BACKGROUND & AIMS: BACKGROUND:The routine application of whole-body CT after extracorporeal cardiopulmonary resuscitation (ECPR) in out-of-hospital cardiac arrest (OHCA) has not been extensively investigated. We aimed to evaluate the benefit of CT in this context. METHODS:We retrospectively analyzed all OHCA patients who had received ECPR between January 2006 to May 2019. Electronic records were reviewed to filter out patients who had a whole-body CT as their first clinical evaluation after ECPR. CT findings and major hospital outcomes were evaluated. RESULTS:From January 2006 to May 2019, 700 patients had received ECPR in our institution. We identified 93 OHCA patients who received whole-body CT as the first clinical evaluation after ECPR. 22.6% of those had no acute findings detected on CT requiring immediate treatment. In the remaining 77.4%, CT had findings that might lead to alterations in clinical course. Most important findings were myocardial infarction (57.0%), hypoxic brain injury (29.0%), sternal/rib fractures (16.1%), aortic dissection (7.5%), pulmonary embolism (5.4%), and cardiac tamponade (5.4%). There were no significant differences in ICU/hospitalization days, time on ECMO support, survival and neurological outcomes between those with and without immediate CT. In our OHCA cohort, there were 27 patients with CT evidence of hypoxic brain injury, of whom 22.2% (n = 2) managed to wean from ECMO support, 14.8% (n = 4) survived to discharge, but only 3.7% (n = 1) survived with good neurological outcome. Hypoxic brain injury on CT has a 95% specificity in predicting poor neurological outcome, with a false positive rate of only 3.7%. Logistic regression suggested a potential correlation between CT findings of hypoxic brain injury and poor neurological outcome [Odds ratio (OR) = 12.53 (1.55 to 10.1), p = 0.02)]. CONCLUSIONS:Routine whole-body CT after ECPR in OHCA patients appears to have a limited role, as the majority is caused by ACS. However, it may be a useful tool when CPR-related injury or non-ACS causes of OHCA are suspected, as well as in cases where the cause of OHCA is unknown. On the contrary, routine brain CT may be a valuable tool in guiding anticoagulant therapy during ECMO and in aiding outcome prediction.

背景与目标：

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: RATIONALE:Despite increasing number of left ventricular assist device (LVAD) implantation, standardized cardiopulmonary resuscitation (CPR) protocol for patients with LVAD, especially in out-of-hospital settings are not well known. PATIENT CONCERNS:A 41-year-old LVAD implanted man became cardiac arrest in an out-of-hospital setting. Bystander CPR was started and the patient was brought to our hospital without noticing LVAD. Upon arrival, the medical staff noted the LVAD and that the battery of the LVAD was exhausted. DIAGNOSIS:Cardiac arrest on LVAD. INTERVENTIONS:It took 50 minutes to change the battery, then the patient has become ventricular fibrillation; hence, we introduced extracorporeal membranous oxygenation and defibrillated the patient. After the sinus rhythm was restored, the LVAD started working uneventfully. OUTCOMES:The patient became brain dead. LESSONS:There are several difficulties in treating these patients. First, hemodynamic collapse is difficult to diagnose. Second, chest compression for LVAD implanted patients remains controversial. Third, education to first responders who are not familiar with LVAD are not enough. Appropriate education for those issues is needed.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Heart rate recovery (HRR) is a marker of vagal tone, which is a powerful predictor of mortality in patients with cardiovascular disease. Sacubitril/valsartan (S/V) is a treatment for heart failure with reduced ejection fraction (HFrEF), which impressively impacts cardiovascular outcome. This study aims at evaluating the effects of S/V on HRR and its correlation with cardiopulmonary indexes in HFrEF patients. METHODS:Patients with HFrEF admitted to outpatients' services were screened out for study inclusion. S/V was administered according to guidelines. Up-titration was performed every 4 weeks when tolerated. All patients underwent laboratory measurements, Doppler-echocardiography, and cardiopulmonary exercise stress testing (CPET) at baseline and at 12-month follow-up. RESULTS:Study population consisted of 134 HFrEF patients (87% male, mean age 57.9 ± 9.6 years). At 12-month follow-up, significant improvement in left ventricular ejection fraction (from 28% ± 5.8% to 31.8% ± 7.3%, p < 0.0001), peak exercise oxygen consumption (VO2peak) (from 15.3 ± 3.7 to 17.8 ± 4.2 mL/kg/min, p < 0.0001), the slope of increase in ventilation over carbon dioxide output (VE/VCO2 slope )(from 33.4 ± 6.2 to 30.3 ± 6.5, p < 0.0001), and HRR (from 11.4 ± 9.5 to 17.4 ± 15.1 bpm, p = 0.004) was observed. Changes in HRR were significantly correlated to changes in VE/VCO2slope (r = -0.330; p = 0.003). After adjusting for potential confounding factors, multivariate analysis showed that changes in HRR were significantly associated to changes in VE/VCO2slope (Beta (B) = -0.975, standard error (SE) = 0.364, standardized Beta coefficient (Bstd) = -0.304, p = 0.009). S/V showed significant reduction in exercise oscillatory ventilation (EOV) detection at CPET (28 EOV detected at baseline CPET vs. 9 EOV detected at 12-month follow-up, p < 0.001). HRR at baseline CPET was a significant predictor of EOV at 12-month follow-up (B = -2.065, SE = 0.354, p < 0.001). CONCLUSIONS:In HFrEF patients, S/V therapy improves autonomic function, functional capacity, and ventilation. Whether these findings might translate into beneficial effects on prognosis and outcome remains to be elucidated.

背景与目标：

BACKGROUND & AIMS: PURPOSE:Olprinone is a phosphodiesterase type III inhibitor that is often used to increase cardiac output after cardiopulmonary bypass (CPB). Hemodilution by CPB is likely to decrease total olprinone concentration, but it may also increase the free (unbound) concentration of olprinone due to reduced protein binding. The aim of this study was to investigate the effect of hemodilution on the protein binding of olprinone. METHODS:Eleven patients scheduled for elective cardiac surgery with CPB were enrolled in our study. Olprinone was continuously infused at a rate of 0.2 μg/kg/min from the time of the first surgical incision until the patient arrived at the recovery unit. Protein binding was evaluated twice, just before the start of CPB and at the beginning of withdrawal from CPB. Olprinone concentration and protein binding were determined with high-performance liquid chromatography and ultrafiltration methods, respectively. Olprinone protein binding was also evaluated in vitro. RESULTS:Olprinone protein binding to albumin was 63 % in vitro, but it did not bind to alpha-1 acid glycoprotein. Olprinone protein binding in patients before CPB was 81.5 ± 4.3 %, whereas protein binding at withdrawal from CPB was 63.3 ± 14.3 %. CONCLUSIONS:Unbound olprinone concentration increased by 20 % during CPB, which suggests that the pharmacological effects of olprinone might be enhanced during and after CPB. Close hemodynamic monitoring is necessary to control the effects of olprinone after CPB, because CPB alters olprinone's pharmacokinetics.

背景与目标：

BACKGROUND & AIMS: INTRODUCTION:Initiation of venoarterial extracorporeal membrane oxygenation (ECMO) under ongoing cardiopulmonary resuscitation (eCPR) in patients with refractory cardiac arrest may improve otherwise deleterious outcome. In general, the duration of mechanical resuscitation from collapse to ECMO ranges from 40 to 70 min. CPR-related injuries are reported frequently in non-eCPR patients. We wanted to quantify CPR-related injuries in eCPR patients. METHODS:All eCPR patients cannulated at a tertiary referral medical center between October 2010 and October 2017 were included in a retrospective registry study. A full-body CT scan was performed within the first 24 h after eCPR. RESULTS:A total of 103 patients (mean age 58.8 ± 16.7 years, CPR duration 61.7 ± 31.9 min, and hospital survival 13.6 %) underwent eCPR and immediate full-body computed tomography (CT). Full-body CT detected the cause for collapse in 16.5% of patients. Average number of pathologies detected per CT scan was 6.5 ± 3.3 findings per patient, of which 2.6 ± 1.5 findings were retrospectively considered of clinical relevance for subsequent treatment. Most frequent findings were multiple rib or sternal fractures (65.5%), pneumo- or hemothorax (32.3%) and pulmonary infiltrates (91.3%). Intracranial bleedings and cerebral edema were frequent (10.7% and 26.2%). A total of 20 patients (19.4%) had findings in whole-body CT that were considered to be so severe that further treatment was considered futile and therapy was subsequently discontinued. Most findings were associated with poor outcome with the exception of rib fractures, bleedings and abdominal trauma, which might have been caused by vigorous resuscitation efforts and were associated with favorable outcome. CONCLUSION:A full-body CT scan performed after eCPR revealed substantial clinically significant findings. Therefore, it might be reasonable to routinely perform a full-body CT in all eCPR patients.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:To examine the hypothesis that nitrite/nitrate, neopterin, and procalcitonin (PCT) levels can be useful predictors of sepsis-associated mortality and predictors of the postoperative complications after cardiopulmonary bypass (CPB). DESIGN:Prospective clinical study. SETTING:Intensive care unit of the Medical University Hospital. PATIENTS:41 patients with sepsis, 42 patients subjected to open heart surgery with CPB, and 30 healthy volunteers. MEASUREMENTS AND RESULTS:Nitrite/nitrate, neopterin, and PCT levels were measured in septic patients as soon as sepsis was recognized and then on the 2nd, 3rd, and 5th days of treatment. Statistically significant differences between survivors and nonsurvivors were found for neopterin and PCT. The area under receiver operating characteristic curve (AUC) for both parameters as predictors of mortality was above 0.8. The nitrite/nitrate level was also higher in nonsurvivors, but the AUC remained below 0.8, which indicates poor predictive power. The same parameters were measured in patients undergoing cardiac surgery before, during and after CPB establishment. The development of post-operative complications was correlated with increased postoperative neopterin and PCT levels. Additionally, neopterin was found as an early marker for the prognosis of postoperative complications, since patients who developed organ dysfunction had had elevated concentration of this parameter even before surgery (AUC 0.83). Measurement of NO metabolite levels was less specific and less sensitive. CONCLUSIONS:Our results confirm the value of PCT and neopterin measurement as diagnostic tools in monitoring the clinical course of patients in intensive care units.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To investigate the effect of ventilation with 100% oxygen on lung injury associated with surgery involving cardiopulmonary bypass (CPB). DESIGN:A prospective randomized study. SETTING:University hospital. PARTICIPANTS:Thirty patients undergoing coronary artery bypass graft surgery with CPB. INTERVENTIONS:Patients were randomized to receive 100% oxygen (Oxygen group) or 50% oxygen (Air group) throughout surgery. During CPB, patients' lungs in the Air group were flushed with air and in the Oxygen group with 100% oxygen. MEASUREMENTS AND MAIN RESULTS:Lung injury was evaluated by arterial oxygen tension-inspired oxygen concentration (PaO2-FIO2) ratio and cytokine levels (tumor necrosis factor-alpha and interleukin-8) in blood and bronchoalveolar lavage fluid measured before and after CPB. The lowest PaO2-FIO2 value was observed after 40 minutes following the completion of CPB in both groups. PaO2-FIO2 values 6 hours after CPB were not different from baseline in the Air group but remained lower (359+/-63 mmHg and 298+/-78 mmHg; p = 0.013) in the Oxygen group. Blood cytokine levels rose during surgery in both groups. Bronchoalveolar lavage levels of interleukin-8 did not change, whereas tumor necrosis factor-alpha increased only in the Oxygen group (p = 0.035). CONCLUSIONS:A significant decrease of oxygenation was observed in the early post-CPB period in both groups of patients, with delay in recovery in patients treated with 100% oxygen. A larger increase of the proinflammatory cytokines was found in patients treated with 100% oxygen. High oxygen concentrations during surgery with CPB should be used only when specifically required.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The metastrongyloid nematodes Aelurostrongylus abstrusus, Troglostrongylus brevior and Angiostrongylus chabaudi are cardiopulmonary parasites affecting domestic cats (Felis catus) and wildcats (Felis silvestris). Although knowledge on these nematodes has been improved in the past years, gaps in our knowledge of their distribution and role of gastropods as intermediate hosts in Europe still exist. This study reports on the presence of these nematodes and their intermediate hosts in an area in Greece where domestic cats and wildcats occur in sympatry. METHODS:Terrestrial gastropods were collected in the field and identified morphologically and by mitochondrial DNA-sequence analysis. Metastrongyloid larvae were detected by artificial digestion, morphologically identified to the species and stage level and their identity was molecularly confirmed. RESULTS:Aelurostrongylus abstrusus was found in the snails Massylaea vermiculata and Helix lucorum, T. brevior in the slug Tandonia sp., and A. chabaudi in the slug Limax sp. and the snails H. lucorum and M. vermiculata. CONCLUSIONS:To the best of our knowledge this study provides the first reports of (i) terrestrial gastropods being naturally infected with A. chabaudi, (ii) T. brevior naturally infecting terrestrial gastropods in Europe, and (iii) A. abstrusus naturally infecting terrestrial gastropods in Greece. Furthermore, the present study describes for the first time developmental stages of A. chabaudi and T. brevior in naturally infected gastropods. The biological characteristics of various intermediate gastropod hosts that could influence the distribution and expansion of feline cardiopulmonary nematodes are discussed, along with epizootiological implications and perspectives.

背景与目标：

BACKGROUND & AIMS: During cardiopulmonary bypass (CPB) an adequate reservoir volume is maintained by the addition of crystalloid, colloid or packed cells to the reservoir. This volume contributes to the overall perioperative positive fluid balance. We studied the effect of the preoperative addition of either 75 g albumin, or 50 g mannitol followed by 50 g at commencement of rewarming or both of the above to a bypass circuit prime of lactated Ringer's solution (LR) on intraoperative fluid balance, postoperative indices of oxygenation and time to extubation. The study was a prospective, randomized, single-blinded controlled trial of 103 patients undergoing cardiac surgery requiring CPB. There was a large and highly significant reduction in volume of fluid added to the reservoir during CPB (2137 +/- 1499 ml versus 144 +/- 230 ml), the fluid balance during bypass, including prime volume (3236 +/- 650 ml versus 5876 +/- 1465 ml), and perioperative fluid balance (4470 +/- 936 ml versus 7023 +/- 1760 ml) in the group receiving both mannitol and albumin in the pump prime compared with the group receiving only lactated Ringer's solution. There were no differences between the groups with respect to both measured indices of oxygenation measured on return to ICU (alveolar-arterial oxygen tension difference (DA-aO2) or arterial oxygen tension to inspired oxygen fraction ratio (PaO2/FiO2), or time from ICU admission to extubation.

背景与目标： 在体外循环 (CPB) 期间，通过向储存器中添加晶体，胶体或填充细胞来维持足够的储存器体积。该体积有助于整个围手术期的积极液体平衡。我们研究了术前添加75g白蛋白或50g甘露醇，然后在重新加温开始时添加50g或以上两者对乳酸林格氏液 (LR) 旁路回路的影响，对术中液体平衡，术后氧合指数和拔管时间。该研究是一项前瞻性，随机，单盲对照试验，对103名需要CPB进行心脏手术的患者进行了试验。在CPB期间 (2137 +/-1499毫升对144 +/-230毫升)，在旁路期间的流体平衡，包括主要体积 (3236 +/-650毫升对5876 +/-1465毫升)，添加到储层的流体体积有很大且非常显著的减少，与仅接受乳酸林格氏液的组相比，在泵中同时接受甘露醇和白蛋白的组的围手术期液体平衡 (4470/-936毫升对7023/-1760毫升)。两组之间在返回ICU时测量的氧合指标 (肺泡动脉氧张力差异 (DA-aO2) 或动脉血氧张力与吸入氧分数之比 (PaO2/FiO2) 或从ICU入院到拔管的时间) 方面没有差异。

BACKGROUND & AIMS: :Integrated backscatter intravascular ultrasound (IB-IVUS) is a useful method for analyzing coronary plaque tissue. We evaluated whether tissue composition determined using IB-IVUS is associated with the progression of stenosis in coronary angiography. Sixty-three nontarget coronary lesions in 63 patients with stable angina were evaluated using conventional IVUS and IB-IVUS. IB-IVUS images were analyzed at 1-mm intervals for a length of 10 mm. After calculating the relative areas of the tissue components using the IB-IVUS system, fibrous volume (FV) and lipid volume (LV) were calculated through integration of the slices, after which percentages of per-plaque volume (%FV/PV, %LV/PV) and per-vessel volume (%FV/VV, %LV/VV) were calculated. Progression of coronary stenosis was interpreted from the increase in percent diameter stenosis (%DS) from baseline to the follow-up period (6–9 months) using quantitative coronary angiography. %DS was 24.1 ± 12.8 % at baseline and 23.2 ± 13.7 % at follow-up. Using IB-IVUS, LV was 31.7 ± 10.5 mm3, and %LV/PV and %LV/VV were 45.6 ± 10.3 % and 20.2 ± 6.0 %, respectively. FV, %FV/PV, and %FV/VV were 35.5 ± 12.1 mm3, 52.1 ± 9.5 %, and 23.4 ± 7.1 %, respectively. The change in %DS was −0.88 ± 7.25 % and correlated closely with %LV/VV (r = 0.27, P = 0.03) on simple regression. Multivariate regression after adjustment for potentially confounding risk factors showed %LV/VV to be correlated independently with changes in %DS (r = 0.42, P = 0.02). Logistic regression analysis after adjusting for confounding coronary risk factors showed LV (odds ratio 1.08; 95 % confidence interval 1.01–1.16; P = 0.03) and %LV/VV (odds ratio 1.13; 95 % confidence interval 1.01–1.28; P = 0.03) to be independent predictors of the progression of angiographic coronary stenosis. Our findings suggest that angiographic luminal narrowing of the coronary artery is likely associated with tissue characteristics. IB-IVUS may provide information about the natural progression of luminal narrowing in coronary stenosis.

背景与目标： : 背向散射积分血管内超声 (ib-ivus) 是分析冠状动脉斑块组织的有用方法。我们评估了使用ib-ivus确定的组织成分是否与冠状动脉造影的狭窄进展相关。使用常规IVUS和ib-ivus评估了63例稳定型心绞痛患者的63例非目标冠状动脉病变。以1mm的间隔分析ib-ivus图像的长度为10毫米。使用ib-ivus系统计算组织成分的相对面积后，通过切片的积分计算纤维体积 (FV) 和脂质体积 (LV)，之后每斑块体积的百分比 (% FV/PV，% LV/PV) 和每个容器体积 (% FV/VV，% LV/VV) 进行计算。使用定量冠状动脉造影从基线到随访期 (6-9个月) 的直径狭窄百分比 (% DS) 的增加来解释冠状动脉狭窄的进展。% DS在基线时为24.1 ± 12.8%，在随访时为23.2 ± 13.7%。使用ib-ivus，LV为31.7 ± 10.5立方毫米，% LV/PV和 % LV/VV分别为45.6 ± 10.3% 和20.2 ± 6.0%。FV、 % FV/PV和 % FV/VV分别为35.5 ± 12.1立方毫米、52.1 ± 9.5% 和23.4 ± 7.1%。% DS的变化为-0.88 ± 7.25%，并且在简单回归时与 % LV/VV密切相关 (r = 0.27，P = 0.03)。对潜在混杂危险因素进行校正后的多元回归显示 % LV/VV与 % DS的变化独立相关 (r = 0.42，P = 0.02)。校正混杂冠状动脉危险因素后的Logistic回归分析显示LV (优势比1.08; 95% 置信区间1.01-1.16; P = 0.03) 和 % LV/VV (优势比1.13; 95% 置信区间1.01-1.28; P = 0.03) 是血管造影冠状动脉狭窄进展的独立预测因子。我们的发现表明，冠状动脉的血管造影管腔狭窄可能与组织特征有关。Ib-ivus可能提供有关冠状动脉狭窄管腔变窄的自然进展的信息。

BACKGROUND & AIMS: OBJECTIVE:Emergency coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) is associated with increased operative mortality. It has been suggested that this mortality might be reduced by performing the operation without cardiopulmonary bypass (CPB). METHODS:Between January 1992 and April 1998, 77 patients underwent emergency CABG within 48 h of AMI. Thirty seven were operated on with CPB, and 40 without CPB. The two groups were similar regarding age, gender, left-ventricular ejection fraction (EF) and preoperative use of intra-aortic balloon pump (IABP; 50%). The mean number of grafts/patient was 3 in the CPB group, and 1.9 in the No-CPB group (P<0.0001). RESULTS:Operative mortality in the CPB group was 24% (nine of 37) compared to 5% (two of 40) without CPB (P=0.015). Follow-up ranged between 6 and 66 months. There were no late deaths in the CPB group compared to nine (22%) in the No-CPB group (P<0.0066). Patients operated on with CPB had lower rates of recurrent angina (0 versus 15%; P=0.04) and re-interventions (0 versus 15%; P=0.04). CONCLUSIONS:Our experience suggests that CABG without CPB is the preferred method of myocardial revascularization, due to the fact that it carries lower mortality than CABG with CPB. The trade-off includes increased rates of recurrent angina, re-interventions and late mortality.

背景与目标：

BACKGROUND & AIMS: :Platelet dysfunction after cardiopulmonary bypass (CPB) can contribute to excessive post-operative bleeding. Most trials of the protective effect of aprotinin in this setting have involved hypothermic CPB, which is more deleterious for platelets than normothermic CPB. Here we investigated the effect of aprotinin on platelet function during normothermic CPB in pediatric patients. Twenty patients (9 newborns [<1 month old] and 11 infants [<36 month old]), weighting less than 15 kg and undergoing normothermic CPB (35-36 degrees C) were randomly assigned to two equal groups, one of which received high-dose aprotinin. Platelet function was assessed by flow cytometry just before CPB and 5 minutes after heparin neutralization. F1 + 2 fragments were measured by ELISA before and 5 minutes after CPB. Platelet activation marker expression (CD62P and activated alphaIIbbeta3) induced by ADP or TRAP was lower after CPB than before CPB, suggesting a deleterious effect of normothermic CPB on platelet function. Prothrombin fragment F1 + 2 levels increased after CPB. Aprotinin administration did not influence the level of prothrombin fragments or platelet marker expression measured in basal condition. However, after CPB, the capacity for platelet activation was higher in the aprotinin group, as shown by measuring CD62P expression after TRAP activation (p = 0.05). This study suggests that pediatric normothermic CPB causes platelet dysfunction, and that high-dose aprotinin has a protective effect.

背景与目标： : 体外循环 (CPB) 后的血小板功能障碍可导致术后出血过多。在这种情况下，大多数有关抑肽酶保护作用的试验都涉及低温CPB，这对血小板比常温CPB更有害。在这里，我们研究了抑肽酶对儿童患者常温CPB期间血小板功能的影响。20名患者 (9名新生儿 [<1个月大] 和11名婴儿 [<36个月大])，体重小于15千克并接受常温CPB (35-36摄氏度)，被随机分配到两个相等的组，其中一个接受高剂量抑肽酶。在CPB之前和肝素中和后5分钟通过流式细胞术评估血小板功能。在CPB之前和之后5分钟通过ELISA测量F1 2片段。CPB后ADP或TRAP诱导的血小板活化标志物表达 (CD62P和活化的alphaIIbbeta3) 低于CPB之前，表明常温CPB对血小板功能具有有害作用。CPB后凝血酶原片段F1 2水平升高。抑肽酶的给药不会影响基础条件下凝血酶原片段或血小板标志物表达的水平。然而，CPB后，抑肽酶组的血小板活化能力较高，如在TRAP激活后测量CD62P表达所示 (p = 0.05)。这项研究表明，小儿常温CPB引起血小板功能障碍，高剂量抑肽酶具有保护作用。

BACKGROUND & AIMS: BACKGROUND:Evidence points to clinicians' beliefs and practice behaviours related to low back pain (LBP), which are discordant with contemporary evidence. While interventions to align beliefs and behaviours with evidence among clinicians have demonstrated effectiveness, a more sustainable and cost-effective approach to positively developing workforce capacity in this area may be to target the emerging workforce. The aim of this study was to investigate beliefs and clinical recommendations for LBP, and their alignment to evidence, in Australian university allied health and medical students. METHODS:Final-year students in chiropractic, medicine, occupational therapy, pharmacy and physiotherapy disciplines in three Western Australian universities responded to a survey. Demographic data, LBP-related beliefs data [modified Health Care Providers Pain and Impact Relationship Scale (HC-PAIRS) and the Back Pain Beliefs Questionnaire (BBQ)] and activity, rest and work clinical recommendations for an acute LBP clinical vignette were collected. RESULTS:Six hundred two students completed the survey (response rate 74.6%). Cross-discipline differences in beliefs and clinical recommendations were observed (p > 0.001). Physiotherapy and chiropractic students reported significantly more helpful beliefs compared with the other disciplines, while pharmacy students reported the least helpful beliefs. A greater proportion of chiropractic and physiotherapy students reported guideline-consistent recommendations compared with other disciplines. HC-PAIRS and BBQ scores were strongly associated with clinical recommendations, independent to the discipline of study and prior experience of LBP. CONCLUSIONS:Aligning cross-discipline university curricula with current evidence may provide an opportunity to facilitate translation of this evidence into practice with a focus on a consistent, cross-discipline approach to LBP management.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Airway irritation was hypothesized to trigger the transient cardiovascular stimulation associated with desflurane. The authors administered desflurane during cardiopulmonary bypass (CPB), thus avoiding airway contact, and compared the effects of rapid increases of desflurane to 1.5 MAC on systemic vascular resistance index (SVRI) and catecholamine response to those of 1.5 MAC sevoflurane.

METHODS:Forty-eight patients, undergoing elective coronary bypass surgery, were randomly allocated to receive either desflurane or sevoflurane during hypothermic (32-33 degrees C) nonpulsatile CPB at exhaust gas concentrations of 1.5 MAC for 15 min. SVRI was calculated at baseline, 1, 2, 3, 4, 5, 7, 9, 12, and 15 min after starting volatile anesthetics' delivery. Plasma catecholamine concentrations were determined in 12 desflurane-treated patients and 12 sevoflurane-treated patients at baseline, 5, and 15 min.

RESULTS:The time-course of deltaSVRI, (changes in SVRI from baseline), from baseline to 5 min was significantly different between desflurane- and sevoflurane-treated patients, whereas there was no difference from 7 to 15 min. In the desflurane group, SVRI from 1 to 7 min remained unchanged to baseline level, thereafter declining to significantly lower values at 9, 12, and 15 min compared with values from 0 to 5 min, whereas sevoflurane produced an immediate and significant reduction in SVRI. With desflurane, catecholamine concentrations remained unchanged to baseline level at 5 and 15 min; with sevoflurane, they decreased with time.

CONCLUSIONS:The authors' results indicate that desflurane is associated with a different hemodynamic and catecholamine response compared with sevoflurane when administered into the oxygenator's gas supply line during CPB.

背景与目标： 背景 : 假定气道刺激会触发与地氟醚相关的短暂心血管刺激。作者在体外循环 (CPB) 期间使用地氟醚，从而避免了气道接触，并比较地氟醚快速增加1.5 MAC对全身血管阻力指数 (SVRI) 和儿茶酚胺对1.5 MAC七氟醚反应的影响。
方法 : 48例接受择期冠状动脉搭桥手术的患者，在1.5 MAC的废气浓度下，在低温 (32-33 ℃) 非脉动CPB期间随机分配接受地氟醚或七氟醚15分钟。在开始挥发性麻醉剂递送后的基线，1、2、3、4、5、7、9、12和15分钟计算SVRI。在基线，5和15分钟确定了12例地氟醚治疗的患者和12例七氟醚治疗的患者的血浆儿茶酚胺浓度。
结果 : deltaSVRI的时间过程，(SVRI从基线变化)，地氟醚和七氟醚治疗的患者从基线到5分钟有显着差异，而从7到15分钟没有差异。在地氟醚组中，从1到7分钟的SVRI与基线水平保持不变，此后在9、12和15分钟的值与0到5分钟的值相比下降至显着较低，而七氟醚在SVRI中立即显着降低。使用地氟醚时，儿茶酚胺的浓度在5和15分钟时保持与基线水平不变; 使用七氟醚时，它们会随时间降低。
结论 : 作者的结果表明，在CPB期间将地氟醚与七氟醚相比，与七氟醚相比，地氟醚与血液动力学和儿茶酚胺反应不同。