摘要： BACKGROUND High flow nasal oxygen may better support the vulnerable respiratory state of patients during procedural sedation. OBJECTIVE The objective of this study was to investigate the effects of high flow nasal oxygen in comparison to facemask oxygen on ventilation during cardiac implantable electronic device procedures performed with procedural sedation. DESIGN A randomised controlled trial. SETTING The study was conducted at one academic hospital in Canada. PARTICIPANTS Adults undergoing elective cardiac implantable electronic device procedures with sedation administered by an anaesthesia assistant, supervised by an anaesthesiologist from August 2019 to March 2020. INTERVENTIONS Participants were randomised 1 : 1 to facemask (>= 8 l center dot min(-1)) or high flow nasal oxygen (50 l center dot min(-1) and a 50 : 50 oxygen to air ratio). MAIN OUTCOME MEASURES The primary outcome was peak transcutaneous carbon dioxide. Outcomes were analysed using Bayesian statistics. RESULTS The 129 participants who were randomised and received sedation were included. The difference in peak transcutaneous carbon dioxide was 0.0 kPa (95% CI -0.17 to 0.18). Minor adverse sedation events were 6.4 times more likely to occur in the high flow nasal oxygen group. This estimate is imprecise (95% CI 1.34 to 42.99). The odds ratio for oxygen desaturation for the high flow nasal oxygen group compared with the facemask group was 1.2 (95% CI 0.37 to 3.75). The difference in satisfaction with sedation scores between groups was 0.0 (95% CI -0.33 to 0.23). CONCLUSIONS Ventilation, as measured by TcCO2, is highly unlikely to differ by a clinically important amount between high flow nasal oxygen at 50 l min(-1) or facemask oxygen at 8 l min(-1). Further research with a larger sample size would be required to determine the optimal oxygen:air ratio when using high flow nasal oxygen during cardiac implantable electronic device procedures performed with sedation.

关键词： Enclosure convections   Conjugate heat and species transfer   Convective flux lines   Multiple steady flows   Correlations  

摘要： Double-diffusive natural convection in a vertical enclosure containing various solid block arrays is numerically and analytically investigated in present work, where heat and species source and sink are simultaneously attached on the walls. Rayleigh number, buoyancy force ratio, number of inner solid blocks, solid thermal conductivity and mass diffusion coefficient have been varied to observe inherent flow structures and mechanism of thermal and mass transports, regarding of different levels of solid-to-fluid volume ratios. Correlations have been presented for different flow regimes, namely thermal buoyancy driven flow and solutal buoyancy driven flow. Simulation and correlation results demonstrate that influences of thermal conductivity and mass diffusion coefficient of the solid block arrays on average Nusselt and Sherwood numbers are not evident compared with that of Rayleigh number. Furthermore, there is a positive correlation between average Nusselt number and Sherwood number. In addition, under certain values of Rayleigh number, absolute values of buoyancy force ratio close to unity will cause multiple steady solutions in pure natural convection. This research could benefit the future thermal and species management for electronics and built environment.

关键词： Complimentary medicine   Malaysia   South east asia   Rural community health   Gender difference   Cultural influences  

摘要： The choice to take-up specific complimentary and alternative medicine (CAM) modalities is influenced by many factors including cultural background, experience and peer-participation. In this study we investigated the beliefs and attitudes that contributed to CAM choices in a non-urban Malaysian population (N = 700). We found significant differences in the beliefs held by men and women in this population. Specifically, women believed more strongly than men that CAM providers offered healthy lifestyle advice (p = 0.042) and that those who were averse to discomfort from conventional treatments were more likely to take up CAM (p = 0.016). In addition, those individuals who chose to use CAM more strongly believed that CAM products were more healthy than conventional treatments (p = 0.002), that their effects were well understood (p = 0.002) and that CAM products worked with the body (p = 0.017). The data obtained in this study emphasize the lessons that can be learned by conventional healthcare providers in communicating the benefits of treatments to their patients. CAM users also believed that CAM products never caused harm (p = 0.007), which is a concern given that the modes of action of some CAM modalities and their interaction with prescribed treatments are not always well understood.

关键词： antivirals   homogeneous liquid-liquid microextraction   plasma   sample preparation   sugaring-out  

摘要： Miniaturization of liquid-liquid extraction is a growing field of sample preparation to reduce solvent consumption, protect the environment, and preserve operators' health. In this work, four different modes of liquid-liquid microextraction have been compared including dispersive liquid-liquid microextraction, binary and ternary salting-out, and sugaring-out induced liquid-liquid microextraction. The extraction efficiency was evaluated by the enrichment factors of 14 different drugs from three pharmacological classes. Compared with the other modes, sugaring-out induced liquid-liquid microextraction was found to be the most efficient and, thus, it was applied for sample preparation of the antivirals in human plasma. Method optimization was performed using response surface methodology for the sugar type and amount (in mg), the sample pH, the equilibration time (in min), and the extractant volume (in mu L). The method was then validated and found linear in the concentration range of 0.10-10 mu g/mL for daclatasvir, 0.05-10 mu g/mL for velpatasvir, and 0.20-10 mu g/mL for ledipasvir, with correlation coefficients in the range 0.996-0.999. These results shows that sugaring-out induced liquid-liquid microextraction could be a more efficient microextraction mode for preparation of biological samples. Compared with other types of microextraction, sugaring-out induced liquid-liquid microextraction is greener, simpler, and cost-effective, with less tendency to affect the sample pH.

关键词： whipping cream alternative fat   hydrogenated palm kernel oil   enzymatic acyl migration   fat polymorphism   physicochemical properties  

摘要： We developed an alternative whipping cream fat using shea butter but with low saturation. Enriched stearic-oleic-stearic (SOS) solid fat was obtained from shea butter via solvent fractionation. Acyl migration reactant, which mainly contains asymmetric SSO triacylglycerol (TAG), was prepared through enzymatic acyl migration to obtain the creaming quality derived from the beta'-crystal form. Through enzymatic acyl migration, we obtained a 3.4-fold higher content of saturated-saturated-unsaturated (SSU) TAG than saturated-unsaturated-saturated (SUS) TAG. The acyl migration reactant was refined to obtain refined acyl migration reactant (RAMR). An alternative fat product was prepared by blending RAMR and hydrogenated palm kernel oil (HPKO) at a ratio of 4:6 (w/w). The melting points, solid fat index (SFI), and melting curves of the alternative products were similar to those of commercial whipping cream fat. The alternative fat had a content of total unsaturated fatty acids 20% higher than that of HPKO. The atherogenic index (AI) of alternative fat was 3.61, much lower than those of whipping cream fat (14.59) and HPKO (1220.3), because of its low atherogenic fatty acid content and high total unsaturated fatty acids. The polymorphic crystal form determined by X-ray diffraction spectroscopy showed that the beta'-crystal form was predominant. Therefore, the alternative fat is comparable with whipping cream that requires creaming quality, and has a reduced saturated fat content.

摘要： In August 2014, the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine (AACOM) signed a memorandum of understanding with the Accreditation Council for Graduate Medical Education (ACGME) to create the Single Accreditation System (SAS) for graduate medical education (GME) in the United States. The AOA made the decision that it would close its GME accreditation system in response to dramatic growth in colleges of osteopathic medicine, a shortfall in osteopathic GME positions with increasing dependence on the ACGME system, ACGME policy decisions that adversely impacted osteopathic students, and declining osteopathic student interest in primary care. Osteopathic teaching institutions bore responsibility for meeting ACGME accreditation standards between 2015 and 2020, including determining institutional sponsorship, which program applications to submit, program size, educational leadership, and whether to pursue Osteopathic Recognition. Approximately 692 of 954 (72.5%) eligible osteopathic GME programs in 2014-2015 obtained ACGME accreditation by June 1, 2020. There were sharp reductions in surgical and subspecialty programs and a significant drop of DOs in educational leadership positions. A low percentage of ACGME-accredited programs applied for Osteopathic Recognition. In closing its GME accreditation system and joining the ACGME, the AOA gave up control of its direct relationship with osteopathic residents, fellows, and teaching institutions to gain critical GME opportunities. In this article, the author considers whether this gain will offset the risks taken by the AOA, including decreased DO leadership opportunities and role models, lower than expected interest in Osteopathic Recognition, and possible decreased DO interest in osteopathic organizations and osteopathic specialty board certification. Time and the choices of current and future DO trainees in ACGME programs will determine the future of the osteopathic

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