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Severe cases of coronavirus disease 2019 (COVID-19) cannot be adequately managed with mechanical ventilation alone. The role and outcome of extracorporeal membrane oxygenation (ECMO) in the management of COVID-19 is currently unclear. Eight COVID-19 patients have received ECMO support in Shanghai with 7 with VV ECMO support and 1 VA ECMO during cardiopulmonary resuscitation. As of March 25, 2020, 4 patients died (50% mortality), three patients (37.5%) were successfully weaned off ECMO after 22, 40 days and 47 days support respectively, but remain on mechanical ventilation. One patient is still on VV ECMO with mechanical ventilation.The PaO2/FiO2 ratio before ECMO initiation were between 54 to 76 and all were well below 100. The duration of mechanical ventilation before ECMO ranged from 4-21 days. Except the one emergent VA ECMO during cardiopulmonary resuscitation, other patients were on ECMO support for between 18 to 47 days. In conclusion, ensuring effective, timely, and safe ECMO support in COVID-19 is key to improving clinical outcomes. ECMO support might be an integral part of the critical care provided for COVID-19 patients in centers with advanced ECMO expertise.Computational fluid dynamics has become a dynamic tool in the development of ventricular assist devices (VADs) and as a predictor of thrombosis within these pumps. MitomycinC The genesis of thrombi could be in loco, due to deposition within the VAD, or upstream such as the left atrial appendage or inside the left ventricle. To calibrate our group's computational model, a retrospective analysis of 29 explanted HeartMate II (HMII) VADs due to suspected pump thrombosis (PT) from the University of Michigan was conducted. Thrombi in these pumps were characterized by their frequency, composition, severity, and physical distribution in five regions of the blood flow pathway. The outlet bearing/stator region had the highest frequency of deposition (≈72%), and the preponderance of thrombi appeared white and unlaminated in their microstructure. Conversely, 41.3% of VADs showed thrombus on the fore bearing of the HMII, and these formations tended to be red and laminated, indicating they formed in layers over time. Furthermore, the majority of clots observed in the fore bearing and outlet bearing/stator regions were partially occlusive in nature. Fourteen VADs presented PT in multiple regions and analysis of the data showed a statistically significant correlation (p less then 0.01) between deposition in the fore bearing and subsequent thrombosis in the outlet bearing/stator; however, no other regions exhibited statistically significant correlations. This gives credence to the hypothesis that thrombi do not occur independently in multiple regions of the blood flow pathway in the HMII but may propagate downstream.OBJECTIVES To characterize the literature on operative interventions for proximal humerus nonunions in adults. Second, to identify prognostic factors associated with outcomes for locked plate ORIF. DATA SOURCES PubMed, EMBASE, MEDLINE, Scopus, and Cochrane databases were searched for articles from 1990-2020. STUDY SELECTION Studies reporting outcomes of proximal humerus nonunions managed with open reduction and internal fixation (ORIF), hemiarthroplasty (HA), shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RTSA) were included. Studies failing to stratify outcomes by treatment or fracture sequelae were excluded. DATA EXTRACTION Two authors independently extracted data and appraised study quality via MINORS score. DATA SYNTHESIS Descriptive statistics were reported. Outcomes for ORIF and arthroplasty groups were not compared due to differing patient populations. CONCLUSIONS Thirty-seven articles were included, representing 508 patients (246 ORIF, 137 HA/TSA, and 125 RTSA). Patients managed by ORIF were younger with simpler fracture patterns than those managed via arthroplasty. With regard to ORIF, locked plates achieved highest union rates (97.0%), but clinical outcomes were comparable with all plate fixation constructs (FF 123-144°; ER 42-46°; Constant score 75-84). Complication and reoperation rates for ORIF were 26.0% and 14.6%, respectively. Further, subgroup analysis of locked plate ORIF demonstrated shorter consolidation time with initial conservative fracture management (4.3 vs. 6.0 months) and autograft use (3.9 vs. 5.5 months). With arthroplasty, RTSA demonstrated greater forward flexion (109.4° vs. 97.2°) but less external rotation (16.5° vs. 36.8°) than HA/TSA. Complication and reoperation rates were 18.2% and 10.9% for HA/TSA and 21.6% and 14.4% for RTSA, respectively. LEVEL OF EVIDENCE IV.External fixation is often used for temporary stabilization of the tibia in several clinical scenarios. Conventional placement of external fixation pins may impede instrumentation with intramedullary nailing, thus requiring pin removal, loss of reduction, and increased operative time during definite fixation. In this paper, we describe a strategic pin placement routinely used at our institution in which we create a medially-based inverted triangular construct that allows for pins to remain in place during definitive fixation.This paper is number 7 in a series developed through a partnership between ISIMM and NordiQC with the purpose of reporting research assessing the performance characteristics of immunoassays in an external proficiency testing program.The Coronavirus Disease 2019 (COVID-19) pandemic, caused by SARS-CoV-2, has caused severe disease outcomes and widespread infections not seen in terms of its case fatality rate and global economic impact since the 1918-1919 Spanish flu; the latter leading to 675,000 deaths in the United States (US) (50 million worldwide).Age-progressive neural stem cell (NSC) dysfunction leads to impaired neurogenesis, cognitive decline and the onset of age-related neurodegenerative pathologies. p38MAPK signalling pathway limits stem cell activity during aging in several tissues. Its role in NSCs remains controversial. In this work, we show that p38MAPK activity increases in NSCs with age in the subventricular zone (SVZ) and its pharmacological inhibition is sufficient to rejuvenate their activity in vitro. These data reveal a cell-autonomous role for p38MAPK increase in decreasing NSC homeostasis with age. This information shed light in the role of p38MAPK in NSC aging.
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