Comparison of emergency surgical cricothyroidotomy and percutaneous cricothyroidotomy by experienced airway providers in an obese,in vivo porcine hemorrhage airway model

Background: Emergency front-of-neck airway(eFONA) is a life-saving procedure in “cannot intubate, cannot oxygenate”(CICO). The fastest and most reliable method of eFONA has not been determined. We compared two of the most advocated approaches: surgical cricothyroidotomy and percutaneous cricothyroidotomy, in an obese, in vivo porcine hemorrhage model, designed to introduce real-time physiological feedback, relevant and high provider stress. The primary aim was to determine the fastest method to secure airway. Secondary aims were arterial saturation and partial pressure of oxygen, proxy survival and influence of experience.Methods: Twelve pigs [(60.3±4.1) kg] were anesthetized and exposed to 25%–35% total blood volume hemorrhage before extubation and randomization to Seldinger technique “percutaneous cricothyroidotomy”(n=6) or scalpelbougie-tube technique “surgical cricothyroidotomy”(n=6). Specialists in anesthesia and intensive care in a tertiary referral hospital performed the eFONA, simulating an actual CICO-situation.Results: In surgical cricothyroidotomy vs. percutaneous cricothyroidotomy, the median(interquartile range, IQR) times to secure airway were 109(IQR 71–130) s and 298(IQR 128–360) s(P=0.0152), arterial blood saturation(SaO2) were 74.7(IQR 46.6–84.2)% and 7.9(IQR 4.1–15.6)%(P=0.0167), PaO_(2) were 7.0(IQR 4.7–7.7) kPa and 2.0(IQR 1.1–2.9) kPa(P=0.0667), and times of cardiac arrest(proxy survival) were 137–233 s, 190(IQR 143–229) s, from CICO. All six animals survived surgical cricothyroidotomy, and two of six(33%) animals survived percutaneous cricothyroidotomy. Years in anesthesia, 13.5(IQR 7.5–21.3), did not influence time to secure airway.Conclusions: eFONA by surgical cricothyroidotomy was faster and had increased oxygenation and survival, when performed under stress by board certified anesthesiologists, and may be an indication of preferred method in situations with hemorrhage and CICO, in obese patients.

开放型集散控制系统中的过程信息模型

首先简要介绍了开放型集散控制系统（ＤｉｓｔｒｉｂｕｔｅｄＣｏｎｔｒｏｌＳｙｓｔｅｍ，简称为ＤＣＳ）的一种结构模型ＣＩＣＯ，然后详细描述了ＣＩＣＯ中的过程信息模型ＰＥＤＳ．基于过程自然层次结构的ＰＥＤＳ模型适合计算机集成过程系统（ＣｏｍｐｕｔｅｒＩｎｔｅｇｒａｔｅｄＰｒｏｃｅｓＳｙｓｔｅｍ，简称为ＣＩＰＳ）对信息集成、控制集成和综合优化的要求．

白枕鹤、东方白鹳、雪雁卵壳的超微结构

通过对白枕鹤、东方白鹳、雪雁卵壳的扫描电镜观察 ,比较了它们的超微结构的差别 .并分析了它们种的特异性及卵壳对环境的适应特点 .

草酰氯分子的紫外光解

对草酰氯分子的多键解离方式进行了理论和实验的研究。计算表明，草酰氯的第一电子激发态增强了C－C键而削弱了C－Cl键，解离出Cl原子和ClCOCO自由基。在351nm光解实验中观察到中间物ClCOCO的红外发光，该中间物很容易进一步热解为ClCO和CO，势垒仅为0．4eV。第二电子激发态形成C－C较强的反键轨道，造成C－C键的解离而产生ClCO，在248nm光解实验中，产生了振转激发的终产物CO。以瞬态模型分析了CO的振转内能分配，与实验值吻合。

行为问题改善策略:Check in-Check out及其实施

Check in-Check out是正向行为支持三级干预模式中二级干预的具体实施策略。作为高效、弹性化的干预策略,其实施可于传统方式基础上根据个体需求做个别化调整。文章总结了Check in-Check out的传统及调整实施方式,并在此基础上提出建议和意见,为特殊学生行为问题的改善提供可操作的干预方法。