BACKGROUND & AIMS: BACKGROUND:Pulmonary surfactant dysfunction may contribute to the development of ventilator induced lung injury (VILI). Tracheal gas insufflation (TGI) is a technique in which fresh gas is introduced into the trachea and augment ventilation by reducing the dead space of ventilatory system, reducing ventilatory pressures and tidal volume (V(T)) while maintaining constant partial arterial CO2 pressure (PaCO(2)). We hypothesised that TGI limited peak inspiratory pressure (PIP) and V(T) and would minimize conventional mechanical ventilation (CMV) induced pulmonary surfactant dysfunction and thereby attenuate VILI in rabbits with acute lung injury (ALI). METHODS:ALI was induced by intratracheal administration of lipopolysaccharide in anaesthetized, ventilated healthy adult rabbits randomly assigned to continuous TGI at 0.5 L/min (TGI group) or CMV group (n = 8 for each group), and subsequently ventilated with limited PIP and V(T) to maintain PaCO(2) within 35 to 45 mmHg for 4 hours. Physiological dead space to V(T) ratio (V(D)/V(T)), dynamic respiratory compliance (Cdyn) and partial arterial O(2) pressure (PaO(2)) were monitored. After ventilation, lungs were analysed for total phospholipids (TPL), total proteins (TP), pulmonary surfactant small to large aggregates ratio (SA/LA) in bronchoalveolar lavage fluid (BALF) and for determination of alveolar volume density (V(V)), myeloperoxidase and interleukin (IL)-8. RESULTS:TGI resulted in significant (P < 0.05 or P < 0.01) decrease in PIP [(22.4 +/- 1.8) cmH2O vs (29.5 +/- 1.1) cmH2O], V(T) [(6.9 +/- 1.3) ml/kg vs (9.8 +/- 1.11) ml/kg], V(D)/V(T) [(32 +/- 5)% vs (46 +/- 2)%], TP [(109 +/- 22) mg/kg vs (187 +/- 25) mg/kg], SA/LA (2.5 +/- 0.4 vs 5.4 +/- 0.7), myeloperoxidase [(6.2 +/- 0.5) U/g tissue vs (12.3 +/- 0.8) U/g tissue] and IL-8 [(987 +/- 106) ng/g tissue vs (24 +/- 3) mN/m] of BALF, and significant (P < 0.05) increase in Cdyn [(0.47 +/- 0.02) ml.cmH2O(-1).kg(-1) vs (0.31 +/- 0.02) ml.cmH2O(-1).kg(-1)], PaO(2) [(175 +/- 24) mmHg vs (135 +/- 26) mmHg], TPL/TP (52 +/- 8 vs 33 +/- 11) and Vv (0.65 +/- 0.05 vs 0.44 +/- 0.07) as compared with CMV. CONCLUSIONS:In this animal model of ALI, TGI decreased ventilatory requirements (PIP, V(T) and V(D)/V(T)), resulted in more favourable alveolar pulmonary surfactant composition and function and less severity of lung injury than CMV. TGI in combination with pressure limited ventilation may be a lung protective strategy for ALI.

背景与目标：

BACKGROUND & AIMS: :Costly signalling theory has become a common explanation for honest communication when interests conflict. In this paper, we provide an alternative explanation for partially honest communication that does not require significant signal costs. We show that this alternative is at least as plausible as traditional costly signalling, and we suggest a number of experiments that might be used to distinguish the two theories.

背景与目标： : 代价高昂的信号理论已成为利益冲突时诚实交流的常见解释。在本文中，我们为不需要大量信号成本的部分诚实通信提供了另一种解释。我们证明了这种替代方案至少与传统的昂贵信号一样合理，并且我们建议进行一些实验，以区分这两种理论。

BACKGROUND & AIMS: OBJECTIVES:To evaluate first-year doctor of pharmacy (PharmD) students' communication apprehension, outcome expectations, and self-efficacy for communication over the duration of a 15-week patient-counseling course. DESIGN:First-year PharmD students (n=94) were asked to complete a 47-item, self-administered questionnaire on 3 occasions over the duration of the Nonprescription Drugs/Patient-Counseling course during the fall 2009 and 2010 semesters. ASSESSMENT:Eighty-seven of 94 students completed the survey instrument across data collection periods. There were significant reductions in total communication apprehension scores and in the communication apprehension subscores for meetings and public speaking, and significant increases in self-efficacy over time. No differences were found for outcome expectations of communication scores or the subscores for interpersonal conversations and group discussion. CONCLUSIONS:Communication apprehension may be decreased and self-efficacy for communication increased in first-year PharmD students through a 15-week Nonprescription Drugs/Patient-Counseling course using small-group practice sessions, case studies, and role-play exercises in conjunction with classroom lectures.

背景与目标：

BACKGROUND & AIMS: :As there are many conflicting sources of e-cigarette information, research is needed to determine the impact of these sources on e-cigarette attitudes to inform future communication campaigns. Source credibility is important in shaping attitudes toward other health topics; however, no study has examined its role in influencing e-cigarette attitudes. Data from the 2015 Health Information National Trends Survey-FDA (HINTS-FDA) were utilized to assess differences in trust in different sources by e-cigarette user status and to investigate the associations between trust in sources and e-cigarette attitudes (n = 3,738). Differences in trust in sources were examined using weighted linear regression. Associations between trust in sources of e-cigarette health effects and attitudes toward e-cigarettes were assessed using weighted logistic regression. Overall, e-cigarette ever users reported significantly lower trust in governmental agencies as compared to never users. Trust in e-cigarette companies was negatively associated with perceived addictiveness of e-cigarettes (AOR = 0.76, 95% CI = 0.58, 1.00), while trust in doctors/pharmacists/healthcare providers was negatively associated with harm perceptions of e-cigarettes relative to conventional cigarettes (AOR = 0.72, 95% CI = 0.55, 0.95). Trust in tobacco companies and trust in e-cigarette companies were negatively associated with absolute perceived harm of e-cigarettes (AOR = 0.70, 95% CI = 0.51, 0.95; AOR = 0.60, 95% CI = 0.46, 0.79, respectively). Results from this study indicate that the associations between trust in sources of e-cigarette health effects and e-cigarette attitudes differ both by source and specific attitude assessed. Ultimately, future campaigns should incorporate messaging to discredit industry sources of information and utilize non-governmental sources to effectively influence e-cigarette attitudes.

背景与目标： : 由于存在许多相互矛盾的电子烟信息来源，因此需要进行研究以确定这些来源对电子烟态度的影响，以为未来的交流活动提供信息。来源可信度对于塑造对其他健康主题的态度很重要; 但是，没有研究检查其在影响电子烟态度中的作用。来自2015健康信息国家趋势调查-FDA (HINTS-FDA) 的数据被用来评估电子烟用户状况对不同来源信任的差异，并调查来源信任与电子烟态度之间的关联 (n = 3,738)。使用加权线性回归检查来源信任的差异。使用加权逻辑回归评估了对电子烟健康影响来源的信任与对电子烟的态度之间的关联。总体而言，与从未使用过的电子烟用户相比，曾经使用过的电子烟用户对政府机构的信任度明显降低。对电子烟公司的信任与电子烟的感知成瘾性负相关 (AOR = 0.76，95% CI = 0.58，1.00)，而对医生/药剂师/医疗保健提供者的信任与电子烟相对于传统香烟的危害感知负相关 (AOR = 0.72，95% CI = 0.55，0.95)。对烟草公司的信任和对电子烟公司的信任与电子烟的绝对感知危害呈负相关 (AOR = 0.70，95% CI = 0.51，0.95; AOR = 0.60，95% CI = 0.46，0.79)。这项研究的结果表明，对电子烟健康影响来源的信任与电子烟态度之间的关联因来源和评估的特定态度而异。最终，未来的运动应纳入信息传递，以抹黑行业的信息来源，并利用非政府来源有效地影响电子烟的态度。

BACKGROUND & AIMS: Eight patients were studied under general anaesthesia for elective pulmonary lobectomy to see if intrinsic positive end-expired pressure (PEEPi) would appear or increase in the dependent lung during one-lung ventilation (OLV) or if application of external PEEP equal to individually measured PEEPi would produce better arterial oxygenation, haemodynamic state and oxygen delivery than either zero PEEP (ZEEP) or an external PEEP 5 cm H2O greater than PEEPi. Patients were non-obese, without obstructive airways disease, aged 53-76 yr and ASA < III. They received standardized anaesthesia with fentanyl, 50% nitrous oxide in oxygen and isoflurane; monitoring included radial and fibreoptic pulmonary arterial catheters and intermittent positive pressure ventilation with a tidal volume of 8 ml kg-1, 16 bpm, and an I2. PEEPi was measured during two-lung ventilation (TLV) and OLV, using rapid airway occlusion at end-expiration. There was no PEEPi during TLV, but 2-6 mm Hg of PEEPi appeared during OLV. Applying external PEEP equal to individually measured PEEPi reduced venous admixture and increased PaO2 without a decrease in cardiac index (thus increasing oxygen delivery) compared with ZEEP, but the improvement in pulmonary gas exchange was lost and an additional penalty of reduced cardiac output was imposed when external PEEP was increased to 5 mm Hg above PEEPi.

背景与目标： 在全身麻醉下对八名患者进行了选择性肺叶切除术的研究，以查看在单肺通气 (OLV) 期间是否会出现或依赖肺的内在正末期呼气压力 (PEEPi) 增加，或者是否应用等于单独测量的PEEPi的外部PEEP会产生更好的动脉氧合，血液动力学状态和氧气输送比零PEEP (ZEEP) 或外部PEEP 5厘米H2O大于PEEPi。患者非肥胖，无阻塞性气道疾病，年龄53-76岁，ASA

BACKGROUND & AIMS: OBJECTIVE:This study aimed to determine the impact of providing chest physiotherapy after routine clinical assessment on the duration of mechanical ventilation, outcome and intensive care length of stay. DESIGN AND SETTING:Single-centre, single-blind, prospective, randomised, controlled trial in a university hospital general intensive care unit. PATIENTS AND PARTICIPANTS:180 patients requiring mechanical ventilation for more than 48 h. INTERVENTIONS:Patients randomly allocated, one group receiving physiotherapy as deemed appropriate by physiotherapists after routine daily assessments and another group acting as controls were limited to receiving decubitus care and tracheal suctioning. MEASUREMENTS AND RESULTS:Primary endpoints were initial time to become ventilator-free, secondary endpoints included intensive care unit (ICU) and hospital mortality and ICU length of stay. Kaplan-Meier analysis censored for death revealed a significant prolongation of median time to become ventilator-free among patients receiving physiotherapy (p=0.047). The time taken for 50% of patients (median time) to become ventilator-free was 15 and 11 days, respectively, for physiotherapy and control groups. There were no differences between groups in ICU or hospital mortality rates, or length of ICU stay. The number of patients needing re-ventilation for respiratory reasons was similar in both groups.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Neuro-ventilatory efficiency (NVE), defined as the tidal volume to electrical diaphragm-activity ratio (VT/EAdi) at the beginning and end of the weaning process after acute hypoxaemic respiratory failure, may provide valuable information about patient recovery. METHODS:This observational study included 12 patients breathing with neurally adjusted ventilatory assist (NAVA). When a spontaneous breathing trial (SBT) with pressure support of 7 cm H2O and PEEP was unsuccessful, NAVA was used and the level was adjusted to obtain an EAdi of ∼60% of maximal EAdi during SBT. VT and EAdi were recorded continuously. We compared changes in NVE between NAVA and SBT at the first failed and first successful SBT. RESULTS:When patients were switched from NAVA to SBT, NVE was significantly reduced during both unsuccessful and successful SBT (-56 and -38%, respectively); however, this reduction was significantly lower when SBT was successful (P=0.01). Between the first and last day of weaning, we observed that NVE decreased with NAVA [40.6 (27.7-89.5) vs 28.8 (18.6-46.7); P=0.002] with a significant decrease in NAVA level, whereas it remained unchanged during SBT [15.4 (10.7-39.1) vs 19.5 (11.6-29.6); P=0.50] with significant increases in both EAdi and VT and no difference in respiratory rhythm. CONCLUSIONS:These results suggest that in patients after respiratory failure and prolonged mechanical ventilation, changes in VT and NVE, between SBTs are indicative of patient recovery. Larger clinical trials are needed to clarify whether changes in NVE reliably predict weaning in patients ventilated with NAVA.

背景与目标：

BACKGROUND & AIMS: :The second most important infectious complication in hospitalised patients is pneumonia, and it hits first place in the Intensive Care Unit (ICU). Almost 80% of the episodes of health-care pneumonia happens when patient is under mechanical ventilation, causing ventilator-associated pneumonia (VAP). VAP is associated with the highest rates of mortality in ICU infections, mainly if due to Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). It also increases days under mechanical ventilation and the length of stay in ICU and hospital. Although all the diagnostic procedures, the diagnosis of VAP is based basically in the clinics: X-ray infiltrates and purulent endotracheal secretions are the cornerstone of the diagnosis. We should evaluate and screen any risk factor for multiresistant pathogens. If we have an early VAP and no risk factors, the majority of empiric antibiotic strategies are useful, but if we have a patient with more than one week under mechanical ventilation, previous antibiotic use, and risk factors for multiresistant pathogens, we should then individualize empiric antibiotic treatment.

背景与目标： : 住院患者中第二重要的感染并发症是肺炎，在重症监护病房 (ICU) 中排名第一。当患者处于机械通气状态时，几乎80% 的医疗保健肺炎发作发生，导致呼吸机相关性肺炎 (VAP)。VAP与ICU感染的死亡率最高，主要是由于铜绿假单胞菌和耐甲氧西林金黄色葡萄球菌 (MRSA) 引起的。它还会增加机械通气下的天数以及在ICU和医院的住院时间。尽管所有诊断程序，但VAP的诊断基本上基于临床: x射线浸润和化脓性气管内分泌物是诊断的基石。我们应该评估和筛选多重耐药病原体的任何危险因素。如果我们有早期VAP并且没有危险因素，则大多数经验性抗生素策略是有用的，但是如果我们有一个患者在机械通气下超过一周，以前使用过抗生素以及多重耐药病原体的危险因素，则我们应该个体化经验性抗生素治疗。

BACKGROUND & AIMS: OBJECTIVE:The purpose of this study is to identify the major challenges to coordination between emergency department (ED) teams and emergency medical services (EMS) teams. DESIGN:We conducted a series of focus groups involving both ED and EMS team members using a crisis scenario as the basis of the focus group discussion. We also collected organizational workflow data. RESULTS:We identified three major challenges to coordination between ED and EMS teams including ineffectiveness of current information and communication technologies, lack of common ground, and breakdowns in information flow. DISCUSSION:The three challenges highlight the importance of designing systems from socio-technical perspective. In particular, these inter-team coordination systems must support socio-technical issues such as awareness, context, and workflow between the two teams.

背景与目标：

BACKGROUND & AIMS: :An intact embryo-maternal communication is critical for the establishment of a successful pregnancy. To date, a huge number of studies have been performed describing the complex process of embryo-maternal signaling within the uterus. However, recent studies indicate that the early embryo communicates with the oviductal cells shortly after fertilizationand that this is important for the successful establishment of pregnancy. Only if the early embryo is capable to signal the mother within a precise timeframe and to garner a response, will the embryo be able to survive and reach the uterus. This review will give an overview of all the experimental designs which have investigated embryo-maternal interaction in the oviduct. In addition to that, it will provide a comprehensive analysis of the findings to date elucidating the morphological and molecular changes in the oviduct which are induced by the presence of the early embryo highlighting how the tubal responses affect embryo development and survival.

背景与目标： : 完整的胚胎-母体交流对于成功怀孕至关重要。迄今为止，已经进行了大量研究，描述了子宫内胚胎-母体信号传导的复杂过程。然而，最近的研究表明，受精后不久，早期胚胎与输卵管细胞相通，这对于成功建立妊娠很重要。只有早期胚胎能够在精确的时间范围内向母亲发出信号并获得反应，胚胎才能存活并到达子宫。这篇综述将概述所有研究输卵管中胚胎-母体相互作用的实验设计。除此之外，它还将对迄今为止的发现进行全面分析，阐明由早期胚胎的存在引起的输卵管的形态和分子变化，突出了输卵管反应如何影响胚胎发育和存活。

BACKGROUND & AIMS: BACKGROUND:Difficult airway (DA), including difficult bag-mask ventilation (DBMV), and difficult intubation (DI) is an important challenge for the pediatric anesthesiologist. While expected DBMV can be successfully managed with appropriate equipment and personnel, unexpected DBMV relies on the resources available and the experience of the anesthesiologist at the time of the emergency. The incidence and risk factors of unexpected DA in otherwise healthy children, including DBMV among pediatric patients are not known. The aim of this study was to expand the scientific knowledge of unexpected DBMV among pediatric patients. METHODS:Patients between the ages of 0 and 8 years, undergoing elective surgery requiring bag-mask ventilation BMV and intubation at the Montreal Children's Hospital were recruited in this prospective observational study. Data on the incidence of DBMV and risk factors were collected over a 3-year period. RESULTS:In a sample of 484 children, the incidence of unexpected difficult BMV was 6.6% (95% CI [4.6, 9.2]). The incidence of expected DA among the screened patients (N = 4865) was 0.5% (95% CI [0.3, 0.7]). In a logistic regression analysis, age (OR 0.98; 95%CI [0.97, 0.99]), undergoing otolaryngology (ENT) surgery (OR 2.92; 95% CI [1.08, 7.95]) and use of neuromuscular blocking agents (OR 3.49; 95%CI [1.50-8.11]) were independently associated with DBMV. The incidence of DI was 1.2%. No association between DBMV and DI was found (Fisher's exact test, P = 1.0). CONCLUSIONS:This is the first published report of the incidence of unexpected DBMV among healthy pediatric patients.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The aim of this study was to identify predictors of prolonged mechanical ventilation (PMV) following surgery for acute type A aortic dissection (AAAD) and to assess the influence of this complication on clinical outcomes. METHODS AND RESULTS:A total of 243 patients underwent emergency surgery for AAAD in the period of 1997-2006. Ten patients died within 48 h after surgery. The remaining 233 patients were divided into 2 groups according to the duration of mechanical ventilation; less than 48 h (group A: n=149) or 48 h or longer (group B; n=84). Multivariate analysis was used to identify predictors of PMV. Short and late outcomes were compared between groups. Multivariate analysis showed that shock (systolic BP <90 mmHg; p=0.007), postoperative renal dysfunction (creatinine >2.0 mg/dl; p=0.016), coronary artery bypass grafting (CABG) (p=0.017), and limb ischemia (p=0.044) were independent predictors of PMV. There was no significant difference in in-hospital mortality (group A, 2.7% vs group B, 3.6%) or 5-year survival (group A, 85.9% vs group B, 76.8%). CONCLUSIONS:Shock, limb ischemia, CABG, and postoperative renal dysfunction increase the risk for PMV. Knowing the predictors of PMV should help optimize postoperative management of these patients.

背景与目标：

BACKGROUND & AIMS: :Iopamidol-carrying liposomes were studied as potential hepatosplenographic contrast agents. Large unilamellar vesicles (0.3-1 mu) prepared from phosphatidylcholine:Dipalmotylphosphatidic acid (PC:DPPA) 9:1 and 300 MgI/mL iopamidol solution showed favorable entrapment measured as mg entrapped iodine/mg lipids (I/L). The effect of extrusion through polycarbonate membranes on liposome characteristics and in vivo distribution was investigated. Extrusion above the transition temperature of lipids reduced the average size and size distribution and increased the I/L ratio. Distribution studies of extruded and nonextruded liposomes in rats demonstrated different behavior of the preparations; extruded liposomes showed higher spleen uptake than did unextruded, while liver uptake was comparable; lung entrapment, observed with unextruded particles, was almost eliminated with extruded liposomes. Preliminary imaging studies in rats were carried out at a dose of 250 mgI/kg; typical computed tomography (CT) scans of the liver demonstrated contrast enhancement of greater than or equal to 60 HU from 90' up to 240' after injection.

背景与目标： : 研究了携带碘帕醇的脂质体作为潜在的肝脾造影造影剂。由磷脂酰胆碱: 二棕榈基磷脂酸 (PC:DPPA) 9:1和300 MgI/mL碘帕醇溶液制备的大单层囊泡 (0.3-1 mu) 显示出良好的包封作用，以mg包封的碘/mg脂质 (I/L) 测量。研究了通过聚碳酸酯膜挤出对脂质体特性和体内分布的影响。高于脂质转变温度的挤出降低了平均尺寸和尺寸分布，并增加了I/L比。大鼠中挤出和非挤出脂质体的分布研究表明制剂的行为不同; 挤出的脂质体显示出比未挤出的更高的脾脏摄取，而肝脏摄取相当; 用未挤出的颗粒观察到的肺包封几乎被挤出的脂质体消除。以250 mgI/kg的剂量在大鼠中进行了初步成像研究; 典型的计算机断层扫描 (CT) 肝脏扫描显示，注射后从90' 到240 '的对比度增强大于或等于60 HU。

BACKGROUND & AIMS: :Buck and Duffy (1980) and Borod et al. (1985) found evidence of deficits in spontaneous expressiveness in right brain-damaged (RBD) patients relative to LBD patients and controls. Using FACS, Mammucari et al. (1988) failed to replicate this result and questioned our methods and findings. This paper replies (a) that Mammucari et al. (1988)'s review of our work is selective and misleading; (b) that there are aspects of their study that can account for their null results, including the insufficient sensitivity of FACS for the measurement of spontaneous expressiveness; and (c) that the results of Mammucari et al. (1988) regarding "aversive eye movements" to a negative film in LBD and control, but not RBD, patients are in fact compatible with our findings. This paper also suggests a general strategy for the objective and comprehensive analysis of spontaneous emotional expressiveness.

背景与目标： : Buck和Duffy (1980) 和Borod等人 (1985) 发现右脑受损 (RBD) 患者相对于LBD患者和对照组的自发表达能力不足的证据。使用FACS，mamucari等人 (1988) 未能复制该结果，并质疑我们的方法和发现。本文回答 (a) mamucari等人 (1988) 对我们工作的审查是选择性的和误导性的; (b) 他们的研究有一些方面可以解释他们的无效结果，包括FACS对自发表现力测量的敏感性不足; 并且 (c) mammicuari等人 (1988) 关于LBD和对照 (而不是RBD) 患者对底片的 “厌恶性眼球运动” 的结果实际上与我们的发现兼容。本文还提出了客观综合分析自发情绪表现力的一般策略。

BACKGROUND & AIMS: INTRODUCTION:This pilot study used a simulation-based platform to evaluate the effect of an automated mechanical chest compression device on team communication and patient management. METHODS:Four-member emergency department interprofessional teams were randomly assigned to perform manual chest compressions (control, n = 6) or automated chest compressions (intervention, n = 6) during a simulated cardiac arrest with 2 phases: phase 1 baseline (ventricular tachycardia), followed by phase 2 (ventricular fibrillation). Patient management was coded using an Advanced Cardiovascular Life Support-based checklist. Team communication was categorized in the following 4 areas: (1) teamwork focus; (2) huddle events, defined as statements focused on re-establishing situation awareness, reinforcing existing plans, and assessing the need to adjust the plan; (3) clinical focus; and (4) profession of team member. Statements were aggregated for each team. RESULTS:At baseline, groups were similar with respect to total communication statements and patient management. During cardiac arrest, the total number of communication statements was greater in teams performing manual compressions (median, 152.3; interquartile range [IQR], 127.6-181.0) as compared with teams using an automated compression device (median, 105; IQR, 99.5-123.9). Huddle events were more frequent in teams performing automated chest compressions (median, 4.0; IQR, 3.1-4.3 vs. 2.0; IQR, 1.4-2.6). Teams randomized to the automated compression intervention had a delay to initial defibrillation (median, 208.3 seconds; IQR, 153.3-222.1 seconds) as compared with control teams (median, 63.2 seconds; IQR, 30.1-397.2 seconds). CONCLUSIONS:Use of an automated compression device may impact both team communication and patient management. Simulation-based assessments offer important insights into the effect of technology on healthcare teams.

背景与目标：