Percutaneous Balloon Catheter Occlusion to Treat Extravasation from an Inferior Vena Cava Laceration Associated With a Pelvic Fracture Following Blunt Abdominal Trauma: A Case Report.

Blunt abdominal injury with pelvic fracture is common in polytrauma cases and is a major challenge for emergency physicians. Fluid resuscitation and massive transfusion protocol should be activated when pelvic fracture patients are found in hypovolemic shock. At the emergency department, resuscitative endovascular balloon occlusion of the aorta may be performed to temporarily control bleeding. Finally, a damage control operation or trans-arterial embolization may be performed in the hybrid operating room.

Quadriceps and Hamstring Strength in Adolescents 6 Months After ACL Reconstruction With Femoral Nerve Block, Adductor Canal Block, or No Nerve Block.

BACKGROUND: Femoral nerve block (FNB) and adductor canal block (ACB) have been used increasingly for pain control during anterior cruciate ligament (ACL) reconstruction in adolescent patients. However, recent evidence suggests that the use of FNB may affect quadriceps strength recovery 6 months after surgery. PURPOSE/HYPOTHESIS: To compare postoperative isokinetic strength in adolescents who received FNB, ACB, or no block for perioperative analgesia during ACL reconstruction. We anticipated lower postoperative quadriceps and hamstring isokinetic deficits in adolescents who received FNB as compared with ACB. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients were included in the study if they had undergone hamstring tendon autograft ACL reconstruction by a single surgeon from July 2008 to January 2018 and if they underwent isokinetic muscle testing at 4 to 8 months postoperatively. The participants were divided into 3 groups (no block, FNB, and ACB), and we compared the deficit in percentages between the affected and unaffected limbs as calculated from the isokinetic quadriceps and hamstring strength testing at 60 and 180 deg/s. Between-group analysis was performed using analysis of variance, with an alpha of .05. RESULTS: A total of 98 participants were included in the analysis (31 no block, 36 FNB, and 31 ACB). The mean ± SD age of the patients was 15.26 ± 1.15, 15.50 ± 1.42, and 15.71 ± 1.44, for no block, FNB, and ACB, respectively. At 5.61 months postoperatively, there was no significant difference across the 3 groups in isokinetic quadriceps deficits (P ≥ .99), and the only significant difference in isokinetic hamstring deficit was observed for peak flexion at 180 deg/s, in which the ACB group had lower peak torque than the FNB group (-9.80% ± 3.48% vs 2.37% ± 3.23%; P = .035). The ratio of participants with a deficit exceeding 15% did not differ significantly among the 3 groups. CONCLUSION: Contrary to previous research, our findings indicate only minimal difference in quadriceps strength among the 3 types of perioperative analgesia in adolescents approximately 6 months after ACL reconstruction. The only significant strength deficit was seen in the hamstrings of patients receiving ACB at peak flexion as compared with those receiving FNB.

A Rare Case of Spontaneous Pseudo-Aneurysm Rupture of an Extra-Anatomical Axillo-Femoral Bypass Graft: A Case Report.

BACKGROUND: Sudden onset of chest wall bulging is a rare chief symptom in the emergency department (ED). However, it may represent life-threatening diseases, such as tumor bleeding, aneurysm rupture, or subcutaneous emphysema. CASE REPORT: We present an 89-year-old woman who visited our ED with a chief symptom of abrupt bulging of the right chest wall accompanied with severe pain. The patient had a history of peripheral artery disease and 10-year post-extra-anatomical axillo-femoral bypass (AxFB) status. After several examinations, the patient was diagnosed as having spontaneous pseudo-aneurysm rupture of an extra-anatomical AxFB graft. Emergency endovascular intervention with stent insertion was performed immediately, and the patient was eventually discharged successfully. WHY SHOULD EMERGENCY PHYSICIANS BE AWARE OF THIS?: Although spontaneous pseudo-aneurysm rupture of an extra-anatomical AxFB graft is rare, the disease may consequently lead to a fatal outcome once misdiagnosed, and prompt intervention is warranted. Therefore, we should always consider the differential diagnosis of this disease in patients with a bulging chest wall and history of AxFB graft placement.

Long-term effect of weak nitrogen limitation on polyhydroxyalkanoates production of propionate-fed activated sludge operated at long sludge retention time.

A sequencing batch reactor (SBR) submitted to aerobic dynamic feeding condition was fed with weakly nitrogen-limited substrate (COD/N ratio of 60 mg/mg, propionate as the sole carbon source), and operated at 15 days sludge retention time (SRT). Then, the nitrogen-limited sludges at different cultivating periods (45th, 120th, 195th and 240th days) were harvested to conduct aerobic batch experiments of PHAs production under various nitrogen concentrations. Experimental results indicated that PHAs accumulating behavior of the propionate-fed sludge declined significantly after long-term cultivation, implying that weak nitrogen limitation and long SRT operation cannot achieve a stable PHAs producing performance of the sludge. Supplementing enough nitrogen was consequently a requisite to guarantee the stability of the propionate-fed PHAs accumulating culture. Besides, the sludge with higher PHAs content in SBR did not ensure a better PHAs producing capability in the batch PHAs production phase. Batch experiments also indicated that the propionate-fed sludge with 0.7 N mmol/L exhibited a better PHAs producing capability than with other nitrogen concentrations.

Synthesis of poly(3-hydroxybutyrate/3-hydroxyvalerate) from propionate-fed activated sludge under various carbon sources.

This study investigated the potential of a propionate-fed PHAs accumulating sludge, which was submitted to aerobic dynamic feeding (ADF) condition, for producing poly (3-hydroxybutyrate/3-hydroxyvalerate), P(HB/HV). Results of batch P(HB/HV) production tests indicated that propionate-ADF sludge with propionate or valerate exhibited better PHAs production performance than with acetate in terms of kinetics and stoichiometry. However, acetate-ADF sludge obtained a superior PHAs production capability from acetate than from propionate. Choice of carbon source for PHAs production therefore relied significantly on the cultivating substrate of PHAs accumulating sludge. Furthermore, mixture of acetate and valerate in molar ratio of 50:50 achieved higher P(HB/HV) content than in molar ratio of 75:25, and obtained a P(HB/HV) copolymer with optimum HV fraction of 45 mol%. The above findings propose that elevating the applicability of P(HB/HV) production require simultaneously two conditions: cultivating a propionate-fed sludge and providing the sludge with mixture of odd- and even-number carbon sources.