Generalized granuloma annulare after pneumococcal vaccination

Abstract Granuloma annulare may be caused by multiple triggers. Among these are vaccinations, which have been described as an infrequent cause of granuloma annulare. The authors report the first case of generalized granuloma annulare associated with pneumococcal vaccination in a 57-year-old woman, who presented cutaneous lesions 12 days after vaccination.

Ultrasonography for predicting a difficult laryngoscopy. Getting closer.

Our objective was to evaluate the usefulness of five ultrasound measurements to predict a difficult laryngoscopy (DL). Prospective observational study. 50 patients underwent scheduled surgery under general anesthesia with orotracheal intubation with classical laryngoscopy at the University Hospital of Jaén (Spain). Sociodemographic variables, classic preintubation screening tests and ultrasound measurements of the neck soft tissue from skin to hyoid (DSH), epiglottis (DSE) and glottis (DSG) were obtained, as well as two measurements derived from the above: DSH + DSE and DSE - DSG. The relationship between a DL and ultrasound measurements was evaluated using t student test. The ROC Curve was used to establish the diagnostic accuracy of ultrasound measurements to discriminate a DL and logistic regression was used to establish a cut-off point. Multivariate analysis was performed to assess the impact of these measures in clinical practice. Patients with DL showed greater thickness of DSE (2.9 ± 0.46 cm vs 2.32 ± 0.54 cm; p = 0.001), DSH + DSE (4.25 ± 0.45 cm vs 3.62 ± 0.77 cm; p = 0.001) and DSE - DSG (1.83 ± 0.54 cm vs 1.24 ± 0.46 cm; p = 0.001) than those with an easy laryngoscopy. DSE and DSE - DSG had the highest diagnostic accuracy for DL with an area under the ROC curve of 0.79 [95%IC 0.66-0.92] and 0.82 [95%IC 0.68-0.96], respectively. It was established that DSE ≥ 3 cm, could predict a DL with a positive predictive value (PPV) of 69.23% [95%CI 40.3-98.2], and DSE - DSG ≥ 1.9 cm would do so with a PPV of 78.57% [95%CI 53.31-100%]. The multivariate analysis endorsed that DSE and DSE - DSG combined with classic tests (the Modified Mallampati score, the thyromental distance and the upper lip bite test) improved the preoperative detection of a DL. The inclusion of DSE and DSE - DSG in a multivariate model with classic parameters may offer the anesthesiologist better information for detecting a DL preoperatively.

Generalized granuloma annulare after pneumococcal vaccination.

Granuloma annulare may be caused by multiple triggers. Among these are vaccinations, which have been described as an infrequent cause of granuloma annulare. The authors report the first case of generalized granuloma annulare associated with pneumococcal vaccination in a 57-year-old woman, who presented cutaneous lesions 12 days after vaccination.

Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2).

Importance: The Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery. Objective: To assess the association of use of the ERAS protocols with complications in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Design, Setting, and Participants: This multicenter, prospective cohort study included patients recruited from 131 centers in Spain from October 22 through December 22, 2018. All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients were stratified between those treated in a self-designated ERAS center (ERAS group) and those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15 through September 15, 2019. Exposures: Total hip or knee arthroplasty and perioperative management. Sixteen individual ERAS items were assessed in all included patients, whether they were treated at a center that was part of an established ERAS protocol or not. Main Outcomes and Measures: The primary outcome was postoperative complications within 30 days after surgery. Secondary outcomes included length of stay and mortality. Results: During the 2-month recruitment period, 6146 patients were included (3580 women [58.2%]; median age, 71 [interquartile range (IQR), 63-76] years). Of these, 680 patients (11.1%) presented with postoperative complications. No differences were found in the number of patients with overall postoperative complications between ERAS and non-ERAS groups (163 [10.2%] vs 517 [11.4%]; odds ratio [OR], 0.89; 95% CI, 0.74-1.07; P = .22). Fewer patients in the ERAS group had moderate to severe complications (73 [4.6%] vs 279 [6.1%]; OR, 0.74; 95% CI, 0.56-0.96; P = .02). The median overall adherence rate with the ERAS protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P < .001). Among the patients with the highest and lowest quartiles of adherence to ERAS components, the patients with the highest adherence had fewer overall postoperative complications (144 [10.6%] vs 270 [13.0%]; OR, 0.80; 95% CI, 0.64-0.99; P < .001) and moderate to severe postoperative complications (59 [4.4%] vs 143 [6.9%]; OR, 0.62; 95% CI, 0.45-0.84; P < .001) and shorter median length of hospital stay (4 [IQR, 3-5] vs 5 [IQR, 4-6] days; OR, 0.97; 95% CI, 0.96-0.99; P < .001). Conclusions and Relevance: An increase in adherence to the ERAS program was associated with a decrease in postoperative complications, although only a few ERAS items were individually associated with improved outcomes.

Efficient hydrogen evolution in transition metal dichalcogenides via a simple one-step hydrazine reaction.

Hydrogen evolution reaction is catalysed efficiently with precious metals, such as platinum; however, transition metal dichalcogenides have recently emerged as a promising class of materials for electrocatalysis, but these materials still have low activity and durability when compared with precious metals. Here we report a simple one-step scalable approach, where MoOx/MoS2 core-shell nanowires and molybdenum disulfide sheets are exposed to dilute aqueous hydrazine at room temperature, which results in marked improvement in electrocatalytic performance. The nanowires exhibit ∼100 mV improvement in overpotential following exposure to dilute hydrazine, while also showing a 10-fold increase in current density and a significant change in Tafel slope. In situ electrical, gate-dependent measurements and spectroscopic investigations reveal that hydrazine acts as an electron dopant in molybdenum disulfide, increasing its conductivity, while also reducing the MoOx core in the core-shell nanowires, which leads to improved electrocatalytic performance.

High rate and durable, binder free anode based on silicon loaded MoO3 nanoplatelets.

In order to make fast-charging batteries a reality for electric vehicles, durable, more energy dense and high-current density resistant anodes need to be developed. With such purpose, a low lithiation potential of 0.2 V vs. Li/Li(+) for MoO3 nanoplatelet arrays is reported here for anodes in a lithium ion battery. The composite material here presented affords elevated charge capacity while at the same time withstands rapid cycling for longer periods of time. Li2MoO4 and Li(1.333)Mo(0.666)O2 were identified as the products of lithiation of pristine MoO3 nanoplatelets and silicon-decorated MoO3, respectively, accounting for lower than previously reported lithiation potentials. MoO3 nanoplatelet arrays were deposited using hot-wire chemical vapor deposition. Due to excellent voltage compatibility, composite lithium ion battery anodes comprising molybdenum oxide nanoplatelets decorated with silicon nanoparticles (0.3% by wt.) were prepared using an ultrasonic spray. Silicon decorated MoO3 nanoplatelets exhibited enhanced capacity of 1037 mAh g(-1) with exceptional cyclability when charged/discharged at high current densities of 10 A g(-1).