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The complex and diverse phenomenon of fungal bioluminescence has captured human curiosity. Nevertheless, in the field of studies, there are not many attempts made particularly to reveal the new species of these interesting fungi. This study comprehensively reviews the diversity, distribution, evolution, bioluminescence mechanisms, ecological roles, and potential applications of these fungi. Most importantly, we also present an updated list of the reported bioluminescent fungi (122) so far identified from five distinct evolutionary lineages worldwide—Armillaria, Eoscyphella, Lucentipes, Mycenoid, and Omphalotus—mainly in tropical and subtropical areas. Bioluminescent fungi are descended from the last common ancestor of the Mycenoid and the Marasmioid clades of Agaricales, which have been maintained for at least 160 million years of evolution. We underscore the potential for future research to understand the ecological role of bioluminescent fungi, inspiring hope and optimism for the future of this field.

Traumatic pneumothorax (PTX) occurs in up to 50% of patients with severe polytrauma and chest injuries. Patients with a traumatic PTX with clinical signs of tension physiology and hemodynamic instability are typically treated with an urgent decompressive thoracostomy, tube thoracostomy, or needle decompression. There is recent evidence that non-breathless patients with a hemodynamically stable traumatic PTX can be managed conservatively through observation or a percutaneous pigtail catheter. We present here a 52-year-old woman who presented to the emergency department with a 55 mm traumatic PTX. Following aspiration of 1500 mL of air, a clinical improvement was immediately observed, allowing the patient to be discharged shortly thereafter. In hemodynamically stable patients with a post-traumatic PTX, without specific risk factors or oxygen desaturation, observation or simple needle aspiration can be a reasonable approach. Although the recent medical literature supports conservative management of small traumatic PTXs, guidelines are lacking for hemodynamically stable patients with a significantly large PTX. This case report documents our successful experience with needle aspiration in such a setting of large traumatic PTX. We aimed in this article to review the available literature on needle aspiration and conservative treatment of traumatic pneumothorax. A total of 12 studies were selected out of 190 articles on traumatic PTX where conservative treatment and chest tube decompression were compared. Our case report offers a novel contribution by illustrating the successful resolution of a sizable pneumothorax through needle aspiration, suggesting that even a large PTX in a hemodynamically stable patient, without other risk conditions, can be successfully treated conservatively with simple needle aspiration in order to avoid tube thoracostomy complications.

Idiopathic acute pancreatitis (IAP) presents a diagnostic challenge and refers to cases where the cause of acute pancreatitis remains uncertain despite a comprehensive diagnostic evaluation. Endoscopic ultrasound (EUS) has emerged as a valuable tool in the diagnostic workup of IAP. This review explores the pivotal role of EUS in detecting the actual cause of IAP and assessing its accuracy, timing, safety, and future technological improvement. In this review, we investigate the role of EUS in identifying the actual cause of IAP by examining the available literature. We aim to assess possible existing evidence regarding EUS accuracy, timing, and safety and explore potential trends of future technological improvements in EUS for diagnostic purposes. Following PRISMA guidelines, 60 pertinent studies were selected and analysed. EUS emerges as a crucial diagnostic tool, particularly when conventional imaging fails. It can offer intricate visualization of the pancreas, biliary system, and adjacent structures. Microlithiasis, biliary sludge, chronic pancreatitis, and small pancreatic tumors seem to be much more accurately identified with EUS in the setting of IAP. The optimal timing for EUS is post-resolution of the acute phase of the disease. With a low rate of complications, EUS poses minimal safety concerns. EUS-guided interventions, including fine-needle aspiration, collection drainage, and biopsies, aid in the cytological analysis. With high diagnostic accuracy, safety, and therapeutic potential, EUS is able to improve patient outcomes when managing IAP. Further refinement of EUS techniques and cost-effectiveness assessment of EUS-guided approaches need to be explored in multicentre prospective studies. This review underscores EUS as a transformative tool in unraveling IAP’s enigma and advancing diagnostic and therapeutic strategies.

Background Acute aortic dissection (AAD) is a rare condition but represents a time-sensitive disease for which a wrong and untimely identification in the triage phase could compromise the subsequent diagnostic, therapeutic path and patient's prognosis. The emergency nurse plays a crucial role in identifying and managing patients with possible AAD. The aim of this paper is to describe the emergency department nursing approach to critical patients with suspected hyperacute/acute AAD. Purpose It is crucial to examine the emergency departments nursing approach to patients with suspected AAD. It is fundamental to have a rapid and standardized approach related to life-saving procedures, practices, and management of critical patients during the triage phase, with the assessment of the most common presentation of clinical signs and symptoms and patient management during each step in the emergency department. Conclusion Early identification and diagnosis in ED allow prompt treatment that improves prognosis. The emergency nurse plays a crucial role in correctly identifying and managing patients with acute aortic dissection. High clinical suspicion from the triage stages, early diagnosis, monitoring, and initial clinical stabilization in the emergency department plays a key role while awaiting definitive treatment.

A 48-year-old female presented to the emergency department with chest pain and collapsed at the front desk. She was reanimated with mechanical chest compression, and after coronary angiography, a left anterior descending/diagonal bifurcation mini-crush stenting was performed. Few hours after the procedure, the patient showed severe hypotension. Abdominal ultrasound and computed tomography (CT) scan evidenced a massive subcapsular liver hematoma (Grade IV, American association for the surgery of trauma (AAST) liver injury scale) of the right lobe with extrahepatic blushing. Transhepatic embolization was attempted but without benefit, so the patient underwent emergency laparotomy for damage control surgery with perihepatic packing. After hemodynamic stabilization, right hepatectomy was performed with a favorable outcome and full recovery. The patient CT scan was retrospectively processed to obtain a virtual model visualizable through a head-mounted display. The virtual reconstruction could improve the comprehension of the injury and the liver surgical anatomy for educational purpose, and it could represent a new tool for preoperative planning.

Abstract A substantial number of patients are at high-risk of intra- or post-operative complications or both. Most perioperative deaths are represented by patients who present insufficient physiological reserve to meet the demands of major surgery. Recognition and management of critical high-risk surgical patients require dedicated and effective teams, capable of preventing, recognize, start treatment with adequate support in time to refer patients to the satisfactory ICU level provision. The main task for health-care planners and managers is to identify and reduce this severe risk and to encourage patient’s safety practices. Inadequate tissue perfusion and decreased cellular oxygenation due to hypovolemia, heart dysfunction, reduced cardiovascular reserve, and concomitant diseases are the most common causes of perioperative complications. Hemodynamic, respiratory and careful sequential monitoring have become essential aspects of the clinical practice both for surgeons and intensivists. New monitoring techniques have changed significantly over the past few years and are now able to rapidly identify shock states earlier, define the etiology, and monitor the response to different therapies. Many of these techniques are now minimally invasive or non-invasive. Advanced hemodynamic and respiratory monitoring combines invasive, non-invasive monitoring skills. Non-invasive ultrasound has emerged during the last years as an essential operative and perioperative evaluation tool, and its use is now rapidly growing. Perioperative management guided by appropriate sequential clinical evaluation combined with respiratory and hemodynamic monitoring is an established tool to help clinicians to identify those patients at higher risk in the attempt to reduce the complications rate and potentially improve patient outcomes. This review aims to provide an update of currently available standard concepts and evolving technologies of the various respiratory and hemodynamic monitoring systems for the high-risk surgical patients, highlighting their potential usefulness when integrated with careful clinical evaluation.

Environmental changes and heavy metal pollution are some of the consequences of anthropogenic activities. Many ecosystems, including edaphic ecosystems, suffer from the effects of pollution. The accurate assessment of soil heavy metal contamination leads to better approaches for remediating soils. The exploration of different ways, including biological methods, to conduct environmental monitoring is still ongoing. Here, we focus on reviewing the potential of ectomycorrhizal fungi as a natural indicator of soil heavy metal pollution. Mycorrhizal fungi fulfill basic criteria required as natural bio-indicators for heavy metal contamination. These fungi use different mechanisms such as avoidance and tolerance to survive in metalliferous soils. Thus, we promote ectomycorrhizal fungi as natural indicators. This review also synthesizes existing research on ectomycorrhizal mushrooms as natural bio-indicators for heavy metal pollution and the elaboration of mechanisms, by which ectomycorrhizal fungi meet the criteria required for a successful bio-indicator.

Due to the complexity of liver surgery, the interest in 3D printing is constantly increasing among hepatobiliary surgeons. The aim of this study was to produce a patient-specific transparent life-sized liver model with tissue-like haptic properties by combining additive manufacturing and 3D moulding. A multistep pipeline was adopted to obtain accurate 3D printable models. Semiautomatic segmentation and registration of routine medical imaging using 3D Slicer software allowed to obtain digital objects representing the structures of interest (liver parenchyma, vasculo-biliary branching, and intrahepatic lesion). The virtual models were used as the source data for a hybrid fabrication process based on additive manufacturing using soft resins and casting of tissue-mimicking silicone-based blend into 3D moulds. The model of the haptic liver reproduced with high fidelity the vasculo-biliary branching and the relationship with the intrahepatic lesion embedded into the transparent parenchyma. It offered high-quality haptic perception and a remarkable degree of surgical and anatomical information. Our 3D transparent model with haptic properties can help surgeons understand the spatial changes of intrahepatic structures during surgical manoeuvres, optimising preoperative surgical planning.

Background: Asbestos products are manufactured and used in Sri Lanka in the construction and automobile industries. Objective: To determine radiologically if exposure to asbestos caused lung disease among workers handling asbestos products, and to generate data in Sri Lanka where no such data exist due to poor reporting and a poor surveillance system. Methods: Following ethics approval and written consent plain chest X-rays and exposure data were obtained in 230 workers in asbestos manufacturing, building construction, building demolition, tsunami debris cleanup, and other trades. The assumption was that all exposed workers were exposed to chrysotile. Participants were from provinces with asbestos factories, and where tsunami cleanup had occurred. Findings and Conclusions: Radiological findings of the 230 participants showed lung fibrosis in 7% (16 cases), and other non-asbestos-related lung conditions. Of the 16 fibrosis cases, none were in manufacturing workers, one in a construction worker, six in tsunami workers, six in demolition workers, and three cases in others. Globally, Sri Lanka has one of the highest consumptions of chrysotile asbestos per capita. This first known study documenting asbestos disease in Sri Lanka is clearly a limited, self-selected group of workers studied with obvious limitations. The prevalence of asbestos-related lung disease among tsunami and demolition worker indicates that a risk exists for asbestos material already in use in Sri Lanka. Hence a significant concern is the safety of asbestos demolition workers and cleanup workers exposed to asbestos debris from major natural disasters such as hurricanes, tornados, typhoons, and tsunamis.

A 57-year-old man attempted a suicide self-inflicting multiple scissors stab wounds in the chest. At the scene, Focused Assessment with Sonography in Trauma (FAST) showed an important left pleural effusion and pericardial fluid. Computed Tomography Angiography confirmed the pericardial effusion. The patient underwent immediate surgery. Three epicardial wounds of the anterior surface of the right ventricle were identified, one of which was actively bleeding. The lesion was sutured, the patient recovered uneventfully, and on the sixth postoperative day was transferred to a psychiatric unit. At 6-month follow-up, he is doing well and has returned to work. We discuss the importance of FAST for an early diagnosis of chest penetrating trauma leading to a rapid life-saving cardiac procedure and propose a clinical-based protocol for the management of patients with suspected penetrating cardiac injury which we have applied in our service for last six years. Midline sternotomy should be considered the incision of choice in patients with penetrating trauma in the cardiac box with evidence of injury to the heart and great vessels. Emergency Department Thoracotomy can be a possible option for those patients with impending cardiac arrest despite adequate resuscitation.

Tetanus with cephalic involvement is not a typical presentation of the disease; characteristic signs and symptoms are strictly localized in cranial district, although it could frequently progress to the classical generalized form. Tetanus is still spread worldwide, especially in particular subgroups as elderly and newborn babies and in countries with an inadequate vaccine coverage.We report a case of an adult man with generalized tetanus with cephalic presentation in Emergency Department. We aim to outline how difficult it was to diagnose in an adult patient without apparent exposition of previous minimal trauma or injury because of a lot of confusing factors and slow progressing clinical signs. Prompt recognition of signs and symptoms, opportune target therapy and supportive care, in association with correct vaccination schedule, are paramount to determine the prognosis for affected patients.

Platypnea-orthodeoxia syndrome (POS) is an unusual cause of hypoxia characterized by enormous variation in oxygen saturation during postural changes. We describe here the clinical presentation, the diagnostic challenge of POS and discuss the main pathophysiological etiologies of the disease in a 75-year-old woman who was admitted because shortness of breath. After ruling out the most important causes of dyspnea we observed that the symptoms improved when the patient was lying flat. The diagnostic workup with computed tomography scan and air bubble saline echocardiography lead us to a correct diagnosis.

Rectus sheath hematoma (RSH) is an uncommon cause of abdominal pain that can lead to life-threatening bleeding, particularly in elderly patients receiving anticoagulation therapy. Type III RSHs, based on computer tomography (CT) evaluation, is characterized by active bleeding with intramuscular or intraperitoneal extension and hemodynamic instability. Medical contemporary knowledge of this condition is contentious and overall 20% of acute mortality has been reported. The purpose of this study was to retrospectively review our experience and outcomes in the management of RSHs treated with percutaneous arterial embolization of the epigastric vessels. We retrospectively analyzed 43 patients with RSH type III, submitted to percutaneous epigastric artery embolization from 2007 to 2015. Percutaneous arterial embolization was feasible and successful in patients with a high burden of comorbidities and receiving anticoagulation therapy. There was no acute mortality and a late mortality at 3 months of 9.1% (4/43) was not directly related to RSHs or arterial embolization. Patients with late mortality had lower ejection fraction, prolonged PTT, greater RDW and warfarin in overlapping with low-molecular-weight heparins. Transcatheter arterial embolization of the epigastric vessels was safe, feasible and effective in stopping the bleeding. Despite anti-platelets/anti-coagulation therapy and a high burden of comorbidities, there was no acute mortality related to RSH.

Acute abdominal pain represents a challenge for the physician because it can hide a serious intra-abdominal pathology necessitating emergency intervention. A 65-year-old man presented to Emergency Department with sudden-onset abdominal pain. He underwent liver transplantation four years before. He complained tenderness on abdominal palpation. Blood chemistry and abdominal x-ray were normal. Contrast-enhanced computed tomography showed acute renal artery thrombosis. The patient underwent renal arterial thrombectomy and stent placement in less than two hours. Organ transplantation is a condition that makes patients at greater risk of life-threatening conditions. Renal artery thrombosis is a rare, severe and misdiagnosed condition which can benefit from a prompt cooperation among emergency physician, surgeon, and interventional radiologist. Transplant patients with acute abdominal pain should be considered at high risk of medical emergency. Acute renal artery thrombosis is a time dependent medical emergency in those patients with chronic drug-induced nephrotoxicity.

Spontaneous hepatic rupture (SHR) during pregnancy is a rare but well known complication and it usually occurs alongside eclampsia or HELLP syndrome. SHR in uncomplicated pregnancy is extremely rare and can be associated to different undiagnosed pathological conditions. We report the case of a nulliparous woman, 27 weeks pregnant, with a peliosis hepatis, previously unknown, who was admitted to our unit due to SHR and massive hemoperitoneum. The conception was obtained by embryo transfer after multiple attempts of hormone-supported cycles using estrogens and progesterone. After emergency laparotomy the patient was submitted to deliver of the dead foetus and damage control of the hepatic bleeding source. At relaparotomy a right posterior sectionectomy (segments VI and VII) and segmentectomy of segment V were performed. The patient was discharged in good physical conditions after 18 days from admission. If hepatic rupture is suspected in a pregnant patient a collaborative multidisciplinary approach is mandatory. The cornerstones of medical and surgical management are highlighted. At the best of our knowledge this is the first case of SHR in a pregnant woman with peliosis hepatis. A possible correlation of an increased risk for SHR in a pregnant patient who was submitted to several attempts for embryo transfer is discussed. The relevant scientific literature of the possible causative role of the estrogen therapy in inducing politic liver damage is also reviewed.

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Biliary complications continue to be a major cause of morbidity after split-liver transplantation (SLT). In this report we describe an uncommon late biliary complication. One year after SLT the patient showed an intrahepatic bile dicy dilatation with severe cholangitis episodes. The segmentary bile duct of hepatic segment VI-VII draining in the left duct was unidentified and tied at the time of the in situ split-liver procedure. We perform a permanent obliteration of the dilated intrahepatic ducts by a percutaneous embolization using an n-butyl cyanoacrylate (NABC). The management of biliary complications after SLT requires a multidisciplinary approach. The use of NBCA in obliteration of a dilated bile duct seems to be a safe procedure with good results providing a less invasive option than hepatic resection and decreasing the morbidity associated with chronic external biliary drainage. Further studies are needed to determine whether this approach is effective and safe and whether it could reduce hospital stay and cost.