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Cardiogenic shock carries high morbidity and mortality. The purpose of this review was to determine the safety and efficacy of pulmonary artery catheterization (PAC) in adult patients hospitalized with cardiogenic shock. We performed a systematic review and meta-analysis of observational studies and randomized controlled trials comparing PAC vs no PAC in cardiogenic shock. We searched MEDLINE, EMBASE, Cochrane CENTRAL, and grey literature. We screened articles, abstracted data, and evaluated risk of bias in duplicate. We pooled data using a random-effects model and evaluated the quality of evidence using the GRADE framework. Outcomes of interest were mortality, length of stay, and procedural complications. We identified 19 eligible observational studies (≥ 2,716,287 patients) and no randomized controlled trials; 14 studies were at high risk of bias (lack of adjustment for prognostic variables and/or co-interventions). When pooling adjusted results, PAC was associated with improved survival to hospital discharge (relative risk [RR], 0.77; 95% confidence interval [CI], 0.64 to 0.91, I2 = 98%; very low-quality evidence) and at longest available follow-up (RR, 0.72; 95% CI, 0.60 to 0.87; I2 = 99%; very low-quality evidence). Unadjusted length of stay was 3.5 days longer (95% CI, 1.49 to 5.54; I2 = 100%; very low-quality evidence) with PAC. Procedural complications were inconsistently reported. Very low-quality observational evidence suggests PAC use in patients with cardiogenic shock is associated with lower mortality. Overall, these results support consideration of PAC for hemodynamic assessment in cardiogenic shock. Prospective randomized clinical trials are needed to further characterize the role of PAC in this population.

Background Collagen cross-linking (CXL) is an evolving procedure that enhances the biomechanical rigidity of the cornea and can slow or halt ectatic disease. CXL requires delivery of 5.4 J/cm2 of ultraviolet A (UVA) radiation to a cornea saturated with riboflavin in order to induce cross-link formation. The conventional CXL procedure achieves this fluence by exposing the cornea to a 3 mW/cm2 UVA lamp for 30 min; however, some surgeons have proposed accelerated protocols which achieve the same fluence in a shorter period of time by using a higher power light source. Whether accelerated protocols are as effective in arresting ectasia as the established conventional procedure remains unclear. Accordingly, this study will systematically review and synthesise the evidence on accelerated CXL and compare it to the conventional approach across an array of clinical outcomes. Methods We will search 16 electronic databases, including MEDLINE, Embase, and the Cochrane Library, from inception to February 1, 2019. We will include all randomised controlled trials comparing accelerated and conventional CXL for any corneal ectatic disease. Two reviewers will independently screen search results to identify eligible articles, complete data collection, and conduct quality assessment. The quality of individual trials will be assessed using the Cochrane Collaboration’s Risk of Bias Assessment Tool. Our primary outcome will be the change in maximal keratometry (K max) at 12 months following treatment. Additional outcomes will include: incidence of disease progression, incidence of serious adverse events, as well as change in K max at longest follow-up, mean stromal demarcation line depth, mean uncorrected distance visual acuity, mean corrected distance visual acuity, mean K max, mean endothelial cell density, mean central corneal thickness, mean spherical equivalent, mean intraocular pressure, and mean corneal power, at 12 months following treatment. We will calculate relative risks and 95% confidence intervals (CIs) for dichotomous outcomes and weighted mean differences and corresponding 95% CIs for continuous outcomes. Prespecified subgroup analyses will be performed to investigate heterogeneity. We will rate the overall quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Discussion This review will provide a comprehensive evaluation of the evidence on accelerated and conventional CXL approaches and serve to inform clinical practice, medical device design, and future research. Evaluating variations of the CXL protocol aimed at reducing treatment duration is of critical importance and a prerequisite to expanding treatment availability to more patients. Systematic review registration PROSPERO CRD42018104151

We prove an extension theorem of "Ohsawa-Takegoshi type" for Dolbeault q$-classes of cohomology ($q\geq 1$) on smooth compact hypersurfaces in a weakly pseudoconvex K\"ahler manifold, Comment: to appear in Manuscripta Mathematica

Bacterial adhesion onto polyester cloth was greatly reduced by coating the cloth with polyvinyl alcohol (PVA). Under autoclaving conditions, the PVA coating was stable in water but not in 1% SDS. However, the treatment of the PVA-coated cloth with acidic 1% glutaraldehyde stabilized the coating to retain full resistance to bacterial adhesion even after autoclaving in 1% SDS.

Escherichia coli 3300 (constitutive for β-galactosidase) had a greater adhesion (assayed by β-galactosidase) to polyester cloth than to cotton cloth. Adhered bacteria developed immobilized cells on the cloth which can generate progeny efficiently. Similarly, four other Gram-negative bacteria and three Gram-positive bacteria had greater adhesion to polyester cloth than to cotton cloth. Since coating of polyester cloth with polyvinyl alcohol greatly decreased the bacterial adhesion, hydrophobic interaction is likely responsible for the bacterial adhesion to polyester cloth.

We present a case of epidural lipomatosis in a non-obese patient with no history of steroid use. On MRI, the lipomatous mass had an unusual appearance and was centered over thoracic vertebrae with Paget's disease. Decompressive laminectomy was effective in promoting resolution of the neurological deficits.