Outcomes of patients with blastomycosis-associated respiratory failure requiring veno-venous ECMO: a case series.

Blastomycosis can result in lung injury with high mortality rates. The literature on veno-venous extracorporeal membrane oxygenation (VV-ECMO) used as a rescue therapy is limited to case reports and small case series collected over extended time periods. This report describes the clinical course and post-hospitalization outcomes among patients with blastomycosis-induced respiratory failure requiring VV-ECMO in the most recent time frame. The data were collected retrospectively from the health records of eight patients with blastomycosis-induced respiratory failure admitted to a tertiary care center between 2019 and 2023. The mean time from the start of mechanical ventilation to ECMO initiation was 57 h. All patients survived to ECMO decannulation, and seven of them survived to hospital discharge. All six patients whose post-discharge follow-up information was available were weaned from mechanical ventilation and lived at home while two required supplemental oxygen. This includes a case where the provision of adequate ECMO support was challenging due to the patient's morbid obesity. The most common residual imaging abnormalities included pulmonary infiltrates and pneumatoceles. The study demonstrates the feasibility of VV-ECMO as a rescue therapy in patients with blastomycosis-related refractory respiratory failure. Rapid initiation of ECMO support in eligible patients may have contributed to the good outcomes.

Life cycle greenhouse gases emissions from high-speed rail in Spain: The case of the Madrid - Toledo line.

The Madrid - Toledo high-speed rail (HSR) line is 74.5 km long, has an average speed of 140 km/h and a maximum speed of 270 km/h. It averages almost 104 million passenger-kilometres travelled and has a utilisation rate (passengers per available seats) of 0.75 as of 2019. This study analyses the life cycle greenhouse gases (GHG) emissions of the Madrid - Toledo HSR line using the life cycle assessment methodology, taking into consideration the stages of construction, maintenance and operation for the infrastructure, as well as the manufacturing, maintenance and operation stages for trains. The most significant stage is infrastructure construction, which accounts for an average 75 % emissions, followed by train operation, with an average 18.2 %. The results highlight several environmental benefits of the deployment of the line, as after 40 years of operation there will be an average 21 % reduction in GHG emissions for passenger mobility between Madrid and Toledo compared to the case where no HSR line was built. Moreover, the line's GHG emissions are offset between 19 and 23 years after starting operation, mainly due to the emissions avoided by passengers switching to a carbon-friendlier mode of transportation in terms of operation, and the adoption of a 100 % renewable energy mix for the operation of trains since 2019. These findings point to opportunities for improving the life cycle GHG emissions of high-speed rail lines, such as increasing the occupancy of trains by applying new pricing policies and investing in intermodal infrastructures to achieve higher modal shift rates, promoting proximity criteria for the supply of raw materials during the infrastructure construction stage and improving the maintenance stage to prolong the lifetime of the infrastructure, thus deferring life cycle emissions for longer.