Severe spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema precipitated by pepper spray-induced acute laryngitis: a case report.

We report a patient with severe spontaneous pneumomediastinum (SPM), pneumothorax and widespread subcutaneous emphysema with acute epiglottitis after inhaling pepper spray. The effects of pepper spray, which is a lachrymatory agent, on the respiratory system have not been reported. Upper airway obstruction is not a well-described cause of SPM, with which subcutaneous emphysema and pneumothorax might coexist; thus, mechanical ventilation might be detrimental.

Electronic Health Record-Based Prediction of 1-Year Risk of Incident Cardiac Dysrhythmia: Prospective Case-Finding Algorithm Development and Validation Study.

BACKGROUND: Cardiac dysrhythmia is currently an extremely common disease. Severe arrhythmias often cause a series of complications, including congestive heart failure, fainting or syncope, stroke, and sudden death. OBJECTIVE: The aim of this study was to predict incident arrhythmia prospectively within a 1-year period to provide early warning of impending arrhythmia. METHODS: Retrospective (1,033,856 individuals enrolled between October 1, 2016, and October 1, 2017) and prospective (1,040,767 individuals enrolled between October 1, 2017, and October 1, 2018) cohorts were constructed from integrated electronic health records in Maine, United States. An ensemble learning workflow was built through multiple machine learning algorithms. Differentiating features, including acute and chronic diseases, procedures, health status, laboratory tests, prescriptions, clinical utilization indicators, and socioeconomic determinants, were compiled for incident arrhythmia assessment. The predictive model was retrospectively trained and calibrated using an isotonic regression method and was prospectively validated. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC). RESULTS: The cardiac dysrhythmia case-finding algorithm (retrospective: AUROC 0.854; prospective: AUROC 0.827) stratified the population into 5 risk groups: 53.35% (555,233/1,040,767), 44.83% (466,594/1,040,767), 1.76% (18,290/1,040,767), 0.06% (623/1,040,767), and 0.003% (27/1,040,767) were in the very low-risk, low-risk, medium-risk, high-risk, and very high-risk groups, respectively; 51.85% (14/27) patients in the very high-risk subgroup were confirmed to have incident cardiac dysrhythmia within the subsequent 1 year. CONCLUSIONS: Our case-finding algorithm is promising for prospectively predicting 1-year incident cardiac dysrhythmias in a general population, and we believe that our case-finding algorithm can serve as an early warning system to allow statewide population-level screening and surveillance to improve cardiac dysrhythmia care.

Kinetics of SARS-CoV-2 positivity of infected and recovered patients from a single center.

Recurrence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive detection in infected but recovered individuals has been reported. Patients who have recovered from coronavirus disease 2019 (COVID-19) could profoundly impact the health care system. We sought to define the kinetics and relevance of PCR-positive recurrence during recovery from acute COVID-19 to better understand risks for prolonged infectivity and reinfection. A series of 414 patients with confirmed SARS-Cov-2 infection, at The Second Affiliated Hospital of Southern University of Science and Technology in Shenzhen, China from January 11 to April 23, 2020. Statistical analyses were performed of the clinical, laboratory, radiologic image, medical treatment, and clinical course of admission/quarantine/readmission data, and a recurrence predictive algorithm was developed. 16.7% recovered patients with PCR positive recurring one to three times, despite being in strict quarantine. Younger patients with mild pulmonary respiratory syndrome had higher risk of PCR positivity recurrence. The recurrence prediction model had an area under the ROC curve of 0.786. This case series provides characteristics of patients with recurrent SARS-CoV-2 positivity. Use of a prediction algorithm may identify patients at high risk of recurrent SARS-CoV-2 positivity and help to establish protocols for health policy.

Anesthetic management of a patient with localised scleroderma.

INTRODUCTION: Scleroderma is a progressive fibrotic disorder of connective tissue which can present multiple anesthetic challenges to anesthetists, especially airway management. Awake intubation with fiberoptic bronchoscope is widely accepted and implemented for progressive systematic scleroderma patients. With the development and improvement of intubation devices these years, there is no report addressing other intubation methods for sclerotic patients. CASE DESCRIPTION: A 47 year-old, 42-kg man with 1-year history of localized scleroderma was scheduled for the operation of inner fixation after 6 days of his acetabular fracture. With careful pre-anesthesia assessment, we chose general anesthesia and intubated the patient with Shikani optical stylet under rapid sequence introduction successfully. DISCUSSION: Scleroderma is a multisystem disease that can affect every aspect of anesthesia especially airway management, which can pose a significant challenge for anesthesiologists. As a result, understanding its pathophysiological changes and implementing a meticulous pre-anesthesia check-up are essential when making an anesthetic plan. CONCLUSION: Anesthetists should have a thorough consideration of all the patho-physiological changes in patients with scleroderma, so as to make a full preparation peri-operatively. Shikani optical stylet may become an alternation for difficult airway in patients with scleroderma.

Baicalein induces human osteosarcoma cell line MG-63 apoptosis via ROS-induced BNIP3 expression.

Baicalein, a flavonoid compound, is one of the active constituents of the root of Scutellariae Radix. Its antitumor effects have attracted widespread attention worldwide. One of its major functions is to induce the apoptosis of tumor cells, but the antitumor mechanism is currently unclear. In the present study, we found that baicalein increased MG-63 cell mortality in a dose-dependent manner. Meanwhile, baicalein activated apoptosis through induced intracellular reactive oxygen species (ROS) generation, and that ROS scavenger N-acetyl-cysteine (NAC), glutathione (GSH), and superoxide dismutase (SOD) apparently inhibited intracellular ROS production, consequently attenuating the baicalein-induced apoptosis. Baicalein also induce the mitochondrial fragmentation which precedes the cell apoptosis. This morphological alteration is accompanied by an increase in the expression of the protein BNIP3 as well as Mul1 and Drp1. Furthermore, we show that the inhibition of BNIP3 expression can inhibit cell apoptosis by baicalein treatment. Taken together, our results bring the evidence of a mechanism that links apoptosis and ROS-induced BNIP3 expression in MG-63 cells with bacalein treatment and suggest that baicalein has a good potential as an anti-osteosarcoma drug.

[Effects of different ventilation modes for one-lung ventilation anesthesia on respiratory function and F(A)/F(I) changes during sevoflurane inhalation].

OBJECTIVE: To investigate the effects of different ventilation modes for one lung ventilation anesthesia on arterial blood-gas, airway pressure, intrapulmonary shunt, and F(A)/F(I) changes in patients receiving sevoflurane inhalation. METHODS: Thirty ASA class II-III patients with lung cancer undergoing pulmonary lobectomy were randomized into 3 equal groups. The patients in group A received volume-controlled ventilation (VCV) without positive end-expiratory pressure (PEEP) (VT=8 ml/kg, Rf=12/min), and those in group B, after a preceding VCV stabilize the airway pressure, had pressure-controlled ventilation with maintenance of an identical peak pressure (Ppeak) (Rf=12/min, PEEP=0). In group C, the patients received small tidal volume ventilation with PEEP (VT=6 ml/kg, Rf=16/min, PEEP=5 cm H(2)O). Blood gas analysis was carried out at 10 min after TLV and at 20, 45 and 70 min after one lung ventilation (OLV); the heart rate (HR), mean arterial pressure (MAP), SpO(2) and Ppeak were also recorded and blood samples collected from the artery and jugular vein at these time points. Inhalation of 1.5% sevoflurane for 20 min started at 20 min of OLV. RESULTS: Compared with those in TLV, the Ppeak increased, lung compliance decreased, arterial oxygenation (PaO(2)) decreased and intrapulmonary shunt (Qs/Qt) increased during OLV. Group B showed the fastest increase of F(A)/F(I) in the initial 8 min, followed by groups A and C, but the curves became similar with the passage of time. CONCLUSIONS: During OLV, the 3 ventilation modes result in similar F(A)/F(I) changes during sevoflurane inhalation but PCV can increase pulmonary compliance.