Haganmccartney0314

2% of survivors. In conclusion, continuous monitoring of coronary care mortality based on CUSUM charts and the GRACE score demonstrated the occurrence of series of favorable and unfavorable outcomes on a real-time basis. Additionally, plotting the expected-to-observed probability of death for individual cases was useful to individualize unexpected deaths in low-risk patients. Although overall coronary care performance was adequate according to the GRACE score, we found that there is still some room for improvement, since over half of the deaths occurring in low-risk patients were potentially preventable.BACKGROUND In April 2016 Chile enacted the Law 20.900, which restricted electoral publicity on public roads. It established two important regulations first, candidates were allowed, 30 days before any election, to publicize their campaigns in specific street locations. Second, roadside publicity must follow strict size standards to avoid visual contamination. This paper examines the impact of this regulation in reducing road traffic crashes. METHODS We obtained number of traffic injuries and fatalities per population from public records. A time-series difference-in-difference study, using generalized linear models with an interaction between time-period and intervention, compared a municipal election period before the introduction of Law 20,900 (2012) to the first municipal election affected by the law (2016). We adjusted for precipitation and temperature, and applied models to three cities Santiago, Gran-Valparaíso, and Concepción. We assessed the overall impact of the intervention using random effects meta-analyses. RESULTS The law was associated with a decrease of 0.01 (95% Confidence Interval [CI] -0.02; -0.00) in Santiago, a decrease of 0.01 (95% CI -0.03; -0.00) in Valparaíso and an increase of 0.09 (95% CI 0.06; 0.13) in Concepción, in all daily injuries and fatalities per 100,000 population. After 40 days of its implementation, the intervention was associated with a mild absolute reduction of 34 (95% Reduction Interval -270; 67) traffic injuries and fatalities. CONCLUSIONS This study estimates that regulation of public road publicity had an overall mild effect on reducing traffic injuries and fatalities in three large cities in Chile.BACKGROUND Rigid bronchoscopy intubation poses a significant risk of complication to patients from mechanical trauma. Despite the importance of precision in forces exerted by surgeons during intubation, no prior study has analyzed the overall forces and torques involved in rigid bronchoscopy intubation, and whether existing training modalities accurately replicate them. METHODS A bronchoscope was equipped with a 6-axis load sensor to measure forces and torques applied during rigid bronchoscopy intubation. The device was applied to measure intubation forces in low-fidelity manikins and patients by interventional pulmonologists. RESULTS Axial and lateral forces were measured during rigid bronchoscope intubation from the mouth to the mid-trachea. The mean axial/lateral forces recorded during manikin trials were 6.93/18.06 N, whereas those recorded during patient trials were 4.57/9.43 N. Average axial and lateral force application was therefore 51.6% and 92.6% higher in manikin, respectively. Applied axial torque averaged across all human trials was 130.5 N-mm compared with 78.3 N-mm for manikin trials, 40% lower in manikin than in human. Lateral torque application during manikin intubation showed greater variation in between trials and a greater range of SDs within trials. CONCLUSION This was the first application of a rigid bronchoscope measurement device designed to measure forces applied at the handle. Force and torque discrepancies between manikin training and patient applications were found, indicating a possible mismatch between the haptic feedback received by physicians during rigid training and application. This inconsistency could be resolved via novel haptic training modalities and help increase atraumatic intubations.BACKGROUND Controversy remains regarding the effect of needle size on the diagnostic yield of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration. We conducted a prospective study comparing the diagnostic yield of 19 and 21 G EBUS needles and hypothesized that the 19 G have a greater EBUS-guided transbronchial needle aspiration diagnostic yield as compared with the 21 G needle. METHODS A total of 60 patients undergoing EBUS-guided transbronchial needle aspiration were enrolled with informed consent. Both 19 and 21 G needles were used at each lymph node station in alternating fashion, we randomized which needle, to begin with. Two rapid on-site cytology evaluation stations were present and assigned to one of the 2 needles. They reported sample adequacy and prepared a separate cell block per lymph node sampled for their assigned needle. RESULTS A total of 141 lymph nodes were analyzed. Diagnosis included 69 benign lymph nodes, 47 malignant lymph nodes, 22 noncaseating granulomas, and 3 infected lymph nodes. Five hundred seventy-three passes (average 4.1 passes/lymph node) were done with 19 G and 581 passes with 21 G needles (average 4.1 passes/lymph node). Diagnostic yield was similar between 19 and 21 G needles overall (89.4% vs. 88.7%, P=0.71). The 19 G needles showed higher smear cellularity (32.6% vs. 13.0%, P=0.05), and rapid on-site cytology evaluation adequacy (84.8% vs. 63.0%, P=0.004) in lymph nodes with cancer diagnosis. In 7 of the 141 lymph nodes, samples from only one of the needles provided the final diagnosis. CONCLUSION There is no difference in the overall diagnostic yield between 19 and 21 G needles. Further studies are needed to confirm the trend of the superiority of 19 G in cancerous lymph nodes.BACKGROUND The goal of this study is to determine critical genes and pathways associated with topotecan using publicly accessible bioinformatics tools. METHODS Topotecan signatures were downloaded from the Library of Integrated Network-Based Cellular Signatures (LINCS) database (http//www.ilincs.org/ilincs/). Differentially expressed genes (DEGs) were defined as genes that appeared at least three times with p values less then 0.05 and a fold-change of ≥50% (|log2FC|≥0.58). Hub genes were identified by evaluating the following parameters using a protein-protein interaction network node degrees, betweenness, and eigenfactor scores. Hub genes and the top-40 DEGs by |log2FC| were used to generate a Venn diagram, and key genes were identified. Functional and pathway enrichment analysis was performed using the Kyoto Encyclopedia of Genes and Genomes (KEGG) databases. Information on ovarian cancer patients derived from The Cancer Genome Atlas (TCGA) database was analyzed, and the effect of topotecan on the protein expression was examined by western blotting. RESULTS Eleven topotecan signatures were downloaded, and 65 upregulated and 87 downregulated DEGs were identified. Twenty-one hub genes were identified. We identified eight key genes as upregulated genes, including NFKBIA, IKBKB, GADD45A, CDKN1A, and HIST2H2BE, while EZH2, CDC20, and CDK7 were identified as downregulated genes, which play critical roles in the cell cycle and carcinogenesis in KEGG analysis. In the TCGA analysis, the CDKN1A+/EZH2- group had the longest median survival, while the CDKN1A-/EZH2+ group had the shortest median survival. Topotecan treated murine ovarian (MOSEC), colorectal (CT26), and lung (LLC) cancer cell lines displayed upregulated CDKN1A encoding p21 and downregulated Ezh2. CONCLUSION Using publicly accessible bioinformatics tools, we evaluated key genes and pathways related to topotecan and examined the key genes using the TCGA database and in vitro studies.The emerging outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread all over the world. Agents or vaccines of proven efficacy to treat or prevent human coronavirus infection are in urgent need and are being investigated vigorously worldwide. This review summarizes the current evidence of potential therapeutic agents, such as lopinavir/ritonavir, remdesivir, favipiravir, chloroquine, hydroxychloroquine, interferon, ribavirin, tocilizumab and sarilumab. More clinical trials are being conducted for further confirmation of the efficacy and safety of these agents in treating COVID-19.As the outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread over the world, the World Health Organization has declared the outbreak of COVID-19 an international public health emergency. Besides typical respiratory symptoms and signs of COVID-19, digestive symptoms and liver injury have been frequently reported during the course of the disease. In this review, we summarized the recent studies reporting of gastrointestinal and liver manifestations during the course of COVID-19. Digestive symptoms, including anorexia, nausea, vomiting and diarrhea, are not uncommon in patients with COVID-19, and in some cases digestive symptoms may occur in the absence of any respiratory symptoms. Furthermore, SARS-CoV-2 could be detected in the stool of infected patients, implicating the possibility of fecal-oral transmission. Attention should also be paid to monitor liver function during the course of COVID-19, especially in patients with higher disease severity.Severe cases of coronavirus disease 2019 (COVID-19) cannot be adequately managed with mechanical ventilation alone. The role and outcome of extracorporeal membrane oxygenation (ECMO) in the management of COVID-19 is currently unclear. Eight COVID-19 patients have received ECMO support in Shanghai with 7 with VV ECMO support and 1 VA ECMO during cardiopulmonary resuscitation. As of March 25, 2020, 4 patients died (50% mortality), three patients (37.5%) were successfully weaned off ECMO after 22, 40 days and 47 days support respectively, but remain on mechanical ventilation. One patient is still on VV ECMO with mechanical ventilation.The PaO2/FiO2 ratio before ECMO initiation were between 54 to 76 and all were well below 100. The duration of mechanical ventilation before ECMO ranged from 4-21 days. Except the one emergent VA ECMO during cardiopulmonary resuscitation, other patients were on ECMO support for between 18 to 47 days. In conclusion, ensuring effective, timely, and safe ECMO support in COVID-19 is key to improving clinical outcomes. ECMO support might be an integral part of the critical care provided for COVID-19 patients in centers with advanced ECMO expertise.Computational fluid dynamics has become a dynamic tool in the development of ventricular assist devices (VADs) and as a predictor of thrombosis within these pumps. The genesis of thrombi could be in loco, due to deposition within the VAD, or upstream such as the left atrial appendage or inside the left ventricle. To calibrate our group's computational model, a retrospective analysis of 29 explanted HeartMate II (HMII) VADs due to suspected pump thrombosis (PT) from the University of Michigan was conducted. Thrombi in these pumps were characterized by their frequency, composition, severity, and physical distribution in five regions of the blood flow pathway. The outlet bearing/stator region had the highest frequency of deposition (≈72%), and the preponderance of thrombi appeared white and unlaminated in their microstructure. Conversely, 41.3% of VADs showed thrombus on the fore bearing of the HMII, and these formations tended to be red and laminated, indicating they formed in layers over time. Furthermore, the majority of clots observed in the fore bearing and outlet bearing/stator regions were partially occlusive in nature.