Tension Pneumoperitoneum: A Rare Complication of Cardiopulmonary Resuscitation (CPR).

Tension pneumoperitoneum is a surgical emergency. Although rare, failure to diagnose and treat the condition may be lethal. Hence, being aware of this phenomenon, particularly in scenarios involving cardiopulmonary resuscitation (CPR), is important. Existing literature emphasises immediate abdominal needle decompression as the initial management followed by close monitoring and keeping a low threshold for surgical intervention as a definitive measure. We decided to write up this case report to raise awareness that a tension pneumoperitoneum can result as a complication of CPR, a well-known and widely practiced algorithm.

A critical review on renewable battery thermal management system using heat pipes.

The critical review presented here exclusively covers the studies on battery thermal management systems (BTMSs), which utilize heat pipes of different structural designs and operating parameters as a cooling medium. The review paper is divided into five major parts, and each part addresses the role of heat pipes in BTMS categorically. Experimental studies, numerical analyses, combined experimental and numerical investigations, optimum utilization of a phase-change material (PCM) with a heat pipe (HP), oscillating heat pipe (OHP), and micro heat pipes combined with PCM for Li-ion BTMS using heat pipes are presented. The usage of HP's and PCM can keep the temperature of the battery system in the desirable limit for a longer duration compared to other traditional and passive methods. More emphasis is made on how one can achieve a suitable cooling system design and structure, which may tend to enhance the energy density of the batteries, improve thermal performance at maximum and minimum temperature range. Arrangement of battery cells in a pack or module, type of cooling fluid used, heat pipe configuration, type of PCM used, working fluid in a heat pipe, and surrounding environmental conditions are reviewed. According to the study, the battery's effectiveness is significantly influenced by temperature. The usage of flat HPs and heat sink proves to be the best cooling method for keeping the battery working temperature below 50 °C and reduces the heat sink thermal resistance by 30%. With an intake temperature of 25 °C and a discharge rate of 1 L per minute, an HP that uses water as a coolant is also effective at regulating battery cell temperature and maintaining it below the permissible 55 °C range. Using beeswax as a PCM in HPs reduces the temperature of BTMS by up to 26.62 °C, while the usage of RT44 in HPs reduces the temperature of BTMS by 33.42 °C. The use of fins along with copper spreaders drastically decreases the temperature capability of HPTMS by 11 °C. MHPA shows excellent performance in controlling the battery temperature within 40 °C. The effective thermal management can be done by incorporating heat pipe alone or by coupling with liquid cooling or metal plate. However, extensive and extended research is required to improve thermal management to safely and effectively use the battery for day-to-day applications.

Quality Improvement Intervention Bundle Using the PUPPIES Acronym Reduces Pressure Injury Incidence in Critically Ill Patients.

OBJECTIVE: To assess whether a quality improvement bundle focusing on prevention is effective in reducing pressure injury (PI) incidence or costs or delaying PI onset. METHODS: A combined retrospective/prospective cohort study was performed at an academic tertiary care ICU on all patients admitted with a length of stay longer than 48 hours and Braden scale score of 18 or less. Following retrospective data collection (preintervention), a multimodal quality improvement bundle focusing on PI prevention through leadership initiatives, visual tools, and staff/patient education was developed, and data were prospectively collected (postintervention). RESULTS: Statistical and cost analyses were performed comparing both cohorts. A total of 930 patients met the study inclusion criteria (preintervention, n = 599; postintervention, n = 331). A significant decrease in PI incidence was observed from preintervention (n = 37 [6%]) to postintervention (n = 7 [2%], P = .005). This led to a predicted yearly cost savings of $826,810. Further, a significant increase in time to PI occurrence was observed from preintervention (mean, 5 days) to postintervention (mean, 9 days; P = .04). Staff were compliant with the bundle implementation 80% of the time. CONCLUSIONS: Implementation of the quality improvement bundle focused on multimodal PI prevention in critically ill patients led to a significant reduction in PI incidence, increased time to PI occurrence, and was cost-effective.

Optimization of Thermal and Structural Design in Lithium-Ion Batteries to Obtain Energy Efficient Battery Thermal Management System (BTMS): A Critical Review.

Covid-19 has given one positive perspective to look at our planet earth in terms of reducing the air and noise pollution thus improving the environmental conditions globally. This positive outcome of pandemic has given the indication that the future of energy belong to green energy and one of the emerging source of green energy is Lithium-ion batteries (LIBs). LIBs are the backbone of the electric vehicles but there are some major issues faced by the them like poor thermal performance, thermal runaway, fire hazards and faster rate of discharge under low and high temperature environment,. Therefore to overcome these problems most of the researchers have come up with new methods of controlling and maintaining the overall thermal performance of the LIBs. The present review paper mainly is focused on optimization of thermal and structural design parameters of the LIBs under different BTMSs. The optimized BTMS generally demonstrated in this paper are maximum temperature of battery cell, battery pack or battery module, temperature uniformity, maximum or average temperature difference, inlet temperature of coolant, flow velocity, and pressure drop. Whereas the major structural design optimization parameters highlighted in this paper are type of flow channel, number of channels, length of channel, diameter of channel, cell to cell spacing, inlet and outlet plenum angle and arrangement of channels. These optimized parameters investigated under different BTMS heads such as air, PCM (phase change material), mini-channel, heat pipe, and water cooling are reported profoundly in this review article. The data are categorized and the results of the recent studies are summarized for each method. Critical review on use of various optimization algorithms (like ant colony, genetic, particle swarm, response surface, NSGA-II, etc.) for design parameter optimization are presented and categorized for different BTMS to boost their objectives. The single objective optimization techniques helps in obtaining the optimal value of important design parameters related to the thermal performance of battery cooling systems. Finally, multi-objective optimization technique is also discussed to get an idea of how to get the trade-off between the various conflicting parameters of interest such as energy, cost, pressure drop, size, arrangement, etc. which is related to minimization and thermal efficiency/performance of the battery system related to maximization. This review will be very helpful for researchers working with an objective of improving the thermal performance and life span of the LIBs.

Colon cancer survival in California from 2004 to 2011 by stage at diagnosis, sex, race/ethnicity, and socioeconomic status.

BACKGROUND: Disparities in cancer survival exist between groups. This study aims to examine these disparities in stage-, sex-, race/ethnicity-, and socioeconomic-specific colon cancer net survival in California for adults diagnosed between 2004 and 2011. METHODS: We estimated age-standardized net survival using the Pohar Perme estimator for colon cancer by stage at diagnosis (localized, regional, and distant), sex, race/ethnicity (Non-Hispanic White, Non-Hispanic Black, and Hispanic), and socioeconomic status (SES). Data from the Surveillance, Epidemiology, and End Results database on adults diagnosed with malignant colon cancer during 2004-2011 in California were included (n = 78,285). County-level SES was approximated using quintile groupings based on the Federal Poverty Level. RESULTS: Five-year survival for all included adults was 66.0 % (95 % CI: 65.6 %-66.4 %). The difference between Non-Hispanic White (White) adults and Non-Hispanic Black (Black) adults was 9.3 %, and between White adults and Hispanic adults was 3.4 %. A higher proportion of Black (24.5 %) and Hispanic (21.4 %) adults were diagnosed with distant disease compared to White adults (19.4 %). Differences in sex-specific survival were minimal, with only differences between Hispanic men (62.0 % [60.5 %-63.4 %]) and women (65.9 % [64.4 %-67.3 %]). SES differences were largest between the lowest quintile 63.0 % (62.3 %-65.2 %) and the highest quintile 67.8 % (66.8 %-68.8 %). SES-, stage-, and race/ethnicity-stratified analysis demonstrated improving trends for White adults with localized and regional disease, and Hispanic adults with regional disease. CONCLUSION: Colon cancer survival in California is lower for Black and Hispanic adults than for White adults in all three categories: stage, sex, and SES, suggesting the need for improved health policy for Hispanic and Black adults.

Altered anabolic signalling and reduced stimulation of myofibrillar protein synthesis after feeding and resistance exercise in people with obesity.

KEY POINTS: Lifestyle modifications that include the regular performance of exercise are probably important for counteracting the negative consequences of obesity on postprandial myofibrillar protein synthetic responses to protein dense food ingestion. We show that the interactive effect of resistance exercise and feeding on the stimulation of myofibrillar protein synthesis rates is diminished with obesity compared to normal weight adults. The blunted myofibrillar protein synthetic response with resistance exercise in people with obesity may be underpinned by alterations in muscle anabolic signalling phosphorylation (p70S6K and 4E-BP1). The results obtained in the present study suggest that further exercise prescription manipulation may be necessary to optimize post-exercise myofibrillar protein synthesis rates in adults with obesity. ABSTRACT: We aimed to determine whether obesity alters muscle anabolic and inflammatory signalling phosphorylation and also muscle protein synthesis within the myofibrillar (MYO) and sarcoplasmic (SARC) protein fractions after resistance exercise. Nine normal weight (NW) (21 ± 1 years, body mass index 22 ± 1 kg m-2 ) and nine obese (OB) (22 ± 1 years, body mass index 36 ± 2 kg m-2 ) adults received l-[ring-13 C6 ]phenylalanine infusions with blood and muscle sampling at basal and fed-state of the exercise (EX) and non-exercise (CON) legs. Participants performed unilateral leg extensions and consumed pork (36 g of protein) immediately after exercise. Basal muscle Toll-like receptor 4 (TLR4) protein was similar between OB and NW groups (P > 0.05) but increased at 300 min after pork ingestion only in the OB group (P = 0.03). Resistance exercise reduced TLR4 protein in the OB group at 300 min (EX vs. CON leg in OB: P = 0.04). Pork ingestion increased p70S6K phosphorylation at 300 min in CON and EX of the OB and NW groups (P > 0.05), although the response was lower in the EX leg of OB vs. NW at 300 min (P = 0.05). Basal MYO was similar between the NW and OB groups (P > 0.05) and was stimulated by pork ingestion in the EX and CON legs in both groups (Δ from basal NW: CON 0.04 ± 0.01% h-1 ; EX 0.10 ± 0.02% h-1 ; OB: CON 0.06 ± 0.01% h-1 ; EX 0.06 ± 0.01% h-1 ; P < 0.05). MYO was more strongly stimulated in the EX vs. CON legs in NW (P = 0.02) but not OB (P = 0.26). SARC was feeding sensitive but not further potentiated by resistance exercise in both groups. Our results suggest that obesity may attenuate the effectiveness of resistance exercise to augment fed-state MYO.

Remnant lipoprotein size distribution profiling via dynamic light scattering analysis.

BACKGROUND: Remnant lipoproteins (RLP) are a metabolically derived subpopulation of triglyceride-rich lipoproteins (TRL) in human blood that are involved in the metabolism of dietary fats or triglycerides. RLP, the smaller and denser variants of TRL particles, are strongly correlated with cardiovascular disease (CVD) and were listed as an emerging atherogenic risk factor by the AHA in 2001. METHODS: Varying analytical techniques used in clinical studies in the size determination of RLP contribute to conflicting hypotheses in regard to whether larger or smaller RLP particles contribute to CVD progression, though multiple pathways may exist. RESULTS: We demonstrated a unique combinatorial bioanalytical approach involving the preparative immunoseparation of RLP, and dynamic light scattering for size distribution analysis. CONCLUSIONS: This is a new facile and robust methodology for the size distribution analysis of RLP that in conjunction with clinical studies may reveal the mechanisms by which RLP cause CVD progression.

Use of omental pedicles in mycotic abdominal aortic aneurysm repair.

We report a case of a sixty year old man with a mycotic infra-renal abdominal aortic aneurysm complicated by a left psoas abscess. After treatment with parenteral antibiotics he underwent early aortic reconstruction with an in-situ prosthetic graft wrapped in an omental pedicle. Mycotic abdominal aortic aneurysms can be treated in this way despite the potential for graft infection from persisting retroperitoneal sepsis.

Torsion of the gallbladder.

The authors report a case of a 79-year-old female who presented with signs and symptoms of acute cholecystitis. She was taken to theatre within 24 h of acute admission to undergo laparoscopic cholecystectomy. The gallbladder was found to have undergone torsion upon its mesentery leading to its infarction and necrosis. Laparoscopic cholecystectomy was performed, and the patient made an uneventful recovery.

Spontaneous vaginal evisceration.

Management of vaginal prolapse in the elderly lacks a uniform consensus and continues to remain challenging. The authors report a case of an elderly lady who presented with a spontaneous vaginal evisceration. She had a long-standing vaginal prolapse being controlled by a shelf pessary, which, in her case became displaced 2 weeks prior to admission. The patient underwent a laparotomy with an intent to replace the bowel back within the peritoneal cavity and repair the vault. During the pelvic floor repair, she sustained an inadvertent button-hole injury to the rectum, which was oversewn. She went on to develop a rectovaginal fistula requiring a de-functioning colostomy. The patient made good recovery subsequently.

A solitary rectal mucosa-associated lymphoid tissue (MALT) lymphoma.

Mucosa-associated lymphoid tissue (MALT) is a type of extra nodal malignant lymphoma seen in organs such as the stomach, thyroid and salivary glands. Furthermore, occurrence of colorectal MALT lymphoma is extremely rare. We report a case of a solitary rectal MALT lymphoma treated by surgical resection and radiotherapy. Lymphoma should be considered as a rare differential diagnosis when dealing with large bowel pathology. We would advocate the use of surgery as a primary treatment option for a medically fit patient.

Passage of intestinal (small bowel) cast--an unusual complication of neutropenic sepsis.

A 52-year-old woman was admitted with neutropenic sepsis, 3 days following the final cycle of adjuvant chemotherapy for breast cancer. Her condition deteriorated with progressive abdominal distension, bilious vomiting and diarrhoea. Abdominal examination revealed a mild degree of peritonism. Five days later she passed a small bowel cast per rectum, showing gross fungal contamination on histology. She was managed conservatively with antibiotics and antifungal medications and nutritional support.

Laparoscopic bladder flap ureteral reimplantation: survival porcine study.

PURPOSE: The bladder or Boari flap is a useful technique for ureteroneocystostomy when the distal ureter is too short to reach the bladder without undue tension. We report our experience with laparoscopic Boari flap ureteroneocystostomy in the chronic porcine model. MATERIALS AND METHODS: Six female farm pigs underwent unilateral laparoscopic Boari bladder flap ureteroneocystostomy. Refluxing direct ureteral reimplantation was performed in the initial 3 animals. In the next 3 animals a submucosal tunnel was formed to achieve nonrefluxing ureteroneocystostomy into the Boari flap. The animals were sacrificed 6 weeks after surgery. At sacrifice ascending cystography, ipsilateral antegrade pyelography and autopsy examination of the ureteroneocystostomy site was performed. RESULTS: No intraoperative or postoperative complications were noted. Average operative time was 140 minutes. Postoperatively serum creatinine and hemoglobin were normal in all pigs. All 3 animals with direct ureteroneocystostomy into the Boari flap had free reflux into the kidney and all 3 with a submucosal tunnel reimplant had no reflux on ascending cystography and free drainage on antegrade pyelography. Autopsy confirmed a patent anastomotic site in all 6 cases. CONCLUSIONS: Laparoscopic ureteroneocystostomy using the Boari bladder flap technique is feasible. Our survival porcine model confirms the successful application of the refluxing and nonrefluxing technique of ureteral reimplantation. Clinical application of the technique has the potential to decrease patient morbidity associated with traditional open surgery.

Reproductive performance and milk production of Damascus goats fed acacia shrubs or berseem clover hay in North Sinai, Egypt.

Thirty-three adult Damascus does (29 +/- 1.1 kg BW) were fed 0.6 kg per head per day of a concentrate diet plus ad libitum rice straw (Oryza sativa, control, R), or green acacia (Acacia saligna, A) or berseem clover hay (Trifolium alexandrinum, B). All treatment groups had free access to underground saline water containing 3600 ppm TDS. The DM intake was lower (p < 0.05) for the R group but did not differ between the other two groups. The DM intake of acacia was 0.64 kg per head per day (1.98% BW) during pregnancy and 0.93 kg per head per day (2.95% BW) during lactation. The drinking water differed (p < 0.05) between the three dietary treatments; group B had the highest mean intake and group A had the lowest. The percentage kidding and the litter weight at birth did not differ significantly between the groups. However, the number of kids weaned/doe kidding and the weight of the kids weaned/doe kidding were significantly higher for group B. The mean body weight of the kids at birth and at weaning were significantly lower for group R. The total milk yield over 10 weeks and the milk composition (total solids, fat and protein percentages) were significantly different between the three groups; group B having the highest means and group R the lowest. These results suggest that supplemental feeding is required to enhance the productivity of goats in arid or semi-arid environments and Acacia saligna should not be used fresh in excessive quantities for extended periods.

Alleviation of the heat load on lactating goats with the use of diuretics and drinking cool water.

The effect was studied of different heat loads connected with the application of diuretics and of 10 to 15 degrees C drinking water on the milk production and some related physiological parameters of 19 Egyptian Baladi goats under experimental conditions. The increase in heat stress increased the respiration rate, rectal temperature, and serum prolactin concentration significantly, while it significantly decreased the milk production, the content of alkaline, and acid phosphatases creatinine, urea, red blood cells, and haemoglobin concentration. The diuretic Thiameterine and cool drinking water under hot conditions improved the milk yield and had a positive effect on the physiological status of the animals, especially their blood composition. The higher mill production by the goats (14.7% in the experiment) is attributed to the increased feed uptake caused by the treatments.