Hiccup Relief Using Active Prolonged Inspiration.

Background Hiccups are a common physiologic reflex resulting from intermittent and involuntary spasmodic contraction of the diaphragm and intercostal muscles. While most cases are self-limited, lasting less than 48 hours, rare pathologies may result in prolonged symptoms. Hiccups can be disruptive and uncomfortable, leading many to seek management strategies using common home remedies. Few methods for terminating hiccups have been published in the scientific literature. We report the efficacy of the Hiccup relief using Active Prolonged Inspiration (HAPI) technique, which combines phrenic and vagal nerve stimulation with transient hypercapnia for hiccup relief. Methods Twenty patients with self-limited hiccups and one patient with prolonged hiccups were successful in eliminating hiccups using HAPI. In this method, patients are instructed to inspire maximally. Once at the peak of inspiration, they continue to attempt to inspire with an open glottis for a total of 30 seconds. This is followed by a slow expiration and resumption of normal respiration. Results In all cases, patients reported immediate hiccup relief. Conclusion These findings suggest the HAPI technique is a simple and viable method for hiccup relief. Further studies are needed to validate effectiveness.

Space Launch System acoustics: Far-field noise measurements of the Artemis-I launch.

To improve understanding of super heavy-lift rocket acoustics, this letter documents initial findings from noise measurements during liftoff of the Space Launch System's Artemis-I mission. Overall sound pressure levels, waveform characteristics, and spectra are described at distances ranging from 1.5 to 5.2 km. Significant results include: (a) the solid rocket boosters' ignition overpressure is particularly intense in the direction of the pad flame trench exit; (b) post-liftoff maximum overall levels range from 127 to 136 dB, greater than pre-launch predictions; and (c) the average maximum one-third-octave spectral peak occurred at 20 Hz, causing significant deviation between flat and A-weighted levels.

Novel high-strength thromboresistant poly(vinyl alcohol)-based hydrogel for vascular access applications.

Adherence of proteins, cells, and microorganisms to the surface of biomaterials used for vascular access contribute to device failure by thrombosis, occlusions, and infections. Current technologies for inhibiting these complications are limited to coatings and additives that are limited in duration of efficacy and often induce adverse side effects. In this work, we developed a novel composite hydrogel structure comprising of a porous poly(vinyl alcohol) (PVA) that is impregnated with poly(acrylic acid) (PAA) and heat treated to create a physically cross-linked high-strength hydrogel material. The swelling and mechanical properties can be controlled by the temperature and duration of heat treatment to increase the cross-link density of the matrix. The heat treated composite PVA/PAA hydrogel exhibits both the mechanical strength and durability of thermoplastic polyurethanes (TPUs) and the inherently non-thrombogenic surface functionality of PVA-based hydrogels without the use of chemical cross-linking agents. The composite hydrogels were found to maintain their mechanical integrity and surface functionality after accelerated aging in a simulated-use in vitro model for 162.5 days real-time equivalent. Relative to commercial catheter materials, the composite PVA/PAA hydrogel exhibited up to an average of 97% reduction in platelet adhesion when exposed to an in vitro blood loop model and a lower rate of tip occlusion due to thrombosis. This high-strength thromboresistant hydrogel could have a major impact as a novel biomaterial for use in vascular access applications to improve patient health.

Short-term outcomes after emergency surgery for complicated peptic ulcer disease from the UK National Emergency Laparotomy Audit: a cohort study.

OBJECTIVES: This study used national audit data to describe current management and outcomes of patients undergoing surgery for complications of peptic ulcer disease (PUD), including perforation and bleeding. It was also planned to explore factors associated with fatal outcome after surgery for perforated ulcers. These analyses were designed to provide a thorough understanding of current practice and identify potentially modifiable factors associated with outcome as targets for future quality improvement. DESIGN: National cohort study using National Emergency Laparotomy Audit (NELA) data. SETTING: English and Welsh hospitals within the National Health Service. PARTICIPANTS: Adult patients admitted as an emergency with perforated or bleeding PUD between December 2013 and November 2015. INTERVENTIONS: Laparotomy for bleeding or perforated peptic ulcer. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was 60-day in-hospital mortality. Secondary outcomes included length of postoperative stay, readmission and reoperation rate. RESULTS: 2444 and 382 procedures were performed for perforated and bleeding ulcers, respectively. In-hospital 60-day mortality rates were 287/2444 (11.7%, 95% CI 10.5% to 13.1%) for perforations, and 68/382 (17.8%, 95% CI 14.1% to 22.0%) for bleeding. Median (IQR) 2-year institutional volume was 12 (7-17) and 2 (1-3) for perforation and bleeding, respectively. In the exploratory analysis, age, American Society of Anesthesiology score and preoperative systolic blood pressure were associated with mortality, with no association with time from admission to operation, surgeon grade or operative approach. CONCLUSIONS: Patients undergoing surgery for complicated PUD face a high 60-day mortality risk. Exploratory analyses suggested fatal outcome was primarily associated with patient rather than provider care factors. Therefore, it may be challenging to reduce mortality rates further. NELA data provide important benchmarking for patient consent and has highlighted low institutional volume and high mortality rates after surgery for bleeding peptic ulcers as a target for future research and improvement.