This study was conducted (at high altitude [1969 meters]) to determine whether chicks predisposed to cardiac failure and ascites could be identified and followed during growout with non-invasive electrocardiographic (ECG) techniques. ECG recordings were made on 40 chicks at 1 week of age. All recordings were analyzed by quantifying the amplitude in millivolts of the R-, S-, and T-waves in each of the recordings. During the study, ascites-related mortality was 40%, with the majority of the deaths occurring between 5 and 8 weeks of age. Chicks exhibiting moderate-to-severe right ventricular hypertrophy, as identified by ECG analysis at 1 week of age, were predisposed to development of ascites. Thus, the variability in ascites-related mortality observed in field cases may be directly related to the number of predisposed chicks at the time of placement in the broiler house.

Robotic-Assisted Bronchoscopy (RAB) is a novel technique that is particularly valuable in the sampling peripheral pulmonary nodules. RAB has been reported to have a lesion localization rate of 96.2% with a diagnostic yield of 74% in patients with 1 to 5 cm peripheral pulmonary nodules. Thus far, no studies have reported the diagnostic yield of RAB in sampling subcentimeter pulmonary nodules.METHODS: This is a retrospective observational study of all RAB cases completed at a community hospital between August 2020 and March 2021. RAB was executed using the MonarchÔ platform (Auris Health, Inc., Redwood City, CA) and all cases were performed by a single operator. Only procedures performed for biopsy of a peripheral pulmonary nodule <10 mm in size were included in the study. Transbronchial biopsy for pathology and microbiology, transbronchial brushings for cytology, and transbronchial needle aspiration for cytology were performed during all cases that were included in this study. The primary outcome was diagnostic yield. A secondary outcome was incidence of procedure related complications. Baseline demographic information, nodule characteristics, and procedural outcomes were recorded.RESULTS: A total of 30 patients underwent RAB in our hospital and 3 patients were identified with a pulmonary nodule <10 mm in size. The mean nodule diameter was 5.9 mm and 66% of the sampled nodules were described as calcified. The diagnostic yield in this subset of patients was 100%. Diagnoses confirmed by biopsy were neuroendocrine tumor, cryptogenic organizing pneumonia, and Mycobacterium avium complex. No complications were reported. CONCLUSIONS:This study demonstrates high diagnostic yield with minimal complications using RAB to sample subcentimeter peripheral pulmonary nodules in a community hospital. RAB can be safely used to sample malignant and benign subcentimeter nodules. CLINICAL IMPLICATIONS:The widespread use of high-resolution CT scans for lung cancer screening has led to expedited and increased detection of peripheral pulmonary nodules. Thus, exploring the potential for earlier nodule sampling is crucial. As recent technologic advancements have made the biopsy of peripheral pulmonary nodules more feasible, clinicians can consider sampling sub-centimeter nodules concerning for malignancy. Earlier biopsy may lead to accelerated diagnosis and treatment, although these advantages must be weighed against the risk of complications.

Background Limited data exist about the impact of gender-specific outcomes in patients with heart failure (HF) who develop concomitant sepsis. Methods This is a retrospective cohort study of patients with HF who developed sepsis. Clinical outcomes, including in-hospital mortality, development of cardiogenic shock (CS), pulmonary edema requiring urgent intravenous diuretics (IVD), acute kidney injury (AKI), length of stay (LOS), and 30-day HF-related readmission, were evaluated in men vs. women. Results This cohort of 618 patients includes 272 (44%) women with a mean age of 75±14 years. Coronary artery disease (p<0.0001), diabetes mellitus (p=0.0213), stage ≥ 3 chronic kidney disease (p<0.0001), and HF with reduced ejection fraction (HFrEF) (p=0.0015) were more prevalent in men. The implementation of the Surviving Sepsis Campaign (i.e., intravenous (IV) crystalloids in the first six hours) was more aggressive in women (p=0.0192). There was no difference in in-hospital mortality (p=0.2385) between men and women. After adjusting for HF types, women with HF with preserved ejection fraction (HFpEF) developed more episodes of pulmonary edema requiring urgent IVD (p=0.0389), while men with HFpEF had more CS requiring inotropes (p=0.0400) and a longer LOS (p=0.0434). Conversely, women with HFrEF were most likely to develop CS requiring inotropes (p=0.0132). Conclusion Women with HF who developed sepsis receive a more aggressive implementation of the Surviving Sepsis Campaign than men, leading to more pulmonary edema events in women with HFpEF and more cardiogenic shock in women with HFrEF. A cautiously tailored approach is desperately needed for patients with HF who develop sepsis.

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