Life-threatening respiratory failure requiring extra-corporeal membrane oxygenation secondary to the anti-synthetase syndrome.

Veno-venous extra-corporeal membrane oxygenation (VV ECMO) provides support in severe acute respiratory failure (SARF) refractory to maximal conventional ventilatory support. ECMO does not treat the lungs per se, but allows time for the underlying condition to reverse or resolve. Common indications include acute respiratory distress syndrome (ARDS) and life-threatening asthma. On occasion, rarer conditions causing respiratory failure are diagnosed during ECMO support. The anti-synthetase syndrome (ASS) comprises of a group of conditions characterised by the presence of anti-aminoacyl-tRNA-synthetase antibodies with one or more of interstitial lung disease, inflammatory myositis and/or arthritis. Mainstay of management is immunosuppression. Here, we present two patients requiring ECMO support for SARF, whose respiratory function failed to respond to usual treatment for their assumed pneumonia. Both showed a rapid improvement in respiratory function and oxygenation once immunosuppressive therapy was instigated. Further testing revealed anti-synthetase antibodies, therefore both went on to receive further immunosuppression and an ultimately good outcome. Despite life-threatening respiratory failure, VV ECMO support allowed time for stabilisation, diagnosis and treatment. Outcomes in acute inflammatory interstitial pneumonitis are improved if immunosuppressive treatment is initiated as soon as possible. Our experience with these two cases have led to an institutional change in practice to send an urgent auto-antibody screen (including extractable nuclear antigen panel) on admission for all our SARF patients.

Analysis of microstructure characteristics and mechanical properties of beetle forewings, Allomyrina dichotoma.

In this study, the internal microstructure of the forewings of Allomyrina dichotoma is investigated by scanning electron microscopy (SEM) analysis. The results of SEM test show that the inner microstructure of the forewings possesses an integrated sandwich-like plate supported by trabeculae, which is composed of upper and lower skins of unequal thicknesses, and a honeycomb core with trabeculae. Beetle forewing is a natural composite material composed of chitin fibres and proteins. Also, based on the micro dimensions of the forewings observed by SEM, two groups of micro finite element (FE) models of the forewings (i.e., core with trabeculae and core without trabeculae) are established to compare and comprehensively understand the effect of trabeculae on the mechanical properties of the forewings. The FE simulation results demonstrate that the trabeculae could effectively (1) improve the stress state on the upper skin, lower skin, and core layer of the forewings, (2) improve the overall bending stiffness of the forewings, (3) enhance the peeling resistance between the skins and core layer, and (4) improve the buckling strength of the thin-walled core layer. The unique forewing structure of the Allomyrina dichotoma can provide an excellent bionic model for optimizing the traditional honeycomb panel structure.

Unusual operative treatment and outcome of femoral shaft fracture in a non-ambulatory cerebral palsy patient.

Cerebral palsy patients are prone to spontaneous fractures due to poor bone quality. The treatment options of femoral fractures include conservative and operative management which is tailored according to the patient's needs, co-morbidities and the presence of skilled surgeon. We present a 20 year old non-ambulatory CP patient who had a fractured femoral shaft which was treated by surgical excision of the fracture which is a surgical modality that according to our knowledge hasn't been addressed before in literature.