Bryantstaal6218

Positioning during endotracheal intubation (ETI) is critical to ensure its success. We aimed to determine if the ramping position improved laryngeal exposure and first attempt success at intubation when compared to the sniffing position.

PubMed, EMBASE, and Cochrane CENTRAL databases were searched systematically from inception until January2020. Our primary outcomes included laryngeal exposure as measured by Cormack-Lehane Grade1or2 (CLG 1/2), CLG3or4 (CLG 3/4), and first attempt success at intubation. Secondary outcomes were intubation time, use of airway adjuncts, ancillary maneuvers and complications during ETI.

Seven studies met our inclusion criteria, of which4 were RCTs and 3were cohort studies. The meta-analysis was conducted by pooling the effect estimates for all 4 included RCTs (n=632). There were no differences found between ramping and sniffing positions for odds of CLG1/2, CLG3/4, first attempt success at intubation, intubation time, use of ancillary airway maneuvers and use of airway adjuncts, with evidence of high heterogeneity across studies. However, the ramping position in surgical patients is associated with increased likelihood of CLG 1/2 (OR=2.05, 95%CI1.26to3.32, p=0.004) and lower likelihood of CLG 3/4 (OR=0.49, 95%CI0.30to0.79, p=0.004), moderate quality of evidence.

Our meta-analysis demonstrated that the ramping position may benefit surgical patients undergoing ETI by improving laryngeal exposure. Large-scale well-designed multicentre RCTs should be carried out to further elucidate the benefits of the ramping position in the surgical and intensive care unit patients.

Our meta-analysis demonstrated that the ramping position may benefit surgical patients undergoing ETI by improving laryngeal exposure. Large-scale well-designed multicentre RCTs should be carried out to further elucidate the benefits of the ramping position in the surgical and intensive care unit patients.

Penetrating Carotid artery injuries are rarely encountered even in busy in urban Trauma Centers. Repair is preferred over ligation for Internal (IC) and Common Carotid (CC) arteries. To date, the use of temporary shunts correlated to neurological outcomes has not been reported.

In patients with penetrating IC or CC injury requiring repair, does use of temporary shunts decrease mortality and/or improve neurologic outcomes?We hypothesized that the use of temporary shunts during revascularization might produce improvements in both areas.

A literature search was performed through Medline Complete-PubMed, Cochrane, Ovid, and Embase for the period of 1900-2019. PRISMA guidelines were utilized. Thirty-two articles met inclusion criteria, ranging from 1960-2018. These were analyzed to determine whether surgical repair was performed with or without the use of temporary shunts. check details External Carotid artery injuries were excluded. Pre- and postoperative neurological outcomes and overall outcomes were analyzed. Non-paraa slightly lower mortality rate and similaror unchanged neurological outcomes versus those repaired without shunts. Based on this evidence, we recommend thoughtful interoperative consideration for the use of temporary shunts for patients requiring complex repairs of these injuries.

Patients sustaining penetrating Internal and Common Carotid injuries repaired with temporary shunts have a slightly lower mortality rate and similar or unchanged neurological outcomes versus those repaired without shunts. Based on this evidence, we recommend thoughtful interoperative consideration for the use of temporary shunts for patients requiring complex repairs of these injuries.

Cancer tumors constitute a complicated environment for conventional anti-cancer treatments to confront, so solutions with higher complexity and, thus, robustness to diverse conditions are required. Alternations in the tumor composition have been documented, as a result of a conventional treatment, making an ensemble of cells drug resistant. Consequently, a possible answer to this problem could be the delivery of the pharmaceutic compound with the assistance of nano-particles (NPs) that modify the delivery characteristics and biodistribution of the therapy. Nonetheless, to tackle the dynamic response of the tumor, a variety of application times of different types of NPs could be a way forward.

The in silico optimization was investigated here, in terms of the design parameters of multiple NPs and their application times. The optimization methodology used an open-source simulator to provide the fitness of each possible treatment. Because the number of different NPs that will achieve the best performance is not known a priori, the evolutionary algorithm utilizes a variable length genome approach, namely a metameric representation and accordingly modified operators.

The results highlight the fact that different application times have a significant effect on the robustness of a treatment. Whereas, applying all NPs at earlier time slots and without the ordered sequence unveiled by the optimization process, proved to be less effective.

The design and development of a dynamic tool that will navigate through the large search space of possible combinations can provide efficient solutions that prove to be beyond human intuition.

The design and development of a dynamic tool that will navigate through the large search space of possible combinations can provide efficient solutions that prove to be beyond human intuition.

Cardiotocography (CTG) is the most popular prenatal diagnostic examination, which includes continuous monitoring of foetal heart rate (FHR, bpm) and uterine contraction (UC, mmHg) signals. Compared with CTG paper reports, digitized reports have better storage, transmission and retrieval capabilities, in addition to being able to assess foetal health. However, most of the existing digitization methods extract signals from paper reports with colour background grids, and they cannot extract signals completely from paper reports with binary background grids, which are widely used in clinical CTG monitoring. Moreover, the existing digitization algorithms often neglect the image distortion caused by the imaging equipment.

To overcome the above drawbacks, a digitization method for CTG paper reports with binary background grids taken by smartphones is proposed in this paper. In the stage of removing the grid background, a region merger based on super-pixels and an improved binary line mask removal are designed. Then, signal extraction is performed separately according to the different states of the image column.