bluuebunny/crossref_metadata_2025 huggingface dataset:
An Overview and Awareness of Acute Coronary Syndrome Based on Risk Factors, Early Clinical Assessment Tools, and Improving Clinical Outcomes
Authors: D'souza Eulalia
Published: May 2019

Background

Cardiovascular disease is the leading cause of death worldwide accounting for 17.3 million deaths per year, a number that is estimated to grow to more than 23.6 million by 2030. Coronary artery disease (CAD) is the most common form of cardiovascular diseases and remains the number one cause of death in the United States, killing more than 375,000 Americans every year. Acute coronary syndrome (ACS) is a manifestation of CAD, which is life threatening and an emergency situation.

Objective

To provide an overview and an awareness of ACS based on risk factors, early clinical assessment tools, and to improving clinical outcomes.

Methods

For registered nurses (RNs) in any clinical setting, this overview will educate and inform nurses how they can approach patient care in an urgent and timely manner.

Results

Advances in diagnostic cardiac biomarkers, risk assessment tools, medical management, and invasive strategies have allowed for earlier and more accurate diagnosis and treatment of ACS, thereby improving clinical outcomes.

Conclusions

Competence in early recognition of the major differences in clinical presentation of ACS will enable prompt diagnosis and initiation of proven therapies.

Implications for Nursing Practice

As the prevalence for ACS continues to rise, RNs in all clinical settings should make a concerted effort to identify and mitigate risk factors early as well as to recognize, diagnose, and respond to ACS events in a timely manner.
The Impact of Shift Work on Diabetes Self-Management Activities
Authors: Navarro Daniel J. , Alpert Patricia T. , Cross Chad
Published: May 2019

Background

Once a person is diagnosed with diabetes, aggressive management is imperative to minimize poor glycemic control devastating outcomes. However, for some patients reaching optimum blood glucose levels is challenging due to the complexity of diabetes care. To achieve good blood glucose control, patients affected by diabetes must engage in self-care activities that include routine blood glucose check, dietary control, physical activity, medication regimen, and routine medical provider visits. Diabetes-associated self-care activities aimed to reach good blood glucose control can be hindered by multiple factors including shift work.

Objective

To evaluate self-management activities of individuals affected by diabetes who are employed as shift workers. This study also informs primary care nurse practitioners of the challenges shift workers face in managing their disease.

Methods

This was a cross-sectional descriptive study. Participants were individuals affected by type II diabetes from a single primary care practice (N = 86); 45 were individuals working on the dayshift and 41 worked on the evening/night shift. Each participant completed the diabetes self-management questionnaire and author-developed demographic/supplemental questionnaire.

Conclusions

There were no differences in self-reported diabetes management activities (i.e., physical activity, glucose management, and healthcare use) between the two groups. Thirty-nine percent of participants working shifts reported worse sleep patterns compared to their dayshift counterparts (X2[1, N = 85] = 8.73, p = .003). Evening/night shift workers also reported more symptoms such as leg pain, fungal infection, numbness of the feet and legs, dizziness, and vision changes (X2[1, N = 79] = 43.037, p < .001).

Implications for Practice

A better understanding of the impact that shift work has on diabetes care may help healthcare providers formulate meaningful treatment plans to meet the needs of evening/night shift diabetic workers. The use of a patient-centered medical home is one strategy.
Development and Evaluation of Preoperative Teaching Materials for CABG/Valve Surgery Patients
Authors: McLaughlin Patricia A.
Published: May 2019

Background

Patients often experience anxiety and feel overwhelmed by the prospect of undergoing open-heart surgery. Randomized controlled trials have found preoperative education materials and counseling to reduce levels of patient anxiety, depression, and perioperative complications following coronary artery bypass grafting (CABG)/valve surgery.

Objective

The purposes of this performance improvement project were to develop preoperative teaching materials for cardiac surgery inpatients and evaluate their usability.

Methods

Existing CABG/valve teaching materials were evaluated. A new booklet was developed through an iterative process. An expert panel reviewed the final draft using the patient education materials assessment tool for printable materials (PEMAT-P). Patients were surveyed for usability and usefulness.

Results

Expert reviewer results for using the PEMAT-P tool for understandability and actionability were 99% and 100%. Of 62 teaching booklets and patient preparedness questionnaires distributed, N = 11 (17.7%) were returned. Nearly all respondents (90.9%) agreed or strongly agreed for questions related to how well the booklet prepared them for surgery. Likewise, 90.9% of respondents agreed or strongly agreed with statements about design and content of the booklet. The hospital consumer assessment of healthcare providers and systems performance reports from October 1, 2016 to December 31, 2016 showed improvement for discharge information (96.2% from 92.2%), symptom to look for (100% from 94.9%), and care transitions (66.2% from 54.3%).

Conclusions

The development and implementation of evidence-based preoperative teaching materials help patients and families prepare for open-heart surgery and self-care after discharge.

Implications for Nursing

Nurses' utilization of preoperative teaching materials improves patient satisfaction, preparedness, and usefulness.
What Is It All About? Examining the Sustainability of the DNP Project
Authors: Ketron Christina J.
Published: May 2019

Background

Students invest many hours of work conducting root cause analyses, researching clinical practice guidelines, and implementing quality improvement projects for their Doctor of Nursing Practice (DNP). Often when the student graduates, however, the logistics and details of the project can fall by the wayside.

Objective

The aim of this clinical article is to begin the conversation about the sustainability of the DNP project and provide suggestions for further research and linear curriculum consideration.

Methods

A review of literature was conducted to examine the history of the DNP project and any efforts being made to support project sustainability. The PubMed database was utilized for data sourcing, including full text published in the last 10 years and English language.

Results

Findings demonstrated variability in the DNP project across nursing programs, however, what was more apparent was the lack of research on project sustainability itself.

Conclusions

The DNP project serves to demonstrate the rigor and quality of the terminal practice degree in nursing, therefore, sustainability of the project would support its significance.

Implications for Nursing

This article provides a starting point for research on DNP project sustainability and provides suggestions for how this could be accomplished through academic–practice partnerships and linear communication across nursing curricula.
Interaction of dietary protein and energy-protein ratio on growth performance of snakehead Channa striata
Authors: Wijianti Hani , Suprayudi Muhammad Agus , Utomo Nur Bambang Priyo , Jusadi Dedi
Published: May 2019

ABSTRACTThe study proposed to discover the optimum protein content and energy-protein ratio in practical diet for snakehead, Channa striata. The experiment applied complete randomized design, consisted of six treatments with four replications on each treatment. The treatments were: A (32.5%; 11.82 kcal GE/g), B (32.5%; 13.32 kcal GE/g), C (37.17%; 10.64 kcal GE/g), D (37.33%; 12.07 kcal GE/g), E (43.08%; 10.02 kcal GE/g), and F (42.88%; 10.66 kcal GE/g). Snakehead with average weight of 6.21 ± 0.03 g were reared for 8 weeks. The treatments showed significant results. Increased protein dietary level had increased the growth rate and treatment with high energy-protein ratio at the same protein dietary level provided better growth performance. However, increased energy-protein ratio at E and F treatments caused a decline in growth performance. The improvement of energy-protein dietary ratio had positive correlation with the level of lipid and protein content in fish body. Similar finding was found in liver and muscle glycogen. The results also showed that the increament of energy-protein dietary ratio was significantly and positively correlated with cholesterol, triglyceride, HDL, glucose, and albumin, yet it had no significant effect on LDL. It can be concluded that excellent growth performance was achieved by protein dietary level of 37.33% and energy-protein ratio of 12.07 kcal GE/g.Keywords: energy-protein ratio, growth, snakehead ABSTRAKPenelitian ini bertujuan untuk memperoleh kadar protein dan rasio energi-protein pakan buatan yang optimum bagi performa pertumbuhan ikan gabus. Penelitian ini mengaplikasikan rancangan acak lengkap dengan 6 perlakuan, yaitu: A (32,78%;11,82  kkal GE/g), B (32,56%;13,32 kkal GE/g), C (37,17%:10,64 kkal GE/g), D (37,33%:12,07 kkal GE/g), E (43,08%:10,02 kkal GE/g), dan F (42,88%:10,66 kkal GE/g) dan masing-masing terdiri 4 ulangan. Bobot rata-rata ikan gabus yang digunakan dalam penelitian ini yaitu 6,21 ± 0,03 g dan dipelihara selama 8 minggu. Hasil penelitian menunjukkan bahwa peningkatan kadar protein pakan meningkatkan laju pertumbuhan, dan perlakuan dengan rasio energi-protein tinggi pada level protein pakan yang sama memberikan kinerja pertumbuhan yang lebih baik. Namun demikian, pada perlakuan E dan F, peningkatan rasio energi-protein menyebabkan penurunan kinerja pertumbuhan. Peningkatan rasio energi-protein pakan berkorelasi positif terhadap kadar lemak dan protein tubuh ikan. Hal yang sama juga terjadi pada glikogen hati dan otot. Hasil penelitian juga menunjukkan bahwa peningkatan rasio energi-protein pakan berpengaruh nyata (P<0,05) dan  berkorelasi positif terhadap kolesterol, trigliserida, HDL, dan albumin, tetapi tidak berpengaruh nyata terhadap LDL  (P>0.05). Kesimpulan yang didapat adalah kinerja pertumbuhan optimal dihasilkan oleh kadar protein pakan 37,33% dan rasio energi protein pakan 12,07 kkal GE/g.Kata kunci: albumin, energi, ikan gabus, pertumbuhan, protein
Hak Pilih Penyandang Disabilitas dalam Pemilihan Umum di Indonesia
Authors: Rahman Moh Syaiful , Indrayati Rosita
Published: May 2019

The birth of Law No. 7 of 2017, as compared to Law No. 42 of 2008 about the General Election of President and Vice President, includes a difference in Article 5. The requirement in Article 5 is not followed by an explanation of what are the requirements that must be fulfilled by persons with disabilities, and there is no mention of the requirement so as to raise the question of such requirements are contradictory to the 1945 Constitution of the State of the Republic of Indonesia more specifically those requirements are contradictory or not with Law Number 39 of 1999 Article 43 that every citizen has the right to be elected and elect in elections based on equality of rights through voting in accordance with the provisions of legislation. The research used for preparation of this thesis is juridical normative.This research uses legislative and analytical approaches. Persons with disabilities enrolled in the Special Electoral List may empower  persons with disabilities to exercise their suffrage.

Keywords: Suffrage, Disability and General Elections
Model Kontrol Keimigrasian dalam Mencegah Tindak Pidana Terorisme di Indonesia
Authors: Citrawan Harison , Nadilla Sabrina
Published: May 2019

This article attempts to elaborate an immigration control model that is capable in preventing terrorist activities in Indonesia. By observing several terrorism case-laws, this study draws a nexus between terrorism and several aspects within immigration, including passport issuance, border control, foreigner surveillance, and visa and entry permit issuance. Technically, in relation to such a nexus, this study finds that the current immigration control model is built upon three elements of duty: namely intelligence, surveillance, and border control. In principle, these three elements ought to be executed as an interconnected cycle. Consequently, a preventive control model should be circular, in the sense that any activities between elements of duty cannot be separated from one another. In order to become an established terrorism prevention mechanism, this control model requires information and data exchange amongst the immigration units. Moreover, any involvements from other institutions, such as police, BNPT, BIN, and NCB-Interpol are also preconditioned to ensure the efficacy of the circular model.

Keywords: Immigration, Control, Terrorism
Good Selling Buying Agreement and Legal Protection for Sellers
Authors: Eleanora Fransiska Novita , Sari Andang
Published: May 2019

The concept of the agreement is accorded to Article 1313 of the Civil Code (KUHPdt). According to the Civil Code, what is said as an act is an agreement with one person with another person and can be said more and in mutual binding. The scope of the agreement is too broad, including the marriage agreement regulated in the field of family law. A unilateral agreement is an agreement that is not allowed which is indeed not only coming or popping up from various parties or parties, and also not permitted between the two or the other parties. In the agreement there should be an element of binding to each other, meaning that the party from the other agreement maker can always tie themselves to the other party and the other party also binds themselves to those who are different or different. The agreement is evident between the two parties. Without stating the purpose in an agreement by the parties that make the agreement and for what the agreement was made, moreover the contents of the agreement are unclear and prohibited by law. This study uses a research method that is literature study where by referring to literature or books and the rules of existing or normative legislation. The results achieved are then it can be said that the agreement is null and void. According to these reasons, the concept of agreement can be formulated with an agreement in which in the field called assets occurs something or things and material things that are mutual to always bind themselves from the seller or buyer to implement the agreement. Agreements that have been implemented must be carried out in accordance with the rights and obligations of each party and there is no default or negligence in carrying out their obligations so that they can be said to have good intentions in the agreement.

Keywords: Legal Protection, Seller, Good Faith
III. Béla király csontjainak tanúsága – Az Árpád-ház eredete
Authors: BERNERT Zsolt , FEHÉR Tibor , VARGA Dániel , SZÉKELY Gábor , NÉMETH Endre
Published: May 2019

The role of applications based on machine learning is continuously growing in the industry, health sector/bioinformatics and scientific research. American researchers published a bit more than 10 years ago the first machine learning algorithms, which were able to safely predict Y-SNP based haplogroups from Y-STR data.

The goal of the present study was to predict with machine learning algorithms the SNP-based subgroup of three ancient DNA samples (King Béla III and two Khazar samples) belonging to Y-DNA Haplogroup R1a, in order to predict their geographic origin and mutual genetic relatedness more accurately. This is the first study applying machine learning algorithms for researching Hungarian prehistory.

Based on the Y-STR haplotype of King Béla III, we estimated with the machine learning algorithm in the first step that he belonged to the R1a-Z93 subgroup that is most common among Indo-Iranic and Turkic speaking peoples. The second step predicted that King Béla III belonged to the Z2123 subgroup of R1a-Z93. The Phylogenetic analysis showed King Béla III most likely belonged to the relatively rare YP451+ YP449- subgroup of Z2123, which practically only appears in the North Caucasus, especially among Karachays and Balkars.

Based on our results, we could hypothetically conclude that the Árpád Dynasty has common origin with one ethnic component of the Karachay people.

In our study we proved that it is possible to increase the accuracy of Y-DNA haplogroup prediction of historical aDNA samples with mathematical methods using contemporary Y-STR haplotypes. With the help of this method, larger historical aDNA studies could save a lot of research funds and DNA carrying out tailored deep SNP-testing of samples instead of using general SNaPshots.
Analysis of the Effect of Coaching on Teamwork Performance
Authors: Aldrin Neil , Utama Andyan Pradipta
Published: May 2019

This study aims to examine the effect of coaching on teamwork, using a quantitative approach to test whether there are significant differences. The research sample was 15 employees who joined in one teamwork at the same company. The results show that the correlation between before using coaching and after its use is very strong and significant. So that it can be said that there is a significant difference in teamwork after being given coaching. Thus it is proven that coaching affects teamwork performance. Results are seen three months after coaching is taught. This is intended to see whether it can really be applied to the work team. The results found that there were very significant differences in the work team before and after coaching was taught.
Competency Model of Social Entrepreneurs
Authors: Guritno Purnaning Dhyah , Suyono Haryono , Sunarjo Sunarjo
Published: May 2019

Social entrepreneurship is a potential alternative to address social problems but social business still needs to be strengthened to provide far-reaching impact. One strategy to flourish is benchmarking against successful social enterpreneurs because previous studies show that entrepreneur’s competence is a determinant of small-medium business performance and growth. Social entrepreneur competencies which drive social business success and how these competencies are developed, unfortunately have not clear yet. This study aims to build a competency model for social entrepreneurs and to find out pattern (in method, period, sources) for developing competencies by studying successful Indonesian social entrepreneurs. The reports on social entrepreneur competency model presented in this paper. This research adopt qualitative approach using multiple case study design. Data collected by indepth interviewing 29 informants, studying documents and conducting field observation in eight cities. Results show that successful social entrepreneurs have shared competencies which indicate existence of social entrepreneur competency model. The result of this study complements empirical studies in social entrepreneurs’ competencies by showing competencies that drive success of social business i.e: Achievement orientation, Persistence, Initiative, Courage to take opportunities, Networking, Influencing others, Team leadership, Developing others, Teamwork-Colaboration, Orientation to help and serve others, Mission orientation, Affiliate interest, Creative problem solving. The finding has direct implication on social entrepreneur education and development programs included method, materials, design and sources of development because the competencies determine the success constitute mostly of attitudes, motives and traits instead of knowledge and skills.
The Impact of Audit Committee Characteristics on Environmental and Social Disclosures
Authors: Biçer Ali Altuğ , Feneir Imad Mohamed
Published: May 2019

The main reasons for corporate participation in environmental and social disclosure are stability, development, and continuity through participation in protecting the environment and optimizing the use of available resources. As well as the company practices and participation in society of the most important means to create a good image of the company in the community. There is a rise demand for companies to take accountability for their environmental and societal impacts. A core role of the Audit Committee (AC) is to help the board of directors in overseeing the company's reporting policy and oversees the quality of financial reporting in the company. This study examined the impact of audit committee characteristics on the level of environmental and social disclosures in listed banks in Borsa Istanbul. The results of the study showed that there is no statistically significant relationship between the characteristics of the audit committee and the environmental and social disclosures. Consequently, these characteristics have no effect on the volume or type of disclosure and their inability to predict them.
Análisis e interpretación de la distribución espacial de banderas de España y simbología religiosa en los balcones del municipio de Sevilla
Authors: Fraile-Jurado Pablo , Fernández-Díaz Miguel
Published: May 2019

Durante los últimos años se ha intensificado el fenómeno de colgar banderas de España en balcones de domicilios particulares en diferentes ciudades españolas, llegando a su máximo a finales de 2017 durante la escala de tensión de la crisis institucional en Cataluña. En este trabajo se identifican los patrones espaciales de la distribución de banderas de España y de simbología religiosa en los balcones del municipio de Sevilla, analizando a continuación su relación con los resultados electorales de las últimas elecciones al Parlamento Andaluz, y con otras variables socioeconómicas. Los resultados indican una clara correlación con la ideología de los votantes, identificándose correlaciones positivas con respecto al voto al PP y Vox y negativas con respecto al voto a Adelante Andalucía y al PSOE.
Diffusivity of Gas Into Bitumen: Part I—Analysis of Pressure-Decay Data With Swelling
Authors: Richardson W. D. , Schoeggl F. F. , Maini B.. , Kantzas A.. , Taylor S. D. , Yarranton H. W.
Published: May 2019

The oil-production rate of in-situ heavy-oil-recovery processes involving the injection of gaseous hydrocarbons partly depends on the diffusivity of the gas in the bitumen. The gas diffusivities required to model these processes are determined indirectly from models of mass-transfer experiments. However, the data in the literature are scattered partly because different methods and model assumptions are used in each case. In this work, the pressure-decay method is examined with a focus on accounting for swelling and the dependence of the diffusivity on the solvent content. To assess these issues, the diffusion of gaseous propane into bitumen is measured at conditions where significant swelling occurs. A numerical model is developed for the pressure-decay experiment that accounts for swelling (including excess volumes of mixing) and variable diffusivity. For gases, such as propane, with a relatively high solubility in bitumen, the error in the calculated diffusivity reached 25% when swelling was not included in the model. The error in the height of the gas/oil interface reached 15%. Nonideal mixing had no effect on the calculated diffusivity and only a small effect on the height of the interface. It was found that the diffusion data from a single experiment could be modeled equally well with a constant or a solvent-concentration-dependent (or viscosity-dependent) diffusivity. However, the apparent constant diffusivities for each experiment were different, confirming their dependence on the solvent content. The constant diffusivity approximately correlated to the viscosity of the oil. A larger data set is required to fully develop and test a correlation, and this work will be presented in Part II of this study (Richardson et al. 2019).
Diffusivity of Gas Into Bitumen: Part II—Data Set and Correlation
Authors: Richardson W. D. , Schoeggl F. F. , Taylor S. D. , Maini B.. , Yarranton H. W.
Published: May 2019

The oil-production rate of in-situ heavy-oil-recovery processes involving the injection of gaseous hydrocarbons partly depends on the diffusivity of the gas in the bitumen. Data for gas diffusivities, particularly above ambient temperature, are relatively scarce because they are time consuming to measure. In this study, the diffusion and solubilities of gaseous methane, ethane, propane, and n-butane in a Western Canadian bitumen were measured from 40 to 90°C and pressures from 300 to 2300 kPa, using a pressure-decay method. The diffusivities were determined from a numerical model of the experiments that accounted for the swelling of the oil. In Part I of this study (Richardson et al. 2019), it was found that both constant and viscosity-dependent diffusivities could be used to model the mass of gas diffused and the gas-concentration profile in the bitumen; however, the constant diffusivity was different for each experiment and mainly depended on the oil viscosity. In this study, a correlation for the constant diffusivity to the oil viscosity is developed as a tool to quickly estimate the gas diffusivity. A correlation of diffusivity to the mixture viscosity is also developed for use in more-rigorous diffusion models. The maximum deviations in the mass diffused over time predicted with the constant and viscosity-dependent (mixture viscosity) correlations at each condition are on average 7.4 and 8.7%, respectively.
Isolated peripheral-type facial palsy due to the central lesion:two-case reports
Authors: jiang jiwei , Shang Xiuli
Published: May 2019

Background

Isolated peripheral facial palsy (P-FP) can lead to lesions involving the inferomedial tegmentum of the pons. However, cases with P-FP in result of a medullary lesion have rarely been reported and result from a paraventricular lesion have never been reported before.

Cases presentation

We described a 63-year-old man presenting with isolated P-FP due to ipsilateral pontomedullary infarction. Brain diffusion MRI revealed a hyper-intense signal on the left dorsolateral portion of the upper medulla and pontomedullary junction. And then we experienced a 77-year-old man presenting with lateral paraventricular infarction who showed contralateral peripheral type facial palsy. Brain diffusion-weighted image(DWI) showed a high-signal intensity lesion in the right lateral paraventricule and part of the posterior limb of the right internal capsule.

Conclusions

These two cases caution that a central nervous etiology should be considered in patients with P-FP, especially if they have high risk factors of cerebral infarction.
Determinants for tuberculosis in HIV infected patients in Debre Birhan town, Amhara national regional state, Ethiopia: a case control study
Authors: tewabe tilahun , zeleke gebyaw , Mohammed Abdurahman
Published: May 2019

Abstract
Background: Tuberculosis (TB) is one of the most frequent opportunistic infections in people living with the Human Immunodeficiency Virus (HIV). It is a leading cause of morbidity and mortality in high HIV prevalent population. There are various factors contributing for the occurrence of TB/HIV co-infection that are not well studied in this area. The purpose of this study is to assess determinants of Tuberculosis infection among HIV positive patients attending ART clinics in governmental health facilities at Debre Birhan town North Shoa, Ethiopia.
Methods: A case control study design was conducted from February 15, 2017 to April 30, 2017 in governmental health facilities at Debre Birhan town. A total of 276 individuals were to participated in this study (92 cases and 184 controls). Cases were adult patients with TB/HIV who were co-infection and controls were adult HIV patients without TB. A pre- tested interviewer administered structured questionnaire was used to collect data on Socio demographic variables, housing characteristics and personal behaviours. Host, clinical and immunological variables were taken from ART card and log books.
Result: In this study participants who; earn low monthly income (AOR) 0.024; 95% CI 0.004 to 0.14), smoker (AOR 10.53; 95% CI 1.53 to 72.18), kerosene (AOR 2.49; 95% CI 1.22 to 5.07), alcohol (AOR=5.48; 95% CI 1.29 to 23.56), family history of TB (AOR=2.51; 1.03,6.15) were at high risk of tuberculosis. While patients with opportunistic infections (AOR=3.35; 95% CI 1.62 to 6.91), bronchial asthma (AOR=14.77; 95% CI 6.25 to 34.91), diabetes mellitus (AOR 10.62; 95% CI 2.77 to 40.50) and low CD4 level (AOR=6.03; 95% CI 2.27 to 16.18) were at high risk of TB.
Conclusion: HIV patients with risk behaviours, opportunistic infections, diabetes, asthma, low CD4, kerosene user and poor were at risk of TB. To reduce the risk of TB health care providers and government should work to reduce risk behaviours, early screening and initiation of treatment for opportunistic infections, health education for chronic diseases, early staging and initiation of treatment for HIV, working with poor to improve their life were recommended.
Key words: Tuberculosis Infection, HIV Patients, Debre Birhan Town, Ethiopia
Ultrasound assessed a new method of needle insertion at an angle of 90°to the apex of the sacral hiatus for caudal block in newborns: a randomized controlled study
Authors: Li Shangyingying , Tan Yanzhe , Yang Fei , Liu Lifei , Tu Shengfen
Published: May 2019

Background

Caudal block is widely used in paediatric anaesthetic practice. Many angles for needle insertion were compared to find a optimal angle during caudal block with high successful caudal injection and minimal risk of complications. The aim of this study is to evaluate the safety and effectivity of a new method of needle insertion at an angel of 90°to the apex of the sacral hiatus for caudal block in newborns.

Methods

Sixty patients were included in our study, aged 0 to 28 days, posted for inguinal hernia surgery, randomly divided into two groups: a conventional method (CM) group and a new method (NM) group. In both groups, 1 ml∙kg-1 0.5% lignocaine at a rate of approximately 0.5 ml∙s-1 was given for caudal blocks after anaesthesia, and ultrasonographic observation of local anesthetic in the epidural space. Failure rate at the first attempt, puncture frequency, complications, and durations of block were recorded.

Results

The failure rate at the first attempt of caudal block were 16.7% in the conventional method group and 3.3% in the new method group (p<0.05). The mean time required (standard deviation) to perform needle insertion in the conventional method group was 2.6±0.5 minutes and in new method group 1.6±0.5 minutes (p<0.05). There were three cases aspirating the needle to find blood and one case to find cerebrospinal fluid in the conventional method group. The majority level which the local anesthetic reached are L1 by ultrasound imaging, 86.7% in the conventional method group and 83.3% in the new method group.

Conclusion

The study found that using the new method, the chance of performing a successful caudal injection can be increased, the time and the risk can be minimized compared to conventional technique. It is a safe and effective method.
Prevalence and Association of Retinal Vascular Abnormalities:a study among the Elderly in Rural Southwestern Harbin, China
Authors: Liu Ping , Wang Junwei , Leng Fei , Li Zhijian , Tang Xianling , Qian Hua , Li Xiaoguang , Zhang Yi , Chen Xuedong , Du Haitao
Published: May 2019

Background: Data on the retinal vessel morphology in the north China are still scarce so far. The study aimed to evaluate retinal vascular abnormalities and their associations with self-reported diagnosis of cardiovascular and cerebrovascsular diseases in a rural adult population of northeast China.
Methods: A population-based, cross-sectional study was conducted, using the cluster random sampling method. two 40° non-mydriatic retinal photographs of one eye from each participant was taken using a fundus camera. The main Outcome measures: the prevalence of focal and general arteriolar narrowing, arteriovenous nicking, arteriolar sheathing, and retinopathy. Clinical data including general parameters and system diseases were collected by physical and laboratory examination and standard questionnaires.The association between retinal vascular abnormalities and cardiovascular and cerebrovascsular diseases and their risk factors was determined using logistic regressions.
Results: Among 6 267 participants with an age ≥50 years, photographs were obtained of 99.2%, with quality sufficient to perform retinal evaluations in 82.5% (from 5172 participants). Among them, 432 subjects had diabetes. The average age was 61.25±7.37 years. The prevalence of focal arteriolar narrowing, arteriovenous nicking, arteriolar sheathing, retinopathy and general arteriolar narrowing were 9.1%, 8.9 %, 5.0 %, 6.6 % and 6.2% respectively. All the retinal lesions were associated with hypertension (all P<0.01). No significant associations were found between the subjects with or without the presence of diabetes mellitus (P >0.05). After adjusting for age, gender and left/right eyes, hypertension, hyperlipidemia, diabetes mellitus, habits of past or current smoking and alcohol drinking, arteriovenous nicking was strongly associated with the self-reported histories of coronary heart diseases (OR, 1.44; 95% CI, 1.09, 1.89) and retinopathy was significantly associated with self-reported histories of stroke (OR, 2.05; 95% CI, 1.18, 3.57).
Conclusions: Retinopathy is associated with self-reported diagnosis stroke while arteriovenous nicking is associated with the self-reported diagnosis of coronary heart diseases, but the rest retinal lesions are not consistently related to the self-reported diagnosis of coronary heart diseases. Thus, an examination of retinal microvascular characteristics may offer clues to the cardiovascular and cerebrovascsular diseases and could be a potentially novel risk marker.
The acid-producing capacity and anti-microbial activity of Lactobacillus species isolated from patients treated for cancer in the head and neck region
Authors: Rahne Matilda , Basic Amina , Almståhl Annica
Published: May 2019

Background: Lactobacillus are acid-producing bacteria associated with caries development. Some Lactobacillus have also anti-microbial properties. In patients treated for cancer in the head and neck region, a marked increase in Lactobacillus has previously been reported. The consequences of this ecological shift towards a Lactobacillus friendly environment are, however, still unknown. Little is known about the prevalence of different Lactobacillus species and their characteristics in these patients.
The aim of this study was therefore to identify Lactobacillus isolates from patients with head and neck cancer and to determine their acid-producing capacity and anti-microbial activity.
Methods: Lactobacillus isolates were collected from 21 patients pre-treatment, six and 12 months post treatment. For identification to species level, the isolates were subjected to DNA-extraction, amplification of 16S and restriction fragment length polymorphism analysis using the restriction enzymes Hpa II and Hae III. The acid-producing capacity was analyzed using a colorimetric fermentation test in microtiter plates. The anti-microbial activity of the isolates against Streptococcus mutans associated with caries, and the mucosal pathogens Staphylococcus aureus, Candida albicans and Enterococcus faecalis was determined by determining inhibitory zones on agar plates.
Results: The most frequent species were L. paracasei (n=21), L. casei/rhamnosus (n=17) and L. fermentum (n=10). The highest proportion showing acid-producing capacity using sugars and sugar-alcohols was found among L. paracasei and the lowest proportions were seen for L. fermentum. Seventy-one strains showed an anti-microbial activity against S. mutans, one strain against S. aureus and none against C. albicans or E. faecalis.
Conclusion: The most frequent species Lactobacillus species isolated from patients with head and neck cancer were L. paracasei, L. casei/rhamnosus and L. fermentum of which L. paracasei showed the best acid-producing capacity. A weak anti-microbial activity against S. mutans was frequently detected. Further studies are needed to increase the knowledge of the role and characteristics of oral Lactobacillus.
Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study
Authors: Domenech Gonzalo , Kampel Matias , Guzzo Maria Eugenia Garcia , Novas Delfina Sanchez , Terrasa Sergio , Fornari Gustavo Garcia
Published: May 2019

Background: Current neuromuscular blockade (NMB) management techniques cannot completely prevent residual NMB (RNMB) during the postoperative period. Evidently, compliance to NMB monitoring is persistently low, and the risk of RNMB during the perioperative period remains underestimated. We have not found publications that report the incidence of RNMB in a university hospital where access to quantitative NMB monitoring and sugammadex is unlimited and where NMB management is not protocolised. The primary aim of this study was to estimate the incidence of RNMB in patients managed with or without sugammadex or neostigmine as antagonists and quantitative NMB monitoring in the operating room. The secondary aim was to explore the associations between RNMB and potentially related variables. Methods: This retrospective observational cohort study was conducted at a tertiary referral university hospital in Buenos Aires, Argentina. Records created between June 2015 and December 2015 were reviewed. In total, 240 consecutive patients who had undergone elective surgical procedures requiring NMB were included. All patients were monitored via acceleromyography at the adductor pollicis muscle within 5 min of arrival in the postanaesthesia care unit. Scheduled recovery in the intensive care unit was the only exclusion criterion. The primary outcome was the presence of RNMB, defined as a train-of-four ratio of <0.9. The secondary outcomes were the associations between RNMB and potentially related variables. Results: RNMB was present in 1.6% patients who received intra-operative quantitative NMB monitoring and 32% patients whose NMB was not monitored (P<0.01). Multivariable analysis revealed that the use of intra-operative quantitative NMB monitoring and sugammadex were associated with a lower incidence of RNMB, with calculated odds ratios of 0.04 (95% confidence interval [CI]: 0.005 to 0.401) and 0.18 (95% CI: 0.046 to 0.727), respectively. Conclusions: The results of the present study suggest that quantitative intra-operative NMB monitoring and use of sugammadex are associated with a decreased incidence of RNMB in the PACU, reinforcing the contention that the optimal strategy for RNMB avoidance is the use of quantitative NMB monitoring and eventual use of reversal agents, if needed, prior to emergence from anaesthesia.
Therapeutic Drug Monitoring and Impact Indicator of Vancomycin Pharmacokinetics in Abdominal Cancer Patients complicated with Severe Infectious Disease
Authors: Zhang Xiaowu , Lyu Yang , Wang Donghao
Published: May 2019

Abstract
Objective: This study was designed to investigate effectiveness of therapeutic drug monitoring (TDM) and impact indicator of vancomycin pharmacokinetics in abdominal cancer patients complicated with severe infectious disease.
Methods: A total of 78 patients abdominal cancer patients complicated with severe infectious disease were included. Vancomycin serum trough concentrations were measured using the fluorescence polarization immunoassay (FPIA) method. The patients were divided into early and delayed groups based on whether they achieve the target concentration. And clinical factors were compared between two groups.
Results: The average initial therapeutic dose of vancomycin was 15.18±3.29 mg/kg (q12h). Ultimately, we collected 78 patient‘s trough concentrations data. The research revealed that the abdominal cancer patients complicated with severe infectious disease had significantly lower initial vancomycin trough concentrations (median [IQR]: 6.90[5.28-11.20] mg/L) compared with the recommended standard goal vancomycin trough concentration (10-15 or 15-20 mg/L). Multiple regression analysis revealed that Cys-C was the most important variable for vancomycin target trough achievement. We divided patients into early and delayed groups based on whether the initial trough concentration achieved standard goal trough concentration. Although the clinical outcomes were similar between two groups, the duration of mechanical ventilation in Early group was considerably shorter compared with group Delayed group (χ2=4.532; p < 0.05; Fig 1E). Propensity score weighting further confirmed that the duration of mechanical ventilation (χ2=6.607; p < 0.05; Fig 1F) and vasoactive agent (χ2=6.106; p < 0.05; Fig 1D) was considerably shorter compared with group Delayed group.
Conclusions: The steady-state initial vancomycin trough concentration was significantly reduced in abdominal cancer patients complicated with severe infectious disease. Higher initial dosage regimen is needed to ensure clinical effectiveness. The baseline Cys-C level measured prior to administration of vancomycin is suggested to be the most suitable parameter to predict whether vancomycin trough concentration is up to standard dosage. Early attainment of target concentration significantly improved hemodynamic stability and reduced duration of mechanical ventilation.
Posterior deep neck infections at a single territory referral center
Authors: Zhao Jing-Chun , Zhang Nan , Wu Zhen-Dong , Wang Jian , Yu Qing-Hua , Hong Lei , Shi Kai , Yu Jia-Ao
Published: May 2019

Background

Although the incidence and mortality of deep neck infection has decreased, this infection still relatively frequent and can be associated with lethal complications. In this study, the authors present our clinical experience of patients with posterior deep neck infection (PDNI) diagnosed and treated in a territory reconstructive unit in northeastern China.

Methods

A retrospective chart review of patients diagnosed with PDNI from January 2009 and December 2018 was performed. A data analysis was performed relating to demographic characteristics, clinical presentation, comorbidities, bacterial culture, laboratory and radiographic evaluations, diagnostic clues, management, complications as well as the clinical course and outcome.

Results

During the ten-year period there were 174 consecutive patients admitted to our reconstructive center with final diagnosis of PDNI were included. All the patients were adults with the majority were male (67.2%). The patient mean age was 51.3 years (range, 15 - 88 years). There were 114 patients (65.5%) who had associated systemic diseases, with the most common comorbidity was diabetes mellitus (40.2%). Common presented clinical symptoms were pain (90.8%), swelling (85.1%) and erythema (77%) of the neck. Surgical treatment was performed in all the patients and most of them (83.9%) received the first surgery within 24 h. The most commonly isolated pathogen was Staphylococcus aureus (30%). Vancomycin (21.3%) was the most commonly used antibiotics, followed by cefepime (18.4%). All the patients survived and discharged with mean duration of hospitalization of 28.7 days. Those patients with underlying systemic diseases (31.4 ± 12.35 days) or complications (41.0 ± 12.5 days) tended to have a longer hospital stay. The mean cost of admission per patient was 47 644 RMB.

Conclusion

This study highlights the high cost burden of PDNI patients. Those patients with underlying systemic diseases or complications tended to have a longer hospital stay.
Management of Severe Hand, Foot and Mouth Disease in Xiangyang, China during 2008-2013
Authors: Liu Jian , Qi Jing , Zhan Fei , Jiao Rong
Published: May 2019

Background

Therapeutic strategies of severe hand, foot and mouth disease (HFMD) are inconsequent or deficient in evidence by now.

Methods

We have retrospectively analyzed HFMD outbreaks in Xiangyang from June 2008 to December 2013. All severe cases were enrolled to analyze the risk factors causing mortality and to compare the efficiency and outcome of some therapies by binary logistic regression.

Results

The HFMD involved 637 (1.26%) severe cases and 38 were fatal (0.75‰). Analysis indicate that age (<3y), EV71 (+), autonomic nervous system (ANS) dysregulation, pulmonary edema/haemorrhage, CRP (>40mg/L) and cardiac troponin I (cTnI) (>0.04ng/mL) are significant predictors of outcome for severe HFMD (all P < 0.05). IVIG and mechanic ventilation can significantly improve outcome of HFMD at early stage III (both P < 0.05) with odds ratios of 0.24 (95% CI: 0.10-0.57) and 0.01 (95% CI: 0.00-0.10) respectively. Methylprednisolone and milrinone administered at any stage did not make any significant differences on mortality (all P > 0.05). All therapies had no statistical significance on outcome at stage I and II (all P > 0.05).

Conclusions

Exactly recognition of the sever HFMD cases in early stage III and timely IVIG and mechanic ventilation application can significantly decrease mortality. Mechanic ventilation training program, and dispatching experts to county-level or district hospital when there are severe HFMD cases who lost transfer opportunity are two key successful administrative experience.
Response of Grain Quality to Alternate Wetting and Moderate Soil Drying Irrigation in Rice
Authors: Xu Yunji , Gu Daojian , Li Ke , Zhang Weiyang , Zhang Hao , Wang Zhiqin , Yang Jianchang
Published: May 2019

Alternate wetting and moderate soil drying irrigation (WMD) has been widely adopted in rice (Oryza sativa L.) production for saving irrigation water and increasing grain yield. However, limited information is available about the effect of WMD on rice grain quality. The main purpose of this study was to evaluate the characteristics of grain quality in response to WMD. Two rice varieties, Yangdao 6 (YD6, indica) and Hanyou 8 (HY8, japonica), were grown in the field, with two water management treatments, well‐watered (WW) and WMD from 10 d after transplanting to maturity. In comparison with WW, WMD prominently increased grain yield by 7.57 to 9.72%, and improved some grain quality parameters such as milling, appearance, and eating and cooking qualities, including increases in head rice and decreases in chalkiness. The two varieties showed the same tendency. However, WMD had a negative impact on some nutritional quality traits in rice grains, such as reduction in the contents of amino acids and the micronutrient elements Cu, Fe, Mn, Mo, Se, and Zn. The WMD treatment also markedly decreased As content and exhibited no significant effect on Cd content in grains. The results demonstrated that WMD has an overall impact on rice grain quality with both positive and negative effects.