Total spinal anaesthesia following obstetric neuraxial blockade: a narrative review.

BACKGROUND: Total spinal anaesthesia (TSA) is an emergency caused by high neuraxial blockade. It is a recognised complication of all neuraxial techniques in obstetric anaesthesia. Its incidence and outcomes have not been evaluated. There is compelling evidence that TSA continues to be a problem in contemporary practice, having the capacity to cause significant morbidity and mortality if not recognised early and promptly treated. This review based on a literature search aims to clarify the epidemiology of TSA, summarise its pathophysiology, and identify risk factors and effective treatments. METHODS: We performed a literature search using PubMed, Web of Science and Google Scholar databases using specified search terms for materials published using search terms. For each case, the type of block, the difficulty of the procedure, the dose of local anaesthetic, positivity of aspiration before and after the event, maternal outcome, Apgar score, onset of symptoms, cardiorespiratory and neurological manifestations, cardiorespiratory support employed, admission to an intensive care unit, cardiac arrest events and duration of mechanical ventilation were extracted. RESULTS: A total of 605 cases were identified, of which 51 were sufficiently detailed for analysis. Although TSA is described after all neuraxial techniques, spinal after epidural was a particular concern in recent reports. Respiratory distress was universal but apnoea was not. The onset of apnoea was variable, ranging from 1 to 180 min. Hypotension was not invariable and occurred in approximately half of cases. Multiple fatalities and neurological injuries were reported, often in under-resourced areas when providers were not skilled in airway management or when recognition and intervention were delayed. In the most recent reports good outcomes were achieved when effective treatments were rapidly provided. CONCLUSIONS: The available literature confirms that TSA remains an active clinical problem and that with prompt recognition and treatment good outcomes can be achieved. This requires anticipation and preparedness in all clinical areas where neuraxial techniques are performed.

Dynamics around small irregularly shaped objects modeled as a mass dipole.

In this work, we investigate the dynamics of a spacecraft near two primary bodies. The massive body is considered to have a spherical shape, while the less massive one is elongated and modeled as a dipole. The dipole consists of two connected masses, one is spherical and the other is an oblate spheroid. The gravitational potential of the elongated body is determined by four independent parameters. To study the dynamics, we construct the equations of motion of a spacecraft with negligible mass under the effect of the current force model. The existence and locations of the equilibrium points are analyzed for various values of the system parameters. We found that the existence and locations of the points are affected by the system parameters. Also, we studied the linear stability of the equilibrium points. We found some stable collinear points when the oblateness parameter is negative, otherwise the points are not stable. We used the curves of zero velocity to identify the regions of allowed motion. Furthermore, we discussed the 2001 SN263 asteroid system and found some stable collinear points when the oblateness parameter is negative. In addition, the triangular points of the system are stable in a linear sense.

Understanding the Application of Mechanical Dyssynchrony in Patients with Heart Failure Considered for CRT.

Over the past two decades of CRT use, the failure rate has remained around 30-35%, despite several updates in the guidelines based on the understanding from multiple trials. This review article summarizes the role of mechanical dyssynchrony in the selection of heart failure patients for cardiac resynchronization therapy. Understanding the application of mechanical dyssynchrony has also evolved during these past two decades. There is no role of lone mechanical dyssynchrony in the patient selection for CRT. However, mechanical dyssynchrony can complement the electrocardiogram and clinical criteria and improve patient selection by reducing the failure rate. An oversimplified approach to mechanical dyssynchrony assessment, such as just estimating time-to-peak delays between segments, should not be used. Instead, methods that can identify the underlying pathophysiology of HF and are representative of a substrate to CRT should be applied.

Unilateral progressive anterior iris adhesions in Mowat-Wilson syndrome: a new ocular finding.

Ocular associations in Mowat-Wilson syndrome (MWS) are rare. Those involving the anterior segment are scarce in the literature. We describe a child with genetic confirmation of MWS that presented with acquired onset of unilateral anterior iris adhesions with no known trauma.

Photothermally Triggered Nanoreactors with a Tunable Catalyst Location and Catalytic Activity.

Thermosensitive microgels based on poly(N-isopropylacrylamide) (PNIPAm) have been widely used to create nanoreactors with controlled catalytic activity through the immobilization of metal nanoparticles (NPs). However, traditional approaches with metal NPs located only in the polymer network rely on electric heating to initiate the reaction. In this study, we developed a photothermal-responsive yolk-shell nanoreactor with a tunable location of metal NPs. The catalytic performance of these nanoreactors can be controlled by both light irradiation and conventional heating, that is, electric heating. Interestingly, the location of the catalysts had a significant impact on the reduction kinetics of the nanoreactors; catalysts in the shell exhibited higher catalytic activity compared with those in the core, under conventional heating. When subjected to light irradiation, nanoreactors with catalysts loaded in the core demonstrated improved catalytic performance compared to direct heating, while nanoreactors with catalysts in the shell exhibited relatively similar activity. We attribute this enhancement in catalytic activity to the spatial distribution of the catalysts and the localized heating within the polydopamine cores of the nanoreactors. This research presents exciting prospects for the design of innovative smart nanoreactors and efficient photothermal-assisted catalysis.

Multi-functionalized carbon nanotubes towards green fabrication of heterogeneous catalyst platforms with enhanced catalytic properties under NIR light irradiation.

Metal/carbon nanotubes (CNTs) have been attractive hybrid systems due to their high specific surface area and exceptional catalytic activity, but their challenging synthesis and dispersion impede their extensive applications. Herein, we report a facile and green approach towards the fabrication of metal/CNT composites, which utilizes a versatile glycopeptide (GP) both as a stabilizer for CNTs in water and as a reducing agent for noble metal ions. The abundant hydrogen bonds in GP endow the formed GP-CNTs with excellent plasticity, enabling the availability of polymorphic CNT species from dispersion to viscous paste, gel, and even to dough by increasing their concentration. The GP molecules can reduce metal precursors at room temperature without additional reducing agents, enabling the in situ immobilization of metal nanoparticles (e.g. Au, Ag, Pt, and Pd) on the CNT surface. The combination of the excellent catalytic properties of Pd particles with photothermal conversion capability of CNTs makes the Pd/CNT composite a promising catalyst for the fast degradation of organic pollutants, as demonstrated by a model catalytic reaction using 4-nitrophenol (4-NP). The conversion of 4-NP using the Pd/CNT composite as the catalyst has increased by 1.6-fold under near infrared light illumination, benefiting from the strong light-to-heat conversion effect of CNTs. Our proposed strategy opens a new avenue for the synthesis of CNT composites as a sustainable and versatile catalyst platform.

Oxidized Low-density Lipoproteins and Lipopolysaccharides Augment Carotid Artery Plaque Vulnerability in Hypercholesterolemic Microswine.

Atherosclerosis is a chronic inflammatory disease and hypercholesterolemia is a risk factor. This study aims to compare the potency of lipopolysaccharide (LPS) and oxidized low-density lipoproteins (oxLDL) to induce plaque formation and increase plaque vulnerability in the carotid artery of hypercholesterolemic Yucatan microswine. Atherosclerotic lesions at the common carotid artery junction and ascending pharyngeal artery were induced in hypercholesterolemic Yucatan microswine at 5-6 months of age with balloon angioplasty. LPS or oxLDL were administered intraluminally at the site of injury after occluding the arterial flow temporarily. Pre-intervention ultrasound (US), angiography, and optical coherence tomography (OCT) were done at baseline and just before euthanasia to assess post-op parameters. The images from the US, OCT, and angiography in the LPS and the oxLDL-treated group showed increased plaque formation with features suggestive of unstable plaque, including necrotic core, thin fibrous caps, and a signal poor region more with oxLDL compared to LPS. Histomorphology of the carotid artery tissue near the injury corroborated the presence of severe lesions in both LPS and oxLDL-treated pigs but more in the oxLDL group. Vascular smooth muscle and endothelial cells treated with LPS and oxLDL showed increased folds changes in mRNA transcripts of the biomarkers of inflammation and plaque vulnerability compared to untreated cells. Collectively, the results suggest that angioplasty-mediated intimal injury of the carotid arteries in atherosclerotic swine with local administration of LPS or ox-LDL induces vulnerable plaques compared to angioplasty alone and oxLDL is relatively more potent than LPS in inducing vulnerable plaque.

Case report: Interdisciplinary treatment of complex C1/C2 fractures in a patient with concomitant three-vessel coronary artery disease requiring bypass surgery.

Background: Acute myocardial infarction (MI) frequently leads to consciousness disturbance following hemodynamic collapse. Therefore, MI can occur together with upper cervical spine trauma. Herein, we report the successful treatment of complex C1/C2 fractures in a patient with concomitant three-vessel coronary artery disease (CAD). Case presentation: A 70-year-old patient presented in our emergency outpatient clinic after a hemodynamic collapse without neurological deficits or heart-related complaints. Computed tomography (CT) scan of the cervical spine revealed a dislocated odontoid fracture Anderson and D'Alonzo type II and an unstable Gehweiler type III injury (Jefferson's fracture). An intradiploic arachnoid cyst in the posterior wall of the posterior fossa was a coincident radiological finding. Furthermore, coronary angiography confirmed three-vessel CAD with high-grade coronary artery stenosis. Indication for upper cervical spine surgery and bypass surgery was given. An interdisciplinary team of neurosurgeons, cardiothoracic surgeons and anesthesiologists evaluated the patient's case to develop the most suitable therapy concept and alternative strategies. Finally, in first step, C1-C2 fusion was performed by Harms technique under general anesthesia with x-ray guidance, spinal neuronavigation, Doppler ultrasound and cardiopulmonary monitoring. Cardiothoracic surgeons were on standby. One month later bypass surgery was performed uneventfully. Follow-up CT scan of cervical spine revealed intraosseous screw positioning and beginning fusion of the fractures. The patient did not develop neurological deficits and recovered completely from both surgeries. Conclusions: Treating complex C1/C2 fractures with concomitant severe CAD requiring treatment is challenging and carries a high risk of complications. To our knowledge, the literature does not provide any guidelines regarding therapy of this constellation. To receive upper cervical spine stability and to prevent both, spinal cord injury and cardiovascular complications, an individual approach is required. Interdisciplinary cooperation to determine optimal therapeutic algorithms is needed.

Poly(ionic liquid) nanovesicles via polymerization induced self-assembly and their stabilization of Cu nanoparticles for tailored CO2 electroreduction.

Herein, we report a straightforward, scalable synthetic route towards poly(ionic liquid) (PIL) homopolymer nanovesicles (NVs) with a tunable particle size of 50 to 120 nm and a shell thickness of 15 to 60 nm via one-step free radical polymerization induced self-assembly. By increasing monomer concentration for polymerization, their nanoscopic morphology can evolve from hollow NVs to dense spheres, and finally to directional worms, in which a multilamellar packing of PIL chains occurred in all samples. The transformation mechanism of NVs' internal morphology is studied in detail by coarse-grained simulations, revealing a correlation between the PIL chain length and the shell thickness of NVs. To explore their potential applications, PIL NVs with varied shell thickness are in situ functionalized with ultra-small (1 âˆ¼ 3 nm in size) copper nanoparticles (CuNPs) and employed as electrocatalysts for CO2 electroreduction. The composite electrocatalysts exhibit a 2.5-fold enhancement in selectivity towards C1 products (e.g., CH4), compared to the pristine CuNPs. This enhancement is attributed to the strong electronic interactions between the CuNPs and the surface functionalities of PIL NVs. This study casts new aspects on using nanostructured PILs as new electrocatalyst supports in CO2 conversion to C1 products.

Improvement of the combustion, emission, and stability features of diesel-methanol blends using n-decanol as cosolvent.

This research endeavored to boost the applicability of methanol in CI engines utilizing n-decanol as cosolvents. The work was split into binary phases. Firstly, the stabilities of pure methanol (M100) and hydrous-methanol (MH10), with diesel as a reference fuel, were examined applying various temperatures: 10 °C, 20 °C, and 30 °C. The findings showed that the M100-diesel and MH10-diesel combinations were unstable. Thus, n-decanol was utilized as a cosolvent. Following by the engine combustion and emissions characteristics were evaluated by manipulating three proportions of M100-diesel mixtures with n-decanol. Three mixtures comprised of 5, 10, and 15% M100 with 20% n-decanol, which are denoted as M5, M10, and M15, correspondingly. These combinations were assessed via thermogravimetric assessment, and their physicochemical properties were assessed corresponding to the ASTM. The maximum in-cylinder pressure, heat release rate, and pressure rise rate diminished by 10, 11, and 10%, respectively, for the M100/diesel/n-decanol combinations compared with the diesel oil. The brake thermal efficiency lowered by 10%, whereas the brake specific fuel consumption enlarged by 10% for the combinations compared with the diesel. NOx and smoke opacity levels diminished by about 30 and 50%, respectively, whereas the CO and UHC enlarged by about 50 and 60% for the blends compared with the diesel oil.

ENCEPHALOPATHY TREATED AFTER SURGERY FOR GRAVES' DISEASE.

Introduction: This case report is the fourth of its type in the medical literature. It describes total thyroidectomy for recurrent relapses of Graves encephalopathy (GE) despite medical treatment. Case presentation: A 33-year-old male presented with impaired consciousness and convulsions. He had post-thyroid surgery recurrent Graves' disease with a goitre. Based on this fact, high thyroid antibodies titres and the exclusion of other causes of such neurological manifestations, he was diagnosed to have GE. This is a rare variant of "encephalopathy associated with autoimmune thyroid disease" (EAATD). Despite the administration of steroid therapy and other standard therapeutic measures, he developed five relapses within 17 months. Total thyroidectomy was advised. Unfortunately, he got another severe attack that required intensive care admission. After three days of discharging, he had urgent total thyroidectomy. The operation went well and for 18 months' follow-up he had no more attacks. However, thyroid antibodies remained high. Discussion: The report provides details on the diagnosis, standard management and the indication for thyroidectomy for GE. It describes its challenges, precautions, technique and outcomes. It reviews the extent of surgery as well as the clinical and antibody outcomes of the previous three related reports, in comparison with the current one. Conclusion: For medically uncontrolled relapse of GE, thyroidectomy consistently results in ending the attacks. It, therefore, should be put in more consideration in the treatment protocols. On the other hand, one should not depend on antibody levels as a measure of treatment success.

COVID-19 breakthrough infections in rheumatic diseases patients after vaccination.

BACKGROUND: Rheumatic diseases patients receiving Rituximab had severe COVID-19 disease. Although they had impaired humoral immune responses following COVID-19 vaccine, they had preserved cellular immune responses. Waning of COVID-19 antibody responses was observed within six months post vaccination among immunocompromised patients. Recent reports showed fatal outcome of breakthrough SARS-CoV-2 infections among vaccinated high-risk rheumatic diseases patients receiving Rituximab. SAR-CoV-2 serological tests were not performed. OBJECTIVE: Evaluation of COVID-19 vaccine humoral responses and breakthrough infections among low risk fully vaccinated rheumatic patients during the Delta Variant Era. METHODS: A case series of 19 fully vaccinated patients with rheumatic diseases were followed to determine post vaccine SARS-CoV-2 neutralizing antibody titers and to monitor the development of breakthrough infections up to eight months post vaccine at our tertiary care center in Jeddah, Saudi Arabia from 1st April until 30th November 2021. RESULTS: The mean age of patients was 49 years old. 10% of patients were receiving Rituximab. 73% of patients had positive SARS-CoV-2 serological testing post second vaccine. Two mild breakthrough COVID-19 infections were diagnosed six months post second dose of vaccine. Patients were less than 65 years, did not receive Rituximab, did not have interstitial lung diseases and had positive post vaccine serological testing. CONCLUSIONS: We demonstrated high SARS-CoV-2 neutralizing antibodies seroprevalence and self-limiting breakthrough infections in low risk rheumatic diseases patients during the Delta Era. Future studies are needed to study the outcome of rheumatic diseases patients in the Era of Omicron in view of viral immune escape responses.

Assessment of the latest prescribed drug-related problems.

OBJECTIVE: Drug-related problems (DRPs) could affect patient care and lead to deleterious manifestations, therefore, this investigation aimed to review the recently published studies concerning DRPs to improve their availability to clinical pharmacists, hoping that this information will be supportive and relevant to their practice settings. MATERIALS AND METHODS: A search of Elsevier, Sage, Springer/Nature, and Wiley online libraries on Egyptian Knowledge Bank (EKB) was limited to the cumulative period from 1/1/2015 to 20/10/2020. The abstracts of 156 articles were critically reviewed and 50 articles were included based on relevance while excluding books. The selected articles reported DRPs and different strategies to reduce them. Moreover, drug-drug interactions (DDIs) in various patient populations were confirmed by many articles. Additionally, potential drug-drug interactions (pDDIs) predisposing factors were reported by others. RESULTS: 24 articles (48%) illustrated DDIs, 5 articles (10%) demonstrated ADRs, 4 articles (8%) showed medication errors (MEs), and 25 articles (50%) revealed efforts to reduce DRPs. The psychiatric population is at the utmost risk of pDDIs. Polypharmacy was the furthest recurrently reported risk factor related to DDIs. Adverse drug events (ADEs) increased healthcare costs. Different strategies to avoid DRPs were published through the stated period. CONCLUSIONS: Our findings can be supportive to healthcare professionals in enhancing their patients' quality of care by reducing the exposure to ADEs.

Template synthesis of dual-functional porous MoS2 nanoparticles with photothermal conversion and catalytic properties.

Advanced catalysis triggered by photothermal conversion effects has aroused increasing interest due to its huge potential in environmental purification. In this work, we developed a novel approach to the fast degradation of 4-nitrophenol (4-Nip) using porous MoS2 nanoparticles as catalysts, which integrate the intrinsic catalytic property of MoS2 with its photothermal conversion capability. Using assembled polystyrene-b-poly(2-vinylpyridine) block copolymers as soft templates, various MoS2 particles were prepared, which exhibited tailored morphologies (e.g., pomegranate-like, hollow, and open porous structures). The photothermal conversion performance of these featured particles was compared under near-infrared (NIR) light irradiation. Intriguingly, when these porous MoS2 particles were further employed as catalysts for the reduction of 4-Nip, the reaction rate constant was increased by a factor of 1.5 under NIR illumination. We attribute this catalytic enhancement to the open porous architecture and light-to-heat conversion performance of the MoS2 particles. This contribution offers new opportunities for efficient photothermal-assisted catalysis.

Surface-Functionalized Au-Pd Nanorods with Enhanced Photothermal Conversion and Catalytic Performance.

Bimetallic nanostructures comprising plasmonic and catalytic components have recently emerged as a promising approach to generate a new type of photo-enhanced nanoreactors. Most designs however concentrate on plasmon-induced charge separation, leaving photo-generated heat as a side product. This work presents a photoreactor based on Au-Pd nanorods with an optimized photothermal conversion, which aims to effectively utilize the photo-generated heat to increase the rate of Pd-catalyzed reactions. Dumbbell-shaped Au nanorods were fabricated via a seed-mediated growth method using binary surfactants. Pd clusters were selectively grown at the tips of the Au nanorods, using the zeta potential as a new synthetic parameter to indicate the surfactant remaining on the nanorod surface. The photothermal conversion of the Au-Pd nanorods was improved with a thin layer of polydopamine (PDA) or TiO2. As a result, a 60% higher temperature increment of the dispersion compared to that for bare Au rods at the same light intensity and particle density could be achieved. The catalytic performance of the coated particles was then tested using the reduction of 4-nitrophenol as the model reaction. Under light, the PDA-coated Au-Pd nanorods exhibited an improved catalytic activity, increasing the reaction rate by a factor 3. An analysis of the activation energy confirmed the photoheating effect to be the dominant mechanism accelerating the reaction. Thus, the increased photothermal heating is responsible for the reaction acceleration. Interestingly, the same analysis shows a roughly 10% higher reaction rate for particles under illumination compared to under dark heating, possibly implying a crucial role of localized heat gradients at the particle surface. Finally, the coating thickness was identified as an essential parameter determining the photothermal conversion efficiency and the reaction acceleration.

An Electrostatic MEMS Roll-Pitch Rotation Rate Sensor with In-Plane Drive Mode.

In this paper, we presented a novel electrostatic Roll/Pitch MEMS gyroscope with in-plane drive mode and out-of-plane sense mode. The proposed structure is developed based on a tuning fork gyroscope with decoupled sense mass on each tine that control the sense out-of-plane frequency. A multi-height deep reactive ion etching (DRIE) fabrication process was utilized to achieve and enhance decoupling between the drive and sense modes. We presented our design methodology followed by an analytical and finite element (FEM) model. Our experimental results showed a good match between the analytical model and those obtained experimentally, from the drive and sense oscillation frequencies. Our characterization setup used a custom made application specific integrated circuit (ASIC) for characterization and was able to achieve ARW of 0.2 deg/rt-h, a bias instability 5.5 deg/h, and scale factor non-linearity (SFNL) 156 ppm FS.

Impacts of octanol and decanol addition on the solubility of methanol/hydrous methanol/diesel/biodiesel/Jet A-1 fuel ternary mixtures.

This study attempts to enhance the mixture instability of methanol/hydrous methanol mixed with diesel fuel, waste cooking oil (WCO) biodiesel, and Jet A-1 fuel using n-octanol and n-decanol as cosolvent at numerous temperatures of 10 °C, 20 °C, and 30 °C. The experiment is divided into two stages: first, blending pure methanol with diesel oil, Jet A-1, and WCO biodiesel individually utilizing n-octanol and n-decanol as cosolvent at various temperatures. Second, combining hydrous methanol (90% methanol + 10 wt% water) with diesel oil, Jet A-1, and WCO biodiesel independently and applying n-octanol and n-decanol as cosolvent at different temperatures. Pure methanol or hydrous methanol is mixed with the base fuels at different mixing proportions varying from 0 to 100 vol% with 10 vol% increments. The co-solvent, mainly n-octanol and n-decanol (titrant), is progressively and separately inserted into the tube with continuous shaking by utilizing a high-precision pipette until the ternary mixtures' phase borders seem. The findings demonstrate phase separation in pure methanol-diesel and pure methanol-Jet A-1 combinations even when the blend temperature increased to 60 °C. The pure methanol/biodiesel combination proves complete solubility without adding an external agent. The results also illustrate that the ambient temperature considerably affects the stability of mixture and amount of cosolvent in the blend. n-Octanol and n-decanol showed promising performance in enhancing the phase stability issue of methanol and hydrous methanol with the base fuels. It can be deduced that the minimum amount of cosolvent is recorded for biodiesel-hydrous methanol, Jet A-1-hydrous methanol, and diesel-hydrous methanol, respectively.

Physiological and behavioral responses of land molluscs as biomarkers for pollution impact assessment: A review.

Environmental pollution caused by human activities is a global public health concern. This review discusses the impact of different types of pollutants such as pesticides, metals, nanoparticles and others on land molluscs. These molluscs are of great interest as good model organisms for studying biomarker responses in ecotoxicological monitoring programs. Several biomarkers are utilized to characterize and quantify the exposure and harmful impacts of various pollutants. In this review, we have identified physiological and behavioral endpoints (feeding, growth, avoidance, mucus secretion, locomotion and reproductive behavior) for the diagnosis of environmental pollution. The present review displays that all types of pollutants can disturb physiological and behavioral endpoints of gastropods, and these impacts depend on the matrix, exposure time and route as well as the type and concentration of the pollutants in the environment. We have also confirmed that terrestrial gastropods particularly snails as sentinel species could be used as potential bioindicator organisms for environmental quality assessment and thus for predicting potential hazards to human health.

Decoding the kinetic limitations of plasmon catalysis: the case of 4-nitrothiophenol dimerization.

Plasmon-mediated chemistry presents an intriguing new approach to photocatalysis. However, the reaction enhancement mechanism is not well understood. In particular, the relative importance of plasmon-generated hot charges and photoheating is strongly debated. In this article, we evaluate the influence of microscopic photoheating on the kinetics of a model plasmon-catalyzed reaction: the light-induced 4-nitrothiophenol (4NTP) to 4,4'-dimercaptoazobenzene (DMAB) dimerization. Direct measurement of the reaction temperature by nanoparticle Raman-thermometry demonstrated that the thermal effect plays a dominant role in the kinetic limitations of this multistep reaction. At the same time, no reaction is possible by dark heating to the same temperature. This shows that plasmon nanoparticles have the unique ability to enhance several steps of complex tandem reactions simultaneously. These results provide insight into the role of hot electron and thermal effects in plasmonic catalysis of complex organic reactions, which is highly important for the ongoing development of plasmon based photosynthesis.