In process design, the values of design variables X for equipment and operating conditions should be optimized for entire processes, including all unit operations, such as reactors and distillation columns, to consider effects between unit operations. However, as the number of X increases, many more simulations are required to search for the optimal X values. Furthermore, multiple objective variables Y, such as yields, make the optimization problem difficult. We propose a process design method based on adaptive design of experiments and Bayesian optimization. Optimization of X values that satisfy target values of multiple Y variables are searched, and simulations for the optimized X values are then repeated. Therefore, X will be optimized by a small number of simulations. We verify the effectiveness of this method by simulating an ethylene oxide production plant.

As an attractive alternative technology for the separation of long chain olefin and paraffin, a novel silver-based deep eutectic solvent (Ag-DES) was prepared and utilized for 1-octene/n-octane separations. Comprehensive reactive extraction separation experiments were performed to highlight the Ag-DES concentration and operating temperature discriminations using compounds with different ratio of 1-octene/n-octane. The novel Ag-DES showed optimal separation performance regarding 1-octene/n-octane and possessed the highest levels separation selectivity in the range 3.75-16.74 with excellent circulation stability in our best knowledge. Furthermore, FT-Raman measurements and quantum chemistry calculation were performed to elucidate the interaction mechanism of Ag-DES in the separation of 1-octene and n-octane, which revealed that both chemical complexation and strong physical attraction existed in the complex of Ag-DES with 1-octene rather than n-octane. This study lends important insight for the development of Ag-DES reactive extraction separation process for the energy-efficient long chain α-olefin purification from F-T synthesis products.

The Popeye Domain Containing Protein 1 (POPDC1), a tight junction-associated transmembrane protein with a unique binding site for cAMP, has been shown to act as a tumour suppressor in cancer cells. Through interaction with many downstream effectors and signalling pathways, POPDC1 promotes cell adhesion and inhibits uncontrolled cell proliferation, epithelial-to-mesenchymal transition, and metastasis. However, POPDC1 expression is downregulated in many types of cancer, thereby reducing its tumour-suppressive actions. This review discusses the role of POPDC1 in the progression of the malignant phenotype and highlights the broad range of benefits POPDC1 stabilisation may achieve therapeutically. Cancer stem cells (CSC) are a key hallmark of malignancies and commonly promote treatment resistance. This article provides a comprehensive overview of CSC signalling mechanisms, many of which have been shown to be regulated by POPDC1 in other cell types, thus suggesting an additional therapeutic benefit for POPDC1-stabilising anticancer drugs.

Capparis odoratissima is a tree species native to semi-arid environments of the northern coast of South America where low soil water availability coexists with frequent nighttime fog. A previous study showed that water applied to leaf surfaces enhanced leaf hydration, photosynthesis, and growth, but the mechanisms of foliar water uptake are unknown. Here we combine detailed anatomical evaluations with water and dye uptake experiments in the laboratory, and use immunolocalization of pectin and arabinogalactan protein epitopes to characterize water uptake pathways in leaves. Abaxially, the leaves of C. odoratissima are covered with peltate hairs, while the adaxial surfaces are glabrous. Both surfaces are able to absorb condensed water, but the lower surface has higher rates of water uptake. Numerous idioblasts connect the adaxial leaf surface and the abaxial peltate hairs, both of which contain hygroscopic substances such as arabinogalactan proteins and pectins. The highly specialized anatomy of the leaves of C odoratissima fulfills the dual function of minimizing water loss when stomata are closed, while maintaining the ability to absorb liquid water. Cell-wall related hygroscopic compounds in the peltate hairs and idioblasts create a network of microchannels that maintain leaf hydration and promote water uptake.

Background: Mucopolysaccharidoses (MPSs) are lysosomal storage disorders in which glycosaminoglycans accumulate due to insufficiency of the enzymes to degrade them. Patients have organomegaly, short stature, and/or intellectual disability. The earliest symptoms are otologic and upper respiratory obstruction and are the main reasons for doctor consultation. Methods: We reviewed 42 patients (30 male and 12 female), with a median age of 20.5 years, who had MPS (16.7% type I, 35.7% type II, 19.0% type IIIB, 21.4% type IVA, and 7.2% type VI). Otorhinolaryngologic manifestations were collected, and quality of life after surgery was documented. Results: Ear, nose, and throat (ENT) symptoms occurred in patients with all MPS types. We found recurrent otitis media in 42.9% of cases. We noted hearing loss in 81.0% (mixed in 45.2%, conductive in 19.0%, sensorineural in 16.7%), adenotonsillar hypertrophy in 76.2%, frequent infections of the upper airway in 47.6%, and obstructive sleep apnea syndrome in 26.2%. Seventy-six percent of patients underwent ENT surgery, including adenoidectomy, tonsillectomy, tympanostomy with ventilation tube insertion, tracheotomy, and supraglottoplasty. Conclusions: ENT surgery reduced the severity of hearing loss, and decreased the degree of symptoms related to upper airway obstruction which improved patients’ quality of life.

Objective To assess whether a full enhanced recovery after surgery (ERAS) program can further reduce perioperative outcomes among patients undergoing gynaecologic laparoscopic procedures relative to those undergoing limited ERAS management. Design Single-center, open-label, randomized trial. Setting A tertiary hospital, China: December 2018 to October 2019. Population One hundred and forty-four women scheduled for an elective simple gynaecologic laparoscopic surgery. Methods Patients were randomized into two groups: full ERAS intervention or limited ERAS management. Primary outcome Postoperative length of stay (LOS). Results Postoperative LOS for the full ERAS program showed a 1-day reduction in comparison to the limited ERAS group (median of 1.0 day versus 2.0 days, respectively; P = .002). Multivariate regression analysis identified preoperative carbohydrate loading and opioid-sparing analgesia as the independent factors for discharging on postoperative day (POD) 1. Patients in the full ERAS program reported less postoperative pain within 72 hours postoperatively and had a lower narcotic consumption rate compared with those in the limited ERAS management. They also enjoyed better and faster recovery as demonstrated by the QoR-15 scale on POD 3: median of 137.0 for full ERAS program versus 130.0 for limited ERAS management, respectively (P = .020). There were no significant differences between groups regarding postoperative complication rate, readmission rate, or in-hospital cost. Conclusion The addition of full ERAS management can further reduce postoperative length of stay and improve patients’ quality of life after laparoscopic surgery for gynaecologic diseases. Keywords enhanced recovery after surgery, perioperative management, gynaecologic laparoscopic surgery, length of stay.

This note presents corrections to our paper

Dear Sir,We read with interest Kasaven et al., (1) who eloquently describe some of the implications to the practice of obstetrics and gynaecology. They correctly identify the heightened anxiety that patient’s face when attending hospital during pregnancy. During this time the reduction in patient attendance can be multifactorial. However, we feel one area which has been neglected is partner support. There is evidence that having a partner present during a birth can reduce a woman’s anxiety and additionally be beneficial to the partner (2). Father’s also can experience significant anxiety in the peri-natal period (2) and maternal stress particularly with relationship strain can be harmful to the baby. Parental presence during CPR for a child is beneficial for parents as they can make sense of the situation. It logically would also be beneficial to partners with maternal emergency caesarean sections and of course postnatally to bond with the baby (3). Current policy dictates that fathers can only be present during the birth, however in a multiparous woman or a woman requiring a crash caesarean section the timeframe allowing for partner’s attendance is not reasonable or feasible. COVID-19 is clearly the reason for this policy, however, examining the risk of a couple, who have both been screened as negative on a COVID-19 test and live in the same household. If the male member of the couple has COVID-19 the female is likely to have a high viral load from the partner due to kissing or sexual intercourse (4), a common practice in an attempt to induce labour. The early knowledge of infection can allow for appropriate infection control measures to be put in place. The rate of a false negative is 4-30% (4) but this is still a risk with the mother. The risk to staff with correct personal protective equipment and training is minimal (4). Additionally, women who do not have continuous support are more likely to have an instrumental/surgical delivery, use more pain medication, prolonged labours which may result in complications such as postpartem haemorrhage (5), which ultimately places hospitals and clinicians at greater risk of litigation. With risk of domestic violence and risk of increased mental health issues as highlighted by Kasaven et al., are we doing more harm than good and is this an unintended consequence of COVID-19 that could be prevented? The implication to patient care is huge for what appears to be little benefit. Have we forgotten that we should be delivering patient centred care? Perhaps it is time for change.Herron JBT (1), Herron RL (2)1. University of Sunderland, Faculty of health science and wellbeing, Chester Road, Sunderland SR1 3SD.2. Northumbria University, School of Nursing, Midwifery and Health, 2 Sandyford Rd, Newcastle upon Tyne NE1 8QH.

Mass cytometry reveals unique subsets of T cells and lymphoid cells in nasal polyps from patients with chronic rhinosinusitis (CRS)

BACKGROUND Several methods have been proposed to locate the conduction gap on the pulmonary vein isolation (PVI) ablation line. However, the value of the interval of far-field potential (FF potential) and pulmonary vein potential (PV potential) is unknown. METHODS: The state of PV potential and the location of that ablation sites were particularly recorded for analysis once LSPV was isolated in a development cohort of consecutive patients undergoing PVI ablation at a single center. These findings informed the development of a novel algorithm to discriminate the location of a conduction gap between upper portion and inferior portion of LSPV. The performance of this novel algorithm was prospectively tested in a validation cohort of consecutive re-do patients undergoing PVI ablation RESULTS: A total one hundred sixteen patients were recruited, of which 56 formed the validation cohort. Interval of FF potential and PV potential was associated with the location of the conduction gap, and the interval <5 ms predicted that there was a conduction gap in the upper portion of ostium with 92.9% sensitivity and 96.9% specificity. In the prospective evaluation, the interval was able to correctly predict the site of successful ablation in 89.6%. CONCLUSIONS: Interval of far-field potential and pulmonary vein potential is a novel and accurate marker to predict the location of a conduction gap.

Introduction: The currently available options for restoring right ventricle (RV) to pulmonary artery (PA) continuity are far from satisfactory. In absence of an ideal conduit, hand sewn bovine pericardial conduit with Polytetrafluroethylene (PTFE) tri-leaflet valve (BPCTV) may serve as a satisfactory alternative particularly in low and middle income countries (LMIC). Material and Methods: The hospital records of all patients who received BPCTV in RV to PA position from January 2014 to June 2019 were retrospectively analysed. A total of 41 patients were further classified into two groups; pulmonary hypertension group (PH) and non-pulmonary hypertension group (NPH). The primary endpoints of the study were mortality, and freedom from re-operation for conduit failure. The secondary end point was to study the impact of pulmonary hypertension on the conduit function and durability. Results: The Mean age and weight of patients at time of conduit implantation was 56.8 months (range 2-196 months) and 12.3 kg (range 3-44 kg) respectively. The mean size of conduit was 18 mm (range 12-24 mm). The mean duration of follow up was 30 months (range 8-72 months). The freedom from re-intervention was 86% at 30 months (range 8-72 months). The cost of BPCTV was less than one-sixth of the commercially available bovine jugular vein conduit. Conclusion: The hand sewn BPCTV is a cost effective alternative to commercially available conduits with acceptable outcomes. However, more research with a larger sample size and a longer follow-up is required.

Background A solitary fibrous tumor (SFT) of the kidney with thrombus extended into the inferior vena cava (IVC) and right atrium (RA) is very rare. Methods and conclusion We reported here an extremely case of right renal SFT extended to the IVC and RA, treated late with an urgent RA mass removal and IVC thrombectomy.

In this work, we introduce the concept of double quantum integrals for the interval-valued functions of two variables. We offer several new inclusions of the Hermite-Hadamard type for co-ordinated convex interval-valued functions using the newly defined integrals. Moreover, we prove trapezoidal type inequalities for interval-valued functions of two variables using the ideas of the Pompeiu--Hausdorff distance between the intervals. It is also revealed that the results offered in this work are the generalization of several existing results.

Quantitative assessment of the effects of climate change and human activities on runoff is very important for regional sustainable water resources utilization. Determining abrupt changes in runoff could enhance identification of the main driving factors for the sudden changes. In this study, the double mass curves analysis combined with field investigation is used to determine abrupt changes in runoff in two sub-catchments of Upper Yongding River Basin(UYRB), while trend analysis via the traditional Mann–Kendall test for the period 1961–2017 is used to identify the basic trend of precipitation, temperature and potential evapotranspiration(E0). The results suggest an insignificant change in precipitation, a significant increase in temperature and a significant decline in E0 in both sub-catchments. For both of the sub-catchments, abrupt changes in runoff occurred in 1982 and 2003. Both Budyko’s curve and double mass curves are used to evaluate the potential impacts of climate variability and human activities on mean annual streamflow. The results showed that, from the 1960s to the 1980s, runoff declined by 20.01% and 22.28% for Xiangshuibu and Shixiali, respectively; from the 1980s to the 2000s, runoff declined by 68.23% and 67.77% respectively. In the variation stage Ⅰ (1983~2003), human activities contributed 90.6% and 62.7% of the mean annual streamflow change in YRB and SRB, respectively. In the variation stage Ⅱ(2004~2017), human activities contributed 99.5% and 93.5% of the change in YRB and SRB, respectively. It is also noted that the first abrupt decline in runoff was actually at the beginning of China’s land reform, when the land reform motivated farmers to productively manage their reallocated lands, agricultural water consumption therefore increased. The second abrupt change point occurred in 2003, when “Capital water resources planning” implemented including water conservation projects and irrigation district construction. In general, human activities, including soil and water conservation projects and water consumption, are found to be the dominant factors responsible for the significant decline in the annual streamflow in the UYRB over the last six decades.

Atopic dermatitis (AD) is a chronic remitting-relapsing inflammatory skin disorder. Due to the multifactorial pathogenesis, there are numerous therapeutic management approaches, mainly based on symptomatic treatments. In recent years Allergen Immunotherapy (AIT) has been progressively advanced as targeted disease-modifying treatment of allergic disease. The most recent guideline from the American Academy of Dermatology concludes that data available do not support its use in AD. The Joint Task Force and The European Academy of Dermatology suggest that clinicians can consider AIT treatment in selected patients characterized by aeroallergen sensitization, prevalently HDM, severe AD, clinical exacerbation after exposure to the causative allergen. Nevertheless, its role in AD is still under debate, especially in children.

Beasley Lake Watershed is an agriculturally influenced drainage basin in western Mississippi that has been intensively studied for 25 years. As part of the USDA Conservation Effects Assessment Project (CEAP), the watershed has archived hydrology, precipitation, and water quality data in order to measure the effects of multiple USDA Natural Resources Conservation Service conservation practices on lake water quality. The long-term database is available to researchers using a web-based application, Sustaining the Earth’s Watersheds, Agricultural Research Data System (STEWARDS). STEWARDS is a GIS-based data retrieval application that encompasses spatial and temporal data collected from multiple sites within the watershed. This data note describes information located in the STEWARDS Beasley Lake Watershed database, including hydrology, precipitation, and water quality data. This information is valuable to researchers and agencies beyond the USDA as an available and useful database to improve the understanding of how land-use practices affect the water quality of shallow lake systems.

A 16-Year old with Lemierre’s Syndrome and Multiple Septic Pulmonary EmboliChristopher M Oermann, MDDepartment of Pediatrics, Children’s Mercy Kansas City, Kansas City MOCorresponding Author:Christopher M Oermann, MDChildren’s Mercy Kansas City2401 Gillham RoadKansas City, MO 64108816-302-3354 (telephone)816-302-9736 (fax)cmoermann@cmh.eduRunning Head: Pulmonary Septic Emboli in Lemierre SnKey Words: Lemierre Syndrome, Septic EmboliWord Count: 1035To the Editor,Lemierre’s syndrome (LS) is a rare disease resulting from infective thrombophlebitis of the internal jugular vein (JV) following oropharyngeal infection. The incidence of LS has increased after decades of decline. Septic pulmonary emboli (PE) are common, but all organ systems can be involved. Although LS is most often caused byFusobacterium necrophorum , other pathogens have been implicated. Persistent high fever and organ-specific signs and symptoms result from the septic emboli (SE). The diagnosis is often suspected following growth of Fusobacterium from blood cultures and is confirmed by head/neck imaging. Therapy includes antimicrobials, drainage of abscesses, and anticoagulation. Significant morbidity/mortality occur if diagnosis and treatment are delayed. Pediatric pulmonologists must be familiar with the diagnosis and management of LS.A previously healthy 16-year old male was admitted to hospital following two weeks of fever, myalgia, nausea/vomiting/diarrhea with 10-pound weight loss, and dry cough. He had been evaluated by his primary care provider (PCP) ten days prior to admission for pharyngitis and fever of 40oC. Rapid streptococcal antigen and SARS-CoV-2 testing were negative, and he was treated with antipyretics. Continued symptoms led to PCP reevaluation after 7 days. Chest imaging demonstrated a single round pneumonia in the right lower lobe, and he received 3 days of azithromycin. He failed to improve and was referred to the emergency department 3 days later. Computed tomography (CT) of the chest/abdomen/pelvis demonstrated bilateral pulmonary nodules. He was admitted for evaluation and treatment.Considerations from the admitting team included atypical infection (fungal or mycobacterial) versus e-cigarette or vaping product use associated lung injury (EVALI), so Pulmonary Medicine service was consulted. EVALI was thought unlikely based on the radiographic appearance of the lesions (Figure 1). Additional considerations included septic PE, paragonimiasis, autoimmune disease with small vessel vasculitis (polyangiitis with granulomatosis), and inflammatory bowel disease. Evaluation for these potential diagnoses was initiated and empiric therapy with vancomycin and ceftriaxone was commenced. Echocardiogram, infectious diseases testing, and autoimmune evaluation were all normal. Painful swelling in the right, anterior neck and a tender spot on his upper right back developed the day after admission. His blood culture grew gram-negative anaerobic rods, raising concern for LS. Doppler ultrasound of the neck demonstrated occlusive thrombus within the right external JV with extension into the internal JV. Metronidazole was added to his intravenous antimicrobial regimen and anticoagulation therapy was initiated.CT Imaging demonstrated normal CNS with confirmation of thrombosis of the JVs and inflammation over the surrounding soft tissues of the anterior right neck and a large abscess involving the posterior spinal musculature of the upper thorax. A drain was placed, and 25 cc of pus removed. Magnetic resonance imaging of the spine demonstrated extension of the abscess into the T1 spinous process suggesting osteomyelitis. The blood culture grew Fusobacterium necrophorum and antibiotic coverage was changed to ampicillin/sulbactam to treat potential polymicrobial infection. Fevers resolved, pain and other symptoms improved, and the drain was removed after 3 days. He was discharged to continue 6 weeks of ampicillin/sulbactam and anticoagulation therapy.LS is a rare complication of infections of the head/neck, with a reported incidence of one per million people per year.1 Common during the “pre-antibiotic era”, LS had decreased in incidence for decades but has increased since the 1990s. This is possibly due to better antimicrobial stewardship and decreased use of antimicrobials for pharyngitis.1Disease is attributed to infections of the tonsils and peritonsillar tissue in 87% of cases and infections of the pharynx, parotid glands, sinuses, mastoids, middle ears, and teeth/gums in 13%.2 Males and females are equally affected.3 LS has been reported in individuals aged 2 months to 78 years, although it is most commonly reported among previously healthy adolescents and young adults.2,3LS originates with primary infection of the head/neck.4 This is followed by spread of the infection through the soft tissues of the neck resulting in thrombophlebitis of the internal JV. Dissemination of infection via SE occurs, with lung involvement in up to 80% and bones/joints in up to 27%.1-4 Additional sites of infection include cardiovascular, skin/muscles, central nervous system, abdominal organs (liver and spleen), and kidneys. Pulmonary involvement has included septic PE, abscess formation, necrotizing pneumonia, empyema, pneumothorax, pulmonary embolism, and acute respiratory distress syndrome. LS is most often caused by Fusobacterium necrophorum , part of the normal flora of the pharynx, accounting for up to 85%. Additional causes include other Fusobacterium species, anaerobes (Bacteroides , Peptococcus , and Peptostreptococcusspecies), and aerobes (Streptococcus , and Staphylococcusspecies), among others. Polymicrobial infections are reported in up to 30%.2 Significant morbidity results from delayed diagnosis. Mortality has been reported as 4-18%; more recent reviews suggest a lower rate.3,5LS often presents 4-12 days after the initiating oropharyngeal infection, which may have resolved by presentation. Symptoms include high fever (up to 80%), gastrointestinal (50%), pharyngitis with cervical adenopathy or neck pain/swelling, myalgia/arthralgia, rigors, and respiratory symptoms (cough or dyspnea).1,2,5Additional symptoms may be secondary to organ dysfunction caused by SE. Diagnosis is often made via Doppler ultrasound or CT imaging of the head/neck or the growth of Fusobacterium from blood/abscess cultures.Therapy for LS involves long term, intravenous antibiotics, surgical drainage of abscesses, and anticoagulation.1-5Metronidazole is often reported as standard therapy for LS. Other antibiotic considerations include carbapenems or penicillin/beta-lactamase inhibitor combinations, which provide broader coverage for polymicrobial infections. Duration of therapy is 4-6 weeks, allowing for adequate penetration of thrombi and treatment of secondary problems such as osteomyelitis. Anticoagulation therapy is more controversial; some data suggest that anticoagulation hastens overall response while others indicate adequate clinical response without additional therapy.LS is a rare disorder of the head/neck that may be associated with significant morbidity/mortality if diagnosis and treatment are delayed. Pediatric pulmonologists will typically encounter LS in patients hospitalized with prolonged fever and multiple septic PE. LS must be considered in every child with multiple cavitary nodules identified on chest imaging. This is particularly true if there is a history of preceding oropharyngeal infection or signs/symptoms suggesting pathology in the head/neck. The growth of Fusobacterium species from blood culture or abscesses should also suggest LS. Doppler ultrasound examination of the neck and CT imaging of the head/neck should be obtained. Therapy is long-term, intravenous antibiotics. Adjuvant therapy includes surgical incision and drainage of abscesses and anticoagulation therapy.

Sanjiang Plain is the largest area of freshwater wetland in China. Due to agricultural development, a large volume of groundwater in this area has been extracted over the last few decades, resulting in wetland degradation. In order to provide information for the development and protection of wetland ecosystem, investigations examining processes of wetland degradation are important. The aim of this work is to assess the impacts of wetland degradation on the communities of soil microbial community under four different types of degradation wetland including swamp meadow (SW), meadow wetland (MW), paddy farmland (PF), and cropland (CL) in Sanjiang Plain. Using both 16S and ITS rRNA gene amplicon sequencing to evaluate the fungal and bacterial diversity and composition. The dominant fungal phyla and bacterial were Ascomycota and Proteobacteria in this study, respectively. In addition, wetland degradation remarkably augmented the partial affluence of Chloroflexi and Gemmatimonadetes, but the partial affluence of Proteobacteria and Verrucomicrobia significantly diminished. Bacterial Shannon index of SW was lower than those in other sites. While, fungal diversity had no significant differences under different types of degradation wetland. Along with the wetland degradation, such differential reactions of the dominant phyla microbial and diversity were notably coordinated with TP, TK, AK, and SOM, which were the most essential criteria influencing the soil microbial communities. Generally, these outcomes suggested that wetland degradation could result in variations in soil microbial community composition structure. These changes could be used as an early warning signal for the degradation wetland in Sanjiang Plain.

Heterotopic pregnancy (HP) is a rare event of ectopic pregnancy after natural pregnancy or assisted reproductive technology (ART) procedures, and its pathophysiologic mechanisms have not been clarified. Moreover, it is difficult to diagnose an HP due to the rarity and the asymptomatic nature. Here we present a case of an unexplained infertility woman following in vitro fertilization - embryo transfer (IVF - ET) developed HP — intrauterine pregnancy and tubo - ovarian pregnancy, and managed conservatively by laparoscopic. HP after ART represents an emergency and therefore the intrauterine pregnancy and the fertility potential will be better preserved by improved sonographic imaging and experienced surgical hands.

Acute aortic dissection is the most challenging, life-threatening condition and requires prompt diagnosis and management. However about one-third of patients with type A acute aortic dissection (TAAAD) die within 24 hours, 50% within 48 hours and 95% die within first month. [1] Futhermore aortic dissection complicate with malperfusion syndrome is a devastating condition. Acute myocardial infarction within the TAAAD is the most fatal situation and occurs in about 1-2% of cases.[2] A total coronary artery avulsion is somewhat rare event in setting of TAAAD specially when it’s asymptomatic. the authors describe a case of a young man who underwent aortic root surgery and aortic arch replacemente for aortic type A dissectioc with complete right coronary artery avulsion completely asintomatic at presentation.

A 38-year-old female with severe septic shock and multiorgan failure secondary to MDR-ESBL E. coli secondary to septic abortion. She had a miscarriage at 22 weeks of gestation after IVF pregnancy, complicated by cervical tear, developed ARDS, required ventilation, ECMO and CRRT. She had an ECMO cannula induced tear in the right internal jugular vein 1 cm before joining the subclavian vein to form the innominate vein. She had a cardiac arrest after extracorporeal membrane oxygenation (ECMO) institution, required resuscitation. The iatrogenic Rt Internal jugular vein tear was managed in the cardiac operating room. She was well managed by a multidisciplinary team in the ICU and after a prolonged ICU stay, she was discharged to home.

Introduction: Labour is one of the most exciting and important events of woman’s life, but often is accompanied by fear related to childbirth. Objective: To assess the effectiveness of doula care on level of anxiety among labouring mothers. Design: Quasi-experimental Setting: CLR, Nehru Hospital, PGIMER, Chandigarh. Sample: 120 labouring mothers Methods: Tools used for data collection was interview schedule composed of socio-demographic and obstetrical profile and state and trait anxiety inventory used for the assessment of anxiety level. The Level of anxiety was assessed in the experimental group after implementing the doula care (psychological support by doula as a birth companion, effleurage massage, breathing exercises, and positioning) and in the control group after giving routine care. Main outcome: level of anxiety Results: The pre-test showed no difference in anxiety level among both the groups. (p>0.05). In the post-test there was significantly low anxiety level in experimental group as compared to control group as shown by Mann-Whitney and Wilcoxon Test (p<0.05). Conclusion It is concluded that doula care is effective in reduction of anxiety during labour. Keywords: Doula, Doula care, Intra-natal period, effleurage massage. Clinical trial registry – India, ctri.nic.in/clinicaltrials/login.php. (CTRI/2019/07/020367)

We describe a case of ICM implantation in a 74-year-old woman with SIT and ESUS for detection of AF. ICM implantation was performed successfully without any complications. AF was detected at 28 days after ICM insertion. ICMs can be safely implanted in patients with SIT, allowing successful detection of AF.

Tracheal stenosis can be a disastrous consequence of prolonged endotracheal intubation. In the COVID-19 era, vigilance must be maintained not to overlook this complication.