Effusion Rate Research Articles

Chest drainage after oesophageal resection: A systematic review.

Modern enhanced recovery protocols discourage drain use due to negative impacts on patient comfort, mobility, and recovery, and lack of proven clinical benefit. After oesophagectomy, however, drains are still routinely placed. This review aimed to assess the evidence for, and how best to use chest drains after oesophageal surgery. A systematic literature search was performed in Medline, Embase and Cochrane collaboration databases. Studies reporting outcomes for different types or uses of thoracic drainage, or outcomes related to drains after trans-thoracic oesophagectomy were included. Studies were collated into domains based on variations in number, position, type, removal criteria, diagnostic use and complications of drains. Methodological quality was assessed with Newcastle-Ottawa and Jadad scores. Among 434 potentially relevant studies, 27 studies met the inclusion criteria and these included 2564 patients. Studies that examined the number of drains showed pain reduction with a single drain compared to multiple drains (3 studies, n = 103), and transhiatal placement compared to intercostal (6 studies, n = 425). Amylase levels may aid diagnosis of anastomotic leak (9 studies, n = 888). Narrow calibre Blake drains may effectively drain both air and fluid (2 studies, n = 163). Drain removal criteria by daily drainage volumes of up to 300mL did not impact subsequent effusion rates (2 studies, n = 130). Complications related directly to drains were reported by 3 studies (n = 59). Available evidence on the impact of thoracic drainage after oesophagectomy is limited, but has the potential to negatively affect outcomes. Further research is required to determine optimum drainage strategies.

714 UTILITY, TECHNIQUES, AND OUTCOMES FOR THORACIC DRAINAGE AFTER OESOPHAGECTOMY: A SYSTEMATIC REVIEW

Abstract The routine use of post-operative drains in surgery continues to evolve as part of modern practices. Modern enhanced recovery protocols eschew using abdominal drains due to their impact on patient comfort, mobility, and recovery. This change in practice has not applied to thoracic drainage after oesophagectomy, where one or multiple drains are routinely placed. The aim of this study was to determine the evidence for, and how best to use drains during oesophageal surgery. Methods A systematic literature search was performed in Medline, Embase and Cochrane collaboration databases until Jan 25th, 2021. All studies which compared outcomes for different types or uses of thoracic drainage, or reported outcomes directly related to chest drains in oesophageal surgery were included. Studies were collated into domains based on variations in number, position, type, removal criteria, diagnostic use and complications of drains. Methodological quality was assessed by the Newcastle-Ottawa and Jadad Scores. Results 28 studies met the inclusion criteria. Four studies compared drain numbers, three showed similar outcomes and pain reduction using one. A single study showed that another, ‘anastomotic drain’ aided diagnosis and reduced leak mortality. Transhiatal drains had less pain and similar outcomes compared to intercostal drains. Drain fluid amylase aids leak diagnosis, however, accuracy requires drains to remain for 6 days. Removal of drains with daily volumes of less than 300 mL did not impact effusion rate. Complications can arise from drains with a 7% chance of drains migrating into the lumen of a leak and a risk of drain-site metastasis. Conclusion Drain use is a small facet of oesophageal surgery that can have a significant impact on outcomes. There is no evidence for non-drain use. A single transhiatal drain reduces pain without impacting on outcomes. Drains can have a role in diagnosing and managing anastomotic leaks, however, to be accurate drains have to stay in situ for longer. This extends patients discomfort and moves away from ERP trends and other surgical specialities.

Clinical Characteristics and Outcomes of Hypertensive Patients Infected with COVID-19: A Retrospective Study.

BackgroundHypertension has been reported as the most prevalent comorbidity in patients with coronavirus disease 2019 (COVID-19). This retrospective study aims to compare the clinical characteristics and outcomes in COVID-19 patients with or without hypertension.MethodsA total of 944 hospitalized patients with laboratory-confirmed COVID-19 were included from January to March 2020. Information from the medical record, including clinical features, radiographic and laboratory results, complications, treatments, and clinical outcomes, were extracted for the analysis.ResultsA total of 311 (32.94%) patients had comorbidity with hypertension. In COVID-19 patients with hypertension, the coexistence of type 2 diabetes (56.06% vs 43.94%), coronary heart disease (65.71% vs 34.29%), poststroke syndrome (68.75% vs 31.25%) and chronic kidney diseases (77.78% vs 22.22%) was significantly higher, while the coexistence of hepatitis B infection (13.04% vs 86.96%) was significantly lower than in COVID-19 patients without hypertension. Computed tomography (CT) chest scans show that COVID-19 patients with hypertension have higher rates of pleural effusion than those without hypertension (56.60% vs 43.40%). In addition, the levels of blood glucose [5.80 (IQR, 5.05–7.50) vs 5.39 (IQR, 4.81–6.60)], erythrocyte sedimentation rate (ESR) [28 (IQR, 17.1–55.6) vs 21.8 (IQR, 11.5–44.1), P=0.008], C-reactive protein (CRP) [17.92 (IQR, 3.11–46.6) vs 3.15 (IQR, 3.11–23.4), P=0.013] and serum amyloid A (SAA) [99.28 (IQR, 8.85–300) vs 15.97 (IQR, 5.97–236.1), P=0.005] in COVID-19 patients with hypertension were significantly higher than in patients without hypertension.ConclusionIt is common for patients with COVID-19 to have the coexistence of hypertension, type 2 diabetes, coronary heart disease and so on, which may exacerbate the severity of COVID-19. Therefore, optimal management of hypertension and other comorbidities is essential for better clinical outcomes.

Contemporaneous Comparison of Outcomes Among Patients Implanted With a Leadless vs Transvenous Single-Chamber Ventricular Pacemaker

The safety and efficacy of leadless VVI pacemakers have been demonstrated in multiple clinical trials, but the comparative performance of the device in a large, real-world population has not been examined. To compare patient characteristics and complications among patients implanted with leadless VVI and transvenous VVI pacemakers. The Longitudinal Coverage With Evidence Development Study on Micra Leadless Pacemakers (Micra CED) is a continuously enrolling observational cohort study evaluating complications, utilization, and outcomes of leadless VVI pacemakers in the US Medicare fee-for-service population. Patients implanted between March 9, 2017, and December 1, 2018, were identified and included. All Medicare patients implanted with leadless VVI and transvenous VVI pacemakers during the study period were enrolled. Patients with less than 12 months of continuous enrollment in Medicare prior to leadless VVI or transvenous VVI implant and with evidence of a prior cardiovascular implantable electronic device were excluded, leaving 5746 patients with leadless VVI pacemakers and 9662 patients with transvenous VVI pacemakers. Data were analyzed from May 2018 to April 2021. Medicare patients implanted with leadless VVI pacemakers or transvenous VVI pacemakers. The main outcomes were acute (30-day) complications and 6-month complications. Of 15 408 patients, 6701 (43.5%) were female, and the mean (SD) age was 81.0 (8.7) years. Compared with patients with transvenous VVI pacemakers, patients with leadless VVI pacemakers were more likely to have end-stage kidney disease (690 [12.0%] vs 226 [2.3%]; P < .001) and a higher mean (SD) Charlson Comorbidity Index score (5.1 [3.4] vs 4.6 [3.0]; P < .001). The unadjusted acute complication rate was higher in patients with leadless VVI pacemakers relative to transvenous VVI pacemakers (484 of 5746 [8.4%] vs 707 of 9662 [7.3%]; P = .02). However, there was no significant difference in overall acute complication rates following adjustment for patient characteristics (7.7% vs 7.4%; risk difference, 0.3; 95% CI, -0.6 to 1.3; P = .49). Pericardial effusion and/or perforation within 30 days was significantly higher among patients with leadless VVI pacemakers compared with patients with transvenous VVI pacemakers in both unadjusted and adjusted models (unadjusted, 47 of 5746 [0.8%] vs 38 of 9662 [0.4%]; P < .001; adjusted, 0.8% vs 0.4%; risk difference, 0.4; 95% CI, 0.1 to 0.7; P = .004). Patients implanted with leadless VVI pacemakers had a lower rate of 6-month complications compared with patients implanted with transvenous VVI pacemakers (unadjusted hazard ratio, 0.84; 95% CI, 0.68-1.03; P = .10; adjusted hazard ratio, 0.77; 95% CI, 0.62-0.96; P = .02). In this study, despite significant differences in patient characteristics, patients in whom a leadless pacemaker was implanted were observed to have higher rates of pericardial effusion and/or perforation but lower rates of other device-related complications and requirements for device revision at 6 months. Understanding the benefits and risks associated with leadless VVI pacemakers compared with transvenous VVI pacemakers can help clinicians and patients make informed treatment decisions.

Usefulness of neutrophil-to-lymphocyte ratio for predicting acute pericarditis outcomes

Background In daily practice, C-reactive protein (CRP) may be used to predict recurrence and treatment response in patients with acute pericarditis; however, the predictive role of CRP might be insufficient for clinical prediction in some patients. In this study, we aimed to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR) and the composite endpoint of pericarditis recurrence and/or tamponade within 1 year in patients with acute pericarditis. Methods A total of 104 patients diagnosed with acute idiopathic pericarditis (mean age 42.8 ± 15.2 years, 55.8% male) were included in the study. Physical examination findings of these patients, electrocardiography, echocardiography, chest X-ray and laboratory findings were evaluated and analysed. During the 1-year follow-up, the composite of cardiac tamponade and/or pericarditis recurrence was investigated as the primary endpoint of the study. Results Compared to the group without the composite outcome, the group with the composite outcome had significantly higher rates of moderate and severe pericardial effusion (p < 0.01) and higher white blood cell (WBC) count (p:0.001), platelet count (p = 0.003), NLR (2.14 (1.49–3.02) vs 6.60 (5.50–8.68); p < 0.001) and high-sensitivity C-reactive protein (hs-CRP) (8.01 (5.1–24.5 vs 69.5 (40.8–128); p:0.001). Higher hs-CRP (p < 0.001), WBC (p:0.001), NLR (p < 0.001) and platelets (p:0.02) were associated with pericarditis recurrence. NLR and hs-CRP were independently associated with the composite endpoint (p < 0.001 and p < 0.001, respectively). Conclusion NLR and hs-CRP were found to be independent predictors for the composite endpoint of tamponade and/or recurrence in acute pericarditis patients during the 1-year follow-up. Similar to hs-CRP, NLR may also be used for risk assessment in patients with idiopathic pericarditis.

COVID-19 in Egypt after a year: the first and second pandemic waves from the radiological point of view; multi-center comparative study on 2000 patients

BackgroundOne year has passed since the announcement of COVID-19 as a pandemic and two waves had already stricken Egypt. The authors witnessed several atypical radiological features through the second pandemic wave, either early at the active infective stage or delayed at the post-infectious convalescent period. They believed every radiologist should be familiar with these features. Therefore, they performed this comparative study on 2000 Egyptian patients using multi-slice computed tomography (MSCT) to highlight the radiological differences between the first and second pandemic waves and correlate them to the clinical status.ResultsThis random multi-center comparative study was retrospectively conducted on 2000 COVID-19 Egyptian patients; 1000 patients were registered at the first pandemic wave from April 2020 till September 2020, while the other 1000 patients were registered at the second pandemic wave from October 2020 till March 2020. Follow up CT examinations were performed for 49 and 122 patients through the first and second pandemic waves respectively. MSCT examinations were carefully evaluated by four expert consulting radiologists who came to a consensus. Meanwhile, the correlation with the clinical outcome was performed by two consulting pulmonologists. During the second pandemic wave, the prevalence rate of the “crazy-paving” pattern had significantly increased by 1.3 times (P value = 0.002). Additionally, the prevalence rate of the “air-bubble” sign had significantly increased by 1.9 times (P value = 0.02). Similarly, the presence of enlarged mediastinal lymph nodes (> 1 cm in short-axis diameter) had significantly increased by 1.7 times (P value = 0.036). Furthermore, the prevalence rate of pericardial effusion had significantly increased by 2.5 times (P value = 0.003). The above-mentioned signs were correlated to increased clinical severity and higher rates of hospitalization. Unexpectedly, other atypical radiological signs were only encountered through the second pandemic wave, including bronchiectatic changes (2.5%), “head-cheese” pattern (0.8%), cavitation (0.5%), and “bulls-eye” sign (0.2%). The prevalence rate of post-COVID fibrosis had doubled through the second wave but not in a significant way (P value = 0.234). Secondary fungal infection was only encountered throughout the second pandemic wave in four patients. COVID-19 reinfection was encountered in a single patient only during the second pandemic wave.ConclusionAfter 1 year from the announcement of COVID-19 as a pandemic, the radiological presentation of COVID-19 patients showed some significant differences between its first and second waves.

Diagnostic value of different color ultrasound diagnostic method in endometrial lesions

BACKGROUNDEndometrial lesions include endometrial cancer and inferior fibroids. Among them, endometrial cancer as a malignant tumor seriously endangers the life and health of patients. Ultrasonography is an important means of diagnosing female reproductive system diseases, and it is of critical value for the early diagnosis of endometrial cancer. However, different ultrasound inspection programs have achieved different results. It is of great significance to choose a suitable inspection program.AIMTo explore the diagnostic efficacy of different ultrasonic examination methods in clinical endometrial lesions.METHODSThe 140 patients with endometrial lesions who were treated in our hospital from April 2018 to October 2019 were used as the research subjects. All patients underwent transvaginal color ultrasound and transabdominal color ultrasound. We compared the diagnostic coincidence and image display effects of the two different examination methods, and the endometrial thickness, blood flow, uterine effusion and resistance index of different diseases were observed by transvaginal color ultrasound.RESULTSThe diagnostic coincidence rate of all types of diseases of transvaginal color ultrasound was significantly higher than that of transabdominal color ultrasound (P = 0.001, 0.005, 0.001 and 0.001). In addition, the excellent and good rate of image display of transvaginal color ultrasound was higher than that of transabdominal color ultrasound (P = 0.001). There were significant differences in endometrial thickness in patients with different types of endometrial lesions through the transvaginal color examination (P = 0.001). The incidence rate of uterine effusion in patients with endometrial carcinoma was significantly higher than that in patients with other types of endometrial lesions (P = 0.001), and the rate of the blood flow was the highest (P = 0.001). The comparison of blood flow resistance index indicated that the blood flow resistance index in endometrial cancer patients was the lowest, which shows that the difference was statistically significant (P = 0.001).CONCLUSIONThe overall diagnostic efficacy of transvaginal color ultrasound in the clinical diagnosis of endometrial lesions is better than that of transabdominal color ultrasound, which held higher diagnostic coincidence rate and image display effect. There were significant differences in the thickness of the endometrium and the blood flow in different types of lesions.

Safety and efficacy of ultrasound-guided low-pressure perfusion mini-percutaneous nephrolithotomy in children aged 1-7years: a retrospective observational study.

This article analyzed the safety and efficacy of ultrasound-guided mini-percutaneous nephrolithotomy (MPCNL) with low-pressure perfusion for the treatment of upper urinary tract stones in children. The clinical data of 690 patients (805 renal units) aged 1-7years were retrospectively analyzed in terms of postoperative outcome. The mean patient age was 3.7 ± 1.6years, and the stone burden was 2.8 ± 2.1 cm2. A middle posterior calyceal puncture was created in 719 (89%) renal units, and 16F puncture tracts were the most common method used in 557 (69%) renal units. The stone-free rate was 711 (88%) renal units, and the mean operation time was 35 ± 15.3min (between 15 and 110min). Among all cases, the transfusion rate was 4 (0.6%) patients, and the mean decrease in hemoglobin was 1.3 ± 0.9g/L. In addition, the incidence rates of fever, sepsis, perirenal effusion, and intraperitoneal effusion were 40 (5.9%), 3 (0.4%), 28 (4.1%), and 8 (1.2%) patients, respectively. After the operation, 348 patients were followed-up for 32.8 ± 11.3months, and stone recurrence occurred in 136 (39%) of 348 patients. This study suggests that ultrasound-guided MPCNL with low-pressure perfusion technology is a safe and feasible treatment.

Kīlauea's Pu‘u ‘Ō‘ō Eruption (1983–2018): A synthesis of magmatic processes during a prolonged basaltic event

Kīlauea's Pu‘u ‘Ō‘ō eruption was the longest lived (35+ years), and most voluminous (~4.4 km3) and intensely monitored historical eruption of this Hawaiian volcano. A synthesis and update are presented here on the remarkable petrologic and geochemical evolution of lava erupted from its inception on 03 Jan. 1983 to its demise on 01 May 2018. This time-series analysis chronicled mantle and crustal processes that varied during this eruption, which had more than a two-fold lava effusion rate increase. Our frequent sampling of Pu‘u ‘Ō‘ō lava allowed the changes in crustal and mantle process during this single magmatic event to be assessed. New major element, trace element, and Sr isotope data are presented here for the period from 2010 to 2018. These results are combined with our previous geochemical studies to reveal the complex interplay of crustal processes that dominated the eruption's first 500 days. Subsequently, mantle geochemical signatures became discernible as the crustal-stored magma was flushed from the conduit system and replace by new mantle-derived magma. This flushing was possible because of the relatively small size of the summit magma reservoir system compared to the volume of magma erupted at Pu‘u ‘Ō‘ō (≤0.2 vs. 4.4 km3). Parental magma compositions changed rapidly during the eruptionreflecting source heterogeneity in the mantle plume. The depth of melt segregation may have also changed during the eruption. These results demonstrate the importance of systematic temporal sampling during an active eruption.

The petrologic and degassing behavior of sulfur and other magmatic volatiles from the 2018 eruption of Kīlauea, Hawaiʻi: melt concentrations, magma storage depths, and magma recycling

Kīlauea Volcano’s 2018 lower East Rift Zone (LERZ) eruption produced exceptionally high lava effusion rates and record-setting SO2 emissions. The eruption involved a diverse range of magmas, including primitive basalts sourced from Kīlauea’s summit reservoirs. We analyzed LERZ matrix glasses, melt inclusions, and host minerals to identify melt volatile contents and magma storage depths. The LERZ glasses and melt inclusions span nearly the entire compositional range previously recognized at Kīlauea. Melt inclusions in Fo86-89 olivine from the main eruptive vent (fissure 8) underwent 70–170 °C cooling during transport in LERZ carrier melts, causing extensive post-entrapment crystallization and sulfide precipitation. Many of these melt inclusions have low sulfur (400–900 ppm) even after correction for sulfide formation. CO2 and H2O vapor saturation pressures indicate shallow melt inclusion trapping depths (1–5 km), consistent with formation within Kīlauea’s Halemaʻumaʻu and South Caldera reservoirs. Many of these inclusions also have degassed δ34S values (− 1.5 to − 0.5‰). Collectively, these results indicate that some primitive melts experienced near-surface degassing before being trapped into melt inclusions. We propose that decades-to-centuries of repeated lava lake activity and lava drain-back during eruptions (e.g., 1959 Kīlauea Iki) recycled substantial volumes of degassed magma into Kīlauea’s shallow reservoir system. Degassing and magma recycling from the 2008–2018 Halemaʻumaʻu lava lake likely reduced the volatile contents of LERZ fissure 8 magmas, resulting in lower fountain heights compared to many prior Kīlauea eruptions. The eruption’s extreme SO2 emissions were due to high lava effusion rates rather than particularly volatile-rich melts.

Clinical significance of myocardial involvement in acute idiopathic pericarditis

Acute idiopathic pericarditis (AIP) is frequently accompanied by myocardial involvement (AIPM). Although in acute myocarditis, the myocardial inflammation can lead to life-threatening complications, the outcome of patients with AIPM has been described as good. It remains unclear if a good prognosis of patients with AIPM reflects mild myocardial involvement or good medical management. A retrospective analysis of life-threatening complications and life-saving interventions in a cohort of 248 consecutive patients admitted to a single medical center between 2006 and 2017 with AIP (n = 169) or AIPM (n = 79). Major adverse cardiac events (MACE) included cardiac tamponade, cardiogenic shock, ventricular tachycardia, pericardiocentesis, pericardiectomy, large pericardial effusion and death. Patients with AIPM were younger than patients with AIP (p < 0.001), and more often had left ventricular dysfunction (31.6% vs. 1.2%, p < 0.001) and less often had large pericardial effusion (1.3% vs. 13.6%, p = 0.002), and MACE (5.1% vs. 14.8%, p = 0.014). Cardiac tamponade occurred in 5.3% of the patients with AIP as opposed to 1.3% of the patients with AIPM (p = 0.176). Severe left ventricular dysfunction with cardiogenic shock occurred exclusively among patients with AIPM but the rate was low (2.5%). Life-saving interventions were used in both groups at comparable rates (2.5% vs. 5.3%, p = 0.510). There were no in-hospital deaths. Myocardial involvement in acute pericarditis is associated with a low rate of severe left ventricular dysfunction and cardiogenic shock and a reduced rate of large pericardial effusion, resulting in a lower rate of MACE. Life-saving interventions were used at comparable rates in patients with and without myocardial involvement having excellent survival rates.

A leadless pacemaker in the real-world setting: Patient profile and performance over time

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Medtronic, Inc. OnBehalf Micra Acute Performance EMEA Investigators Background The first in-man implant of the Micra leadless pacemaker occurred in December 2013. While prior trials demonstrated a high implant success rate and favorable safety and efficacy results; whether the patient population and outcomes have changed over time is not well studied. Purpose To characterize the evolution of patient profile and outcomes for patients receiving a leadless pacemaker through the pre-market and post-market environment. Methods Patients undergoing a Micra leadless pacemaker implant attempt from the initial Micra Investigational Device Exemption [IDE] and current Micra studies (Micra post-approval registry [PAR], Micra acute performance [MAP] study) were analyzed. Patient characteristics and pericardial effusions regardless of severity were summarized. Results The 3466 patients included in the analysis underwent a Micra implant attempt and were enrolled during consecutive timeframes: patients from the Micra IDE study (n = 726) underwent a Micra implant attempt from 2013-2015, patients from the PAR (n = 1814) from 2015-2018, and patients from Micra MAP cohort (n = 926) from 2018 – 2020. Implant success was &amp;gt;99.0% in all 3 studies. Median age ranged from 78 – 79 years among the 3 studies without significant difference. There were more patients requiring dialysis in the MAP cohort compared to the PAR or IDE cohorts (10.3%, 7.9%, and 3.9%, respectively; P &amp;lt; 0.001), but fewer patients with congestive heart failure (8.3%, 13.1%, and 18.0%; P &amp;lt; 0.001). Pacing indication was significantly different between the studies, with fewer patients in MAP having an indication of bradyarrhythmia associated with atrial fibrillation (AF) and more having an indication associated with atrioventricular block without AF (P &amp;lt; 0.001). The number of patients considered to be precluded for a transvenous pacemaker implant increased significantly from the initial IDE study to the PAR and MAP studies (6.2%, 23.9%, and 44.1%, respectively, P &amp;lt; 0.001). Implant site placement was mostly apical for the IDE but shifted to mostly septal placement in the PAR and MAP (septal placement: 33.3%, 64.0%, and 79.5%, respectively). The rate of pericardial effusion regardless of severity was 1.79% (n = 13) in the IDE, 0.83% (n = 15) in the PAR, and 0.97% (n = 9) in MAP (figure). Mean pacing thresholds among MAP EMEA patients were low (0.61 ± 0.40V) at implant and remained stable through 12 months (0.62 +/- 0.41V). Conclusion Despite patient differences over time, the Micra leadless pacemaker was implanted with a high success rate and a low perforation rate, in-line with prior reports. Abstract Figure. Pericardial effusion rate by study

Submarine and Subaerial Morphological Changes Associated with the 2014 Eruption at Stromboli Island

Stromboli is an active insular volcano located in the Southern Tyrrhenian Sea and its recent volcanic activity is mostly confined within the Sciara del Fuoco (SdF, hereafter), a 2-km wide subaerial–submarine collapse scar, which morphologically dominates the NW flank of the edifice. In August-November 2014, an effusive eruption occurred along the steep SdF slope, with multiple lava flows reaching the sea. The integration of multisensor remote sensing data, including lidar, photogrammetric, bathymetric surveys coupled with SAR amplitude images collected before and after the 2014 eruption enabled to reconstruct the dynamics of the lava flows through the main morphological changes of the whole SdF slope. Well-defined and steep-sided ridges were created by lava flows during the early stages of the eruption, when effusion rates were high, favoring the penetration into the sea of lava flows as coherent bodies. Differently, fan-shaped features were emplaced during the declining stage of the eruption or in relation to lava overflows and associated gravel flows, suggesting the prevalence of volcaniclastic breccias with respect to coherent lava flows. The estimated volume of eruptive products emplaced on the SdF slope during the 2014 eruption, accounts for about 3.7 × 106 m3, 18% of which is in the submarine setting. This figure is different with respect to the previous 2007 eruption at Stromboli, when a large lava submarine delta formed. This discrepancy can be mainly related to the different elevation of the main vents feeding lava flows during the 2007 eruption (around 400 m) and the 2014 eruption (around 650 m). Besides slope accretion, instability processes were detected both in the subaerial and submarine SdF slope. Submarine slope failure mobilized at least 6 × 105 m3 of volcaniclastic material, representing the largest instability event detected since the 2007 lava delta emplacement.

Maximal voluntary ventilation and forced vital capacity of pulmonary function are independent prognostic factors in colorectal cancer patients: A retrospective study of 2323 cases in a single-center of China.

Preoperative pulmonary function assessment is applied to select surgical candidates and predict the occurrence of postoperative complications. This present study enrolled 2323 colorectal cancer patients. Forced vital capacity (FVC) and maximal voluntary ventilation (MVV) were measured as predicted values. Associations between patient pulmonary function and both prognosis and postoperative complications was analyzed. The value of FVC and MVV optimal cutoff was 98.1 (P < .001) and 92.5 (P < .001), respectively. Low FVC and low MVV were associated with higher rates of postoperative fever (23.8% vs 13.9%, P < .001; 17.8% vs 13.3%, P = .049, respectively) and with higher rates of pneumonia (3.75% vs 1.73%, P = .002; 3.00% vs 1.71%, P = .009, respectively), pleural effusion (3.00% vs 1.57%, P = .033; 3.18% vs 1.42%, P = .006, respectively), and poor patient prognosis (5-year overall survival: 80.0% vs 90.3%, P < .001; 71.7% vs 91.9%, P < .001, respectively). In addition, low FVC was closely related to the higher rate of anastomosis leak (4.31% vs 2.29%, P = .013), low MVV was correlated with the higher rate of uroschesis (2.38% vs 0.65%, P < .001). In subgroup analyses, the predictive value of FVC and MVV in patients with different tumor stage was analyzed. Both low FVC and MVV were independent risk factors for poor prognosis in stage II and III, indicating that low FVC and MVV are predictive of poorer prognosis and higher risk of postoperative complications in colorectal cancer patients.

Effects of bruxism on temporomandibular joint internal derangement in patients with unilateral temporomandibular joint pain: The role of magnetic resonance imaging diagnostics

ABSTRACT Objective This study compared temporomandibular joint (TMJ) magnetic resonance imaging (MRI) findings between bruxism and control groups with unilateral TMJ pain as well as the TMJ MRI findings for the painful and non-painful sides of individuals in the two groups. Methods Clinical and MRI findings of patients seen at Uşak University, Dentistry Faculty, Department of Oral and Maxillofacial Surgery for unilateral TMJ pain between 2017 and 2020 were analyzed. Bruxism was diagnosed based on clinical findings and patient history. The MRI variables were disc/condyle relationship (normal, disc displacement with reduction, or disc displacement without reduction), disc structure (normal and abnormal), condyle degeneration type (normal, moderate, or severe), and joint effusion (absent or present). Pain was recorded based on a visual analog scale (VAS) numbered between 0 and 10. Statistical analyses were performed using IBM SPSS. The data were distributed non-normally according to the results of Kolmogorov–Smirnov tests. The Mann–Whitney U test was used to compare age and VAS. Chi-square tests were used to compare categorical variables. Statistical significance was defined as p < 0.05 Results This study assessed the MRI records of 558 cases of TMJ pain. No significant differences in disc/condyle relation, disc structure, condyle structure, or effusion were observed between the control and bruxism groups (p > 0.05). However, a significant difference in TMJ MRI findings was observed between the painful and non-painful sides of each individual in the control and bruxism groups (p = 0.001, p < 0.001 and p = 0.004, p < 0.001, respectively). Conclusion The results of this study established a relationship between the painful side for each patient and TMJ MRI findings. In particular, individuals with bruxism had a higher rate of TMJ internal derangement and effusion on the painful side.

The use of UAV remote sensing for observing lava dome emplacement and areas of potential lahar hazards: An example from the 2017–2019 eruption crisis at Mount Agung in Bali

Mount Agung (the highest volcano in Bali, Indonesia) began to erupt on November 21, 2017, after having been dormant for 53 years. More than 100,000 people were evacuated within the hazard zone between September 2017 (when the highest volcanic alert was issued) and early 2018. The eruptions continued until June 2019, accompanied by at least 110 explosions. During the eruptive crisis, the observation of the lava dome's emplacement was essential for mitigating the potential hazard. Details of the lava dome growth, including the volumetric changes and effusion rates, provide valuable information about potential eruption scenarios and lahar depositions. In this paper, the essential role of multi-temporal unmanned aerial vehicle (UAV) images in the monitoring of Mt. Agung's lava dome, and in determining the areas of potential lahar hazards during the crisis between 2017 and 2019 is described. A fixed-wing UAV was launched outside the hazard zone to photograph the lava dome on five occasions. Image enhancement, machine learning, and photogrammetry were combined to improve image quality, remove point clouds outliers, and generate digital terrain models (DTMs) and orthoimages. The analysis of the obtained DTMs and orthoimages resulted in qualitative and quantitative data highlighting the changes inside the crater and on the surrounding slopes. These results reveal that, from November 25 to December 16, 2017, the lava dome grew vertically by 126 m and reached a volume of 26.86 ± 0.64 × 106 m3. In addition, its surface experienced a maximal uplift of approximately 52 m until July 2019 with the emergence of a new dome with a volume estimated at 9.52 ± 0.086 × 106 m3. The difference between the DTMs of 2017 and 2019 reveals the total volume of erupted material (886,100 ± 8000 m3) that was deposited on the surrounding slopes. According to the lahar inundation simulation, the deposited material may cause dangerous lahars in 21 drainages, which extend in the north (N), north-east (N-E), south (S), south-east (S-E), and south-west (S-W) sectors of the volcano. This paper presents the use of UAV remote sensing for the production of high-spatial resolution DTMs, which can be used to both observe the emplacement of a lava dome, and to identify areas with potential lahar risk during a volcano crisis.

Effect of Intact Pleura on Early Outcome after Off-Pump Coronary Artery Bypass Grafting

Background: Among the various options of treatment of ischemic heart disease coronary artery bypass grafting (CABG) remains one of the standard modes of revascularization. Coronary artery bypass grafting can be done with or without using cardiopulmonary bypass (CPB). This study was to compare postoperative early (up to 1 month) outcome of intact versus open pleura after off pump coronary artery bypass grafting (OPCAB).&#x0D; Methods: In this study, sixty patients aged 18-70 years admitted in Department of Cardiac Surgery, NICVD who underwent OPCAB were selected for the study sample and divided into two groups. Groups I (n=30) consist of the patients who underwent OPCAB with pleurotomy and Group II (n=30) consists of patients who underwent OPCAB with intact pleura. Outcome of patients including Forced expiratory volume in first second (FEV1) &amp; Forced vital capacity were evaluated.&#x0D; Results: Patients having OPCAB with intact pleura showed lower incidence of atelectasis and pleural Effusion in 2nd postoperative &amp; 5th postoperative day (p&lt;0.05). Lower amount of chest tube drainage and transfusion requirement were observed in group II patients than Group I (530.00 ± 28.97 vs. 485.96±38.62; p&lt;0.05 and 611.23±99.22 vs. 577.93±135.38, p&gt;0.05, respectively). Moreover, higher duration of ventilation were noted in group I (7.50 ± 2.22 vs. 6.30±2.32, p&lt;0.05). Beside these, total duration of ICU stay &amp; hospital stay were significantly higher in patients OPCAB with open pleura (p&lt;0.05).&#x0D; Conclusion: Keeping the pleura intact during OPCAB is significantly associated with low rate of atelectasis and pleural effusion. Clinically, it decreases postoperative amount of blood loss and significantly lowers ICU stay, mechanical ventilation time and hospital stay. Therefore, it can be concluded that intact pleura during OPCAB improves postoperative pulmonary outcomes.&#x0D; Cardiovasc. j. 2021; 13(2): 112-119

Monitoring and forecasting hazards from a slow growing lava dome using aerial imagery, tri-stereo Pleiades-1A/B imagery and PDC numerical simulation

In December of 2017, a lava dome emerged at the Nevados de Chillan volcanic complex in the southern Andean volcanic zone, Chile, at the base of a summit crater excavated by explosions during two preceding years of unrest. This posed a number of potential hazards to the surrounding touristic region, so the eruption was carefully monitored. Structure from Motion techniques were used to generate DEMs from satellite and aerial images, from which several useful measurements could be made. Dome growth was characterised at an unprecedented resolution, allowing for the calculation of discharge rates and effusion rates in near real time. A simple model fit to the distance between the dome and crater rim predicted relatively accurately the arrival of the dome toe at the crater rim and the onset of dome collapse outside the crater. Simulations of the path and extent that potential pyroclastic density currents (PDC) generated by dome collapse would follow showed that PDC were not directly threatening populated areas. Over its life cycle as of August 2019, the dome growth was punctuated by frequent explosions, averaging around 30 per day, one of which generated a minor 600 m long PDC on 13 to 15 of July 2018. There appears to be a positive correlation between explosion frequency and lava dome growth rate suggesting that both explosive and effusive processes can coexist, operating at different timescales but responding to the same driving force. A positive correlation is apparent between dome growth rate and seismic activity such as the frequency of tremor and long-period earthquakes suggesting that these might be used as proxies to estimate effusion rate. Initial lava dome effusion rates of 1730 ± 110 m3/day in January 2018 declined to 100 ± 150 m3/day in June 2019. These growth rates are extremely slow when compared to other lava domes, about 300 to 600 times slower than the lava domes at Mt Unzen (1992) and Mt. St. Helens (1980).

Clinical significance of incidentally detected lead perforations by computed tomography.

Computed tomography (CT) has an established role in detecting perforation of implanted pacemaker and defibrillator leads. The clinical significance of incidental finding of delayed lead perforation remains unclear. The aim of this study was to assess the prevalence of lead perforation as detected by CT in a cohort of patients undergoing transvenous laser lead extraction and characterize the association between finding of incidental lead perforation with periprocedural outcomes. Consecutive patients that underwent chest CT and lead extraction were retrospectively assessed for presence of lead perforation. A total of 143 patients and 348 leads were assessed. The finding of lead perforation was correlated with findings from peri-procedural transesophageal echocardiography (TEE) and outcomes of the lead extraction procedure. Lead perforations (including perforations<5mm and ≥5mm) were detected in 66 (46%) patients and 73 (21%) leads. Lead perforation ≥5mm were less common and detected in 13 (9%) of patients and 14 (4%) of leads. There was no significant difference in the rates of peri-procedural death, cardiac avulsion, cardiac tamponade or post-extraction pericardial effusion in patients with and without lead perforation. Incidental delayed lead perforations detected by CT are common and do not correlate with significant TEE findings or adverse peri-procedural outcomes in patients undergoing lead extraction. Larger studies are needed to further characterize the frequency and safety of these findings.

Earthquakes indicated magma viscosity during Kīlauea's 2018 eruption.

Magma viscosity strongly controls the style (for example, explosive versus effusive) of a volcanic eruption and thus its hazard potential, but can only be measured during or after an eruption. The identification of precursors indicative of magma viscosity would enable forecasting of the eruption style and the scale of associated hazards1. The unanticipated May 2018 rift intrusion and eruption of Kīlauea Volcano, Hawai'i2 displayed exceptional chemical and thermal variability in erupted lavas, leading to unpredictable effusion rates and explosivity. Here, using an integrated analysis of seismicity and magma rheology, we show that the orientation of fault-plane solutions (which indicate a fault's orientation and sense of movement) for earthquakes preceding and accompanying the 2018 eruption indicate a 90-degree local stress-field rotation from background, a phenomenon previously observed only at high-viscosity eruptions3, and never before at Kīlauea4-8. Experimentally obtained viscosities for 2018 products and earlier lavas from the Pu'u 'Ō'ō vents tightly constrain the viscosity threshold required for local stress-field reorientation. We argue that rotated fault-plane solutions in earthquake swarms at Kīlauea and other volcanoes worldwide provide an early indication that unrest involves magma of heightened viscosity, and thus real-time monitoring of the orientations of fault-plane solutions could provide critical information about the style of an impending eruption. Furthermore, our results provide insight into the fundamental nature of coupled failure and flow in complex multiphase systems.