Exercise Intolerance in Patients With Heart Failure: JACC State-of-the-Art Review

Exercise intolerance is the cardinal symptom of heart failure (HF) and is of crucial relevance, because it is associated with a poor quality of life and increased mortality. While impaired cardiac reserve is considered to be central in HF, reduced exercise and functional capacity are the result of key patient characteristics and multisystem dysfunction, including aging, impaired pulmonary reserve, as well as peripheral and respiratory skeletal muscle dysfunction. We herein review the different modalities to quantify exercise intolerance, the pathophysiology of HF, and comorbid conditions as they lead to reductions in exercise and functional capacity, highlighting the fact that distinct causes may coexist and variably contribute to exercise intolerance in patients with HF.     

The effect of various in-vitro and ex-vivo parameters on irrigant flow and apical pressure using manual syringe needle irrigation: Systematic review

BackgroundFluid dynamics is a majorly neglected aspect to be studied in root canal irrigation. The fundamental rule to understand mechanics is to observe patterns of flow during the process. Thus, this work is conducted to do a systemic assessment of the in-vitro and ex-vivo based studies to evaluate the effect of various parameters on the irrigant flow and apical pressure on using a manual syringe needle for root canal irrigation.MethodsThe literature search was conducted through libraries such as PubMed (Medline), CINAHL, Embase, Scopus and other hand literature from Google Scholar, the British medical library etc. The systematic review was reported following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. As they include studies that were in-vitro and ex-vivo based, the risk of bias of the selected articles was assessed using a customized tool based on the previous literature and parameters evaluated in the studies included.ResultsThe literature search resulted in 101 items of which 19 records were included in this review. Results reported that multiple factors and parameters were assessed to evaluate the flow and apical pressures on using manual syringe needle irrigation.ConclusionsPresent systematic review gives insights in-depth about the irrigation dynamics of manual syringe needle irrigation. Besides, it is inconclusive to compile a single factor or a single parameter contributing to the enhanced irrigant flow and least apical pressures.     

重症肺炎并呼吸衰竭患儿接受早期持续气道正压通气治疗对血气指标及预后的影响

目的分析重症肺炎并呼吸衰竭患儿接受早期持续气道正压通气(CPAP)治疗对血气指标及预后的影响。方法选取2019年2月至2020年6月本院收治的110例重症肺炎并呼吸衰竭患儿,按照组间基本资料具有可比性的原则分为对照组与实验组,各55例。对照组接受常规方案治疗,实验组接受早期持续CPAP治疗,比较两组血气指标改善情况以及患儿预后。结果治疗后,两组PaO₂、PaCO₂、SaO₂均显著改善,且实验组改善程度明显优于对照组(P<0.05)。实验组临床病死率明显低于对照组(P<0.05)。两组并发症发生率比较差异无统计学意义。结论采用早期持续CPAP治疗重症肺炎并呼吸衰竭患儿效果显著,能明显改善血气指标和预后,具有临床推广价值。     

Neuroprotection in paediatric traumatic brain injury

Traumatic brain injury (TBI) is the leading cause of trauma-related death and disability in children worldwide. The outcome from TBI can be improved by early aggressive management of oxygenation and blood pressure. There is evidence to suggest that adhering to guidelines when managing these patients can have a positive effect on the outcomes. In this article we review the general supportive and targeted neuroprotective measures that are outlined in international paediatric guidelines and are most widely used in the critical care management of patients with TBI; we further review how these measures can influence the underlying evolving pathophysiology in these patients. The aim of critical care management of patients with TBI is to prevent or limit secondary brain injury by optimizing cerebral perfusion and oxygenation to improve survival and clinical outcomes. We also discuss how to monitor patients with traumatic brain injury on the paediatric intensive care unit and we give a practical approach on how to respond to deteriorating patients and to the complications arising during the course of their management.