COVID-19: A new challenge for ECMO.

COVID results in a variety of pathophysiology that causes cardiorespiratory and the need for ECMO. These include hypoxic respiratory failure, cardiogenic shock, cardiac arrest, multisystem inflammatory disease, and vascular thrombosis with pulmonary embolism. A variety of cannulation strategies are required and the "hyperinflammation" and consequent coagulation abnormalities mandate new strategies to provide optimal ECMO support.

Performance of a pilot-scale packed bed reactor for perchlorate reduction using a sulfur oxidizing bacterial consortium.

A novel sulfur-utilizing perchlorate reducing bacterial consortium successfully treated perchlorate (ClO4⁻) in prior batch and bench-scale packed bed reactor (PBR) studies. This study examined the scale up of this process for treatment of water from a ClO 4⁻ and RDX contaminated aquifer in Cape Cod Massachusetts. A pilot-scale upflow PBR (∼250-L) was constructed with elemental sulfur and crushed oyster shell packing media. The reactor was inoculated with sulfur oxidizing ClO4⁻ reducing cultures enriched from a wastewater seed. Sodium sulfite provided a good method of dissolved oxygen removal in batch cultures, but was found to promote the growth of bacteria that carry out sulfur disproportionation and sulfate reduction, which inhibited ClO4⁻ reduction in the pilot system. After terminating sulfite addition, the PBR successfully removed 96% of the influent ClO4⁻ in the groundwater at an empty bed contact time (EBCT) of 12 h (effluent ClO4⁻ of 4.2 µg L(-1)). Simultaneous ClO4⁻ and NO3⁻ reduction was observed in the lower half of the reactor before reactions shifted to sulfur disproportionation and sulfate reduction. Analyses of water quality profiles were supported by molecular analysis, which showed distinct groupings of ClO4⁻ and NO3⁻ degrading organisms at the inlet of the PBR, while sulfur disproportionation was the primary biological process occurring in the top potion of the reactor.

Spontaneous fracture of the genial tubercles: a case report.

UNLABELLED: Spontaneous fracture of the genial tubercles is rare and, of the 13 reported cases in the literature, all involve the older edentulous patient. A case of genial tubercle fracture in a 62-year-old edentulous female is presented. The symptoms are pain and swelling of the floor of the mouth and restricted tongue movement. Surgical intervention was not required and a complete recovery without loss of function was made. CLINICAL RELEVANCE: This case aims to make practitioners aware of genial tubercle fracture as a possible diagnosis when the older edentulous patient presents with pain and swelling in the floor of the mouth.

Extracorporeal Cardiopulmonary Resuscitation in Adults. Interim Guideline Consensus Statement From the Extracorporeal Life Support Organization.

DISCLAIMER: Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly being deployed for selected patients in cardiac arrest who do not attain a native circulation with conventional CPR (ECPR). This ELSO guideline is intended to be a practical guide to implementing ECPR and the early management following establishment of ECMO support. Where a paucity of high-quality evidence exists, a consensus has been reached amongst the authors to provide guidance to the clinician. This guideline will be updated as further evidence in this field becomes available.

COVID-19 and beyond: implications for dental radiography.

Due to the coronavirus pandemic, all routine dental care in the UK ceased on 25 March 2020. Liverpool University Dental Hospital (LUDH) responded by commencing an emergency dental service on the same date. Clinicians were redeployed within the Hospital to meet the needs of the service, including staffing of the radiology department. LUDH followed Royal College recommendations by taking extraoral radiographs in preference to intraoral radiographs due to the risk of inducing an aerosol. Issues were identified with clinical diagnosis from sectional panoramic radiographs, which led to the introduction of extraoral bitewings being taken as an alternative. A quality assurance audit found that these images provided a substantially lower radiation dose and produced excellent quality images with improved diagnostic accuracy. This article aims to summarise how our radiography practices changed in response to the coronavirus and how the lessons that we have learnt provide an opportunity to modify and improve future practice, beyond the pandemic.

Cannulation technique: femoro-femoral.

The cannulation technique used during veno-venous extracorporeal membrane oxygenation (VV ECMO) insertion can have a major impact on a patients' overall outcome. We have developed a technique that aims to combine speed and effectiveness, with minimal risk. The steps include: (I) percutaneous cannulation using the Seldinger technique; (II) ultrasound guided access and positioning of cannulas; (III) femoro-femoral circuit configuration with a later option of high flow; (IV) a no skin cut serial dilation technique; (V) non-suturing securing of cannulas and (VI) a non-surgical manual pressure technique of explantation. The following is a discussion around these techniques and their various advantages and disadvantages.

Use of Supplementary Patient Education Material Increases Treatment Adherence and Satisfaction Among Acne Patients Receiving Adapalene 0.1%/Benzoyl Peroxide 2.5% Gel in Primary Care Clinics: A Multicenter, Randomized, Controlled Clinical Study.

INTRODUCTION: Poor adherence to acne treatment may lead to unnecessary treatments, increased healthcare costs, and reduced quality of life (QoL). This multicenter study evaluated the effect of supplementary patient education material (SEM) (a short video, information card, and additional information available online) on treatment adherence and satisfaction among acne patients treated with the fixed-dose combination adapalene 0.1%/benzoyl peroxide 2.5% gel (A/BPO) in primary care clinics versus (1) standard-of-care patient education (SOCPE) (package insert and oral instruction) and (2) SOCPE plus more frequent clinic visits. METHODS: Subjects with acne were randomized to receive once-daily A/BPO for 12 weeks plus (1) SEM in addition to SOCPE; (2) SOCPE only with two additional visits; or (3) SOCPE only. Other assessments included a subject appreciation questionnaire, a physician questionnaire, and safety. RESULTS: Ninety-seven subjects were enrolled. At baseline, most (87.6%) had mild to moderate acne. Better adherence was observed in the A/BPO + SEM group compared with A/BPO + more visits or A/BPO alone [mean 63.1%, 48.2% (p = 0.0206), and 56.5%, respectively]. The A/BPO + SEM group had more subjects with greater than 75% adherence (45%, 30.4%, and 25%, respectively). According to the subject appreciation questionnaire, the SEM was more helpful to adhere to treatment (56.7%) versus more visits (32.3%) and A/BPO alone (15.2%), better use the product (70%, 61.3%, and 54.5%, respectively), and better manage skin irritation (53.3%, 48.4%, and 36.4%, respectively). All physicians were satisfied with the SEM and 90% would consider using it in their practice. Safety assessment showed fewer treatment-related adverse events in the A/BPO + SEM group. CONCLUSION: Use of the SEM may increase adherence of acne patients treated with once-daily A/BPO gel in primary care, consequently improving treatment and QoL in the long term. FUNDING: Nestle Skin Health-Galderma R&D. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02307266.

Solution structure of a luteoviral P1-P2 frameshifting mRNA pseudoknot.

A hairpin-type messenger RNA pseudoknot from pea enation mosaic virus RNA1 (PEMV-1) regulates the efficiency of programmed -1 ribosomal frameshifting. The solution structure and 15N relaxation rates reveal that the PEMV-1 pseudoknot is a compact-folded structure composed almost entirely of RNA triple helix. A three nucleotide reverse turn in loop 1 positions a protonated cytidine, C(10), in the correct orientation to form an A((n-1)).C(+).G-C(n) major groove base quadruple, like that found in the beet western yellows virus pseudoknot and the hepatitis delta virus ribozyme, despite distinct structural contexts. A novel loop 2-loop 1 A.U Hoogsteen base-pair stacks on the C(10)(+).G(28) base-pair of the A(12).C(10)(+).G(28)-C(13) quadruple and forms a wedge between the pseudoknot stems stabilizing a bent and over-rotated global conformation. Substitution of key nucleotides that stabilize the unique conformation of the PEMV-1 pseudoknot greatly reduces ribosomal frameshifting efficacy.

Generalised hypercementosis: a case report.

The following case report describes the clinical and radiographical presentation of a female who attended a general dental practice as a new patient. The patient was diagnosed with generalised hypercementosis, possibly attributable to oral neglect. Hypercementosis is associated with a number of aetiological factors, which may be local or systemic in nature. It is important that the general dental practitioner is aware of these factors and is able to distinguish presentation due to a local cause from that of a systemic disease process. The aims of this paper are to illustrate an unusual presentation of hypercementosis and to discuss the radiographic differentiation that led to diagnosis.

A simple organic reaction mediates the crystallization of the inorganic nanocluster [Ga13(mu3-OH)6(mu2-OH)18(H2O)24](NO3)15.

We report the single-crystal structure of an inorganic gallium cluster [Ga13(mu3-OH)6(mu2-OH)18(H2O)24](NO3)15.6H2O prepared using a simple organic reaction to drive the formation of the crystalline inorganic cluster.

Thermodynamic analysis of conserved loop-stem interactions in P1-P2 frameshifting RNA pseudoknots from plant Luteoviridae.

The RNA genomes of plant luteovirids beet western yellows virus (BWYV), potato leaf roll virus (PLRV), and pea enation mosaic virus (PEMV RNA1; PEMV-1) contain a short mRNA pseudoknotted motif overlapping the P1 and P2 open reading frames required for programmed -1 mRNA ribosomal frameshifting. The relationship between structure, stability, and function is poorly understood in these RNA systems. A m(5)-C(8)-substituted BWYV RNA is employed to establish that the BWYV P1-P2 pseudoknot is protonated at cytidine 8 in loop L1 (delta(N(3)H)+ = 12.98 ppm), which stabilizes a C(+.)(G-C) major groove base triple by Delta(DeltaG(37))(protonation) = 3.1 (+/-0.4) kcal mol(-1). The stabilities of both the PLRV and PEMV-1 P1-P2 pseudoknots are also strongly pH-dependent, with Delta(DeltaG(37))(protonation) = 2.1 (+/-0.2) kcal mol(-1) for the PEMV-1 pseudoknot despite a distinct structural context. As previously found for the BWYV pseudoknot [Nixon and Giedroc (2000) J. Mol. Biol. 296, 659], both the PLRV and PEMV-1 RNAs are stabilized by DeltaH > or = 30 kcal mol(-)(1) in excess of secondary structure predictions, attributed to loop L2-stem S1 minor groove triplex interactions. BWYV RNAs containing single 2'-deoxy or A --> G substitutions that disrupt L2-S1 hydrogen bonding are strongly destabilized with Delta(DeltaG(37))(folding) (pH = 7.0) ranging from approximately 1.8 (+/-0.3) to > or =4.0 kcal mol(-1), relative to the wild-type BWYV RNA. These findings suggest that each member of this family of pseudoknots adopts a tightly folded structure that maximizes the cooperativity and complementarity of L1-S2 and L2-S1 loop-stem interactions required in part to offset the low intrinsic stability of the short three base pair pseudoknot stem S2.