Background and Purpose: Cystic fibrosis (CF) is a recessive inherited disease caused by mutations affecting anion transport by the epithelial ion channel cystic fibrosis transmembrane conductance regulator (CFTR). The disease is characterized by mucus accumulation in the airways and intestine, but the major cause of mortality in CF is airway mucus accumulation, leading to bacterial colonization, inflammation and respiratory failure. One of the drug targets under evaluation to alleviate airway mucus obstruction in CF is the epithelial sodium channel, ENaC. Experimental Approach: To explore effects of ENaC inhibitors on mucus properties, we used two model systems to investigate mucus characteristics, mucus attachment in mouse ileum and mucus bundle transport in piglet airways. We quantified mucus attachment in explants from CFTR null (CF) mice and tracheobronchial explants from newborn CFTR null (CF) piglets to evaluate effects of ENaC or sodium/hydrogen exchange (NHE) inhibitors on mucus attachment. Key Results: ENaC inhibitors detached mucus in the CF mouse ileum, although the ileum lacks ENaC expression. This effect was mimicked by two sodium/proton exchange (NHE) inhibitors. Airway mucus bundles were immobile in untreated newborn CFTR null (CF) piglets but were detached by the therapeutic drug candidate AZD5634. Conclusion and Implications: These results suggest that the ENaC inhibitor AZD5634 causes detachment of CF mucus in the ileum and airway via NHE inhibition and that drug design should focus on NHE instead of ENaC inhibition.

Being the leading cause of mortality by a single infectious agent, tuberculosis (TB) continues as one of the most relevant issues of public health. Another pandemic disease is type 2 diabetes mellitus (T2D) is usually associated with immunodeficiency. Thus, an increased prevalence of TB-T2D comorbidity represents one of the most significant challenges for health providers. During the chronic phase of both diseases, several immunoendocrine abnormalities are occurring, but extra-adrenal production of active glucocorticoids (GCs) is a possible deleterious factor in both entities. Active GCs have been related to insulin resistance and suppression of Th1 responses, contributing to T2D and TB pathogenesis. 11-β-hydroxysteroid dehydrogenase type 1 (11-βHSD1) catalyzes the conversion of inactive GGs in their active form (cortisol or corticosterone in rodents) in the lungs and liver and could be responsible for this immunoendocrine disfunction. Dehydroepiandrosterone (DHEA) is an anabolic adrenal hormone with antagonist effects against GCs on immune cells and glucose metabolism. A synthetic analog of DHEA, the 16a-bromoepindrosterone (BEA), lacks an anabolic effect while keeping his immune and metabolic effect. The therapeutic efficiency of BEA was studied in a murine model of T2D-TB comorbidity. TB-T2D mice underwent more severe lung disease than in TB-infected but non-diabetic animals. BEA decreased the active form of GCs and 11-βHSD1 expression, while increasing 11-βHSD2 expression, which reduced hyperglycemia and liver steatosis, lung bacillary loads, and pneumonia. Thus, it seems that BEA is an efficient therapy to control metabolic and immune abnormalities caused by high active GCs production.

Cricoid pressure is used to reduce the risk of aspiration during rapid sequence induction. The recommended force applied to the cricoid is 10-20 newtons (N; 1.020-1.040 kg) on awake patients and 30-40N (3.060-4.080 kg) on anaesthetised patients. However clinically, it is difficult to estimate the required force. We assessed the effectiveness of 3 recommended teaching methods on the ability to apply the correct force using an airway model that simulated “awake” and “anaesthetised” patients. Thirty nurses and doctors from two hospitals and with clinical experience applying cricoid pressure were included. Measurements of baseline force for “awake” and “anaesthetised” patients were obtained from all participants using measuring scales. Participants were blinded to the force applied. Participants were taught one of three different techniques: biofeedback, nose and syringe. Post-teaching, blinded force measurements were repeated. Data analysis was performed using a linear mixed model and marginal prediction models of applied force reported. For “awake” patients, nose method forces were within the recommended range (mean 14.6N, 95%CI 9.7-19.4). The biofeedback method led to predicted forces at the upper limit of recommended (21.6N, 95%CI 16.7-26.4) and the syringe method forces were greater than recommended (29.0N, 95%CI 23.9-34.0). For “anaesthetised” patients, nose method forces were less than recommended (26.3N, 95%CI 21.6-31.1), the biofeedback method led to predicted forces within range (33.4N, 28.4-38.3) and syringe method forces were above those recommended (40.8N, 95%CI 35.8-45.8). The biofeedback technique is the most effective method for teaching the application of recommended cricoid pressure force for both awake and anaesthetised patients.

With new technology comes new complications. We discuss the interesting case presented by Bjelic and colleagues regarding a missplaced TAVR valve into the inflow cannula of an LVAD, leading to hemodynamic collapse. The authors describe the pitfalls of the new technology and interesting surgical maneuvers to address these complications.

Background: Improving patient safety is an increasing priority for health workers who have roles in perioperative care about patient safety. Also, patient safety initiatives aimed at creating a safe operating room culture are increasingly being adopted. This study aims to evaluate the attitudes of health workers who have roles in perioperative care about patient safety. Methods: The cross-sectional study was conducted in a state hospital in the eastern part of Turkey between January 2018 and March 2018 with the participation of 129 volunteer health workers including surgeons, surgical technicians, nurses and other health workers who have roles in perioperative care by using the SAQ-OR instrument. Results: An analysis of the relationship between SAQ-OR total and sub-scales score and age indicated a positive, significant relationship between Teamwork Climate, Job Satisfaction, Safety Climate, Working Conditions and SAQ-OR total scores (p<0.05). Besides, Job Satisfaction, Perceptions of Management, Safety Climate sub-scales and weekly working hours indicated a positive, statistically significant relationship (p<0.01). Conclusion: Participating health personnel’s attitudes towards operating rooms were found to be low. More attention should be attached on the issue by the hospital administration in order to improve patient safety culture which was not found at good levels.

Multiple Shooting was tested with a slalom-skiing optimal control problem. A model of the underlying physics was put together and thereby time-optimal solutions for slalom-skiing tracks where found.

In order to overcome the low precision of vibration fatigue life analysis of complex engineering structures, a structural dynamic model updating method for random vibration fatigue life prediction was established. In this model updating method, the stiffness and modal damping of key parts such as structural connection are extracted as model modification parameters. The approximate model of modified parameters and target is established to replace the finite element model of complex structure based on the Kriging method. The actual natural frequency and random vibration response spectrum of the structure are taken as the modified objectives to design the optimization experiment and find the optimal model parameters. And based on the amplitude probability density method of random vibration fatigue life analysis, the vibration fatigue life of complex structure is obtained. Finally, the method is verified by structural dynamic experiment. The result shows that the method can effectively modify the parameters of dynamic finite element model for the prediction of structural vibration fatigue life, and improve the accuracy of structural random vibration fatigue life prediction.

Aim: Two recommendations for hemodialysis in lithium poisoning, one from the Extracorporeal TReatments in Poisoning (EXTRIP) workgroup and a single center retrospective one (Paris), differ. We compared outcomes in lithium poisoning based on these criteria with a primary outcome of worsening neurological symptoms in patients where EXTRIP and Paris criteria were discordant. Methods: Poison center data were queried for lithium poisoned patients for whom hemodialysis was either recommended or performed. Patients were categorized according to EXTRIP and Paris criteria and excluded if the peak lithium concentration was <1.2 mmol/L or if neurological follow-up was unavailable. Comparative analyses were only performed when both criteria could be assessed. Results: 219 patients were analyzed. Paris criteria were applied in 70 and EXTRIP criteria in 178. 42 patients were excluded because Paris criteria could not be applied. When Paris and EXTRIP both supported hemodialysis, 50/57 (88%) of patients who received hemodialysis improved, as did all 3 who did not receive hemodialysis. When Paris and EXTRIP opposed hemodialysis, all non-dialyzed patients did well. Among the 86 patients for whom EXTRIP supported hemodialysis but Paris did not, 4/19 (21%) patients not dialyzed deteriorated (p=0.02; OR=8.7, 95%CI=1.5-51.8), one of whom died. All 8 patients for whom Paris criteria supported hemodialysis but EXTRIP did not were dialyzed and improved. Conclusion: When the EXTRIP and Paris criteria are discordant, EXTRIP criteria outperforms the Paris criteria at identifying potentially ill patients who might benefit from hemodialysis.

Treatment of Chronic Spontaneous Urticaria With Benralizumab: Report of Primary Endpoint Per Protocol Analysis, and Exploratory EndpointsStandard treatments for chronic spontaneous urticaria (CSU) including the second-generation H1-antihistamines (SGAH) are often ineffective even with four-times the FDA-recommended dose.1,2Eosinophilic infiltrates and an abundance of interleukin-5 (IL5) in CSU lesions (hives) support a role for IL5 in the pathomechanism of CSU.3 Thus, the use of biologic therapies, e.g. benralizumab targeting IL5-receptor-α, in treating SGAH-resistant CSU was hypothesized.A repeated-measures, 24-week study was designed and conducted at an urticaria clinic to determine clinical efficacy of benralizumab in CSU. Twelve SGAH-unresponsive CSU patients (3 males, 9 females; 2 blacks, 10 whites; between ages 32-65 years) having a median daily Urticaria Activity Score (UAS7)4 of 4, and pruritus severity ≥2 were enrolled. After a baseline run-in period, subjects were treated with a subcutaneous placebo dose followed by benralizumab 30mg subcutaneously every month (×3 doses) followed by two off-medication monthly-visits. Subject-reported responses to UAS7 and CU-QoL questionnaires were recorded at the monthly visits. The primary and exploratory endpoints were the change in UAS7 and Chronic Urticaria Quality-of-Life Total Score (CUQoLTS) respectively, from 4 weeks after placebo dose (visit 2) to 4 weeks after last dose of benralizumab (visit 5). Nine subjects completed the study; three withdrew after the first benralizumab dose. An intent-to-treat (ITT) analysis (n=12) of the primary endpoint has been reported previously.5Per-protocol (PP) analysis (n=9) of the primary endpoint, and PP vs. ITT of the exploratory endpoint are reported here. It was presumed that lesions were not self-limiting, and any improvement in outcomes during the study were because of intervention. Non-responders to benralizumab were identified if at any time during the 16 weeks after the first benralizumab dose there was <40% improvement in UAS7 from baseline vs. responders if UAS7 was ≤6.The average duration of urticarial symptoms was 7.0 years. Baseline UAS7 and CUQoLTS ranged between 22-42 and 36-95 respectively. Both outcomes significantly improved at visit 5 vs. visit 2 in 7 of 9 (78%) subjects completing the study. The average difference (95% CL) between visit 2 and visit 5 for UAS7, was -15.5 (-4.1, -26.8, p=0.003) and for CUQoLTS, using ITT analysis, was-13.2 (-2.4, -24.0, p=0.0005) or, using PP analysis, was -11.6 (-0.8, -22.4, p=0.03) (Figure-1 ). Five responders reported no hives/pruritus (UAS7=0) at visit 5 or 6.Between responders and non-responders, the average age (51.6 vs. 53, p=0.9) and symptom duration (5 vs. 9 years, p=0.5) did not differ significantly. However, the adjusted mean UAS7 percentage difference, adjusted for symptom duration, age, and blood eosinophils (eos%), from visit 2 till visit 5 was -84% for responders and +7.5% for non-responders, p=0.0009 (Table-1) . The average baseline UAS7 was not statistically significant (27 vs. 37.5, p=0.5) between groups however, the baseline mean difference for eos% was -6±1 (p=0.001), and for basophil% was -1.2±0.2, p=0.02), which were not observed at visit 5 (eos%: 0±1, p=0.9; basophil%: 0.2±0.2, p=0.8) (Table-1 ). Thus, clinical improvement among responders was independent of baseline disease severity. Non-responsiveness to benralizumab, measured by changes in UAS7, are likely due to other mechanistic factors unrelated to eos% which are eliminated by blocking IL-5R with benralizumab(S-Figure-1) .UAS7 and CU-QoLTS values were significantly correlated (r2=0.9, p<0.0001) (S-Table-3) . CU-QoL components that improved significantly were the pruritus/wheal scores, urticarial interference with physical activities, sleep and spare time (S-Table-4) .This study supports the use of benralizumab for treatment of SGAH-unresponsive CSU. Benralizumab-related improvements in UAS7 and CUQoLTS reported here are similar to the efficacy of omalizumab in CSU reported in a previous study (S-Table-5) .6The sustained significant improvement in urticarial lesions based on subject-reported outcomes by benralizumab warrants further investigation of underlying biologic pathways to better elucidate the role of IL-5 in CSU.

Left ventricular assist devices can extend life for select patients with advanced heart failure. However, adverse events, including outflow graft obstruction, may occur over time. Outflow graft obstruction is generally insidious in onset and may result in low LVAD flows and symptoms of heart failure. In this report, we describe a patient who presented with acute decompensation requiring temporary mechanical support due to development of extrinsic compression of the outflow graft after HeartMate 3 implantation. The acuity and severity of this case demonstrate the importance of avoiding this complication and promptly diagnosing and treating it if it does occur.

The diarrhoea of pigs, in particular, for the newborns, is very harmful to the pig industry. Porcine circovirus-like virus (Po-Circo-like (PCL) virus) is a circular replication-associated protein (Rep)-encoding single-stranded (CRESS) DNA virus. Two PCL virus strains, with severe diarrhoea and hemorrhagic enteritis, have been found in two different pig farms in Guangdong province, China. Subsequently, the full genomes of two strains (PCL virus GD06 and PCL virus GD09) were sequenced. The two PCL viruses contains 3942 nucleotides and 3925 nucleotides, which vary from the genomes of other PCL virus strains with 3912, 3923, and 3942 nucleotides. Besides, the nucleotide identities between two strains and other strains of PCL viruses and Bo-Circo-like virus/CH were 78%-89%. A multiple sequence alignment of these strains showed a similarity of 86.2%-94.4% for the Rep gene sequence and 89.4%-97.7% for the Rep protein sequence. This study found that 9.5% (4/42) of diarrhoea samples and 11.8% (2/17) of pig farms were positive for PCL virus, suggesting that PCL virus may already be widespread in Pig farms in China. Further research on the pathogenicity and epidemiology of PCL virus is required.

Objectives Stroke has potentially devastating consequences for patients receiving veno-arterial extracorporeal membrane support (VA-ECMO). Arterial cannulation sites for VA-ECMO include the ascending aorta, axillary artery, and femoral artery. However, the influence of cannulation site on stroke risk has not been well described. The purpose of this study was to investigate the association between occurrence and patterns of stroke with ECMO arterial cannulation sites. Methods We retrospectively reviewed 414 consecutive patients who received VA-ECMO support for cardiogenic shock between March 2007 and May 2018. Patients were categorized by cannulation strategy. The rates, subtype and location of strokes as assessed by neuroimaging during and after VA-ECMO support were analyzed. Results Median age was 61 years (IQR 50-69); 67% were men. 77 patients were cannulated via the ascending aorta (17%), 31 via the axillary artery (7%), and 306 (69%) via the femoral artery. In total, 26 patients (6.3%) developed 30 stroke lesions at a median of 6.0 (IQR 3.1-8.7) days after ECMO cannulation. Ischemic stroke was the most common subtype (64%), followed by hemorrhagic transformation (20%) and hemorrhagic stroke (16%). Location by CT was right hemispheric in 38%, left hemispheric in 24%, bilateral in 21%, and vertebrobasilar in 17%. The incidence of stroke was similar across cannulation strategies: aorta (n=5, 6.5%), axillary artery (n=2, 6.5%), and femoral artery (n=19, 6.2%), (p=0.99). Conclusions Incidence of stroke does not appear to differ among patients cannulated via the ascending aorta, axillary artery, or femoral artery. Ischemic stroke was the most common subtype of stroke.

Helopeltis theivora Waterhouse (Hemiptera: Miridae), commonly as tea mosquito bug (TMB), is an economic pest to the world tea industry and its resistance has been promoting for a novel management strategy. Moreover, to understand and explore the effect of such biotic factor i.e.TMB’s sap-sucking and abiotic factor i.e. artificial mechanical injury on tea foliages, metabolomics is rapidly emerging as a one-step tool. Therefore, a comparative and qualitative HR-LCMS based metabolomic study is carried out on four young tea leaf samples viz. healthy (HTL), un-infested (UIP), infested (IP), and artificial spots (ACS). From a unique methodology, dynamic and selective hypersensitive (like) responses of tea are observed, for the TMB’s sap-sucking and artificial mechanical injury. Interestingly under TMB’s biotic stress, the UIP sample shows the expression (N=24) and suppression (N=27) of metabolites as compared to HTL sample. Whereas, the ACS sample from abiotic stress reveals unique metabolites (N=20) in comparison to the UIP and HTL samples. The IP sample from biotic stress surprisingly carries unique metabolites (N=9) in contrast to UIP, HTL, and ACS samples. Based on pharmacological and chemical properties, these nine secreted metabolites of TMB are hypothesized for the overall molecular mechanism of TMB’s sap-sucking process.

OBJECTIVE: The aim of this study was to evaluate the vasoactive-inotropic score (VIS) as the predictor for postoperative acute kidney injury (AKI) in adult patients with cardiovascular surgery. DESIGN: Retrospective cohort study. SETTING: Single center. PARTICIPANTS: 1935 adult patients with cardiovascular surgery between September 2017 and May 2019. MEASUREMENTS AND MAIN RESULTS: We calculated VIS-max by using the highest doses of vasoactive and inotropic medications during the first 24h after cardiovascular surgery. In 1935 patients, 291 patients (15.0%) developed postoperative AKI from second day to seventh day after cardiovascular surgery, and 30 patients (1.6%) needed RRT. Multivariate logistic regression analysis showed that VIS-max was associated with postoperative AKI (odds ratio[OR]: 1.18, 95% confidence interval [CI]: 1.10-1.27, P<0.001) and need for RRT in AKI patients (OR: 1.04, 95%CI: 1.01-1.06, P=0.004). The area under the ROC curve (AUC) of VIS-max as a continuous variable was significantly than the AUC of EuroSOCRE, SOFA or APACHE II score as continuous variables ( VIS-max vs EuroSCORE: 0.81 vs 0.71, P<0.001, VIS-max vs SOFA score: 0.81 vs 0.67, P<0.001, VIS-max vs APACHE II score: 0.81 vs 0.68, P<0.001), and the optimal cutpoint of VIS-max was 7.5 points. The AUC of VIS-max for predicting need for RRT in patients with postoperative AKI was significantly higher than EuroSOCRE (0.75 vs 0.58, P=0.024), and the cut-off value was 12.5 points. CONCLUSIONS: VIS-max may be a useful tool in predicting postoperative AKI in adult patients after cardiovascular surgery.

Accurately quantifying the evaporation loss of surface water is essential for regional water resources management, especially in arid and semi-arid areas where water resources are already scarce. The long-term monitoring of stable isotopes (δ18O and δ2H) in water can provide a sensitive indicator of water loss by evaporation. In this study, we obtained surface water samples of Shiyang River Basin from April to October between 2017 and 2019. The spatial and temporal characteristics of stable isotopes in surface water show the trend of enrichment in summer, depletion in spring, enrichment in deserts and depletion in mountains. The Surface Water Line (SWL) has been defined by the lines: δ2H=7.61δ18O+14.58 for mountainous area, δ2H=4.19δ18O-17.85 for oasis area, δ2H=4.08δ18O-18.92 for desert area. The slope of SWL shows a gradual decrease from mountain to desert, indicating that the evaporation of surface water is gradually increasing. The evaporation loss of stable isotopes in surface water is 24.82% for mountainous area, 32.19% for oasis area, and 70.98% for desert area, respectively. Temperature and air humidity are the main meteorological factors affecting the evaporation loss, and the construction of reservoirs and farmland irrigation are the main man-made factors affecting the evaporation loss.

Objective: Concerns exist regarding the risks of mid-urethral slings (MUS) for stress urinary incontinence (SUI), particularly the lack of long-term data. We compare patient reported outcomes of a multicentre randomised controlled trial of retropubic (TVT-GYNECARE) versus transobturator (TOT-MONARC) tape surgery at 12 years. Design and setting: A multicentre study was performed in 11 tertiary referral centres. Population: The 180 participants from the original trial. Methods: Postal questionnaire survey of Patient Reported Outcome Measures using the International Consultation on Incontinence Questionnaire, Patient Global Impression of Improvement questionnaire (PGI-I) and a Numeric rating scale pain questionnaire. Main outcome measures: comparison of the efficacy and complications between the TVT and TOT procedures in the long term. Results: 110/180 responses were received: 55 TVT and 55 TOT participants. Mean follow up: 12.8 years, STD +/- 0.29 years. TVT was significantly superior to TOT in terms of cure ie no SUI: 41.8% TVT versus 21.8% TOT (p=0.04). Urgency urinary incontinence (UUI) was the most bothersome urinary symptom: 14.5% TVT and TOT respondents reported UUI most or all the time. Severe groin/ vaginal pain was reported in 4.8% TVT and 1.7% TOT participants. 80% TVT and 77% TOT participants reported their symptoms as improved on the PGI-I. Conclusions: TVT is superior to TOT for SUI cure. Efficacy and patient satisfaction are reduced by 12 years. Severe vaginal or groin pain is uncommon. Careful patient counselling of long-term outcomes is required. The MUS appears to be an effective treatment for the majority of women with SUI.

Letter to the Editor, BJOG Exchange

BackgroundThe optimum management of respiratory failure in COVID-19 patients has been a challenge for physicians across the globe. Many scientific societies have suggested the use of CPAP (continuous positive airway pressure) in severe cases, in an effort to reduce invasive ventilation. We investigated mortality outcomes in patients who needed CPAP but were not suitable for invasive ventilation.MethodsWe retrospectively evaluated the mortality outcomes of all consecutive COVID-19 cases with severe type 1 respiratory failure requiring FiO2 >0.6 who were admitted to our hospital between 12th March and 04th May’20. British Thoracic Society guidelines were followed for identifying patients needing CPAP. Their outcomes were recorded and compared with a similar group of patients who had oxygen as a ceiling of care. Prospectively collected data between 5th May and 7th June’20 in similar but smaller group of patients was also analysed.Results:A total of 104 COVID-19 patients with documented Do Not Attempt Resuscitation (DNAR) decision required high fraction of inspired oxygen (FiO2) >0.6 to maintain peripheral oxygen saturation (SpO2)> 92% (SpO2> 88% in COPD). 24 received CPAP as the ceiling of care with a mortality rate of 92.5%. The remaining 80 patients who were on oxygen as a ceiling of treatment had 91.7% mortality.Conclusion CPAP did not appear to improve survival of patients with severe respiratory failure due to COVID-19 who were not suitable for invasive ventilation. Further studies are warranted to adequately inform appropriate management strategies for this group of patients.KeywordsCPAP; non-invasive ventilation; COVID-19; critically ill; respiratory failure

Humans have relied on coastal resources for centuries. However, current growth in population and increased accessibility of coastal resources through technology have resulted in overcrowded and often conflicted spaces. The recent global move towards development of national blue economy strategies further highlights the increased focus on coastal resources to address a broad range of blue growth industries. The need to manage sustainable development and future exploitation of both over-utilised and emergent coastal resources is both a political and environmental complexity. To address this complexity, we draw on the perspectives of a multidisciplinary team, utilising two in depth exemplary case studies in New Zealand and within the Myanmar Delta Landscape, to showcase barriers, pathways and actions that facilitate a move from Business as Usual (BAU) to a future aligned with the Sustainable Development Goals (SDGs) and the UN International Decade of Ocean Science for Sustainable Development 2021-2030. We provide key recommendations to guide interest groups, and nations globally towards sustainable utilisation, conservation and preservation of their marine environments in a fair and equitable way, and in collaboration with those who directly rely upon coastal ecosystems. We envision a sustainable future where: (i) Change is motivated and facilitated (ii) Coastal ecosystems are co-managed by multiple reliant groups (iii) Networks that maintain and enhance biodiversity are implemented (iv) Decision-making is equitable and based on ecosystem services (v) Knowledge of the marine realm is strengthened-'mapping the ocean of life' (vi) The interests of diverse user groups are balanced with a fair distribution of benefits

A document by Luca Bonadies. Click on the document to view its contents.

The use of noninvasive ventilation (NIV) is considered for the treatment of mild and moderate cases of acute respiratory failure (ARF). Conventional trigger modes during NIV have a higher rate of asynchronies when compared to the electrical activity of the diaphragm (AEdi) trigger. Based on previous studies, the hypothesis of the present study is that there is evidence of lower rate of asynchronies and favorable clinical outcomes related to the non-invasive neurally adjusted ventilatory assist (NIV NAVA) mode when compared to the use of conventional NIV in pediatric patients with ARF. Purpose: To compare the asynchrony index (AI) and clinical outcomes presented during the use of NIV NAVA vs. conventional NIV in the treatment of ARF in pediatrics. Methods: This is a systematic review of clinical trials conducted between April and May 2020 in the electronic databases Cochrane Library, Embase, Lilacs, Pubmed/Medline, Scopus and Web of Science. Results: A total of 184 studies were found, four of which were eligible for qualitative synthesis. The sample analyzed 39 participants, aged between 35 days and 15 years with male predominance (61.5%). The primary outcome analyzed in three of the four studies was the significant decrease (p <0.001) in the AI during NIV NAVA compared to conventional NIV. Clinical outcomes were inconclusive due to methodological limitations. Conclusion: We conclude that NIV NAVA decreases the AI when compared to conventional NIV in pediatric patients with ARF. However, the other clinical outcomes present inconclusive results, requiring further studies with different methodological formats for confirmation.

Introduction: The aspiration of foreign bodies into the airway (AFB) is an important cause of death in children worldwide. The incidence is higher in children aged 1-2 years. The presentation and severity depends in the degree of airway obstruction. In the event of a compatible clinical history, a bronchoscopy evaluation is needed. Methods: Retrospective study. Included pediatric patients who underwent bronchoscopy for removal of AFB at the Service of Respiratory Endoscopy in the period from January 2014 until June 2020. We reviewed medical and bronchoscopy records, collected information about the equipment used, foreign body location and nature, age, sex, success rate and complications. Results: 40 pediatric patients were treated. Children under 3 years accounted for 51% of cases with a peak incidence between 1 to 2 years accounting for 35.5% of cases. The majority of the removals were done by a flexible bronchoscopy (90%), using a basket (47,5%) or a rat tooth forceps (35%). The overall removal success rate was 100%. Complications occurred in 3 cases (7.5%). No deaths were reported. Discussion: The bronchoscopic removal of AFB in children is a complex and demanding procedure with a high potential for complications. Historically, rigid bronchoscopy has been the gold standard for the treatment of pediatric foreign body inhalation, but several authors have described flexible bronchoscopy as a diagnostic and therapeutic method for the removal of AFB. Our results show that, in most cases, flexible bronchoscopy is a safe and effective for the removal of AFB.

Polyaluminium chloride (PAC) and cationic polyacrylamide (CPAM) play a crucial role for separating microorganisms from bulk media. However, the mechanism of adsorption between cells and flocculants remain to be further defined to improve the flocculation efficiency (FE) in extreme conditions. This study conducted the flocculation process of Rhodotorula glutinis induced by PAC and CPAM, firstly. The result demonstrated that CPAM possessed more efficient harvesting ability for R. glutinis compared to PAC. The difference of flocculation capacity was then thermodynamically explained by the extended DLVO (eDLVO) theory, it turned out that the poor harvesting efficiency of PAC was attributed to lacking of binding sites as well as low adsorption force within particles. Based on this, the FE of PAC to R. glutinis was mechanically enhanced to 99.84% from 32.89% with 0.2 g/L CPAM modification at an optimum pH of 9.

This paper investigates the European option valuation under the condition that the dividend payments follow a Markov-modulated Merton jump-diffusion model. We consider the dividend discount model under real probability measure, the stock price process is then deduced. The regime switching Esscher transform is employed to determine a risk-neutral measure. Finally, we obtain the closed form solution of European option when the dividend announcement time and the dividend payment time are consistent or inconsistent.