Small Bowel Does Not Belong in the Pericardium: Case of a Traumatic Intrapericardial Diaphragmatic Hernia.

Intrapericardial diaphragmatic hernia (IPDH) is rare and most often a sequela of blunt thoracic trauma. The trans-abdominal or thoracic repair approaches are based on the acuteness of presentation and the expectation of encountering intrapericardial adhesions. We present an acute IPDH in an 80-year-old female patient managed with a laparoscopic trans-abdominal repair. Misdiagnosis and complications from the delayed presentation can be avoided with careful attention to the initial exam, imaging, and early operative repair if the patient is a candidate for the trans-abdominal approach.

Diatom Microbubbler for Active Biofilm Removal in Confined Spaces.

Bacterial biofilms form on and within many living tissues, medical devices, and engineered materials, threatening human health and sustainability. Removing biofilms remains a grand challenge despite tremendous efforts made so far, particularly when they are formed in confined spaces. One primary cause is the limited transport of antibacterial agents into extracellular polymeric substances (EPS) of the biofilm. In this study, we hypothesized that a microparticle engineered to be self-locomotive with microbubbles would clean a structure fouled by biofilm by fracturing the EPS and subsequently improving transports of the antiseptic reagent. We examined this hypothesis by doping a hollow cylinder-shaped diatom biosilica with manganese oxide (MnO2) nanosheets. In an antiseptic H2O2 solution, the diatoms doped by MnO2 nanosheets, denoted as diatom bubbler, discharged oxygen gas bubbles continuously and became self-motile. Subsequently, the diatoms infiltrated the bacterial biofilm formed on either flat or microgrooved silicon substrates and continued to generate microbubbles. The resulting microbubbles merged and converted surface energy to mechanical energy high enough to fracture the matrix of biofilm. Consequently, H2O2 molecules diffused into the biofilm and killed most bacterial cells. Overall, this study provides a unique and powerful tool that can significantly impact current efforts to clean a wide array of biofouled products and devices.