Effects of varying blood flow rate during peripheral veno-arterial extracorporeal membrane oxygen (V-A ECMO) on left ventricular function measured by two-dimensional strain

BackgroundWe evaluated the effects of varying blood flow rate during peripheral veno-arterial extracorporeal membrane oxygen (V-A ECMO) on left ventricular function measured by two-dimensional strain.MethodsAdult patients who were supported by peripheral V-A ECMO were recruited. Serial hemodynamic and cardiac performance parameters were measured by transthoracic echocardiogram within the first 48 h after implementation of V-A ECMO. Measurements at 100%, 120%, and 50% of target blood flow (TBF) were compared.ResultsA total of 54 patients were included and the main indications for V-A ECMO were myocardial infarction [32 (59.3%)] and myocarditis [6 (11.1%)]. With extracorporeal blood flow at 50% compared with 100% TBF, the mean arterial pressure was lower [66 ± 19 vs. 75 ± 18 mmHg, p < 0.001], stroke volume was greater [23 (12–34) vs. 15 (8–26) ml, p < 0.001], and cardiac index was higher [1.2 (0.7–1.7) vs. 0.8 (0.5–1.3) L/min/m2, p < 0.001]. Left ventricular contractile function measured by global longitudinal strain improved at 50% compared with 100% TBF [−2.8 (−7.6- −0.1) vs. −1.2 (−5.2–0) %, p < 0.001]. Similarly, left ventricular ejection fraction increased [24.4 (15.8–35.5) vs. 16.7 (10.0–28.5) %, p < 0.001] and left ventricular outflow tract velocity time integral increased [7.7 (3.8–11.4) vs. 4.8 (2.5–8.5) cm, p < 0.001]. Adding echocardiographic parameters of left ventricular systolic function to the Survival After Veno-arterial ECMO (SAVE) score had better discriminatory value in predicting eventual hospital mortality (AUROC 0.69, 95% CI 0.55–0.84, p = 0.008) and successful weaning from V-A ECMO (AUROC 0.68, 95% CI 0.53–0.83, p = 0.017).ConclusionIn the initial period of V-A ECMO support, measures of left ventricular function including left ventricular ejection fraction and global longitudinal strain were inversely related to ECMO blood flow rate. Understanding the heart-ECMO interaction is vital to interpretation of echocardiographic measures of the left ventricle while on ECMO

Dental Environmental Noise Evaluation and Health Risk Model Construction to Dental Professionals

Occupational noise is unavoidably produced from dental equipment, building facilities, and human voices in the dental environment. The purpose of this study was to investigate the effect of occupational noise exposure on the dental professionals’ health condition. The psychoacoustics approach noise exposure assessment followed by the health risk assessment was carried on at the paediatric dentistry clinic and the dental laboratory in the Prince Philip Dental Hospital of Hong Kong. The A-weighted equivalent sound level, total loudness, and sharpness values were statistically significantly higher for the noise at the laboratory than that at the clinic. The degree of perceived influences and sharpness of noise were found to have the impacts on the dental professionals’ working performance and health. Moreover, the risk of having a bad hearing state would a have 26% and 31% higher chance for a unit increment of the short-term and long-term impact scores, respectively. The dental professionals with the service length more than 10 years and the daily working hours of more than eight showed the highest risk to their hearing state. The worse the hearing state was, the worse the health state was found for the dental professionals. Also, the risk of dissatisfaction would be increased by 4.41 and 1.22 times for those who worked at the laboratory and a unit increment of the long-term impact score. The constructed health risk mode with the scientific and statistical evidence is hence important for the future noise management of environmental improvement

An Infinity Tube with an Expansion Chamber for Noise Control in the Ductwork System

This paper proposes a muffler with simple geometry to effectively reduce low-frequency noise in ductwork systems. A muffler named infinity tube with an expansion chamber (ITEC) is developed from the infinity tube (IT). Theoretical and numerical analyses of wave propagation in the ITEC have been conducted in this paper. The transfer matrix method is adopted to predict transmission loss theoretically. The theoretical results are validated by the finite element method simulation. The comparison of the transmission loss between the IT and ITEC illustrates that the ITEC has an advantage in low-frequency noise reduction. The transmission loss results of the ITEC are compared with the Helmholtz resonator system to assess the potential for industrial application. Finally, the geometric parameters of the proposed ITEC on its noise attenuation performance have been analyzed. The proposed ITEC can effectively reduce low-frequency noise, and it is suitable for ductwork systems in constrained spaces

Advanced informatics understanding of clinician-patient communication: A mixed-method approach to oral health literacy talk in interpreter-mediated pediatric dentistry.

BACKGROUND:In the clinical dental consultation, multi-party configurations predominate with the presence of parents/ primary caregivers in pediatric dentistry adding another layer of complexity. In managing child oral healthcare, parents/ primary caregivers are critical, especially in dental caries prevention. This study aimed (1) to identify the structure of oral health literacy (OHL) talk in interpreter-mediated pediatric dentistry and (2) to analyze interpreter contributions to the communication strategies: patient-centered direct interpreting (PC-DI), patient-centered mediated interpreting (PC-MI), clinician-centered direct interpreting (CC-DI), and clinician-centered mediated interpreting (CC-MI). METHODS:Visual text analysis (VTA) of video recorded pediatric clinical consultations in Hong Kong utilized Discursis™ software to illustrate temporal and topical structures and their distribution across turns-at-talk. Conversation analysis (CA) was applied to analyze turn-taking of the identified OHL talk qualitatively. The mixed-method approach of combining VTA and CA was applied to analyze the patterns and features of the recorded OHL talk. RESULTS:The conceptual recurrences of the 77 transcribed video recordings were plotted visually. CC- and PC-OHL talk were identified by the recurrence patterns of monochromatic and multi-colored triangular clusters formed by off-diagonal boxes, respectively. CA of interpreter-mediated turns supported earlier findings regarding patterns of MI in multilingual adult dental consultations; however, the role of the interpreter in parent/ primary caregiver education and patient management was more distinctive in the pediatric dentistry. CONCLUSIONS:The mixed-method approach assisted in unpacking the complexities of the multi-party interactions, supported identification of effective communication strategies, and illustrated the roles of the dental professionals in initiating CC- and PC-OHL talk in pediatric dentistry. The intervention showed the implication of the professional education of evidence-based practices for clinicians in balancing agenda management and the communicative dimension of OHL with the help of VTA and CA in multilingual consultations

Datasheet1_Effects of varying blood flow rate during peripheral veno-arterial extracorporeal membrane oxygen (V-A ECMO) on left ventricular function measured by two-dimensional strain.docx

BackgroundWe evaluated the effects of varying blood flow rate during peripheral veno-arterial extracorporeal membrane oxygen (V-A ECMO) on left ventricular function measured by two-dimensional strain.MethodsAdult patients who were supported by peripheral V-A ECMO were recruited. Serial hemodynamic and cardiac performance parameters were measured by transthoracic echocardiogram within the first 48 h after implementation of V-A ECMO. Measurements at 100%, 120%, and 50% of target blood flow (TBF) were compared.ResultsA total of 54 patients were included and the main indications for V-A ECMO were myocardial infarction [32 (59.3%)] and myocarditis [6 (11.1%)]. With extracorporeal blood flow at 50% compared with 100% TBF, the mean arterial pressure was lower [66 ± 19 vs. 75 ± 18 mmHg, p 2, p ConclusionIn the initial period of V-A ECMO support, measures of left ventricular function including left ventricular ejection fraction and global longitudinal strain were inversely related to ECMO blood flow rate. Understanding the heart-ECMO interaction is vital to interpretation of echocardiographic measures of the left ventricle while on ECMO.</p

Use of the International Prostate Symptom Score (IPSS) in Chinese male patients with benign prostatic hyperplasia

© 2017 Informa UK Limited, trading as Taylor & Francis Group. Purpose: To test the psychometric properties of the International Prostate Symptom Score (Hong Kong Chinese version 2) (IPSS) in Chinese male patients with benign prostatic hyperplasia (BPH) under secondary care. Methods: A prospective longitudinal study was done by interviewing subjects at baseline, at 2 week after baseline for assessing testâretest reliability and at 26 week after baseline for assessing responsiveness. All subjects were interviewed to complete a structured questionnaire including IPSS, Short Form-12 Health Survey version 2 (SF-12v2) and Depression Anxiety Stress Scale (DASS). Results: The IPSS HRQOL score had weak correlations with SF-12v2 summary and DASS domain scores. For reliability analysis, Cronbachâs alpha coefficient was 0.90 for the seven symptom-related items. The intraclass correlation coefficients of the IPSS total symptom score and HRQOL score were 0.90 and 0.86, respectively. For sensitivity, statistically significant differences were detected between the subjects with BPH and those without for IPSS total symptom score (effect size = 0.68) but not the IPSS HRQOL score. The areas under ROC curves for the IPSS total symptom and HRQOL scores were 0.67 and 0.60, respectively. Conclusions: The IPSS was valid, reliable instrument in Chinese patients with BPH. The IPSS total symptom score, but not the HRQOL score, is sensitive in differentiating subgroups.Link_to_subscribed_fulltex

Simeprevir Potently Suppresses SARS-CoV-2 Replication and Synergizes with Remdesivir

International audienc