Minor Scratches Research Articles

Fracture properties of carbon/glass fiber composite laminates with surface scratch damage

Carbon/glass fiber reinforced polymer composite panels may experience minor surface scratches during processing or use. These shallow scratches can expand and potentially lead to dangerous fracture failure as the specimens are continually loaded. This study presents a closed form non-LEFM model for predicting the fracture performance of materials with slight scratches. First, 3-p-b tests and direct tensile tests were conducted on 115 carbon/glass fiber composite laminated panel specimens. A comparison of the two test methods revealed that 3-p-b tests were more suitable for analyzing quasi-brittle fracture in carbon/glass fiber composites. The tensile strength ft and fracture toughness KIC of 3-p-b specimens with and without notched were discussed using the weighted average calculation method to determine the thickness of the “composite” single-layer prepreg as the characteristic composite unit Cch. A normal distribution method was also introduced to analyze the experimental discrete points, covering almost all the experimental scatterers with desired reliability. Furthermore, the same method was applied to specimens with different layup methods, and the data analysis confirmed its effectiveness. As the seam-thickness ratio α increases within a certain range, the tensile strength ft showed an overall increasing trend and the peak load Pmax showed a decreasing trend. Additionally, the laboratory routine dimensions can be utilized to efficiently predict the fracture of large size members with defects at the same thickness, which is significant for the safe design of composite structures.

Use of a silicone shield to protect the optical cylinder following osteo- and osteo-odonto-keratoprosthesis (O/OKP) procedures.

To describe the placement of a silicone shield to protect the optical cylinder following osteo-keratoprosthesis or osteo-odonto-keratoprosthesis (O/OKP) procedures in four patients. In this retrospective observational study, we reviewed all patients who underwent O/OKP in our tertiary medical centre. We found four patients in whom a protective cellphone silicone shield (VisionGuard+, Zagg, Utah, USA) was cut with a 3 mm dermal punch and placed on the polymethyl methacrylate (PMMA) optical cylinder of an O/OKP 3-4 months after implantation to either correct or prevent abrasions. The first patient presented with a severely abraded OOKP optic that reduced BCVA from 6/6 to 6/20. The shield smoothed the optical surface and filled minor scratches, leading to BCVA improvement to 6/9. In the subsequent three patients, the optic was relatively clear, and the shield was used as a preventive measure. In two patients, the shield fell off after a few weeks and was replaced. Placing a protective silicone shield on the optical cylinder of an O/OKP can prevent permanent abrasions and, in an already scratched polymethyl methacrylate (PMMA) optic cylinder, improve vision by smoothing the surface. This intervention can be clinically significant, considering that the optical cylinder cannot be removed after implantation.

TGF-β-Based Therapies for Treating Ocular Surface Disorders.

The cornea is continuously exposed to injuries, ranging from minor scratches to deep traumas. An effective healing mechanism is crucial for the cornea to restore its structure and function following major and minor insults. Transforming Growth Factor-Beta (TGF-β), a versatile signaling molecule that coordinates various cell responses, has a central role in corneal wound healing. Upon corneal injury, TGF-β is rapidly released into the extracellular environment, triggering cell migration and proliferation, the differentiation of keratocytes into myofibroblasts, and the initiation of the repair process. TGF-β-mediated processes are essential for wound closure; however, excessive levels of TGF-β can lead to fibrosis and scarring, causing impaired vision. Three primary isoforms of TGF-β exist-TGF-β1, TGF-β2, and TGF-β3. Although TGF-β isoforms share many structural and functional similarities, they present distinct roles in corneal regeneration, which adds an additional layer of complexity to understand the role of TGF-β in corneal wound healing. Further, aberrant TGF-β activity has been linked to various corneal pathologies, such as scarring and Peter's Anomaly. Thus, understanding the molecular and cellular mechanisms by which TGF-β1-3 regulate corneal wound healing will enable the development of potential therapeutic interventions targeting the key molecule in this process. Herein, we summarize the multifaceted roles of TGF-β in corneal wound healing, dissecting its mechanisms of action and interactions with other molecules, and outline its role in corneal pathogenesis.

Innovative Wedge Anchorage for CFRP Plates: Development and Testing

Gripping prestressed carbon fiber-reinforced polymers (CFRPs) in structural strengthening applications is challenging due to CFRPs’ susceptibility to lateral loading. This paper presents a reliable and reusable wedge anchorage for gripping CFRP plates that are 50 mm wide and 1.2 mm thick. The cylindrical anchorage, which is 75 mm long and 76.2 mm in diameter, consists of an external steel barrel, two internal steel wedges, and two soft copper sleeves. The barrel-wedge interface is designed using an innovative arc–linear configuration, through which the desired stress distribution is attained, preventing stress concentration and the premature failure of the CFRP plate. The wedge anchorage was experimentally tested by applying a displacement-controlled tensile load of 0.6 mm/min until the complete fracture of the CFRP plate. The anchorage’s performance was examined under distinct installation conditions by applying different presetting levels: high (40–120 kN) and low (hammering) presetting. It was observed that the anchorage successfully prevented CFRP premature failure in all tests by achieving an average tensile loading of 172.3 (±5.7) kN, exceeding its reported tensile strength of 168 kN (2800 MPa). Minor CFRP displacements of 6.26 (±0.75) mm and 3.33 (±0.16) mm were recorded under low and high presetting levels, respectively. Similarly, the CFRP slippage relative to the wedges for the low and high presetting tests was only 1.18 (±0.75) mm and 0.33 (±0.15) mm, respectively. Also, only minor scratches were observed in the wedge–barrel interface, indicating the absence of extensive plastic deformation.

Analysis of the Sand Erosion Effect and Wear Mechanism of Wind Turbine Blade Coating

The wind–sand climate prevalent in the central and western regions of Inner Mongolia results in significant damage to wind turbine blade coatings due to sand erosion. This not only leads to a decline in power generation but also poses safety risks. This study replicated the wind–sand environment of Alashan and numerically simulated the erosion and wear process of the blade coatings of a 1.5 MW horizontal axis wind turbine under rotational conditions using the DPM model. Additionally, erosion tests were conducted on the operating wind rotor in a wind tunnel. The simulation results demonstrate that sand particle trajectories in the rotating domain are influenced by vortex, incoming wind speed, and sand particle size. For small-sized sand particles, variations in wind speed do not substantially alter the number of particles in contact with the wind turbine blades. However, alterations in the momentum of these particles lead to changes in the impact force on the coating surface. Conversely, the change of wind speed will not only alter the number of large-size sand particles in contact with the wind rotor but also modify the impact force on the coating surface. Furthermore, after impacting the blade, small sand particles continue to move along an approximate helical trajectory with the airflow, while large-size sand particles swiftly rebound. Through statistical analysis of erosion pits on the blade surface after the erosion experiments, it was observed that, in comparison among the leading edge, windward side, trailing edge, and leeward side, the leading edge presents the greatest number of erosion pits, whereas the leeward side has the fewest. Along the spanwise direction, the 0.7R-blade tip segment exhibits the highest count, while the blade root-0.3R section displays the fewest number of pits. The wear morphology of the blade coating was observed from the blade root to tip. The leading edge coating exhibits a range from shallow pits to coating flaking and deeper gouge pits. On the windward side, the coating displays wear patterns varying from tiny cutting pits to cutting marks, and then to gouge pits and coating flaking. Erosion morphology of the trailing edge evolves from only minor scratches to spalling pits, further deepening and enlarging. These research findings provide a basis for the study of zoning-adapted coating materials for wind turbine blades in wind–sand environments.

A bilateral feature fusion network for defect detection on mobile cameras

Defect detection in mobile phone cameras constitutes a critical aspect of the manufacturing process. Nonetheless, this task remains challenging due to the complexities introduced by intricate backgrounds and low-contrast defects, such as minor scratches and subtle dust particles. To address these issues, a Bilateral Feature Fusion Network (BFFN) has been proposed. This network incorporates a bilateral feature fusion module, engineered to enrich feature representation by fusing feature maps from multiple scales. Such fusion allows the capture of both fine and coarse-grained details inherent in the images. Additionally, a Self-Attention Mechanism is deployed to garner more comprehensive contextual information, thereby enhancing feature discriminability. The proposed Bilateral Feature Fusion Network has been rigorously evaluated on a dataset of 12,018 mobile camera images. Our network surpasses existing state-of-the-art methods, such as U-Net and Deeplab V3+, particularly in mitigating false positive detection caused by complex backgrounds and false negative detection caused by slight defects. It achieves an F1-score of 97.59%, which is 1.16% better than Deeplab V3+ and 0.99% better than U-Net. This high level of accuracy is evidenced by an outstanding precision of 96.93% and recall of 98.26%. Furthermore, our approach realizes a detection speed of 63.8 frames per second (FPS), notably faster than Deeplab V3+ at 57.1 FPS and U-Net at 50.3 FPS. This enhanced computational efficiency makes our network particularly well-suited for real-time defect detection applications within the realm of mobile camera manufacturing.

A Case of Prurigo Nodularis with Skin Rash that Occurred after COVID-19 Vaccination

Objectives: This study is to report a case of prurigo nodularis with skin rash that occurred after COVID-19 vaccination improved by Korean medicine treatment.Methods: The patient visited our hospital complaining of prurigo nodularis and skin rashes which occurred in various parts of the body (Total score 17). The patient complained of sleep disturbance (NRS 9) due to nighttime pruritus (NRS 7). Based on the patient’s symptoms, herbal medicine Soshiho-tang and acupuncture on the left Triple Energizer Hangyeok was prescribed.Results: Most of the skin symptoms improved significantly leaving only scars, minor scratches and pigmentation (Total score 17 → 6). The patient's sleep condition improved (NRS 7 → 1) as the pruritus decreased from NRS 9 to 2.Conclusions: This study is significant in that the patient with prurigo nodularis accompanied by skin rash effectively improved by the Korean Medicine treatment.

Finding the Best Lighting Mode for Daguerreotype, Ambrotype, and Tintype Photographs and Their Deterioration on the Cruse Scanner Based on Selected Methods.

In the digital heritage field, the accurate reproduction of hard-to-photograph items, such as daguerreotypes, ambrotypes, and tintypes, is an ongoing challenge. Industrial contactless sensors offer the potential to improve the quality of scanned images, but their capabilities and limitations have not been fully explored. In our research, a dataset of 48 scans was created using the hi-tech industrial contactless sensor CRUSE. Moreover, 3 rare original photographs were scanned in 16 different modes, the most suitable images were determined by specialists in the restoration, and validated through experiments involving eye-tracking, multiple computer vision, and image processing methods. Our study identified the Cruse scanning modes, which can be utilized to achieve the most accurate digital representation of scanned originals. Secondly, we proposed several methods for highlighting the degradation and minor scratches on photographs that otherwise might not be detected by the restorer's naked eye. Our findings belong to four overlapping areas, i.e., image understanding, digital heritage, information visualization, and industrial sensors research. We publish the entire dataset under the CC BY-NC 4.0 license. The CRUSE sensor shows promise as a tool for improving the quality of scanned images of difficult-to-photograph items. Further research is necessary to fully understand its capabilities and limitations in this context.

Percutaneous Release of the First Extensor Tendon Compartment in De Quervain's Disease by Acupotomy with US-Guidance: A Cadaveric Study.

De Quervain's disease is a painful stenosing tenosynovitis of the first dorsal compartment of the hand affecting the tendons of the abductor pollicis longus and extensor pollicis brevis. This study aimed to evaluate the safety and efficacy of percutaneous first extensor compartment releases performed on embalmed cadaveric models by acupotomy operation with or without US guidance. Percutaneous release was performed with an acupotomy on 59 wrists of cadavers; 23 wrists were operated with US guidance, and 39 wrists were operated without US guidance. Each arm was dissected and assessed regarding the amount of release as well as the extent of neurovascular and tendon injury. Anatomical structures were also observed in this study. Twenty cases (87%) were successfully released with ultrasound-assisted techniques, and 27 cases (75%) were successfully released with blind techniques. No neurovascular injury occurred in any arm, regardless of technique. No significant tendon injury was seen in any arm. Although minor surface scratches were visualized in 11 cases, they occurred in 3 cases (13.04%) with ultrasound assistance and in 8 cases (22.22%) with blind techniques. There was no statistically significant difference between the two groups in the measurement of the distance from the incision marks to the blood vessels and nerves. A fibrous septum and bony protrusions were found in the first dorsal compartment, which may be anatomical factors affecting the success of treatment. Both traditional and US-guided percutaneous release by acupotomy of the first extensor tendon compartment can be performed for all wrists. US-guided techniques can improve the success rate and reduce damage during acupotomy operations.

Characterization of Escherichia coli and other bacteria isolated from condemned broilers at a Danish abattoir.

Meat inspection is important to ensure food safety and protect public health. Visual inspection of slaughtered carcasses for pathological changes should be supported by bacteriological analysis to determine whether the entire carcass or parts of it should be condemned. The aim of this study was to determine the bacterial species present in different sample types from condemned broiler carcasses. Furthermore, we investigated the genetic characteristics, zoonotic potential, and relatedness of Escherichia coli, the predominant bacterial species isolated from the carcasses. A total of 400 broiler carcasses condemned because of cellulitis (100), scratches (100), hepatitis (100), and healthy control carcasses (100) were selected. Samples of meat, pathological lesion, and bone marrow of each carcass were obtained for microbial analysis. From the analyzed samples, 469 bacterial isolates were recovered with E. coli accounting for 45.8%, followed by Aeromonas spp. (27.9%), in particular A. veronii. The highest rate of bacterial isolation was observed in carcasses condemned with cellulitis, whereas carcasses with hepatitis had the lowest rate of bacterial isolation. Forty-four E. coli isolates originating from different sample types were selected for whole genome sequencing. A clonal relationship was shown between E. coli from different sample types of the same carcass condemned with cellulitis and scratches. A major clade of E. coli was found in carcasses condemned with cellulitis with isolates containing mdf(A), tet(A), and bla TEM-1B genes that confer resistance to macrolides, tetracycline, and ampicillin, respectively. E. coli in this clade all belonged to ST117 and clustered with E. coli isolates previously collected from dead chickens and carcasses condemned due to cellulitis in Denmark, Finland, and the United Kingdom. Bacterial evaluation results of carcasses condemned with cellulitis, scratches (moderate to severe skin lesion), and acute hepatitis confirmed the need for total condemnation of carcasses with these pathological findings. A similar evaluation should be done for carcasses affected with chronic hepatitis, and minor scratches lesions.

Experimental investigation on rotating domain wear of hydrodynamic machine due to particulate flow

The particulate flow through a hydrodynamic machine causes wear of the runner due to surface-particle interactions like sliding, rolling, and impinging at different angles. In the present work, experiments have been performed on rotor wear of a centrifugal slurry pump in a pilot plant test rig for three different sized particulate slurries at two flow rates and 3500 ppm solid concentration. Initially, the experiments were carried out to identify the wear prone zones inside the flow passage using a multilayer paint modelling method. Then the material loss due to wear is determined by fixing specimens at the grooves of identified zones along the rotor flow passage. The weight loss measurement of different specimens after the test is used to calculate the mass loss rate. Furthermore, the material removal mechanism of the rotor flow passage surface is analysed using the scanning electron microscope (SEM). It is observed that the wear at the leading edge of pressure side is contributed by abrasion grooves, deep plough and platelets formation together with some crack formation at the start of vane. The suction side zone is dominantly worn out by subsurface deformation with some minor scratches. Moreover, the flow field of the rotor flow passage is investigated through numerical modelling to correlate the particle impinging condition with wear behaviour. • Worn out zone of rotor is identified using paint wear modelling method. • The material loss has been measured along the identified worn out zones. • Effect of particle size and flow rate on the wear of rotor has been investigated. • Failure mechanism of worn out surfaces has been described using SEM micrographs. • The effect and cause of erosion wear are explained using multi-phase simulation.

Friction and Wear Characteristics of Polydimethylsiloxane under Water-Based Lubrication Conditions.

In this study, the friction and wear characteristics of polydimethylsiloxane (PDMS) were evaluated when using lubricants created by adding surfactants at various ratios to deionized (DI) water. When pure DI water is used as a lubricant, the repulsion of water from the hydrophobic PDMS surface is large and the interfacial affinity is low; thus, the lubrication properties cannot be significantly improved. However, when a lubricant with a surfactant is added to DI water, the interfacial affinity with the PDMS surface increases to form a lubricating film, and the friction coefficient is greatly reduced. In this study, under dry and pure DI water conditions, severe wear tracks were formed on the PDMS surface after 10,000 cycles of reciprocating sliding motion under a vertical load of 100 mN, whereas in the case of the surfactant-based and water-based lubricant, no severe wear tracks occurred. The friction and wear characteristics of the PDMS were evaluated by increasing the normal loads and sliding cycles with a water-based lubricant containing 1 wt % surfactant. Under normal loads of 300 mN and 500 mN, only minor scratches occurred on the PDMS surface up to 10,000 and 100,000 cycles, respectively, but after 300,000 cycles, very severe pit wear tracks occurred.

Condition monitoring of water pump bearings using ensemble classifier

The bearings faults are reported to be the major reason for centrifugal pump (CPs) failures. Limited literature is available to diagnose the minor scratches in the bearing surface through non-intrusive condition monitoring techniques. Recent research on the analysis of bearing scratches through non-intrusive motor current analysis (MCA) has shown encouraging results where the comparison of machine learning and convolutional neural networks (CNNs) was performed in the classification of healthy bearings and faulty bearings (holes and scratches). The fault classification accuracy of 89.26% through MCA combination with machine learning and CNN algorithm was reported which is very low. The key factors of low accuracies were identified as low amplitudes of the harmonics in the MCA spectrum, the magnitude of environmental noise, and utilization of conventional feature extraction techniques. This problem has been tackled in this paper by developing a novel feature extractor (NFE) that extracts powerful features from the integrated current and voltage sensors data. The NFE has been derived using the threshold-based decision mechanism which has the capability to identify the location of the feature harmonic, feature extraction, measure the amplitude of the fault component, and compare it with the derived threshold. The experimental data has been collected for the bearing balls (BB), bearing cage (BC), inner race (IR) and the outer race (OR) faults, and the performance of the NFE has been tested on an ensemble classifier (CatBoost) and the better classification accuracy (99.2% for an individual feature and 100% with the combination of two or more features) of NFE has been achieved as compared to previously reported methods.

Ultrasound-Guided Percutaneous A1 Pulley Release by Acupotomy (Needle-Knife): A Cadaveric Study of Safety and Efficacy.

PurposeThis study was to assess the safety and effectiveness of ultrasound-guided percutaneous A1 pulley release by acupotomy on unembalmed cadavers.Materials and MethodsSixty digits (from six cadavers, three male and three female) were split into two groups using stratified randomization. All procedures were completed by a single doctor with rich experience in ultrasound-guided treatment. In the acupotomy group, the A1 pulley was released under ultrasound-guided by a needle-knife; while in the needle group, the A1 pulley was released under ultrasound-guided by a 21-gauge needle. Two groups completed six thumbs and 24 fingers, respectively. Another anatomist, blinded to the two techniques, assessed the safety, including the minimum distance between the incision and the neurovascular; flexor tendon, neurovascular and A2 pulley injury or not. Completeness release of the A1 pulley was recorded as effectiveness.ResultsNo neurovascular or A2 pulley injuries were recorded. However, the incision of the thumb in both groups biased to the radial side (P <0.05), while the incision of the finger biased to the ulnar side (P <0.05). No significant flexor tendon injury was found, and only five cases (16.7%) had minor scratches in the acupotomy group; while in the needle group, 15 cases had minor scratches and lacerations occurred in three cases. The flexor tendon injury rate was 60%. Compared with the needle, ultrasound-guided acupotomy release is safer (P <0.05). The ultrasound-guided acupotomy technique was significantly more likely to result in a complete A1 pulley release compared to the needle technique (28 of 30 [93.3%] versus 11 of 30 [36.7%]; P <0.05).ConclusionUltrasound-guided percutaneous A1 pulley release by acupotomy is a safe and effective technique. When releasing the thumb by ultrasound-guided, be careful not to bias to the radial side to avoid neurovascular injury, while when releasing a finger, be careful not to bias to the ulnar side.

Observational and cross-sectional study of prescription pattern in the pediatric out-patient department at a tertiary care center of Bihar

Medical therapy is the most common form of health care provided to the patients. More the practice, more the error is substantiated by the fact that medication errors are probably the most common medical error. Detailed information on these errors is the first step to prevent these errors becoming a health hazard for the individual as well as the society.To generate data on the extent of rational/irrational prescribing pattern, to review the prescribing practices.An observational study with cross sectional design Prescriptions of the patients attending the pediatric OPD were reviewed to collect required data.1200 prescriptions were reviewed that had 3384 drugs listed. The mean age was 8.3± 4.62 years with male&amp;#62; female. Weight of the patient was recorded in 82.8% of the prescriptions. The average number of drugs per prescription was 2.82. The range of drugs per encounter varied from zero to 5. Ailments like minor scratches or other non-organic problems were those where no drugs were prescribed. Around 50% of the drugs prescribed were in generic names. Syrups were most commonly prescribed followed by tablets and capsules. Injection use was very less. Antibiotics were widely used for treatment with 73.8% of the prescriptions had at least one antibiotic.The findings of the current study highlight the continuing crisis of the irrational drug practice in this part of the country. This will help authorities to take necessary action and formulate guidelines on proper and rational drug prescription.

Electrical Characterization of Thin PEDOT:PSS Films on Alumina and Thiol-Ene Substrates.

Transparent polymer layers that heal minor scratches and maintain the optical properties of the devices for a long time are highly desirable in optoelectronics. This paper presents the results of the electrical characterization of thin PEDOT:PSS films on the novel, optically transparent thiol–ene substrates capable of healing scratches under room-temperature conditions. Electrical properties of the PEDOT:PSS films deposited on the conventional alumina ceramic substrates were also tested for comparative purposes. This study demonstrated that the substrate can have a significant effect on the electrical properties of PEDOT:PSS films, and the electrical resistance of the films on thiol–ene substrates is not as stable as on alumina ceramics. However, the changes in electrical resistance of the films on thiol–ene are small enough over a sufficiently wide range of operating temperatures and relative humidities and allow the application of such bilayers in various polymeric optoelectronic devices.

Marine Fungal Cerebroside Flavuside B Protects HaCaT Keratinocytes against Staphylococcus aureus Induced Damage.

Cerebrosides are glycosylated sphingolipids, and in mammals they contribute to the pro-/anti-inflammatory properties and innate antimicrobial activity of the skin and mucosal surfaces. Staphylococcus aureus infection can develop, not only from minor scratches of the skin, but this pathogen can also actively promote epithelial breach. The effect of cerebroside flavuside B from marine sediment-derived fungus Penicillium islandicum (Aniva Bay, the Sea of Okhotsk) on viability, apoptosis, total caspase activity, and cell cycle in human epidermal keratinocytes HaCaT line co-cultivated with S. aureus, as well as influence of flavuside B on LPS-treated HaCaT cells were studied. Influence of flavuside B on bacterial growth and biofilm formation of S. aureus and its effect on the enzymatic activity of sortase A was also investigated. It was found S. aureus co-cultivated with keratinocytes induces caspase-depended apoptosis and cell death, arrest cell cycle in the G0/G1 phase, and increases in cellular immune inflammation. Cerebroside flavuside B has demonstrated its antimicrobial and anti-inflammatory properties, substantially eliminating all the negative consequences caused by co-cultivation of keratinocytes with S. aureus or bacterial LPS. The dual action of flavuside B may be highly effective in the treatment of bacterial skin lesions and will be studied in the future in in vivo experiments.

Research on Intelligent Damage Assessment System for Time-sharing Rental Vehicles Based on Image Recognition

With the popularity of the concept of sharing, car sharing has become a new hot spot. Currently, there are more than 100 brands operating car sharing in the market. The group composition of car rental is relatively complex, and most of them are novices in driving technology. Some minor scratches and other injuries are easy to occur during the driving of rental vehicles, which poses new challenges to the car-sharing operation platform. Therefore, in the operation of car-sharing business, it is very important to realize the automatic determination of vehicle damage in the process of each use. This paper presents a method and system for automatic damage determination of vehicles based on the shared vehicle four-corner images. By comparing the damage information before and after renting each vehicle, this scheme can effectively save labor cost, realize rapid damage recognition, clear responsibility definition, and improve user experience and damage treatment efficiency.

A Rare Case of Symmetrical Cutaneous Alternaria Infections after Bilateral Lung Transplant

Introduction Lung transplant recipients are prone to opportunistic infections like fungi in view of the high levels of sustained immunosuppression required to avoid graft rejection. We report an unusual fungal pathogen, Alternaria, presenting with bilateral, cutaneous lesions with an atypical morphology. Case Report A 73-year-old male underwent bilateral lung transplantation in October 2017 for idiopathic pulmonary fibrosis with basiliximab induction. The patient was on typical three-drug immunosuppression of tacrolimus (goal trough 7-8ng/ml), prednisone, and mycophenolate mofetil (lower dose 250mg bid). At his one year follow up, he was noted to have symmetrical, keratotic lesions on both lower extremities. The patient reported no traumatic source, except for fire ant bites or minor scratches while gardening. Punch biopsies were performed and histopathology revealed epidermal hyperplasia with associated underlying granulomatous host response. After assessing morphology and Fontana masson stain, a differential of Blastomyces species was favored over Cryptococcus. However, serum tests were negative for Blastomyces and fungal cultures from the biopsy grew Alternaria. Given non-contiguous sites and concern for dissemination, a chest CT was performed, but did not note changes consistent with pulmonary involvement. He was treated with posaconazole (300mg daily) for a 3-month regimen with a decrease of tacrolimus levels. With noted regression of nodules after three months, posaconazole was stopped. A year later, a recurrence of Alternaria appeared on his lower extremities, distal to the previous infections, with the same raised violaceous appearance. Treatment with posaconazole (200mg daily) was initiated. Due to recurrence, mycophenolate was halted and serum tacrolimus levels were targeted lower. After 6 months, posaconazole was stopped as the lesions had healed. Summary Our path to diagnosis in this case highlights the challenges in confirming infectious species by histopathology alone and hence the importance of culture and molecular diagnosis. This case was particularly unusual with the presentation of symmetrical lower extremity lesions as it was not clear if this represented dual inoculation or a disseminated infection. A high level of suspicion needs to be maintained for lesser known fungal pathogens, like Alternaria, in highly immunocompromised hosts.

Tension Hemopneumothorax in the Setting of Mechanical CPR during Prehospital Cardiac Arrest

Introduction There are several complications associated with automated mechanical CPR (AM-CPR), including tension pneumothoraces. The incidence of these complications and the risk factors for their development remain poorly characterized. Tension hemopneumothorax is a previously unreported complication of AM-CPR. The authors present a case of a suspected tension hemopneumothorax that developed during the use of an automated mechanical CPR device. Case Description: A 67 year-old woman with a history of COPD and CABG was observed by an off-duty firefighter to be slumped behind the wheel of an ice cream truck that drifted off the road at a low rate of speed and was stopped by a wooden fence, resulting in only minor paint scratches. The patient was found to be in cardiac arrest with a shockable rhythm. No signs of trauma were noted, and equal bilateral breath sounds were present with BVM ventilation. After 13 minutes of manual CPR, fire department personnel applied their Defibtech LifeLine ARM mechanical CPR device to the patient. During resuscitation, the device had to be repositioned twice due to rightward piston migration off of the sternum. Seven minutes after AM-CPR application, the patient had absent right-sided breath sounds and ventilations were more difficult. Needle decompression was performed with an audible release of air. A chest tube was placed by an EMS physician and roughly 400 mL of blood were immediately returned. At the next 2-minute pulse check, ROSC was noted, and the patient was transported to the hospital. She had an ischemic EKG and elevated troponin. Chest CT showed emphysematous lungs, bilateral rib fractures, and a small right-sided pneumothorax. Despite aggressive measures, the patient’s condition gradually worsened, and she died 48 hours after presentation. Discussion/Conclusion: Migration of AM-CPR device pistons may contribute to the development of iatrogenic injuries such as hemopneumothoraces. Patients with underlying lung disease may be at a higher risk of developing pneumothoraces or hemopneumothoraces during the course of AM-CPR. Awareness of these potential complications may aid first responders by improving vigilance of piston location and by providing quicker recognition of iatrogenic injuries that need immediate attention to improve the opportunity for ROSC.