摘要： BACKGROUND Airway management is more challenging in the obese. Compared with the supine position, the sitting position can decrease the collapsibility of the upper airway and improve respiratory mechanics. OBJECTIVE The aim of this study was to evaluate the 25 degrees semisitting position on the effectiveness of mask ventilation in anaesthetised paralysed obese patients. DESIGN A randomised, cross-over study. SETTING Medical centre managed by a university tertiary hospital. PATIENTS Thirty-eight obese adults scheduled for general anaesthesia. METHODS After anaesthesia and paralysis, two-handed mask ventilation was performed in the supine and 25 degrees semi-sitting positions with a cross-over, in a randomised order. During mask ventilation, mechanical ventilation was delivered with a pressure-controlled mode with a peak inspiratory pressure of 15 cmH(2)O, a respiratory rate of 15 bpm, and no positive end-expiratory pressure. Ventilatory outcomes were based upon lean body weight. MAIN OUTCOMES Exhaled tidal volume (ml kg(-1)), respiratory minute volume (ml kg(-1) min(-1)), and the occurrence of inadequate ventilation, defined as an exhaled tidal volume less than 4 ml kg(-1), or absence of end-tidal CO2 recording. RESULTS Exhaled tidal volume (mean +/- SD) in the 25 degrees semi-sitting position was higher than in the supine position, 9.3 +/- 2.7 vs. 7.6 +/- 2.4 ml kg(-1);P less than 0.001. Respiratory minute volume was improved in the 25 degrees semisitting position compared with that in the supine position, 139.6 +/- 40.7 vs. 113.4 +/- 35.7 ml kg(-1) min(-1);P less than 0.001. CONCLUSION The 25 degrees semisitting position improved mask ventilation compared with the supine position in anaesthetised paralysed obese patients. TRIAL REGISTRY NUMBER *** (NCT03996161).

关键词： breast milk   antimicrobial activity   microscopy   spectrophotometry   Candida albicans  

摘要： Antimicrobial properties are traditionally evaluated by the seeding technique, which is laborious, time-consuming, and rather imprecise. We studied the possibility of using microscopy and spectrophotometry methods for evaluation of cytotoxic activity of breast milk serum against opportunistic microbes. Activity of 50 breast milk samples obtained from healthy women at different lactation stages was tested against opportunistic yeast C. albicans. Microscopy showed that incubation of cell suspension with lactoserum led to destruction of cell walls and cytoplasmic membranes with the formation of vesicular debris that absorbed the dye from the medium. Spectrophotometric measurement of the dye remained in the medium revealed a dose-depended effect of the lactoserum on C. albicans cells and strong inverse correlation between the lactation period and cytotoxic activity of the lactoserum (r=-0.948). These methods can be used in veterinary and food processing for estimation of biological activity of milk.

摘要： BACKGROUND The lower oesophageal sphincter (LOS) barrier serves to prevent regurgitation of gastric contents. Although general anaesthesia depresses its function, its recovery process during emergence from anaesthesia has not been systematically examined. OBJECTIVE To explore whether recovery of lower oesophageal barrier function differed between patients receiving a mixture of 1mg atropine and 2mg neostigmine and those receiving 2mg kg(-1) sugammadex during emergence from anaesthesia. DESIGN An unblinded randomised controlled pilot study. SETTING A single university hospital from January 2016 to December 2018. PATIENTS A total of 20 non-obese adult females undergoing minor surgery. INTERVENTION The patients were randomly assigned to a group either receiving atropine and neostigmine or sugammadex for reversal of rocuronium. MAIN OUTCOME MEASURES Through use of the high-resolution manometry technique, the lower oesophageal barrier pressure (P-BAR: primary variable) defined as a pressure difference between pressures at the LOS and the stomach was measured at five distinguishable time points during emergence from total intravenous anaesthesia. A mixed effects model for repeated measures was used to test the hypothesis. RESULTS In all patients baseline P-BAR values were positive even under muscle paralysis and general anaesthesia before administration of reversal agents, and did not differ between the groups (P = 0.299). During recovery from muscle paralysis and general anaesthesia, PBAR (mean +/- SD) significantly increased (P = 0.004) from 17.0 +/- 2.9 to 21.0 +/- 5.0mmHg in the atropine and neostigmine group (n = 8) and from 19.1 +/- 9.0 to 24.5 +/- 12.7mmHg in the sugammadex group (n = 11). P-BAR significantly increased immediately after return of consciousness in both groups, whereas return of muscle tone, lightening of anaesthesia and tracheal extubation did not change it. CONCLUSION Recovery of the lower oesophageal barrier function does not differ between patien

关键词： Neutron gamma density   Characteristic capture gamma rays   Boron sleeve gamma detector   Boron-10 element   Formation water salinity  

摘要： Neutron gamma density measurement using dual gamma detectors (NGD-GD) is a popular density measurement method. Compared with other NGD methods, the NGD-GD method has many advantages in tool optimization, cost control, and density precision;however, it is easily affected by the salinity of formation water. To improve the NGD-GD method, the influence mechanism of formation water salinity was discussed, and a feasible improvement scheme using characteristic gamma information was proposed. A special boron sleeve gamma detector was designed to record the capture gamma rays from the boron-10 element. By analyzing the gamma spectrum, pure boron-10 gamma information was extracted from the total capture gamma spectrum for density calculation. Finally, a new NGD method with boron sleeve gamma detectors (NGD-BD) was developed. Results depict that although the NGD-BD method has a slight decrease in density accuracy and precision compared with the NGD-GD method, its performance is significantly improved in high-brine formations, and oil and gas formations. In addition, the NGD-BD method exhibits better performance in terms of density accuracy, density precision, and environmental impact than another NGD method that uses hydrogen capture gamma information. Moreover, the NGD-BD method is easily implemented with low cost and has little impact on existing NGD tools, and hence, it can coexist with other NGD methods to improve logging quality. Overall, the NGD-BD method is a very promising alternative to the NGD-GD method.

关键词： Modified Holling-Tanner model   Alternative food   Turing instability   Turing patterns  

摘要： In this manuscript, we consider temporal and spatio-temporal modified Holling-Tanner predator-prey models with predator-prey growth rate as a logistic type, Holling type II functional response and alternative food sources for the predator. From our result of the temporal model, we identify regions in parameter space in which Turing instability in the spatio-temporal model is expected and we show numerical evidence where the Turing instability leads to spatio-temporal periodic solutions. Subsequently, we analyse these instabilities. We use simulations to illustrate the behaviour of both the temporal and spatiotemporal model. (c) 2021 Elsevier B.V. All rights reserved.

关键词： Access to electricity   Energy use trend   Supply-demand gap   Energy diversification barriers   Policy & governance  

摘要： Providing uninterrupted and reliable electricity to all at an affordable price is a major undertaking for the governments of increasingly energy-hungry countries. This study assesses the energy supply-demand gap, progress, and prospects of alternative energy sources in Bangladesh. Several methods, including descriptive, trend, and comparative analyses, were carried out using time-series energy data to determine the current and historical energy status. Results show that between 1990 and 2018, the country experienced an approximate 3.05-fold increase in energy consumption from 12,743 to 38,807 ktoe, and a 3.11-fold increase in energy pro-duction from 10,760 to 33,504 ktoe. The shortfall between supply and consumption is approximately 26%, but this can be resolved by addressing energy diversification barriers related to policy, governance through regu-latory actions, investment, transmission and distribution, resources optimisation, energy efficiency, conserva-tion, research and education, and regional cooperation.

关键词： Lung   Bronchopulmonary dysplasia   Hyperoxia   Vasoactive intestinal peptide   Pituitary adenylate cyclase-activating polypeptide   Preterm newborns  

摘要： The use of oxygen therapy (high doses of oxygen hyperoxia) in the treatment of premature infants results in their survival. However, it also results in a high incidence of chronic lung disease known as bronchopulmonary dysplasia, a disease in which airway hyper-responsiveness and pulmonary hypertension are well known as consequences. In our previous studies, we have shown that hyperoxia causes airway hyper-reactivity, characterized by an increased constrictive and impaired airway smooth muscle relaxation due to a reduced release of relaxant molecules such as nitric oxide, measured under in vivo and in vitro conditions (extra-and intrapulmonary) airways. In addition, the relaxation pathway of the vasoactive intestinal peptide (VIP) and/or pituitary adenylate cyclase activating peptide (PACAP) is another part of this system that plays an important role in the airway caliber. Peptide, which activates VIP cyclase and pituitary adenylate cyclase, has prolonged airway smooth muscle activity. It has long been known that VIP inhibits airway smooth muscle cell proliferation in a mouse model of asthma, but there is no data about its role in the regulation of airway and tracheal smooth muscle contractility during hyperoxic exposure of preterm newborns.

摘要： In 2020, the National Resident Matching Program (NRMP) sponsored the inaugural "Single Match"-the first time that seniors and graduates of U.S. MD-granting and DO-granting schools participated in one Match. In honor of the Single Match milestone, the authors examine the NRMP's history, reflecting on the organization's efforts since the 1950s to support learners and the graduate medical education community by fostering a responsive, robust matching program while remaining true to its founding principles to provide parity of experience for applicants and reduce coercive practices. The chaos and stress associated with the pre-Match days in the 1920s and 1930s that led to the call for a national clearinghouse are highlighted as are significant NRMP accomplishments, from the organization's incorporation as a 501(c)(3) organization in 1953 as a simple internship placement system through the first Single Match. Recognizing that the current transition to residency is not without its stressors, the authors note that the NRMP remains committed and willing to continue to evolve and identify innovative and meaningful ways to address learner needs and improve the transition to residency.

摘要： BACKGROUND Hospital admissions and surgical operations commonly trigger anxiety in young children. Despite employing numerous support measures in our hospital, such as a pre-operative play room, the encouragement of parental companionship during induction of anaesthesia and distraction therapy, allaying the anxiety of our young surgical patients remains a challenge. OBJECTIVES To evaluate the effectiveness of a Home-Initiated-Programme-to-Prepare-for-Operation (HIPPO) on emotional manifestation and anxiety in children undergoing surgery. DESIGN, SETTING AND PATIENTS One hundred and thirty children were randomly assigned to either control or intervention group between February 2018 and April 2019 in a tertiary paediatric hospital in Singapore. INTERVENTION In addition to our standard pre-operative workflow, the intervention group received an additional home preparation kit consisting of an animated video on preoperative preparation and age-specific preoperative preparation activity sheets. MAIN OUTCOME MEASURES The primary outcome was the Children's Emotional Manifestation Scale score to evaluate behaviour and emotion in the children before and during induction of anaesthesia. Secondary outcomes evaluated anxiety levels in parents and children, the child's behaviour and degree of co-operation using the State-Trait Anxiety Inventory scores, State-Trait Anxiety Inventory Children scores, the Induction Compliance Checklist scores, the Visual Analogue Scale scores for anxiety and the feedback questionnaire. RESULTS The difference between the Children's Emotional Manifestation Scale score in control and intervention groups was not statistically significant. A promising difference was however observed in one of the secondary outcomes where the state-State-Trait Anxiety Inventory Children scores of 7 to 10-year olds in the intervention group almost reached significance;P = 0.067. CONCLUSION Despite being a child-friendly, easily accessible and affordable tool for patient ed

关键词： COVID-19   SARS-CoV-2   Kawasaki-like   Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS)   Bibliometric   Preprint   Multisystem inflammatory syndrome in children (MIS-C)  

摘要： Introduction: At the end of April 2020, three European pediatric societies published an alert on a new hyperinflammatory disorder linked to SARS-CoV-2. This disease has alternatively been called Kawasaki-like disease, pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS), and multisystem inflammatory syndrome in children (MIS-C). These alerts provide a clear starting point from which to study the early response of the medical and scientific community to a new disease in terms of scientific publications, and to compare the timeline of this response with levels of general public interest. To this aim, we conducted a bibliometric analysis of articles on this disease published between 1 April and 5 July 2020. Method: A literature search was performed using PubMed and in three preprint repositories. For each article, the name used for the disease in the title, the number of authors, the number of patients, the citations according to Google Scholar, the journal impact factor, and the Altmetric score were retrieved. Google search trends for the terms "Kawasaki'' and "COVID,'' "COVID-19,'' and "coronavirus'' were also retrieved, as was the number of Reuters news articles published on the topic. These data were compared longitudinally on a weekly basis. The quality of the reporting of the study was evaluated using the STROBE guidelines for observational studies with more than three patients and using the CARE guidelines for case reports of three or fewer patients. Results: Eighty-six articles were included, among which ten were preprints (three of which were subsequently published) and 49 were clinical articles (57%). A total of 857 patients were described. The median number of authors per article was five (range, 1-45), the median number of patients was four (1-186), the median number of citations was one (0-170), the median Altmetric score was 12 (0-7242), and the median journal impact factor was 3.7 (1-74.7). For the clinica