摘要： BACKGROUND Decision-making deficits in airway emergencies have led to adverse patient outcomes. A cognitive aid would assist clinicians through critical decision-making steps, preventing key action omission. OBJECTIVE We aimed to investigate the effects of a visual airway cognitive aid on decision-making in a simulated airway emergency scenario. DESIGN Randomised controlled study. SETTING Single-institution, tertiary-level hospital in Toronto, Canada from September 2017 to March 2019. PARTICIPANTS Teams consisting of a participant anaesthesia resident, nurse and respiratory therapist were randomised to intervention (N = 20 teams) and control groups (N = 20 teams). INTERVENTION Participants in both groups received a 15-min didactic session on crisis resource management which included teamwork communication and the concepts of cognitive aids for the management of nonairway and airway critical events. Only participants in the intervention group were familiarised, oriented and instructed on a visual airway cognitive aid that was developed for this study. Within 1 to 4 weeks after the teaching session, teams were video-recorded managing a simulated 'cannot intubate-cannot oxygenate' scenario with the aid displayed in the simulation centre. MAIN OUTCOME MEASURES Decision-making time to perform a front-of-neck access (FONA), airway checklist actions, teamwork performances and a postscenario questionnaire. RESULTS Both groups performed similar key airway actions;however, the intervention group took a shorter decision-making time than the control group to perform a FONA after a last action [mean +/- SD, 80.9 +/- 54.5 vs. 122.2 +/- 55.7 s;difference (95% CI) -41.2 (-76.5 to -6.0) s, P = 0.023]. Furthermore, the intervention group used the aid more than the control group (63.0 vs. 28.1%, P < 0.001). Total time of scenario completion, action checklist and teamwork performances scores were similar between groups. CONCLUSIONS Prior exposure and teaching of a visual airway cogniti

摘要： Biologic aortic valves are constructed with 3 stents corresponding to the commissures, which sit in the aortic root. When implanted using interrupted sutures, these stents may make the valve difficult to tie down safely in patients with small, calcified aortic roots. We present an easily reproducible technique to make this valve tie down safer. (C) 2021 by The Society of Thoracic Surgeons

摘要： During autophagy, proteins of the ATG8 family are conjugated to phosphatidylethanolamine (PE) in double-membrane structures called phagophores. Now, Durgan et al. have found that, during the non-canonical process of conjugating ATG8 proteins to single-membrane structures, ATG8 can be ligated to phosphatidylserine. Here, I discuss the potential consequences of their findings.

关键词： Norovirus   Genetic diversity   Argentina   Developing countries  

摘要： In developing countries, the acute gastroenteritis outbreaks submitted for viral testing are limited due to deficient surveillance programs. The aim of this study was to analyze a passive surveillance strategy for monitoring the molecular epidemiology of norovirus (NV) and counterbalance the genetic diversity data gap. Laboratory-confirmed rotavirus negative sporadic stool samples (N = 523) collected between 2010 and 2017 from children were selected from our archival collection and were tested for NV and sequencing was performed on the positive samples. Passive surveillance information was compared with the genetic diversity data that was available from local norovirus-confirmed gastroenteritis outbreaks. Each year, norovirus detection in the sporadic samples ranged from 12 to 29%. GI and GII norovirus were detected in 7 (1.3%) and 101 (19.3%) of the specimens, respectively. Four GI and six GII capsid genotypes were identified. Six out of 9 strains detected in the NV outbreaks panel were also identified in the set of sporadic samples either coincidently in the same year, the previous or the later year. Also, this set of samples depicted even better the circulating epidemic strain. Thus, implementing norovirus testing and genotyping in stool samples collected with other purposes represent a suitable strategy for providing genetic diversity information. (c) 2021 Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://***/licenses/by-nc-nd/4.0/).

关键词： Hazards  

摘要： Models for estimating earthquake ground motions are a key component in seismic hazard analysis. In data-rich regions, these models are mostly empirical, relying on the ever-increasing ground-motion databases. However, in areas in which strong-motion data are scarce, other approaches for ground-motion estimates are sought, including, but not limited to, the use of simulations to replace empirical data. In Israel, despite a clear seismic hazard posed by the active plate boundary on its eastern border, the instrumental record is sparse and poor, leading to the use of global models for hazard estimation in the building code and all other engineering applications. In this study, we develop a suite of alternative ground-motion models for Israel, based on an empirical database from Israel as well as on four data-calibrated synthetic databases. Two host models are used to constrain model behavior, such that the epistemic uncertainty is captured and characterized. Despite the lack of empirical data at large magnitudes and short distances, constraints based on the host models or on the physical grounds provided by simulations ensure these models are appropriate for engineering applications. The models presented herein are cast in terms of the Fourier amplitude spectra, which is a linear, physical representation of ground motions. The models are suitable for shallow crustal earthquakes;they include an estimate of the median and the aleatory variability, and are applicable in the magnitude range of 38 and distance range of 1-300 km.

摘要： BACKGROUND Reducing pain and minimising the use of opioids after caesarean section are crucial to enhancing maternal recovery and promoting mother-newborn interaction. Various techniques have been implemented to improve analgesia. We compared the analgesic efficacy of posteromedial quadratus lumborum block with that of wound infiltration following elective caesarean section. OBJECTIVE We hypothesised that within a multimodal analgesia approach, posteromedial quadratus lumborum block would, due to its potential to relieve visceral pain, result in a 15% reduction in 24-h postoperative opioid consumption compared with wound infiltration. DESIGN A double-blind, randomised, placebo-controlled clinical study. SETTING A single-centre study between August 2019 and May 2020. PATIENTS One hundred and sixteen women were randomly allocated into two groups. In the quadratus lumborum group, 20 ml 0.9% saline was injected into the surgical wound followed by bilateral posteromedial quadratus lumborum block using 20 ml 0.25% levobupivacaine per side. In the wound infiltration group, 20 ml of 0.25% levobupivacaine was injected into the surgical wound followed by a bilateral posteromedial quadratus lumborum injection with 20 ml 0.9% saline per side. MAIN OUTCOME MEASURES The primary outcome was opioid (piritramide) consumption at 24 h. Secondary outcomes were piritramide consumption at 48 h, time-to-first analgesic request, pain scores at rest and with movement, surgery-to-first-ambulation time, surgery-to-breastfeeding time, sedation, pruritus and complications. RESULTS Piritramide consumption in 24 h was significantly lower with posteromedial quadratus lumborum block (1.5 +/- 1.8 mg) than with wound infiltration (2.2 +/- 1.7 mg) (P = 0.04), mean difference of -0.7 mg, (95% CI -1.3 to -0.03). In those who required piritramide, time-to-first analgesic request was significantly longer with posteromedial quadratus lumborum block 11 [7 to 14] h, than with wound infiltration 7 [5 to 11] h

摘要： BACKGROUND During inhalational induction of anaesthesia for children, severe respiratory events can occur but can be rapidly treated once intravenous access is in place. Reducing the time to successful cannulation during inhalational induction for children with poor vein visibility would improve safety. OBJECTIVE To study the effectiveness of a near-infrared (NIR) vascular imaging device (Veinviewer) to facilitate intravenous cannulation. DESIGN A prospective, multicentre, randomised, open clinical trial. SETTING The operating rooms of three paediatric hospitals in Paris, France, from 1 October 2012 to 31 March 2016. PATIENTS Children up to the age of 7 years, with poor vein visibility requiring general anaesthesia. INTERVENTION Inhalational anaesthesia was initiated and intravenous cannulation was performed with the standard approach or with the Veinviewer Vision. MAIN OUTCOME MEASURES The primary outcome was the time to successful intravenous cannulation. A secondary outcome was the proportion of successful first attempts. RESULTS The mean time to successful intravenous cannulation was 200 (95% CI, 143 to 295) seconds in the Veinviewer and 252 (95% CI, 194 to 328) seconds for the control group: hazard ratio 1.28 (1.02 to 1.60) (P = 0.03). The adjusted hazard ratio for known predictive factors was 1.25 (0.99 to 1.56) (P = 0.06). Success at the first attempt was 64.6% (102/158) in the 'Veinviewer' group vs. 55.6% (85/153) in the 'control' group (P = 0.10). CONCLUSION The Veinviewer has limited value in reducing the time to successful intravenous cannulation during inhalational anaesthesia for young children with poor vein visibility. However, there is a strong trend to reducing the delay in some cases and, given its absence of side effects, it could be part of a rescue option for a difficult venous-access strategy.

摘要： [...]laboratory and imaging studies can usually identify other causes of chronic N & V that mimic GP (e.g., pancreatitis, hepatitis, and celiac artery compression syndrome; Table 3).Table 2. [...]a recent large meta-analysis reported that, when optimally measured, there is a relationship between delayed GE and symptoms (e.g., nausea, vomiting, abdominal pain, and early satiety) in some patients, although the effect size was not large. A prospective survey study of patients with FD demonstrated that symptom scores, using the validated GP Cardinal Symptom Index questionnaire, were only slightly lower than in GP patients (8). [...]although GP and FD can be considered part of the same disease spectrum of gastric sensorimotor dysfunction, patients with typical symptoms (Table 4) and a mild delay in emptying should be characterized as having FD, not GP. Key mistakes include not stopping medications that affect GE; not measuring blood glucose levels; using a nonstandardized meal (i.e., oatmeal); and not performing a 4-hour scan (Table 5).

关键词： 心血管病   控制体重   危险因素  

摘要： 评估控制体重对其他心血管病危险因素的影响。方法:对40例本医院的健康体检予以项目研究,选于2019年4月至2020年4月,全部体检者均予以血压、血糖、血脂及尿酸检查,分析体检者其他心血管病相关指标。结果:(1)肥胖组、超重组的体检者经由检查后,与参照组的患者检查后进行对比,其舒张压、收缩压、空腹血糖较高,P<0.05说明其差异相对较高。(2)肥胖组、超重组的体检者经由检查后,与参照组的患者检查后进行对比,其总胆固醇、甘油三酯、低密度脂蛋白胆固醇、尿酸较高、高密度脂蛋白胆固醇较低,P<0.05说明其差异相对较高。结论:肥胖及超重均会导致其他心血管病风险升高,临床中应积极控制体重,降低患者血压、血糖、血脂及尿酸水平。

关键词： 当代艺术思潮   其他领域   关联   影响  

摘要： 艺术思潮这个词汇的出现,是人类发展到高级阶段的产物.艺术的雏形是人类劳动、模仿、游戏等活动的伴生物,在满足人类生存需要的同时,出现了艺术的影子,随着人类不断进化和发展,艺术也越来越展示出它的存在价值与作用,当艺术融化在人类日常生活中不可割裂开时,各个领域里都必然裹挟着艺术的氛围.艺术表现着生活、美化着生活、引领着生活,人类就像不可缺乏氧气般的不能脱离艺术气息.