Olsenrodgers4054

2 cmH2O, (-0.4 to 0.9) and -0.1 cmH2O (-1.9 to 1.7); end-expiratory transpulmonary pressure, -0.6 cmH2O (-1.7 to 0.4) and -0.4 cmH2O, (-2.2 to 1.5); lung stress -0.9 cmH2O (-3.0 to 1.1) and -1.5 cmH2O (-4.4 to 1.4). Conclusions Both Optivent and the bedside system showed clinically acceptability if compared to the gold standard device. The possibility to apply one of these systems could allow a wider use of esophageal pressure in clinical practice.Background Ultrasonic measurements of carotid artery corrected flow time (FTc) and respirophasic variation in blood flow peak velocity (ΔVpeak) were recently introduced to predict fluid responsiveness in non-obstetric patients. We designed the present study to evaluate the performance of these two ultrasonic indices in predicting fluid responsiveness in healthy parturients. Methods 75 parturients undergoing elective cesarean delivery were enrolled. Carotid doppler parameters including FTc, ΔVpeak, the inferior vena cava diameter at the end of expiration (IVCexp) and inspiration (IVCins), inferior vena cava collapsibility index (IVCCI), and stroke volume index (SVI) were measured before and after fluid challenge. Fluid responsiveness was defined as a 15% or more increase in SVI as assessed by transthoracic echocardiography after the fluid challenge. Results FTc and ΔVpeak but not IVCins, IVCexp and IVCCI were proved to be two independent predictors for fluid responsiveness by multivariate logistic regression, with the odds ratios of 1.191 (95% confidence interval (CI), 1.070 to 1.326) and 0.521 (95% CI, 0.351 to 0.773). The area under the ROC curve to predict fluid responsiveness for FTc was 0.846 (95% CI, 0.751-0.940) and for ΔVpeak was 0.810 (95% CI, 0.709-0.910), which were significantly higher than those for IVCins (0.436, 95% CI, 0.300-0.572), IVCexp (0.595, 95% CI, 0.460-0.730) and IVCCI (0.548, 95% CI, 0.408-0.688). Conclusions Compared with IVCins, IVCexp and IVCCI, FTc and ΔVpeak measured by ultrasonography seem to be the highly feasible and reliable methods to predict fluid responsiveness in parturients with spontaneous breathing undergoing elective cesarean delivery.Background The incidence of delirium following open abdominal aortic aneurysm (AAA) surgery is significant, with incidence rates ranging from 12 to 33%. However, it remains unclear on what level of care a delirium develops in AAA patients. The aim of this study was to investigate the incidence of delirium in the ICU and on the surgical ward after AAA surgery. Methods A single centre retrospective cohort study was conducted that included all patients treated electively for an open AAA repair and patients who underwent emergency treatment for a ruptured AAA between 2013 and 2018. The diagnosis of delirium was verified by a psychiatrist or geriatrician using the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria. The incidence of delirium was calculated. Cox proportional hazards regression analyses were used to analyse six and twelve months survival. Results A total of 135 patients were included, 46 patients (34%) had a delirium during admission. Of these, 30 patients (65%) developed a delirium in the ICU and 16 patients (35%) on the surgical ward. There was no significant difference in six months and twelve months mortality between the ICU and ward delirium groups (HR 1.64 95%CI 0.33-8.13 and HR 1.12 95%CI 0.28-4.47 respectively). Conclusions Delirium frequently occurs in patients who undergo AAA surgery. This study demonstrated that patients on the surgical ward remain at risk of developing a delirium after ICU dismissal. Patients with ICU delirium differ in clinical characteristics and outcomes from patients with a delirium on the surgical ward.Background The passage of tube across the glottis-inlet being the significant 'active' component of intubation, associating postoperative sore throat (POST) with 'passive' presence of high-volume low-pressure tracheal-tube cuff is unjustified. Tracheal-tube introducers (TTI), commonly employed to facilitate tracheal intubation during difficult airway management, can influence intubation quality and decrease incidence of POST. Methods Four hundred and fifty patients undergoing laparoscopic/open surgery were randomly allocated to receive conventional intubation (Non-TTI group, n=150) or intubation facilitated with rigid-TTI (Rigid-TTI group, n=150) or non-rigid TTI (Non-rigid TTI group, n=150). This study analysed effects of conventional versus TTI-guided intubation on reducing the incidence of POST (primary objective); intubation profile (time, attempts, response), and complications (trauma, inspiratory stridor) (secondary objectives). Results Four hundred and twenty patients completed the study. The incidence of POST was lowest in patients of 'Rigid-TTI group' (n=40, 29.0%); which was significantly lower than the 'Non-TTI' group (n=64, 45.1%) (P=0.005) but comparable to the 'Non-Rigid-TTI' group (n=53, 37.9%, P=0.117). In addition, the incidence of POST in 'Rigid-TTI' group was significantly lower than those in the 'non-TTI' group at 2-hour ('Rigid-TTI' group n=19, 13.8%, 'Non-TTI' group n=41, 28.9%; P=0.002) and 4-hour ('Rigid-TTI' group n=23, 16.7%, 'Non-TTI' group n=43, 30.3%, P=0.007) time points. No difference was found in the incidence of airway management related morbidity, including, laryngospasm and inspiratory stridor in the three groups. Conclusions Rigid-TTI by its ability to positively modify friction dynamics between glottis- inlet and the passing tracheal-tube; has the potential to improve quality of intubation and decrease the incidence of POST.Objective To summarize the active changes of Wnt signaling pathway in osteoarthritis (OA) as well as the influence and mechanism of dual-targeted regulation on cartilage and subchondral bone and the role of crosstalk between them on OA process. Methods The relevant literature concerning the articular cartilage, subchondral bone, and crosstalk between them in OA and non-OA states by Wnt signaling pathway in vivo and vitro experimental studies and clinical studies in recent years was reviewed, and the mechanism was analyzed and summarized. Results Wnt signaling can regulate the differentiation and function of chondrocytes and osteoblasts through the classic β-catenin-dependent or non-classical β-catenin-independent Wnt signaling pathway and its cross-linking with other signaling pathways, thereby affecting the cartilage and bone metabolism. Moreover, Wnt signaling pathway can activate the downstream protein Wnt1-inducible-signaling pathway protein 1 to regulate the progress of OA and it also can be established gap junctions between different cells in cartilage and subchondral bone to communicate molecules directly to regulate OA occurrence and development. Intra-articular injection of Wnt signaling inhibitor SM04690 can inhibit the progress of OA, and overexpression of Wnt signaling pathway inhibitor Dickkopf in osteoblasts can antagonize the role of vascular endothelial growth factor work on chondrocytes and inhibit the catabolism of its matrix. Conclusion The regulation of metabolism and function of cartilage and subchondral bone and crosstalk between them is through interactions among Wnt signaling pathway and molecules of other signaling. Therefore, it plays an vital role in the occurrence and development of OA and is expected to become a new target of OA treatment through intervention and regulation of Wnt signaling pathway.Objective To summarize the progress in treatment of unstable atlas fracture, the existing problems, and the research direction. Methods Related literature at home and abroad was reviewed. The stability evaluation of atlas fracture and treatment methods were introduced, and the selection of surgical approach and fixation instruments in treatment of unstable atlas fracture were summarized and analyzed. Results At present, atlas fractures are considered as unstable fractures except single anterior arch fractures with complete transverse ligament or simple posterior arch fractures. The treatment of unstable atlas fracture has been developed from nonsurgical treatment and traditional fusion surgery to single-segment fixation. Nonsurgical treatment is less effective, while traditional fusion surgery has a disadvantage of limited the motion of the upper cervical spine. Single-segment fixation can not only restore and fix the fracture, but also preserve the upper cervical motion function. Single-segment fixation approaches include posterior and transoral approaches, and the fixation instruments are being constantly improved, mainly including screw-rod system, screw-plate system, and plate system. Conclusion For unstable atlas fracture, single-segment fixation is an ideal surgical method, and has more advantages when compared with nonsurgical treatment and traditional fusion surgery. Single-segment fixation via transoral approach is more direct for atlas anterior arch fracture reduction, but there is a high risk of infection; and single-segment fixation via posterior approach is less effective for the reduction of atlas anterior arch fracture. Therefore, a better reduction method should be explored.Objective To summarize the research progress of killer turn in posterior cruciate ligament (PCL) reconstruction. Methods The literature related to the killer turn in PCL reconstruction in recent years was searched and summarized. Results The recent studies show that the killer turn is considered to be the most critical cause of graft relaxation after PCL reconstruction. In clinic, this effect can be reduced by changing the fixation mode of bone tunnel, changing the orientation of bone tunnel, squeezing screw fixation, retaining the remnant, and grinding the bone at the exit of bone tunnel. But there is still a lack of long-term follow-up. Conclusion There are still a lot of controversies on the improved strategies of the killer turn. More detailed basic researches focusing on biomechanics to further explore the mechanism of the reconstructed graft abrasion are needed.Objective To investigate the effect of micro RNA (miR)-335-5p regulating bone morphogenetic protein 2 (BMP-2) on the osteogenic differentiation of human bone marrow mesenchymal stem cells (hBMSCs). Methods hBMSCs were cultured in vitro and randomly divided into control group (group A), miR-335-5p mimics group (group B), miR-335-5p mimics negative control group (group C), miR-335-5p inhibitor group (group D), and miR-335-5p inhibitor negative control group (group E). After grouping treatment and induction of osteogenic differentiation, the osteogenic differentiation of cells in each group was detected by alkaline phosphatase (ALP) and alizarin red staining; the expressions of miR-335-5p and BMP-2, Runt-related transcription factor 2 (Runx2), osteopontin (OPN), and osteocalcin (OCN) mRNAs were detected by real-time fluorescence quantitative PCR analysis; the expressions of Runx2, OPN, OCN, and BMP-2 proteins were detected by Western blot. Oxaliplatin chemical structure Results Compared with group A, the relative proportion of ALP positive cells and the relative content of mineralized nodules, the relative expressions of BMP-2, miR-335-5p, OPN, OCN, Runx2 mRNAs, the relative expressions of Runx2, OPN, OCN, and BMP-2 proteins in group B were significantly increased ( P0.05). Conclusion miR-335-5p can up-regulate BMP-2 expression and promote osteogenic differentiation of hBMSCs.