General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multi-centre observational study

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%)

Ion beam induced strain relaxation in pseudomorphous epitaxial SiGe layers

The effects of irradiation with Ge+ and Ar+ ions at elevated temperatures on the relaxation behavior of pseudomorphic Si0.79Ge0.21/Si heterostructures have been compared. It was found the strain relaxation in the structures implanted with Ge+ at 400°C started already upon implantation, post-implantation thermal annealing of this sample resulted in considerably higher degree of relaxation than that in control (non-implanted) samples as well as in samples implanted with Ar+ both at 230 and 4000°C and with Ge+ at 230°C. This result points to a dramatic influence of both the implantation temperature and ion species on relaxation behavior of the ion-irradiated heterostructure. Two possible mechanisms for this effect are discussed.</p

Ion beam induced strain relaxation in pseudomorphous epitaxial SiGe layers

The effects of irradiation with Ge+ and Ar+ ions at elevated temperatures on the relaxation behavior of pseudomorphic Si0.79Ge0.21/Si heterostructures have been compared. It was found the strain relaxation in the structures implanted with Ge+ at 400°C started already upon implantation, post-implantation thermal annealing of this sample resulted in considerably higher degree of relaxation than that in control (non-implanted) samples as well as in samples implanted with Ar+ both at 230 and 4000°C and with Ge+ at 230°C. This result points to a dramatic influence of both the implantation temperature and ion species on relaxation behavior of the ion-irradiated heterostructure. Two possible mechanisms for this effect are discussed.</p

Timing of breast cancer surgery in relation to menstrual cycle phase: No effect on three-year prognosis: The ITS Study

Background: The effect of breast cancer surgery timing during the menstrual cycle on prognosis remains controversial. We conducted a multi-centre prospective study to establish whether timing of interventions influences prognosis. We report three-year overall and disease-free survival (OS/DFS) results for ‘primary analysis’ patients (regular cycles, no oral contraceptives within previous six months). Methods: Data were collected regarding timing of interventions in relation to patients’ last menstrual period (LMP) and first menstrual period after surgery (FMP). Hormone profiles were also measured. Cox’s Proportional Hazards model incorporated LMP in continuous form. Exploratory analyses used menstrual cycle categorisations of Senie, Badwe and Hrushesky. Hormone profiles with LMP and FMP data were also used to define menstrual cycle phase. Results: 412 ‘primary analysis’ patients were recruited. Three-year OS from first surgery was 90.7%, 95% confidence interval (CI) [87.9%, 93.6%]. Menstrual cycle according to LMP was not statistically significant (OS hazard ratio (HR)=1.02, 95%CI [0.995,1.042], p=0.14; DFS HR=1.00, 95%CI [0.980,1.022], p=0.92). Conclusion: Timing of surgery in relation to menstrual cycle phase had no significant impact on three-year survival. This may be due to 97% of patients receiving some form of adjuvant therapy. Survival curves to 10 years indicate results may remain true for longer-term survival