Braunschofield1307

Spontaneous intracranial hypotension (SIH) is a condition that results from leakage of cerebrospinal fluid (CSF) from the spine, and which typically presents with debilitating orthostatic headache, but can be associated with a wide range of other symptoms. The causes of spontaneous CSF leaks that lead to SIH include dural tears, leaking meningeal diverticula, and CSF-venous fistulas. Imaging plays a central role in the initial diagnosis of SIH and in its subsequent investigation and management. This article reviews the typical neuroimaging manifestations of SIH and discusses the utility of different myelographic techniques for localising spinal CSF leaks as well as the role of image-guided treatment.

To compare the ability of qSOFA, NEWS2, SOFA, LODS, SIRS, APACHE-II and SAPS-II scores.

Analysis of in-hospital mortality of 203 patients admitted to the ICU because of sepsis. The scores were compared according to their application. Discrimination was evaluated with AUC-ROC curve and performance with the Akaike's (AIC) and Bayesian information criterion (BIC).

In-hospital mortality was 31.53%. NEWS2 showed better mortality discrimination ability and better performance considering the AIC/BIC criterion for mortality tan qSOFA (AUC-ROC=.615 and .536; P=.039). SOFA presented higher performance and AUC-ROC tan LODS (.776 vs .693; P=.01) and both showed higher discrimination ability than SIRS (AUC-ROC=.521; P<.003). Finally, SAPS-II was able to predict mortality with better performance than APACHE-II and presented higher discrimination capacity but without statistical significance compared (AUROC=.738 for SAPS-II and AUROC=.673 for APACHE-II; P=.08).

NEWS2 is a better predictor of mortality than qSOFA and its implementation for the early recognition of the septic patient or the patient with higher risk in the emergency and hospitalization wards should be addressed. In addition, given that SOFA and SAPS-II showed better performance and are simpler than LODS and APACHE-II, respectively, both should be considered the scores of choice in this setting.

NEWS2 is a better predictor of mortality than qSOFA and its implementation for the early recognition of the septic patient or the patient with higher risk in the emergency and hospitalization wards should be addressed. In addition, given that SOFA and SAPS-II showed better performance and are simpler than LODS and APACHE-II, respectively, both should be considered the scores of choice in this setting.In this paper, we investigate the problem of prescribed-time stabilization for a class of semilinear parabolic systems subject to spatiotemporal-varying disturbance via distributed control. By employing the time-varying feedback gain and disturbance suppression method, the proposed control law is continuous and stabilizes the closed-loop system within the prescribed time, where the convergence time is independent of initial values and can be given in advance as needed. When the upper bound of disturbance is known, we use a hyperbolic tangent function to restrain disturbance. While the upper bound of disturbance is unknown, we design the prescribed-time adaptive law and a prescribed-time disturbance observer estimating the disturbance itself. Some numerical examples are provided to verify the theoretical results.Steady-state optimization is of vital importance in two-layer model predictive control for bringing better steady-state and dynamic performance. However, the global optimality of steady-state sequences provided by local steady-state optimization cannot be guaranteed. Therefore, a new steady-state sequence optimization approach is proposed in the paper, to improve the global optimality of steady-state sequences. First, the non-global optimality of local steady-state sequences is discussed using an example. Subsequently, aiming at improving the global optimality, a novel sequence optimization strategy designed for steady-state optimization is proposed. Its basic formulation is given and the lower bound of the introduced parameter is analyzed. Then, the relation and difference between the proposed steady-state sequence optimization and the existing global steady-state optimization and local steady-state optimization are discussed. Finally, the steady-state performance, dynamic performance, and computational burden of the proposed approach are studied. The proposed approach provides engineers a brand-new way to realize steady-state optimization and effectively improves the global optimality of calculated steady-state sequences. Extensive simulations verify the effectiveness and reliability of the proposed method.

Postoperative pain management is a significant challenge in patients undergoing Nuss repair for pectus excavatum chest wall deformity. Therapeutic anesthetic options primarily include patient-controlled intravenous analgesia, thoracic epidural analgesia (TEA), and cryoanalgesia. However, TEA is limited to inpatient use and both TEA and cryoanalgesia can result in neurologic injury. The novel technique of ultrasound-guided erector spinae plane regional analgesia has been used recently in our patients undergoing the Nuss repair and has shown impressive pain relief, but without the potential complications of other modalities. Erector spinae plane block (ESPB) postoperative pain management outcomes were studied as compared to TEA.

Thirty consecutive patients with severe pectus excavatum undergoing Nuss repair and placement of ultrasound-guided ESPB were each paired to a historical cohort control patient with TEA postoperative pain management. The cohort patient match was defined by age (±2 years), gender, and CT pectus index (±15%). Study variables included hospital length of stay (LOS), pain scores, and pain medication usage.

Pain scores as measured by area under the curve per hour (Day 1 2.72 (SD = 1.37) vs. 3.90 (SD = 1.81), P = 0.006; Day 2 2.83 (SD = 1.32) vs. 3.97 (SD = 1.82), P = 0.007) and oral morphine equivalent (OME) pain medication usage (Day 1 11.9 (SD = 4.9) vs 56.0 (SD = 32.2), P<0.001; Day 2 14.7 (SD = 7.1) vs. 38.0 (SD = 21.7), P<0.001) were higher for the first two postoperative days in the ESPB group. However, mean hospital LOS was nearly one day shorter for ESPB patients (3.78 (SD = 0.82) vs. Selleck CI-1040 2.90 (SD = 0.87), P<0.001) who were discharged home with the catheter in place until removal, typically at 5-7 days postoperatively.

Ultrasound-guided ESPB is thus a feasible, safe, and effective alternative to TEA in postoperative pain management after Nuss repair and results in decreased hospital stay.

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Little is known about stoma related morbidity in young children. Therefore, the aim of this study is to assess major morbidity after stoma formation and stoma closure and its associated risk factors.

All consecutive young children (age ≤ three years) who received a stoma between 1998 and 2018 at our tertiary referral center were retrospectively included. The incidence of major stoma related morbidity (Clavien-Dindo grade ≥III) was the primary outcome. This was separately analysed for stoma formation alone, stoma closure alone and all stoma interventions combined. Non-stoma related morbidity was excluded. Risk factors for major morbidity were identified using multivariable logistic regression analysis.

In total 336 young children were included with a median follow-up of 6 (IQR2-11) years. Of these young children, 5% (n=17/336) received a jejunostomy, 57% (n=192/336) an ileostomy, and 38% (n=127/336) a colostomy. Following stoma formation, 27% (n=92/336) of the young children experienced major stoma related morbidity, mainly consisting of high output stoma, prolapse and stoma stenosis. The major morbidity rate was 23% (n=66/292) following stoma closure, most commonly comprising anastomotic leakage/stenosis, incisional hernia and adhesive obstructions. For combined stoma interventions, major stoma related morbidity was 39% (n=130/336). Ileostomy was independently associated with a higher risk of developing major morbidity following stoma formation (OR2.5; 95%-CI1.3-4.7) as well as following closure (OR2.7; 95%-CI1.3-5.8).

Major stoma related morbidity is a frequent and severe clinical problem in young children, both after stoma formation and closure. The risk of morbidity should be considered when deliberating a stoma.

Major stoma related morbidity is a frequent and severe clinical problem in young children, both after stoma formation and closure. The risk of morbidity should be considered when deliberating a stoma.Franklin Mall (1862-1917) made fundamental discoveries in the embryology of malrotation and the development of the diaphragm, pathological conditions basic to pediatric surgery. As the inaugural professor of anatomy at the new Johns Hopkins University School of Medicine when it opened in 1893, Mall was among the first fulltime researchers in basic medical science in American medical schools, a new role that came to characterize the modern academic medical center.

Employees with fluoridated drinking water access at work can reap oral health benefits. The purpose of this study was to assess the availability, appeal, and promotion of fluoridated tap water in publicly accessible spaces compared with retail beverages at the University of California, San Francisco.

The authors collected information on beverages available in publicly accessible spaces at University of California, San Francisco hospitals and campuses in San Francisco, California, from December 2019 through February 2020 using a web-based survey tool. Data collected included fluoridated water and retail beverage locations; type of water or retail beverage source; number of water sources per station; cleanliness, flow, and any obstruction of water sources; proximity of water stations to retail beverage locations; signage near the beverage locations about water and beverage consumption; and type of retail beverages available.

Fluoridated water stations were identified in 230 locations and had 377 water sources (for example, traditional drinking fountain and motion-sensor bottle-filling station). One water station was available for every 80 students and employees; however, 25% were obstructed, dirty, or had unsatisfactory flow. Approximately 1 in 5 watercoolers lacked disposable cups. Of 41 retail beverage locations identified, 29% had a water station within sight. Only 11% of beverage locations had signage encouraging healthier beverage choices.

A systematic assessment of work site access to fluoridated water can provide actionable evidence to improve availability, appeal, and promotion.

This study provides a model to assess work site availability of fluoridated drinking water that can be used for future evaluations.

This study provides a model to assess work site availability of fluoridated drinking water that can be used for future evaluations.Intraoperative mortality is now rare. In contrast, 30-day postoperative mortality remains common, with most deaths occurring during the initial hospitalisation. The legacy of anaesthesiology will be determined by our success in dealing with postoperative mortality, which is currently the major problem in perioperative medicine. Carpe diem!