Peripheral vascular bypass with cadaveric arterial allograft in a toddler with femoral mycotic aneurysm.

Mycotic aneurysms are exceedingly rare in the pediatric population. The optimal surgical treatment for children with this disease is unclear as aneurysm resection and vascular reconstruction are uncommonly performed in young children. We present a unique case of a 21-month-old child with a complex cardiac history who presented with limb ischemia and was discovered to have thrombosis of the common femoral and superficial femoral artery. Groin exploration revealed a left common femoral and superficial femoral artery mycotic aneurysm that was successfully repaired with excision of the mycotic aneurysm, external iliac to profunda femoral artery vascular bypass using cryopreserved arterial allograft and femoral vein reconstruction. This case demonstrates successful vascular reconstruction can be performed in a young child with an Aspergillus mycotic aneurysm using cadaveric arterial allograft.

Groundwater arsenic contamination: impacts on human health and agriculture, ex situ treatment techniques and alleviation.

Groundwater is consumed by a large number of people as their primary source of drinking water globally. Among all the countries worldwide, nations in South Asia, particularly India and Bangladesh, have severe problem of groundwater arsenic (As) contamination so are on our primary focus in this study. The objective of this review study is to provide a viewpoint about the source of As, the effect of As on human health and agriculture, and available treatment technologies for the removal of As from water. The source of As can be either natural or anthropogenic and exposure mediums can either be air, drinking water, or food. As-polluted groundwater may lead to a reduction in crop yield and quality as As enters the food chain and disrupts it. Chronic As exposure through drinking water is highly associated with the disruption of many internal systems and organs in the human body including cardiovascular, respiratory, nervous, and endocrine systems, soft organs, and skin. We have critically reviewed a complete spectrum of the available ex situ technologies for As removal including oxidation, coagulation-flocculation, adsorption, ion exchange, and membrane process. Along with that, pros and cons of different techniques have also been scrutinized on the basis of past literatures reported. Among all the conventional techniques, coagulation is the most efficient technique, and considering the advanced and emerging techniques, electrocoagulation is the most prominent option to be adopted. At last, we have proposed some mitigation strategies to be followed with few long and short-term ideas which can be adopted to overcome this epidemic.

Electrocoagulation followed by sound agitation for removal of nitrogen and carbon-based pollutants from industrial wastewater.

The herculean imprecation of nitrogen-based pollutant like ammoniacal nitrogen (AN) and chemical oxygen demand (COD) on aquatic milieu is now a concern for the dye, pharma and fertiliser industries. Wastewater from these is characterised with high concentration of AN, COD and total dissolved solids (TDS), treatment of which is of utmost importance for a cleaner environment. In the current research work, an attempt was made to apply integrated electro-coagulation (EC) - sonication process for the removal of COD and AN from highly acidic dye intermediate wastewater containing high to very high concentration of COD and AN. Systematic laboratory experiments were conducted for the treatment of dye intermediate wastewater and influences of pH (5-11), applied voltage (0.5-4V) and electrolysis time (30-120 min) were investigated. A Response Surface Methodology (RSM) was used for optimization of major operating parameters for EC. The conditions for minimum fraction remaining (C/C0), was found to be same for both COD and AN, i.e. pH 7, time 90 min and applied voltage 2V. The C/Co value for COD and AN were 0.244 and 0.302, respectively. The C/Co value of COD and AN in combined EC-Sonication process with optimum operating conditions were 0.145 and 0.228 respectively with sonication time 60 min at a frequency of 33 kHz. Thus, EC - sonication process is an efficacious process for their removal from dye industrial wastewater.

Quality of transbronchial biopsy with large forceps compared to cryobiopsy: a randomized controlled, single blinded live animal study.

Background: Transbronchial forceps biopsy is the widely accepted modality for obtaining tissue specimens for the evaluation of unexplained lung parenchymal abnormalities. However, cryoprobe biopsy provides large specimen sizes and higher yield performance. Utilization of cryoprobe biopsy remains limited by its need to be performed under rigid bronchoscopy and subsequent required operator expertise. We evaluated whether a larger, 2.8 mm forceps could be utilized for parenchymal biopsies. A larger size would surrogate the cryoprobe's large sample size and forceps mechanism to obviate the need for rigid bronchoscopy and its requirement for removing the sample en bloc. Methods: This prospective, randomized controlled, single-blinded porcine study compared a 1.9 mm cryoprobe, a 2.4 mm cryoprobe, and a 2.8 mm forceps. Assessment of histopathologic quality, sample quality and surface area, attempts to retrieve specimen samples, fluoroscopy activation time, overall procedural time, and complications were compared. Results: Although cryoprobe yielded larger specimens, there was no statistical difference amongst all tools with respect to alveolar tissue surface area. There was bleeding on all cryoprobe biopsies. No bleeding was observed with forceps. Out of 32 potential combinations of interventions for bleeding control, 18 (56.3%) were made. There was no significant difference in sample quality between all three modalities. There was one pneumothorax in the forceps arm. Conclusions: Large forceps (LF) biopsy is a feasible technique while providing high diagnostic yield without the need for advanced therapeutic tools. Human studies are needed to further corroborate this technique.

'Ergopaedics': the future of ergonomics in orthopaedics.

Ergonomics is the scientific study of people and their working conditions, aiming to improve effectiveness. Improved ergonomics of orthopaedic theatres and equipment would reduce the risk of occupational injury and help to encourage more women into an underrepresented specialty.

Myopericarditis after messenger RNA Coronavirus Disease 2019 Vaccination in Adolescents 12 to 18 Years of Age.

OBJECTIVES: To characterize the clinical course and outcomes of children 12-18 years of age who developed probable myopericarditis after vaccination with the Pfizer-BioNTech (BNT162b2) coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccine. STUDY DESIGN: A cross-sectional study of 25 children, aged 12-18 years, diagnosed with probable myopericarditis after COVID-19 mRNA vaccination as per the Centers for Disease Control and Prevention criteria for myopericarditis at 8 US centers between May 10, 2021, and June 20, 2021. We retrospectively collected the following data: demographics, severe acute respiratory syndrome coronavirus 2 virus detection or serologic testing, clinical manifestations, laboratory test results, imaging study results, treatment, and time to resolutions of symptoms. RESULTS: Most (88%) cases followed the second dose of vaccine, and chest pain (100%) was the most common presenting symptom. Patients came to medical attention a median of 2 days (range, <1-20 days) after receipt of Pfizer mRNA COVID-19 vaccination. All adolescents had an elevated plasma troponin concentration. Echocardiographic abnormalities were infrequent, and 92% showed normal cardiac function at presentation. However, cardiac magnetic resonance imaging, obtained in 16 patients (64%), revealed that 15 (94%) had late gadolinium enhancement consistent with myopericarditis. Most were treated with ibuprofen or an equivalent nonsteroidal anti-inflammatory drug for symptomatic relief. One patient was given a corticosteroid orally after the initial administration of ibuprofen or an nonsteroidal anti-inflammatory drug; 2 patients also received intravenous immune globulin. Symptom resolution was observed within 7 days in all patients. CONCLUSIONS: Our data suggest that symptoms owing to myopericarditis after the mRNA COVID-19 vaccination tend to be mild and transient. Approximately two-thirds of patients underwent cardiac magnetic resonance imaging, which revealed evidence of myocardial inflammation despite a lack of echocardiographic abnormalities.

Myocardial infarction due to thrombosis of native aorta late after Fontan procedure for hypoplastic left heart syndrome.

Patients with single ventricle physiology who have undergone the Fontan procedure are at risk for long-term complications such as thrombus formation. Thrombus formation in the native aortic root (NAR) can be life-threatening if retrograde filling of the coronary arteries (CAs) is impaired. We present three cases of NAR thrombus with embolization to the CA, resulting in myocardial infarction. Thromboembolic events are well-documented complications of Fontan physiology, and optimal prevention and treatment strategies are poorly defined.

Use of pembrolizumab in MSI-high uterine leiomyosarcoma; a case report and review of the literature.

•Overall prognosis of uterine leiomyosarcoma (ULMS) is poor with a low 5-year survival rate.•Microsatellite instability (MSI)-high ULMS is not well documented in current literature.•Immune checkpoint inhibitors such as pembrolizumab have been shown to have good efficacy in treating MSI-high solid tumors.•Targeting MSI-high ULMS with pembrolizumab can potentially maintain a patient's quality of life and extend overall survival.

Safety and Feasibility of a Novel Protocol for Percutaneous Dilatational Tracheostomy in Patients with Respiratory Failure due to COVID-19 Infection: A Single Center Experience.

INTRODUCTION: The rapidly spreading Novel Coronavirus 2019 (COVID-19) appeared to be a highly transmissible pathogen in healthcare environments and had resulted in a significant number of patients with respiratory failure requiring tracheostomy, an aerosol-generating procedure that places healthcare workers at high risk of contracting the infection. Instead of deferring or delaying the procedure, we developed and implemented a novel percutaneous dilatational tracheostomy (PDT) protocol aimed at minimizing the risk of transmission while maintaining favorable procedural outcome. Patients and Methods. All patients who underwent PDT per novel protocol were included in the study. The key element of the protocol was the use of apnea during the critical part of the insertion and upon any opening of the ventilator circuit. This was coupled with the use of enhanced personnel protection equipment (PPE) with a powered air-purifying respirator (PAPR). The operators underwent antibody serology testing and were evaluated for COVID-19 symptoms two weeks from the last procedure included in the study. RESULTS: Between March 12th and June 30th, 2020, a total of 32 patients underwent PDT per novel protocol. The majority (80%) were positive for COVID-19 at the time of the procedure. The success rate was 94%. Only one patient developed minor self-limited bleeding. None of the proceduralists developed positive serology or any symptoms compatible with COVID-19 infection. CONCLUSION: A novel protocol that uses periods of apnea during opening of the ventilator circuit along with PAPR-enhanced PPE for PDT on COVID-19 patients appears to be effective and safe for patients and healthcare providers.

Bilateral pulmonary emboli in a teenager with positive SARS-CoV-2 antibody.

Thromboembolic phenomena, particularly pulmonary emboli, have been described in adult patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but have been less evident in children. We describe a case of a teenager with bilateral pulmonary emboli leading to cardiovascular collapse in the setting of a positive SARS-CoV-2 IgM antibody.

Randomized clinical trial of high concentration versus titrated oxygen use in pediatric asthma.

OBJECTIVE: To compare the effects of high concentration to titrated oxygen therapy (HCOT) on transcutaneous carbon dioxide (PtCO2 ) level in pediatric asthma exacerbation. Titrated oxygen therapy (TOT) in acute asthma will avoid a rise in PtCO 2 in the pediatric population. METHOD: The study design is a prospective, randomized, clinical trial comparing HCOT (maintain SpO2 92-95%) while being treated for asthma exacerbation in the emergency department (ED). INCLUSION CRITERIA: 2 to 18 years, previously diagnosed asthma with acute exacerbation (asthma score >5). PtCO2 and asthma scores were measured at 0, 20, 40, 60 minutes and then every 30 minutes until disposition decision. The primary outcome was a change in PtCO 2 . Secondary outcomes were admission rate and change in asthma score. RESULTS: A total of 96 patients were enrolled in the study with a mean age of 8.27 years; 49 in HCOT and 47 in the TOT group. The 0 minute PtCO2 was similar (35.33 + 3.88 HCOT vs 36.66 + 4.69 TOT, P = 0.13); whereas, the 60 minutes PtCO 2 was higher in the HCOT (38.08 + 5.11 HCOT vs 35.51 + 4.57 TOT, P = 0.01). The asthma score was similar at 0 minute (7.55 + 1.34 HCOT vs 7.30 + 1.18 TOT, P = 0.33); whereas, the 60 minutes asthma score was lower in the TOT (4.71 + 1.38 HCOT vs 3.57 + 1.25 TOT, P = 0.0001). The rate of admission to the hospital was 40.5% in HCOT vs 25.5% in the TOT (P = 0.088). CONCLUSIONS: HCOT in pediatric asthma exacerbation leads to significantly higher carbon dioxide levels, which increases asthma scores and trends towards the increasing rate of admission. Larger studies are needed to explore this association.

A mathematical model for the determination of mouse excisional wound healing parameters from photographic data.

We present a mathematical model to quantify parameters of mouse excisional wound healing from photographic data. The equation is a piecewise linear function in log scale that includes key parameters of initial wound radius (R0 ), an initial wound stasis phase (Ti ), and time to wound closure (Tc ); subsequently, these terms permit calculation of a latter active proliferative phase (Tp ), and the healing rate (HR) during this active phase. A daily photographic record of wound healing (utilizing 6 mm diameter splinted excisional wounds) permits the necessary sampling for robust parameter refinement. When implemented with an automated nonlinear fitting routine, the healing parameters are determined in an operator-independent (i.e., unbiased) manner. The model was evaluated using photographic data from a splinted excisional surgical procedure involving several different mouse cohorts. Model fitting demonstrates excellent coefficients of determination (R2 ) in each case. The model, thus, permits quantitation of key parameters of excisional wound healing, from initial wounding through to wound closure, from photographic data.

Fine-Sampled Photographic Quantitation of Dermal Wound Healing Senescence in Aged BALB/cByJ Mice and Therapeutic Intervention with Fibroblast Growth Factor-1.

Objective: To determine quantitative parameters of dermal wound healing senescence in aged BALB/cByJ mice (an important animal model of aging) and to evaluate the potential for therapeutic intervention by fibroblast growth factor-1 (FGF-1). Approach: Utilize a novel noninvasive fine-sampled photographic methodology to quantify wound healing parameters for healing phases from wounding through to wound closure. Results: Parameters associated with key healing phases were quantified and compared between nonaged and aged cohorts of both genders. The results identify a sexual dimorphism in dermal wound healing, with nonaged females exhibiting a greater overall healing efficiency than males. This enhanced healing in females, however, senesces with age such that healing parameters for aged males and females are statistically indistinguishable. Topical application of FGF-1 was identified as an effective therapeutic intervention to treat dermal healing senescence in aged females. Innovation: The FGF intervention is being analyzed using a new recently published model. This approach significantly increases the amount of preclinical animal data obtainable in wound healing studies, minimizes cohort number compared with (lethal) histological studies, and permits a direct statistical comparison between different healing studies. Conclusion: Quantitative parameters of dermal wound healing, obtained from noninvasive fine-sampled photographic data, identify topical FGF-1 as an effective therapeutic to treat the senescence of dermal healing present in aged female BALB/cByJ mice.

Long-term effects of bisphosphonate therapy: perforations, microcracks and mechanical properties.

Osteoporosis is characterised by trabecular bone loss resulting from increased osteoclast activation and unbalanced coupling between resorption and formation, which induces a thinning of trabeculae and trabecular perforations. Bisphosphonates are the frontline therapy for osteoporosis, which act by reducing bone remodelling, and are thought to prevent perforations and maintain microstructure. However, bisphosphonates may oversuppress remodelling resulting in accumulation of microcracks. This paper aims to investigate the effect of bisphosphonate treatment on microstructure and mechanical strength. Assessment of microdamage within the trabecular bone core was performed using synchrotron X-ray micro-CT linked to image analysis software. Bone from bisphosphonate-treated fracture patients exhibited fewer perforations but more numerous and larger microcracks than both fracture and non-fracture controls. Furthermore, bisphosphonate-treated bone demonstrated reduced tensile strength and Young's Modulus. These findings suggest that bisphosphonate therapy is effective at reducing perforations but may also cause microcrack accumulation, leading to a loss of microstructural integrity and consequently, reduced mechanical strength.

Effect of Crop Volume on Contraction Rate in Adult House Fly.

The functional aspects of the adult house fly crop have not been studied even though various human and domestic animal pathogens have been discovered within the crop lumen. The average volume consumed (midgut and crop) by flies starved for 24 h was 3.88 µl by feeding both sexes on a sucrose phosphate glutamate buffer. In addition, various volumes of a solution (0.125 M sucrose plus Amaranth dye) were fed to 3-d-old adult female house flies to quantify the crop contraction rate as affected by crop volume. As crop volume increased, the contraction rate increased until it reached a peak at 2 µl, after which it declined. It is hypothesized that the high contraction rate of the crop, which in house fly is almost twice the rate of three other fly species, is one of the factors that makes house fly an excellent vector. The mechanism for such a high contraction rate needs to be investigated.

A mild form of SLC29A3 disorder: a frameshift deletion leads to the paradoxical translation of an otherwise noncoding mRNA splice variant.

We investigated two siblings with granulomatous histiocytosis prominent in the nasal area, mimicking rhinoscleroma and Rosai-Dorfman syndrome. Genome-wide linkage analysis and whole-exome sequencing identified a homozygous frameshift deletion in SLC29A3, which encodes human equilibrative nucleoside transporter-3 (hENT3). Germline mutations in SLC29A3 have been reported in rare patients with a wide range of overlapping clinical features and inherited disorders including H syndrome, pigmented hypertrichosis with insulin-dependent diabetes, and Faisalabad histiocytosis. With the exception of insulin-dependent diabetes and mild finger and toe contractures in one sibling, the two patients with nasal granulomatous histiocytosis studied here displayed none of the many SLC29A3-associated phenotypes. This mild clinical phenotype probably results from a remarkable genetic mechanism. The SLC29A3 frameshift deletion prevents the expression of the normally coding transcripts. It instead leads to the translation, expression, and function of an otherwise noncoding, out-of-frame mRNA splice variant lacking exon 3 that is eliminated by nonsense-mediated mRNA decay (NMD) in healthy individuals. The mutated isoform differs from the wild-type hENT3 by the modification of 20 residues in exon 2 and the removal of another 28 amino acids in exon 3, which include the second transmembrane domain. As a result, this new isoform displays some functional activity. This mechanism probably accounts for the narrow and mild clinical phenotype of the patients. This study highlights the 'rescue' role played by a normally noncoding mRNA splice variant of SLC29A3, uncovering a new mechanism by which frameshift mutations can be hypomorphic.