Comparative efficacy of swallowing therapies for dysphagia to prevent pneumonia in patients with acute or subacute stroke: A network meta-analysis of randomized controlled trials

Pneumonia is a frequent complication in patients with acute and subacute stroke. Hence, pneumonia prevention is a prominent issue. Although previous reports have demonstrated the efficacy of various swallowing therapies in preventing pneumonia, details of their efficacy profiles have not been fully elucidated. This study aimed to compare the effectiveness of behavior interventions （BI）, metoclopramide （MCP）, prophylactic antibiotics （PA）, and pharyngeal electrical stimulation （PES） in preventing pneumonia between patients with acute to subacute stroke and a control group （N）. A network meta-analysis of randomized controlled trials was conducted. The primary endpoint was the frequency of pneumonia. Integrated estimates were expressed as odds ratios （ORs） and 95％ credible intervals （CIs）. Five studies （n＝1,179） were included in the analysis. The frequency of pneumonia was significantly lower in group MCP than in groups BI, PA, and N （OR ［95％ CI］ of MCP vs. BI, PA vs. MCP, and MCP vs. N: 0.127 ［0.018 to 0.450］, 24.15 ［3.653 to 84.50］, and 0.081 ［0.013 to 0.273］, respectively）. There was no significant difference in the frequency of pneumonia between each treatment pair among the BI, PA, PES, and N groups. MCP showed good pneumonia prophylaxis in patients with acute to subacute stroke compared to BI or PA. Further clinical studies to verify the efficacy and safety profile of MCP in preventing pneumonia are warranted

Significance of adrenomedullin under cardiopulmonary bypass in children during surgery for congenital heart disease.

To elucidate the effect of adrenomedullin (AM) on fluid homeostasis under cardiopulmonary bypass (CPB), we investigated the serial changes in plasma AM and other parameters related to fluid homeostasis in 13 children (average age, 28.2 months) with congenital heart disease during cardiac surgery under CPB. Arterial blood and urine samples were collected just after initiation of anesthesia, just before commencement of CPB, 10 min before the end of CPB, 60 min after CPB, and 24 h after operation. Plasma AM levels increased significantly 10 min before the end of CPB and decreased 24 h after operation. Urine volume increased transiently during CPB, which paralleled changes in AM. Simple regression analysis showed that plasma AM level correlated significantly with urinary vasopressin, urine volume, urinary sodium excretion, and plasma osmolarity. Stepwise regression analysis indicated that urine volume was the most significant determinant of plasma AM levels. Percent rise in AM during CPB relative to control period correlated with that of plasma brain natriuretic peptide (r = 0.57, P &#60; 0.01). Our results suggest that AM plays an important role in fluid homeostasis under CPB in cooperation with other hormones involved in fluid homeostasis.</p

Installation Cost and Heat Extraction Performance Analysis of H-Shaped PC Pile Ground Heat Exchangers for Small Buildings

Ground source heat pump systems are one of the renewable energy heat utilization technologies that can reduce the energy for HVAC and hot water supplies and consequently mitigate the progression of global warming. On the other hand, the development of ground heat exchangers that can be installed in small buildings with low installation costs is an important challenge for increasing the installation number of ground source heat pump systems in Japan. This study proposes H-shaped PC pile ground heat exchangers to reduce installation costs. The installation test and installation cost estimation of H-shaped PC pile ground heat exchangers showed that installation costs could be reduced to less than half compared to the conventional borehole double U-tube ground heat exchanger. The coefficient of heat extraction/injection of H-shaped PC pile ground heat exchangers was evaluated as 2.2–2.4 W/(m K) from the results of actual measurements during the heating and cooling operation of the GSHP system, and this was slightly high compared to the borehole single U-tube ground heat exchanger. In addition, the GSHP system with an 8 by 8 m long H-shaped PC pile ground heat exchanger could supply adequate heating output for the heating load of the residential house and operate with an SCOP of more than 3.0. Finally, the authors have confirmed that the GSHP system with H-shaped PC pile ground heat exchangers can reduce installation costs by 40% or more while maintaining the same running cost compared to conventional GSHP systems

Continuous PECS II block for postoperative analgesia in patients undergoing transapical transcatheter aortic valve implantation

Abstract It has been reported that PECS II block can alleviate postoperative pain following transapical transcatheter aortic valve implantation (TA-TAVI). However, the effectiveness of continuous PECS II block with catheterization has not yet been reported on the postoperative pain in patients undergoing TA-TAVI. We experienced two cases of TA-TAVI who received PECS II block with catheterization to manage postoperative pain. In the first case, a bolus injection for intraoperative pain and subsequent catheterization were performed before the implantation. However, the patient developed severe pain postoperatively in spite of the continuous block due to displacement of the catheter. In the second case, a bolus injection and the catheterization for the continuous block were performed before and after the implantation, respectively, which provided high-quality pain control. Continuous PECS II block may be useful to control perioperative pain associated with TA-TAVI. The insertion of the catheter after the implantation could be useful to avoid its displacement during the surgery

A New Simulation Model for Vertical Spiral Ground Heat Exchangers Combining Cylindrical Source Model and Capacity Resistance Model

Considering the heat capacity inside vertical spiral ground heat exchanger (VSGHEX) in the simulation is one of the most noteworthy challenge to design the ground source heat pump (GSHP) system with VSGHEXs. In this paper, a new simulation model for VSGHEXs is developed by combining the ICS model with the CaRM. The developed simulation model can consider the heat capacity inside VSGHEX and provide dynamic calculation with high speed and appropriate precision. In order to apply the CaRM, the equivalent length was introduced. Then, the equivalent length was approximated by comparing the results of the CaRM and the numerical calculation. In addition, the calculation model of the VSGHEX was integrated into the design and simulation tool for the GSHP system. The accuracy of the tool was verified by comparing with the measurements. The error between supply temperatures of the measurements and calculation is approximately 2 degrees C at the maximum. Finally, assuming GSHP systems with VSGHEXs, whose spiral diameter was 500 mm and depth was 4 m, were installed in residential houses in Japan, the required numbers of VSGHEXs were estimated. The results showed a strong correlation between the total heating or cooling load and the required number. Therefore, the required number can be estimated by using the simplified approximate equation

Clinical Implications of Determining Individualized Positive End-Expiratory Pressure Using Electrical Impedance Tomography in Post-Cardiac Surgery Patients: A Prospective, Non-Randomized Interventional Study

Optimal positive end-expiratory pressure (PEEP) can induce sustained lung function improvement. This prospective, non-randomized interventional study aimed to investigate the effect of individualized PEEP determined using electrical impedance tomography (EIT) in post-cardiac surgery patients (n = 35). Decremental PEEP trials were performed from 20 to 4 cmH2O in steps of 2 cmH2O, guided by EIT. PEEP levels preventing ventilation loss in dependent lung regions (PEEPONLINE) were set. Ventilation distributions and oxygenation before the PEEP trial, and 5 min and 1 h after the PEEPONLINE setting were examined. Furthermore, we analyzed the saved impedance data offline to determine the PEEP levels that provided the best compromise between overdistended and collapsed lung (PEEPODCL). Ventilation distributions of dependent regions increased at 5 min after the PEEPONLINE setting compared with those before the PEEP trial (mean &plusmn; standard deviation, 41.3 &plusmn; 8.5% vs. 49.1 &plusmn; 9.3%; p &lt; 0.001), and were maintained at 1 h thereafter (48.7 &plusmn; 9.4%, p &lt; 0.001). Oxygenation also showed sustained improvement. Rescue oxygen therapy (high-flow nasal cannula, noninvasive ventilation) after extubation was less frequent in patients with PEEPONLINE &ge; PEEPODCL than in those with PEEPONLINE &lt; PEEPODCL (1/19 vs. 6/16; p = 0.018). EIT-guided individualized PEEP stabilized the improvement in ventilation distribution and oxygenation. Individual PEEP varies with EIT measures, and may differentially affect oxygenation after cardiac surgery