Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China:lessons learnt and international expert recommendations

Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan, China, a panel of international airway management experts discussed the results and formulated consensus recommendations for the management of tracheal intubation in COVID-19 patients. Of 202 COVID-19 patients undergoing emergency tracheal intubation, most were males (n=136; 67.3%) and aged 65 yr or more (n=128; 63.4%). Most patients (n=152; 75.2%) were hypoxaemic (Sao2 <90%) before intubation. Personal protective equipment was worn by all intubating healthcare workers. Rapid sequence induction (RSI) or modified RSI was used with an intubation success rate of 89.1% on the first attempt and 100% overall. Hypoxaemia (Sao2 <90%) was common during intubation (n=148; 73.3%). Hypotension (arterial pressure <90/60 mm Hg) occurred in 36 (17.8%) patients during and 45 (22.3%) after intubation with cardiac arrest in four (2.0%). Pneumothorax occurred in 12 (5.9%) patients and death within 24 h in 21 (10.4%). Up to 14 days post-procedure, there was no evidence of cross infection in the anaesthesiologists who intubated the COVID-19 patients. Based on clinical information and expert recommendation, we propose detailed planning, strategy, and methods for tracheal intubation in COVID-19 patients

WEI nasal jet tube during monitored anaesthesia care for removal of oesophageal foreign body for a patient with fragile cardiopulmonary function

This manuscript reports a case of foreign body removal surgery and anaesthesia of an elderly patient with a challenging airway and fragile cardiopulmonary function. WEI Nasal Jet Tube (WNJ) was used to sustain sufficient oxygenation without interfering with the gastroscopy operation. Because the device could be well tolerated by the patient, it was beneficial to maintain circulation stability as well. This case was a considerable anaesthetic challenge, as the anaesthesia depth for the patient was difficult to manage

Supraglottic jet oxygenation and ventilation assisted fiberoptic intubation in a paralyzed patient with morbid obesity and obstructive sleep apnea: a case report

Abstract Background Hypoxia is a major concern and cause of morbidity or mortality during tracheal intubation after anesthesia induction in a pathological obese patient with obstructive sleep apnea (OSA). We introduce a case using Supraglottic jet oxygenation and ventilation (SJOV) to promote oxygenation/ventilation during fiberoptic intubation in a paralyzed patient with morbid obesity and OSA. Case presentation A 46-year-old man weighting 176 kg with BMI 53.7 kg/m2 was scheduled for gastric volume reduction surgery to reduce body weight under general anesthesia. SpO2 decreased during induction, and two hand pressured mask ventilation partial failed. We then placed WEI Nasal Jet Tube (WNJ) in the patient’s right nostril to provide SJOV. Then fiberoptic bronchoscopy guided endotracheal intubation was performed via mouth approach, and vital signs were stable. The operation was successfully completed after 3 h. Patient recovered smoothly in hospital for 8 days and did not have any recall inside the operating room. Conclusion SJOV via WNJ could effectively maintain adequate oxygenation/ventilation during long time fiberoptic intubation in an apnea patient with morbid obesity and OSA after partial failure of two hand pressured mask ventilation, without obvious complications. This may provide a new effective approach for difficult airway management in these patients

Efficient removal of fluoride ion by the composite forward osmosis membrane with modified cellulose nanocrystal interlayer

In this paper, the performance of three-layer film composite (TFC) forward osmosis (FO) membrane for the retention of fluoride ions was investigated. A cellulose nanocrystal (CNC) interlayer was introduced on the porous substrate by coating method to enhance the hydrophilicity and retention capacity of the FO membrane. In order to improve the dispersibility of CNC, boric acid (BA) and (3-aminopropyl)triethoxysilane (APTES) were used for chemical modification, respectively. The characterization results demonstrated the successful introduction of CNC, BA/CNC and APTES/CNC–CNC interlayers. The introduction of the interlayer enhanced the hydrophilicity of the membrane and increased the negative surface charge, which facilitated the transport of water molecules and the retention of fluoride ions. The FO tests indicated that the water flux of TFC/CNC membrane was increased by 46.4% compared to the original TFC membrane, and the water flux of TFC/APTES-CNC and TFC/BA-CNC membranes were higher than that of TFC/CNC membranes by 5.9% and 13.0%, respectively. 97.0% and 97.6% of the fluoride ions of TFC/BA-CNC and TFC/APTES-CNC could be retained. Based on the molecular simulation of adsorption, it was demonstrated that BA-CNC interlayer was more favorable for the adsorption of water molecules than CNC and APTES-CNC interlayer. This study contributes to the development of high-performance TFC-FO membrane for the treatment of wastewater containing fluoride

Strength Assessment of Broken Rock Postgrouting Reinforcement Based on Initial Broken Rock Quality and Grouting Quality

To estimate postgrouting rock mass strength growth is important for engineering design. In this paper, using self-developed indoor pressure-grouting devices, 19 groups of test cubic blocks were made of the different water cement ratio grouting into the broken rock of three kinds of particle sizes. The shear strength parameters of each group under different conditions were tested. Then this paper presents a quantitative calculation method for predicting the strength growth of grouted broken rock. Relational equations were developed to investigate the relationship between the growth rates of uniaxial compressive strength (UCS), absolute value of uniaxial tensile strength (AUTS), internal friction angle, and cohesion for post- to pregrouting broken rock based on Mohr-Coulomb strength criterion. From previous test data, the empirical equation between the growth rate of UCS and the ratio of the initial rock mass UCS to the grout concretion UCS has been determined. The equations of the growth rates of the internal friction coefficient and UCS for grouting broken rock with rock mass rating (RMR) and its increment have been established. The calculated results are consistent with the experimental results. These observations are important for engineered design of grouting reinforcement for broken rock mass

Risk factors and predictive model for pulmonary complications in patients transferred to ICU after hepatectomy

Abstract Objective Postoperative pulmonary complications (PPCs) seriously harm the recovery and prognosis of patients undergoing surgery. However, its related risk factors in critical patients after hepatectomy have been rarely reported. This study aimed at analyzing the factors related to PPCs in critical adult patients after hepatectomy and create a nomogram for prediction of the PPCs. Methods 503 patients’ data were collected form the Peking University People’s Hospital. Multivariate logistic regression analysis was used to identify independent risk factors to derive the nomogram. Nomogram’s discriminatory ability was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was assessed using the Hosmer–Lemeshow goodness-of-fit test and calibration curve. Results The independent risk factor for PPCs are advanced age (odds ratio [OR] = 1.026; P = 0.008), higher body mass index (OR = 1.139; P < 0.001), lower preoperative serum albumin level (OR = 0.961; P = 0.037), and intensive care unit first day infusion volume (OR = 1.152; P = 0.040). And based on this, we created a nomogram to predict the occurrence of PPCs. Upon assessing the nomogram’s predictive ability, the AUC for the model was 0.713( 95% CI: 0.668–0.758, P<0.001). The Hosmer–Lemeshow test (P = 0.590) and calibration curve showed good calibration for the prediction of PPCs. Conclusions The prevalence and mortality of postoperative pulmonary complications in critical adult patients after hepatectomy are high. Advanced age, higher body mass index, lower preoperative serum albumin and intensive care unit first day infusion volume were found to be significantly associated with PPCs. And we created a nomogram model which can be used to predict the occurrence of PPCs

Determination of Weak Terrestrial Water Storage Changes from GRACE in the Interior of the Tibetan Plateau

Time series of the Gravity Recovery and Climate Experiment (GRACE) satellite mission have been successfully used to reveal changes in terrestrial water storage (TWS) in many parts of the world. This has been hindered in the interior of the Tibetan Plateau since the derived TWS changes there are very sensitive to the selections of different available GRACE solutions, and filters to remove north-south-oriented (N-S) stripe features in the observations. This has resulted in controversial distributions of the TWS changes in previous studies. In this paper, we produce aggregated hydrology signals (AHS) of TWS changes from 2003 to 2009 in the Tibetan Plateau and test a large set of GRACE solution-filter combinations and mascon models to identify the best combination or mascon model whose filtered results match our AHS. We find that the application of a destriping filter is indispensable to remove correlated errors shown as N-S stripes. Three best-performing destriping filters are identified and, combined with two best-performing solutions, they represent the most reliable solution-filter combinations for determination of weak terrestrial water storage changes in the interior of the Tibetan Plateau from GRACE. In turn, more than 100 other tested solution-filter combinations and mascon solutions lead to very different distributions of the TWS changes inside and outside the plateau that partly disagree largely with the AHS. This is mainly attributed to less effective suppression of N-S stripe noises. Our results also show that the most effective destriping is performed within a maximum degree and order of 60 for GRACE spherical harmonic solutions. The results inside the plateau show one single anomaly in the TWS trend when additional smoothing with a 340-km-radius Gaussian filter is applied. We suggest using our identified best solution-filter combinations for the determination of TWS changes in the Tibetan Plateau and adjacent areas during the whole GRACE operation time span from 2002 to 2017 as well as the succeeding GRACE-FO mission

In-situ preparation of multi-layered sandwich-like CuCo2S4/rGO architectures as anode material for high-performance lithium and sodium ion batteries

To improve electron transfer and ion diffusion for lithium ion batteries (LIBs) and sodium ion batteries (SIBs), multi-layered sandwich-like CuCo2S4/rGO architectures (MS-CuCo2S4/rGO) are fabricated, in which the inserted CuCo2S4 spheres are anchored on the surface of rGO tightly due to strong chemical bonding. The MS-CuCo2S4/rGO architectures exhibit impressive electrochemical performance as anodes for both LIBs and SIBs. They show a high and stable capacities of 792 mAh g(-1) at 500 mA g(-1) after 1000 cycles for LIBs and 344.5 mAh g(-1) at 1000 mA g(-1) after 800 cycles for SIBs, which are 5 and 3.5 times that of pure CuCo2S4 for LIBs and SIBs, respectively. The electrochemical results show about 77.8% and 68.4% charge contribution from capacitive-controlled capacity for LIBs and SIBs, leading to excellent electrochemical performance. The in-situ XRD tests also prove that a conversion-type sodium storage mechanism is beneficial to high capacity. Additionally, the successfully paired Na3V2(PO4)(3)parallel to MS-CuCo2S4/rGO full sodium ion cell displays a reversible capacity of 225 mAh g(-1) at 500 mA g(-1) after 100 cycles. These results will shed light on the practical application of MS-CuCo2S4/rGO as high-performance electrode with long-term cycling stability for next generation LIBs and SIBs. (C) 2020 Elsevier B.V. All rights reserved

Invariant Content Synergistic Learning for Domain Generalization of Medical Image Segmentation

While achieving remarkable success for medical image segmentation, deep convolution neural networks (DCNNs) often fail to maintain their robustness when confronting test data with the novel distribution. To address such a drawback, the inductive bias of DCNNs is recently well-recognized. Specifically, DCNNs exhibit an inductive bias towards image style (e.g., superficial texture) rather than invariant content (e.g., object shapes). In this paper, we propose a method, named Invariant Content Synergistic Learning (ICSL), to improve the generalization ability of DCNNs on unseen datasets by controlling the inductive bias. First, ICSL mixes the style of training instances to perturb the training distribution. That is to say, more diverse domains or styles would be made available for training DCNNs. Based on the perturbed distribution, we carefully design a dual-branches invariant content synergistic learning strategy to prevent style-biased predictions and focus more on the invariant content. Extensive experimental results on two typical medical image segmentation tasks show that our approach performs better than state-of-the-art domain generalization methods.Comment: 10 pages, 5 figure