Zobrazení zdroje stránky Blackburnmackay3518

BACKGROUND We sought to evaluate the acute effects of different inspiratory loads using nasal and oral interfaces on the volumes of the chest wall and its compartments, breathing pattern, and respiratory muscle activation in children with mouth-breathing syndrome. METHODS Children with mouth-breathing syndrome were randomized into 2 groups, one with an inspiratory load intensity 20% of maximum inspiratory pressure (n = 14), and the other with an inspiratory load intensity 40% of maximum inspiratory pressure (n = 15). The chest wall volumes and electromyography of sternocleidomastoid, rectus abdominis, scalene, and internal intercostal muscles were used to analyze respiration against the 2 load intensities and using 2 interfaces (ie, nasal and oral). RESULTS A total of 72 children with mouth-breathing syndrome were recruited, and 29 were evaluated in this study. The use of inspiratory load promoted improvement in the components of the breathing pattern breathing frequency (P = .039), inspiratory time (P = .03), and total respiratory time (P = .043); and increases in tidal volume (P less then .001), end-inspiratory volume (P less then .001), and electrical activity of scalene muscles and sternocleidomastoid muscles (P less then .001) when compared to quiet breathing. The load imposed via a nasal interface versus an oral interface provided an increase in tidal volume (P = .030), end-inspiratory volume (P = .02), and electrical activity of scalene muscles (P less then .001) and sternocleidomastoid muscles (P = .02). CONCLUSIONS The use of acute inspiratory loads improved the breathing pattern and increased lung volume and electrical activity of inspiratory muscles. This work brings new perspective to the investigation of using nasal interfaces during the application of inspiratory loads. The nasal interface was more effective compared to the oral interface commonly used in clinical practice. Copyright © 2020 by Daedalus Enterprises.BACKGROUND Unplanned extubation (UE) is an important quality metric in the neonatal ICU that is associated with hypoxia, bradycardia, and risk for airway trauma with emergent re-intubation. Initial efforts to reduce UE in our level 4 neonatal ICU included standardized securement of the endotracheal tube (ETT) and requiring multiple providers to be present for ETT adjustments and patient positioning as phase 1 interventions. After an initial decline, the UE rate plateaued; an internal retrospective review revealed that the odds of UE were 2.9 times higher in the setting of an ETT tip at or above T1 (high ETT) on chest radiograph just prior to UE. [https://www.selleckchem.com/products/taurochenodeoxycholic-acid.html check details] The team hypothesized that advancing ETT tips to below T1 would reduce UE risk in infants of all gestational ages. METHODS Over a period of 32 months, we compared pre-intervention and post-intervention UE rates in our neonatal ICU after a 2-step initiative that focused initially on ETT securement and assessment, with a subsequent addition of a single intervention to advance ETT tips below T1. To determine if the decrease in UE rate could be secondary to our intervention, data were analyzed from 3 cohorts a control group of 40 infants with 185 chest radiographs and no UEs, 46 infants with chest radiographs prior to 58 UE events before the intervention, and 37 infants with chest radiographs prior to 48 UE events following the intervention. RESULTS Advancing ETT tips below T1, in addition to the use of a standard UE-prevention bundle, led to a significant decrease in the UE rate from 1.23 to 0.91 UEs per 100 ventilator days, with 14% of postintervention UEs attributed to ETT advancement. CONCLUSIONS High ETTs are significantly associated with UEs in the neonatal ICU. Optimizing ETT position may be an underrecognized driver in the provider's toolbox to reduce UEs. Because ETT repositioning carries risk of UE, extra caution should be taken during advancement. Copyright © 2020 by Daedalus Enterprises.BACKGROUND Clinicians are often required to provide a qualified guess on the probability of decannulation in estimating patients' rehabilitation potential and relaying information about prognosis to patients and next of kin. The objective of this study was to use routinely gathered clinical data to develop a prognostic model of time to decannulation in subjects with acquired brain injury, for direct implementation in clinical practice. METHODS Data from a large cohort including 574 tracheostomized subjects admitted for neurorehabilitation were analyzed using discrete time-to-event analysis with logit-link. Within this model, a reference hazard function was modeled using restricted cubic splines, and estimates were presented using odds ratios (95% CIs). RESULTS A total of 411 subjects (72%) were decannulated within a median of 27 d (interquartile range 16-49) at the rehabilitation hospital. The prognostic model for decannulation included age, diagnosis, days from injury until admission for rehabilitation, swallowing, and overall functional level measured with the Early Functional Abilities score. Among these, the strongest predictors for decannulation were age and a combination of overall functional abilities combined with swallowing ability. CONCLUSIONS A prognostic model for decannulation was developed using routinely gathered clinical data. Based on the model, an online graphical user interface was applied, in which the probability of decannulation within x days is calculated along with the statistical uncertainty of the probability. Furthermore, a layman's interpretation is provided. The online tool was directly implemented in clinical practice at the rehabilitation hospital, and is available through this link (http//www.hospitalsenhedmidt.dk/regionshospitalet-hammel/research-unit/Prognosissoftware/). Copyright © 2020 by Daedalus Enterprises.Homologous recombination is an important mechanism for genome integrity maintenance, and several homologous recombination genes are mutated in various cancers and cancer-prone syndromes. However, since in some cases homologous recombination can lead to mutagenic outcomes, this pathway must be tightly regulated, and mitotic hyper-recombination is a hallmark of genomic instability. We performed two screens in Saccharomyces cerevisiae for genes that, when deleted, cause hyper-recombination between direct repeats. One was performed with the classical patch and replica-plating method. The other was performed with a high-throughput replica-pinning technique that was designed to detect low-frequency events. This approach allowed us to validate the high-throughput replica-pinning methodology independently of the replicative aging context in which it was developed. Furthermore, by combining the two approaches, we were able to identify and validate 35 genes whose deletion causes elevated spontaneous direct-repeat recombination.