ЭФФЕКТИВНОСТЬ НОЧНОЙ ИНТУБАЦИИ ПРИ ОПЕРАЦИЯХ ПО ПОВОДУ РАКА ОРГАНОВ ПОЛОСТИ РТА – РЕТРОСПЕКТИВНОЕ ИССЛЕДОВАНИЕ

In the post-operative period of maxillofacial oncological operations, tracheostomy is the most commonly used method for securing the airway. These untoward complications made practitioners choose alternative modalities like submental intubation, but literature support on alternatives to tracheostomy for oral oncologic cases is limited. The aim of this observational study is to ascertain whether the use of overnight intubation is a safer and cost-effective practice and if it can be considered an alternative to tracheostomy.Material and methods. 30 patients, 23 males and 7 females in the age group of 34–80 years who underwent treatment for head and neck cancer with major intraoral resection and a unilateral or bilateral neck dissection were included in the study. The following variables were recorded: age, sex, site of tumour, type of neck dissection, use of mandibulotomy/ mandibulectomy, type of reconstruction, duration of stay in ICU, mean hospital stay and Mallampati classification. Postoperative complications, associated with the airway, if any, were recorded simultaneously.Results. None of the 30 patients required re-intubation nor did they develop any respiratory distress post extubation.Conclusion. The purpose of this study is to raise the conscience of every surgeon to cogitate his/her choice of procedure for his/her patients and advocate the use of overnight intubation, as it is a virtuous alternative to tracheostomy.В послеоперационном периоде у больных со злокачественными новообразованиями челюстно-лицевой области трахеостомия является самым распространенным методом, обеспечивающим проходимость воздушных путей. Осложнения трахеостомии побуждают врачей выбирать альтернативные методы, такие как субментальная интубация трахеи. Литературные данные об альтернативных трахеостомии методах при операциях по поводу опухолей органов полости рта ограничены.Цель исследования – выяснить, является ли использование ночной интубации более безопасной и рентабельной по цене, можно ли считать её альтернативой трахеостомии.Материал и методы. Исследование включало 30 больных раком органов головы и шеи (23 мужчины и 7 женщин) в возрасте 34–80 лет, которым была произведена внутриротовая резекция органов полости рта в большом объеме и односторонняя или двусторонняя шейная диссекция. Учитывались следующие параметры: возраст, пол, локализация опухоли, тип шейной диссекции, применение мандибулотомии/мандибулэктомии, тип реконструкции, продолжительность пребывания в реанимации, среднее время пребывания в больнице и классификация Маллампати. Также велась регистрация послеоперационных осложнений, связанных с обеспечением проходимости дыхательных путей.Результаты. Ни один из 30 пациентов не нуждался в повторной интубации, и у них не возникало каких-либо респираторных дистрессов после экстубации.Заключение. Цель этого исследования заключалось в том, чтобы каждый хирург мог обдумать и взвесить свой выбор процедуры для конкретного больного и выступить в поддержку ночной интубации как эффективной альтернативы трахеостомии

Classifying the Arithmetical Complexity of Teaching Models

This paper classifies the complexity of various teaching models by their position in the arithmetical hierarchy. In particular, we determine the arithmetical complexity of the index sets of the following classes: (1) the class of uniformly r.e. families with finite teaching dimension, and (2) the class of uniformly r.e. families with finite positive recursive teaching dimension witnessed by a uniformly r.e. teaching sequence. We also derive the arithmetical complexity of several other decision problems in teaching, such as the problem of deciding, given an effective coding $\{\mathcal L_0,\mathcal L_1,\mathcal L_2,\ldots\}$ of all uniformly r.e. families, any $e$ such that $\mathcal L_e = \{L^e_0,L^e_1,\ldots,\}$, any $i$ and $d$, whether or not the teaching dimension of $L^e_i$ with respect to $\mathcal L_e$ is upper bounded by $d$.Comment: 15 pages in International Conference on Algorithmic Learning Theory, 201

Characterization of Escherichia coli Phylogenetic Groups Associated with Extraintestinal Infections in South Indian Population

Background: Escherichia coli strains mainly fall into four phylogenetic groups (A, B1, B2, and D) and that virulent extra‑intestinal strains mainly belong to groups B2 and D. Aim: The aim was to determine the association between phylogenetic groups of E. coli causing extraintestinal infections (ExPEC) regarding the site of infection, expression of virulence factors, antimicrobial resistance patterns, and clinical outcome. This descriptive study was carried out in a multi‑specialty Tertiary Care Hospital.Materials and Methods: A total of 300 E. coli causing ExPEC were studied. Triplex polymerase chain reaction was used to classify the phylogenetic groups; hemolysin production was assessed on sheep blood agar and biofilm production in a microtiter plate assay. Production of extended spectrum of beta‑lactamase (ESBLs) was detected by combination disk method; AmpC was detected by AmpC disk test, Carbapenemase production was detected by modified Hodge test and metallo‑â‑lactamase by metallo‑beta‑lactamases (MBL) E‑test.Results: Of 300 isolates, 61/300 (20 %) belonged to phylogroup A, 27/300 (9%) to phylogroup B1, 104/300 (35%) were B2 and 108/300 (36%) belonged to group D, respectively. Phylogroups B2 and D were the most predominant groups in urinary tract infection and sepsis. Prognoses were better in infections with group A and B1 isolates, and relapses and death were common in infections with B2 and D. Expression of biofilm was greatest in B1 and hemolysin in group B2. Group A and B1 showed higher resistance to ciprofloxacin and were most frequent â‑lactamase (ESBL, AmpC, Carbapenemase and MBL) producers.Conclusions: Phylogenetic group B2 and D were predominant in ExPEC and exhibited least antimicrobial resistance among the groups. Resistance to multiple antibiotics was most prevalent in group A and B1. Regular monitoring of antimicrobial susceptibility in commensal strains is essential as they might transfer the property of antimicrobial resistance to pathogenic strains.Keywords: Drug resistance, Escherichia coli, Extraintestinal infections, Polymerase chain reaction, Phylogenetic group, Virulenc

Human exercise-induced circulating progenitor cell mobilization is nitric oxide-dependent and is blunted in South Asian men

This article is available open access through the publisher’s website. Copyright @ 2010 American Heart Foundation.Objective— Circulating progenitor cells (CPC) have emerged as potential mediators of vascular repair. In experimental models, CPC mobilization is critically dependent on nitric oxide (NO). South Asian ethnicity is associated with reduced CPC. We assessed CPC mobilization in response to exercise in Asian men and examined the role of NO in CPC mobilization per se. Methods and Results— In 15 healthy, white European men and 15 matched South Asian men, CPC mobilization was assessed during moderate-intensity exercise. Brachial artery flow-mediated vasodilatation was used to assess NO bioavailability. To determine the role of NO in CPC mobilization, identical exercise studies were performed during intravenous separate infusions of saline, the NO synthase inhibitor l-NMMA, and norepinephrine.  Flow-mediated vasodilatation (5.8%±0.4% vs 7.9%±0.5%; P=0.002) and CPC mobilization (CD34+/KDR+ 53.2% vs 85.4%; P=0.001; CD133+/CD34+/KDR+ 48.4% vs 73.9%; P=0.05; and CD34+/CD45− 49.3% vs 78.4; P=0.006) was blunted in the South Asian group. CPC mobilization correlated with flow-mediated vasodilatation and l-NMMA significantly reduced exercise-induced CPC mobilization (CD34+/KDR+ −3.3% vs 68.4%; CD133+/CD34+/KDR+ 0.7% vs 71.4%; and CD34+/CD45− −30.5% vs 77.8%; all P<0.001). Conclusion— In humans, NO is critical for CPC mobilization in response to exercise. Reduced NO bioavailability may contribute to imbalance between vascular damage and repair mechanisms in South Asian men.British Heart Foundatio

Genome-wide diel growth state transitions in the diatom Thalassiosira pseudonana

Marine diatoms are important primary producers that thrive in diverse and dynamic environments. They do so, in theory, by sensing changing conditions and adapting their physiology accordingly. Using the model species Thalassiosira pseudonana, we conducted a detailed physiological and transcriptomic survey to measure the recurrent transcriptional changes that characterize typical diatom growth in batch culture. Roughly 40% of the transcriptome varied significantly and recurrently, reflecting large, reproducible cell-state transitions between four principal states: (i) "dawn," following 12 h of darkness; (ii ) "dusk," following 12 h of light; (iii ) exponential growth and nutrient repletion; and (iv) stationary phase and nutrient depletion. Increases in expression of thousands of genes at the end of the reoccurring dark periods (dawn), including those involved in photosynthesis (e.g., ribulose-1,5- bisphosphate carboxylase oxygenase genes rbcS and rbcL), imply large-scale anticipatory circadian mechanisms at the level of gene regulation. Repeated shifts in the transcript levels of hundreds of genes encoding sensory, signaling, and regulatory functions accompanied the four cell-state transitions, providing a preliminary map of the highly coordinated gene regulatory program under varying conditions. Several putative light sensing and signaling proteins were associated with recurrent diel transitions, suggesting that these genes may be involved in light-sensitive and circadian regulation of cell state. These results begin to explain, in comprehensive detail, how the diatom gene regulatory program operates under varying environmental conditions. Detailed knowledge of this dynamic molecular process will be invaluable for new hypothesis generation and the interpretation of genetic, environmental, and metatranscriptomic data from field studies

A genetic algorithm for cocyclic hadamard matrices

A genetic algorithm for finding cocyclic Hadamard matrices is described. Though we focus on the case of dihedral groups, the algorithm may be easily extended to cover any group. Some executions and examples are also included, with aid of Mathematica 4.0

Assessment methods and resource requirements for milestone reporting by an emergency medicine clinical competency committee

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) introduced milestones for Emergency Medicine (EM) in 2012. Clinical Competency Committees (CCC) are tasked with assessing residents on milestones and reporting them to the ACGME. Appropriate workflows for CCCs are not well defined. OBJECTIVE: Our objective was to compare different approaches to milestone assessment by a CCC, quantify resource requirements for each and to identify the most efficient workflow. DESIGN: Three distinct processes for rendering milestone assessments were compared: Full milestone assessments (FMA) utilizing all available resident assessment data, Ad-hoc milestone assessments (AMA) created by multiple expert educators using their personal assessment of resident performance, Self-assessments (SMA) completed by residents. FMA were selected as the theoretical gold standard. Intraclass correlation coefficients were used to analyze for agreement between different assessment methods. Kendall\u27s coefficient was used to assess the inter-rater agreement for the AMA. RESULTS: All 13 second-year residents and 7 educational faculty of an urban EM Residency Program participated in the study in 2013. Substantial or better agreement between FMA and AMA was seen for 8 of the 23 total subcompetencies (PC4, PC8, PC9, PC11, MK, PROF2, ICS2, SBP2), and for 1 subcompetency (SBP1) between FMA and SMA. Multiple AMA for individual residents demonstrated substantial or better interobserver agreement in 3 subcompetencies (PC1, PC2, and PROF2). FMA took longer to complete compared to AMA (80.9 vs. 5.3 min, p \u3c 0.001). CONCLUSIONS: Using AMA to evaluate residents on the milestones takes significantly less time than FMA. However, AMA and SMA agree with FMA on only 8 and 1 subcompetencies, respectively. An estimated 23.5 h of faculty time are required each month to fulfill the requirement for semiannual reporting for a residency with 42 trainees