BACKGROUND Congenital cataract,facial dysmorphism,and neuropathy(CCFDN)syndrome is an extremely rare multiorgan disorder.Characteristics include congenital cataracts,facial deformation,extremity deformities,and demyel...BACKGROUND Congenital cataract,facial dysmorphism,and neuropathy(CCFDN)syndrome is an extremely rare multiorgan disorder.Characteristics include congenital cataracts,facial deformation,extremity deformities,and demyelinating neuropathy.CCFDN syndrome is associated with increased risk during anesthesia including rhabdomyolysis or epileptic seizures.There is a lack of published information about difficult airways in these patients.Difficult airways during intubation represent one of the most dreaded anesthesia complications:A"can not intubate,can not oxygenate"scenario.Presented herein is the first described successful endotracheal intubation of a CCFDN syndrome patient.CASE SUMMARY We report the anesthetic management of a 13-year-old girl with CCFDN syndrome scheduled for posterior neuromuscular scoliosis correction surgery.The patient suffered from extensive progressive neuromuscular scoliosis with a Cobb angle of 83°.Her limitations included neuropathy and a scoliotic curve.This condition negatively impacted her quality of life.This case reflects the potential anesthetic complications for posterior scoliosis correction and CCFDN syndrome.The challenge for our anesthetic team was the limited amount of data about anesthetic management of this condition.In total,one case report without any data about endotracheal intubation of patients with this condition was available.Endotracheal intubation in our case was uncomplicated.Another focus of our case was the prevention of possible complications associated with this syndrome,including rhabdomyolysis and seizures.Rhabdomyolysis can be triggered by some types of anesthetic agents like suxamethonium or volatile anesthetics,especially in patients with certain types of myopathies.CONCLUSION Adequate understanding of the anesthetic management of CCFDN syndrome can reduce perioperative complications and improve patient outcome after surgery.展开更多
AIM: To investigate the use of the Gaumard's Noelle S550.100 Maternal and Neonatal Simulators for teaching forceps delivery.METHODS: Twenty two(n = 22) resident physicians were enrolled in a simulation course on o...AIM: To investigate the use of the Gaumard's Noelle S550.100 Maternal and Neonatal Simulators for teaching forceps delivery.METHODS: Twenty two(n = 22) resident physicians were enrolled in a simulation course on operative forceps deliveries. The physicians enrolled in the course were all part of an accredited Obstetrics and Gynecology residency program and ranged in their training from post graduate year(PGY) 1-4. Each participant received simulation based teaching on the indications, contraindications, proper application, delivery and removal of forceps by a single teacher. The Gaumard's simulator and Simpson forceps were used for this course. Statistical analysis using SPSS statistical software was performed after the completion of the simulation training program. A paired student t-test was performed to compare the cohort's mean pretest and post simulation training scores. Follow up skills assessment scores at one month, 3 mo and 6 mo were compared to thebaseline pretest score using a paired student t-test. RESULTS: There was statistically significant improvement in the post simulation training performance evaluations compared to the pretest, 13.7(SD = 3.14) vs 7.9(SD = 4.92), P < 0.05. Scores at 1 mo, 3 mo, and 6 mo were compared to the pretest score and showed retention of skills: 4.6(SD = 5.5, 95%CI: 2.21-7.07), 4.4(SD = 5.2, 95%CI: 2.13-6.70), and 5.6(SD = 4.8, 95%CI: 3.53-7.75) points, respectively. There were statistically significant differences between residents by post graduate training year on pretest scores, however these differences were not present after simulation training. Pretest scores for PGY 1, 2, 3, 4 were 3.5(SD = 2.27, 95%CI: 2.13-5.00), 7.25(SD = 6.70, 95%CI: 1.50-13.00), 10.75(SD = 1.5, 95%CI: 9.50-12.00), 12.17(SD = 2.57, 95%CI: 10.33-14.00). After simulation training PGY 1 residents did as well as well as the upper level residents. Posttest mean test scores for PGY 1, 2, 3, 4 were 13.75(SD = 1.49, 95%CI: 12.75-14.63), 10.25(SD = 0.24, 95%CI: 4.25-14.00), 15.00(SD = 1.16, 95%CI: 14.00-16.00), 15.17(SD = 0.75, 95%CI: 14.67-15.67). CONCLUSION: Our simulation based training program not only produced short term gains, but participants were able to retain the skills learned and demonstrate their knowledge months later.展开更多
The new potential model of interlayer intermolecular interaction was proposed to represent“ABAB”stacking of graphite.The bombardment of hydrogen atoms on the graphite surface was investigated using molecular dynamic...The new potential model of interlayer intermolecular interaction was proposed to represent“ABAB”stacking of graphite.The bombardment of hydrogen atoms on the graphite surface was investigated using molecular dynamics simulation.Before the first graphene fromthe surface side was broken,the hydrogen atoms caused the following processes.In the case of the incident energy of 5 eV,many hydrogen atoms were adsorbed on the front of the first graphite.In the case of the incident energy of 15 eV,almost all hydrogen atoms were reflected by the first graphene.In the case of the incident energy of 30 eV,the hydrogen atoms were adsorbed between the first and second graphenes.The radial distribution function and the animation of the MD simulation demonstrated that the graphenes were peeled off one by one,which is called graphite peeling.One C2H2 was generated in such chemical sputtering.But the other yieldedmolecules often had chain structures terminated by the hydrogen atoms.The erosion yield increased linearly with time.展开更多
The multi-hierarchy simulation model for magnetic reconnection is developed,where both micro andmacro hierarchies are expressed consistently and simultaneously.Two hierarchies are connected smoothly by shake-hand sche...The multi-hierarchy simulation model for magnetic reconnection is developed,where both micro andmacro hierarchies are expressed consistently and simultaneously.Two hierarchies are connected smoothly by shake-hand scheme.As a numerical test,propagation of one-dimensional Alfv´en wave is examined using the multihierarchy simulation model.It is found that waves smoothly pass through frommacro to micro hierarchies and vice versa.展开更多
文摘BACKGROUND Congenital cataract,facial dysmorphism,and neuropathy(CCFDN)syndrome is an extremely rare multiorgan disorder.Characteristics include congenital cataracts,facial deformation,extremity deformities,and demyelinating neuropathy.CCFDN syndrome is associated with increased risk during anesthesia including rhabdomyolysis or epileptic seizures.There is a lack of published information about difficult airways in these patients.Difficult airways during intubation represent one of the most dreaded anesthesia complications:A"can not intubate,can not oxygenate"scenario.Presented herein is the first described successful endotracheal intubation of a CCFDN syndrome patient.CASE SUMMARY We report the anesthetic management of a 13-year-old girl with CCFDN syndrome scheduled for posterior neuromuscular scoliosis correction surgery.The patient suffered from extensive progressive neuromuscular scoliosis with a Cobb angle of 83°.Her limitations included neuropathy and a scoliotic curve.This condition negatively impacted her quality of life.This case reflects the potential anesthetic complications for posterior scoliosis correction and CCFDN syndrome.The challenge for our anesthetic team was the limited amount of data about anesthetic management of this condition.In total,one case report without any data about endotracheal intubation of patients with this condition was available.Endotracheal intubation in our case was uncomplicated.Another focus of our case was the prevention of possible complications associated with this syndrome,including rhabdomyolysis and seizures.Rhabdomyolysis can be triggered by some types of anesthetic agents like suxamethonium or volatile anesthetics,especially in patients with certain types of myopathies.CONCLUSION Adequate understanding of the anesthetic management of CCFDN syndrome can reduce perioperative complications and improve patient outcome after surgery.
文摘AIM: To investigate the use of the Gaumard's Noelle S550.100 Maternal and Neonatal Simulators for teaching forceps delivery.METHODS: Twenty two(n = 22) resident physicians were enrolled in a simulation course on operative forceps deliveries. The physicians enrolled in the course were all part of an accredited Obstetrics and Gynecology residency program and ranged in their training from post graduate year(PGY) 1-4. Each participant received simulation based teaching on the indications, contraindications, proper application, delivery and removal of forceps by a single teacher. The Gaumard's simulator and Simpson forceps were used for this course. Statistical analysis using SPSS statistical software was performed after the completion of the simulation training program. A paired student t-test was performed to compare the cohort's mean pretest and post simulation training scores. Follow up skills assessment scores at one month, 3 mo and 6 mo were compared to thebaseline pretest score using a paired student t-test. RESULTS: There was statistically significant improvement in the post simulation training performance evaluations compared to the pretest, 13.7(SD = 3.14) vs 7.9(SD = 4.92), P < 0.05. Scores at 1 mo, 3 mo, and 6 mo were compared to the pretest score and showed retention of skills: 4.6(SD = 5.5, 95%CI: 2.21-7.07), 4.4(SD = 5.2, 95%CI: 2.13-6.70), and 5.6(SD = 4.8, 95%CI: 3.53-7.75) points, respectively. There were statistically significant differences between residents by post graduate training year on pretest scores, however these differences were not present after simulation training. Pretest scores for PGY 1, 2, 3, 4 were 3.5(SD = 2.27, 95%CI: 2.13-5.00), 7.25(SD = 6.70, 95%CI: 1.50-13.00), 10.75(SD = 1.5, 95%CI: 9.50-12.00), 12.17(SD = 2.57, 95%CI: 10.33-14.00). After simulation training PGY 1 residents did as well as well as the upper level residents. Posttest mean test scores for PGY 1, 2, 3, 4 were 13.75(SD = 1.49, 95%CI: 12.75-14.63), 10.25(SD = 0.24, 95%CI: 4.25-14.00), 15.00(SD = 1.16, 95%CI: 14.00-16.00), 15.17(SD = 0.75, 95%CI: 14.67-15.67). CONCLUSION: Our simulation based training program not only produced short term gains, but participants were able to retain the skills learned and demonstrate their knowledge months later.
基金This work was supported in part by a Grand-in Aid for Ex-ploratory Research(C),2007,No.17540384 from the Ministry of Education,Culture,Sports,Science and TechnologyThis work was also supported by National Institutes of Natural Sciences undertaking for Forming Bases for Interdisciplinary and Interna-tional Research through Cooperation Across Fields of Study,and Collaborative Research Programs(No.NIFS06KDAT012,No.NIFS06KTAT029,No.NIFS07USNN002 and No.NIFS07KEIN0091).
文摘The new potential model of interlayer intermolecular interaction was proposed to represent“ABAB”stacking of graphite.The bombardment of hydrogen atoms on the graphite surface was investigated using molecular dynamics simulation.Before the first graphene fromthe surface side was broken,the hydrogen atoms caused the following processes.In the case of the incident energy of 5 eV,many hydrogen atoms were adsorbed on the front of the first graphite.In the case of the incident energy of 15 eV,almost all hydrogen atoms were reflected by the first graphene.In the case of the incident energy of 30 eV,the hydrogen atoms were adsorbed between the first and second graphenes.The radial distribution function and the animation of the MD simulation demonstrated that the graphenes were peeled off one by one,which is called graphite peeling.One C2H2 was generated in such chemical sputtering.But the other yieldedmolecules often had chain structures terminated by the hydrogen atoms.The erosion yield increased linearly with time.
基金This work was partially supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science(No.18340188)the Research Cooperation Program on’Hierarchy and Holism in Natural Sciences 2’at National Institutes of Natu-ral Sciences,and General Coordinated Research at National Institute for Fusion Science(NIFS06KTAT037,NIFS07KNXN095).
文摘The multi-hierarchy simulation model for magnetic reconnection is developed,where both micro andmacro hierarchies are expressed consistently and simultaneously.Two hierarchies are connected smoothly by shake-hand scheme.As a numerical test,propagation of one-dimensional Alfv´en wave is examined using the multihierarchy simulation model.It is found that waves smoothly pass through frommacro to micro hierarchies and vice versa.