Usefulness of Jackson mask ventilation during bronchoscopy in patients with acute respiratory failure: A retrospective review

Bronchoscopy is a procedure for diagnosis and treatment decision-making in patients with lung disease, especially those with acute respiratory failure. However, the optimal bronchoscopic method for patients with acute respiratory failure is not known. Therefore, in the real world, we sometimes hesitate to perform bronchoscopy in such patients because of safety and have experienced treating patients without bronchoscopy. To address this problem, we evaluated the usefulness and safety of Jackson mask ventilation, a novel noninvasive method of bronchoscopy performed under mask ventilation using the Jackson Rees circuit, in patients with acute respiratory failure.We retrospectively reviewed patients with acute respiratory failure who underwent bronchoscopy at our institution between January 2015 and May 2018. We compared patients who received Jackson mask ventilation (Jackson group) and those who received conventional oxygen administration (conventional group). Mean percutaneous oxygen saturation (SpO₂) and mean oxygen flow rate were compared between the groups by the Wilcoxon signed-rank test. We excluded patients who were intubated and those without acute respiratory failure who received Jackson mask ventilation preventively.Of 1262 patients who underwent bronchoscopy, 12 were classified into the Jackson group and 13 into the conventional group. Proper oxygenation was maintained in the Jackson group, with SpO₂ increasing after Jackson mask ventilation (89.4% to 96.8%, P = .03). Mean SpO₂ was significantly higher in the Jackson group than in the conventional group (96.8% vs 95.2%, P = .03). Mean oxygen flow rate was significantly lower in the Jackson group (4.0 L/min vs 7.9 L/min, P < .001). There was no significant difference in safety.Our findings suggest that Jackson mask ventilation is safe and effective when performing bronchoscopy in patients with acute respiratory failure. Jackson mask ventilation maintained proper oxygenation and decreased the oxygen flow rate compared with the conventional method. Using Jackson mask ventilation, we could perform bronchoscopy safely and effectively in patients with acute respiratory failure, including some who had unstable respiratory status. (UMIN000038481).     

Study on Rheological Properties of Bituminous Binders and Mixtures Containing Waste Printed Circuit Boards (PCBs) and SBR Compound Modified Bitumen

Improper handling of waste printed circuit boards (PCBs) can cause serious pollution to the water and soil environments. In order to explore a new method of recycling waste PCBs, this study investigated the effect of PCBs and butadiene styrene rubber (SBR) on the rheological properties of neat bitumen. The dynamic shear rheological (DSR) test was used to study the effect of different PCB contents on the high-temperature rheological properties of SBR-modified bitumen. Fluorescence microscopy and Fourier-transform infrared spectroscopy were used to study the microstructure change law and modification mechanism of PCB and SBR composite modified bitumen. Finally, the feasibility of the bitumen properties was verified through a test of the bituminous mixture properties. The DSR test results showed that the addition of PCBs improves the elastic recovery modulus, dynamic shear modulus, and rutting factor of SBR-modified bitumen, indicating that the high-temperature properties were improved. Infrared spectroscopy analysis revealed that a new absorption peak was generated in the infrared spectrum of the compound bitumen after the addition of PCBs, and the intensity of the original absorption peak also changed, indicating that PCBs and SBR-modified bitumen were mainly physically blended and accompanied by a weak chemical reaction. It was further found that the absorption peak of the unsaturated C=C double bond was significantly enhanced, and the increase in the content of the unsaturated bond C=C in the main chain of the polymer significantly increases the stiffness of the bitumen. Macroscopically, the high-temperature rutting resistance was improved to a certain extent. The fluorescence diagram shows that when PCBs do not exceed 10%, the PCBs can form a homogeneous structure and be dispersed in SBR-modified bitumen. The road test of PCBs and SBR composite modified bituminous mixtures showed that PCBs can significantly improve the rutting resistance and water stability of SBR-modified bitumen at high temperatures at the recommended optimum content. The crack resistance at low temperatures is weakened but still meets actual engineering requirements. The correlation analysis between the properties of bitumen and bituminous mixtures is carried out based on grey correlation theory. The results show that the index of modified bitumen has a very good guiding effect on the bituminous mixture properties. The development of PCBs and SBR composite-modified bitumen provides a new practical method for recycling waste PCBs.     

不同顺应性微量注射泵泵用延长管阻塞报警延迟时间的研究

目的提高微量注射泵使用的安全性。方法采用2×3析因设计,用医用三通人为制造阻塞模型,记录不同顺应性微量注射泵泵用延长管在不同泵注速度下的阻塞报警延迟时间,并进行统计分析。结果两种泵用延长管在不同的泵注速度下均存在阻塞报警时间延迟,最短为（414．43±64．67）s,最长为（2770．16±420．20）S;泵速越慢,报警延迟时间越长（P〈0．05）。当泵速为5ml／h和10ml／h时,泵速相同使用软硬管的报警延迟时间差异无统计学意义（P〉0．05）。但当以2ml／h的速度泵注药物时,软管报警延迟时间较硬管长（P〈0．05）。结论护士要正确认识微量注射泵泵注阻塞报警延迟并及时干预处理,合理选择泵用延长管类型,合理调节微量注射泵泵注速度,减少各种阻塞导致的报警延迟,提高微量注射泵使用的安全性,保证病人安全。     

自制尿液报警器在颅脑损伤伴尿失禁患者中的应用

目的 了解自制尿液报警器在颅脑损伤伴尿失禁患者中的应用效果.方法 选取2010年3月至2011年11月解放军第94医院神经外科收治的颅脑损伤伴尿失禁患者138例,根据入院先后将其分为对照组71例和观察组67例,对照组患者定时更换接尿具,观察组患者则加用尿液报警器,记录并比较两组患者入院1周内的会阴及臀部皮肤损伤情况、排尿后的单次护理时间及24 h累计护理时间.结果 观察组和对照组患者皮肤损伤的发生率分别为1.49％、11.27％,两组差异有统计学意义（x2＝3.92,P＜0.05）;观察组患者排尿后的单次及24 h累计护理时间均短于对照组,差异均有统计学意义（均P＜0.05）.结论 应用自制尿液报警器能有效预防颅脑损伤伴尿失禁患者发生红肿、湿疹、破溃等皮肤并发症,有利于提高护理工作效率.     

Dedicated olfactory neurons mediating attraction behavior to ammonia and amines in Drosophila

Animals across various phyla exhibit odor-evoked innate attraction behavior that is developmentally programmed. The mechanism underlying such behavior remains unclear because the odorants that elicit robust attraction responses and the neuronal circuits that mediate this behavior have not been identified. Here, we describe a functionally segregated population of olfactory sensory neurons (OSNs) and projection neurons (PNs) in Drosophila melanogaster that are highly specific to ammonia and amines, which act as potent attractants. The OSNs express IR92a, a member of the chemosensory ionotropic receptor (IR) family and project to a pair of glomeruli in the antennal lobe, termed VM1. In vivo calcium-imaging experiments showed that the OSNs and PNs innervating VM1 were activated by ammonia and amines but not by nonamine odorants. Flies in which the IR92a⁺ neurons or IR92a gene was inactivated had impaired amine-evoked physiological and behavioral responses. Tracing neuronal pathways to higher brain centers showed that VM1-PN axonal projections within the lateral horn are topographically segregated from those of V-PN and DC4-PN, which mediate innate avoidance behavior to carbon dioxide and acidity, respectively, suggesting that these sensory stimuli of opposing valence are represented in spatially distinct neuroanatomic loci within the lateral horn. These experiments identified the neurons and their cognate receptor for amine detection, and mapped amine attractive olfactory inputs to higher brain centers. This labeled-line mode of amine coding appears to be hardwired to attraction behavior.     

“Turn It Off!”: Diabetes Device Alarm Fatigue Considerations for the Present and the Future

Safe and widespread use of diabetes technology is constrained by alarm fatigue: when someone receives so many alarms that he or she becomes less likely to respond appropriately. Alarm fatigue and related usability issues deserve consideration at every stage of alarm system design, especially as new technologies expand the potential number and complexity of alarms. The guiding principle should be patient wellbeing, while taking into consideration the regulatory and liability issues that sometimes contribute to building excessive alarms. With examples from diabetes devices, we illustrate two complementary frameworks for alarm design: a “patient safety first” perspective and a focus on human factors. We also describe opportunities and challenges that will come with new technologies such as remote monitoring, adaptive alarms, and ever-closer integration of glucose sensing with insulin delivery.     

PirB regulates a structural substrate for cortical plasticity

Experience-driven circuit changes underlie learning and memory. Monocular deprivation (MD) engages synaptic mechanisms of ocular dominance (OD) plasticity and generates robust increases in dendritic spine density on L5 pyramidal neurons. Here we show that the paired immunoglobulin-like receptor B (PirB) negatively regulates spine density, as well as the threshold for adult OD plasticity. In PirB^−/− mice, spine density and stability are significantly greater than WT, associated with higher-frequency miniature synaptic currents, larger long-term potentiation, and deficient long-term depression. Although MD generates the expected increase in spine density in WT, in PirB^−/− this increase is occluded. In adult PirB^−/−, OD plasticity is larger and more rapid than in WT, consistent with the maintenance of elevated spine density. Thus, PirB normally regulates spine and excitatory synapse density and consequently the threshold for new learning throughout life.Experience generates both functional and structural changes in neural circuits. The learning process is robust at younger ages during developmental critical periods and continues, albeit at a lower level, into adulthood and old age (1–3). For example, young barn owls exposed to horizontally shifting prismatic spectacles can adapt readily to altered visual input, but adult owls cannot. The experience in the young owls results in a rearranged audiovisual map in tectum that is accompanied by ectopic axonal projections (1). Experience-dependent structural changes have also been observed in the mammalian cerebral cortex. Enriched sensory experience or motor learning are both associated with an increase in dendritic spine density, and a morphological shift from immature thin spines to mushroom spines which harbor larger postsynaptic densities (PSDs) and stronger synapses (4–7). On the flip side, bilateral sensory deprivation induces spine loss (8, 9). Abnormal sensory experience also results in structural modification of inhibitory synapses and circuitry that is temporally and spatially coordinated with changes in excitatory synapses on dendritic spines (10–13).These experience-driven spine changes are thought to involve synaptic mechanisms of long-term potentiation (LTP) and long-term depression (LTD). In hippocampal slices, induction of LTP causes new spines to emerge, as well as spine head enlargement on existing spines (14–16); induction of LTD results in rapid spine regression (14, 17). Importantly, the emergence or regression of spines starts soon after the induction of LTP or LTD, suggesting that these structural changes underlie the persistent expression of long-term plasticity (14, 17).Little is known about molecular mechanisms that restrict experience-dependent plasticity at circuit and synaptic levels and connect it to spine stability. Paired Ig-like receptor B (PirB), a receptor expressed in cortical pyramidal neurons, is known to limit ocular dominance (OD) plasticity both during the critical period and in adulthood (18). PirB binds major histocompatibility class I (MHCI) ligands, whose expression is regulated by visual experience and neural activity (19–21) and thus could act as a key link connecting functional to structural plasticity. If so, mice lacking PirB might be expected to have altered synaptic plasticity rules on the one hand and changes in the density and stability of dendritic spines on the other.     

Evaluation of the Effects of Insufficient Blood Volume Samples on the Performance of Blood Glucose Self-Test Meters

Background

Accuracy of blood glucose readings is (among other things) dependent on the test strip being completely filled with sufficient sample volume. The devices are supposed to display an error message in case of incomplete filling. This laboratory study was performed to test the performance of 31 commercially available devices in case of incomplete strip filling.

Methods

Samples with two different glucose levels (60–90 and 300–350 mg/dl) were used to generate three different sample volumes: 0.20 µl (too low volume for any device), 0.32 µl (borderline volume), and 1.20 µl (low but supposedly sufficient volume for all devices). After a point-of-care capillary reference measurement (StatStrip, NovaBiomedical), the meter strip was filled (6x) with the respective volume, and the response of the meters (two devices) was documented (72 determinations/meter type). Correct response was defined as either an error message indicating incomplete filling or a correct reading (±20% compared with reference reading).

Results

Only five meters showed 100% correct responses [BGStar and iBGStar (both Sanofi), ACCU-CHEK Compact+ and ACCU-CHEK Mobile (both Roche Diagnostics), OneTouch Verio (LifeScan)]. The majority of the meters (17) had up to 10% incorrect reactions [predominantly incorrect readings with sufficient volume; Precision Xceed and Xtra, FreeStyle Lite, and Freedom Lite (all Abbott); GlucoCard+ and GlucoMen GM (both Menarini); Contour, Contour USB, and Breeze2 (all Bayer); OneTouch Ultra Easy, Ultra 2, and Ultra Smart (all LifeScan); Wellion Dialog and Premium (both MedTrust); FineTouch (Terumo); ACCU-CHEK Aviva (Roche); and GlucoTalk (Axis-Shield)]. Ten percent to 20% incorrect reactions were seen with OneTouch Vita (LifeScan), ACCU-CHEK Aviva Nano (Roche), OmniTest+ (BBraun), and AlphaChek+ (Berger Med). More than 20% incorrect reactions were obtained with Pura (Ypsomed), GlucoCard Meter and GlucoMen LX (both Menarini), Elite (Bayer), and MediTouch (Medisana).

Conclusions

In summary, partial and incomplete blood filling of glucose meter strips is often associated with inaccurate reading. These findings underline the importance of appropriate patient education on this aspect of blood glucose self-monitoring.     

Alarm limit settings for early warning systems to identify at-risk patients

Title.  Alarm limit settings for early warning systems to identify at-risk patients.
Aim.  This paper is a report of a study conducted to provide objective data to assist with setting alarm limits for early warning systems.
Background.  Early warning systems are used to provide timely detection of patient deterioration outside of critical care areas, but with little data from the general ward population to guide alarm limit settings. Monitoring systems used in critical care areas are known for excellent sensitivity in detecting signs of deterioration, but give high false positive alarm rates, which are managed with nurses caring for two or fewer patients. On general wards, nurses caring for four or more patients will be unable to manage a high number of false alarms. Physiological data from a general ward population would help to guide alarm limit settings.
Methods.  A dataset of continuous heart rate and respiratory rate data from a general ward population, previously collected from July 2003–January 2006, was analyzed for adult patients with no severe adverse events. Dataset modeling was constructed to analyze alarm frequency at varying heart rate and respiratory rate alarm limits.
Results.  A total of 317 patients satisfied the inclusion criteria, with 780·71 days of total monitoring. Sample alarm settings appeared to optimize false positive alarm rates for the following settings: heart rate high 130–135, low 40–45; respiratory rate high 30–35, low 7–8. Rates for each selected limit can be added to calculate the total alarm frequency, which can be used to judge the impact on nurse workflow.
Conclusion.  Alarm frequency data will assist with evidence-based configuration of alarm limits for early warning systems.