Healthcare Quality According to ICU Level of Care

Introduction: Little is known about the quality of healthcare in intensive care units (ICUs) in Poland. Data on patients hospitalized in ICUs in Warsaw and the results of their treatment are scarce. This information, crucial for improving the quality of ICU healthcare services, is not collected routinely. Quality indicators are essential in the concept of holistic quality management. Implementation of these indicators in ICUs is a complex and time-consuming process. Systematic increase in demand for quality assessment tools that can reflect real conditions of the practices of ICUs, prompts the search for effective solutions. Methods: The study included 12,155 patients hospitalized in 16 ICUs of Warsaw hospitals (8 ICUs, n = 3293 of the first level of care, and 8 ICUs, n = 8862 of the second level) between 1st January 2017 and 31st December 2018. ICUs in pediatric and oncological hospitals were excluded from the study. Characteristics and demography of patients as well as the structure, treatment and human resources of the ICUs in Warsaw were analyzed. Length of stay, unexpected extubations, nosocomial infections, ICU readmissions and standardized mortality ratios (SMR) were retrieved from National Health Fund, Ministry of Health, and other public databases. Results: In primary level ICUs patients’ age (66.42 vs. 64.43 years;p = 0.005) and comorbidity rate (30.56% vs. 22.78%, p = 0.037) were higher when compared to ICUs of the second level of care. The crude mortality rate in ICUs in Warsaw was significantly higher than in other EU countries and differed between ICUs of the first and the second level (34.77% vs. 24.53%, respectively;p = 0.004). SMRs were however very low: 0.71 and 0.64 (ns), respectively. ICU readmission rate, unexpected extubations, central catheter related infections, and length of stay were identical in both groups. More patients were admitted to ICU form emergency department and/or discharged home in Level 1 ICUs (18.9% vs 12.9%, p Conclusions: There are no major differences in quality of care provided by Level 1 and Level 2 ICUs in Poland, although more rigorous adhesion to admission and discharge policies is needed. Implementation of the instruments for assessing quality of ICUs including benchmarking, self-assessment of departments and evaluation of changes resulting from audits according to the Deming cycle is of utmost importance. Standardization of quality measures and markers, communication, and cooperation in reporting and creation of ICU medical registers is necessary to improve the quality of healthcare.

Antidepressant effect of electroacupuncture regulates signal targeting in the brain and increases brain- derived neurotrophic factor levels

Electroacupuncture improves depressive behavior faster and with fewer adverse effects than antidepressant medication. However, the antidepressant mechanism of electroacupuncture remains poorly understood. Here, we established a rat model of chronic unpredicted mild stress, and then treated these rats with electroacupuncture at Yintang （EX-HN3） and Baihui （DU20） with sparse waves at 2 Hz and 0.6 mA for 30 minutes, once a day. We found increased horizontal and vertical activity, and decreased immobility time, at 2 and 4 weeks after treatment. Moreover, levels of neurotransmitters （5-hydroxytryptamine, glutamate, and y-aminobutyric acid） and protein levels of brain-derived neurotrophic factor and brain-derived neurotrophic factor-related proteins （TrkB, protein kinase A, and phosphorylation of cyclic adenosine monophosphate response element binding protein） were increased in the hippocampus. Similarly, protein kinase A and TrkB mRNA levels were increased, and calcium-calmodulin-dependent protein kinase lI levels decreased. These findings suggest that electroacupuncture increases phosphorylation of cyclic adenosine monophosphate response element binding protein and brain-derived neurotrophic factor levels by regulating multiple targets in the cyclic adenosine rnonophosphate response element binding protein signal- ing pathway, thereby promoting nerve regeneration, and exerting an antidepressive effect.

Unexpected gallbladder cancer:Surgical strategies and prognostic factors

Gallbladder cancer is the most common tumor of the biliary tract and it is associated with a poor prognosis.Unexpected gallbladder cancer is a cancer incidentally discovered,as a surprise,at the histological examination after cholecystectomy for gallstones or other indications.It is a potentially curable disease,with an intermediate or good prognosis in most cases.An adequate surgical strategy is mandatory to improve the prognosis and an adjunctive radical resection may be required depending on the depth of invasion.If the cancer discovered after cholecystectomy is a pTis or a pT1a,a second surgical procedure is not mandatory.In the other cases(pT1b,pT2 and pT3 cancer) a re-resection(4b + 5 liver segmentectomy,lymphadenectomy and port-sites excision in some cases) is required to obtain a radical excision of the tumor and an accurate disease staging.The operative specimens of re-resection should be examined by the pathologist to find any "residual" tumor.The "residual disease" is the most important prognostic factor,significantly reducing median disease-free survival and disease-specific survival.The other factors include depth of parietal invasion,metastatic nodal disease,surgical margin status,cholecystectomy for acute cholecystitis,histological differentiation,lymphatic,vascular and perineural invasion and overall TNM-stage.

Histological examination of frozen sections for patients with acute cholecystitis during cholecystectomy

BACKGROUND： Unexpected gallbladder cancer may present with acute cholecystitis-like manifestat/ons. Some authors rec- ommended that frozen section analysis should be performed during laparoscopic cholecystectomy for all cases of acute cholecystitis. Others advocate selective use of frozen section analysis based on gross examination of the specimen by the surgeon. The aim of the present study was to evaluate whether surgeons could effectively identify suspected gallbladder with macroscopic examination alone. If not, is routine frozen sec- tion analysis worth advocating？

The Indicator System Based on BP Neural Network Model for Net-mediated Public Opinion on Unexpected Emergency

Because unexpected emergency owns the characteristics of explosive,uncertain evolution direction and group diffusion,more and more researchers concentrate on and try to control it. In addition,considering the force of network,the information of the unexpected emergency will be spread and enlarged rapidly on internet. It is a new viewpoint using the indicator system to estimate the heat degree of net-mediated public opinion on unexpected emergency,which can reveal the underlying reasons about the formation of the heat degree. Moreover,we use BP(Back Propagation) neural network method instead of traditional subjective weight assignment to calculate the weights of the indicators which can make evaluation results more accurate and objective.

Unexpected FDG-PET uptake in the gastrointestinal tract:Endoscopic and histopathological correlations

AIM: To investigate the nature and significance of unexpected positron emission tomography with fluorodeoxyglucose (FDG-PET) uptake within the gastrointestinal tract (GIT).

Unexpected Selective Absorption of Lithium in Thermally Reduced Graphene Oxide Membranes

Lithium plays an increasingly important role in scientific and industrial processes, and it is extremely important to extract lithium from a high Mg^(2+)/Li^(+) mass ratio brine or to recover lithium from the leachate of spent lithiumion batteries. Conventional wisdom shows that Li^(+) with low valence states has a much weaker adsorption(and absorption energy) with graphene than multivalent ions such as Mg^(2+). Here, we show the selective adsorption of Li^(+) in thermally reduced graphene oxide(rGO) membranes over other metal ions such as Mg^(2+), Co^(2+), Mn^(2+),Ni^(2+), or Fe^(2+). Interestingly, the adsorption strength of Li^(+) reaches up to 5 times the adsorption strength of Mg^(2+),and the mass ratio of a mixed Mg^(2+)/Li^(+) solution at a very high value of 500 : 1 can be effectively reduced to 0.7 : 1 within only six experimental treatment cycles, demonstrating the excellent applicability of the rGO membranes in the Mg^(2+)/Li^(+) separation. A theoretical analysis indicates that this unexpected selectivity is attributed to the competition between cation–π interaction and steric exclusion when hydrated cations enter the confined space of the rGO membranes.

On Mars, Location and Orientation of Dykes Exposed along the Valles Marineris Walls Reveal Expected and Unexpected Stress Fields

Structural and geomorphological analysis of the Martian surface in the visible spectral range using the NASA/Viking images in the 90’s,complemented by experimental modelling(Mège and Masson,1996a;Mège et al.,2003)suggested that the Valles Marineris trough(chasma)system is aligned with a mafic dyke swarm,named the Syria Planum Dyke Swarm.Cross-cutting relationships and

Effects of the Discharge Parameters on the Efficiency and Stability of Ambient Metastable-Induced Desorption Ionization

Ionization efficiency is an important factor for ion sources in mass spectrometry and ion mobility spectrometry.Using helium as the discharge gas,acetone as the sample,and high-field asymmetric ion mobility spectrometry（FAIMS） as the ion detection method,this work investigates in detail the effects of discharge parameters on the efficiency of ambient metastableinduced desorption ionization（AMDI） at atmospheric pressure.The results indicate that the discharge power and gas flow rate are both significantly correlated with the ionization efficiency.Specifically,an increase in the applied discharge power leads to a rapid increase in the ionization efficiency,which gradually reaches equilibrium due to ion saturation.Moreover,when the discharge voltage is fixed at 2.1 kV,a maximum efficiency can be achieved at the flow rate of 9.0 m/s.This study provides a foundation for the design and application of AMDI for on-line detection with mass spectrometry and ion mobility spectrometry.

Physical activity in sudden unexpected death in epilepsy: much more than a simple sport

Sudden unexpected death in epilepsy （SUDEP） is the most important direct epilepsy-related cause of death. Additionally, potential pathomechanisms for SUDEP is unknown, but it is very probable that cardiac arrhythmia during and between seizures, electrolyte disturbances, arrhythmogenic drugs or transmission of epileptic activity via the autonomic nervous system to the heart may play a potential role. Quite interestingly, clinical and experimental data have shown that physical activity can decrease seizure frequency, as well as lead to improved cardiovascular health in patients with epilepsy. Based on these facts, the purpose of this article is to review the body of literature of the possible contribution of physical exercise to the SUDEP prevention in a comprehensive manner.

Resolution performance analysis of cumulants-based rank reduction estimator in presence of unexpected modeling errors

Compared to the rank reduction estimator （RARE） based on second-order statistics （called SOS-RARE）, the RARE employing fourth-order cumulants （referred to as FOC-RARE） is capable of dealing with more sources and mitigating the negative influences of the Gaussian colored noise. However, in the presence of unexpected modeling errors, the resolution behavior of the FOC-RARE also deteriorate significantly as SOS-RARE, even for a known array covariance matrix. For this reason, the angle resolution capability of the FOC-RARE was theoretically analyzed. Firstly, the explicit formula for the mathematical expectation of the FOC-RARE spatial spectrum was derived through the second-order perturbation analysis method. Then, with the assumption that the unexpected modeling errors were drawn from complex circular Gaussian distribution, the theoretical formulas for the angle resolution probability of the FOC-RARE were presented. Numerical experiments validate our analytical results and demonstrate that the FOC-RARE has higher robustness to the unexpected modeling en＇ors than that of the SOS-RARE from the resolution point of view.

Multidisciplinary approach to suspected sudden unexpected infant death caused by milk-aspiration:A case report

BACKGROUND The term sudden unexpected infant death(SUID)is not always properly invoked.It refers to a broad range of conditions that sometimes defy classification.There is not only a strong emotional impact on the family,but such cases are also quite complex.Underlying causes may be multiple,not always readily apparent,and have potential repercussions,especially in terms of forensics.CASE SUMMARY A 5-month-old male baby was pronounced dead following acute lung failure and cardiopulmonary arrest.The parents had immediately rushed their child to the hospital,stating the baby was found prone and not breathing.Total-body postmortem computed tomography(PMCT)was performed,revealing a hypodense material of indeterminate nature within the main airways and areas of ground-glass parenchymal change.At autopsy,the respiratory tract mucosa appeared edematous and was coated with a whitish stringy material.There was widespread airspace reduction due to parenchymal collapse.Alveolar sacs and bronchial openings contained abundant amorphous material admixed with white blood cells.Immunohistochemical studies were performed,targeting CD15,CD68,and alpha-lactalbumin.Ultimately,the focus was on alpha-lactalbumin(milk protein),which showed marked immunopositivity within alveolar spaces.Cytoplasmic staining of macrophages was also particularly prominent.CONCLUSION Postmortem investigations are thus essential to identify causes of death and surrounding circumstances.PMCT is a useful tool in this setting,given the frequent dearth of autopsy findings and ambiguity as to cause of death in SUID cases.These findings,later confirmed by immunohistochemical investigations,were indicative of active pneumonia due to aspirated milk.The present account illustrates the importance a broad diagnostic approach to SUID in cases of forensic concern.PMCT is a very valuable aid in cases of forensic interest,as it can provide useful information in all those situations in which the cause of death is uncertain or there are no suggestive dynamics or lesions.

A Comparison Between the English and the Chinese Love Poetry Before the Modern Period

The thcme of romantic love may well be said to be a universal One inpoetry.But,since the content of love varies from one culture to another,itstreatments in the respective literatures also differ from one another.A com-parison between the English and the Chinese love poetry reveals their inter-defining relationship,adding unexpected new dimensions to our understandingof both.The theory of literary criticism,to be sure,could also benefit ap-preciably from the conclusions of sucn a comparison.

Study on the Total Synthesis of Hainanolide (Ⅱ)──An Unexpected Hydroperoxide Containing Tricyclic Skeleton

An unexpected compound, hydroperoxide (4) formed from (3), the exo-cycloaddition product, which was synthesized through the Lewis acid catlyzed intramolecular Diels-Alder (IMDA) reaction. Its structure was confirmed by spectra and X-Ray diffraction analysis, An 1O2oxidation mechanism was proposed.

Selection and Optimization of Path Responding to Unexpected Environmental Incidents in China

By analyzing disposal status of unexpected environmental incidents by government,public and enterprise,and combining the characteristics of unexpected environmental incidents,specific measures of responding to unexpected environmental incidents are proposed from the aspects of perfecting guarantee system of emergency nomocracy,enhancing information disclosure,encouraging public participation,enhancing the construction of emergency response capability,and enhancing post-event management,to improve the ability of defending environmental risk.

The Challenge of Improving IVF Results in Normogonadotrophic (Unexpected) Young Poor Ovarian Responders: The Predictive Value of a Flexible Treatment Protocol Based on the “Biophysical Profile of the Uterus”

Objective: To study whether the unexpected poor ovarian responders optimization of uterine receptivity with a flexible controlled ovarian hyper stimulation protocol based on the Biophysical Profile of the Uterus, has an impact on their reproductive performance. Design: Observational Prospective study. Setting(s): i) General hospital-IVF and Infertility Centre;ii) University hospital. Patient(s): 44 normogonadotrophic young women (26 - 38 yrs) with previous “unexpected” poor ovarian response underwent IVF/ICSI treatment on a protocol based on the Biophysical Profile of their uterus (Group A). The same patients were used as controls in a preceded IVF cycle on the conventional stimulation protocol. Intervention(s): None. Main outcome measure(s): Pregnancy, miscarriage and home take baby rates, amount and duration of gonadotropins required, number and quality of embryos resulted, Biophysical Profile of the Uterus score. Result(s). Treatment in Group A in comparison to Group B resulted in significantly larger number of eggs retrieved per patient, and improved fertilization rates and higher number of embryos/ET (p = 0.011, 0.010 and 0.034 respectively). Group A also demonstrated a trend for higher rates of clinical pregnancy (29.5% v.s. 15.9%), viable stage pregnancies ≥ 24 weeks (33.3% v.s. 20%) and home take babies (26.6% v.s. 16%). The amount of gonadotropins used per patient (IU) was similar in the two groups (p = 0.264). Cancellation, implantation and miscarriage rates as well as embryos quality, although superior in the treatment Group A, showed no significant difference. The number of pregnancies achieved in Group A, were directly related with the score in the Biophysical Profile of the Uterus 12 point scale. Conclusion(s): Unexpected Poor Ovarian Responders on the flexible IVF/ICSI protocol (Group A), adjusting the management according to the Biophysical Profile of their uterus (duration of stimulation, day of HCG and day of embryo transfer), had a significantly better performance in comparison to the Group B managed on the conventional protocol in this difficult to manage and so far, rather understudied population.

Long-term potentiation in autonomic ganglia:Potential role in cardiovascular disorders

Ganglionic long-term potentiation(gLTP) is an activitydependent,enduring enhancement of ganglionic transmission.This phenomenon may be induced in autonomic ganglia of an organism under certain conditions whererepetitive impulses surge from the central nervous system(CNS) to the periphery.Chronic stress,repetitive epileptic seizure or chronic use of CNS stimulants could induce gL TP,which would result in a long lasting heightening of sympathetic tone to the cardiovascular system causing hypertension and disturbed cardiac rhythm that may lead to sudden cardiac death.These conditions are briefly reviewed in this article.

Medicine in the future-with subspecialists in medullary neurology and brain dentistry

The solitary tract nucleus of the medulla with its limited watershed vascular capacity may occasionally be the focus of transient ischemia caused by the increased metabolic demands associated with frequent and intense neuronal stimulation from other organs and other parts of the brain. Case reports have suggested that these ischemic changes may sometimes result in the initiation of intense autonomic discharges, which can occasionally be fatal. Therapeutic interventions for the medulla oblongata are hamperedby its limited accessibility. Systemically administered pharmaceuticals may have some usefulness in future years. Previous experience with vagus nerve stimulation in the treatment of epilepsy suggests that it may have some usefulness in stabilizing medullary autonomic discharges. Computerized electronic stimulation of other cranial nerves may be helpful as well, especially the chorda tympani nerve, and may be most easily accomplished from implanted dental appliances, especially molar modules, transmitting signals via secondary transmitters procedurally placed on cranial nerves. Future technology may enable wireless signaling from the implanted dental appliance to the secondary transmitter placed at the nerve site. By the year 2050 subspecialists in medullary neurology and brain dentistry may use computerized electronic stimulation of cranial nerves to prevent sudden unexpected death and treat "chest pain from the brain".