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Acknowledgements: Not applicable., Funder: Fisher and Paykal Healthcare, BACKGROUND: Minimally invasive surgery is becoming more common and transfemoral transcatheter aortic valve replacement is offered to older patients with multiple comorbidities. Sternotomy is not required but patients must lie flat and still for up to 2-3 h. This procedure is increasingly being performed under conscious sedation with supplementary oxygen, but hypoxia and agitation are commonly observed. METHODS: In this randomised controlled trial, we hypothesised that high-flow nasal oxygen would provide superior oxygenation as compared with our standard practice, 2 l min-1 oxygen by dry nasal specs. This was administered using the Optiflow THRIVE Nasal High Flow delivery system (Fisher and Paykel, Auckland, New Zealand) at a flow rate of 50 l min-1 and FiO2 0.3. The primary endpoint was the change in arterial partial pressure of oxygen (pO2) during the procedure. Secondary outcomes included the incidence of oxygen desaturation, airway interventions, the number of times the patient reached for the oxygen delivery device, incidence of cerebral desaturation, peri-operative oxygen therapy duration, hospital length of stay and patient satisfaction scores. RESULTS: A total of 72 patients were recruited. There was no difference in change in pO2 from baseline using high-flow compared with standard oxygen therapy: median [IQR] increase from 12.10 (10.05-15.22 [7.2-29.8]) to 13.69 (10.85-18.38 [8.5-32.3]) kPa vs. decrease from 15.45 (12.17-19.33 [9.2-22.8]) to 14.20 (11.80-19.40 [9.7-35.1]) kPa, respectively. The percentage change in pO2 after 30 min was also not significantly different between the two groups (p = 0.171). There was a lower incidence of oxygen desaturation in the high-flow group (p = 0.027). Patients in the high-flow group assigned a significantly higher comfort score to their treatment (p ≤ 0.001). CONCLUSION: This study has demonstrated that high flow, compared with standard oxygen therapy, does not improve arterial oxygenation over the course of the procedure. There are suggestions that it may improve the secondary outcomes studied. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number (ISRCTN) 13,804,861. Registered on 15 April 2019. https://doi.org/10.1186/ISRCTN13804861.

Resumen Introduccion El uso de la terapia con canulas de alto flujo (CNAF) en las unidades neonatales ha experimentado un incremento en los ultimos anos, pero no existen guias de consenso sobre sus indicaciones y estrategias de aplicacion. Nuestro objetivo fue conocer la tasa de empleo de CNAF, sus indicaciones y la variabilidad de uso entre las unidades neonatales espanolas. Material y metodos Encuesta de 25 preguntas dirigida a personal medico y de enfermeria. Se contacto telefonicamente con unidades de nivel II y III y se envio en formato Google Forms entre septiembre 2016 y diciembre 2018. Resultados Se recibieron 97 respuestas (63,9% medicina, 36,1% enfermeria), de 69 unidades neonatales que representan a 15 comunidades autonomas (87% nivel asistencial III; 13% nivel II). Todas las unidades, salvo una, disponen de CNAF con sistema humidificado y caliente. Sus indicaciones mas frecuentes son: destete de ventilacion no invasiva (VNI) (79,4%), bronquiolitis (69,1%), distres respiratorio del recien nacido a termino (RNT) (58,8%), tras extubacion (50,5%). El flujo minimo varia entre 1-5 lpm y el flujo maximo entre 5-15 lpm. El 22,7% ha experimentado algun efecto indeseado por su uso (9 fuga aerea, 12 traumatismo nasal). Menos de la mitad tiene protocolo de empleo, pero todas las respuestas coinciden en la utilidad de unas recomendaciones nacionales. Conclusiones La terapia con CNAF esta ampliamente extendida en las unidades espanolas, pero existe gran variabilidad en sus indicaciones y estrategias de utilizacion. Unas recomendaciones a nivel nacional serian aplicables en la mayoria de las unidades y permitirian unificar su empleo.

For patients with chronic non-malignant lung disease, severe chronic breathlessness can significantly impact quality of life, causing significant disability, distress, social isolation, and recurrent hospital admissions. Caregivers for people with challenging symptoms, such as severe breathlessness, are also profoundly impacted. Despite increasing research focused on breathlessness over recent years, this symptom remains extremely difficult to manage, with no effective treatment that completely relieves breathlessness. A new potential treatment for relieving breathlessness in patients at home is nasal high flow (NHF) therapy. NHF therapy is a respiratory support system that delivers heated, humidified air (together with oxygen if required) with flows of up to 60 L/min. This case describes a patient with very severe chronic obstructive pulmonary disease who received domiciliary NHF therapy (approximately 8 hours/day, flow rate of 20 L/min) over twelve months with good effect for the relief of severe chronic breathlessness. We discuss the management principles for severe chronic breathlessness, the physiological effects of NHF therapy and the evidence for long-term use in the community setting. With the support of respiratory and palliative care clinicians together, domiciliary NHF therapy has great potential for improving current symptom management approaches in people with life-limiting illnesses.

Background While the role of high flow nasal cannulae (HFNC) in the management of respiratory failure continues to expand, few studies describe its use in acute hypercapnic respiratory failure. Aims In this retrospective study we assessed the safety and efficacy of HFNC for treatment of acute hypercapnic respiratory failure. Methods Admissions with acute hypercapnic respiratory failure to a thoracic medicine unit at a tertiary centre between January and August 2018 were included if treated with either HFNC or non-invasive ventilation (NIV). The primary outcome was post-treatment change in arterial pCO2 . Demographics, comorbidities, length of stay, readmission rate and mortality were also collected. Results 64 patients were identified, comprising 69 presentations grouped according to initial treatment: HFNC (n=24) or NIV (n=45). Patients in the NIV group had more severe blood gas derangement. In both groups, mean arterial pCO2 improved significantly (-10 (95% CI: -14 to -6) mmHg) from baseline with no evidence of a differential effect between groups. Six (25%) patients were transitioned from HFNC to NIV, of whom 3 had comorbid obesity and 2 had sleep disordered breathing. No significant differences in hospital length of stay, 30-day readmission rate or 90-day mortality were observed. Conclusions HFNC may be a reasonable initial treatment for patients with mild acute hypercapnic respiratory failure who do not have comorbid obesity or sleep disordered breathing. Prospective study may help identify clinical factors or phenotypes predictive of success with this treatment modality. This article is protected by copyright. All rights reserved.

Background Airway surgery presents a unique environment for operating room fire to occur. This study aims to explore the factors of combustion when using KTP laser with high flow oxygen in an ex-vivo model. MethodsThe variables tested were varying tissue type, tissue condition, oxygen concentration, laser setting, and smoke evacuation in a stainless-steel model. Outcome measures were time of lasing to the first spark and/or flame. A multivariate Cox proportional hazard model was used to determine the risk of spark and flame across the different risk factors. ResultsFor every 10% increase in oxygen concentration above 60% the risk of flame increased by a factor of 2.3. Continuous laser setting at 2.6W increased the risk by a factor of 72.8. The risk of lasing adipose tissue is 7.3 times higher than that of muscle. Charred tissue increases the risk of flame by a factor of 92.8. Flame occurred without a preceding spark 93.6% of the time. Conclusions Using KTP laser in the pulsed mode with low wattages, minimising lasing time, reducing the oxygen concentration and avoiding lasing adipose or charred tissue produce a relatively low estimated risk of spark or flame.

Rationale: High-flow nasal therapy (HFNT) has beneficial effects in patients hospitalized with acute hypoxemic respiratory failure. HFNT has not been extensively studied following hospitalization for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Objective: We explored the feasibility of conducting a multicentered trial to evaluate the use of HFNT to increase the time to next moderate/ severe exacerbation in patients recently hospitalized for a COPD exacerbation. In this pilot study we measured the hours of home daily HFNT use, maximally tolerated flow rates and temperature, and side effects for a period of 90 days. Methods: Patients were enrolled in a 90-day, open-labeled pilot study of HFNT to determine the safety and feasibility of home use for daily outpatient COPD management. Patients ≥ 40 years of age with prior hospitalization within the past 12 weeks for an AECOPD were enrolled. COPD was the primary diagnosis in all patients. Results: Thirty patients presented for HFNT titration. Two dropped out; 1 after receiving a lung transplant and the other was lost to follow-up. The remaining 28 patients completed 90 days of HFNT. None withdrew from HFNT due to intolerance. Use of HFNT averaged 6.8 (2.1) hours daily. Conclusions: Daily home HFNT for up to 3 months is feasible in COPD patients following hospitalization for AECOPD. Improvements observed in disease-specific quality of life, respiratory symptoms, and 6-minute walk distance suggest the need for a prospective multicenter controlled clinical trial.

Climate change and its impact on surface runoff in the upper Blue Nile basin and sub-basins have been widely studied in future climate projections. However, the impact on extreme flow events of rivers is barely investigated discretely. In this paper, the change in temperature and rainfall under the Representative Concentration Pathway (RCP) highest emission scenario (RCP 8.5) and its impact on the high flow and low flow simulated by the Soil and Water Assessment Tool (SWAT 2012) in major watersheds of the Lake Tana Basin has been evaluated by comparing the baseline period (1971–2000) with the 2020s (2011–2040), 2050s (2041–2070), and 2080s (2071–2100). The high flows of watersheds were selected by the Annual Maximum Series (AMS) model, whereas the low-flow watersheds were selected by the 7-day sustained mean annual minimum flow method. The result showed that the highest change in maximum temperature ranged from 2.93 °C to 5.17 °C in monthly time scales in the 2080s. The increment in minimum temperature is also more prominent in the 2080s and it is expected to rise by 4.75 °C. Inter-annual variability of the change in rainfall has shown increasing and decreasing patterns. The highest increments are expected by 22.37%, 25.58%, and 29.75% in the 2020s, 2050s, and 2080s, respectively, whereas the projected highest decrease in rainfall dictates the decrease of 6.42%, 7.11%, and 9.26% in 2020s, 2050s, and 2080s, respectively. Due to changes in temperature and rainfall, the low flow is likely to decrease by 8.39%, 8.33%, 6.21%, and 5.02% in Ribb, Gumara, Megech, and Gilgel Abay watersheds, respectively, whereas the high flow of Gilgel Abay, Megech, Gumara, and Ribb watersheds are expected to increase by 13.94%, 12.16%, 10.90%, and 10.24%, respectively, every 30 years.

Objective:The acute respiratory distress syndrome (ARDS)-associated coronavirus disease-2019 (COVID-19), caused by the highly contagious severe acute respiratory syndrome coronavirus 2 novel coronavirus, is a major cause of death during the pandemic period. Here, we aim to present a retrospective data analysis of the success of extubation to high-flow nasal oxygen (HFNO) among COVID-19 ARDS patients.Materials and Methods:The data of 22 COVID-19 ARDS patients who were laboratory confirmed and extubated on HFNO while under intubation in the intensive care unit (ICU) were analyzed. Respiratory variables and demographic characteristics were collected at admission. During the intubation period, mechanical ventilation volumes and pressures and blood gas measurements were recorded. HFNO flow rate, FiO2, and oxygenation variables were collected for 5 days after extubation. After the planned extubation, the 5-day reintubation rate, length of stay in the ICU, and mortality were recorded.Results:Sixteen of 22 patients were male (72.7%). The mean age was 69.9±13.2 years and the highest comorbidity was hypertension (59.1%). The time between symptom onset and admission to the ICU was 6.5±7.9 days. Almost all patients were intubated on the same day. Twenty patients were successfully extubated to HFNO. Two patients experienced reintubation. The mean duration of HFNO treatment and length of stay in the ICU were 17.4±6 and 4.8±3.6 days, respectively. The ICU mortality rate of these complete data was 13.6% (3/22).Conclusion:In high-risk COVID-19 ARDS patients undergoing extubation, HFNO therapy should be considered to prevent respiratory failure after reintubation and post-extubation.

Clinical use of heated, high-flow nasal cannula (HFNC) for noninvasive respiratory support is increasing and may have a therapeutic role in stabilizing the upper airway in obstructive sleep apnea (OSA). However, physiological mechanisms by which HFNC therapy may improve upper airway function and effects of different temperature modes are unclear. Accordingly, this study aimed to determine effects of incremental flows and temperature modes (heated and nonheated) of HFNC on upper airway muscle activity (genioglossus), pharyngeal airway pressure, breathing parameters, and perceived comfort. Six participants (2 females, aged 35 ± 14 yr) were studied during wakefulness in the supine position and received HFNC at variable flows (0-60 L/min) during heated (37°C) and nonheated (21°C) modes. Breathing parameters via calibrated Respitrace inductance bands (chest and abdomen), upper airway pressures via airway transducers, and genioglossus muscle activity via intramuscular bipolar fine wire electrodes were measured. Comfort levels during HFNC were quantified using a visual analog scale. Increasing HFNC flows did not increase genioglossus muscle activation despite increased negative epiglottic pressure swings (

This study reviews the mechanisms of action and physiologic effects of nasal continuous positive airway pressure (nCPAP) and high-flow nasal cannula (HFNC) in preterm infants with respiratory distress syndrome, discusses the main characteristics of available devices and patients' interfaces, reports on risk of failure and possible adverse effects, and summarizes clinical evidence regarding effectiveness for preventing mechanical ventilation as primary respiratory support or after extubation in the neonatal intensive care unit. nCPAP is preferred to HFNC as primary mode of noninvasive respiratory support in preterm infants with respiratory distress syndrome, whereas HFNC is an effective alternative to nCPAP after extubation.

Introducción: La COVID-19 grave se asocia con una neumonía bilateral hipoxemiante que desemboca en la necesidad de ventilación mecánica en un considerable número de pacientes. Hasta la fecha no existen recomendaciones acerca del momento óptimo para el inicio de la ONAF. Pacientes y Métodos: Estudio retrospectivo de todos los pacientes ingresados por neumonía por COVID-19 y que precisaron ONAF entre marzo de 2020 y febrero de 2021. Se agruparon los pacientes en función del momento de inicio de la ONAF de acuerdo con la PaFi modificada. Resultados: Se incluyeron 53 pacientes, en 44 se inició la ONAF precozmente y en 9 de ellos se inició tardíamente. No existieron diferencias clínico-epidemiológicas significativas. La utilización precoz de la ONAF se asoció con una disminución de la necesidad de intubación (29,5% vs 66,6%, p=0,044), de la estancia hospitalaria (18,8 d vs 36 d, p=0,022) y de la mortalidad (22,7% vs 55,5%, p=0,061). Conclusiones: El empleo precoz de la ONAF se asocia con una disminución de la necesidad de intubación, de la mortalidad y de la estancia hospitalaria global.

The high-flow nasal cannula (HFNC) has been recently used in several clinical settings for oxygenation in adults. In particular, the advantages of HFNC compared with low-flow oxygen systems or non-invasive ventilation include enhanced comfort, increased humidification of secretions to facilitate expectoration, washout of nasopharyngeal dead space to improve the efficiency of ventilation, provision of a small positive end-inspiratory pressure effect, and fixed and rapid delivery of an accurate fraction of inspired oxygen (FiO2) by minimizing the entrainment of room air. HFNC has been successfully used in critically ill patients with several conditions, such as hypoxemic respiratory failure, hypercapneic respiratory failure (exacerbation of chronic obstructive lung disease), post-extubation respiratory failure, pre-intubation oxygenation, and others. However, the indications are not absolute, and much of the proven benefit remains subjective and physiologic. This review discusses the practical application and clinical uses of HFNC in adults, including its unique respiratory physiologic effects, device settings, and clinical indications.

Background: High flow nasal oxygen (HFNO) is used as an alternative respiratory support in hypoxemic respiratory failure in COVID -19. However the use of HFNO was associated with a lower risk of invasive mechanical ventilation and duration of stay in ICU. This study is aimed at comparing ventilator free days and duration of ICU stay between early mechanical ventilation and HFNO use in COVID -19 to predict the clinical outcome. Methods: We performed a unicentre prospective observational analytical study on subjects with respiratory failure due to COVID -19 comparing effect of ROX index on ventilator free days with use of HFNO therapy and mechanical ventilation on first day of intensive care unit admission. Each group had 20 subjects. Clinical outcome was measured in terms of ventilator free days between two groups. Standard statistical comparisons were used to compare the length of icu stay as secondary outcome. APACHE II and SOFA sores were compared and analysed between two groups. Results: 40 adult subjects critically ill due to COVID -19 were included in the study with 20 in each group. Subjects in HFNO group had higher ventilator free days than those were put on early mechanical ventilation with significant difference. Whereas the duration of icu stay was prolonged in HFNO group but there was no significant statistical difference. Conclusions: In this prospective study HFNO had better clinical outcome in terms of ventilator free days compared to early mechanical ventilation. Duration of stay in ICU had no difference. Key words: Ventilator free days, HFNO, number of days in ICU, ROX index, APACHE II, SOFA score.

Nasal high flow therapy has been previously studied for the management of acute hypoxic respiratory failure in patients with chronic obstructive pulmonary disease but the data regarding its use outside of the intensive care unit are sparse. We aimed to evaluate safety and efficacy of nasal high flow therapy outside of the intensive care unit in patients with acute hypoxic respiratory failure and known chronic obstructive pulmonary disease. We conducted a retrospective matched historic cohort study of adult patients with diagnosed chronic obstructive pulmonary disease presenting with acute hypoxic respiratory failure between December 2017 to June 2019, after the initiation of a new protocol, which allowed patients to be managed with nasal high flow therapy on the medical/surgical wards instead of transferring them to the ICU per prior standard of care. Nasal high flow therapy was initiated either in the emergency department or on the medical/surgical wards. Patients were matched with historical cohorts who were managed with prior standard of care based on age, body mass index, comorbidities, and home oxygen use. Primary outcome of interest was difference in rates of mechanical ventilation. Secondary outcomes included hospital length of stay, total number of days spent in the intensive care unit, and in-hospital mortality. A total of 90 patients met study inclusion criteria and were matched to 90 historical control patients. Among the study group, 8% required mechanical ventilation versus 9% in the control group (p = 0.79). Hospital length of stay was 7 days in study group versus 6 days in control group (p = 0.02), and in-hospital mortality was the same in both study and control groups at 12% (p = 0.99). Nineteen percent of study group patients required ICU level of care at any time during the admission compared with 49% of control group (p

INTRODUCTION There are only scarce data regarding the cardiovascular impact of arteriovenous fistula after kidney transplantation depending on fistula flow. METHODS We performed a single-center, prospective, cohort study including 49 patients with a functional fistula at 1 year from kidney transplantation. Patients were convened for a clinical work-up, a biological analysis, a fistula's Doppler ultrasonography and an echocardiography. Main judgment criterion was comparison of echocardiography parameters between patients with relative (fistula flow >1 L/min and a fistula flow/cardiac output ratio >20%), absolute high-flow fistula (fistula flow >2 L/min) and normal-flow fistula. RESULTS High-flow fistula frequency was 69%. Significantly higher left ventricular end-diastolic and systolic diameters were observed in this group compared with the normal-flow fistula group (53 ± 6 vs. 48 ± 7 mm; p = 0.04 and 33 ± 6 vs. 28 ± 8 mm; p = 0.02) and between the absolute and relative high-flow fistula subgroups (56 ± 6 vs. 51 ± 6 mm; p = 0.009 and 35 ± 6 vs. 31 ± 5 mm; p = 0.01). The study showed no other significant differences. CONCLUSIONS This study showed a significantly higher but not pathological left ventricular end-diastolic and systolic diameters values in patients with high-flow fistula compared with patients with normal-flow fistula and between patients with respectively absolute and relative high-flow fistula.

BACKGROUND Oxygen therapy is required to prevent hypoxaemia during the endobronchial ultrasonography (EBUS) procedure. AIMS To compare the effectiveness of oxygen therapy delivered through high-flow nasal cannula (HFNC) and conventional nasal cannula (CNC) in patients undergoing EBUS. The primary outcome was the proportion of patients who desaturated. Patient compliance and satisfaction were also evaluated. METHODS This single-centre prospective interventional study was conducted in a tertiary hospital among patients who presented to the EBUS unit in 2018 and 2019. Patients were randomly assigned to the HFNC group or the CNC group. RESULTS The study included 170 patients (111 men and 59 women) with a mean age of 58 ± 14 years. The number of patients experiencing desaturation while receiving oxygen was statistically significantly lower (P

BACKGROUND: Aerosol delivery via high-flow nasal cannula (HFNC) has been increasingly used in recent years. However, the effects of different HFNC devices, nebulizer types, and placement on aerosol deposition remain largely unknown. METHODS: An adult manikin with anatomically correct upper airway was used with a collection filter placed between the manikin’s trachea and a breathing simulator, composed of a dual-chamber model lung driven by a critical care ventilator. Three HFNC device configurations were compared, with vibrating mesh nebulizer and small-volume nebulizer placed at the humidifier (inlet for Optiflow and outlet for Airvo 2) and proximal to the nasal cannula at gas flows of 10, 20, 40 and 60 L/min, in quiet and distressed breathing patterns. Albuterol (2.5 mg) was nebulized for each condition (no. = 3). The drug was eluted from the collection filter and assayed with ultraviolet spectrophotometry (276 nm). RESULTS: At all settings, except when a nebulizer was placed proximal to the nasal cannula with the Optiflow and when the HFNC flow was set at 60 L/min, the vibrating mesh nebulizer generated a higher inhaled dose than did the small-volume nebulizer (all P CONCLUSIONS: During transnasal aerosol delivery, the vibrating mesh nebulizer generated a higher inhaled dose than did the small-volume nebulizer when the nebulizer was placed at the humidifier. With the vibrating mesh nebulizer placed at the humidifier and an HFNC flow > 10 L/min, the inhaled dose was higher than with the vibrating mesh nebulizer placed proximal to the nasal cannula, and the inhaled dose was higher with Optiflow than with Airvo 2.

Objective: High flow nasal cannula (HFNC) plays role in many indications of oxygen therapy. Unfortunately, in middle income with a developing country like Thailand, HFNC is totally imported and high cost. For this whole reason, we would like to conduct DIY HFNC for comparing the efficacy with the standard marketing machine (Airvo-2). Materials and Methods: The present study was an experimental study. The DIY HFNC was generated from our many medical equipment. Targeted gas flow and fractional oxygen (FiO2) were calculated by gas concentration stoichiometry formula. The efficacy of DIY HFNC was measured gas flow, FiO2 compared with the standard machine. Results: Testing DIY HFNC when set-flow of 30 liters/min (L/m) and set-FiO2 in the range of 30 to 60% show achieved-flow in the range of 29.30 to 34.48 L/m (relative different (Δ) -2.33 to 14.93%), achieved-FiO2 as 30.60, 41.80, 52.50 and 60.50% (Δ2, 4.50, 5 and 0.83%, respectively). The next set-flow of 40 L/m and set-FiO2 in the range of 40 to 60% show achieved-flow in the range of 42.28 to 45.25 L/m (Δ10.70 to 13.13%), achieved-FiO2 as 41.50, 51.50 and 60.50% (Δ3.75, 3 and 0.83%, respectively). The next set-flow of 50 L/m and set-FiO2 at 60% show achieved-flow as 57.09 L/m (Δ14.18%), achieved-FiO2 as 60.10% (Δ0.17%). The last set-flow of 60 L/m and set-FiO2 at 60% show achieved-flow as 68.98 L/m (Δ14.97%), achieved-FiO2 as 63% (Δ5%). All usage periods give the same measure values. Conclusion: The DIY HFNC shows the efficacy nearby the standard machine in gas flow range of 30 to 60 L/m and FiO2 range of 30 to 60%. Keywords: High flow nasal cannula (HFNC); Do it by yourself (DIY)

Venturi-based flow generators are commonly used for noninvasive continuous positive airway pressure (CPAP) of high-flow nasal oxygen (HFNO). The system is simple and allows to increase the total flow while decreasing the FiO2 starting from a single oxygen source. In this report we describe the characteristics and performance of a novel Venturi system (EasyVEE, Levate, BG, Italy), which allows to vary the size of the port through which ambient air is entrained, hence allowing a continuous modulation of FiO2. The system allowed to modify FiO2 continuously between 35% and 80% and, consequently, a 1.5- to 4.5-fold increase of the total flow rate. A minimal decrease in entrainment performance was observed for positive end-expiratory pressure levels above 12.5 cmH2O. EasyVEE system appears to be a simple, flexible, and reliable solution to generate continuous flow for noninvasive respiratory support interfaces.

INTRODUCTION Appropriate treatment of scalp arteriovenous malformations (SAVMs) remains largely unclear given the rarity of reported cases. This single-institution case series presents consecutive patients with extracranial SAVMs and long-term follow up.The primary aim of this study was to review treatment decisions, evaluate clinical outcomes, and compare our experience to available literature in order to better understand SAVMs and improve future outcomes. MATERIALS AND METHODS A retrospective review of consecutive patients with extracranial SAVMs between January 2015 and December 2019 was performed. Treatment factors of interest included embolization method, embolic agents, and decision to proceed with surgical resection. Relevant clinical outcomes included recurrence rates, cure rates, and complications. RESULTS Seven patients were included in the present series. Satisfactory outcomes were ultimately achieved for all 7 patients using embolization with or without combined surgical resection. Embolizations performed in combination with resection were curative in 4 of 4 cases (100%). Embolizations performed without resection were curative in 0 of 4 cases (0%), satisfactory in 2 of 4 cases (50%), and unsatisfactory in 2 of 4 cases (50%). DISCUSSION All SAVM patients in this series were treated satisfactorily using embolization with or without operative resection. This study strongly suggests that embolization combined with surgical resection during the same admission yields the best treatment outcomes for SAVMs, specifically demonstrating lower rates of recurrence and embolization-related complications. Decisions on whether or not to proceed with resection should be made by the interventional radiologist, the plastic surgeon, and the patient together.

Calculations performed with modern computer fluid dynamics (CFD) programs aid in optimizing the flow path of a centrifugal compressor. The characteristics of the stator elements of the flow path, calculated by CFD methods, are considered to be quite accurate. Optimization of three-stage reverse-directing devices with a large flow rate (0.15) and different theoretical head coefficients (0.45; 0.60; 0.70) has been carried out. For optimizing return channels a parameterized model was created. Optimization was performed with MOGA (Multi-Objective Genetic Algorithm) optimization method in the Direct Optimization program of the ANSYS software package. The optimization goal was to achieve the minimum loss factor at the design point. In the optimization process, the following parameters were varied: the number of and the inlet angle of the vanes, the height of the vanes at the inlet, external and internal radii of curvature of the U-bend. For the return channel with a minimum loss coefficient, the dependences of this parameter on the flow coefficient were calculated. Comparison with the characteristics of the initial variant showed that the optimized return channels are more efficient over the entire flow range. Optimization allowed reducing the loss factor by 20%.

Background Recently high flow nasal oxygenation was used to prolong the safe apnoea period during induction of general anaesthesia. This randomized study was designed to compare between using transnasal humidified rapid insufflation ventilator exchange technique (THRIVE) and traditional face mask for preoxygenation in caesarean section. The primary aim was to measure the safe apnoea time. Methods The study was performed on 100 ASA II pregnant women scheduled for elective caesarean section under general anaesthesia. Patients were randomly assigned to either face mask ventilation or THRIVE. Results The safe apnoea time was significantly longer under THRIVE with median of 7 min compared to facemask ventilation with 4 min. PaO2 with the facemask was 101 mmHg (74–215, median and range) after 3 min of apnoea vs. 355 mmHg (120–498) with THRIVE (P Conclusion High humidified nasal flow oxygenation is more effective and practicable than face mask ventilation in improving oxygenation during induction of anaesthesia during caesarean section and might improve patients’ safety by avoiding desaturation.

Objective. To explore the clinical application of dynamic volume CT multiparameter imaging in the observation of penile hemodynamics in patients with abnormal vascular erections. Methods. 90 patients with suspected vascular abnormal erections treated in our hospital from January 2016 to January 2020 were included in the study, and 40 patients with psychologically abnormal erections were selected for the control. The corpus cavernosum injection vasoactive drug test (ICI) and dynamic volume CT and Doppler ultrasound were used to test the hemodynamics of the corpus cavernosum of all selected patients and to analyze the changes of penile length, circumference, systolic peak flow rate, diastolic peak flow rate, and blood flow resistance index in different types of penile erection disorder patients before and after ICI test. Results. Among the 90 patients with suspected vascular abnormal erection, 34 patients had arterial abnormal erection, 25 patients had venous abnormal erection, and 31 patients had mixed vascular abnormal erection. In patients with arterial abnormal erection and mixed vascular abnormal erection, penile cavernous body diameter, PSV, and abnormal erection V are smaller than those in patients with venous abnormal erection and psychological abnormal erection, while arterial abnormal erection and psychological abnormal erection are obviously higher in RI than venous abnormal erection and mixed vascular abnormal erection, and the difference is statistically significant ( P < 0.05 ). Before the ICI test, there was no significant difference in the penis circumference and length between the four groups of patients with arterial abnormal erection, venous abnormal erection, mixed vascular abnormal erection, and psychological abnormal erection ( P > 0.05 ); after the ICI test, patients with arterial abnormal erections had significantly shorter penis perimeter and penis length than those with venous abnormal erections, mixed vascular abnormal erections, and psychological abnormal erections ( P < 0.05 ). Conclusion. Dynamic volume CT can clearly reflect the penile hemodynamic state of patients with vascular abnormal erections, provide a powerful diagnostic basis for accurately and effectively determining the classification of vascular abnormal erections, and be worthy of popularization and clinical use.

Introduction: Infants and children with congenital heart disease may develop respiratory failure in association with cardiac surgery or as a result of heart disease. In fact, the postextubation period in this group of patients can be complex and the use of continuous positive airway pressure or non-invasive ventilation may be necessary if conventional oxygen therapy is not sufficient. The aim of our study was to compare efficiency and outcomes of high-flow nasal cannula or conventional oxygen therapy post-extubation after pediatric cardiac surgery. Patients and Methods: A single centre retrospective study was conducted between January and December 2020 in our 12 beds pediatric cardiac intensive care unit. Patients were divided into two groups. In one group 45 patients (Group I), those who received high-flow nasal cannula after extubation, and in the other group 45 patients (Group II), those who received oxygen therapy with a mask after extubation. The aim of the study was to evaluate the rela- tive efficacy of high flow nasal cannula and conventional oxygen therapy on PaCO2, PaO2 and PaO2/FiO2. Results: PaO2 values at 1, 6, 12, 24 and 48 hour post-extubation were significantly higher in high-flow nasal cannula group (p< 0.05). PaCO2 values were significantly lower in the high-flow nasal cannula group at 1, 6, 12, 24 and 48 hour post-extubation (p= 0.01). PaO2/FiO2 values in high-flow nasal cannula group at all-time points post-extubation were significantly higher than in conventional oxygen therapy group (p= 0.01). Conclusion: High-flow nasal cannula is useful in decreasing PaCO2 and improving PaO2 in children follow- ing extubation after cardiac surgery. In addition, the simplicity of and tolerability to high-flow nasal cannula is also important. Although more expensive, the use of high-flow nasal cannula can be considered as a safe and effective alternative to conventional oxygen therapy following pediatric cardiac surgery.

An online questionnaire survey was used to assess the application of noninvasive strategies in the management of COVID-19 patients. We found a marked increase in the proportion of facilities using high flow nasal cannula (HFNC) oxygen therapy successfully in the 3rd epidemic wave as compared to the 1st wave (49% vs. 12%) and rare reports of associated nosocomial infection in the medical personnel. Furthermore, the proportion of facilities using HFNC as first-line therapy for half or more than half of their patients who did not respond to conventional oxygen therapy increased from 9% in the first to 33% in the second survey. Conversely, the rate of mechanical ventilation with intubation usage following conventional oxygen therapy failure decreased from 62% to 54%. These changes could be due to the limited medical resources available during the larger 3rd wave coupled with increased internal reports on the success of HFNC.

Reclaimed water has demonstrated its broad applications in social construction to alleviate the contradiction of water shortage in Beijing, China. Using multivariate statistical analysis, the current study investigated the spatial variations of water quality in the Chaobai River restored by reclaimed water during the high-flow period. Hierarchical cluster analysis (CA) classified the 11 sampling sites into four clusters, namely most polluted, highly polluted, moderately polluted, and lowly polluted sections. The Kruskal-Wallis test showed that pH, TDS, EC, Ca2+, Mg2+, Cl−, SO42−, NO3−-N, and TN had significant spatial differences among four clusters (p < 0.05). Mean value of total nitrogen (TN) in the most polluted site exceeded the guideline (15 mg/L) of the Water Quality Standard for Scenic Environment Use, reaching 22.3 mg/L. Principal component analysis (PCA) extracted three principal components (PCs) accounting for 81.5% of the total variance in the data set of water quality. The three PCs reflected the chemical characteristics of reclaimed water, mineral pollution, and nutrient pollution, respectively. With the ordination biplot of sampling sites defined by the first and second PCs, PCA provided a classification of sampling sites based on the similarity of pollution sources, which supported the results of CA. The results revealed that water quality of the Chaobai River restored by reclaimed water was affected by untreated domestic and agricultural sewage with nitrogen and minerals being the main pollutants along the river basin. This study showed rivers restored by reclaimed water had significant spatial variations of water quality, demonstrating effectiveness of multivariate statistical methods on water quality analysis. HIGHLIGHTS Water quality of the river restored by reclaimed water showed significant spatial variations.; Nitrogen pollution was severe compared to standard values.; CA and PCA indicated similar spatial patterns of water quality variations.; Besides reclaimed water, untreated domestic and agricultural sewage were also pollution sources.; The effectiveness of multivariate statistical methods on water quality analysis was demonstrated.

Recently, the demand for high-pressure and high-flow truck-mounted pumps has been increasing due to the frequent occurrence of fires in high-rise buildings. The Korean Fire Equipment Standards, which were specified by the National Fire Agency in January 2018, stipulate the performance test of high-pressure and high-flow fire pumps. In this paper, the relevance of the fire pump standard in Korean Fire Equipment Standards was evaluated by comparison and review the technical standards of domestic KFI certification, NFPA1901 in the United States and EN1028 in Europe based on the performance test of currently used truck-mounted fire pumps. Furthermore, the necessity of establishing performance test facilities for fire pumps was discussed based on the difference between the technical fire pump standards of National Fire Agency and current KFI certification to introduce accurate and safe high-pressure, high-flow fire pumps in the future.