Battling COVID-19: critical care and peri-operative healthcare resource management strategies in a tertiary academic medical centre in Singapore.

In December 2019, a cluster of atypical pneumonia cases were reported in Wuhan, China, and a novel coronavirus elucidated as the aetiologic agent. Although most initial cases occurred in China, the disease, termed coronavirus disease 2019, has become a pandemic and continues to spread rapidly with human-to-human transmission in many countries. This is the third novel coronavirus outbreak in the last two decades and presents an ensuing healthcare resource burden that threatens to overwhelm available healthcare resources. A study of the initial Chinese response has shown that there is a significant positive association between coronavirus disease 2019 mortality and healthcare resource burden. Based on the Chinese experience, some 19% of coronavirus disease 2019 cases develop severe or critical disease. This results in a need for adequate preparation and mobilisation of critical care resources to anticipate and adapt to a surge in coronavirus disease 2019 case-load in order to mitigate morbidity and mortality. In this article, we discuss some of the peri-operative and critical care resource planning considerations and management strategies employed in a tertiary academic medical centre in Singapore in response to the coronavirus disease 2019 outbreak.

Complete genome sequence of the Bifidobacterium animalis subspecies lactis BL3, preventive probiotics for acute colitis and colon cancer.

We report the genome sequence of Bifidobacterium animalis subspecies lactis BL3, which has preventive properties on acute colitis and colon cancer. The genome of BL3, which was isolated from Korean faeces, consisted of a 1 944 323 bp size single chromosome, and its G+C content was 60.5%. Genome comparison against the closest Bifidobacterium animalis strain revealed that BL3 had particularly different regions of four areas encoding flavin-nucleotide-binding protein, transposase, multidrug ABC transporter and ATP binding protein.

In vivo effects of s-pantoprazole, polaprenzinc, and probiotic blend on chronic small intestinal injury induced by indomethacin.

Treatment and prevention methods for non-steroidal anti-inflammatory drug-induced enteropathy have not yet been established. We tested the preventive effects of s-pantoprazole sodium trihydrate (PAN), polaprezinc (PZ), and probiotics on an indomethacin (Indo)-induced small intestinal injury in a rat model. Rats were randomised into 6 groups to receive: normal saline (control), Indo (6 mg/kg), PZ plus Indo, PAN plus Indo, or probiotics plus Indo (at 108 and 109 cfu/head) for 2 weeks. We measured body weight, food intake, severity of small intestinal damage, haemoglobin (Hb) levels in the small intestinal fluid, intestinal inflammatory cytokines, and a few groups of faecal bacteria. The experimental groups were found to have the following survival rates: 0% for the Indo, PZ, and PAN groups; 50% for both probiotic groups; and 100% for control. Treatment with probiotics of different concentrations reduced small intestinal lesion scores and intestinal fluid Hb as compared with the Indo group, while these parameters did not reduce in the PZ and PAN groups. The anti-inflammatory marker interleukin 10 increased in both probiotic groups. Analysis of a few groups of faecal bacteria revealed that Indo-induced a significant increase in Gram-negative bacteria and decreases in Bifidobacterium and Lactobacillus. Similar changes were also observed in the PZ and PAN groups. However, opposite effects were found in both probiotic groups. The use of probiotics appeared to be beneficial in preventing Indo-induced chronic small intestinal injury.

Predicting the impact of biochar additions on soil hydraulic properties.

Different physical and chemical properties of biochar, which is made out of a variety of biomass materials, can impact water movement through amended soil. The objective of this research was to develop a decision support tool predicting the impact of biochar additions on soil saturated hydraulic conductivity (Ksat). Four different kinds of biochar were added to four different textured soils (coarse sand, fine sand, loam, and clay texture) to assess these effects at the rates of 0%, 1%, 2%, and 5% (w/w). The Ksat of the biochar amended soils were significantly influenced by the rate and type of biochar, as well as the original particle size of soil. The Ksat decreased when biochar was added to coarse and fine sands. Biochar with larger particles sizes (60%; >1 mm) decreased Ksat to a larger degree than the smaller particle size biochar (60%; <1 mm) in the two sandy textured soils. Increasing tortuosity in the biochar amended sandy soil could explain this behavior. On the other hand, for the clay loam 1% and 2% biochar additions universally increased the Ksat with higher biochar amounts providing no further alterations. The developed model utilizes soil texture pedotransfer functions for predicting agricultural soil Ksat as a function of soil texture. The model accurately predicted the direction of the Ksat influence, even though the exact magnitude still requires further refinement. This represents the first step to a unified theory behind the impact of biochar additions on soil saturated conductivity.

Effect of missing killer-immunoglobulin-like receptor ligand in recipients undergoing HLA full matched, non-T-depleted sibling donor transplantation: a single institution experience of 151 Asian patients.

This retrospective analysis studied the impact of natural killer (NK) alloreactivity based on the missing ligand model, for a cohort of recipients undergoing haemopoietic stem cell transplant without T-cell depletion from HLA full-matched sibling donors. All patients received a uniform myeloablative conditioning regimen and prophylaxis for GVHD. A total of 151 patients were studied, including 62 patients with AML or myelodysplastic syndrome, 42 patients with ALL and 47 patients with CML. We found that 81% of patients had at least one missing KIR-ligand (KIR-L), and HLA-C1 allogroup homozygosity is present in 70% of patients. From multivariate analysis, we observed that the only consistently significant factor that was associated with superior survival was disease stage. Missing KIR-L, whether considering HLA-Bw and HLA-C alleles, without or with HLA-A ligands or narrowing to only HLA-C alleles alone to classify the number of missing KIR-L, did not have any impact on OS or relapse-free survival. This negative finding implies that as the KIR-L composition of recipient is not important in this matched non-T-depleted setting, further immunotherapeutic measures involving adoptive NK cell infusions have to be explored to exploit the benefit of NK alloreactivity for such transplants.

Evaluation of ease of intubation with the GlideScope or Macintosh laryngoscope by anaesthetists in simulated easy and difficult laryngoscopy.

The GlideScope is a new video laryngoscope developed for management of the difficult airway. We compared the GlideScope with the Macintosh laryngoscope in simulated easy and difficult laryngoscopy. Twenty anaesthetists were allowed three attempts to intubate in each of four laryngoscopy scenarios in a high fidelity simulator. In the simulated easy laryngoscopy scenarios, the anaesthetists took longer to intubate using the GlideScope than the Macintosh laryngoscope (mean (SD) 19.0 (9.7) s vs. 12.7 (5.9) s, respectively; p = 0.006). There was no difference in the number of successful intubations, ease of intubation or choice of intubating device. In the simulated difficult laryngoscopy scenarios, the anaesthetists took less time to intubate using the GlideScope (23.5 (12.7) s vs. 70.5 (101.2) s, respectively; p = 0.001). The slightly higher success rate with the GlideScope was not statistically significant (20/20 vs. 18/20, respectively; p = 0.5). However, the anaesthetists found it easier to intubate using the GlideScope (median (interquartile range [range]) 1 (1-2 [1-2]) vs. 2 (2-3 [1-3]), respectively; p < 0.0001).

Non-woven fabric filter separation activated sludge reactor for domestic wastewater reclamation.

A non-woven fabric filter was experimentally evaluated for solid-liquid separation in an activated sludge reactor as an alternative membrane. A polypropylene fabric filter (70, 50 and 35 g/m2) was used for the experiment. The pilot system was operated in A/O (Anaerobic/Oxic) type in which the filter module was submerged into the oxic compartment. The filtration module consists of 10 plate type rectangular filter elements with effective filtration area, 2 m2. Gravity filtration was carried out for solid-liquid separation by changing the water head 0.05-0.5 m without backwashing during the system operation. Initial permeate flux was set at 0.4 m/d. C/N ratio of raw wastewater was controlled at 4.5 in terms of BOD/T-N. The fabric filter system showed a good performance enough for domestic wastewater treatment. Effluent solid concentration was 3.2 mg/L (93.5% removal). COD removal efficiency was 91.6% producing an effluent concentration around 13 mg/L. 66% of total nitrogen removal could be obtained at the adjusted C/N ratio of influent wastewater. However phosphorus removal was very low at 23%. It was found that the initial flux of 0.4 m/d should be maintained for stable performance of the system.

Laparoscopic appendectomy is feasible for the complicated appendicitis.

We reviewed the results of 339 consecutive appendectomies, including perforated appendicitis, to assess the advantages of the laparoscopic approach for acute appendicitis. Three hundred and eighty-eight patients underwent appendectomy at the Keimyung University Kyungju Dongsan Hospital between March 1994 and June 1996; 339 patients were treated using laparoscopic appendectomy (LA), and 49 patients who were treated with open appendectomy. Special emphasis was given to the results of LA in 27 patients with perforated appendicitis. The mean duration of the operating time for LA was 48.9 minutes. For six patients (1.8%), the procedure was converted to open surgery. Minor complications developed in eight patients (2.4%). There were no complications in the 27 patients with perforated appendicitis. Our experience with LA in perforated appendicitis is limited, but our results show that LA is a safe and acceptable procedure for all forms of acute appendicitis.

Lack of effect of islet amyloid polypeptide in causing insulin resistance in conscious dogs during euglycemic clamp studies.

In this study, we administered constant intravenous infusions of human islet amyloid polypeptide (hIAPP) to conscious dogs during euglycemic glucose-clamp studies. The doses of hIAPP used (5 and 50 pmol.kg-1.min-1) raised the circulating IAPP levels approximately 12- and 50-fold above basal levels, respectively. Studies were conducted at two different insulin infusion rates, resulting in steady-state plasma insulin levels of approximately 600 and 2800 pM. According to our results, the hIAPP infusions did not lead to any measurable change in the insulin-stimulated glucose disposal rate at either insulin infusion rate. Additionally, we observed no effect of IAPP on hepatic glucose production. Although we did not observe any effect of hIAPP on any of the aspects of glucose or insulin metabolism measured, we did find a consistent hypocalcemic effect of this peptide at the 50-pmol.kg-1.min-1 infusion rate. Shortly after the onset of hIAPP infusion, serum calcium levels fell by 10-15% and remained at these levels throughout the course of the hIAPP infusion. In summary, 1) infusion of hIAPP at doses of 5 or 50 pmol.kg-1.min-1 in conscious dogs raised the circulating IAPP level 12- to 50-fold above basal; 2) during these infusion studies, no effect of hIAPP was observed on any of the aspects of glucose or insulin homeostasis measured; 3) 50 pmol.kg-1.min-1 hIAPP lead to a prompt reduction in plasma calcium concentrations with intravenous administration.