Impact of age on perioperative outcome in patients scheduled for lower limb trauma surgery under central neuraxial blockade

Background: The aim of the study was to compare perioperative outcomes between young and elderly trauma patients scheduled for lower limb corrective surgeries in our hospital under central neuraxial blockade. Methods: The study was conducted in Max Superspeciality Hospital, Mohali for a period of 1 year, November 2017 to November 2018 after approval from the Institutional Ethics Committee and review board and written informed consent from the patients. Sixty patients having American Society of Anesthesiologists (ASA) I-III physical status scheduled to undergo lower limb trauma surgery were divided into 2 groups as ‘young’ (?65 years, group Y) or ‘elderly’ (?65 years, group E). Results: The mean age of patients in group Y was 39.67±12.73 years while the mean age of patients in group E was 74.37±6.13 years. The post-operative pain score i.e. visual analogue scores (VAS) were lower inpatients in group Y as compared to group E. This difference in pain scores was found to be statistically significant especially from 8th hour onwards. Injury severity score (ISS) and pre-existing comorbidities [hypertension, renal failure and coronary artery disease (CAD)] were significant risk factors for mortality in group E patients. Conclusions: The elderly are more likely to develop adverse perioperative outcomes and are relatively less able to recover from the same.

Exploration of the Implementation Path of Medical Quality Homogenization in Hospital Branches Based on SPO Theory / 中国医院管理

Setting up branches of public hospital is one of the important ways to allocate high-quality medical re-sources.However,medical quality homogenization is the core problem of multi-campus hospitals.As a result of dif-ferent qualities of clinical departments setting,personnel,supervision,information technology,etc.,it is difficult for hospital branches to achieve medical homogenization as the main campus.It elaborated the implementation path of medical quality homogenization in the construction of one hospital with four campuses in a large public hospital di-rectly under the National Health Commission based on SPO theory.In the three dimensions of structure,process and result,it described the specific practice of resource allocation,comprehensive supervision,performance evalua-tion and improvement,etc,thus to discuss the medical management strategies of different types of branches of hospitals,which is expected to be helpful to the construction of public hospitals with multi-campus.

Using a peak flow meter to assess severity of exacerbation in patients suffering from chronic obstructive pulmonary disease: a prospective observational study

Background: Chronic obstructive pulmonary disease (COPD) is an important and dangerous public health concern, and deaths due to it has become the leading cause of mortality in several countries. Exacerbations of the disease are very common and is frequently responsible for progressive decline in lung function, quality of life and ultimately death. Through this study, we hypothesize whether estimating peak expiratory flow rate (PEFR) using a simple peak flowmeter could help in early prediction of the intensity and severity of exacerbations of COPD. Methods: This study was conducted amongst 100 patients, at Amrita Institute of Medical Sciences, Kochi, Kerala, who were diagnosed with COPD, based on GOLD criteria and respective pulmonary function tests. Their PEFR and oxygen saturation values were recorded during their routine clinic visits and during an exacerbation episode and results were analyzed. Results: Out of 100 patients, 91 were males and 9 were female patients, with a mean age of 64.4 years and commonest age affected is 55 years. Average duration of COPD amongst the study participants ranged from 4 to 11 years with a mean of 7.19 years. PEFR was graded into 3 zones based on guidelines and measurements noted. Of the 76 male patients with 80-100% PEFR recordings, 10 (13.15%) had a drop to 50-80% PEFR and 66 (86.85%) of them dropped to <50% PEFR reading during an exacerbation. For the female subjects, of the 9 patients with 80-100% of expected PEFR, 3 (33.33%) had dropped to 50-80% and 6 (66.69%) had dropped to <50% of PEFR reading. SpO2 had significant change at exacerbations as compared during normal phase dropping with mean of 94.82 to 81.3 which was statistically significant across age and gender. Wilcoxon signed rank test was done to quantify statistical change showed z score of -9.138 with p<0.0001, which was significant across age and gender groups. Conclusions: As a simple, inexpensive tool, peak flowmeter could be useful for bedside monitoring of severity of exacerbation of COPD. This could be vital for early detection and appropriate medical intervention.

Using a peak flow meter to assess severity of exacerbation in patients suffering from chronic obstructive pulmonary disease: a prospective observational study

Background: Chronic obstructive pulmonary disease (COPD) is an important and dangerous public health concern, and deaths due to it has become the leading cause of mortality in several countries. Exacerbations of the disease are very common and is frequently responsible for progressive decline in lung function, quality of life and ultimately death. Through this study, we hypothesize whether estimating peak expiratory flow rate (PEFR) using a simple peak flowmeter could help in early prediction of the intensity and severity of exacerbations of COPD. Methods: This study was conducted amongst 100 patients, at Amrita Institute of Medical Sciences, Kochi, Kerala, who were diagnosed with COPD, based on GOLD criteria and respective pulmonary function tests. Their PEFR and oxygen saturation values were recorded during their routine clinic visits and during an exacerbation episode and results were analyzed. Results: Out of 100 patients, 91 were males and 9 were female patients, with a mean age of 64.4 years and commonest age affected is 55 years. Average duration of COPD amongst the study participants ranged from 4 to 11 years with a mean of 7.19 years. PEFR was graded into 3 zones based on guidelines and measurements noted. Of the 76 male patients with 80-100% PEFR recordings, 10 (13.15%) had a drop to 50-80% PEFR and 66 (86.85%) of them dropped to <50% PEFR reading during an exacerbation. For the female subjects, of the 9 patients with 80-100% of expected PEFR, 3 (33.33%) had dropped to 50-80% and 6 (66.69%) had dropped to <50% of PEFR reading. SpO2 had significant change at exacerbations as compared during normal phase dropping with mean of 94.82 to 81.3 which was statistically significant across age and gender. Wilcoxon signed rank test was done to quantify statistical change showed z score of -9.138 with p<0.0001, which was significant across age and gender groups. Conclusions: As a simple, inexpensive tool, peak flowmeter could be useful for bedside monitoring of severity of exacerbation of COPD. This could be vital for early detection and appropriate medical intervention.

IOT BASED REAL TIME TELE-HEALTHCARE SYSTEM

Tele-healthcare is need of the hour to bridge the vast healthcare gap in developing country like India. Being the second most populous country, quality healthcare facility is not easily accessible in the rural outskirts of India. In this research work the proposed system has acquired ECG, heart rate, SpO2 and body temperature data for better diagnosis and prognosis. The proposed system has been tested on the different patients belonging to different age groups and the result obtained on the health monitoring dashboard is found to be satisfactory. It also provides enhanced accessibility as multiple healthcare professionals can collaborate on the patient's data. This paper concludes with real time audio/ video connectivity, scope of interest of which is very effective and applicable in healthcare world.

Effects of passive smoking on pulmonary functions of individuals in an urban area

Background: Passive smoking is a world health problem and part of the tobacco epidemic which victimizes mostly adolescents. Research articles have addressed the relation between passive smoking and respiratory efficiency in adult population and escalated the hazard of chronic obstructive pulmonary disease and lung cancer among adult passive smokers. The present study was conducted to analyze the effects of exposure to passive smoke on pulmonary functions among nonsmoking individuals. Aim and Objectives: The study was determined to assess the effects of passive smoking on pulmonary functions among individuals in urban region. Materials and Methods: The present study was conducted on smokers, passive smokers, and nonsmokers (control), aged between 17 and 25 years. Ninety healthy individuals were placed in three different groups on the basis of questionnaire (Group A: active smoker, Group B: passive smoker, Group C: control). Study was done with the help of spirometer and pulse oximeter. Results: Forced expiratory flow25–75%, Forced expiratory volume in 1 second/Forced vital capacity % values were significantly reduced in passive smokers as compared to control individuals (P < 0.001, P < 0.05). SpO2 level was decreased in passive smokers and active smokers, but it was not statistically significant. Conclusions: The present study showed a strong association between passive smoking and pulmonary abnormalities in individuals exposed to passive smoke. Health hazards caused by passive smoking should be controlled by creating awareness and regular health check-ups among people.

Effects of different sputum suction pressure on intracranial pressure of severe craniocerebral injury patients / 中国实用护理杂志

Objective:To explore the best negative pressure standard of sputum aspiration in patients with severe craniocerebral injury, so as to achieve the best sputum aspiration effect and maintain relatively stable intracranial pressure.Methods:Totally 120 patients with severe craniocerebral injury admitted to the Department of Neurosurgery of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January to December 2019 were selected by convenience sampling method. According to the random number table method, patients were divided into 4 different negative pressure sputum aspiration groups: 75 mmHg (1 mmHg=0.133 kPa) group, 100 mmHg group, 150 mmHg group, 200 mmHg group, with 30 patients in each group. The levels of intracranial pressure and SpO 2, sputum cleaning time and mucosal injury were observed and compared in 4 groups: 1 min before sputum aspiration, 1 min after sputum aspiration and during sputum aspiration. Results:Comparison of intracranial pressure and SpO 2 in sputum aspiration among the four groups: intracranial pressure in 200 mmHg group was (22.23 ± 4.80) mmHg, which was higher than 75 mmHg group (16.33 ± 2.71) mmHg, 100 mmHg group (17.70 ± 2.32) mmHg, 150 mmHg group (17.20 ± 2.11) mmHg ( q=8.29, 6.58, 7.23), and SpO 2 was 0.906 ± 0.048, which was lower than 0.956 ± 0.013, 0.946 ± 0.018, 0.952 ± 0.023 in the other three groups ( q=7.81, 6.08, 6.69), with statistical significance (all P<0.01). There were statistically significant differences in intracranial pressure ( F=10.55) and SpO 2 ( F=36.57) among the four groups 1 min after sputum aspiration ( P<0.01);the 200 mmHg group had the highest intracranial pressure (15.63 ± 3.64) mmHg; the 100 mmHg group was (12.50 ± 1.48) mmHg and 150 mmHg group was (12.60 ± 1.00) mmHg, which had lower intracranial pressure than the 75 mmHg group (14.03 ± 2.86) mmHg. The sputum cleaning time was (35.53 ± 5.71) s in 75 mmHg group which was the longest and the shortest in 200 mmHg group (24.27 ± 3.22) s, with statistical significance among the four groups ( F=47.81, P<0.01). The incidence of airway mucosal injury in 200 mmHg group was 33.33% (10/30),which was higher than that in the other three groups, and the difference was statistically significant ( χ2=15.41, P<0.01). Conclusions:For patients with severe craniocerebral injury, artificial airway sputum viscosityⅠ-Ⅱ degree, suction negative pressure of 100-150 mmHg can better maintain the stability of intracranial pressure, control the decline of SpO 2 and prevent the damage of airway mucosa, and effectively reduce the adverse effects of sputum aspiration on patients with severe craniocerebral injury.

Pulse oximeter as a home assessment tool: Knowledge and user experience among the community in Malaysia during the COVID-19 pandemic

Objective: To determine the degree of knowledge in the usage of pulse oximeter as a home assessment tool among the community in Malaysia. Methods: A cross-sectional survey was conducted in November 2021. The questionnaire assessed the knowledge in using pulse oximeters, user experience and opinions in using pulse oximeter as a home assessment tool during the pandemic. Results: A total of 504 respondents were included in the study, and the mean score in knowledge related to application of pulse oximetry was 73.00%, while the mean score in knowledge related to factors affecting pulse oximetry readings was only 38.51%. A total of 90.5% of the respondents recognised normal pulse rate and 88.5% knew the blood oxygen saturation levels of a healthy adult, while 69.4% recognised the definition of silent hypoxia. In addition, the majority of the respondents agreed that factors such as poor blood circulation (71.2%), excessive movements (69.8%), and hand position (60.7%) affected oximetry readings. However, 61.7%, 81.7%, 77.2% and 76.8% of the respondents could not identify nail polish, skin colour, skin thickness and tattoos as factors that may affect oximetry readings respectively. Conclusions: The respondents showed a satisfactory level of knowledge related to application of pulse oximetry, but a poor level of knowledge related to factors affecting pulse oximetry readings among the community in Malaysia. Continuous efforts in educating the community on the correct use of pulse oximeters are crucial for appropriate home assessment and avoiding unnecessary stress.

A study to validate thoracic trauma severity score in chest trauma patients

Background: Aim of this study was to validate thoracic trauma severity score (TTSS) in assessing the requirement of mechanical ventilation, mortality, and predicting prognosis in chest injury patients.Methods: This study was conducted in department of general surgery, Dr. S. N. Medical College, Jodhpur, Rajasthan, from December 2018 to September 2019. This was a single centred, prospective, observational study, conducted in 110 patients, aged >18 years, of isolated chest injury, excluding polytrauma patients. Data was summarized in the form of proportions, histograms and tables to show relationships of parameters with results. Data was presented as mean±SD and proportions as appropriate. Chi square test, z test or t tests were used wherever necessary for association analysis between categorical variables. Diagnostic test characteristics for mortality and complications was calculated from the ROC curves. A two sided of p values of less than 0.05 was considered statistically significant.Results: Most common mode of chest injury was blunt trauma and most common age group affected was 42-54 years. Maximum mortality was seen in TTSS between 16-20, shows higher the TTSS more the mortality. Ventilator requirement was more in high TTSS. Patients with higher TTSS had longer hospital stay as compared to patients with lower TTSS.Conclusions: On application of TTSS on admission, TTSS had direct correlation with need for oxygenation, ventilator need, duration of hospital stay, mortality or outcome in chest trauma patients. Thus we recommend TTSS as a good useful score for evaluation of prognosis, outcome and mortality in chest trauma patients.

Surgical choice of posterior osteotomy way for senile osteoporotic thoracolumbar fracture with kyphosis / 中国骨伤

OBJECTIVE@#To investigate the surgical choice of posterior osteotomy way by the observation of clinical outcome of Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO) and vertebral column re-section (VCR) for senile osteoporotic thoracolumbar fracture with kyphosis.@*METHODS@#From June 2015 to August 2017, an amount of 8 elderly patients with thoracolumbar kyphosis caused by osteoporotic vertebral fracture underwent osteotomy approach for posterior osteotomy. All patients were old osteoporotic vertebral fracture more than 6 months and received invalid conservative treatment for 3 months including nonsteroidal anti-inflammatory and analgesic drugs, anti-osteoporosis drugs and acupuncture, etc. There were 3 males and 5 females, with an average age of 73.4 years (66 to 83 years), with an average course of the disease of 34.6 months (8 to 60 months). Eight patients had a total of 8 vertebral fractures, and fracture segment was in T of 1 case, T of 1 case, T of 3 cases, L of 2 cases, L of 1 case. Eight patients showed kyphosis caused by wedge deformation of single segmental vertebral fractures. The thoracolumbar kyphosis and symptoms were progressively developing into central sagittal imbalance. SPO osteotomy was performed in 3 cases, PSO osteotomy in 3 cases, and VCR osteotomy in 2 cases. Orthopaedic effects were analyzed by imaging measurements, including pre- and post-operative kyphosis Cobb angle, localized kyphosis (LK), thoracic kyphosis (TK), lumbar lordosis (LL), sacral tilt angle (ST) and sagittal vertical axis (SVA). Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the pain and lumbar function.@*RESULTS@#All the eight patients were followed up from 8 to 24 months with an average of 13.5 months and all the symptoms of low back pain have significantly reduced or disappeared. The VAS score decreased from 5-8 points (mean 6.5 points) before surgery to 1-4 points (mean 1.88 points) at the final follow-up, and the score was significantly improved. The ODI score decreased from 36-78 points (mean 60.25 points) before surgery to 10-32 points (mean 20.38 points) at the final follow-up, and the functional score improved significantly. During the follow-up period, X-ray examination showed that some patients had a slight decrease in the height of the intervertebral fusion, and the bone graft was healed. There was no obvious corrected degree loss and internal fixation loosening, and the thoracolumbar kyphosis was significantly improved. The mean Cobb angle of T-L was reduced from 25.3° to 2.8° with corrected rate of 89.3% ; LK was reduced from 43.4° to 7.1° with corrected rate of 86.2% ; TK was reduced from 49.9° to 30.6°, LL was reduced from 43.6° to 30.8°, and ST was changed from 24.0° to 32.1°, SVA was changed from 6.23 cm to 2.40 cm.@*CONCLUSION@#For the different pathological features and deformities of senile osteoporotic thoracolumbar fracture combined with kyphosis, SPO, PSO or VCR can achieve good orthopedic effect and clinical efficacy.

The effects of gel-based manicure on pulse oximetry

INTRODUCTION@#Pulse oximetry is the standard monitoring technique of functional oxygen saturation (SpO). As the use of fingernail polish has been described to alter SpO readings, its removal is commonly recommended prior to measurement. Gel-based manicures have gained popularity in recent years due to their attractiveness and longevity. However, the removal of gel nail polish requires a specialised procedure. Valuable time and resources can be saved if removal can be avoided. To our knowledge, there are no available studies on the effect of gel-based manicures on pulse oximetry readings. Hence, we evaluated the effect with two oximeters, using different technology and wavelength combinations.@*METHODS@#17 healthy female adult volunteers were recruited for this single-blind randomised controlled trial. Subjects with hypothermia, hypotension, poor plethysmographic waveform and nail pathology were excluded. Colours tested were: black, purple, navy blue, green, light blue, white, yellow, orange, pink and red. Pulse oximetry was measured at 15- and 30-second intervals using two different pulse oximeters, the Philips M1191BL and Masimo SET®. Means were compared using paired t-tests.@*RESULTS@#Using the Masimo oximeter, light blue (ΔM = 0.97% ± 0.96%; p = 0.001) and orange (ΔM = 0.76 ± 1.17%; p = 0.016) gel nail polish resulted in a statistically significant increase from baseline SpO readings. With the Philips oximeter, the limits of agreement ranged from 2% for pink to 17% for black, indicating imprecision.@*CONCLUSION@#Gel-based manicures can result in overestimations of actual readings, delaying detection of hypoxaemia. Gel nail polish should be routinely removed or an alternative monitoring technique sought.

Correlación de SpO2/FiO2 versus PaO2/FiO2 para monitoreo de la oxigenación en pacientes con trauma de tórax / Correlation of SPO2/FiO2 versus PaO2/FiO2 for oxigenation monitoring in patients with thorax trauma / Correlação de SPO2/FiO2 versus PaO2/FiO2 para monitoração de oxigenação em pacientes com trauma tórax

Resumen: Introducción: La monitorización de la oxigenación se ha realizado tradicionalmente mediante índices como PaO2/FiO2, que requieren de toma de gasometrías para su determinación. La tendencia de una monitorización mínimamente invasiva propone utilizar la saturación de pulso en el índice SpO2/FiO2 con el mismo fin. El índice SpO2/FiO2 tiene ventajas: obtención rápida y no requiere de gasometría. Rice y cols. hicieron la comparación SpO2/FiO2 y PaO2/FiO2, demostrando la validación del índice Patrick y cols. lo incorporaron a la escala SOFA, Kigali mostró la importancia de monitoreo mínimamente invasivo con SpO2/FiO2 y USG pulmonar en SDRA, proponiendo una clasificación comparable con la de Berlín. Objetivos: Demostrar que existe correlación entre SpO2/FiO2 versus PaO2/FiO2 para monitoreo de la oxigenación en los pacientes con trauma de tórax. Material y métodos: Se realizó un estudio observacional, descriptivo, longitudinal y ambispectivo en 25 pacientes ingresados con diagnóstico de trauma de tórax entre enero de 2016 y abril de 2017 en el servicio de cuidados intensivos, de los cuales se excluyeron cinco pacientes. Se realizó un análisis estadístico utilizando correlación bivariada de Pearson y, si ésta fuera significativa, una correlación lineal para determinar el grado de la misma. Se realizó determinación de medias de edad, género, tipo de trauma, días de ventilación mecánica y defunción. Los resultados se analizaron con el programa estadístico SPSS versión 21.0. Conclusiones: Existe desde el ingreso una correlación lineal significativa entre ambos índices, dicha correlación es mayor de 60% desde el ingreso; sin embargo, adquiere mayor significancia estadística con un grado de correlación hasta de 90% a partir de las 24 horas y hasta el fin del estudio. Consideramos, por tanto, una prueba útil y significativa para valorar la oxigenación en pacientes con trauma de tórax.

Abstract: Introduction: Traditionally, oxygenation monitoring has been performed using indices such as PaO2/FiO2, which requires the determination of gasometry. The trend of minimally invasive monitoring proposes to use pulse saturation in the SpO2/FiO2 index for the same purpose. The SpO2/FiO2 index has advantages: rapid obtaining and not requiring gasometry. Rice performed the SpO2/FiO2 and PaO2/FiO2 comparison demonstrating index validation, Patrick incorporates it into the SOFA scale, Kigali shows the importance of minimally invasive monitoring with SpO2/FiO2 and pulmonary USG in ARDS by proposing a comparable classification with that of Berlin. Objectives: To demonstrate that there is a correlation between SpO2/FiO2 vs PaO2/FiO2 for monitoring of oxygenation in patients with chest trauma. Material and methods: An observational, descriptive, longitudinal, ambispective study was performed in 25 patients admitted with a diagnosis of chest trauma between January, 2016 and April, 2017, in the Intensive Care service, of which 5 patients were excluded. A statistical analysis was performed using Pearson's bivariate correlation, and if a linear correlation was significant to determine the degree of correlation. Determination of means of age, gender, type of trauma, mechanical ventilation and death were determined. The results were analyzed with the statistical program SPSS version 21.0. Conclusions: There is a significant linear correlation between the two indexes, a correlation that is greater than 60% from the time of admission, but it acquires the highest statistical significance with a degree of correlation up to 90% from 24 hours to the end Of the study. We therefore consider a useful and significant test to assess oxygenation in patients with chest trauma.

Resumo: Introdução: Tradicionalmente, o monitoramento da oxigenação tem sido realizado por meio de índices como PaO2/FiO2, que exigem o uso de gasometrias para sua determinação. A tendência do monitoramento minimamente invasivo propõe o uso da saturação de pulso no índice SpO2/FiO2 para o mesmo fim. O índice SpO2/FiO2 apresenta vantagens: obtenção rápida e não requerer gasometria. Rice fez a comparação SpO2/FiO2 e PaO2/FiO2 demonstrando a validação do índice, Patrick incorpora na escala SOFA, Kigali mostra a importância da monitorização minimamente invasiva com SpO2/FiO2 e USG pulmonar na SDRA, propondo uma classificação comparável à de Berlim. Objetivos: Demonstrar que há correlação entre a SpO2/FiO2 e a PaO2/FiO2 no monitoramento da oxigenação em pacientes com trauma torácico. Material e métodos: Estudo observacional, descritivo, longitudinal, ambispectivo, realizado em 25 pacientes admitidos com diagnóstico de trauma torácico, entre janeiro de 2016 e abril de 2017, na Unidade de Terapia Intensiva, dos quais 5 pacientes foram excluídos. Uma análise estatística foi realizada usando a correlação bivariada de Pearson, e se esta fosse significativa, uma correlação linear para determinar o grau de correlação da mesma. Determinamos as médias de idade, sexo, tipo de trauma, dias de ventilação mecânica e morte. Os resultados foram analisados com o programa estatístico SPSS versão 21.0. Conclusões: Existe uma correlação linear significativa entre os dois índices, tal correlação é maior que 60% desde a internação, mas adquire a maior significância estatística com um grau de correlação de até 90% a partir das 24 horas e até final do estudo. Portanto, consideramos um teste útil e significativo para avaliar a oxigenação em pacientes com trauma torácico.

Effect of simulated microgravity on peripheral oxygen saturation in rats / 生物医学工程学杂志

To study the effect of microgravity on peripheral oxygen saturation (SpO ) in rats, tail-suspended rats were applied to simulate microgravity environment. SpO and arterial oxygen saturation (SaO ) were measured by pulse oximeter and arterial blood gas analyzer (ABGA) respectively on the 14th day, 21st day and 28th day in tail-suspended group and control group. Paired -test shows that SpO was significantly lower than SaO in tail-suspended group on the 14th day ( < 0.05), the 21st day ( < 0.05) and the 28th day ( < 0.01). The ANOVA results shows that modeling time had significant effect on SpO value but no effect on SaO value in tail-suspended group. These results indicate that pulse oximeter may be not suitable for oxygen saturation test in microgravity environment.

ARDS severity identification based on noninvasive parameter SpO2/FiO2 / 医疗卫生装备

Objective To explore the relationship between SpO2/FiO2(S/F) and PaO2/FiO2(P/F) so as to determine the possibility of ARDS severity identification based on noninvasive parameters. Methods The physiological parameters of corresponding patients were acquired from Medical Information Mart for Intensive Care (MIMIC-Ⅲ),and then divided into a training set and a test set randomly.In the training set the linear relationship between lg(S/F)and lg(P/F)was established with generalized linear regression model,and a log linear regression model was formed with the optimal regression equation;the linear relationship between lg(S/F)and lg(P/F)was compared with that between S/F and P/F.In the test set,the two models were compared on the identification of ARDS in case P/F values were 100(mild ARDS),200(moderate ARDS)and 300(severe ARDS)respectively.Results In the training set(n=61 634)the linear relationship between lg(S/F)and lg(P/F)was deduced as lg(S/F)=1.277+0.437×lg(P/F) (r=0.66,P<0.000 1),and the S/F thresholds in case P/F values were 100,200 and 300 respectively were 131,201 and 271.In the test set (n=26 758)the identification effect was verified with the acquired S/F thresholds,which proved better than that of traditional regression model.Conclusion Noninvasive parameter SpO2/FiO2can replace PaO2/FiO2for the auxiliary diagnosis of ARDS in case the result of blood gas analysis is absent.

Differential proteomics research of Bacillus amyloliquefaciens and its genome-shuffled saltant for improving fengycin production

Abstract In the previous study, we used genome shuffling to improve fengycin production of the original strain Bacillus amyloliquefaciens ES-24. After two rounds of genome shuffling, a high-yield recombinant FMB72 strain that exhibited 8.30-fold increase in fengycin production was obtained. In this study, comparative proteomic analysis of the parental ES-24 and genome-shuffled FMB72 strains was conducted to examine the differentially expressed proteins. In the shuffled strain FMB72, 50 differently expressed spots (p 0.05) were selected to be excised and analyzed using Matrix-Assisted Laser Desorption/Ionization Time of Flight/Time of Flight Mass Spectrometry, and finally 44 protein spots were confidently identified according to NCBI database. According to clusters of orthologous groups (COG) functional category analysis and related references, the differentially expressed proteins could be classified into several functional categories, including proteins involved in metabolism, energy generation and conversion, DNA replication, transcription, translation, ribosomal structure and biogenesis, cell motility and secretion, signal transduction mechanisms, general function prediction. Of the 44 identified proteins, signaling proteins ComA and Spo0A may positively regulate fengycin synthesis at transcriptional level. Taken together, the present study will be informative for exploring the exact roles of ComA and Spo0A in fengycin synthesis and explaining the molecular mechanism of fengycin synthesis.

Evaluación de conocimientos sobre oxigenoterapia y lectura del flujómetro en el personal de salud de pediatría del Hospital Universitario San Ignacio, Bogotá, Colombia / Knowledge Evaluation of Oxygen Therapy and Flowmeter's Reading among Health Workers in the Pediatric Unit at Hospital Universitario San Ignacio, Bogotá, Colombia

Introducción: el oxígeno (O2) es un medicamento que puede generar efectos adversos. Discrepancias en la lectura del flujómetro y metas de saturación de oxígeno (SpC>2) pueden repercutir en la toma de decisiones clínicas, paraclínicas y estancia hospitalaria de pacientes pediátricos. Objetivo: evaluar conocimientos sobre SpO2, efectos adversos del O2 y lectura del flujómetro en el personal de salud del Departamento de Pediatría del Hospital Universitario San Ignacio, Bogotá, Colombia. Métodos: estudio transversal, mediante encuesta autodiligenciada en una muestra por conveniencia durante diciembre de 2016 y enero de 2017. Evaluación de conocimientos sobre oxigenoterapia, SpC>2, efectos adversos y lectura del flujómetro mediante fotografías de flujómetros del hospital con diferente fracción inspirada de oxígeno (FiC>2). Resultados: de 259 personas, el 77% respondió la encuesta. El 22% de los participantes respondió que la SpC>2 aumenta o se mantiene igual cuando el niño duerme; el 78% sabía de complicaciones del uso prolongado de O2, y el 67%, las relacionadas con la administración de una FiC>2 mayor a la necesaria. Con relación a la población neonatal, el 10% consideró que se deben buscar metas de SpO2 iguales o superiores al 96%; entre el 9% y el 19% de las lecturas en las diferentes fotografías de flujómetros fueron respuestas incorrectas. Discusión: es necesario reforzar conceptos actualizados sobre oxigenoterapia, con énfasis en metas de saturación, efectos adversos y lectura de flujómetro mediante campañas educativas periódicas.

Introduction: Supplemental oxygen is considerad a pharmaceutical drug; therafora, it can produce adverse effects. Lack of consensus regarding the reading of oxygen flowmeters and peripheral oxygen saturation (SpC>2) goals can influence clinical and paraclinical decisions and hospital stay length. Objective: To assess knowledge on oxygen therapy, adverse effects, SpC>2 goals and oxygen flowmeter's reading among personnel in the Pediatric Unit at Hospital Universitario San Ignacio, Bogotá, Colombia. Methodology: Cross-sectional study derived from convenience sampling through a self-applied poli between December 2016 and January 2017. The poli evaluated topics on supplemental oxygen therapy fundamentáis and adverse effects, SpC>2 goals and flowmeter readings through flowmeters photographs indicating a specific ffaction of inspirad oxygen (FÍO2). Results: Response rate was 77% from 259 subjects. 22% considered that the oxygen saturation either increases or remains the same during sleep periods in children. 78% participants knew at least one complication associated to prolonged oxygen therapy and 67% due to supplementary oxygen concentration greater than required amounts. In neonatal population, 10% considered oxygen saturation efectos adversos y lectura de flujómetro mediante campañas educativas periódicas.

Differential proteomics research of Bacillus amyloliquefaciens and its genome-shuffled saltant for improving fengycin production

Abstract In the previous study, we used genome shuffling to improve fengycin production of the original strain Bacillus amyloliquefaciens ES-2-4. After two rounds of genome shuffling, a high-yield recombinant FMB72 strain that exhibited 8.30-fold increase in fengycin production was obtained. In this study, comparative proteomic analysis of the parental ES-2-4 and genome-shuffled FMB72 strains was conducted to examine the differentially expressed proteins. In the shuffled strain FMB72, 50 differently expressed spots (p < 0.05) were selected to be excised and analyzed using Matrix-Assisted Laser Desorption/Ionization Time of Flight/Time of Flight Mass Spectrometry, and finally 44 protein spots were confidently identified according to NCBI database. According to clusters of orthologous groups (COG) functional category analysis and related references, the differentially expressed proteins could be classified into several functional categories, including proteins involved in metabolism, energy generation and conversion, DNA replication, transcription, translation, ribosomal structure and biogenesis, cell motility and secretion, signal transduction mechanisms, general function prediction. Of the 44 identified proteins, signaling proteins ComA and Spo0A may positively regulate fengycin synthesis at transcriptional level. Taken together, the present study will be informative for exploring the exact roles of ComA and Spo0A in fengycin synthesis and explaining the molecular mechanism of fengycin synthesis.

The role of spo0A gene in growth and sporulation of Clostridium difficile / 中国感染与化疗杂志

Objective To investigate the role of spo0A gene in growth and sporulation of Clostridium difficile clinical isolates. Methods ClosTron gene knock-out system was used to knock out the spo0A gene of C. difficile strain C25. Bacterial growth curve was plotted by measuring D600 with spectrophotometer in different phases of bacterial growth. Malachite green staining technique was used to count the number of vegetative cells and spores under optical microscope. The sporulation rate was calculated. Results The spo0A mutant and its C25 parental strain showed similar patterns of growth. However, after knock-out of spo0A gene, an asporogenous phenotype was built, while the parental strain could produce spores as usual.Conclusions The spo0A gene plays a key role in sporulation but not growth of C. difficile strain.

The comparison and selection for saturated pulse oximetry sensor / 中国医学装备

Objective:To expound the importance of blood oxygen saturation index, and to analyze the detection method of oxygen saturation index. Besides, to provide scientific and reasonable basis for use and selection of clinical saturated pulse oximetry(SpO2) sensor. Methods: To adopt pertinence detection method to test six kinds of SpO2 sensors (included the original import, original domestic, import commission processing, domestic commission processing, integrated mode sensor and one-time sensor), and to detect and analyze their specifications.Results: The experiment results of six kinds of SpO2 sensor were analyzed, and their main characteristics were obtained. And then, different sensor was recommended to different department or situation according to the actual situation of different hospital.Conclusion: Various clinical department and requirement can give full play to the advantages of various types of sensor, fast detect blood oxygen index for patients, reasonably allocate SpO2 sensor, reduce using cost and improve diagnosis level, at the same time, effectively carry through adjuvant therapy after they select the most suitable SpO2 sensor.

Evaluation of multiple oxygenation indexes in acute respiratory distress syndrome / 军事医学

Acute respiratory distress syndrome(ARDS)and acute lung injury are grave syndromes associated with high morbidity of the mortality.Currently,the criteria for the classification of the severity of ARDS are the PaO 2/FiO2values, while OI,S/F and OSI values are also used as ancillary diagnostic and grading criteria for ARDS.In this review,we sum-marize the effects of four indicators on the diagnosis and severity of ARDS patients,their respective strengths and weaknes-ses,and predit the future development of the classification of severity of ARDS.