Background
The use of veno–arterial extracorporeal membrane oxygenation (VA‐ECMO) decannulation with different percutaneous closure devices has been increasing. At our center, ProGlide devices have ...been used since November 2018, and Manta devices became an alternative since March 2020. This study aimed to compare the success and complication rates and the clinical outcomes of ProGlide and Manta devices for VA‐ECMO decannulation after arteriotomy wound closure.
Methods
We retrospectively reviewed the results of bedside VA‐ECMO decannulation between November 2018 and June 2021. Patients with VA‐ECMO who could be bridged to recovery were recruited and divided into the ProGlide or Manta group based on the closure device used. Procedure time, amount of blood loss, amount of blood products transfused, and use of vasoactive medications during the procedure were documented. Clinical examination and Doppler ultrasound were performed to detect any complications.
Results
After the closure technique, ProGlide was used in 44 patients and Manta was used in 13. There was no significant difference in the success rate between the ProGlide and Manta groups (86.4% vs. 100%). Amount of blood loss was greater in the ProGlide group than in the Manta group (290 100–400 ml vs. 50 50–100 ml), and more patients in the ProGlide group required an increased dose of inotropes during the procedure (59.1% vs. 15.4%), but the transfusion requirement was similar between the two groups.
Conclusions
The success rate of hemostasis using arteriotomy wound closure during VA‐ECMO decannulation was similar between the two devices.
The success rate of haemostasis using arteriotomy wound closure during VA‐ECMO decannulation was similar between ProGlide and Manta.
The complications of percutaneous closure by the two devices were low.
The World Health Organization Caregiver Skills Training Program (WHO-CST) was developed to strengthen caregivers' skills in supporting children with developmental delays and the caregivers' ...well-being. The WHO-CST Hong Kong (HK) was adapted, and pre-pilot tested to support families with children suspected of having developmental delays and autism spectrum disorder and to empower the caregivers to foster their children's learning, social communication, and adaptive behavior. A sequential mixed-methods research methodology was undertaken to examine the adaptation process and initial implementation experiences. The acceptability, feasibility, and perceived benefits of the WHO-CST were assessed using stakeholders' and caregivers' qualitative and caregivers' quantitative pre- and post-intervention feedback. The data included materials generated from (1) three consultation meetings with stakeholders; (2) detailed reviews of the translated and adapted WHO-CST materials by master trainees (n = 10) trained by the WHO-CST representatives; (3) needs assessment focus group interviews with caregivers (n = 15) of children with autism spectrum disorder; and (4) pre- and post-CST program qualitative focus group interviews and quantitative evaluation. Consultation with stakeholders suggested that the program was acceptable for the local community, but the home visit and fidelity components were initially considered to be challenges towards the feasibility and sustainability of the program. Caregivers in the needs assessment focus groups gave widely diverse views about the program's uniqueness, length, delivery mode, and the inclusion of videotaping in-home visits. Post-intervention comments by caregivers about the program were mainly positive, while the MTs were critical of the content and length of the training and fidelity process. As one of the first high-income locations to adopt the WHO-CST, the evaluation findings of the WHO-CST-HK indicate that it is feasible and acceptable to implement the program in a metropolitan area where families have busy work schedules and are very conscious of privacy issues. The study results suggest that the WHO-CST program in HK and other high-income countries require scaling up and further evaluation of its implementation in real community settings. This involves systemic and contextual changes to allow task-sharing between professionals and non-specialists at the macro level. Furthermore, technology should be used to support the supervision of non-specialists. In addition, easier access to the WHO-CST materials at the micro level is required to ensure equity, equality, diversity, and inclusion of diversified families of children with developmental delays.
Globally, mortality rates of patients admitted to the intensive care unit (ICU) have decreased over the last two decades. However, evaluations of the temporal trends in the characteristics and ...outcomes of ICU patients in Asia are limited. The objective of this study was to describe the characteristics and risk adjusted outcomes of all patients admitted to publicly funded ICUs in Hong Kong over a 11-year period. The secondary objective was to validate the predictive performance of Acute Physiology And Chronic Health Evaluation (APACHE) IV for ICU patients in Hong Kong.
This was an 11-year population-based retrospective study of all patients admitted to adult general (mixed medical-surgical) intensive care units in Hong Kong public hospitals. ICU patients were identified from a population electronic health record database. Prospectively collected APACHE IV data and clinical outcomes were analysed.
From 1 April 2008 to 31 March 2019, there were a total of 133,858 adult ICU admissions in Hong Kong public hospitals. During this time, annual ICU admissions increased from 11,267 to 14,068, whilst hospital mortality decreased from 19.7 to 14.3%. The APACHE IV standard mortality ratio (SMR) decreased from 0.81 to 0.65 during the same period. Linear regression demonstrated that APACHE IV SMR changed by - 0.15 (95% CI - 0.18 to - 0.11) per year (Pearson's R = - 0.951, p < 0.001). Observed median ICU length of stay was shorter than that predicted by APACHE IV (1.98 vs. 4.77, p < 0.001). C-statistic for APACHE IV to predict hospital mortality was 0.889 (95% CI 0.887 to 0.891) whilst calibration was limited (Hosmer-Lemeshow test p < 0.001).
Despite relatively modest per capita health expenditure, and a small number of ICU beds per population, Hong Kong consistently provides a high-quality and efficient ICU service. Number of adult ICU admissions has increased, whilst adjusted mortality has decreased over the last decade. Although APACHE IV had good discrimination for hospital mortality, it overestimated hospital mortality of critically ill patients in Hong Kong.
Several ‘carbon-atoms-adjacent’ mixed sandwich cobalta- and ferra-carboranes incorporating the C2B10 and C2B9 systems were synthesized via salt metathesis reactions followed by the oxidation with ...oxygen, which included unexpected cobaltacarboranes (η5-C5H5){η6-C6H4(CO)(CH2)C2B10H10}Co and (η5-C5H5){η6-C6H4(CHOH)(CH2)C2B10H10}Co. All new metallacarboranes were characterized by various spectroscopic techniques, elemental analyses and single-crystal X-ray diffraction studies. The electrochemical data suggest that cyclopentadienyl is the most electron-rich ligand followed by the C2B9 and then C2B10 systems, and ‘carbon-atoms-adjacent’ C2B10 system is more electron-donating than its ‘carbon-atoms-apart’ counterpart.
New ‘carbon-atoms-adjacent’ mixed sandwich cobalta- and ferra-carboranes were synthesized and structurally characterized. The electrochemical data suggest that cyclopentadienyl is the most electron-rich ligand followed by the C2B9 and then C2B10 systems, and ‘carbon-atoms-adjacent’ C2B10 system is more electron-donating than its ‘carbon-atoms-apart’ counterpart. Display omitted
► Synthesis of ferra- and cobalta-carboranes with ‘carbon-atoms-adjacent’ C2B10 and C2B9 systems. ► X-ray structures of all new complexes. ► Electron-donating ability as suggested by electrochemical data: Cp− > 7,8-C2B9H112− > 7,8-C2B10H122− > 7,9-C2B10H122−.
This study aimed to identify radiomic features of primary tumor and develop a model for indicating extrahepatic metastasis of hepatocellular carcinoma (HCC). Contrast-enhanced computed tomographic ...(CT) images of 177 HCC cases, including 26 metastatic (MET) and 151 non-metastatic (non-MET), were retrospectively collected and analyzed. For each case, 851 radiomic features, which quantify shape, intensity, texture, and heterogeneity within the segmented volume of the largest HCC tumor in arterial phase, were extracted using Pyradiomics. The dataset was randomly split into training and test sets. Synthetic Minority Oversampling Technique (SMOTE) was performed to augment the training set to 145 MET and 145 non-MET cases. The test set consists of six MET and six non-MET cases. The external validation set is comprised of 20 MET and 25 non-MET cases collected from an independent clinical unit. Logistic regression and support vector machine (SVM) models were identified based on the features selected using the stepwise forward method while the deep convolution neural network, visual geometry group 16 (VGG16), was trained using CT images directly. Grey-level size zone matrix (GLSZM) features constitute four of eight selected predictors of metastasis due to their perceptiveness to the tumor heterogeneity. The radiomic logistic regression model yielded an area under receiver operating characteristic curve (AUROC) of 0.944 on the test set and an AUROC of 0.744 on the external validation set. Logistic regression revealed no significant difference with SVM in the performance and outperformed VGG16 significantly. As extrahepatic metastasis workups, such as chest CT and bone scintigraphy, are standard but exhaustive, radiomic model facilitates a cost-effective method for stratifying HCC patients into eligibility groups of these workups.
Culture, Emotion Regulation, and Adjustment Matsumoto, David; Yoo, Seung Hee; Nakagawa, Sanae
Journal of personality and social psychology,
06/2008, Letnik:
94, Številka:
6
Journal Article
Recenzirano
This article
reports differences across 23 countries on 2 processes of emotion
regulation--reappraisal and suppression. Cultural dimensions
were correlated with country means on both and the ...relationship between them.
Cultures that emphasized the maintenance of social
order--that is, those that were long-term oriented and
valued embeddedness and hierarchy--tended to have higher
scores on suppression, and reappraisal and suppression tended to be positively
correlated. In contrast, cultures that minimized the maintenance of social order
and valued individual Affective Autonomy and Egalitarianism tended to have lower
scores on Suppression, and Reappraisal and Suppression tended to be negatively
correlated. Moreover, country-level emotion regulation was significantly
correlated with country-level indices of both positive and negative
adjustment.
The chemistry of p-block metallacarboranes of the C2B10 systems is largely unexplored in comparison with that of s-, d-, and f-block metallacarboranes. This article reports several carbons-adjacent ...stannacarboranes of the C2B10 system and their chemical properties for the first time. Reaction of SnCl2 with {μ-1,2-o-C6H4(CH2)2-1,2-C2B10H10}2Na4(THF)6 n gave the Lewis base free stannacarborane {μ-1,2-o-C6H4(CH2)2-1,2-C2B10H10}Sn (1). Recrystallization of 1 from MeCN, THF, and DME afforded the corresponding Lewis base coordinated stannacarboranes {μ-1,2-o-C6H4(CH2)2-1,2-C2B10H10}Sn(MeCN) (2), {μ-1,2-o-C6H4(CH2)2-1,2-C2B10H10}Sn(THF)·THF (3·THF), and {μ-1,2-o-C6H4(CH2)2-1,2-C2B10H10}Sn(DME) (4), respectively. They were fully characterized by various spectroscopic data and elemental analyses. Complexes 2−4 were further confirmed by single-crystal X-ray analyses.
Complications aroused from Meckel’s diverticulum tend to developed in children.Children presented with abdominal pain,intestinal obstruction,intussusception or gastrointestinal bleeding may actually ...suffered from complicated Meckel’s diverticulum.With the advancement of minimally invasive surgery(MIS) in children,the use of laparoscopy in the diagnosis and subsequent laparoscopic excision of Meckel’s diverticulum has gained popularity.Recently,single incision laparoscopic surgery(SILS) has emerged as a new technique in minimally invasive surgery.This review offers the overview in the development of MIS in the management of children suffered from Meckel’s diverticulum.The current evidence in different laparoscopic techniques,including conventional laparoscopy,SILS,the use of special laparoscopic instruments,intracorporeal diverticulectomy and extracorporeal diverticulectomy in the management of Meckel’s diverticulum in children were revealed.
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