Hypoxic respiratory distress potentially secondary to phosphorus trifluoride gas exposure.

We herein report a rare, probable exposure of a patient to phosphorus trifluoride gas. The objective of this case report is to highlight the potential exposure to phosphorus trifluoride gas and discuss the best management of it. A 48-year-old worker at a specialty gases laboratory was transported to the community Emergency Department (ED) in respiratory distress, presenting with peripheral cyanosis, an unobtainable oxygen saturation, chocolate-colored blood, and a Glasgow coma scale of 15. A non-rebreather was placed, poison control was contacted, and the patient was administered empiric methylene blue intravenously due to worsening cyanosis and respiratory distress. Upon arrival at the academic facility, the patient was no longer cyanotic and reported improvement of his symptoms. The patient's employer informed staff that a canister of phosphorus trifluoride gas in his workstation was found to be empty but should have been full. It was also discovered that a coworker left work early the same day with similar but milder symptoms. Hyperbaric oxygen therapy was considered; however, the patient was improving on oxygen via non-rebreather, and he had no other indications. Because the patient continued to require supplemental oxygen to maintain their oxygen saturation above 92%, he was admitted to the ICU and treated with prednisone daily for chemical pneumonitis. After 4 days, he successfully transitioned to room air without hypoxia. While exposures such as this do not occur frequently, it is important to maintain a broad differential and treatment plan as we continue to investigate the etiology and best treatment option.

The heart of the matter: Outcome reporting bias and registration status in cardio-thoracic surgery.

BACKGROUND: Our objective is to compare registered outcomes to published reports; to evaluate for discrepancies favoring statistically significant outcomes; to examine funding source and likelihood of outcome reporting bias; and to evaluate for any temporal trends in outcome reporting bias. METHODS: PubMed was searched for randomized controlled trials published between 2008 and 2015 from 4 high impact cardio-thoracic journals: European Journal of Cardio-thoracic Surgery (EJCS), The Journal of Cardiothoracic Surgery (JCS), The Journal of Thoracic and Cardiovascular Surgery (JTCS), and Annals of Cardiothoracic Surgery (ACS). Data was collected using a standardized extraction form. RESULTS: We reviewed 287 articles, of which 214 (74.6%) did not meet registration criteria. Of those 214, 94 (43.9%) were published in the EJCS, 34 (15.9%) in JCS, 86 (40.2%) in JTCS, and 0 (0%) in the ACS. Of the remaining 73 articles, 34 (46.6%) had a discrepancy between the primary outcome registered and the published outcome, and 11 of the 34 reported p-values favoring the change. We also found that 12 of the 73 registrations had updated primary outcomes from the initial report to the final report. The timing of registration was an incidental finding showing 14 (19.1%) articles retrospectively registered, 29 (39.7%) registered during patient enrollment, and 30 (41.1%) registered prospectively. CONCLUSION: The results indicated that selective outcome reporting is prevalent in cardio-thoracic surgery journals. The more concerning issue, however, is the lack of registration or provision of registration number for randomized controlled trials within these journals.

Vertical load capacities of roof truss cross members.

Trusses used for roof support in coal mines are constructed of two grouted bolts installed at opposing forty-five degree angles into the roof and a cross member that ties the angled bolts together. The load on the cross member is vertical, which is transverse to the longitudinal axis, and therefore the cross member is loaded in the weakest direction. Laboratory tests were conducted to determine the vertical load capacity and deflection of three different types of cross members. Single-point load tests, with the load applied in the center of the specimen and double-point load tests, with a span of 2.4 m, were conducted. For the single-point load configuration, the yield of the 25 mm solid bar cross member was nominally 98 kN of vertical load, achieved at 42 cm of deflection. For cable cross members, yield was not achieved even after 45 cm of deflection. Peak vertical loads were about 89 kN for 17 mm cables and 67 kN for the 15 mm cables. For the double-point load configurations, the 25 mm solid bar cross members yielded at 150 kN of vertical load and 25 cm of deflection. At 25 cm of deflection individual cable strands started breaking at 133 and 111 kN of vertical load for the 17 and 15 mm cable cross members respectively.