Hansenwest6923

001. After adjustments for sufentanil dose and arterial carbon dioxide partial pressure, patients sedated with isoflurane were twice as likely to breathe spontaneously than those sedated with propofol adjusted risk ratio 2.2 [95%CI 1.4, 3.3], p<.001.

Isoflurane compared to propofol sedation promotes early spontaneous breathing in deeply sedated ventilated intensive care patients. The benefit appears to be a direct effect isoflurane rather than being mediated by opioids or arterial carbon dioxide.

Isoflurane compared to propofol sedation promotes early spontaneous breathing in deeply sedated ventilated intensive care patients. The benefit appears to be a direct effect isoflurane rather than being mediated by opioids or arterial carbon dioxide.

Perioperative dysglycaemias are a risk for harm but guidelines to improve glucose management are poorly adhered to.

To determine whether a specialized team and diabetes education improves the implementation of guidelines and glucose values.

We conducted a prospective study of 611 nonselected, consecutive patients attending for elective hip or knee arthroplasty. The first 209 patients received conventional care and the following 402 patients received intervention (Acute Glucose Service, AGS) in two chronological groups; either perioperatively (AGS1) or also preoperatively (AGS2). The AGS-team provided diabetes education, identified the patients with diabetes risk and adjusted the medication when needed. Capillary plasma glucose (CPG) was repeatedly measured and glycated haemoglobin (HbA1c) obtained before and after the surgery. The study objectives were to evaluate the staff actions when hyperglycaemia was severe (CPG >10mmol/L), and to assess improvement of the glycaemic values and the complication rate within 3months.

None of the severely hyperglycaemic events in the reference group were treated according to guidelines. In the AGS 1group, 50% and in the AGS2group, 53% were appropriately managed (p<.001). The events of hyperglycaemia (CPG >7.8mmol/L at least twice) and of severe hyperglycaemia (CPG >10mmol/L) decreased in all patient groups. The medians of the highest, mean and variability of CPG values improved. The mean HbA1c improved significantly within AGS 2. There was no association between improved glycaemic care and early complications.

AGS intervention significantly improves adherence to guidelines and glucose values.

AGS intervention significantly improves adherence to guidelines and glucose values.The purpose of this study was to elucidate the effects of two-stage resting (dough crumbs and dough sheets resting) on the quality of dried noodles. An improvement mechanism was explored according to the texture of dough sheets, gluten network, and microstructure of cooked noodles. After two-stage resting, the extensibility of dough sheets, the contents of glutenin macro polymer (GMP), and disulfide bonds (S-S) increased significantly (p  less then  .05), whereas the content of sulphydryl group (-SH) significantly declined. From the perspective of microstructure, the average length and width of dough sheets protein experienced a significant reduction (p  less then  .05); however, the branching rate, the number of protein lines, and the total length of the protein lines significantly increased (p  less then  .05). Furthermore, the average network line length and width of cooked noodles were significantly reduced as the branching rate rose (p  less then  .05); meanwhile, the number of holes significantly increased while the average area significantly decreased (p  less then  .05). Overall, the two-stage resting has improved the quality of dried noodles and contributed to a more uniform and compact gluten network distribution.

We investigated hospital-level variation in outcomes after in-hospital cardiac arrest (IHCA) in Denmark, and assessed whether variation in outcomes could be explained by differences in patient characteristics.

Adult patients (≥18years old) with IHCA in 2017 and 2018 were included from the Danish IHCA Registry (DANARREST). PX-12 Data on patient characteristics and outcomes were obtained from population-based registries. Predicted probabilities, likelihood ratio tests, intraclass correlation coefficients (ICCs), and median odds ratios (ORs) were calculated for return of spontaneous circulation (ROSC), survival to 30days, and survival to 1year.

A total of 3340 patients with IHCA from 24hospitals were included. We found that hospital-level variation in outcomes after IHCA existed across all measures of variation. The unadjusted median OR for ROSC, survival to 30days, and survival to 1year were 1.28 (95% confidence interval [CI] 1.24, 1.45), 1.38 (95% CI 1.33, 1.60), and 1.44 (95% CI 1.39, 1.70), respectively. The unadjusted ICC suggest that 2.0% (95% 1.6%, 4.4%), 3.3% (95% 2.7%, 6.8%), and 4.3% (95% 3.5%, 8.6%) of the total individual variation in ROSC, survival to 30days, and survival to 1year was attributable to hospital-level variation. These results decreased but persisted in the analyses adjusted for select patient characteristics.

In this study, we found that outcomes after IHCA varied across hospitals in Denmark. However, only about 2%-4% of the total individual variation in outcomes after IHCA was attributable to differences between hospitals, suggesting that most of the individual variation in outcomes was attributable to patient-level variation.

In this study, we found that outcomes after IHCA varied across hospitals in Denmark. However, only about 2%-4% of the total individual variation in outcomes after IHCA was attributable to differences between hospitals, suggesting that most of the individual variation in outcomes was attributable to patient-level variation.Mesoscale eddies are ubiquitous oceanographic features that influence the metabolism and community structure of Synechococcus. However, the metabolic adaptations of this genus to eddy-associated environmental changes have rarely been studied. We recovered two high-quality Synechococcus metagenome-assembled genomes (MAGs) from eddies in the South China Sea and compared their metabolic variations using metatranscriptomic samples obtained at the same time. The two MAGs (syn-bin1 and syn-bin2) are affiliated with marine Synechococcus subclusters 5.2 (S5.2) and 5.3 (S5.3), respectively. The former exhibited a higher abundance at the surface layer, whereas the latter was more abundant in the deep euphotic layer. Further analysis indicated that syn-bin1 had a strong ability to utilize organic nutrients, which could help it to thrive in the nutrient-deprived surface water. By contrast, syn-bin2 had the genetic potential to perform chromatic acclimation, which could allow it to capture green or blue light at different depths. Additionally, transcriptomic analysis showed that syn-bin2 upregulated genes involved in the synthesis of C4 acids, photosystem II proteins, and HCO 3 - transporters in the deep euphotic layer, which might contribute to its predominance in low-light environments. Overall, this study expands our understanding of oceanic S5.2 and S5.3 Synechococcus by revealing their metabolic adaptations to mesoscale eddies.Phenotypic plasticity is observed widely in plants and often studied with reaction norms for adult plant or end-of-season traits. Uncovering genetic, environmental and developmental patterns behind the observed phenotypic variation under natural field conditions is needed. Using a sorghum (Sorghum bicolor) genetic population evaluated for plant height in seven natural field conditions, we investigated the major pattern that differentiated these environments. We then examined the physiological relevance of the identified environmental index by investigating the developmental trajectory of the population with multistage height measurements in four additional environments and conducting crop growth modelling. We found that diurnal temperature range (DTR) during the rapid growth period of sorghum development was an effective environmental index. Three genetic loci (Dw1, Dw3 and qHT7.1) were consistently detected for individual environments, reaction-norm parameters across environments and growth-curve parameters through the season. Their genetic effects changed dynamically along the environmental gradient and the developmental stage. A conceptual model with three-dimensional reaction norms was proposed to showcase the interconnecting components genotype, environment and development. Beyond genomic and environmental analyses, further integration of development and physiology at the whole-plant and molecular levels into complex trait dissection would enhance our understanding of mechanisms underlying phenotypic variation.Perceptions of adolescent-parent and adolescent-peer relationship qualities, and adolescents' attachment states of mind were examined as predictors of adult social and romantic relationship quality, depressive symptoms, and work performance. Adolescents (86 male, 98 female; 58% White, 29% African American, 8% mixed race/ethnicity, 5% other groups) were followed from age 13 to 24 via observational, self-, parent-, and close friend-reports. Adolescent close friendship quality was a significantly better predictor of adult peer and romantic outcomes, work performance, and depressive symptoms than parental reports of the parent-teen relationship; attachment security was also a strong predictor of numerous outcomes. Results are interpreted as reflecting the difficulty for parents judging parent-teen relationship quality and as reflecting the growing importance of close friendships during this period.Patients with cancer and advanced hepatic impairment (HI) (i.e., moderate and severe impairment) are often excluded from first-in-patient, phase II, and phase III studies. Thus, dose recommendations for this subgroup of patients are often derived using a combination of dedicated phase I studies conducted in participants without cancer and a population pharmacokinetic (PK) modeling approach. A standardized risk-based approach to guide the evaluation of HI in patients with cancer is needed. In this review, we evaluated available oncology drug approvals by the US Food and Drug Administration (FDA) from 1999 to 2019, identified strategies utilized by sponsors to characterize the effect of HI on the PK of oncology drugs, and assessed regulatory expectations for each strategy. Finally, we constructed a decision tree that complements current FDA guidance to enable efficient evaluation of the effect of HI on PK and provide guidance for dose recommendations.

Spinal muscular atrophy (SMA) is a rare illness that often leads to severe kyphoscoliosis. This case series adds to the heretofore sparse information as regards the anaesthetic management of SMA scoliosis patients.

This retrospective study reviewed the charts of 79 SMA patients (type II n=34 and type III n=45) presenting for possible scoliosis surgery during the time period 2007-2019. Special attention focused on preoperative assessment and clearance requirements, anaesthesia protocol and postoperative handling.

Out of 79 patients, 17 did not receive clearance for the procedure mostly due to grave respiratory insufficiency. Out of 62 patients with clearance for both surgery and anaesthesia, 56 patients [44 females, 12males; age mean±SD (range) 22±7.3 (10-40) years] underwent the procedure. Their forced vital capacity and forced expiratory volume in 1s were mean±SD (range) 1.41±0.53 (0.61-2.65) L and 1.26±0.47 (0.52-2.27) L, respectively. Intubation difficulties and their resolution, e.g. with the help of fibreoptic technique and video laryngoscopy, are described.