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Three risk groups were obtained low (0-5 points), intermediate (6-12 points), and high risk for VAP (13-16 points). The area under the curve for the final score was 0.905 (95%confidence interval0.888-0.923, p < 0.001).

The RISVAP is the first risk score for VAP in pediatric populations. Using this predictive score, might be helpful to detect vulnerable patients and therefore implement preventative strategies.

The RISVAP is the first risk score for VAP in pediatric populations. Using this predictive score, might be helpful to detect vulnerable patients and therefore implement preventative strategies.

The pre-adjuvant chemotherapy (PAC) status of postoperative pancreatic ductal adenocarcinoma (PDAC) patients has not been studied and elaborated well previously.

The association of PAC variables and prognoses was explored using a multivariable Cox model, restricted cubic spline analysis, and correlation analysis. The main outcomes were overall survival (OS) and progression-free survival (PFS). The secondary outcome was chemotherapy completeness (CHC).

A total of 401 eligible patients were enrolled in sequential surgery and chemotherapy. The chemotherapy regimen, PAC fasting blood glucose (FBG), and elevated fasting blood glucose (eFBG) status were associated with CHC (regimen types p=0.005, continuous FBG p=0.014, eFBG status p=0.012). Early administration of adjuvant chemotherapy (<34days) was a risk factor for the limited OS and PFS (OS aHR 1.61 [1.09-2.38], p=0.016; PFS aHR 1.91 [1.29-2.82], p=0.001). Patients with higher PAC body mass index (BMI), receiving Gemcap regimen, and with lower PAC tumoa risk factor for OS, but not PFS and limited CHC. Those with higher PAC FBG levels were more likely to finish chemotherapy. CEA, compared to CA125 and CA199, was a better prognostic indicator.

This study aimed to determine whether family-centred care (FCC) intervention reduces the ICU delirium prevalence.

A systematic review and meta-analysis.

The databases, including PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL Complete, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc), WANFANG Data and VIP Information, were systematically searched up to 30 November 2021. The search term includes keywords related to intensive care units, delirium and family-centred care. Meta-analyses were performed and presented by risk ratio (RR), mean difference (MD) and corresponding 95% confidence intervals (CIs).

The meta-analysis results showed that compared with the usual care, FCC intervention has positive effects on reducing ICU delirium prevalence [RR=0.54, 95% CIs (0.36, 0.81), p<.05]. However, no effect was observed on ICU stays, mechanical ventilation duration and ICU-acquired infection between the two groups.

Family-centred care is an effective intervention to reduce the ICU delirium prevalence. But the result shouldbetreatedcautiously asthe high levels ofheterogeneity, further high-quality studies are required to determine the effectiveness of FCC intervention in the ICU setting.

Family-centred care is an effective intervention to reduce the ICU delirium prevalence. But the result should be treated cautiously as the high levels of heterogeneity, further high-quality studies are required to determine the effectiveness of FCC intervention in the ICU setting.Synthesis gas fermentation using acetogenic clostridia is a rapidly increasing research area. It offers the possibility to produce platform chemicals from sustainable C1 carbon sources. The Wood-Ljungdahl pathway (WLP), which allows acetogens to grow autotrophically, is also active during heterotrophic growth. It acts as an electron sink and allows for the utilization of a wide variety of soluble substrates and increases ATP yields during heterotrophic growth. While glycolysis leads to CO2 evolution, WLP activity results in CO2 fixation. Thus, a reduction of net CO2 emissions during growth with sugars is an indicator of WLP activity. To study the effect of trace elements and ventilation rates on the interaction between glycolysis and the WLP, the model acetogen Clostridium ljungdahlii was cultivated in YTF medium, a complex medium generally employed for heterotrophic growth, with fructose as growth substrate. The recently reported anaRAMOS device was used for online measurement of metabolic activity, in form of CO2 evolution. The addition of multiple trace elements (iron, cobalt, manganese, zinc, nickel, copper, selenium, and tungsten) was tested, to study the interaction between glycolysis and the Wood ljungdahl pathway. While the addition of iron(II) increased growth rates and ethanol production, added nickel(II) increased WLP activity and acetate formation, reducing net CO2 production by 28%. Also, higher CO2 availability through reduced volumetric gas flow resulted in 25% reduction of CO2 evolution. These online metabolic data demonstrate that the anaRAMOS is a valuable tool in the investigation of metabolic responses i.e. to determine nutrient requirements that results in reduced CO2 production. Thereby the media composition can be optimized depending on the specific goal.

To specify indications and contraindications of the modified percutaneous inferior extensor retinaculum augmentation (PIERA) technique for chronic ankle instability cases, and to introduce technique details and report surgical outcomes and complications.

The PIERA technique was performed on seven patients with chronic ankle instability (four females and three males, 36.4 ± 15.1 years of age, and course of symptoms of 33.7 ± 8.8 months) from June to October 2018 in this retrospective study of case series. All patients demonstrated attenuated ligamentous tissue quality, which was confirmed using preoperative ankle MRI. IER were drew up to the distal fibula using suture anchors with the ankle in neutral position for all cases, to engage the entire IER in reconstructing the stability of the ankle. Patients were assessed using American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS) score and Cumberland Ankle Instability Tool (CAIT) scores pre- and postoperatively at the last follow-up examination. Preoperative and postoperative outcome scores of patients were compared using paired t-test. A p value of less than 0.05 was regarded statistically significant.

Mean follow-up duration was 16.7 ± 1.6 months. The mean AOFAS score significantly improved from 66.9 ± 11.2 preoperatively to 93.7 ± 8.5 postoperatively (P=0.001). Mean CAIT score significantly improved from 13.1 ± 4.7 preoperatively to 26.3 ± 1.8 postoperatively (P=0.001). Patients did not report any wound healing problem, numbness, swelling, or instability at the last follow-up examination, except for one patient who reported pain and minimal stiffness, and presented an AOFAS score of less than 80 and a CAIT score below 24. All patients returned to at least recreational sport activity level.

The PIERA technique can improve the functional outcomes of patients with chronic ankle instability with few complications.

The PIERA technique can improve the functional outcomes of patients with chronic ankle instability with few complications.

This study aimed to examine the prognostic significance of a history of cancer and atrial fibrillation (AF) in antithrombotic therapy for patients with chronic heart failure (CHF).

We enrolled consecutive 4876 CHF patients (69±12years; women, 31.9%) in our multicentre, hospital-based cohort study, the Chronic Heart Failure Analysis and Registry in the Tohoku District-2 (CHART-2), with a median follow-up of 8.7years. Among them, 14% and 41% had a history of cancer and AF, respectively. AF patients with a history of cancer were older, more frequently men. History of cancer was not statistically associated with higher rate of composite of stroke, systemic thrombosis, and major bleeding defined by International Society on Thrombosis and Haemostasis [Fine-Gray sub-distribution hazard ratio (sHR) accounting for the competing risk of all-cause death, 0.91; 95% confidence interval (CI), 0.56-1.48; P=0.715]. The patients with history of cancer and AF had a heightened risk for the composite of stroke, systemic thrombosis, and major bleeding (sHR, 1.64; 95% CI, 1.04-2.60; P=0.033), especially in those aged >75years (sHR, 2.14; 95% CI, 1.01-4.53; P=0.046) and those with ischaemic heart disease (IHD; 2.48; 1.30-4.72; P=0.006). Furthermore, 36% of AF patients with a history of cancer did not receive anticoagulant therapy.

The CHF patients with history of cancer and AF had higher risk for stroke, systemic thrombosis, and major bleeding, especially in the elderly and those with IHD, but considerable number of the patients did not receive anticoagulant therapy, indicating the need for better optimal anticoagulation strategy.

The CHF patients with history of cancer and AF had higher risk for stroke, systemic thrombosis, and major bleeding, especially in the elderly and those with IHD, but considerable number of the patients did not receive anticoagulant therapy, indicating the need for better optimal anticoagulation strategy.

During a conventional measured resection using the posterior reference method for total knee arthroplasty (TKA) in varus knees, proximal tibia is resected from the lateral joint surface for the same thickness as the implant. Distal femur is resected from the worn medial surface for the same thickness as the implant. Posterior femur is resected using the posterior reference method with an external rotation for appropriate degrees. In this situation, although the joint line of the tibia is leveled to the height of lateral joint surface, the posterior joint line of the femur is leveled to the center of medial and lateral posterior condyle, which is a few millimeters lower than the lateral posterior condyle. This discrepancy between the proximal tibia-posterior femoral joint line causes a tight flexion gap in cruciate-retaining TKA. Therefore, downsizing of the femur is necessary to adjust the posterior joint line to the level of the lateral condyle.

To avoid this circumstance, the postoperative joint line should be leveled to the center of the original medial and lateral joint surface. Proximal tibia is resected from the lateral joint surface 1 mm to 2 mm thicker than the implant. Distal femur is resected from the worn medial surface 1 mm to 2 mm thinner than the implant. Posterior femur is resected using the posterior reference method with an external rotation for appropriate degrees. In this situation, all the joint lines are leveled to the center of the medial and lateral joint surface. Otherwise, use of an anatomically shaped implant with a physiologic joint line is another option to avoid joint line discrepancy.

Adopting joint line theory for bone resection can prevent the flexion gap tightness that likely occurs in cruciate-retaining TKA.

Adopting joint line theory for bone resection can prevent the flexion gap tightness that likely occurs in cruciate-retaining TKA.

To analyze the causes of misdiagnosis and missed diagnosis in spinal osteoid osteoma, and to put forward solutions to improve diagnosis accuracy and treatment efficacy in patients.

We performed a retrospective cohort study on patients with spinal osteoid osteoma in Beijing Jishuitan Hospital from January 1983 to September 2019. All patients underwent surgery. The outcome measures were the extent of local pain, nocturnal pain, radicular symptoms of extremities after surgery, and reduction or disappearance of lesions on CT after surgery.

Thirty-seven patients with spinal osteoid osteoma were recruited in the study. A total of 27% were female, and the mean (SD) age at diagnosis was 21.3 (8.7) years. A total of 87.0% of patients presented with nocturnal pain, and 94.7% of patients were responsive to NSAIDS treatment. The mean (SD) time from the initial onset of symptoms to the final diagnosis was 14.7 (12.5) months. Only four of 37 (10.8%) patients were correctly diagnosed with spinal osteoid osteoma on the first visit to the local hospital.