Development and validation of technologies suitable for the decontamination and re-use of contaminated N95 filtering facepiece respirators in response to the COVID-19 pandemic.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has brought significant challenges to society globally, particularly in the area of healthcare provision. A pressing need existed in protecting those tasked with delivering healthcare solutions during the COVID-19 crisis by providing solutions for preserving adequate supplies of effective personal protective equipment (PPE). AIM: To evaluate and validate available methods for the decontamination of N95 filtering facepiece respirators (FFRs) while maintaining functionality during re-use. METHODS: Multiple low-temperature steam and vaporized hydrogen peroxide (VHP) technologies were assessed for inactivation of Mycobacterium spp. and feline calicivirus (employed as representatives of the contamination challenge). FINDINGS: Virus (≥3log10) and Mycobacterium spp. (≥6log10) inactivation was achieved on various types of N95 FFRs using an array of heat (65-71oC), humidity (>50% relative humidity) and VHP without affecting the performance of the PPE. CONCLUSION: The methods have been validated and were authorized by the US Food and Drug Administration under a temporary emergency use authorization. Based on the findings, opportunities exist for development and deployment of decontamination methods made from simple, general purpose materials and equipment should a future need arise.

A multifinger microtriode with carbon nanotubes field emission cathode operating at GHz frequency.

Vacuum microelectronic devices play an important role in the field of micro- and nano-electronics and they have been strongly developed in recent decades. Vacuum microelectronics are mainly based on the field emission effect and the employment of electrons in vacuum in a device with dimensions from tenths to hundredths of a micrometer. In this work, we present the development of a carbon-nanotube-based multifinger microtriode operating from 0.5 to 2 GHz. In this frequency range, a minimum RF signal gain of 5 dB is achieved. Such a device represents an optimized alternative to the standard Spindt-type microtriode. The advantage of such multifinger architecture consists in the possibility to reduce the cathode-grid capacitance by reducing the overlap between the two electrodes using a parallel patterning. This approach allows increasing the cut-off frequency of the devices with respect to the Spindt-type triode. We realized a prototype of the multifinger triode and the field emission properties have been characterized. The frequency behavior has been measured, demonstrating the possibility to amplify RF signal.

Giant solitary fibrous tumors of the pleura: two case reports.

Solitary fibrous tumors of the pleura (SFTP) are rare neoplasms. We report two cases of giant SFTP treated by surgical resection. One of these was enormous (30 x 19 x 18 cm, weight: 4,050 g) and occupied the entire left pleural cavity with complete lung collapse and contralateral mediastinal shift. Both tumors were removed en bloc. The patients had no postoperative complications. Surgical treatment is curative in most patients; resection must be complete because of the possibility of recurrence and metastasis.

Role of diffusing capacity in predicting complications after lung resection for cancer.

BACKGROUND: The purpose of our study was to determine whether the assessment of the diffusing capacity of the lung for carbon monoxide (DL (CO)), together with the forced expiratory volume in 1 second (FEV (1)), could improve the selection of surgical patients. METHODS: The data of 76 patients undergoing major lung resection (pnemonectomy, bilobectomy or lobectomy) for non-small cell lung cancer were retrospectively studied. All patients were reviewed for age, sex, preexisting medical conditions, operative, and pathological findings and postoperative outcome. RESULTS: Univariate and multivariable logistic regression analysis showed that ppoFEV (1) and ppoDL (CO) were the only statistically significant predictors of pulmonary complications. In the group of patients with marginal ppoFEV (1) (between 30 - 40 %), ppoDL (CO) predicted pulmonary morbidity with a better accuracy ( P < 0.005) than ppoFEV (1) ( P > 0.05). Multiple regression analysis showed that pneumonectomy was the only statistical factor correlated with mortality ( P < 0.05). CONCLUSION: Our experience seems to suggest that ppoDL (CO) is a strong predictor of pulmonary complications after major lung resection, allowing a better surgical selection of the patients with compromised respiratory function.

Surgical strategies in cervico-mediastinal goiters.

AIM: We retrospectively studied clinical picture, diagnosis, treatment and complications of patients with cervico-mediastinal goiter who underwent surgery. METHODS: Sixty-three patients underwent surgical treatment for cervico-mediastinal goiter in the last 10 years. Thirty-two patients (50.8%) had cervico-mediastinal goiter, 24 patients (33.3%) had mediastino-cervical goiter and 7 patients (11.1%) had mediastinal goiter. Forty-seven cases were prevascular goiters and 16 were retrovascular goiters. We performed total thyroidectomy in 25 patients, subtotal thyroidectomy in 31 patients and in 7 cases the resection of residual goiter. In 50 patients we used a cervical approach, in 12 patients the cervical incision was combined with median sternotomy (6 in total) and in 1 patient with transverse sternotomy. RESULTS: Three patients (4.7%) died in the postoperative period (2 cardio-respiratory failure and 1 pulmonary embolism). The histologic study revelead 5 (7.9%) carcinomas. Postoperative complications were: dyspnea in 7 cases (11.1%), transient vocal cord paralysis in 5 patients (7.9%), temporary hypoparathyroidism in 6 patients (9.5%) and kidney failure in 1 case (1.6%). CONCLUSIONS: Cervicotomy is the approach of choice but in some limited cases (carcinoma, thyroiditis, retrovascular goiter, ectopic goiter) the sternotomy should be performed. Postoperative mortality and morbidity is very low, independent of surgical techniques.

[Role of the surgeon in the treatment of small cell lung carcinoma]. / Ruolo del hcirurgo nel trattamento del carcinoma polmonare a piccole cellule.

Surgery has never played a precise and well consolidated role in the planned treatment of lung microcytoma (SCLC). The acknowledged therapeutic strategy associates local treatment (radiotherapy) with general treatment (chemotherapy). Exeresis is particularly indicated in limited or peripheral forms, followed by intensive polychemotherapy. Scintigraphy with octreotide may be used for the initial screening of patients with widespread disease. Another minor role played by surgery is in the treatment of neoplastic foci remaining after chemotherapy. In some cases the use of a radioguided method which, after intravenous injection of radiolabeled octreotide, allows the accumulation of somatostatin analog in neoplastic foci to be assayed intraoperatively using a manual probe, might help the surgeon to check the radical nature of the operation. In addition, octreotide can be used as a radiotherapeutic pharmacological agent or to enhance the efficacy of chemotherapy in microcytoma and other lung tumours with neuroendocrine differentiation.

Birth defects and childhood cancer in offspring of survivors of childhood cancer.

OBJECTIVE: To determine the effect of chemotherapy for cancer during childhood and adolescence on subsequent pregnancy outcome and the occurrence of cancer in the offspring. DESIGN: We reviewed the history of 405 former patients with pediatric cancer. A self-administered questionnaire was completed by members of a cohort of consecutively treated patients who were aged 18 years or older at the most recent follow-up visit and who were at least 5 years beyond the initial diagnosis of their cancer. SETTING: Department of Pediatrics of a National Cancer Institute-designated comprehensive cancer center. RESULTS: One hundred forty-eight patients reported 280 pregnancies. Ninety-one of the patients who reported 1 or more liveborn or stillborn infants following the completion of treatment had received 1 or more chemotherapeutic agents as part of their treatment of cancer. The frequency of congenital anomalies was 3.3% among the liveborn offspring of the treated women and 3.3% among the liveborn offspring of the spouses or female companions of the treated men. No cases of childhood cancer have been diagnosed among the offspring. CONCLUSIONS: The present data suggest that prior treatment with mutagenic chemotherapeutic agents, in the dosage ranges examined, does not increase the frequency of congenital anomalies in the offspring of former pediatric and adolescent patients with cancer. Although no cases of childhood cancer have been observed thus far among the offspring, additional follow-up is necessary to adequately assess their risk of childhood cancer.

Hemoconcentration during cardiac arrest and CPR.

The objective of this study was to determine if hemoconcentration occurs during cardiac arrest and cardiopulmonary resuscitation (CPR). The design was an animal model of cardiac arrest and CPR performed at a research institute using six mongrel dogs. After the induction of cardiac arrest, animals were subjected to 4 minutes of ventricular fibrillation followed by 20 minutes of CPR. Resuscitation was then achieved using countershocks, drugs, and intravenous fluids. Hemoglobin concentrations were obtained before arrest and every 5 minutes during CPR. An average peak increase in hemoglobin concentration of 21% was observed during CPR. Hemoconcentration occurs during cardiac arrest and CPR, and this may be a result of a shift in volume from the intravascular to the extravascular space.

Positive-outcome bias: comparison of emergency medicine and general medicine literatures.

OBJECTIVE: The existence of positive-outcome bias in the medical literature is well established. Positive-outcome bias in two emergency medicine journals was compared with that found in two general medicine journals. METHODS: Published original contributions from Annals of Emergency Medicine, American Journal of Emergency Medicine, JAMA, and New England Journal of Medicine were reviewed. Articles were categorized as demonstrating a positive or negative outcome or showing no difference using new criteria. Descriptive articles were excluded. RESULTS: Of 700 articles reviewed, 177 emergency medicine and 211 general medicine articles met the study criteria. The emergency medicine journals had 142 articles (80%) with positive outcomes, 27 (15%) with negative outcomes, and 8 (5%) with no difference. The general medicine journals had 169 articles (80%) with positive outcomes, 33 (16%) with negative outcomes, and 9 (4%) with no difference. There was no significant difference between journal groups (chi-square; p = 0.99). The power of the study was 0.80 to detect a difference of 15% between groups with alpha set at 0.05. CONCLUSION: There was no significant difference in the proportions of positive-outcome studies published in this sample of the emergency medicine literature compared with the general medicine literature. The potential impact of positive-outcome bias and methods of dealing with the problem are reviewed.

Hypovolemic shock and intestinal ischemia: a preventable complication of incomplete formula labeling.

A 19-day-old male infant was seen with full-thickness gangrene of the transverse colon. Hyperosmolar formula feedings caused by inadequate "directions for use" was the probable cause. Improved formula labeling might prevent further cases.