Logistical Reasons Research Articles

Involving hard-to-reach populations is pivotal for the tailoring and implementation of an epidemiological study in cross-border communities of French Guiana and Suriname.

Hard-to-reach, vulnerable and cross-border populations are often disproportionately affected by communicable diseases. Epidemiological data on viral hepatitis in French Guiana and Suriname are available for urban areas, but not for remote communities. The Maroni River, which separates FG and Suriname, is home to Tribal and Indigenous communities. Reaching these populations is challenging due to logistical constraints, cultural and language barriers, and mistrust of outsiders. We aimed to conduct an epidemiological study of viral hepatitis [Maroni Hepatites Virales (MaHeVi)] in this remote and complex area. Here, we describe the operational hurdles and solutions required to achieve this. We undertook a preliminary assessment of the area with local community leaders and health workers to gain approval of MaHeVi, acceptance of blood sampling, and suggestions for adapting the study to cultural and logistical constraints. Anthropological assessments were conducted through focus groups and interviews with key individuals to assess knowledge, beliefs and risk factors for VH. MaHeVi was well received by the local communities. The approval of the community leaders was crucial for the implementation and acceptance of the study. The main adaptations were hiring community health mediators to overcome cultural and language differences, using blotting paper instead of venipuncture for logistical and acceptability reasons, and adapting communication materials. Careful preparation and tailoring of the communication materials and research protocol have enabled the successful implementation of the study. This process could be replicated in this area and transferred to other complex contexts combining borders, logistical hurdles and populations requiring cultural adaptations.

0421 Synchronous Virtual Cognitive Behavioral Therapy for Insomnia: Preliminary Results of Sleep Pattern Changes among Cancer Survivors

Abstract Introduction For cancer survivors, insomnia is a frequent and distressing concern. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment, yet in-person care can be difficult for cancer survivors to access for a variety of socioeconomic, medical and logistical reasons. In a pilot randomized clinical trial, four, weekly sessions of virtually-delivered, synchronous CBT-I were feasible, acceptable, and seemingly efficacious for reducing insomnia among cancer survivors (vs. an enhanced usual care control). The aim of this secondary analysis was to characterize daily patterns in sleep diary metrics during the intervention phase. Methods Adults who had completed treatment for any non-metastatic cancer and had chronic insomnia (DSM-5 criteria and Insomnia Severity Index score <=15) and were randomized to receive CBT-I completed daily assessments of sleep quality (SQ), total sleep time (TST), time in bed (TIB), sleep efficiency (SE), sleep onset latency (SOL), and waking after sleep onset (WASO) for 21 days (i.e., from Session 1-4). Linear mixed models were used to compute trajectories of change for each sleep metric and -2 log likelihood, AIC, and BIC fit indices. Results Among 20 cancer survivors who received CBT-I (mean age 51.2 ± 17.1 years, 90% female), model fit indices indicated that across sleep metrics, linear growth models provided a better fit to the data than either quadratic or cubic growth models. Significant linear improvement was observed for SQ (B = 0.02, t = 3.60, p < 0.001), SE (B = 0.16, t = 2.01, p = 0.046), and SOL (B = -0.41, t = -2.47, p = 0.01), but not TIB, TST, or WASO (ts < 1.12, ps > 0.26). Conclusion Findings elucidate how sleep may be expected to change over the course CBT-I, in particular for the growing population of cancer survivors seeking virtual care for insomnia. The strengths, limitations, and potential modifications to optimize the intervention across sleep metrics will be discussed. Support (if any) This work was conducted with support from the American Cancer Society (Massachusetts General Hospital Institutional Research Grant, PI: Hall).

Impact of anesthetic management on catheter ablation for premature ventricular complexes: insights during the COVID-19 outbreak.

The influence of divergent anesthesia types during ablation of premature ventricular complexes (PVCs) is not known. While previously performed under general anesthesia (GA) at our institution, these procedures were exclusively performed under local anesthesia (LA) ± minimal sedation during the COVID-19 outbreak for logistic reasons. One hundred and eight consecutive patients (82 GA versus 26 LA) undergoing PVC ablation at our center were evaluated. Intraprocedural PVC burden (over 3 min) pre-ablation was measured twice: (1) at the start (before GA induction) and (2) before catheter insertion (after GA induction). Upon cessation of ablation and after a waiting period of ≥ 15 min, acute ablation success (AAS) was defined as absence of PVCs until the end of the recording period. Intraprocedural PVC burden was not significantly different between LA versus GA group: (1) 17.8 ± 3% vs 12.7 ± 2%, P = 0.17 and (2) 10.0 ± 3% vs 7.4 ± 1%, P = 0.43, respectively. Activation mapping-based ablation was performed significantly more in the LA vs GA group (77% vs 26% of patients, P < 0.001, respectively). AAS was significantly higher in LA vs GA group: 22/26 (85%) vs 41/82 (50%), respectively, P < 0.01. After multivariable analysis, LA was the only independent predictor for AAS (OR 13, 95% CI 1.57-107.4, P = 0.017). Ablation of PVC under LA presented significantly higher AAS rate compared to GA. The procedure under GA might be complicated by PVC inhibition (after catheter insertion/during mapping) and PVC disinhibition post-extubation.

Sauna bathing, renal function and chronic kidney disease: cross-sectional and longitudinal findings from the KIHD study.

It is uncertain if passive heat therapies are associated with adverse renal outcomes. We sought to evaluate the cross-sectional and longitudinal associations of the frequency of sauna bathing with renal function measures and chronic kidney disease (CKD). Baseline self-reported sauna bathing habits were assessed in 2071 men aged 42-61 years with normal kidney function. Baseline estimated glomerular filtration rate (GFR) and serum levels of creatinine, potassium (K) and sodium (Na) were measured, with only 11-year measurements of K and Na 11 years in a random subset of participants due to logistical reasons. Study participants were followed up for CKD diagnosed using KDOQI guidelines, which were collected from the National Hospital Discharge Registry. The associations of frequency of sauna bathing with renal function measures were evaluated using regression analyses. Hazard ratios (HRs) (95% CIs) were estimated for CKD. There were no significant changes in baseline levels of estimated GFR, creatinine and Na comparing 4-7 sauna sessions/week vs 1 sauna session/week; there was a slight increase in K 0.05 mmol/l (95% CI, 0.00, 0.10; p=0.033). There were no significant changes in levels of serum K and Na at 11 years. After 25.7 years overall median follow-up, 188 CKD cases were recorded. Comparing 4-7 sauna sessions/week with 1 sauna session/week, there was no evidence of an association with CKD 0.84 (95% CI, 0.46-1.53; p=.56). Cross-sectional and longitudinal observational evidence suggests that frequent sauna bathing is not associated with impaired renal function or the future risk of CKD.

Instability of fecal glucocorticoid metabolites at 4°C: Time to freeze matters.

The use of fecal corticosteroid metabolites (FCMs) has proven to be well suited to evaluate adrenocortical activity, a major component of the stress response, particularly in wildlife. As with any tools, confounding factors and drawbacks must be carefully considered. Among them, sample preservation and storage are of particular importance, as they can affect stability of FCMs and lead to biased results and interpretations. Arguably, immediate freezing of fecal samples upon collection is the best practice to preserve FCM integrity, however, for logistical reasons, this condition is rarely feasible in the field. It is generally argued that temporary storage of samples at low above-zero temperature is an acceptable way of preserving samples in the field before freezing them for long-term storage. However, to our knowledge, there is no empirical study that demonstrates the stability of fecal metabolites in samples stored at +4°C. In this study, we collected a fresh fecal sample from 20 captive roe deer, each of which was homogenized and split into three subsamples (60 subsamples in total) to investigate the effects on FCMs levels of temporary storage at +4°C for 24 h and 48 h before freezing versus immediate freezing at -20°C after feces collection. Compared to immediate freezing, mean FCMs levels decreased by 25% every 24 h when feces were stored at +4°C before freezing. The variance of FCMs levels followed the same pattern, leading to a clear reduction in the ability to detect biological effects. Minimizing the storage time at +4°C before freezing should therefore be seriously considered when establishing sampling and storage protocols for feces in the field for adequate hormonal profiling.

Machine Learning‐Derived Inference of the Meridional Overturning Circulation From Satellite‐Observable Variables in an Ocean State Estimate

AbstractThe oceanic Meridional Overturning Circulation (MOC) plays a key role in the climate system, and monitoring its evolution is a scientific priority. Monitoring arrays have been established at several latitudes in the Atlantic Ocean, but other latitudes and oceans remain unmonitored for logistical reasons. This study explores the possibility of inferring the MOC from globally‐available satellite measurements via machine learning (ML) techniques, using the ECCOV4 state estimate as a test bed. The methodological advantages of the present approach include the use purely of available satellite data, its applicability to multiple basins within a single ML framework, and the ML model simplicity (a feed‐forward fully connected neural network (NN) with small number of neurons). The ML model exhibits high skill in MOC reconstruction in the Atlantic, Indo‐Pacific, and Southern Oceans. The approach achieves a higher skill in predicting the model Southern Ocean abyssal MOC than has previously been achieved via a dynamically‐based approach. The skill of the model is quantified as a function of latitude in each ocean basin, and of the time scale of MOC variability. We find that ocean bottom pressure generally has the highest reconstruction skill potential, followed by zonal wind stress. We additionally test which combinations of variables are optimal. Furthermore, ML interpretability techniques are used to show that high reconstruction skill in the Southern Ocean is mainly due to (NN processing of) bottom pressure variability at a few prominent bathymetric ridges. Finally, the potential for reconstructing MOC strength estimates from real satellite measurements is discussed.

MACHINA, the Movable Accelerator for Cultural Heritage In-situ Non-destructive Analysis: project overview

Over the years, transportable instrumentation for cultural heritage (CH) in situ measurements has noticeably widespread, due to logistic, economical and safety reasons. Ion beam analysis, a powerful set of analytical techniques, of great importance for CH, is instead carried out by using fixed instrumentation. To overcome this limit, the Italian national Institute of Nuclear Physics (INFN), CERN (European Centre for Nuclear Research) and the Opificio delle Pietre Dure (OPD), started MACHINA, the “Movable Accelerator for CH In-situ Non-destructive Analysis: the new generation of accelerators for art” to build a transportable accelerator, compact, with strongly reduced weight, absorbed power and cost. MACHINA will be installed at the OPD and dedicated to CH. It will be moved to major conservation centres and museums, when needed. The INFN-CERN proposal, approved in December 2017, became operative in February 2018. 2018 was dedicated to the acquisition of material/instrumentations, to set up both a dummy accelerator (to test the vacuum system) and a vacuum chamber (to test the source). Due to COVID, in 2020 and 2021 the experimental work was slowed down, but we kept developing the control electronics/software and built the second-generation supporting structure. The HF-RFQ power supplies were integrated in October 2021. At the rise of 2022, after conditioning the cavities, we tested the system and in March 2022 we got the first extracted 2-MeV proton beam. In this paper, we present the structure of the MACHINA system, the approach followed and the main solutions adopted, with a special focus on the control system, and finally the first experimental results.

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Surgical outcome of a double versus a single pancreatoduodenectomy per operating day

BackgroundFor logistical reasons, some high-volume centers have developed surgical programs wherein 1 surgical team performs 2 pancreatoduodenectomies on a single day. It is unclear whether this practice has a negative impact on surgical outcome. MethodsWe conuducted a retrospective analysis including all consecutive open pancreatoduodenectomies in a single high-volume center (2014–2021). Pancreatoduodenectomies were grouped as the first (pancreatoduodenectomy-1) or second (pancreatoduodenectomy-2) pancreatoduodenectomy on a single day (ie, paired pancreatoduodenectomies) and as pancreatoduodenectomy-3 whenever 1 pancreatoduodenectomy was performed per day (ie, unpaired). Patients undergoing minimally invasive procedures were excluded. The primary outcomes were major morbidity (ie, Clavien-Dindo grade ≥IIIa) and mortality. ResultsAmong 689 patients, 151 patients had undergone minimally invasive pancreatoduodenectomy, leaving 538 patients after open pancreatoduodenectomy for inclusion. The overall rate of major morbidity was 37.4% (n = 200/538) and in-hospital/30-day mortality 1.7% (n = 9/538). Overall, 136 (25.3%) patients were operated in 68 pancreatoduodenectomy-1/ pancreatoduodenectomy-2 pairs and 402 (74.7%) patients as unpaired pancreatoduodenectomy (pancreatoduodenectomy-3). No differences were found between pancreatoduodenectomy-1 and pancreatoduodenectomy-2 regarding the rates of major morbidity (35.3% vs 26.5%; P = .265) and mortality (1.5% vs 0%; P = .999). Between the 68 pancreatoduodenectomy-1/ pancreatoduodenectomy-2 pairs and the 402 unpaired pancreatoduodenectomies, the rates of major morbidity (30.9% vs 39.6%; P = .071) and mortality (0.7% vs 2.0%; P = .461) did not differ significantly. In multivariable logistic regression analysis, pancreatoduodenectomy-1 was not associated with major morbidity (odds ratio = 0.913 [95% confidence interval 0.515–1.620]; P = .756), whereas pancreatoduodenectomy-2 was associated with less major morbidity (odds ratio = 0.522 [95% confidence interval 0.277–0.983]; P = .045). ConclusionIn a high-volume setting, performing 2 consecutive open pancreatoduodenectomies on a single operating day appears to be safe. This approach may be an option when logistically required.

Peripheral Regional Anesthesia Using Local Anesthetics: Old Wine in New Bottles?

During the past decade, numerous efforts were undertaken aiming at prolonging the analgesic effect of regional anesthesia. With the development of extended-release formulations and enhanced selectivity for nociceptive sensory neurons, a very promising contribution to the development of pain medications has been achieved. At present, liposomal bupivacaine is the most popular, non-opioid, controlled drug delivery system, but its duration of action, which is still controversially discussed, and its expensiveness have decreased initial enthusiasm. Continuous techniques can be seen as an elegant alternative for providing a prolonged duration of analgesia, but for logistic or anatomical reasons, they are not always the best choice. Therefore, focus has been directed towards the perineural and/or intravenous addition of old and established substances. As for perineural application, most of these so-called 'adjuvants' are used outside their indication, and their pharmacological efficacy is often not or only poorly understood. This review aims to summarize the recent developments for prolonging the duration of regional anesthesia. It will also discuss the potential harmful interactions and side effects of frequently used analgesic mixtures.

A multi-isotope approach reveals seasonal variation in the reliance on marine resources, production of metabolic water, and ingestion of seawater by two species of coastal passerine to maintain water balance

Tracing how free-ranging organisms interact with their environment to maintain water balance is a difficult topic to study for logistical and methodological reasons. We use a novel combination of triple-oxygen stable isotope analyses of water extracted from plasma (δ16O, δ17O, δ18O) and bulk tissue carbon (δ13C) and nitrogen (δ15N) isotopes of feathers and blood to estimate the proportional contribution of marine resources, seawater, and metabolic water used by two species of unique songbirds (genus Cinclodes) to maintain their water balance in a seasonal coastal environment. We also assessed the physiological adjustments that these birds use to maintain their water balance. In agreement with previous work on these species, δ13C and δ15N data show that the coastal resident and invertivore C. nigrofumosus consumes a diet rich in marine resources, while the diet of migratory C. oustaleti shifts seasonally between marine (winter) to freshwater aquatic resources (summer). Triple-oxygen isotope analysis (Δ17O) of blood plasma, basal metabolic rate (BMR), and total evaporative water loss (TEWL) revealed that ~25% of the body water pool of both species originated from metabolic water, while the rest originated from a mix of seawater and fresh water. Δ17O measurements suggest that the contribution of metabolic water tends to increase in summer in C. nigrofumosus, which is coupled with a significant increase in BMR and TEWL. The two species had similar BMR and TEWL during the austral winter when they occur sympatrically in coastal environments. We also found a positive and significant association between the use of marine resources as measured by δ13C and δ15N values and the estimated δ18O values of ingested (pre-formed) water in both species, which indicates that Cinclodes do not directly drink seawater but rather passively ingest when consuming marine invertebrates. Finally, results obtained from physiological parameters and the isotope-based estimates of marine (food and water) resource use are consistent, supporting the use of the triple-oxygen isotopes to quantify the contribution of water sources to the total water balance of free-ranging birds.

Effect of large-scale mass drug administration for malaria on mortality and morbidity in Angumu health zone, Ituri, Democratic Republic of Congo

BackgroundAngumu health zone in Ituri, Democratic Republic of Congo, is a highly malaria-endemic area with an overburdened health system and hosting internally displaced persons (IDP). The World Health Organization recommends mass drug administration (MDA) for malaria in complex emergencies. Therefore, three MDA rounds were implemented by Ministry of Public Health and Médecins sans Frontières from September 2020 to January 2021 in four health areas selected for epidemiological (high malaria incidence) and logistic reasons. Reported mortality and morbidity were compared in locations where MDA has been performed and locations where it has not.MethodsA non-randomized controlled population-based retrospective mortality survey was conducted in March 2021. Two-stage cluster sampling was used in villages; all IDP sites were surveyed with systematic random sampling. The main (mortality rates) and secondary (morbidity) outcomes were estimated and compared between locations where MDA had been conducted and where it had not, using mixed Poisson and binomial regression models respectively.ResultsData was collected for 2554 households and 15470 individuals, of whom 721 died in the 18-month recall period. The under-five mortality rate (U5MR) decreased in the locations where MDA had been implemented from 2.32 [1.48–3.16] “before” the MDA to 1.10 [0.5–1.71] deaths/10,000 children under 5 years/day “after”, whereas it remained stable from 2.74 [2.08–3.40] to 2.67 [1.84–3.50] deaths/10,000 children/day in the same time periods in locations where MDA had not been implemented. The U5MR and malaria-specific mortality was significantly higher in non-MDA locations after MDA was implemented (aRR = 2.17 [1.36–3.49] and 2.60 [1.56–4.33], respectively, for all-cause and malaria-specific mortality among children < 5 years). Morbidity (all age and < 5 years, all cause or malaria-specific) appeared lower in MDA locations 2.5 months after last round: reported malaria-specific morbidity was 14.7% [11–18] and 25.0% [19–31] in villages and IDP sites where MDA had been implemented, while it was 30.4% [27–33] and 49.3% [45–54] in villages and IDP sites with no MDA.ConclusionsDespite traditional limitations associated with non-randomized controlled retrospective surveys, the documented sharp decrease of under-5 mortality and morbidity shows that MDA has the potential to become an important malaria-control tool in emergency settings. Based on these results, new MDA rounds, along with indoor residual spraying campaigns, have been planned in the health zone in 2022. A set of surveys will be conducted before, during and after these rounds to confirm the effect observed in 2021 and assess its duration.

All for one and one for all: A commentary on centralized ex vivo lung perfusion centers

The rise of ex vivo lung perfusion (EVLP) in modern lung transplantation has created the opportunity to further assess donor lungs, which is particularly useful for logistical reasons or in the case of otherwise discarded organs due to the well-known dilemma of low donor utilization rates in lung transplantation, with figures even as low as 25% acceptance for first-ranked candidates (1). EVLP carries promise for both lung evaluation and preservation. The circuit is also being studied for its potential as a platform of intervention for new treatments (2).

“Delayed hyperbaric oxygen treatment for cerebral gas embolism can still be life-saving” - a case report

Background: Cerebral gas embolism (CGE) is an uncommon and often preventable iatrogenic complication. Any peri-procedural neurological event should raise suspicion of CGE and treatment should start immediately. Hyperbaric oxygen therapy (HBOT) is the treatment of choice and early referral is essential. However, HBOT has been shown to be beneficial with full recovery even after delays as long as 60 hours. This report is written to increase awareness about the recognition and management of this dreaded complication. Case Presentation: We report a case of a patient who suffered a cardiac arrest secondary to CGE during routine coronary angiography followed by a ventriculogram. After successful resuscitation, a review of imaging revealed air in the left ventricle and computed tomography (CT) brain showed parenchymal air locules with surrounding ischemic changes. Neurological examination showed hypertonic reflexes with extensor plantar response and intermittent seizures. Hyperbaric oxygen therapy (HBOT) was arranged but there was a delay of about 14 hours between diagnosis and arrival due to logistical reasons. On arrival, the patient was still having seizures intermittently despite the anti-epileptics and sedative infusions. Seizures stopped within 20 minutes of HBOT initiation and a CT brain done 48 hours later demonstrated mild edema but no residual air. Four more sessions were provided in the following 72 hours. Upon eventual discharge, the patient had a near-full neurological recovery, except for a mild left hemiparesis. Conclusion: Acute neurological symptoms after an invasive procedure, should raise the suspicion of CGE. Early HBOT is the treatment of choice as minutes are equal to saved brain cells. However, delayed treatment can still be lifesaving and should be considered.

Management of osteoporosis during martial law: the experience of the Ukrainian Center of Osteoporosis and the challenges of war

Background. Russian aggression has had a critical impact on the provision of medical care to the patients in Ukraine, in general, and to the patients with osteoporosis and its complications, in particular. Destruction of hospitals, limited access to emergency and planned medical care, and increased workload on some hospitals due to a significant number of refugees and internally displaced persons are only some of the problems faced by the Ukrainian medical community. The purpose of the study was to analyze the peculiarities of providing diagnostic and advisory care at the Ukrainian Scientific and Medical Center of Osteoporosis (Kyiv) during martial law in order to determine the main challenges associated with military aggression and the possibilities of their elimination. Materials and methods. In a retrospective analysis of the data, the Center’s activity during 2019–2022 was evaluated depending on the month and year of the observation, the age and gender of the examinees, and type of the patients’ visit (on-line or off-line). Results. The analysis confirmed the decrease in dual-energy X-ray absorptiometry (DXA) procedures and consultations of various specialists from the beginning of martial law in Ukraine. The resumption of the Center’s work, despite difficulties related to logistical and other reasons, took place after 2 weeks in the on-line format and in 1.5 months after the start of martial law (off-line). Despite the decrease in the number of DXA procedures (by 84.3% in April and 24.7% in May 2022 compared to the indices in the same months in 2019) and off-line consultations (by 93.6% in March, 66% in April, and 11.2% in May 2022 compared to the indices of 2019) during the martial law, the Center’s work was characterized by the implementation of on-line consultations, the share of which in the first months after the russian invasion was 66–100% of all consultations. Conclusions. Well-established work using telemedicine allows maintaining the provision of medical care to the patients with osteoporosis and its complications at an appropriate level despite the challenges associated with martial law.

Correspondence between resident‐ and staff‐report on the QABF: Do justice‐involved youth agree with residential staff?

AbstractResidents in juvenile residential treatment facilities (JRTFs) often display various emotional, behavioral, and educational needs. Researchers have recently developed behavioral interventions to increase residents' appropriate behavior such as cooperation with facility staff instructions, accepting feedback from facility staff, and tolerating unpleasant events. However, there is not a generally accepted tool for assessing the operant function of residents' problem behavior in JRTFs. For various logistical reasons, indirect functional assessments may be more appropriate in a JRTF than manipulating either antecedent or consequent events. This study obtained scores on the Questions About Behavior Function (QABF) assessment for 17 residents from two dormitory staff members for each resident. To increase the number of respondents, each resident completed a QABF for their own behavior. Results revealed moderate to high correspondence (i.e., agreement) for highest and lowest potential operant function of problem behavior between combinations of JRTF staff and residents. These preliminary findings suggest additional research with the QABF in JRTFs is warranted.

Transvaginal ultrasound-guided biopsy in patients with suspicious primary advanced tubo-ovarian carcinoma

ObjectiveTo assess the accuracy of pathological diagnosis by transvaginal ultrasound-guided biopsy versus surgery in patients with suspicious primary advanced tubo-ovarian carcinoma. The Feasibility, adequacy, and safety of the procedure were...

Is logistically motivated ex vivo lung perfusion a good idea?

Ex vivo lung perfusion (EVLP) is a technique for reconditioning and evaluating lungs. However, the use of EVLP for logistical reasons is still under discussion. In this retrospective study, all EVLPs performed between July 2012 and October 2019 were analyzed for ventilation and perfusion data. After transplantation, primary graft dysfunction (PGD), lung function, chronic lung allograft dysfunction (CLAD)-free survival, and overall survival were analyzed. Fifty EVLPs were performed: seventeen logistic EVLPs led to 15 lung transplantations (LT) and two rejections (LR), and 33 medical EVLPs resulted in 26 lung transplantations (MT) and seven rejections (MR). Pre-EVLP PaO2 was lower for MT than LT (p < 0.05). Dynamic lung compliance remained stable in MT and LT but decreased in MR and LR. Plateau airway pressure started at a higher level in MR (p < 0.05 MT vs. MR at T60) and increased further in LR. After transplantation, there were no differences between MT and LT in PGD, lung function, CLAD-free survival, and overall survival. In addition, the LT group was compared with a cohort group receiving standard donor lungs without EVLP (LTx). There were no significant differences between LT and LTx for PGD, CLAD-free survival, and overall survival. FVC was significantly lower in LT than in LTx after 1 year (p = 0.005). We found that LT lungs appear to perform better than MT lungs on EVLP. In turn, the outcome in the LT group was comparable with the LTx group. Overall, lung transplantation after EVLP for logistic reasons is safe and makes transplantation timing controllable.

Bovine milk-based and human milk-based fortification for postnatal weight gain in very preterm neonates—a cohort study

Postnatal growth failure happens in about half of the very low birth weight infants and this can have long-term consequences. Human milk-based multi-nutrient fortifiers (HMBF) are thought to be better tolerated than bovine milk-based multi-nutrient fortifiers (BMBF), thus facilitating early progression to full feeds and improved growth in preterm neonates. This study was done to find the advantage of HMBF over BMBF on postnatal growth and other clinical outcomes. This is a retrospective cohort study where babies <1500 g birth weight or gestational age <32 weeks were included to compare the velocity of weight gain (g/kg/day), duration of hospital stay and clinical outcomes between fortification using HMBF and BMBF till 34 weeks postmenstrual age. Eligible neonates included in the study were 322, out of whom 123 (37%) received HMBF and 209 (63%) received BMBF. During the stay, 18 babies were changed from BMBF to HMBF and vice versa in 24 babies due to logistic reasons and parents' preferences. The mean birth weight of the babies was 1124 ± 237 g. Weight gain was higher in the exclusive HMBF group [mean difference 0.77 (0.14, 1.39) g/kg/day; p-value = 0.018]. Feed intolerance [odds ratio (OR) 0.45 (0.22, 0.95), p-value 0.037] was also significantly less in this group. However, other morbidities did not differ significantly between the groups. Higher weight gain and lower feed intolerance in the HMBF group underscores the possible advantage of using HMBF over BMBF. Larger prospective studies might bring out its effect on the duration of hospital stay and other morbidities.

Initial Treatment of High-Altitude Pulmonary Edema: Comparison of Oxygen and Auto-PEEP

Improvement of oxygenation is the aim in the therapy of high-altitude pulmonary edema (HAPE). However, descent is often difficult and hyperbaric chambers, as well as bottled oxygen, are often not available. We compare Auto-PEEP (AP-Pat), a special kind of pursed lips breathing, against the application of bottled oxygen (O2-Pat) in two patients suffering from HAPE. We compare the effect of these two different therapies on oxygen saturation measured by pulse oximetry (SpO2) over time. In both patients SpO2 increased significantly from 65-70% to 95%. Above 80% this increase was slower in AP-Pat compared with O2-Pat. Therapy started immediately in AP-Pat but was delayed in O2-Pat because of organizational and logistic reasons. The well-established therapies of HAPE are always the option of choice, if available, and should be started as soon as possible. The advantage of Auto-PEEP is its all-time availability. It improves SpO2 nearly as well as 3 L/min oxygen and furthermore has a positive effect on oxygenation lasting for approximately 120 min after stopping. Auto-PEEP treatment does not appear inferior to oxygen treatment, at least in this cross-case comparison. Its immediate application after diagnosis probably plays an important role here.