Ventilatory Parameters Measured After One Week of Mechanical Ventilation and Survival in COVID-19-Related ARDS.

Background: Ventilatory parameters measured soon after initiation of mechanical ventilation have limited ability to predict outcome of COVID-19-related ARDS. We hypothesized that ventilatory parameters measured after one week of mechanical ventilation might differ between survivors and non-survivors.

Methods: One hundred twenty-seven subjects with COVID-related ARDS had gas exchange and lung mechanics assessed on the day of intubation and one week later.

Tangential excision (saucerization) of small basal and squamous cell skin cancers with formalin horizontal (en face) comprehensive margin histopathologic evaluation.

Background: Mohs surgery is not appropriate for all skin cancer removals. D&C has an unacceptable recurrence rate of 10-20%. A simple method of skin cancer removal is needed to fill the gap.

COVID-19 vaccines and nanomedicine.

Background: The COVID-19 virus-induced pandemic has been the deadliest pandemic to have occurred in two generations, besides HIV/AIDS. Epidemiologists predicted that the SARS-Cov 2 pandemic would not be able to be brought under control until a majority of the world's population had been inoculated with safe and effective vaccines. A world-wide effort to expedite vaccine development was successful.

Lack of Benefit of Heliox During Mechanical Ventilation of Subjects With Severe Air-Flow Obstruction.

Background: The value of heliox (helium-oxygen mixture) for patients with severe air-flow obstruction is uncertain. The purpose of this study was to determine whether heliox could reduce the degree of hyperinflation and hypercapnia in mechanically ventilated patients with severe air-flow obstruction.

Methods: This was a single-center, prospective observational study conducted in a medical ICU of an academic medical center.

The effect of caffeine on hearing in a guinea pig model of acoustic trauma.

Objective: Caffeine is a widely consumed substance affecting the metabolism of adenosine and cellular metabolism of calcium. Noise also affects these metabolic pathways while inducing hearing loss. The aim of this study was to determine the effect of daily intake of caffeine on hearing loss after an episode of acoustic trauma in guinea pigs.

Use of expiratory change in bladder pressure to assess expiratory muscle activity in patients with large respiratory excursions in central venous pressure.

Background: Expiratory muscle activity may cause the end-expiratory central venous pressure (CVP) to greatly overestimate right atrial transmural pressure.

Methods: We recorded CVP and expiratory change in intra-abdominal pressure (ΔIAP) in 39 patients who had a respiratory excursion in CVP from end-expiration to end-inspiration (CVP(ee)-CVP(ei)) ≥ 8 mmHg. Uncorrected CVP was measured at end-expiration, and corrected CVP was calculated as uncorrected CVP-ΔIAP.

Use of bladder pressure to correct for the effect of expiratory muscle activity on central venous pressure.

Objective: To assess whether subtracting the expiratory change in intra-abdominal (bladder) pressure (Delta IAP) from central venous pressure (CVP) provides a reliable estimate of transmural CVP in spontaneously breathing patients with expiratory muscle activity.

Design And Setting: Prospective observational study in a medical ICU.

Patients: Twenty-four spontaneously breathing patients with central venous and bladder catheters: 18 with no clinical evidence of active expiration (group 1) and 6 with active expiration (group 2).

Hepatic imaging in the 21st century.

Imaging of the liver has progressed rapidly during the past decade with continued advancement of current ultrasound, computed tomography, and magnetic resonance imaging (MRI). Each modality not only has seen refinement enabling better anatomic characterization of disease but also has received strength from the addition of new techniques to its resources. New contrast agents have become available for all modalities and some agents, particularly for MRI, have opened the way for better functional assessment.

Diagnostic value of tissue harmonic imaging compared with conventional sonography.

The purpose of this study was to determine if tissue harmonic imaging (THI) produced diagnostic images more frequently than conventional sonography. A prospective study was performed on 33 patients, to compare the diagnostic value of THI with conventional sonography. Each examination was performed using THI (transmit frequency=2.

Effect of prolongation of expiratory time on dynamic hyperinflation in mechanically ventilated patients with severe asthma.

Objective: To assess the effect of a decrease in respiratory rate on dynamic hyperinflation, as determined by changes in plateau airway pressure, in patients with status asthmaticus whose baseline minute ventilation approximated 10 L/min.

Design: Observational descriptive study.

Setting: Medical intensive care unit.

Panoramic ultrasound of the thyroid.

Panoramic ultrasound is a technical modification of conventional ultrasound that produces images with a large anatomic field of view. Images obtained with this technique display both lobes of the thyroid gland on a single image, and provide an accurate imaging representation of a variety of thyroid disorders. This report describes the use of panoramic ultrasound and presents examples of panoramic ultrasound of the thyroid.

Overestimation of pulmonary artery occlusion pressure in pulmonary hypertension due to partial occlusion.

Objective: To evaluate partial occlusion in patients with pulmonary hypertension with regard to a) the degree to which it leads to overestimation of pulmonary artery occlusion pressure (Ppao) and b) identification of factors that could enhance its recognition.

Design: Observational descriptive study.

Setting: Medical intensive care unit.

A pilot project to study the use of ultrasonography for teaching physical examination to medical students.

The purpose of this study was to study the use of ultrasound as an aid to teaching physical examination. Five medical students were given a 1-week course in ultrasound, and were then assigned to clinical rotations to perform ultrasound and physical examinations on patients. Basic ultrasound skills were assessed by having each student scan the same normal model at the conclusion of the first week and at the conclusion of the project.

Double Orifice Mitral and Tricuspid Valves.

Atrioventricular valve duplication is a rare congenital cardiac anomaly. The anomaly is usually recognized as an incidental finding at autopsy, open heart surgery, or two-dimensional echocardiography. In this article we present the transthoracic and transesophageal presentation of a case of mitral and a case of tricuspid valve duplication.