Gastric Ultrasound in the Management of Emergency Department Patients with Upper Gastrointestinal Bleeding: A Case Series and Sonographic Technique.

Background: Gastrointestinal bleeding (GIB) is a common condition in the emergency department (ED) with high incidence and mortality.

Objectives: Very early risk stratification of GIB patients can sometimes be a challenge. The decision to intubate these patients is multifactorial and requires careful consideration.

Cardiac Point-Of-Care Ultrasound: An Emergency Medicine Review.

Cardiac point-of-care ultrasound (POCUS) can make critical diagnoses and monitor the response to interventions. In contrast with consultative echocardiography, cardiac POCUS serves to answer a specific clinical question. This imaging modality can be used to evaluate for left ventricular systolic and diastolic dysfunction, pericardial effusion and tamponade, acute and chronic right ventricular dysfunction, valvular dysfunction, and cardiac activity in cardiac arrest.

Echocardiographic diagnosis and clinical implications of wide-open tricuspid regurgitation for evaluating right ventricular dysfunction in the emergency department.

The tricuspid regurgitation pressure gradient (TRPG) reflects the difference in pressure between the right ventricle and right atrium (ΔP). Its estimation by echocardiography correlates well with that obtained using right-heart catheterization. An elevated TRPG is an important marker for identifying right ventricular dysfunction in both the acute and chronic settings.

Is pulmonary hypertension protective against cardiac tamponade? A systematic review.

The presence of pulmonary hypertension (PH) may affect whether cardiac tamponade physiology develops from a pericardial effusion. Specifically, the increased intracardiac pressure and right ventricular hypertrophy associated with PH would seemingly increase the intrapericardial pressure threshold at which the right-sided chambers collapse. In this systematic review, we examined the impact of PH on the incidence, in-hospital and long-term mortality, and echocardiographic findings of patients with cardiac tamponade.

Aqua-bis-(2,2'-bi-pyridine-κ,')(isonicotinamide-κ)ruthenium(II) bis-(trifluoromethanesulfonate).

In the title complex, [Ru(CHN)(CHNO)(HO)](CFSO), the central Ru atom is sixfold coordinated by two bidentate 2,2'-bi-pyridine, an isonic-otinamide ligand, and a water mol-ecule in a distorted octa-hedral environment with tri-fluoro-methane-sulfonate ions completing the outer coordination sphere of the complex. Hydrogen bonding involving the water mol-ecule and weak π-π stacking inter-actions between the pyridyl rings in adjacent mol-ecules contribute to the alignment of the complexes in columns parallel to the axis.

(2,2'-Bi-pyridine-κ,')(4,4'-dimeth-oxy-2,2'-bipyridine-κ,')palladium(II) bis-(tri-fluoro-meth-anesulfonate).

In the title complex salt, [Pd(CHN)(CHNO)](CFSO), the palladium(II) atom is fourfold coordinated by two chelating ligands, 2,2'-bi-pyridine and 4,4'-dimeth-oxy-2,2'-bi-pyridine, in a distorted square-planar environment. In the crystal, weak π-π stacking inter-actions between the 2,2'-bi-pyridine rings [centroid-to-centroid distances = 3.8984 (19) Å] and between the 4,4'-dimeth-oxy-2,2'-bi-pyridine rings [centroid-to-centroid distances = 3.

Bis[2,6-bis-(benzimidazol-2-yl)pyridine-κ,','']nickel(II) bis-(tri-fluoro-methane-sulfonate) diethyl ether monosolvate.

In the title complex, [Ni(CHN)](CFSO)·(CHCH)O, the central Ni atom is sixfold coordinated by three nitro-gen atoms of each 2,6-bis-(2-benzimidazol-yl)pyridine ligand in a distorted octa-hedral geometry with two tri-fluoro-methane-sulfonate ions and a mol-ecule of diethyl ether completing the outer coordination sphere of the complex. Hydrogen bonding contributes to the organization of the asymmetric units in columns along the axis generating a porous supra-molecular structure. The structure was refined as a two-component twin with a refined BASF value of 0.

Di-chlorido-(4,7-dimeth-oxy-1,10-phenanthroline-κ,')zinc(II).

In the title complex, [ZnCl(CHNO)], the Zn atom is located on a twofold rotation axis and is fourfold coordinated by two chlorido ligands and a bidentate 4,7-meth-oxy-1,10-phenanthroline ligand in a distorted tetra-hedral environment. Weak π-π stacking inter-actions between adjacent 4,7-dimeth-oxy-1,10-phenanthroline rings [centroid-to-centroid distances = 3.5969 (11) and 3.

What echocardiographic findings differentiate acute pulmonary embolism and chronic pulmonary hypertension?

Background: Pulmonary embolism (PE) and pulmonary hypertension (PH) are potentially fatal disease states. Early diagnosis and goal-directed management improve outcomes and survival. Both conditions share several echocardiographic findings of right ventricular dysfunction.

Di-chlorido-(4,4'-dimethyl-2,2'-bi-pyridine-κ ,')zinc(II) aceto-nitrile monosolvate.

In the title complex, [ZnCl(CHN)]·CHCN, the zinc(II) atom is fourfold coordinated by two chloride ligands and a bidentate 4,4'-dimethyl-2,2'-bi-pyridine ligand in a distorted tetra-hedral shape with a mol-ecule of aceto-nitrile sitting in the outer coordination sphere of the complex. π-π stacking inter-actions between the pyridyl rings in adjacent mol-ecules contribute to the alignment of the complexes in columns parallel to the axis.

Diaceto-nitrile-(2,2'-bi-pyridine-κ ,')palladium(II) bis-(tri-fluoro-methane-sulfonate).

In the title complex, [Pd(CHN)(CHCN)](CFSO) or [Pd(bipy)(CHCN)](CFSO), the palladium(II) ion is fourfold coordinated by two aceto-nitrile mol-ecules and a bidentate 2,2'-bi-pyridine ligand in a distorted square-planar geometry.

Di-μ-chlorido-bis-[(2,2':6',2''-terpyridine-κ ,','')copper(II)] bis-(tri-fluoro-methane-sulfonate).

In the centrosymmetric title complex, [CuCl(CHN)](CFOS), the Cu metal center is fivefold coordinated by two chloride ions and three nitro-gen atoms of the terpyridine ligand in a distorted square-pyramidal geometry; two tri-fluoro-methane-sulfonate ions complete the outer coordination sphere. stacking inter-actions between the pyridyl rings in adjacent mol-ecules contribute to the alignment of the complexes in columns along the -axis. This structure represents the first example of a binuclear dication of formula [Cu(terpy)Cl] with tri-fluoro-methane-sulfonate as counter-ions.

Bis(isonicotinamide-κ)silver(I) tri-fluoro-methane-sulfonate aceto-nitrile disolvate.

The central Ag atom of the title salt, [Ag(INAM)](CFSO)·2CHCN, where INAM is isonicotinamide (CHNO), is twofold coordinated by the pyridine N atoms of two isonicotinamide ligands creating a slightly distorted linear mol-ecular geometry. The formation of polymeric chains {[Ag(INAM)]} , held together by discrete hydrogen bonds through the amide group of the INAM ligand leaves voids for non-coordinating aceto-nitrile mol-ecules that inter-act the silver metal center regium bonds.

[1,2-Bis(di-phenyl-phosphan-yl)ethane-κ ,]chlorido-(isonicotinamide-κ)palladium(II) nitrate aceto-nitrile monosolvate.

The Pd central atom in the title complex, [PdCl(CHP)(CHNO)]NO·CHCN or [PdCl(dppe)(INAM)]NO·CHCN, where dppe is 1,2-bis-(di-phenyl-phosphan-yl)ethane and INAM is isonicotinamide, exists in a slightly distorted square-planar environment defined by the two P atoms of the dppe ligand, a chloride ligand and the N atom of the isonicotinamide pyridyl ring. The crystal packing in the structure is held together by hydrogen bonds between the amide of the INAM ligand and the nitrate ions that complete the outer coordination sphere. A mol-ecule of aceto-nitrile is also found in the asymmetric unit of the title complex.

Pericardial tamponade: A comprehensive emergency medicine and echocardiography review.

Introduction: Pericardial tamponade requires timely diagnosis and management. It carries a high mortality rate.

Objective: This review incorporates available evidence to clarify misconceptions regarding the clinical presentation, while providing an in-depth expert guide on bedside echocardiography.

Phytoplankton responses to repeated pulse perturbations imposed on a trend of increasing eutrophication.

While eutrophication remains one of the main pressures acting on freshwater ecosystems, the prevalence of anthropogenic and nature-induced stochastic pulse perturbations is predicted to increase due to climate change. Despite all our knowledge on the effects of eutrophication and stochastic events operating in isolation, we know little about how eutrophication may affect the response and recovery of aquatic ecosystems to pulse perturbations. There are multiple ways in which eutrophication and pulse perturbations may interact to induce potentially synergic changes in the system, for instance, by increasing the amount of nutrients released after a pulse perturbation.

Causal networks of phytoplankton diversity and biomass are modulated by environmental context.

Untangling causal links and feedbacks among biodiversity, ecosystem functioning, and environmental factors is challenging due to their complex and context-dependent interactions (e.g., a nutrient-dependent relationship between diversity and biomass).

Teaching Module on Ultrasound-Guided Venous Access Using a Homemade Gel Model for Fourth-Year Medical Students.

Introduction: Evidence supports an ultrasound-guided approach in patients with difficult vascular access. Prior research on teaching ultrasound-guided intravenous access has included only small groups of first- and second-year medical students.

Methods: We enrolled fourth-year medical students in our teaching module.

Phytoplankton and cyanobacteria abundances in mid-21st century lakes depend strongly on future land use and climate projections.

Land use and climate change are anticipated to affect phytoplankton of lakes worldwide. The effects will depend on the magnitude of projected land use and climate changes and lake sensitivity to these factors. We used random forests fit with long-term (1971-2016) phytoplankton and cyanobacteria abundance time series, climate observations (1971-2016), and upstream catchment land use (global Clumondo models for the year 2000) data from 14 European and 15 North American lakes basins.

Earlier winter/spring runoff and snowmelt during warmer winters lead to lower summer chlorophyll-a in north temperate lakes.

Winter conditions, such as ice cover and snow accumulation, are changing rapidly at northern latitudes and can have important implications for lake processes. For example, snowmelt in the watershed-a defining feature of lake hydrology because it delivers a large portion of annual nutrient inputs-is becoming earlier. Consequently, earlier and a shorter duration of snowmelt are expected to affect annual phytoplankton biomass.

-Poly[[[bis-(aceto-nitrile-κ)(4,4'-dimeth-oxy-2,2'-bi-pyridine-κ ,')copper(II)]-μ-tri-fluoro-methane-sulfonato-κ :'] tri-fluoro-methane-sulfonate].

The central copper(II) atom of the title salt, {[Cu(CFSO)(CHCN)(CHNO)](CFSO)} or [[Cu(CHCN)(diOMe-bpy)(CFSO)](CFSO)] where diOMe-bpy is 4,4'-dimeth-oxy-2,2'-bi-pyridine, CHNO, is sixfold coordin-ated by the N atoms of the chelating bi-pyridine ligand, the N atoms of two aceto-nitrile mol-ecules, and two tri-fluoro-methane-sulfonate O atoms in a tetra-gonally distorted octa-hedral shape. The formation of polymeric chains [Cu(CHCN)(diOMe-bpy)(CFSO)] leaves voids for the non-coordinating tri-fluoro-methane-sulfonate anions that inter-act with the complex through weak hydrogen bonds. The presence of weakly coordinating ligands like aceto-nitrile and tri-fluoro-methane-sulfonate makes the title compound a convenient starting material for the synthesis of novel metal-organic frameworks.