Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - An observational study in 29 countries

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (V T) size was 500 ml, or 7 to 9 ml kg−1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P ˂ 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P ˂ 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high V T and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome.</p

Regulations and deregulations in the banking industry. When should the law-makers back off?

This paper examines the banking regulatory frameworks that were enforced from the 1980 to date and see if there is a cyclical tendency in the patterns of regulations and deregulations. To analyse this, we look at 10 acts or key events from the US banking industry and compare them against variant macroeconomic indicators. The result shows that lawmakers imposed deregulations upon the banking industry in moments of economic growth and regulatory measures after a period of economic downturn. This has some serious implications for policy making. In the end, we attempt to conclude whether lawmakers should back off and have a hands off approach to banking industry or if they should permanently regulate

A Microfluidic Tool for Fine-Tuning Motion of Soft Micromotors

Contains fulltext : 207409.pdf (publisher's version ) (Closed access)6 p

Isolation and characterization of a human glioblastoma cell line

The characterization of a glioblastoma cells line represents an important achievement in the field of brain tumor research activity, which enables the researchers to obtain strong results with a wide recognition by the scientific community. The objective of this study was to develop a standardized glioblastoma cells line using the resources obtained entirely from the national research projects. The tumor samples was initially obtained intraoperative from a 58 years-old female patient, with the preoperative written consent of the patient. The histopathological exam showed a grad IV WHO glioma (glioblastoma). The sample was prepared by manual fragmentation into pieces up to few millimeters each, followed by enzymatic digestions using different concentration of trypsin. Then, the cellular line was cultivated for more then 100 passages using Dulbecco Modified Eagle's medium enrich with 10% fetal bovine serum. The characterization of the glioblastoma line was made by the evaluation of cells proliferation (growth curve), by morphological studies, by studying the karyotype of the cells and by immunohistochemistry studies for the identification of the specific markers (glial fibrillary acidic proteins - GFAP, vimentin) of the tumor cells. The determination of the expression/amplification of the receptors tyrosine kinases (PDGFR and more important EGFR) is in progress. The characterization of a glioblastoma cells line represents an essential step in order to obtain a better in vitro and in vivo experimental model for glioblastoma

Towards complete specifications with an error calculus

Abstract. We present an error calculus to support a novel specification mechanism for sound and/or complete safety properties that are to be given by users. With such specifications, our calculus can form a foundation for both proving program safety and/or discovering real bugs. The basis of our calculus is an algebra with a lattice domain of four abstract statuses (namely unreachability, validity, must-error and may-error) on possible program states and four operators for this domain to calculate suitable program status. We show how proof search and error localization can be supported by our calculus. Our calculus can also be extended to separation logic with support for user-defined predicates and lemmas. We have implemented our calculus in an automated verification tool for pointer-based programs. Initial experiments have confirmed that it can achieve the dual objectives, namely of safety proving and bug finding, with modest overheads.

Politicization of administrative elites in Western Europe: an introduction

The Institutions of Politics; Design, Workings, and implications ( do not use, ended 1-1-2020

Clinical effects of erdosteine in the treatment of acute respiratory tract diseases in children

Erdosteine has positive effects on mucus rheology and transport due to the active metabolite (Metabolite 1) which contains a free thiol group. Erdosteine inhibits bacterial adhesiveness and has antioxidant properties. A synergistic effect of erdosteine with various antibiotics has been demonstrated in pharmacological and clinical studies. The present study was multicenter, randomized, double-blind and placebo-controlled. The aims of the study were to compare a combination of erdosteine with amoxicillin against an amoxicillin-placebo combination in pediatric patients with acute lower respiratory tract disease. A total of 158 patients (78 in the erdosteine group and 80 in the placebo group) were treated for 7 2 days. The efficacy parameters were cough (primary), polypnea, rhonchi, rales and body temperature (all measured at baseline, on Day 3 and at the end of treatment). Safety was assessed by strictly monitoring the occurrence of adverse events and using standard laboratory parameters. The results of the intention-to-treat analysis showed that the severity of cough was decreased by 47% at Day 3 in the erdosteine group with a statistically significant difference compared to placebo, the difference was still significant at the final visit. The decrease in the severity of rales was significantly greater at Day 3 in the erdosteine group than in the placebo group. The incidence of polypnea and rhonchi in the two groups showed similar decreases, an improvement mainly due to the antibiotic. No adverse events occurred and no adverse changes in laboratory parameters were observed. It is concluded that the combination of erdosteine and amoxicillin is a safe medication which is clinically superior to that of the antibiotic combined with placebo, especially in regard to the effects on cough