Evaluation of N95 respirators,modified snorkel masks and low-cost powered air-purifying respirators: a prospective observational cohort study in healthcare workers

Disposable N95 respirator masks are the current standard for healthcare worker respiratory protection in the COVID-19 pandemic. In addition to shortages, qualitative fit testing can have low sensitivity for detecting poor fit, leading to inconsistent protection. Multiple groups have developed alternative solutions such as modified snorkel masks to overcome these limitations, but validation of these solutions has been lacking. We sought to determine if N95s and snorkel masks with attached high-efficiency filters provide consistent protection levels in healthcare workers and if the addition of positive pressure via an inexpensive powered-air purifying respirator to the snorkel mask would provide enhanced protection. Fifty-one healthcare workers who were qualitatively fitted with N95 masks underwent quantitative mask fit testing according to a simulated workplace exercise protocol. N95, snorkel masks with high-efficiency filters and snorkel masks with powered-air purifying respirators were tested. Respiratory filtration ratios were collected for each step and averaged to obtain an overall workplace protocol fit factor. Failure was defined as either an individual filtration ratio or an overall fit factor below 100. N95s and snorkel masks with high-efficiency filters failed one or more testing steps in 59% and 20% of participants, respectively, and 24% and 12% failed overall fit factors, respectively. The snorkel masks with powered-air purifying respirators had zero individual or overall failures. N95 and snorkel masks with high-efficiency filter respirators were found to provide inconsistent respiratory protection in healthcare workers.     

Máscara laríngea I-Gel® versus bolsa-válvula-mascarilla en la reanimación cardiopulmonar instrumental bajo monitorización capnográfica: ensayo clínico piloto aleatorizado por grupos

ObjectiveTo compare the basic airway and the advanced airway with the supraglottic device I-Gel®, by means of capnography during intermediate CPR.DesignRandomized experimental pilot study by groups.SettingOut-hospital care basic life support units on the Island of Mallorca.ParticipantsAdults attended after cardiorespiratory arrest of non-traumatic origin.InterventionsAdvanced airway management during instrumental CPR with I-Gel® or basic CPR with bag-valve-mask, under capnographic monitoring.Main measurementsCapnometric levels obtained according to the device used, number of insertions of the I-Gel®, cases without achieving correct insertion/ventilation by branches, achievement of ROSC in CPR and number of hospital live admissions.ResultsTwenty-three cases were recruited for analysis. The insertion success rate of the I-Gel® was 92.9% at the first attempt, the mean capnometric values were 16.3 mmHg in the control group and 27.4% in the intervention group. 34.8% (n = 8) of the patients achieved spontaneous circulation recovery at some point and 26.1% (n = 6) were admitted to hospital alive. The survival analysis, taking into account the arrival of the unit and the first minute of ventilations recorded together with the variable hospital admission, suggests a certain trend of greater survival in the intervention branch (P = .066).ConclusionsThe use of I-Gel® raises an improvement in the ventilation of the patients in PCR, evidenced by the mean capnometric values in the intervention group, finding no correlation with CPR outcome variables.     

医用外科口罩和防护口罩生物气溶胶过滤效率的评价

目的:对医用外科口罩和防护口罩的颗粒过滤效率(particle filtration efficiency,PFE)、细菌过滤效率(bacte-rial filtration efficiency,BFE)及病毒过滤效率(viral filtration efficiency,VFE)进行评价。方法:参照YY 0469-2011《医用外科口罩》对不同品牌医用外科口罩在不同生物气溶胶平均颗粒直径(mean particle size,MPS)、不同流量条件下进行PFE、BFE和VFE测试,并分析医用外科口罩PFE和BFE的相关性、BFE和VFE的差异以及实际佩戴+热水浸泡处理后PFE和BFE的变化。参照GB 19083-2010《医用防护口罩技术要求》和YY/T 1497-2016《医用防护口罩材料病毒过滤效率评价测试方法 Phi-X174噬菌体测试方法》对3种防护口罩进行PFE和VFE检测。采用SAS 8.2软件进行统计学分析。结果:医用外科口罩对MPS约为3 μm的气溶胶的BFE高于MPS约为2 μm的BFE;流量越高,PFE越低;对PFE较低的医用外科口罩,BFE与PFE呈现一定相关性(MPS约为2 μm 时R2=0.671 8,MPS约为3 μm 时R2=0.776 5);医用外科口罩的VFE略低于BFE;3种防护口罩的VFE>99.98%;医用外科口罩佩戴8 h后经65 ℃热水浸泡处理30 min,细菌和真菌总数降低至0~60 cfu/g;新医用外科口罩经3次热水浸泡处理后,其PFE基本未发生变化,但佩戴过的口罩经过热水浸泡处理后,PFE和BFE均出现不同程度的降低。结论:该研究可为医用外科口罩和防护口罩的科学使用和相应标准的修订提供数据支撑。     

喉部分切除会厌喉成形术疗效研究(附32例报告)

目的 :探讨会厌喉成形术的可行性及手术方法 ;。方法 :行喉部分切除术后用会厌软骨行喉成形术32例。结果 :在彻底切除喉癌后 ,下移会厌修复残存喉腔的前壁或侧前壁 ,患者恢复了全部或部分 (发声、吞咽保护 )喉功能并保留了会厌的全部或部分功能。 3年、5年存活率分别为 87.5%、76% ,发音成功率为1 0 0 %。结论 :会厌是喉部分切除喉成形术理想的修复材料之一。     

喉癌围手术期细胞免疫功能改变的意义

目的：了解喉癌患者围手术期细胞免疫的状况及手术相关因素对患者细胞免疫的影响;了解T淋巴细胞水平与喉癌临床特征,病程进展的关系。方法：应用SAP法检测喉癌术前2d及术后12d外周血CD3^ ,CD4^ ,CD8^ 细胞水平及CD4^ ／CD8^ 比率的改变,并联系临床分期、淋巴结转移,复发综合分析。结果：喉癌患者CD3^ ,CD4^ ,CD8^ 细胞水平及CD4^ ／CD8^比正常对照组明显下降;术后CD3^ ,CD4^ ,CD8^ 有进一步下降的倾向。晚期喉癌患者CD4^＋细胞水平,CD4^ ／CD8^ 比率明显下降（P＜0．05）。淋 巴结转移者CD4^ ／CD8^ 亦下降,CD8^ 细胞水平却相对升高;复发患者的CD8^ 细胞水平相对提高。结论：喉癌患者T淋 巴细胞免疫功能低下,全麻、手术创伤及术后复合因素是喉癌术后免疫功能进一步低下的原因。CD4^ ,CD8^ 细胞水平及CD4^ ／CD8^ 比率是表明喉癌患者病期进展,淋巴结转移,复发的免疫学指标,围手术期需行免疫治疗。     

再造含披裂软骨的喉发声管在次全喉切除术中的应用(附7例报告)

目的 :于次全喉切除术后重建喉发声功能。方法 :7例喉癌病变范围 T3 N0 M0 行次全喉切除术 ,术中保留健侧的披裂软骨及杓间区粘膜 ,用披裂软骨与下咽粘膜制作具有括约功能的喉发声管。结果 :患者术后发声功能良好 ,无误吸。随访 2～ 5年 ,死亡 2例 ,健在 5例。结论 :该术式可保存部分喉功能。     

治疗复发性喉乳头状瘤喉造口激光切除术

目的：研究治疗复发性喉乳头状瘤的方法。方法：为3例病变范围广泛或多次复发的喉乳头状瘤患者行喉造口激光切除术。结果：3例患者分别经过3次,2次,10次手术治愈,经过半年到3年的随访,肿瘤无复发,喉功能恢复良好。结论：1、此种术式通过一次喉造口,可充分暴露病变,反复精确地切除肿瘤,从而有效地减少了肿瘤种植及复发,可多次切除病变而不需反复行喉裂开术,损伤相对较小,适用于易复发且范围广的喉乳头状瘤,2、采用激光手术治疗喉乳头状瘤,可有效地恢复正常的喉功能,损伤小,疗效好。     

喉癌下咽癌TGFβ1、p16表达的意义

目的 :通过对喉癌、下咽癌组织中转化生长因子 β1(TGFβ1)及 p16蛋白的定位、半定量研究 ,探讨其在喉癌、下咽癌组织中的表达与意义。方法 :采用SABC免疫组化法研究TGFβ1与 p16蛋白的表达 ,并对表达结果进行统计分析。结果 :TGFβ1位于胞浆 /胞膜 ,p16蛋白位于胞浆 /胞核。TGFβ1强表达率为61% ,p16蛋白强表达率为 66%。高分化与中、低分化肿瘤的TGFβ1表达均有统计学差异 (P <0 .0 5) ;高分化与低分化肿瘤的 p16蛋白表达具统计学差异 (P <0 .0 5)。TGFβ1和 p16蛋白之间存在正相关系 (P <0 .0 5)。TGFβ1和 p16蛋白的表达与患者年龄、性别、肿瘤生长部位、病程、临床分期无明显相关。 结论 :TGFβ1与 p16蛋白在喉癌、下咽癌中存在缺失表达 ,在高分化肿瘤中有更高的表达 ,在细胞周期中具有共同的作用。     

Role of lateral neck dissection in cancers of the larynx and hypopharynx with No neck

Radical neck dissection is a standard procedure carried out for the teatment of palpable nodes in the neck but if carried out electively in cases where there are no palpable nodes in the neck it is considered to be an overtreatment with its associated morbity. Lateral neck dissection was carried out on twenty patients who had T31 T4 lesion of the larynx and hypophar-vnx with NO neck. The dissection entails removal of Level II. III and IV nodes. Occult metastasis 80% and 85% respectively. The mean follow up was 13 monts. It appears from our study that elective lateral neck dissection is a promising and safe procedure and may be useful as an important prognostic tool in sampling the lymph nodes and predicting recurrences in the neck.     

Conservative Surgery in T3–T4 Pharyngolaryngeal Squamous Cell Carcinoma: An Alternative to Radiation Therapy and to Total Laryngectomy for Good Responders to Induction Chemotherapy

Objective To evaluate the possibility of preservation of the larynx after neoadjuvant chemotherapy by performing a conservative surgery instead of total laryngectomy initially planned, in patients with previously untreated laryngeal and piriform sinus squamous cell carcinoma (SCC). Study Design Retrospective study. Methods A total of 115 patients treated at Tenon Hospital with induction chemotherapy from 1985 to 1995, all with initial indication of radical surgery, were available for the study. The clinical tumor response was evaluated after three cycles of chemotherapy. According to this response, to preserve laryngeal functions, some patients had a modification of the treatment initially planned: radiation therapy essentially for complete responders, and conservative surgery for some partial responders. Results Of 69 patients with laryngeal cancer, 14 were treated by partial laryngectomy and 19 by radiation therapy; of 46 patients with piriform sinus cancer, 8 were treated by partial surgery and 12 by radiation therapy; the other patients were treated as was initially planned (total laryngectomy with partial pharyngectomy). Overall survival rates, estimated by the Kaplan‐Meier method, were not statistically different between the three treatment groups. The laryngeal functions were preserved in 54% of the patients who were alive at 3 years. Conclusion This report is a retrospective study, but these results suggest the possibility of using conservative surgery, instead of initially planned total laryngectomy, for good responders to induction chemotherapy with a small residual tumor.