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Diagnostics (Basel, Switzerland) May 2024Endotracheal suctioning is an essential but labor-intensive procedure, with the risk of serious complications. A brand new automatic closed-suction device was developed...
Clinical Efficacy and Safety of an Automatic Closed-Suction System in Mechanically Ventilated Patients with Pneumonia: A Multicenter, Prospective, Randomized, Non-Inferiority, Investigator-Initiated Trial.
Endotracheal suctioning is an essential but labor-intensive procedure, with the risk of serious complications. A brand new automatic closed-suction device was developed to alleviate the workload of healthcare providers and minimize those complications. We evaluated the clinical efficacy and safety of the automatic suction system in mechanically ventilated patients with pneumonia. In this multicenter, randomized, non-inferiority, investigator-initiated trial, mechanically ventilated patients with pneumonia were randomized to the automatic device (intervention) or conventional manual suctioning (control). The primary efficacy outcome was the change in the modified clinical pulmonary infection score (CPIS) in 3 days. Secondary outcomes were the frequency of additional suctioning and the amount of secretion. Safety outcomes included adverse events or complications. A total of 54 participants, less than the pre-determined number of 102, were enrolled. There was no significant difference in the change in the CPIS over 72 h (-0.13 ± 1.58 in the intervention group, -0.58 ± 1.18 in the control group, = 0.866), but the non-inferiority margin was not satisfied. There were no significant differences in the secondary outcomes and safety outcomes, with a tendency for more patients with improved tracheal mucosal injury in the intervention group. The novel automatic closed-suction system showed comparable efficacy and safety compared with conventional manual suctioning in mechanically ventilated patients with pneumonia.
PubMed: 38893595
DOI: 10.3390/diagnostics14111068 -
Molecules (Basel, Switzerland) May 2024Drilling through shale formations can be expensive and time-consuming due to the instability of the wellbore. Further, there is a need to develop inhibitors that are...
Drilling through shale formations can be expensive and time-consuming due to the instability of the wellbore. Further, there is a need to develop inhibitors that are environmentally friendly. Our study discovered a cost-effective solution to this problem using Gum Arabic (ArG). We evaluated the inhibition potential of an ArG clay swelling inhibitor and fluid loss controller in water-based mud (WBM) by conducting a linear swelling test, capillary suction timer test, and zeta potential, fluid loss, and rheology tests. Our results displayed a significant reduction in linear swelling of bentonite clay (Na-Ben) by up to 36.1% at a concentration of 1.0 wt. % ArG. The capillary suction timer (CST) showed that capillary suction time also increased with the increase in the concentration of ArG, which indicates the fluid-loss-controlling potential of ArG. Adding ArG to the drilling mud prominently decreased fluid loss by up to 50%. Further, ArG reduced the shear stresses of the base mud, showing its inhibition and friction-reducing effect. These findings suggest that ArG is a strong candidate for an alternate green swelling inhibitor and fluid loss controller in WBM. Introducing this new green additive could significantly reduce non-productive time and costs associated with wellbore instability while drilling. Further, a dynamic linear swelling model, based on machine learning (ML), was created to forecast the linear swelling capacity of clay samples treated with ArG. The ML model proposed demonstrates exceptional accuracy (R score = 0.998 on testing) in predicting the swelling properties of ArG in drilling mud.
PubMed: 38893388
DOI: 10.3390/molecules29112512 -
International Journal of Molecular... May 2024The genus (bladderworts) species are carnivorous plants that prey on invertebrates using traps with a high-speed suction mechanism. The outer trap surface is lined by...
The genus (bladderworts) species are carnivorous plants that prey on invertebrates using traps with a high-speed suction mechanism. The outer trap surface is lined by dome-shaped glands responsible for secreting water in active traps. In terminal cells of these glands, the outer wall is differentiated into several layers, and even cell wall ingrowths are covered by new cell wall layers. Due to changes in the cell wall, these glands are excellent models for studying the specialization of cell walls (microdomains). The main aim of this study was to check if different cell wall layers have a different composition. Antibodies against arabinogalactan proteins (AGPs) were used, including JIM8, JIM13, JIM14, MAC207, and JIM4. The localization of the examined compounds was determined using immunohistochemistry techniques and immunogold labeling. Differences in composition were found between the primary cell wall and the cell secondary wall in terminal gland cells. The outermost layer of the cell wall of the terminal cell, which was cuticularized, was devoid of AGPs (JIM8, JIM14). In contrast, the secondary cell wall in terminal cells was rich in AGPs. AGPs localized with the JIM13, JIM8, and JIM14 epitopes occurred in wall ingrowths of pedestal cells. Our research supports the hypothesis of water secretion by the external glands.
Topics: Cell Wall; Mucoproteins; Plant Proteins; Lamiales; Immunohistochemistry
PubMed: 38892273
DOI: 10.3390/ijms25116089 -
BMC Musculoskeletal Disorders Jun 2024Suction drainages are commonly used after total knee arthroplasty (TKA) procedures; however, their use is somewhat controversial. Recently, some reports have claimed...
BACKGROUND
Suction drainages are commonly used after total knee arthroplasty (TKA) procedures; however, their use is somewhat controversial. Recently, some reports have claimed that the administration of tranexamic acid (TXA) may prevent postoperative bleeding following TKAs. Although numerous studies have reported regarding different dosages, timings of administration, or drain clamping times for intravenous and intra-articular TXA injections (IA-TXAs), few have examined whether suction drainage is necessary when TXA is administered. In this study, we compared using suction drainage without TXA administration and IA-TXA without suction drainage and aimed to examine the need for suction drainage during IA-TXA.
METHODS
This retrospective study was conducted on 217 patients who had received TKA for osteoarthritis; 104 were placed on suction drainage after TKA without TXA (Group A), whereas the remaining 113 received IA-TXA immediately after surgery without suction drainage (Group B). Our clinical evaluation included assessments of the need for transfusion, presence of postoperative complications, incidence of deep vein thrombosis (DVT), and changes in hemoglobin (Hb), hematocrit (Hct), and D-dimer levels.
RESULTS
No significant differences were observed in terms of postoperative complications and preoperative Hb, Hct, or D-dimer levels between the two groups. Although the prevalence of DVT was significantly higher in Group B (p < 0.05), all cases were asymptomatic. Hb and Hct levels were significantly lower in Group A than in Group B at 1, 3, 7, and 14 days postoperatively (p < 0.05), although none of the cases required blood transfusions. D-dimer levels were significantly higher in Group A than in Group B at 1 and 3 days postoperatively (p < 0.05).
CONCLUSION
Suction drainage might not be necessary when IA-TXA is administered after TKA procedures.
Topics: Humans; Tranexamic Acid; Retrospective Studies; Arthroplasty, Replacement, Knee; Female; Male; Aged; Suction; Injections, Intra-Articular; Antifibrinolytic Agents; Middle Aged; Postoperative Hemorrhage; Aged, 80 and over; Osteoarthritis, Knee; Venous Thrombosis; Treatment Outcome
PubMed: 38890633
DOI: 10.1186/s12891-024-07604-w -
Journal of Thoracic Disease May 2024The adequacy of actual lower respiratory tract samples collected using the current collection technique is debated. Endotracheal aspiration is commonly insufficient and...
Feasibility of the modified mini-bronchoalveolar lavage techniques using a nasogastric suction catheter and polytetrafluoroethylene bronchoscopic suction catheter in diagnosing bilateral pneumonia: a pilot study.
BACKGROUND
The adequacy of actual lower respiratory tract samples collected using the current collection technique is debated. Endotracheal aspiration is commonly insufficient and can be contaminated with colonization from the proximal airway. Diagnostic bronchoscopy is the standard method for collecting specimens from the lower respiratory tract. However, it is usually unavailable in resource-limited settings. At present, noninvasive methods with the mini-bronchoalveolar lavage (BAL) catheter are used to collect specimens from the lower respiratory tract. Compared with the nasogastric (NG) tube, the polytetrafluoroethylene (PTFE) catheter, a modified mini-BAL catheter that suctions the more distal part of the tracheobronchial tree, can collect actual lower respiratory tract specimens.
METHODS
This prospective open-label pilot study included patients aged >18 years who were diagnosed with bilateral pneumonia and who required mechanical ventilation. Lower respiratory tract samples were collected via endotracheal aspiration, mini-BAL using an NG tube, and mini-BAL using a PTFE bronchoscopic catheter. Data on return fluid volume, white blood cell (WBC) count, microbiologic information obtained via quantitative culture, and each procedure-related complication were recorded.
RESULTS
The return fluid volumes of the NG tube and PTFE groups were 50 and 40 mL, respectively. The median WBC counts were 245 cells/cumm in the NG tube group and 305 cells/cumm in the PTFE group. Culture from endotracheal aspiration detected polymicrobial organisms in 8 (20.0%) patients. Further, 19 (47.5%) patients in the NG tube group and 18 (45.0%) in the PTFE group presented with polymicrobial organisms. Approximately 10% of patients developed mini-BAL-related complications, including arrhythmia (2.5%), mild hypoxemia (2.5%), and mild bleeding (5.0%).
CONCLUSIONS
The two modified mini-BAL techniques are feasible in diagnosing patients with pneumonia requiring mechanical ventilation. The mini-BAL technique is more likely to detect polymicrobial organisms compared with endotracheal aspiration, which can then identify the causative polymicrobial organism of ventilator associated pneumonia (VAP) and lead to antibiotic adjustment. Moreover, it is easy to perform, can yield adequate specimens, and has few complications.
PubMed: 38883667
DOI: 10.21037/jtd-23-1573 -
Cureus May 2024Pharyngocutaneous fistula (PCF) is an abnormal connection between the pharynx and skin that can occur after laryngectomy surgery. It can have a significant negative...
Pharyngocutaneous fistula (PCF) is an abnormal connection between the pharynx and skin that can occur after laryngectomy surgery. It can have a significant negative impact on patient recovery, delaying wound healing, requiring prolonged nil-per-oral (NPO) status, and reducing quality of life. Traditionally, the management of PCF has relied on conservative measures or surgical intervention. However, negative pressure wound therapy (NPWT) offers a promising alternative approach. This case study involves three patients who underwent laryngectomy and developed postoperative PCF. All patients received NPWT with a modified suction catheter and low negative pressure (20-40 mmHg). With NPWT, all patients achieved complete wound closure, with healing times ranging from two weeks to six weeks. This suggests that NPWT may significantly accelerate PCF healing compared to traditional methods. However, maintaining an airtight dressing on the neck region can be challenging. This study highlights the potential of NPWT for faster PCF closure after laryngectomy. Further research is needed to optimize NPWT application techniques, explore the impact on long-term outcomes, and establish guidelines for broader clinical use.
PubMed: 38883062
DOI: 10.7759/cureus.60457 -
Heliyon Jun 2024A turbulence model study was performed to analyze the flow around the Tubercle Leading Edge (TLE) wing. Five turbulence models were selected to evaluate aerodynamic...
A turbulence model study was performed to analyze the flow around the Tubercle Leading Edge (TLE) wing. Five turbulence models were selected to evaluate aerodynamic force coefficients and flow mechanism by comparing with existing literature results. The selected models are realizable , Shear Stress Transport (SST), ( ) SST model, Transition model and Stress- ω Reynolds Stress Model (RSM). For that purpose, the TLE wing model was developed by using the NACA0021 airfoil profile. The wing model is designed with tubercle wavelength of 0.11c and amplitude of 0.03c. Numerical simulation was performed at chord-based Reynolds number of Re = 120,000. The Computational Fluid Dynamic (CFD) simulation reveals that among the selected turbulence models, Stress- ω RSM estimated aerodynamic forces (i.e. lift and drag) coefficients closest to that of the experimental values followed by realizable , ( ) SST model, SST model and model. However, at a higher angle of attacks i.e. at 16° & 20° SST model predicted closest drag and lift coefficient to that of the experimental values. Additionally, the critical observation of pressure contour confirmed that at the lower angle of attack Stress- ω RSM predicted strong Leading Edge (LE) suction followed by realizable , ( )SST model, SST model and model. Thus, the superiority of Stress- ω RSM in predicting the aerodynamic force coefficients is shown by the flow behavior. In addition to this pressure contours also confirmed that model failed to predict tubercled wing aerodynamic performance. At higher angles of attacks SST model estimated aerodynamic force coefficients closest to that of the experimental values, thus SST model is used at 16° & 20° AoAs. The observed streamline behavior for different turbulence models showed that the Stress- ω RSM model and model failed to model flow behavior at higher AoAs, whereas SST model is a better approach to model separated flows that experience strong flow recirculation zone.
PubMed: 38882326
DOI: 10.1016/j.heliyon.2024.e32148 -
Scientific Reports Jun 2024To elucidate the distribution law of the multiphase coupling slag discharge flow field in gas-lift reverse circulation during drilling shaft sinking, a numerical...
To elucidate the distribution law of the multiphase coupling slag discharge flow field in gas-lift reverse circulation during drilling shaft sinking, a numerical analysis model of gas-liquid-solid multiphase coupling slag discharge was established by CFD-DEM (Coupling of computational fluid dynamics and discrete element method) method, taking the drilling of North Wind well in Taohutu Coal Mine as an example. This model presented the distribution of the multiphase flow field in the slag discharge pipe and at the bottom hole, and was validated through experimentation and theoretical analysis. Finally, the impact of factors, including bit rotation speed, gas injection rate, air duct submergence ratio, and mud viscosity on the slag discharge flow field was clarified. The results indicated that the migration of rock slag at the bottom of the well was characterized by "slip, convergence, suspension, adsorption, and lifting". The slag flow in the discharge pipe exhibited the states of "high density, low flow rate" and "low density, high flow rate", respectively. The multiphase fluid flow patterns in the well bottom and slag discharge pipe were horizontal and axial flows, respectively. The model test of the gas lift reversed circulation slag discharge and the theoretical model of the bottom hole fluid velocity distribution confirmed the accuracy of the multiphase coupling slag discharge flow field distribution model. The rotation speed of the drill bit had the most significant impact on the bottom hole flow field. Increasing the rotation speed of the drill bit can significantly enhance the tangential velocity of the bottom hole fluid, increase the pressure difference between the bottom hole and annular mud column, and improve the adsorption capacity of the slag suction port. These findings can provide valuable insights for gas lift reverse circulation well washing in western drilling shaft sinking.
PubMed: 38879578
DOI: 10.1038/s41598-024-64519-1 -
Respiratory Investigation Jul 2024Cryobiopsy use is anticipated to become more common in diagnosing lung diseases. In Japan, inserting a Fogarty catheter through a suction channel above the endotracheal... (Comparative Study)
Comparative Study
BACKGROUND
Cryobiopsy use is anticipated to become more common in diagnosing lung diseases. In Japan, inserting a Fogarty catheter through a suction channel above the endotracheal tube's cuff for hemostasis is common practice. However, the rigid nature of the endotracheal tube poses challenges to tracheal intubation using a bronchoscope. The endotracheal tube cuff must be removed to prevent interference during Fogarty catheter insertion. To simplify the procedure and enhance safety, we devised and implemented a method of inserting a hemostatic Fogarty catheter with a suction tube externally attached to a softer endotracheal tube. This study aimed to evaluate the sustainability of this Fogarty catheter insertion method using suction tubes.
METHODS
The hemostatic Fogarty catheter insertion method was retrospectively validated. We compared outcomes between 60 patients who underwent the conventional method with a suction channel above the cuff and 50 patients who underwent the novel approach with an externally attached suction tube.
RESULTS
The physicians performing bronchoscopy and inserting the Fogarty catheter in the group in which the suction tube was externally attached for Fogarty catheter insertion had little experience. However, the overall bronchoscopy time was shorter; the two groups showed no significant differences in complications.
CONCLUSION
Regarding cryobiopsy procedures, using an externally attached suction tube for Fogarty catheter insertion was practical and comparable to the conventional method of using a suction channel above the cuff. This method made the procedure more simple and safe.
Topics: Humans; Retrospective Studies; Intubation, Intratracheal; Suction; Bronchoscopy; Male; Female; Aged; Biopsy; Middle Aged; Catheters; Cryosurgery
PubMed: 38878626
DOI: 10.1016/j.resinv.2024.06.001 -
The Journal of International Medical... Jun 2024We herein report a rare case of simultaneous intrauterine molar pregnancy and tubal pregnancy. A woman of childbearing age who had never been pregnant underwent an...
We herein report a rare case of simultaneous intrauterine molar pregnancy and tubal pregnancy. A woman of childbearing age who had never been pregnant underwent an ultrasound examination 70 days after the onset of menopause. She had a history of ovulation induction. The ultrasound findings suggested a partial hydatidiform mole. She was then pathologically confirmed to have a complete hydatidiform mole after uterine suction dilation and curettage. On postoperative day 4, an ultrasound examination before discharge showed an inhomogeneous mass in the left adnexal region with mild lower abdominal pain. On postoperative day 17, the blood human chorionic gonadotropin level did not drop as expected, and a follow-up examination still indicated a mass in the left adnexal region. We were unable to rule out an ectopic hydatidiform mole. Hysteroscopy with laparoscopic exploration of the left adnexal mass and salpingotomy suggested a diagnosis of intrauterine hydatidiform mole combined with left tubal pregnancy.
Topics: Humans; Female; Pregnancy; Hydatidiform Mole; Pregnancy, Tubal; Adult; Uterine Neoplasms; Pregnancy, Heterotopic; Ultrasonography
PubMed: 38869107
DOI: 10.1177/03000605241258572