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BackgroundPatients with severe acute respiratory distress syndrome (ARDS) typically receive ultra-protective ventilation after extracorporeal membrane oxygenation (ECMO) is initiated. While the benefit of ECMO appears to derive from supporting “lung rest”, reductions in the intensity of mechanical ventilation, principally tidal volume limitation, may manifest radiologically. This study evaluated the relative changes in radiographic assessment of lung edema (RALE) score upon venovenous ECMO initiation in patients with severe ARDS.MethodsDigital chest x-rays (CXR) performed at baseline immediately before initiation of ECMO, and at intervals post (median 1.1, 2.1, and 9.6 days) were reviewed in 39 Adult ARDS patients. One hundred fifty-six digital images were scored by two independent, blinded radiologists according to the RALE (Radiographic Assessment of Lung Edema) scoring criteria. Ventilatory data, ECMO parameters and fluid balance were recorded at corresponding time points. Multivariable analysis was performed analyzing the change in RALE score over time relative to baseline.ResultsThe RALE score demonstrated excellent inter-rater agreement in this novel application in an ECMO cohort. Mean RALE scores increased from 28 (22–37) at baseline to 35 (26–42) (p < 0.001) on D1 of ECMO; increasing RALE was associated with higher baseline APACHE III scores [ß value +0.19 (0.08, 0.30) p = 0.001], and greater reductions in tidal volume [ß value −2.08 (−3.07, −1.10) p < 0.001] after ECMO initiation. Duration of mechanical ventilation, and ECMO support did not differ between survivors and non-survivors.ConclusionsThe magnitude of reductions in delivered tidal volumes correlated with increasing RALE scores (radiographic worsening) in ARDS patients receiving ECMO. Implications for patient centered outcomes remain unclear. There is a need to define appropriate ventilator settings on venovenous ECMO, counterbalancing the risks vs. benefits of optimal “lung rest” against potential atelectrauma.

Mariana A Vetrici,1,* Soheila Mokmeli,2,* Andrew R Bohm,3 Monica Monici,4 Scott A Sigman5,* 1Department of Biological Sciences, University of Lethbridge, Lethbridge, AB, Canada; 2Training Institute, Canadian Optic and Laser Center, Victoria, BC, Canada; 3Department of Orthopedics, Lenox Hill Hospital, New York, NY, USA; 4ASA Campus J.L., ASA Res. Division – Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy; 5Department of Orthopedics, Lowell General Hospital, Lowell, MA, 01863, USA*These authors contributed equally to this workCorrespondence: Scott A SigmanDepartment of Orthopedics, Lowell General Hospital, 295 Varnum Avenue, Lowell, MA, 01863, USATel +1 978 856 7676Email sasigmanmd@icloud.comPurpose: Evidence-based and effective treatments for COVID-19 are limited, and a new wave of infections and deaths calls for novel, easily implemented treatment strategies. Photobiomodulation therapy (PBMT) is a well-known adjunctive treatment for pain management, wound healing, lymphedema, and cellulitis. PBMT uses light to start a cascade of photochemical reactions that lead to local and systemic anti-inflammatory effects at multiple levels and that stimulate healing. Numerous empirical studies of PBMT for patients with pulmonary disease such as pneumonia, COPD and asthma suggest that PBMT is a safe and effective adjunctive treatment. Recent systematic reviews suggest that PBMT may be applied to target lung tissue in COVID-19 patients. In this preliminary study, we evaluated the effect of adjunctive PBMT on COVID-19 pneumonia and patient clinical status.Patients and Methods: We present a small-scale clinical trial with 10 patients randomized to standard medical care or standard medical care plus adjunctive PBMT. The PBMT group received four daily sessions of near-infrared light treatment targeting the lung tissue via a Multiwave Locked System (MLS) laser. Patient outcomes were measured via blood work, chest x-rays, pulse oximetry and validated scoring tools for pneumonia.Results: PBMT patients showed improvement on pulmonary indices such as SMART-COP, BCRSS, RALE, and CAP (Community-Acquired Pneumonia questionnaire). PBMT-treated patients showed rapid recovery, did not require ICU admission or mechanical ventilation, and reported no long-term sequelae at 5 months after treatment. In the control group, 60% of patients were admitted to the ICU for mechanical ventilation. The control group had an overall mortality of 40%. At a 5-month follow-up, 40% of the control group experienced long-term sequelae.Conclusion: PBMT is a safe and effective potential treatment for COVID-19 pneumonia and improves clinical status in COVID-19 pneumonia.Keywords: COVID-19, low-level laser therapy, pneumonia, SMART-COP, BCRSS, RALE

This article aims to contextualize the entrepreneurship of a specific social class, the Brazilian Ralé. This term is used by Jessé Souza’s (2009) perspective to classify a forgotten and excluded working class. Articulately, it is used the concept of Carrieri (2012), ordinary management, to assign to the class mentioned above a work context. It is our interest an approach along the lines of Michel de Certeau (1998), analyzing strategies and tactics developed by these entrepreneurs in everyday business. This paper consists of a qualitative descriptive research in order to introduce and develop the subject from respondents reported. The article aims to enable an understanding of specificities of this kind of entrepreneurship still not present in academic discussions.

Roasted cassava roots flour is part of a common meal in Africa, it is known as rale in Mozambique. Fifty six samples of rale were collected from homes and markets in Inhambane Province, Mozambique, for cyanogenic potential (CNp) analyses. The names of cassava varieties used for preparing the rale samples could be determined in the home-collected samples, three varieties were recorded. Xinhembwe variety gave rale samples with 30 ± 8 mg CNp/kg (mean + standard error), Precoce de angola with 43 ± 11 mg CNp/kg and Rungo sabonete with 58 ± 22 mg CNp/kg dry weight. The mean cyanogenic value for all the 56 samples collected was 41 ± 16 mg CNp/kg. Cyanogenic potentials in all the rale samples were above 10 mg HCN/kg, the value regarded by the Codex Alimentarius Commission of the FAO/WHO as safe.