AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) ...AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated outcomes.METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P < 0.001) but not between eras 1 and 2(P = 0.028) or 1 and 3(P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.展开更多
The superior performance of high intensity discharge（HID） headlamp is clearly shown for luxury sedans, and the lamp luminescence properties are analyzed. The principle of its ballast technology is analyzed in detail...The superior performance of high intensity discharge（HID） headlamp is clearly shown for luxury sedans, and the lamp luminescence properties are analyzed. The principle of its ballast technology is analyzed in detail. For against the disadvantage of current ballast technology for sedans lamp, a novel type of electronic ballast for HID is designed based on programmable intelligent computer（PIC） microcontroller unit（MCU） and S1A2410M inverter and it provides guidance and can be easily used in control configuration selection and design. The feasibility and superiority of the system are proved.展开更多
The study aims to determine a mathematical formula that correlates the vertical stiffness of the principal elements of a high speed railway. To do this, beginning on the traditional formulations, a new mathematical mo...The study aims to determine a mathematical formula that correlates the vertical stiffness of the principal elements of a high speed railway. To do this, beginning on the traditional formulations, a new mathematical model has been proposed, and has been verified and confirmed with the real information of high speed railways. Finally, there has been obtained a simple expression that correlates simply the vertical stiffness of the railway with the vertical stiffness of the elements that compound it, essentially with the base plate and the ballast system set. On the other hand, also the accuracy of the model has been verified to select the stiffness of the base plate and the ballast system depending on one of this stiffness and the total vertical stiffness that it is wanted. With this simplified formula, it is possible to optimize the vertical stiffness of the railway to obtain the best behavior in each zone and to reduce the final cost of the use of the via, taking in consideration the energy needed to move the trains, the maintenance cost, the useful life, etc.. The process to optimize the railway stiffness in each point depends on the vertical stiffness of the ballast and the sub-ballast, and it is possible to use different plate bases with different stiffness to obtain the optimal stiffness that has been previously obtained with a cost and maintenance analysis.展开更多
基金Supported by The Department of Anesthesiology and Perioperative Medicine,Tufts Medical Center,Boston,United States
文摘AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated outcomes.METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P < 0.001) but not between eras 1 and 2(P = 0.028) or 1 and 3(P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.
文摘The superior performance of high intensity discharge（HID） headlamp is clearly shown for luxury sedans, and the lamp luminescence properties are analyzed. The principle of its ballast technology is analyzed in detail. For against the disadvantage of current ballast technology for sedans lamp, a novel type of electronic ballast for HID is designed based on programmable intelligent computer（PIC） microcontroller unit（MCU） and S1A2410M inverter and it provides guidance and can be easily used in control configuration selection and design. The feasibility and superiority of the system are proved.
文摘The study aims to determine a mathematical formula that correlates the vertical stiffness of the principal elements of a high speed railway. To do this, beginning on the traditional formulations, a new mathematical model has been proposed, and has been verified and confirmed with the real information of high speed railways. Finally, there has been obtained a simple expression that correlates simply the vertical stiffness of the railway with the vertical stiffness of the elements that compound it, essentially with the base plate and the ballast system set. On the other hand, also the accuracy of the model has been verified to select the stiffness of the base plate and the ballast system depending on one of this stiffness and the total vertical stiffness that it is wanted. With this simplified formula, it is possible to optimize the vertical stiffness of the railway to obtain the best behavior in each zone and to reduce the final cost of the use of the via, taking in consideration the energy needed to move the trains, the maintenance cost, the useful life, etc.. The process to optimize the railway stiffness in each point depends on the vertical stiffness of the ballast and the sub-ballast, and it is possible to use different plate bases with different stiffness to obtain the optimal stiffness that has been previously obtained with a cost and maintenance analysis.
