi , Tanizawa Yutaka , Bando Etsuro , Terashima Masanori
Published: April 2020

Background

Laparoscopic gastrectomy is regarded a standard treatment procedure for early gastric cancer and is widely used in clinical practice. However, the feasibility of laparoscopic gastrectomy for patients with a prior history of open surgery, especially in the case of a complicated operation, remains unclear. Here, we report a laparoscopic gastrectomy case with a prior history of right hepatectomy.

Case presentation

A 70-year-old man was diagnosed with early gastric cancers preceding a right hepatectomy for a solitary hepatocellular carcinoma at risk of rupture. An additional gastrectomy, after non-curative endoscopic submucosal dissection, was planned after the hepatectomy. Extensive adhesions were found around the liver. Rigid adherence of the duodenum to the adjacent hepatoduodenal ligament had formed. In addition, identification of the hepatic artery was difficult due to stiffening of the mesentery. Peeling off the adhesions from the ventral side of the duodenum revealed the supra-pyloric vessels and enabled us to transect the duodenum safely. Further, exposing the proper hepatic artery via the dorsal side of the mesentery and subsequent supra-pancreatic dissection on the outermost layer allowed effective identification of the right gastric artery. The postoperative course was uneventful.

Conclusions

We successfully performed total laparoscopic distal gastrectomy on a patient with a prior history of major hepatectomy.
Successful preservation of the proximal stomach tube by evaluating blood flow using indocyanine green for gastric tube cancer: a case report
Authors: Hara Kazushi , Matsunaga Tomoyuki , Fukumoto Yoji , Miyauchi Wataru , Kono Yusuke , Shishido Yuji , Hanaki Takehiko , Miyatani Kozo , Watanabe Joji , Kihara Kyoichi , Yamamoto Manabu , Tokuyasu Naruo , Takano Shuichi , Sakamoto Teruhisa , Honjo Soichiro , Fujiwara Yoshiyuki
Published: April 2020

Background

There have been two reports on preserving the proximal gastric tube by using intraoperative indocyanine green (ICG)-based photodynamic detection to evaluate blood flow through the anastomosis for gastric tube cancer after esophagectomy. However, in those cases, the period since the first operation was > 3 years 11 months, and there have been no reports of cases with < 1-year periods after the first operation.

Case presentation

A 59-year-old man underwent video-assisted thoracic subtotal esophagectomy and gastric tube reconstruction after two courses of preoperative chemotherapy for middle thoracic esophageal cancer. After half a year, follow-up upper gastrointestinal endoscopy showed a submucosal tumor in the posterior wall of the pre-pyloric region. We performed a biopsy, and the results led to a diagnosis of gastric cancer (moderately differentiated adenocarcinoma: tub2). Clinically, the patient was described as having stage IB (cT2N0M0) gastric cancer of the reconstructed gastric tube. To avoid total gastrectomy, we tried to evaluate the blood flow of the proximal part of the gastric tube by intraoperative ICG-based photodynamic detection. Intraoperative findings confirmed neo-vascularization from the remnant cervical esophagus to the upper region of the gastric tube approximately 7 cm through the esophagogastric anastomosis. Therefore, we dissected the distal part of the gastric tube approximately 4 cm from the esophagogastric anastomosis and then performed Roux-en-Y gastro-jejunostomy via the ante-sternum route. The postoperative course was stable, and the patient was discharged on the 14th postoperative day.

Conclusions

ICG-based photodynamic diagnosis was found to be simple and less invasive. Therefore, even if the postoperative period is short, this method should be considered for evaluation of blood flow prior to performing less invasive surgery.
Recurrent aspiration pneumonia due to bilateral associated laryngeal paralysis after tooth extraction under general anesthesia: a case report
Authors: Koshika Kyotaro , Ouchi Takashi , Serita Ryohei , Koitabashi Toshiya
Published: April 2020

Background

Associated laryngeal paralysis is a clinical condition merged with other cranial nerve disorders associated with vocal cord paralysis. It is a rare complication in patients after general anesthesia. Here, we report our experience with a patient who developed associated laryngeal paralysis after oral surgery.

Case presentation

A healthy 31-year-old man underwent extraction of horizontally impacted wisdom teeth in the bilateral mandible under general anesthesia. During the surgery, no significant changes in respiratory and cardiovascular parameters or neurosurgical abnormalities occurred. After the surgery, the patient was diagnosed with aspiration pneumonia. Furthermore, the results of otorhinolaryngological and neurological examinations led to a diagnosis of a combination of bilateral glossopharyngeal and vagus nerve paralysis, right recurrent nerve paralysis, and right hypoglossal nerve paralysis. In this case, seriously associated peripheral laryngeal paralysis with repeated episodes of aspiration pneumonia improved in approximately 6 months with rehabilitation and vitamin B12 administration, and no complications remained.

Conclusions

We suggest that the anesthesiologist should take care of each procedure minutely. It is important to diagnose cases of nerve palsy as soon as possible to reduce the damage. Having had experience with this case, we believe sharing our experience with anesthesiologists is important.
The first confirmed case of COVID-19 in Tanzania: recommendations based on lesson learned from China
Authors: Tarimo Clifford Silver , Wu Jian
Published: April 2020

As the coronavirus disease (COVID-19) takes its course outside China, the number of imported cases to other countries is on the rise. Currently, Tanzania has received the first imported case on 16 March 2020. This letter serves to describe this specific event and put forth a number of recommendations including establishing more testing points, discouraging all forms of public and religious gatherings, and tailoring a unique model for lockdown and social distancing to prevent further spread of the disease. The letter has also suggested ways to further improve the efforts already in place so as to strengthen the prevention and control system.
Procedural complications of inferior vena cava filter retrieval, an illustrated review
Authors: Quencer Keith B. , Smith Tyler A. , Deipolyi Amy , Mojibian Hamid , Ayyagari Raj , Latich Igor , Ali Rahmat
Published: April 2020

Annually, approximately 65,000 inferior vena cava (IVC) filters are placed in the United States (Ahmed et al., J Am Coll Radiol 15:1553–1557, 2018). Approximately 35% of filters are eventually retrieved (Angel et al., J Vasc Interv Radiol 22: 1522–1530 e1523, 2011). Complications during filter retrieval depend heavily on technique and filter position. In this paper, we review risk factors and incidence of complications during IVC filter removal. We also discuss ways these complications could be avoided and the appropriate management if they occur.
From visual estimates to fully automated sensor-based measurements of plant disease severity: status and challenges for improving accuracy
Authors: Bock Clive H. , Barbedo Jayme G. A. , Del Ponte Emerson M. , Bohnenkamp David , Mahlein Anne-Katrin
Published: April 2020

The severity of plant diseases, traditionally the proportion of the plant tissue exhibiting symptoms, is a key quantitative variable to know for many diseases and is prone to error. Good quality disease severity data should be accurate (close to the true value). Earliest quantification of disease severity was by visual estimates. Sensor-based image analysis including visible spectrum and hyperspectral and multispectral sensors are established technologies that promise to substitute, or complement visual ratings. Indeed, these technologies have measured disease severity accurately under controlled conditions but are yet to demonstrate their full potential for accurate measurement under field conditions. Sensor technology is advancing rapidly, and artificial intelligence may help overcome issues for automating severity measurement under hyper-variable field conditions. The adoption of appropriate scales, training, instruction and aids (standard area diagrams) has contributed to improved accuracy of visual estimates. The apogee of accuracy for visual estimation is likely being approached, and any remaining increases in accuracy are likely to be small. Due to automation and rapidity, sensor-based measurement offers potential advantages compared with visual estimates, but the latter will remain important for years to come. Mobile, automated sensor-based systems will become increasingly common in controlled conditions and, eventually, in the field for measuring plant disease severity for the purpose of research and decision making.